Nihon geka hokan. Archiv fur japanische Chirurgie最新文献

We report a new method of nerve Reconstruction, wrap-around neurorrhaphy, in which the funicular suture site is wrapped with the epineurium of the larger stump. The specific applications of this procedure in brachial plexus reconstruction are described and the clinical results presented. The method was applied in intercostal nerve transfer to the musculocutaneous nerve in 21 patients and in 12 patients with axillary nerve injury who underwent reconstruction with autografts using wrap-around neurorrhaphy. Rigid fixation of the neurorrhaphy site could be obtained using this method, and the clinical results were satisfactory.

We reviewed the records of 13 patients with adrenal masses operated on over a ten-year period to clarify clinical characteristics of adrenal tumors. Tumors were found incidentally in seven of nine patients with primary adrenal tumors (78%); however, three of these seven patients (43%) proved to have shown symptoms related to adrenal hyperfunction when re-evaluated. Other adrenal tumors (metastatic in three patients and inflammatory in one) were found without any symptoms referable to the tumors. In nine of 13 patients (69%), tumors were discovered by computerized tomography (CT). All patients with primary tumors have been gotten free of disease postoperatively. In contrast, although all three patients with metastatic adrenal tumors underwent resection of all known disease tissue, they died of the recurrence of malignancies within 10 months. This study suggests that a number of functional adrenal tumors are possibly left undiagnosed until found incidentally, and that CT is the most powerful tool to detect adrenal tumors. Our data did not support surgical intervention in cases of metastatic adrenal tumors.

Serum bilirubin concentrations were examined in patients who received hepatectomy for biliary tract carcinoma. They were divided into two groups according to the presence or absence of preoperative obstructive jaundice (POJ): the POJ group (n = 14) and non-POJ group (n = 10). The POJ group underwent percutaneous transhepatic drainage to delineate jaundice before definitive surgery. Total bilirubin concentration in the POJ group had increased at 1, 3, 5, 7 and 14 days after operation compared to the non-POJ group; the direct bilirubin level had increased at 1, 3, 5 and 7 days, and the indirect bilirubin level had increased at 1 and 3 days. Liver functional data before and 14 days after the operation were similar for the two groups. The incidence of cholangitis was higher in the POJ group than in the non-POJ group. Blood loss was greater in the POJ group than in the non-POJ group. The morbidity rate in the POJ group was higher than that in the non-POJ group. These results suggest that characteristic hyperbilirubinemia developed after major hepatectomy in patients with biliary tract carcinoma, and the bilirubin response is evoked by underlying preoperative biliary passing disturbance.

The present study was undertaken to investigate the relationship among cell morphology, proliferation, and maturation of chondrocytes in primary cultures. Chondrocytes were isolated from the growth cartilages of the rat ribs and cultured for 6 days. In situ DNA cytofluorometry using an inverted epi-illumination cytofluorometer (Nikon P1-I) and 3H-thymidine autoradiography were carried out for the correlated analysis of cell morphology and proliferation. Cytoskeletal staining with fluorescent phalloidin and 35S-sulphate autoradiography were also performed. In addition, in situ hybridization to c-myc mRNA was carried out using DNA probe. According to the results obtained, the cultured chondrocytes were composed of mixed populations of large, polygonal cells and of small, round cells. The round cells showed a significantly higher 35S uptake than the polygonal cells. The cytoskeletal staining clearly revealed stress fibers in the cytoplasm of the polygonal cells, whereas only a fine filamentous structure was shown in the cytoplasm of the round cells. In situ DNA cytofluorometry clearly demonstrated that cell proliferative activity was high in the polygonal cells and low in the round cells. In addition, 3H-thymidine autoradiography with cumulative labeling method revealed that the polygonal cells were changing into the small, round cells. C-myc mRNA signals were detected in the cytoplasm of over a half of the round cells, whereas no evidence of c-myc expression were found in the polygonal cells. From these results, it appears that as the shape of the cultured chondrocytes shifts from polygonal to round, the cell proliferative activity decreases in association with cell differentiation. It was also suggested that c-myc mRNA is amplified in the well differentiated round chondrocytes, and not in the proliferative polygonal cells.

One hundred and ten cases of Cronkhite-Canada Syndrome (C-C-S) reported in Japan were reviewed in this epidemiologic study. Seventy-five percent of all C-C-S cases reported in the world in literature have been reported from Japan. There has been no special occupation associated with an increased incidence of C-C-S. Mental and physical stress have been confirmed as among the most important risk factors for this syndrome. Hypogeusia is the dominant initial symptom which usually is followed by diarrhea and ectodermal changes including alopecia, nail dystrophy and skin pigmentation. Gastrointestinal polyposis is closely related to the malabsorption which induced these ectodermal changes. However, there is a small number of cases in which alopecia precedes to the diarrhea in the disease course.

Ultrasonography and magnetic resonance imaging (MRI) were used to assess a 4-month-old male infant with a multicystic tumor of the left breast that was identified at birth. The tumor was removed surgically following the diagnosis of a cavernous hemangioma. Only seven similar cases of lymphangioma of the breast have been reported. We review these cases in conjunction with our own findings.

A 79-year old male advanced breast cancer patient with metastases in lymph nodes, bones and anterior chest wall was effectively treated by a combination of chemotherapy (5-fluorouracil, epirubicin and cyclophosphamide), tamoxifen and minor surgery. Two months after five cycles of chemotherapy, all lymph node swellings disappeared. The main breast cancer and the chest wall metastatic nodule were resected under local anesthesia. He was maintained on tamoxifen alone and showed no lymph node recurrence during the follow up period of 20 months, suggesting good control of bone metastatic lesions.