Nihon geka hokan. Archiv fur japanische Chirurgie最新文献

Selenium (Se) is an integral component of glutathione poeroxidase (GSHPx), and the serum selenium concentration is age-depend. We speculated that myocardial GSHPx had relation to reperfusion injury in open heart operations, especially in infants in whom GSHPx activity is low. This study correlated GSHPx activity with the serum and myocardial selenium concentrations in Wistar rats, which were divided into three groups, infants, Se-deficient rats, and control rats. Serum GSHPx activity in infant and Se-deficient rats (22.7 +/- 3.5 U/g protein, 24.6 +/- 22.2 U/g protein) was lower than that in controls (179 +/- 12.0 U/g protein). The serum selenium concentration in infant and Se-deficient rats (3.81 +/- 0.81 micrograms/g protein, 2.06 +/- 1.69 micrograms/g protein) was also lower than that in controls (7.32 +/- 2.96 micrograms/g protein). The myocardial GSHPx activity was significantly lower in infants and Se-deficient rats (4.76 +/- 1.05 x 10(-1) U/mg protein, 3.38 +/- 0.32 x 10(-1) U/mg protein) than that in controls (8.03 +/- 0.57 x 10(-1) U/mg protein). However, the myocardial selenium concentration in infants (1.42 +/- 0.24 x 10(-1) micrograms/mg protein) was significantly higher than that in the other groups (0.31 +/- 0.06 x 10(-1) micrograms/mg protein, 0.28 +/- 0.04 x 10(-1) micrograms/mg protein). Next, in Se-deficient and control rats, isolated hearts were perfused for aerobically with Krebs-Henseleit solution in the Langendorff mode for 15 minutes, followed by 60 minutes of global ischemia at 4 degrees C and then reperfused for 30 minutes in a working mode. The hemodynamic parameters were measured.(ABSTRACT TRUNCATED AT 250 WORDS)

The accurate diagnosis of mesothelioma remains difficult despite advances of diagnostic technique. And specific monoclonal antibody (McAb) against mesothelioma have not been reported. In an attempt to develop mesothelioma specific McAb(s), spleen cells from a mouse immunized with isolated tumor cells were fused to a drug resistant mouse myeloma cell lines. Over 200 hybridomas were assayed for their preferential reactivity with mesothelioma cell lines or mesothelioma tumor biopsy tissues. Two monoclonal antibodies 2A3 and 4E1 were identified that bound 6/7 of the mesotheliomas, tested, but did not bind to the majority, 11/13 (for 2A3) and 12/13 (for 4E1), of other lung tumor types. Based upon western blot analysis of one and two-dimensional gels and upon the distribution pattern of the antibody recognized molecule in mesotheliomas and non-mesothelioma lung tumors, 2A3 binds to the cell adhesion molecule CD44. While the specificity of 4E1 has not yet been unequivocally established it appears to recognize a variant form of the CD44 molecule.

Endosaccular embolization is an innovative and effective treatment for surgically formidable cerebral aneurysms. Platinum microcoils are soft, easily fit to complex configuration of aneurysms, highly thrombogenic, so that suitable for this purpose. Recently developed Guglielmi detachable coils have more advantages in terms of retrievability and electrothrombotic effect. However, distal migration of intraaneurysmal thrombus produces thromboembolism in normal cerebral arteries, leading to neurological deficits. Three cases are presented in which thromboembolic complications occurred during or after embolization of cerebral aneurysms with platinum microcoils. Emergent fibrinolytic treatment resolved neurological deficits in each case without any other complications. From these lessons, a protocol of intra- and postoperative anticoagulation and antiplatelet therapy is presented. In conclusion, perioperative management of fibrinolytic and coagulation activity is extremely important in preventing thromboembolic complication and obtaining successful result.

From January 1989 to September 1993, 59 consecutive patients (35 males and 24 females, mean age 59.6 years old) underwent surgical repair of aortic dissection on the cardiovascular surgical unit at Takeda Hospital. The type of aortic dissection were classified according to Stanford University criteria. Twenty-two patients had acute type A (Ac-A), 10 had chronic type A (Ch-A), 4 had acute type B (Ac-B), and 23 had chronic type B (Ch-B) dissection. Seventeen dissections (29%) in the entire group of 59 cases had ruptured (including cardiac tamponade, pleural effusion and hemoptysis etc.). Ischemia of lower extremity occurred in 7 patients and ischemia of visceral organs in 3 patients. Type A dissection were approached via a median sternotomy and cardiopulmonary bypass with systemic hypothermia. Type B dissections were approached through a left postrolateral thoracotomy. Left heart bypass (left atrial-femoral in 8 cases) and partial cardiopulmonary bypass (femoral-femoral in 12 cases) generally were utilized. Resection of intimal tear and replacement of aorta with vascular grafts (including aortic arch in 19 cases) were performed in most patients and primary closure of the intimal tear was performed in 9 cases using GRF. The over-all operative mortality rate was 36% (8/22) for Ac-A, 20% (2/10) for Ch-A, 25% (1/4) for Ac-B, 22% (5/23) for Ch-B. Main causes of operative death was perioperative brain damage. It is necessary to improve the operative mortality for Ac-A dissections (especially in replacement of aortic arch and arch vessels). Further researches are needed regarding optimal methods of the cerebral protection during reconstruction of aortic arch.

Thirteen patients with acute occlusion of superior mesenteric artery are presented. Eight of them presented with sudden abdominal pain as the initial complaint while the others did with vomiting, abdominal distension or general fatigue. Arterial blood gas and deficit determinations revealed metabolic acidosis in 45.5% and large deficit in 100%, which was considered to be a reliable method for accurate early diagnosis of acute mesenteric arterial occlusion. Eleven patients underwent laparotomy and massive bowel resection, two of which had treatment with selective intraarterial infusion of urokinase prior to operation. One of two remaining patients did not need operation because she went on to complete recovery after fragmentation of embolus in the superior mesenteric artery by the percutaneously inserted catheter on angiography. The other one was inoperable because of poor general condition. The overall mortality in this series was 53.8%.

By upper gastrointestinal series, a 57 years-old woman was pointed out to have scattered calcifications along the greater curvature of the stomach. On computerized tomography, the calcifications distributed in the irregularly thickened gastric wall. With a diagnosis of calcified mucinous adenocarcinoma showing Borrmann type III, total gastrectomy with splenectomy was carried out. The characteristics of this lesion were briefly presented with a review of the literature.