[A case of thymic carcinoma].

A 41-year-old male visited with chief complaints of chest pain and cough. The patient was operated on under a diagnosis of invasive thymoma. The tumor was located in the left lobe of the thymus and measured 6 X 9 cm. Since the tumor invaded the left innominate vein, pericardium, and the upper lobe of the left lung, we resected it with adjacent structures. Postoperative pathological examination indicated squamous cell carcinoma of the thymus. Because the tumor metastasized also to the mediastinal lymph nodes, the patient was treated postoperatively by radiation therapy and adjuvant chemotherapy mainly with CDDP. The patient is well presently 2 years after operation without signs of recurrence.

[The experimental study on long-term cardiac preservation: the efficacy of low-flow continuous perfusion with fluorocarbon].

We compared the effect of simple immersion and continuous perfusion on long-term cardiac preservation, and evaluated the effectiveness of perfusion with oxygenated fluorocarbon solution. The isolated rabbit hearts were preserved for 24 hours at 4 degrees C using the following five preservation techniques: (1) simple immersion with Collins M solution (Group I), (2) perfusion with oxygenated Collins M solution at a flow rate of 10 ml/hr (Group II), (3) perfusion with the same solution as in Group II at a flow rate of 20 ml/hr (Group III), (4) perfusion with oxygenated Collins M solution containing 10% fluorocarbon at a flow rate of 10 ml/hr (Group IV), (5) perfusion with the same solution as in Group IV at a flow rate of 20 ml/hr (Group V). The hearts of Group I showed a significant decrease of myocardial ATP and an increase of myocardial lactate during preservation compared to the hearts of perfusion groups. Assessment of isovolumic left ventricular function following 24-hour preservation using a support animal showed a significant decrease of Max dp/dt and increase of end-diastolic pressure in the hearts of Group I. Perfusion with fluorocarbon (Group IV and V) significantly increased oxygen consumption compared to Group II and III in association with minimum accumulation of myocardial lactate, indicating that aerobic metabolism during preservation is better maintained in the fluorocarbon-perfused hearts. Moreover, CPK release and myocardial water gain during preservation were significantly less, and left ventricular function following preservation was significantly better in these hearts. Increasing the flow rate from 10 ml/hr to 20 ml/hr resulted in sustained increase in perfusion pressure (1.80 +/- 0.53 to 3.70 +/- 0.34 mmHg) and myocardial water content (79.2 +/- 0.4 to 87.2 +/- 0.3%) during preservation in the hearts of Group III, but it did not further improve left ventricular function despite significant enhancement of myocardial oxygen uptake in both Group III and V. These results suggest that hypothermic low-flow continuous perfusion with oxygenated Collins M solution is superior to simple immersion with the same solution for long-term cardiac preservation, and that the addition of fluorocarbon to the perfusate enhances the efficacy of such a perfusion.

[Treatment of the infected emphysematous bulla].

From 1985 to 1987, we had 4 patients with infected emphysematous bulla, three males and one female ranging from 18 to 61 years of age. The male patients had been suffering from emphysematous bullae and had complications stemming from the resulting infection. In the female case, the infection occurred at the pneumatocele which had grown at pneumonia was caught during steroid therapy for SLE. While all cases were medicated with antibiotics intravenously, they were drained with a small caliber tube percutaneously, then were washed using a cytocidal agent (dilute povidone iodine). In two cases, an infected emphysematous bulla and an infected pneumatocele cleared, then shrank and closed. In the remaining cases, the infected emphysematous bullae also cleared and shrank, then the patients underwent operations. All patients then healed. The therapeutic combination of percutaneous drainage with a small caliber tube and washing of infected emphysematous bulla is available for therapy or preoperative treatment for the following reasons: First of all, especially in patients who have remarkably disturbed pulmonary function, it can be performed safely and pt's symptoms and the general condition of the patient improves rapidly. The second reason is that, in some particular cases, it achieves the remarkable shrinkage and closure of infected emphysematous bulla. The third reason is that, the patients experience minimum pain with the use of a small caliber drainage tube.

Pulmonary function after lobectomy in children under ten years of age.

A long-term follow-up study on pulmonary function in twelve lobectomized children under ten years of age at the time of surgery was performed to determine the patterns of compensation. In the patients over ten years old at the time of the test performed over two years postoperatively, there was neither compensatory regeneration nor compensatory overdistension of the remaining lung tissue. However, there appeared to be an increase in the vital capacity, probably due to the growth of surrounding tissue such as thorax, respiratory muscles, and diaphragm. In contrast, the children tested under the age of eight years showed evidence of mild overdistension during the early postoperative period, but not at two years. There was no sign of overdistension in the patients over ten years of age at the time of testing.

Protection against oxygen-induced reperfusion injury of the isolated canine heart by superoxide dismutase and catalase.

While oxygen-derived free radicals have been implicated in the pathogenesis of myocardial injury, the exact nature of this injury is still unclear. To test the hypothesis that oxygen-induced injury may influence the recovery of cardiac function from ischemic damage, we used an oxygen free radical scavenger, superoxide dismutase (SOD), together with catalase, during the reperfusion of isolated canine heart which had been subjected to 15 min of normothermic ischemic arrest followed by 2 hr of hypothermic cardioplegic preservation using a modified Collins solution. Determinations of thiobarbituric acid reactive substances and coenzyme Q10 within the myocardium showed that the treatment with SOD and catalase was capable of inhibiting lipid peroxidation induced by reperfusion. This inhibition was apparently associated with the improvement of myocardial energy metabolism and cardiac performance. Coronary flow was significantly higher in the heart treated with SOD and catalase during the working stage with a corresponding increase in oxygen consumption. Myocardial adenosine triphosphate (ATP) was partially, but significantly restored during reperfusion in these hearts whereas no restoration was observed in the heart without the enzymes. The treatment with SOD and catalase also improved left ventricular stroke work index and left ventricular maximum dp/dt at an early stage of the working mode. These results suggest that the use of SOD and catalase during reperfusion can protect the ischemic heart against reperfusion injury by scavenging oxygen-derived free radicals.

In vitro study on contribution of oxidative metabolism of isolated rabbit heart mitochondria to myocardial reperfusion injury.

The present study was performed to clarify oxygen-induced damage following myocardial reperfusion, using three mitochondrial preparations from isolated rabbit hearts (nonischemic hearts and those subjected to 40 and 90 minutes of normothermic global ischemia). The viability of mitochondria was evaluated by adenosine triphosphate generation. The extent of mitochondrial injury produced by reactive oxygen metabolism was assessed by the intensity of hydroxyl radical signal detected with electron spin resonance spectroscopy and the reduction of coenzyme Q10 level. The greatest oxygen-induced injury was observed in 40-minute ischemic mitochondria exposed to pure oxygen. The use of superoxide dismutase and catalase satisfactorily prevented the oxygen-induced injury. Moreover, the net adenosine triphosphate generation of the 40-minute ischemic mitochondria was comparable to that of the nonischemic mitochondria without the enzymes. These results suggest that reperfusion of the ischemic myocardium with viable mitochondria is deleterious, because mitochondria are susceptible to injury resulting from oxidative metabolism, and that the use of superoxide dismutase, together with catalase, is beneficial for the restoration of cardiac function after ischemia.

[Three surgically treated cases of spontaneous rupture of the esophagus with reference to a new surgical approach--eversion stripping and esophagogastrostomy through the posterior mediastinum].

Three surgical cases of spontaneous rupture of the esophagus were reported. Case 1 was a 56-year-old man who was admitted 3 days after the onset was treated with open drainage. He had no complications whatsoever 8 years after the treatment. In case 2 (a 55-year-old man), eversion stripping of the esophagus and gastrostomy were performed 2 months after diagnosis, but esophageal reconstruction was not successful. He died of acute congestive heart failure 5 years after surgery. The Third case was a 60-year-old women whose rupture was confirmed 11 days after the onset. Cervical esophagostomy, gastrostomy and jejunostomy were performed 16 days after the rupture. Thereafter, esophageal eversion stripping and esophagogastrostomy through the posterior mediastinum were successfully carried out 2 months after the first surgery. She had no postoperative complications. Eversion stripping of the esophagus with esophagogastrostomy through the posterior mediastinum is an effective and safe method for some advanced cases of spontaneous esophageal rupture. We have not found any reports of surgical cases with spontaneous esophageal rupture treated by this approach in the literature.

Surgical treatment of pulmonary abscess in children under ten years of age.

Ten children under ten years of age with pulmonary abscess were treated surgically between 1962 and 1982. In nine patients, lobectomies with or without pulmonary decortication were performed; and in one case, drainage via a chest tube directly from the abscess cavity was successful. There were no surgical or late postoperative deaths. All patients recovered without any complication. The postoperative course has been followed for two months to 20 years. The effect of treatment is correlated with the clinical type of abscess.