[Emphysema evaluation of the remaining lung post lobectomy].

The aim of this study was to confirm that the emphysematous changes had increased in the remaining lung on the operation side after lobectomy. Fourteen patients underwent quantitative analysis by computed tomography (CT) and respiratory function testing before and after the operation for upper or lower lobectomy of the lung between March 2005 and May 2007. The degree of emphysema was calculated by dividing the volume of the emphysematous region (CT values: -1,024 to -950 HU) by the volume of the entire lung (CT values: -1,024 to -600 HU) using a 1 mm thickness high resolution CT slice. Comparison by paired t-test showed significant differences between the emphysema rates pre and post operation in the operation side lung (15.3 +/- 7.9% and 21.7 +/- 10.0%, p = 0.02), but there were no significant differences in the contralateral lung (15.8 +/- 7.5% and 17.7 +/- 8.4%, p = 0.25). On the other hand, there was no significant change in the percent forced expiratory volume in one second (FEV1.0%) between pre and post operation (74.4 +/- 10.5% and 75.5 +/- 7.5%, p = 0.60). We consider that it is necessary to note that the emphysematous changes increased in the remaining lung on the operation side after lobectomy even though the FEV1.0% did not decrease at present.

Multimodality treatments with endoscopic mucosal resection of esophageal squamous cell carcinoma with submucosal invasion.

BACKGROUND AND STUDY AIMS: A standard treatment for esophageal squamous cell carcinoma (SCC) with submucosal invasion is considered to be radical resection at present. In this study, we evaluated the efficacy of multimodality treatments with endoscopic mucosal resection (EMR) of esophageal SCC with submucosal invasion. METHOD: Eighteen cases of SCC with submucosal invasion were treated with EMR. Lymphatic invasion was found in 11 cases (67%), and there were no cases of blood vessel invasion. EMR was performed prior to any other treatment. Chemotherapy and/or radiotherapy were added if indicated by the histopathological features. RESULTS: There were no cases of local recurrence. Lymph-node recurrence was detected in 1 case treated with EMR alone. There were no cases of cancer death. The overall survival rate was 83% in all patients. CONCLUSIONS: Multimodality treatments with EMR were effective in treating esophageal SCC with submucosal invasion.

Thyroid antigen-mediated glomerulonephritis in Graves' disease.

We describe a patient with Graves' disease in whom marked proteinuria, microhematuria and hypoalbuminemia were associated. Renal biopsy demonstrated electrondense deposits in the capillary basement membrane, a finding consistent with immune complex glomerulonephritis. Indirect immunofluorescent examination with rabbit antihuman thyroglobulin indicated that these electron-dense deposits were thyroid antigen-mediated immune complexes.

[A noninvasive study on characteristics of the left ventricular function in elderly hypertensive patients].

To characterize the left ventricular (LV) systolic and diastolic function in elderly hypertensives, mechano-and echocardiography was performed in 27 elderly patients more than 65 years of age (20 hypertensives and 7 normotensives) and 46 middle-aged patients (34 hypertensives and 12 normotensives). In normotensives, a positive correlation was found to exist between age and blood pressure, LV wall thickness, II-RF interval and the A/E ratio, whereas the correlation of age to systolic parameters such as ET/PEP and EF was absent. This suggests that the LV diastolic function was impaired progressively by aging with preservation of the LV systolic function. In elderly hypertensives, LV systolic function was deteriorated and the A/E ratio increased as diastolic blood pressure became elevated. The A/E ratio also increased in this group as compared with that in middle-aged hypertensives, although the differences was not statistically significant. Unlike those in middle-aged hypertensives, the indices of LV function except the elevated blood pressure and the increased cardio-thoracic ratio were not significantly different between hypertensive and normotensive elderly patients. This might be because of the wide range of normal values in elderly persons due to the various degrees of atherosclerotic changes and other pathophysiologic factors, which might have masked obvious characteristics of hypertension in elderly hypertensives.

[Modified Jekler and Lhotka operation in minimized laparotomy for achalasia].

The rationale for surgery in achalasia is to reduce lower esophageal sphincter (LES) pressure and recontruct an antireflux mechanism. Fundopexy as an antireflux procedure after LES myotomy (modified Heller myotomy), called the Jekler and Lhotka method or the Heller and Dor operation, is commonly performed as standard surgery. In our institution, this method has been used since 1982. We have performed the modified Jekler and Lhotha method including long myotomy to confirm complete reduction of LES pressure as measured by intraoperative manometry and fundopexy plus posterior wall fixation to contract the long abdominal esophagus since 1986. Satisfactory results with this procedure have been obtained and reported. Furthermore, we have recently performed this procedure with minilaparotomy. In this review, we describe the modified Jekler and Lhotha method in minimized laparotomy and evaluate this procedure using intraoperative manometry.

[Reconstruction after cervical esophagectomy using a free jejunal graft].

Reconstruction after cervical esophagectomy using a free jejunal graft and forming an additional "vocal canal" are described. It is necessary to pay attention to several points, for example, selection of the jejunal graft, selection of the cervical vessels for anastomosis, technique of hypopharyngeal-jejunal anastomosis, and postoperative management of the anastomotic vessels. These contribute to the improvement of patient quality of life. Forming an additional "vocal canal" in patients who underwent radical surgery is particularly desirable. In this article, we introduce our operative method.