Selective occlusion with fibrin glue under fistuloscopy: seven cases of postoperative management for intractable complex fistulas.

BACKGROUND AND STUDY AIM: Fistula occlusion is not achieved in some fistulas with complex branches. To obtain early fistula closure in such cases, we insert a double-lumen catheter into each fistula branch, with the aid of a guide wire positioned using a small-caliber endoscope, and attempt selective infusion of fibrin glue. PATIENTS AND METHODS: Following removal of foreign bodies and necrotic granulation, we applied the selective occlusion method under fistuloscopic control to seven intractable external fistulas with complex branches, in which fistula closure had not been obtained by a simple occlusion method (SOM). All the fistulas were complex with more than two branches. RESULTS: Fistula occlusion was obtained within 2 weeks in six of the seven patients, and there has been no sign of recurrence over a follow-up period of 4 - 59 months (average 29.8 months). CONCLUSION: Selective occlusion under fistuloscopy is highly effective for intractable external fistulas with complex branches.

Moxibustion treatment of breech presentation.

Breech presentation was successfully corrected by stimulating acupuncture points with moxibustion or low-frequency electrical current. Only patients with breech pregnancies at the 28th week or later were entered into the study. With moxibustion treatment, the control group had a spontaneous correction rate of 165/224 (73.66%), and the treatment group had a correction rate of 123/133 (92.48%) (P<0.0001, x2 test). With low-frequency percutaneous electrical stimulation, the correction rate was 20/941 (83.87%) in the control group and 171/191 (89.52%) in the treatment group (P=0.094, x2 test). The controls in the moxibustion study did no exercises and received no external manipulation to correct breech presentation whereas those in the electrical stimulation study experienced both. Acupuncture stimulation, especially with moxibustion, is expected to serve as a safe and effective modality in the management of breech presentation in a clinical setting.

Differences between coronary hyperresponsiveness to ergonovine and vasospastic angina.

The objective of the present study was to investigate the differences between coronary hyperresponsiveness without ischemia and vasospastic angina in an ergonovine provocation test using multivariate analysis. We have sometimes experienced a more than 50% narrowing response of vascular diameter without ischemia in a coronary response to ergonovine. We studied 107 patients with less than 50% stenosis in a coronary arteriogram. Their vascular responses to ergonovine were measured and the patients were divided into three groups, as follows: Group 1 had 50% or less vascular narrowing response without ischemia; Group 2 had a vascular hyperresponsiveness of more than 50% narrowing response without ischemia; and Group 3 experienced a hyperresponsiveness with ischemia. The degree of coronary response was found to be related to smoking, inpaired glucose tolerance (IGT) and the Gensini score by multiple regression analysis. A multiple logistic analysis revealed that the Gensini score and smoking were significant predictive factors for Group 3 (odds ratio: 1.20 and 8.97). The only factor different between Group 2 and Group 1 was gender. The coronary hyperresponsiveness to ergonovine without ischemia differs from vasospastic angina in the degree of coronary atherosclerosis and smoking habits. The patients with hyperresponsiveness had similar characteristics to those with atypical chest pain rather than vasospastic angina, except for a gender difference.

The relationship of genetic aberrations detected by comparative genomic hybridization to DNA ploidy and tumor size in human oral squamous cell carcinomas.

We have examined genetic alterations in 11 surgically removed oral squamous cell carcinomas (OSCCs) using comparative genomic hybridization (CGH) and laser scanning cytometry (LSC), which allow quantitative analysis of chromosomal abnormalities. CGH analysis revealed gains and/or losses of DNA sequence copy number in all tumors. Gains in DNA sequence copy number were detected frequently for chromosome arms 3q25-28 (6/11), 5p (6/11) and 8q (5/11), and losses in chromosome arms 18q (4/11), 19q (4/11), 17p (3/11), and 19p (3/11). Amplification of 5p was observed in two tumors. LSC detected DNA aneuploidy with DNA indices ranging from 1.30 to 1.82 in 6 of 11 tumors. The number of chromosomal aberrations was higher in DNA aneuploid tumors than in diploid tumors (8.17 vs 3.60/tumor, P<0.05). Furthermore, the average number of chromosomal aberrations was significantly higher in stage T2 tumors and larger tumors than in stage T1 tumors (7.71 vs 3.25/tumor, P<0.05). Our results suggest that DNA aneuploidy and large tumor size reflect an underlying chromosomal instability.

[Apical hypertrophic cardiomyopathy followed by midventricular obstruction and apical aneurysm: a case report].

A 72-year-old man presented with apical hypertrophic cardiomyopathy followed by midventricular obstruction and apical aneurysm. Doppler echocardiography revealed an abnormal blood flow from the apical aneurysm to the left ventricular outflow through the obstructive lesion during diastole. Myocardial perfusion scintigraphy showed no ischemic change in the apex. This case suggests that apical aneurysm may not be caused by ischemia, although previous reports showed ischemic degeneration or fibrosis may be a cause of an apical aneurysm.

Demographic study of first-ever stroke and acute myocardial infarction in Okinawa, Japan.

We performed a cross-sectional survey of stroke and acute myocardial infarction (AMI) in Okinawa, Japan with a census population of about 1.2 million. A total of 3,644 cases of first-ever stroke and 898 cases of initial acute myocardial infarction (AMI) were detected. The age-adjusted annual incidence rate for stroke was 105 per 100,000 standard population of Japan, and that of AMI was 26. The case-fatality rate of stroke within 28 days of onset was 12.8%, and that of AMI was 22.2%. Of the stroke cases, 51.4% were diagnosed as brain infarction, 38.7% as brain hemorrhage, and 9.3% as subarachnoid hemorrhage. The diagnosis of stroke subtypes were confirmed by computed tomography or magnetic resonance imaging in 98.4% of all stroke cases. In Okinawa, the incidence rate of AMI was still considerably lower than that in the Western population, and the rate of stroke was similar to that in the Western population.

[A case of adenoid cystic carcinoma in epipharynx which responded to radiation and chemotherapy].

A 45-year-old man visited our hospital complaining of a right hearing loss. The head and neck examination was unremarkable except for right secretory otitis media. Fiberoptic examination of the nose and the epipharynx revealed a mass. Transnasal biopsy was performed and histologic analysis revealed adenoid cystic carcinoma. Invasion of the sphenoid sinus was identified by MRI. He was treated with FAR therapy (5-FU, Vit A, Radiation) and chemotherapy (intra-arterial infusion of ADM). Severe side effects were not seen during treatment. After treatment, the majority of the tumor mass disappeared on fiberoptic examination and MRI. On repeat biopsy specimens, no cancer cells were found. The patient was alive with no evidence of disease as of August 1997.

Headache as a manifestation of myocardial infarction.

We report a 64-year-old man who complained of headache without chest pain at the onset of acute myocardial infarction (AMI). He had no history of chest pain or headache. Severe headache in this case was the first symptom of AMI. The headache was reproduced during stress test. During the angioplasty procedure, he also complained of headache without vasospastic change in the coronary artery. These findings suggest that the headache which accompanied AMI or myocardial ischemia in this case was due to referred pain rather than a generalized vasospastic disorder.

[Evaluation of the effects of vibro-acoustic stimulation test on the fetus during labor under epidural analgesia and evidence of its safety by way of auditory brainstem response].

This study was undertaken to elucidate the effects of epidural analgesia on vibro-acoustic stimulation test (VAST) during normal labor and auditory brainstem response (ABR) in fifty full term parturients without any complication. The safety of VAST in relation to the ABR of neonates was also studied. The results were as follows, 1) There were some changes in CTG monitoring in five cases (10%) in the 10 minutes after epidural analgesia. However, these changes were not ominous signs but all related to the coiling of the cord, as previously reported. 2) The ABR latency-intensity curve (audio-function of the newborn infants) revealed no hazardous change in VAST-loaded infants or in the controls. The response threshold was 10dB in this study. The application of VAST to the parturients under epidural analgesia was therefore not only harmless to the fetuses but also a useful way to evaluate fetal well-being.

[Neurobehavior and mental development of newborn infants delivered under epidural analgesia with bupivacaine].

The neurobehavior of newborn infants delivered under epidural analgesia with bupivacaine was analyzed by Amiel-Tison's Neurological and Adaptive Capacity Score (NACS), while Tsumori-Image's questionnaire assessed the above infants' mental development. Seventy-two newborn infants under epidural analgesia (39 delivered spontaneously and 33 by vacuum extraction) and twenty-eight newborn infants without epidural analgesia as controls (15 delivered spontaneously and 13 by vacuum extraction) were under study. The following results were obtained 1) In the 24 hour period following childbirth, NACS tended to be low in relation to the total dosage of bupivacaine administered to the mother. 2) In the 24 hour period following childbirth and continuing until the 3rd day, NACS were relatively low regardless of the mode of delivery. 3) There was no significant difference between the neonatal physiological weight loss in newborn infants under epidural analgesia and those without epidural analgesia (controls). 4) Newborn infants under epidural analgesia displayed an average mental quotient at the first, third, and sixth month after childbirth. Although epidural analgesia with bupivacaine might lower the neurobehavior of newborn infants in the immediate postchildbirth period, the newborn infants should return to normal without any complications.