[Thoracic surgery for the penetrating lung or tracheal trauma].

Seven cases suffered from a chest trauma (stab wound in 6 and impalement injury in 1) were emergently transferred to our hospital. Open thoracotomy was performed for the intolerable bleeding immediately after admission. Injured lung was treated by lobectomy in 1 patient, lingual segmentectomy in 2, lower basal segmentectomy in 2, partial resection in 4 and direct suture in 2. The penetrating trachea was carefully repaired by direct suture with additional midsternal thoracotomy. To accomplish appropriate partial resection of the injured lung, a metallic straight suction tube inserted into a pulmonary stab wound was retracted and a stapling instrument was applied underneath the suction tube. With the segmentectomy and the partial resection, the volume of the residual lung was maximally saved. As a result, all 7 patients were successfully alive.

[Two cases of severe cytomegalovirus pneumonitis treated with permissive hypercapnia].

Two patients with severe cytomegalovirus (CMV) pneumonitis were treated with permissive hypercapnia. Case 1 was a 66-year-old male who suffered ventricular septal perforation caused by acute myocardial infarction. Case 2 was a 54-year-old male who sustained a blunt chest injury. In both cases, hypoxia with reduction of lung compliance developed after their operations. They were mechanically ventilated and we limited their peak inspiratory pressure, disregarding hypercapnia (i.e. permissive hypercapnia). During permissive hypercapnia, the maximum arterial partial pressure of carbon dioxide (PaCO2) was 96 mmHg in case 1 and 141 mmHg in case 2. Duration of hypercapnia (PaCO2 > 50mmHg) was 22 days in case 1 and 29 days in case 2. The patients were weaned from the respirator after two months of mechanical ventilation. In conclusion, the permissive hypercapnia was a useful method in the treatment of severe CMV pneumonitis.

[Variation in wound healing factors in trauma patients].

Serial changes of activated factor XIII (XIIIa), alpha 2 Plasmin inhibitor (alpha 2PI) and fibronectin (FN), which have important role in wound healing and host defence mechanism, were studied in 27 trauma patients. We obtained the results as follows. 1) The alpha 2PI and the FN decreased in proportion to injury severity score (ISS) immediately after trauma and they increased statistically significantly on the second or the third hospital day. On the other hand the XIIIa showed no statistically significant changes after trauma. 2) Emergency operations performed on the first hospital day had no influence on the variations of the XIIIa, the alpha 2PI and the FN. 3) The patients with disseminated intravascular coagulation (DIC) showed statistically marked decrease of the XIIIa, the alpha 2PI, and the FN on admission and the first hospital day compared with those patients without DIC. On the second hospital day, there was no difference of these factors between the DIC patients and the patients without DIC, but on the following day the alpha 2PI and the FN decreased again. In conclusion, the alpha 2PI and the FN decrease in proportion to ISS but XIIIa shows no significant changes after trauma. Emergency operations have no influence on the variations of these factors but with complicating DIC, all of these factors decrease significantly.

[Wound healing, blood coagulation and fibrinolysis during operations involving gastric cancer surgery].

Serial changes of FPA, FPB beta 15-42, FN, XIIIa, and alpha 2PI were investigated for the study on wound healing, blood coagulation, and fibrinolysis during gastric cancer surgery. For a control, we compared the preoperative values with the postoperative ones. These results also were compared with the values in healthy volunteers and in patients with cholelithiasis or myoma uteri. Our findings were as follows; 1) Compared with the control values, a statistically significant elevation of FPA, FPB beta 15-42 and FPA/FPB beta 15-42 ratios in patients with gastric cancer was noticed after operation. 2) Compared with the control values, a statistically marked decrease of FN, XIIIa and alpha 2PI in patients with gastric cancer was observed after operation. 3) The preoperative FPA and FPB beta 15-42 levels of gastric cancer patients were appreciably greater than those of normal healthy volunteers. Compared with patients with cholelithiasis or myoma uteri, however, the only preoperative FPA of gastric cancer patients showed significantly high levels. 4) FN and alpha 2PI revealed a notable positive correlation. These results suggest (1) increase of coagulation activity (thrombin formation) in gastric cancer patients; (2) increase of intravascular coagulation and fibrinolytic activity (thrombin and plasmin formation) during gastric cancer surgery; and, (3) depression of FN, XIIIa and alpha 2PI during surgery was due to sequestration at the site of tissue injury.

[Statistical observations on patients with herpes zoster and postherpetic neuralgia (author's transl)].

From 1969 to 1980, 83 patients with herpes zoster and postherpetic neuralgia were referred to our clinic. They consisted of 36 male and 47 female, whose ages ranged from 18 to 91 years. They were tested mainly with stellate ganglion block or epidural block. Patients with postherpetic neuralgia received imipramine 60 mg per day in addition. About half of the patients were relieved of pain or considerably improved after treatment. Other half of the patients somewhat improved excluding those patients whose therapeutic effect could not be assessed. More favourable results were obtained in patients whose treatment was instituted within 2 weeks from onset of herpes zoster than patients over 2 weeks from onset. Duration of treatment was shorter in younger patients (approximately 59 years) than older patients (60 years approximately), but results were same in both age groups. About 10% of the patients had concomitant malignant disease or autoimmune disease. No relationship between the localization of herpes zoster and the site of malignant disease was found.