Abstract: The recent advent of the small vessel suturing apparatus made possible the use of free intestinal segment for reconstruction of the resected cervical esophagus which has been one of the most difficult procedures. In the present communication, successful use of revascularized jejunal segment with Inokuchi’s vascular stapler in 13 cases of upper esophageal cancer was reported. Histological examination of the 10 resected specimens revealed that cancer invasion beyond the esophageal adventitia as well as risky cancer remnant at the resected margins were more frequently present when the tumor extended more than 5 cm longitudinally. Therefore esophageal cancer localized within the neck and extending less than 5 cm may well be indicated for the free intestinal transplantation. Details of the operative technique are described.

Abstract: The preoperative use of Bleomycin (BLM) alone or combined with irradiation in the treatment of esophageal cancer was evaluated in 58 patients who underwent surgical removal of the lesion for the past three and a half years. Histologic study showed such preoperative treatment is effective in inducing favorable changes in neoplastic cells in 69 per cent (40/58) of the primary lesions and in a significant number of involved lymph nodes of the second or the third groups. The study clearly suggests that preoperative Bleomycin administration combined with irradiation may be an useful adjunct preoperative procedure in esophageal cancer.

Abstract: Two cases of massive gangrenous inflammation of the colon proximal to obstructive carcinomatous lesions, the so-called obstructive colitis, are reported. Because, of the rarity of this condition, the etiological factors responsible for this entity are not yet clear. The detailed pathological and microbiological studies at the time of operation are essential to their further clarification.

Abstract: Activation of the kinin system and effects of Trasylol (Bayer, A.G. Lebukusen, West Germany), a kallikrein inhibitor, were investigated on 52 patients during hemodilutional cardiopulmonary bypass (CPB). Immediately after the start of CPB, neither elevation of bradykinin nor reduction of plasma kininogen (KGN: a precursor of bradykinin) were observed. During CPB, bradykinin level in the blood was markedly elevated, correlating with the significant decrease of kininogen (p<0.001). The longer the CPB time, the more marked the reduction of KGN. In the cases requiring over 60 minutes of CPB, the amounts of bradykinin released (4.6–18.0ng/ml) were sufficient to increase capillary permeability as well as peripheral vasodilatation. As shown by the significant increase of hematocrit (p<0.005) and the extreme reduction of vascular resistance found at the end of CPB in the prolonged cases. Infusion of Trasylol into the extracorporeal circuit actually prevented the reduction of kininogen and the increase of hematocrit as well as the extreme decrease of vascular resistance in the cases of over 60 minutes CPB. These results clearly point out that Trasylol is beneficial for the prevention of bradykinin liberation and capillary permeability increase and for the maintenance of optimum peripheral vascular tone during CPB. Furthermore, the significance of these findings with regards to complications during and after prolonged CPB was discussed.

Abstract: A new operative technique for esophagocardial cancer was reported with resection and re-establishment of alimentary continuity at cervical esophagus which obviates thoracotomy but still retains adequate removal of the lesion. Ten cases of esophagocardial cancer thus treated were presented and the clinical data were analyzed. The distance between esophageal stump and esophagocardial junction measured on the resected specimen ranged from 3.0 to 6.7 cm with an average of 5.1 cm. No remaining tumor cells were detected microscopically on the oral cut margin of the specimen in all cases. To compensate for the inadequated lymph node dissection intensive postoperative adjuvant irradiation and/or chemotherapy was advocated.

Abstract: Surface induced deep hypothermia combined with cardiopulmonary bypass (combined method) is excellent in open heart surgery of infants which combines each advantage of cardiopulmonary bypass and hypothermia. The present study was performed to investigate pathophysiological changes, especially metabolic changes, in combined method induced by two stressors such as cardiopulmonary bypass and hypothermia. In general, metabolic changes during hypothermia are temporarily enhanced immediately after the start of cardiopulmonary bypass. Lactacidemia and metabolic acidosis are rapidly improved after the start of perfusion rewarming, but abnormality of ceruloplasmin and cholesterol metabolism in the liver and hypopotassemia are not rapidly improved. Therefore, the treatment for these metabolic abnormalities seems to be necessary during and after the procedure.

Abstract: Streptococcal preparation (OK-432), a new type of anticancer agent, was given to the patients with advanced cancer in combination with Mitomycin-C, 5-FU and Cytosine arabinoside. OK-432 was administered intramuscularly with a daily dose of 2.0 KE consecutively or locally into the tumor with a large-dose of 100 KE. Most cases tolerated the long term administration of OK-432 without any severe side effects and the highest dose reached was 314 KE during 161 days of treatment. Of the 53 patients evaluated, 31 were given the initial large dose intratumoral OK-432. Thirteen were judged 0-C and Category 1 according to the Karnofsky criteria for a response rate of 44.8 per cent as compared with 12.5 per cent in the group without the initial large-dose administration.

Abstract: A case of carcinoma of the cystic duct is presented and comprehensive review of the literature was provided. Since no characteristic clinical signs are present, the diagnosis can only be made incidentally at the time of laparotomy for non-visualizing gallbladder. Even then histological study of the resected specimen is mandatory. In our present case after the confirmation of the diagnosis the second look exploration was done. However, careful examination of the bile duct system failed to find evidence of carcinomatous involvement suggesting that carcinoma found in the cystic duct was of a primary and not a secondary invasion. The present case constitutes the nineteenth case which meets completely the criteria proposed by Farr. Since the only hope of cure lies with the early diagnosis of the disease, early exploratory laparotomy and prophylactic removal of non-functioning or calculous gallbladder are recommended.

Abstract: The use of free peritoneal patch was evaluated for the effect on protection against intestinal anastomotic leakage in dogs. Free peritoneal patch was found to be effective in preventing the anastomotic leakage of the alimentary tract in borderline situation. Free peritoneal patch was more effective when applied with the 'smooth side out' than with the "smooth side in'. The usefulness of free peritoneal patch was also demonstrated in the treatment of the already established fistula of the cervical esophagus.

Abstract: A case of obstructive jaundice resulting from the compression of the common bile duct by a pancreatic pseudocyst is reported, which is of rare occurrence. Total excision of the cyst and choledochojejunostomy were performed. Postoperative course was uneventful with rapid disappearance of jaundice. Nine out of ten cases of pancreatic pseudocyst were treated by total excision with one death during 1951 through 1974.

Abstract: A case of portal hypertension secondary to traumatic hepatoportal arteriovenous fistula with portal fibrosis was successfully treated by ligation of the afferent hepatic arteries which decreased significantly portal pressure and corrected the abnormal blood inflow to the portal vein via A-V fistula resulting in a recovery of the disturbed liver function. Collateral blood supply from the left hepatic artery into the right hepatic lobe was found to be quite satisfactory after the ligation of the hepatic artery. Hemodynamic data and clinical findings of the present case suggest that the mechanism responsible for the portal hypertension is the inflow block resulting from the interruption of portal venous flow by the inflow of arterial blood via A-V fistula and the subsequent increased blood pressure in portal vein radicals.

Abstract: The alteration of pulmonary function in 35 patients with abdominal trauma admitted to the Trauma ICU of Osaka University Hospital were studied. A fall of PaO2 reaching the lowest level on the third postraumatic day, incomplete recovery even on the seventh postraumatic day and of longer duration was remarkable in comparison to those seen after elective abdominal surgery. Thirty two patients recovered without need of particular respiratory control but remaining three died with progressive decrease of PaO2 in spite of the intensive respiratory care. The hypoxia seen in the fatal cases was irresponsive to the administration of 100 per cent O2 with mechanical ventilation. Therefore, increase in intrapulmonary shunt was likely to be responsible for their fatal course.

Abstract: Hyperfunctioning platelets in the thrombocytotic patients after major surgery were satisfactorily controlled by a small dose of aspirin ingestion. Since aspirin is well documented as a potent inhibitor of platelet aggregation, a small dose of prophylactic administration of aspirin appeared to be a legitimate approach to a possible life-threatening thrombo-embolic comlication after surgery, particularly when the platelets are excessively produced and hyperfunctioning.

Abstract: An unusual case of double aortic arch with aneurysm is described. A 61-year-old, hypertensive and syphilitic male patient complained of increasing difficulty in swallowing of approximately five months duration. Barium swallow and subsequent aortography showed the presence of an aneurysm of the ascending aorta involving the left (anterior) arch of the double aortic arch. The tightening of the vascular ring by aneurysmal dilatation of the left aortic arch appeared to be responsible for the delayed onset of the symptom. Surgical correction was made by removing the aneurysmal ascending aorta and left aortic arch and a Dacron graft was inserted between the ascending aorta and the right (posterior) aortic arch. The patient died of cerebral complication about forty hours postoperatively. Surgical problems associated with this unusual condition were discussed retrospectively from the operative and autopsy findings. In reviewing the pertinent literatures this case appeared to be the first operated case of double aortic arch associated with aneurysm.

Abstract: A review is presented of the currently employed approaches and techniques for the treatment of several forms of cyanotic congenital heart disease. Emphasis is placed on unusual associated defects which require special approaches for management. The question of definitive repair in infancy, as opposed to early palliation and later repair, is particularly pertinent to these conditions. It is evident that considerable progress has been made during the thirty-year evolution of surgery for congenital heart disease, but there are many advances yet to be made.

Abstract: A new technique of modified radical mastectomy for early breast cancer was devised with an express purpose of preserving pectoralis major muscle but still enabling radical removal of the regional lymphnodes. The pectoralis major muscle was transected at its midportion to expose the thoracic wall for radical dissection of axillar and subclavicular lymphnodes followed by resuturing of the muscle to preserve its continuity. The parasternal nodes can also be dissected if necessary. The pectoralis minor muscle is either resected or preserved. This procedure should be applied mainly in T1N0 and T1N1a (Stage I in the TNM staging system) which seems recently to be increasing rapidly in number and for which the radical mastectomy with resection of pectoralis major muscle is thought to be too excessive. The procedure proposed in the present communication offers advantage not only in functional but also cosmetic aspect by preserving the pectoralis major muscle while the radicality of the operation is retained. Although the number of cases thus treated is limited and the long-term follow up with survival rate is not yet available, the procedure seems to be of considerable value in selected patients.

Abstract: Intermittent claudication is known as a specific symptom in patients with chronic occlusive arterial lesions. Clinically it is important that neurogenic intermittent pseudo-claudication should be differentiated from true intermittent claudication. Nevertheless confusion still exists in differential diagnosis between these two entities. This paper deals with general review of intermittent pseudo-claudication and a particular emphasis is placed on the different concepts of the pathophysiology and the differential diagnosis from the standpoint of vascular surgery. Recently one case of the neurogenic intermittent pseudo-claudication was encountered and presented in this paper.

Abstract: Simplified operative technique for the long-segment atypical coarctation of the aorta was described. The main objective of this technique is to gain quick access to both thoracic and abdominal aorta with minimal blood loss, and preservation of diaphragmatic function. This procedure consists of standard thoracotomy and pararectal incision with an entry into the retroperitoneal space. Long prosthetic graft was anastomosed in an end-to-side fashion to bypass the coarctated aorta. The graft is placed through peripheral circumference of the left hemidiaphragm, where phrenic nerve injury is not likely to occur. This technique was successfully applied to two cases of long-segment atypical coarctation of the aorta due to Takayasu’s aortitis. Retroperitoncal placement of the graft prevents fatal hemorrhage due to direct contact with the graft. Contamination with transintestinal exudate can also be avoided. Results of the ten-year follow-up of the similar procedure in the literature is encouraging.

Abstract: One hundred and forty one patients with mammary cancer underwent the extended radical mastectomy with parasternal lymph nodes dissection between January, 1966 and December, 1974. From the basis of the present report involvement of parasternal lymph node chain was evaluated retrospectively with respect to the stage, location, size, histological type of cancer, metastasis to axillary and subclavicular lymph nodes, and the five-year survival rate. The parasternal as well as subclavicular and axillary lymph node involvements were not found in non-infiltrating cancer. The more the stage of cancer advanced, the more frequently the parasternal lymph nodes were involved regardless of the location of cancer in the breast. The parasternal lymph node chain alone was rarely involved, but frequently affected along with the axillary lymph nodes. When the parasternal lymph nodes were involved, the five-year survival rate was extremely poor, even after their surgical removal. Subsequently, addition of parasternal lymph node dissection does not seem to be beneficial.

Abstract: Thrombocytopenia is one of the adverse effects of extracorporeal circulation (ECC) but the mechanism of which has not been fully understood. Blood-gas interface, mechanical agitation, rough surface of extracorporeal circuit and sequestration in the liver have been considered to be a cuase of platelet loss. Extracorporeal circuit which provides large artificial surface for contact of blood has been blamed as the site of platelet destruction during oxygenation. However, the part of the oxygenator responsible for platelet loss has not been located. This study was designed to identify the sites of extracorporeal circuit responsible for platelet loss during ECC with scanning electron microscopy (SEM) of the post-perfusion circuit. The accumulation of platelet aggregates was most pronounced at the defoaming net and blood filter where a sudden changes in velocity of blood flow take place. The aggregates were considered to be formed locally at these sites. However, there were no accumulation and/or adherence of platelet aggregates of significant degree at the other parts of the circuit, namely venous and arterial tubings, venous colum and arterial reservoir. Platelets seem to be removed from the circulation during each passage by defoaming net and blood filter. However the other parts of the circuit seem to be less blamed for the platelet loss. It was not possible to conclude whether the formation and trapping of platelet microaggregates at the defoaming net and blood filter or the destruction by oxygen bubbles is mainly responsible for the plateletloss during ECC.

Abstract: In twenty dogs the effects of superior mesenteric artery occlusion (SMAO) for two hours on several conditions likely to be responsible for the lethality of animals or men following release of SMAO were evaluated with and without corticosteroid administration. Six of ten dogs without steroid treatment died from irreversible shock within 24 hours. However, ten steroid treated dogs maintained an adequate blood pressure and survived until sacrifice 24 hours after SMAO. Release of lysosomal hydrolases, metabolic acidosis, hyperkalemia or plasma loss seemed not to have exerted important effects on the fate of animals, because their differences between the groups were not significant. Hence the mechanism underlying the beneficial effects of corticosteroid administered should be sought elsewhere.

Abstract: The histological features of gastric carcinoma in patients survived more than 5 years after the resection were reviewed. In general prognosis and length of survival were related clearly to the degree of malignancy of cancer. Duration of the remission was also reciprocaly related. Certain type of carcinoma simplex or undifferentiated carcinoma was associated with unexpectedly more favorable prognosis. Paradoxical relation was also demonstrated between degree of atypism in adenocarcinoma papillare with introversive pseudopapillary pattern and its prognosis.

Abstract: Change of the surface temperature of the leg during open-heart-surgery was determined in five patients, in whom either side of the femoral artery was ligated for cannulation. While the surface temperature at the patella was least influenced, that at the ankle paralleled closely the changes in the core body temperature and blood supply to the leg. Their difference(P-A difference) was studied to see if they can be used to predict prognosis of patients undergoing open-heart surgery. The P-A difference was followed for several hours after the open-heart surgery. It was marked positive when the surface temperature at the patella was higher than that at the ankle. Total of 54 patients were studied. Only one out of 29 patients with negative P-A difference succumbed. This is in sharp contrast to the 25 remaining patients with positive P-A difference, from whom as many as 12 died. In addition, the postoperative course of the 13 survivors from the latter group was more eventful. Since P-A difference seemed to indicate accurately cardiac output by reflecting the state of the peripheral circulation, it can be used as a useful parameter in prediction of the prognosis in open-heart surgery.