日本に於ける二酸化炭素泉療法の現況

Natural CO(2) springs have been scarcely utilized in Japan, whereas artificial CO(2) bathing has become popular by the introduction of CO(2) tablets and other apparatus for CO(2) water supply. Artificial CO(2) bathing is indicated for degenerative connective tissue disorders such as scleroderma, common stiff and painful shoulders, chronic joint pain, lumbago, and trophic changes due to insufficient peripheral circulation by virtue of the increase of tissue pO(2) and the improvement of tissue perfusion. Artificial CO(2) bathing promotes recovery from fatigue and is beneficial in women whose health has been adversely affected by cold.日本では，天然の二酸化炭素泉は殆ど利用されていない。一方，CO(2)錠剤，CO(2)給水装置が開発されて人工二酸化炭素泉がよく用いられるようになってきた。皮下組織の酸素分圧の上昇と組織循環の改善という好ましい生理作用により，結合織の退行性変化による慢性障害，すなわち強皮症，関節症，慢性関節痛，腰痛症，および末梢循環障害に伴う組織の栄養障害に適応がある。また，疲労回復を促進し，いわゆる冷え症に好ましく作用する

A case of malignant lymphoma of the small intestine

原発性小腸悪性リンパ腫は，術前診断が困難で予後が悪い，比較的希な疾患である。我我の症例は60歳の男性で，右下腹部痛にて来院し，急性虫垂炎の診断で手術を施行した。手術時，回腸末端部より10cm口側に潰瘍性病変を認め，クローン病を疑って回盲部切除を施行した。病理組織検査にて悪性リンパ腫，difuse，medium sized cell typeと診断され，広範回腸切除を含む右記結腸切除及び所属リンパ節郭清を行った。リンパ節転移は認めず，stage I，治癒切除と考えられた。術後7カ月現在，再発の徴候無く外来通院中である。本症は5年生存率22～40％と茅後の悪い疾患であるが，stage I・IIとstage III・IV，治癒切除と非治癒切除の生存率には明かな差があり，早期の診断と根治切除の重要性を示唆している。また本症は，緊急手術を要する場合や自験例のごとく急性虫垂炎の診断で手術を受けることが少なからずあると思われ，根治切除に確信のもてない場合は再手術をためらってはならないと考える。A 60 - year-old man complaining of right lower abdominal pain was sent to the operating room for acute appendicitis. The ileocoecal resection was performed for ulceration of the terminal ileum, which was diagnosed as an intestinal malignant lymphoma histologically. The case, therefore, was re-operated three weeks after the first operation. The right half of colon, and about 70 centimeters of ileum with their regional lymphnodes were resected. The case was revealed as the first stage of clinical classification by Naqvi et al. Up to the present time, 7 months after the first operation, there were no sIgns of reccurence. Intestinal malignant lymphoma somtimes has need to do an emergency oparation, and reoperation should be done without hesitation, if necessary

A case report of appendiceal calculus presented as abdominal tumor

虫垂結石は虫垂炎手術例の数％に見られるに過ぎないが，穿孔性腹膜炎などの重篤な炎症を招く可能性が高いことで知られている。自験例は41才の女性で，右下腹部腫瘤を主訴として来院した。画像診断で腫瘤は虫垂に連続し，内部に石灰化を認めたが，腫瘤が硬く，虫垂炎症状が軽微であったことから，虫垂原発腫瘍を疑い手術を行ったところ，虫垂膿瘍を併発した虫垂結石であった。本症が自験例のように触知可能な腹部腫瘤を形成することは比較的まれである。Appendiceal calculi are found in the only several percent of patients with appendicitis and have been known to be complicated in severe appendicitis or perforated peritonitis. We reported a 41-year-old female patient, whose initial symptom was right lower abdominal tumor of insidious growing. Abdominal examination revealed a small fist sized hard mass in the right lower abdomen with slight tenderness, and free of rebound tenderness and muscle defence. Abdominal ultrasonography and computed tomography showed that the tumor had continuity with appendix and contained calcification inside. Accordingly, she was diagnosed to have an appendiceal neoplasm and operated on. Post-operative diagnosis was appendiceal abscess with a calculus, 1 centimeter in diameter. It is rare that appendiceal calculi manifest a palpable abdominal tumor like this case

Oxygen inhalation therapy for chronic venous ulcer. -An additional treatment modality-

長期にわたり反復する静脈性潰瘍は，静脈圧亢進により拡張した毛細管の増加とその周辺に滲出したフィブリンの沈着により，血液からの酸素，及び栄養物の供給が妨げられている。医用質量分析装置による皮下組織ガス分圧の評価で経鼻的に100　％　の酸素吸入により潰瘍周辺への酸素供給が認められたので，重篤臨床例に対して静脈圧減圧処置に加えて酸素吸入を併用したところ，潰瘍の治癒傾向は著しく速くなり，補助療法としての意義を認めた。Prolonged venous hypertension leads to increase the number of dilated capillaries and to fibrin deposition around them which may form a barrier to the diffusion of oxygen and other nutrients from the blood to the tissue, so that cell death and ulceration may occur. Following inhalation of 100 % -O(2), increased partial pressure of subcutaneous tissue oxygen (pO(2)) around the ulcer was confirmed by means of medical mass spectrometry, which was found comparable to or higher than the level of ulcer-free area (chest) on room air. Four patients suffering from chroriic ulcers were successfully treated by 100 % -O(2) inhalation, 4-5 ℓ/min, for one hour every day in addition to the simpie measures of reducing venous stasis. Suffice it to say that the inhalation of 100 % -O(2) may be applicative to an additional treatment modality in chronic venous ulceration, though inhalation of 100 % -O(2) for a long period of time may not be recommended

Radiation horrnesis with Radon baths

ラドン泉浴の保温作用は，薬効的には高濃度（13,764－23,743Bq／ℓ）ラドンの吸入による組織循環の改善による。ラドンによる脈管作動的機序はなお明らかにし得ていないが，末梢循環改着作用に基づく保温効果は疲労回復，及び退行性変性の慢性疼痛緩解に適応を有する。生物に対する放射能は，すべて有害とする認識が一般的であるが，自然放射能を含めてその刺激作用によりbio-positiveの恩恵を受けている。ラドン泉浴によるbio-negativeの報告も見られる中で，ホメオスターシスの維持に必要なbio-positiveなhormetic effectsとしての刺激作用の解明が望まれる。Radon bathings is indicated for chronic pain caused by degenerative changes in connective tissues by warming effect as a result of the improvement in tissue perfusion based on the experimental inhalation study for high concentration of Radon (13,764-23,743 Bq/ℓ). Radioactive radiation has been thought to be bio-negative in general. The environmental radiation in Misasa hospital of 80.7±7.8mBq/ℓ and 265.8±98.8mBq/ℓ in the steam bath room (727-2,395% of Rn-free district) may contribute on Rn spa therapy, as we have no experiences of bio-negative effects of Rn on epidemiology study. It seems probable that the early data of cosmic radiation effects to promote reproduction rate on the primitive organisms have significance and that the ambient radiation is essential for normal physiological function and life of the living organisms. In order to share the benefit of hormetic effects (hormesis) with Radon springs, optimal dosis should be determined together with the development of precise micro-dosimetry

A case report of linitis plastica type of colon cancer.

原発性びまん浸潤型大腸癌は，全大腸癌症例の1％未満と比較的稀な疾患であり，一般大腸癌症例とくらべてその予後の悪いことで知られている。その原因の一つとして，確定診断の困難さがあるが，これは粘膜病変の欠如のために生検で確論がつきにくい点にある。我々の症例は，43歳の女性で，横行結腸に原発した症例である。腹痛を訴えて入院後，急速にイレウス状態となり，注腸検査で横行結腸の高度な狭窄を認めた。大腸ファイバースコープは腹痛のため病変部まで届かず，膣擦過細胞診およびダグラス窩穿刺腹水細胞診にて腺癌細胞を確認できた。手術所見はP（3）H（0）S（3）N（4）で，姑息切除に終わった。本症は手術時の進行度がきわめて高度であるので，本症を疑って確診のつかない症例には，上記のような細胞診も試みてみるべきと思われる。A 43-year-old women, complaining of abdominal pain and menstrual irregularity was found suffering from adenocarcinoma of the transverse colon by cytology tests for vaginal smear and ascites. She was operated for colonic obstruction palliatively because of the extensive lesions and died 2 months after surgery for all that of the intensive cancer therapy. The histological diagnosis was primary linitis plastica type of carcinoma of the transverse colon. Carcer involvement to the ovaries and uterine tubes could possibly be responsible for the positive cytology test for vaginal smear. This rare type of careinoma demonstrates certain clinicopathological characteristics that differ from those of the ordinary colonic carcinomas, such as unfavourable prognosis with the difficulty for diagnosis due to minimal mucosal changes and the marked thickend wall of the tumor being unable to perform endoscopic studies

ヒドウジョウミャク オ オンゾン シタ ヒオンゾン ビソクスイ セツジョジュツ ショウカカン ニュウセン シュジュツゴ ノ ヒゾウ ノ タイセキ ヘンカ

Aim: There is a paucity of information about changes in splenic volume after surgery. The aim of this study was to investigate postoperative changes in splenic volume（SV）and the factors influencing SV after spleen-preserving distal pancreatectomy（SPDP）with conservation of the splenic artery and vein （CSAV）, and after surgery of the digestive tract and breast.Methods: We investigated 113 patients who underwent SPDP with CSAV（n=7）, breast surgery （n=24）, colorectal surgery（n=45）, distal gastrectomy（n=27）and total gastrectomy（n=10）. SV changes were determined for three years after surgery using volumetry based on computed tomographic imaging, and splenic vein diameter changes after SPDP with CSAV were also determined.Results: Splenic vein diameter after SPDP with CSAV did not change during 3 years. SV did not change significantly during 3 years after SPDP with CSAV and distal gastrectomy. After breast and colorectal surgery, and total gastrectomy, SV was decreased.Conclusions: Postoperative SV changes differed according to the type of surgery. SV did not change significantly during 3 years after SPDP with CSAV

A case report of linitis plastica type of colon cancer.

原発性びまん浸潤型大腸癌は，全大腸癌症例の1％未満と比較的稀な疾患であり，一般大腸癌症例とくらべてその予後の悪いことで知られている。その原因の一つとして，確定診断の困難さがあるが，これは粘膜病変の欠如のために生検で確論がつきにくい点にある。我々の症例は，43歳の女性で，横行結腸に原発した症例である。腹痛を訴えて入院後，急速にイレウス状態となり，注腸検査で横行結腸の高度な狭窄を認めた。大腸ファイバースコープは腹痛のため病変部まで届かず，膣擦過細胞診およびダグラス窩穿刺腹水細胞診にて腺癌細胞を確認できた。手術所見はP（3）H（0）S（3）N（4）で，姑息切除に終わった。本症は手術時の進行度がきわめて高度であるので，本症を疑って確診のつかない症例には，上記のような細胞診も試みてみるべきと思われる。A 43-year-old women, complaining of abdominal pain and menstrual irregularity was found suffering from adenocarcinoma of the transverse colon by cytology tests for vaginal smear and ascites. She was operated for colonic obstruction palliatively because of the extensive lesions and died 2 months after surgery for all that of the intensive cancer therapy. The histological diagnosis was primary linitis plastica type of carcinoma of the transverse colon. Carcer involvement to the ovaries and uterine tubes could possibly be responsible for the positive cytology test for vaginal smear. This rare type of careinoma demonstrates certain clinicopathological characteristics that differ from those of the ordinary colonic carcinomas, such as unfavourable prognosis with the difficulty for diagnosis due to minimal mucosal changes and the marked thickend wall of the tumor being unable to perform endoscopic studies

Antithrombogenic therapy after heart valve replacement - Effect of anti-platelet drug on aggregation-

人工弁置換患者の血栓塞栓症（TE）は，長期予後の成績を左右する。　TEを減少させるために凝固因子を抑制するwarfarinと抗血小板剤による抗血栓療法が行われている。人工弁置換患者103例を対象に，抗血小板剤であるtrapidil（TP）とdipyridamole（DP）の血小板凝集能に与える効果を検討した。36ヵ月間検討したが，warfarin単独群は血小板凝集能に変化がなく，TP，DP共にADP凝集能を抑制した。しかし有意差の見られたのは全経過ではなく，凝集能抑制は強力かつ持続的ではなかった。またコラーゲン誘導凝集能は変化を認めなかった。TPとDPの抗血小板効果は同等と思われる。期間中の血栓塞栓発生は，warfarin単独群9.5％，TP群4.3％，DP群7.7％であった。臨床的に抗血小板剤の併用は有効と思われるが，血小板凝集抑制には投与量の増量，あるいは他の薬剤の検討が必要であろう。To evaluate the effect of anti-thrombotic thrapy after valve replacement, serial platelet aggregation measurememnts were carried out in 103 patients. Patients were divided into three groups. e. i. warfarin alone (control), warfarin with trapidil (TP) of 300mg/day and dipyridamole (DP) of 300mg/day. The aggregation of platelet of the control group did not change through 36 months. TP group showed a decrease in platelet aggregation at 24 and 30 months from the pretreatment value. The aggregation of 24 month in TP was significantly lower than that of control. There was no difference of platelet aggregation between TP and DP group. The incidence of thromboembolism of control, TP and DP group were 9.5%, 4.3% and 7.7%, respectively. These data suggest that the supression of platelet aggregation .by TP and DP is not adequate to continue for long time and TP has similar anti-thrombotic effect to DP