Causative Mechanism of Reflux Esophagitis induced by Digestive Secretions

Mechanisms producing reflux esophagitis were experimentally evaluated to clarify a direct action of digestive secretions to the esophageal mucosa. Mucosal lesions of reflux esophagitis were grossly composed of erosion, ulceration and loss of normal lustrous appearance. Based on histological examination, the degrees of erosion, ulceration and cell infiltraiton were also compared with respect to the severity of reflux esophagitis. Causative mechanisms of reflux esophagitis due to gastric juice alone are different from those due to another digestive secretions in relation to either the gastrectomized status or not

Superficial Carcinoma of the Esophagus

Four cases of esophageal carcinoma in which the invasion is limited to the mucosal layer (m-carcinoma) and 7 cases of it in which the invasion invades the submucosal layer (sm-carcinoma) are studied. In the cases of m-carcinoma, both lymphatic invasion and blood vessel invasion were not found. On the other hand, lymphatic invasion was noted in 4 cases among 7 cases of sm-carcinoma, and in these 4 oases, lymphatic invasion or blood vessel invasion was demonstrated in the primary sites. Among 4 patients who had lymph node metastasis, 2 died of the recurrence of carcinoma, and the other 2 died of other diseases. The prognosis of patients without lymph node metastasis was satisfactory. The best way to elevate the prognosis of esophageal carcinoma is to discover it at the stage of m-carcinoma, and in order to achieve it, endoscopic observation combined withh the Lugol-staining method is most influential. It is also recommended to perform the esophageal endoscopic examination with patients visiting us with other diseases

Surgical Treatment of Acquired Tricuspid Regurgitation with Carpentier\u27s Ring

Between 1976 and 1982, nine patients underwent tricuspid annuloplasty with use of CARPENTIER\u27s ring for acquired tricuspid regurgitation associated with mitral valvular diseases or ruptured aneurysm of the sinus VALSALVA. Of these, one patient died of low cardiac output and respiratory failure. Postoperative cardiac functions were evaluated on remaining eight patients by physical examinations, findings of roentgenogram and contrast echogram. No postoperative regurgitation of the tricuspid valve was detected by contrast echogram in any of the five patients who received this examination after operation. In six of the eight patients, postoperative physical activity improved to grade I of the classification of NYHA, whereas the improvement was limited to grade II in two other patients in whom some forms of the left side cardiac lesions (e. g. mitral regurgitation) still seemed to remain

Instrumental Perforation of the Esophagus A Case Report and Review of Literature

Thanks to the improvement of the types of the endoscope and the progress of its techniques, the incidence of esophageal perforation has been decreasing recently. It should be pointed out, however, that esophageal perforation is a very serious iatrogenic disease requiring an early diagnosis and an adequate drainage in order to save the lives of patients. A woman at the age of 68 received gastrofiberscopical examination under suspicion of gastric ulcer, but immediately after the inspection, the patient had severe epigastric pain and dyspnea, and in five hours subcutaneous pneumatosis appeared on her neck. Chest X-ray pictures revealed mediastinal pneumatosis in high degree and pneumothorax on the left, and blood gas analysis showed the decrease in PO2 and the rise in PCO2. Since the patient fell into the state of shock, esophagography and esophagoscopy were not performed, but operation was given immediately. Hematoma was found at a site immediately above the diaphragm and on the left posterior wall, and abscess was formed in the mediastinum. We did not suture the injured region, but drinage of the mediastinum and the left thoracic cavity was given. After the operation, tracheostomy was performed, and her respiration was managed with a ventilator, simultaneously placing the nasogastric tube within the stomach to reduce the pressure inside it. In 15 days after operation, food intake was resumed, and in 46 days the patient was discharged in good health. Thus, it is important for esophageal perforation to give drainage as early as possible at a most appropriate position, which will enable us to same the patient in dyspnea and shock in esophageal perforation

Comparative Study between the jejunum and Colon as Substitute for the Esophagus in Terms of Blood Flow

The advantages over a substitute for attaining the continuity following resection of the esophagus were experimentally compared between the jejunum and the colon in terms of changes in blood flow in the vascular pedicles under the influence of mechanical tension, induced systemic hypoxia and hypotension. Blood flow of the pedicled jejunal and colonic grafts used were measured with the use of direct collection through catheter introduced to the pedicled vessel. 1) As for tension-load added to the pedicle, the colon was much more tolerable rather than the jejunum. When a 40g tension was added to the jejunum, blood flow was remarkably reduced whereas there was no significant change in the colon even when a 100g tension was added. 2) As for the influence of induced hypoxic load, blood flow to the pedicled grafts was reduced when the arterial Po2 fell to below 70mg and Pco2 over 50mg. 3) As for the influence of induced systemic hypotensive load, it was significantly reduced to below about 30% of the normal systemic blood pressure in the similar patterns between the jejunum and the colon

Effects of Histamine Receptor Blockers and the Rate of Administration of Morphine on Cardiovascular System

Blood pressure reduction during the high dose morphine anesthesia was investigated from the point of view of histamine receptor blockers and the rate of morphine administration. It was found as the results that blood pressure reduction was prevented by the administration of the histamine receptor blockers, and the effect was almost equivalent to that caused by morphine with the rate of infusion at 2 mg/min. Safer anesthesia may be performed in term of blood pressure reduction when H1 and H2 receptor blockers and a slow infusion of morphine with small divided doses are given

Temporary Division of the Superior Vena Cava For Extended Left Atriotomy ; Left-sided Atrioventricular Valve Repair in Corrected Transposition of the Great Arteries

The extended left atriotomy which combines the standard approach with the superior approach by concomitant temporary division of the superior vena cava (SVC) is a safe and useful method in the case of a small atrium. The approach used here is a modification of that which was reported by Selle and Kyger. This technique made it possible to sufficiently expose the laterally situated small left atrium in the case of corrected transposition of the great arteries (cTGA) which requires repair of the left-sided atrioventricular valve (tricuspid valve). In recent mitral surgery, median sternotomy is used with cannulation of the ascending aorta and both venae cavae to establish cardiopulmonary bypass. Although there are some approaches for left atriotomy, the standard procedure is to use vertical left atriotomy immediately posterior and parallel to interatrial sulcus. And in the case of combined mitral with tricuspid valve surgery, a right atriotomy with incision of interatrial septum has been employed to allow excellent exposure of the left atrium and mitral and tricuspid valve including subvalvular supporting structures. Surgical exposure of the mitral valve is often difficult by the conventional approach, especially in the patient with a small left atrium and a deep chest. In the case of cTGA too, sufficient exposure of the left atrium can not be obtained under median sternotomy on accout of anatomical abnormality. We performed prosthetic valve implantaion to the left-sided atrioventricular valve which is tricuspid valve in structure in the case of cTGA by means of new approach with the incision of the lateral to superior wall of the left atrium combined with division of the SVC temporarily. This technique was introduced by Selle 1) in a recent article

Ventricular Septal Myectomy and Mitral and Aortic Valve Replacement in the Case of Discrete Subaortic Stenosis

We experienced a case of discrete subaortic stenosis of fibromuscular collar type, complicated with asymmetrical thicking of the ventricular septum and abnormal attachment of the tendinous cords of the mitral leaflet accompanied by mitral incompetence and aortic incompetence due to infective endocarditis. Surgical treatment comprised resection of subaortic stenotic fibrous tissues, ventricular septal myectomy and replacement of mitral and aortic valves. Preoperative pressure gradient of 120 mmHg across the left ventricular outflow tract was improved to 22 mmHg with a favorable clinical course. This was considered a rare case where fibromuscular type of DSS was accompanied not with secondary myocardial hypertrophy but with IHSS and abnormal tendinous cords of mitral leaflet