Development of Severe Hyponatremia due to Salt-Losing Nephropathy after Esophagectomy for Esophageal Cancer

A 72-year-old woman was admitted to our hospital for esophagectomy for esophageal cancer. On the third postoperative day, she developed polyuria (3.8 L/day), massive natriuresis, hyponatremia (112 mEq/L), hyperkalemia (5.6 mEq/L), and decreased central venous pressure, which was refractory to isotonic saline infusion. Laboratory findings indicated proximal tubular injury (high urinary β2-microglobulin, coexistence of hypouricemia) together with reduced aldosterone action at the cortical collecting duct. A diagnosis of salt-losing nephropathy was made and sodium correction was done with 3% saline and fludrocortisone. She responded well to therapy. The cause of hyponatremia was considered renal tubular dysfunction together with elevated antidiuretic hormone level. Postoperatively, it is important to look for the development of salt-losing nephropathy

A of Lamblial Cholecystitis

A case of lamblial cholecystitis in 31-year-old male patient was stupied, and the following findings were obtained: 1. The patient developed no intestinal symptom, whereas the main complaint was fever and right hypochondralgia. 2. He was a hard muscular laborer and a heavy drinker of raw alcoholic beverage. 3. There was found hepatomegaly, a tumor in cystic region with tender-ness. Lamblia intestinalis was discovered in B-and C-gall. 4. Gastric juice, urine and feces were examined for lamblia. No lamblia was identified by smear method, but culture in Dobell and Waidaw\u27s media proved the presence of lamblia in feces. 5. Hematological study revealed no eosinophilia but relative lymphocytosis. 6. Hypersensitivity of the autonomous nervous system causing Oddi\u27s muscle contraction was not demonstrated. 7. As for treatment, chloroqine diphosphate was used with good response

心臓血管外科領域におけるゼラチンシートの止血効果、癒着防止効果の検討

BACKGROUND:The bi1ayer gelatin sealing sheet was developed as a safe, effective, easy-to-handle and low-cost hemostatic agent. OBJECTIVE:To examine the feasibility of gelatin sealing sheets using a canine aterial hemorrhage mode1. METHODS:In vivo degradation of gelatin sealing sheets was examined by implanting subcutaneously in rats. For the hemostatic and anti-adhesion efficacy investigations, femoral arteries of dogs were pricked with syringe needle to make as mall hole, and a gelatin(i.e. experimental group) or fibrin glue sealing sheet (i.e. control group) was applied on the hole to stop bleeding (n=8). After discontinuation of the bleeding, the skin incisions were closed and re-examined 4 weeks postoperatively. RESULTS:From the degradation study, 4h thermally treated gelatin sheet which degraded within 3 weeks in vivo was chosen for the further hemostatic study. In all cases of gelatin and fibrin glue sealing sheets, bleeding from the needle hole on canine femoral arteries was effectively stopped. Postoperative adhesions and inflammation at the site in the experimental group were significantly less than those in the control group (P<0.01 for adhesion scores). CONCLUSIONS:The gelatin sealing sheet was found to be as effective as the fibrin glue sealing sheet as a surgical hemostatic agent, and more effective in preventing postoperative adhesions.博士（医学）・甲第632号・平成27年3月16日Copyright ©2015 IOS Pres

Effectiveness of Cross‐Linked Gelatin Glue in Canine Lung Surgery Models.

Background. Air leakage is a common postoperative complication in pulmonary surgery, and surgical sealants have been developed to prevent or reduce the incidence of air leaks. In this study, we evaluated the efficacy of cross-linked gelatin glue (gelatin plus glutaraldehyde) in canine lung surgery models. Methods. Pulmonary fistulas and injuries were created in dogs and sealed with gelatin glue, fibrin glue, or fibrin glue with a polyglycolic acid (PGA) sheet. Seal-breaking pressures were measured in the fistula model, and pleural adhesions were assessed 28 days postoperatively in the lung injury model. Results. The seal-breaking pressures for canine cadaver and living lung surgeries (; the maximum pressures were 80 and 40 cm H₂O) were respectively: gelatin glue, 77 ± 6 and 32.3 ± 8.9cm H₂O; fibrin glue using spray, 39.2 ± 9.3 and 32 ± 6cm H₂O; fibrin glue using the rub-and-soak method, 35 ± 13.4 and 40 ± 0 cm H₂O; and fibrin glue with a PGA sheet, 55.5 ± 18.2 and 39 ± 2cm H₂O. In the lung injury model, there were no chest wall adhesions in the gelatin and fibrin glue alone groups, while strong adhesions were observed when treated with fibrin glue with a PGA sheet. Conclusions. Gelatin glue's sealing effect was superior to that of fibrin glue while preventing postoperative pleural adhesions. These findings suggest that gelatin glue may be effective as a surgical sealant or anti-adhesion materialin lung surgery

Prediction of beach erosion at Murozumi beach

Reclamation results generally in beach erosion of a neighbouring coast. Historical changes of shoreline at Murozumi beach, a pocket beach, are first described in accordance with the reclamation. Main causes of beach erosion are then considered by the characteristics of incoming waves over a period of 10 years and of sediment sampled on the present beach plus the consequential effect of reclamation. A method of prediction is proposed for the long-term change and variation of shoreline by the continuity equation of beach change. The long-term beach change of shoreline so estimated agrees well with the results of field survey. It may be concluded, from comparing the results of numerical simulations of beach changes measured before and after reclamation, that the more advances of beach erosion at the coast, the more severe changes of bottom topography and shoreline can be expected

Development of a Spiral Propulsion Mechanism in Wetlands-Relation between Torque and Load

This paper addresses load properties of a spiral propulsion mechanism in wetlands. Recently, area of wetland has been decreasing due to farmland development and so on. The phenomenon is becoming one of the major environmental conservation concerns. The project of investigation of the current state and its degradation trend of the marshland has been started. The most significant challenges to the field surveys focus on the development of locomotion mechanism to carry measurement devices in wetland. One of the authors has proposed spiral propulsion mechanisms for movement in wetlands. Fundamental experiments have been performed in the bank of a river, where was covered with dried long-stem plants, and the traction properties of the spiral propulsion mechanism in wetlands is investigated. We have proposed a simple formula which describes the relation between torque, load and traction. The data of the experiment fit the formula well in range of less than a certain value of load.特集 : 「資源、新エネルギー、環境、防災研究国際セミナー

Percutaneous Endoscopic Gastrostomy, Duodenostomy and Jejunostomy

Although enteral feeding by nasal gastric tube is popular for the patients who have a swallowing disability and require long-term nutritional support, but have intact gut, this tube sometimes causes aspiration pneumonia or esophageal ulcer. For these patients, conventional techniques for performance of a feeding gastrostomy made by surgical laparotomy have been used so far. However, these patients are frequently poor anesthetic and operative risks. Percutaneous endoscopic gastrostomy (PEG) which can be accomplished with local anesthesia and without the necessity for laparotomy has become popular in the clinical treatment for these patients. PEG was performed in 31 cases, percutaneous endoscopic duodenostomy (PED) in 1 case, and percutaneous endoscopic jejunostomy (PEJ) in 2 cases. All patients were successfully placed, and no major complication and few minor complications (9%) were experienced in this procedure. After this procedure, some patients could discharge their sputa easily and their pneumonia subsided. PED and PEJ for the patients who had previously received gastrostomy could also be done successfully with great care. Our experience suggests that PEG, PED, and PEJ are rapid, safe, and useful procedures for the patients who have poor anesthetic or poor operative risks