<CLINICAL REPORT>A case of inverted papilloma of the maxillary sinus

A case of inverted papilloma arising in the maxillary sinus is described. The first symptoms were rhinorroea and discomfort of the left infraorbital region. A biopsy obtained by penetration into the maxillary sinus resulted in a diagnosis of chronic sinusitis. However, the surgical specimen showed characteristic inverted epithelial proliferation. Two years after operation by the Caldwell-Luc method, there are no signs of recurrence. The diagnosis and treatment of inverted papilloma are discussed

Subserosal Inflammatory Pseudotumor Causing Intussusception

We present an adult case of intussusception caused by subserosal inflammatory pseudotumor of the terminal ileum. Enteric intussusception was diagnosed by characteristic Xray finding, so called "beak-like" filling defect in the terminal ileum. An exploratory laparotomy revealed focal subserosal thickening in the terminal ileum, and partial ileocolectomy was performed. Microscopically, we identified a pseudotumor that extended through the muscularis propria into serosa. The pseudotumor was composed of fibrous stroma and chronic inflammatory cells with calcification

下肢静脈瘤治療後に発生する下腿浮腫に対する歩行訓練 : 静脈瘤に対する硬化療法後の下腿浮腫および手術後に発生した下腿浮腫

一次性下肢静脈瘤の治療法として硬化療法と伏在静脈高位結紮術を併用した場合,しばしば頑固な下肢浮腫を認める.そこで,我々は下腿浮腫の予防的アプローチとして弾力包帯による圧迫療法,歩行訓練の有効性を検討した.当院で行った一次性下肢静脈瘤,956人1417肢の内,特に頑固な下肢浮腫を来す可能性のある症例,すなわち手術療法として大および小伏在静脈結紮術,不全交通枝結紮術さらに広範囲な静脈瘤切除術を施行した症例24例を対象とし,下肢静脈瘤治療後に発生する下肢浮腫について歩行訓練の有効性を検討した.歩行訓練としては,手術翌日より,1)足底静脈のフットポンプ機能を活性化させる目的で床歩行を20分間,1日3回,2)下腿膝部から足関節部までの静脈-筋肉ポンプを活性化する目的で階段昇降(100step)を1日3回行わせた.さらに併用療法として,3)足背から大腿中央部まで弾力包帯および弾力ストッキングで圧迫した.術後早期の圧迫療法と歩行訓練の併用は足底部の静脈によるフットポンプおよび静脈(静脈弁)-筋ポンプ作用を有効に働かせるのに有効で下腿浮腫の軽減に効果的であると考えられた.It is well known that lower leg edema occurs in patients who have undergone sclerotherapy and operative procedure or such operative procedures as high ligataion of the long and short saphenous veins of ligation of the perforator branch for varicose veins of the legs. To date, there have been no reports regarding rehavilitation approaches for patients who have undergone the above mentioned procedures. We evaluated the efficacy of gait training to improve such lower leg edema. Group I : sclerotherapy only, group II : operative procedure, group III : both sclerotheraphy and operative procedure, group IV : as controls inpatients with no led varicose vein who had undergone a tonsillectomy. As rehabilitation therapy, the subjects were required to do 1) 20 minutes walking on the floor to activate the venous foot pump function, 2) to go up and down steps to activate the venous muscle pump function, and 3) to undergo added compression therapy using an elastic bandage and elastic stocking. In group I , the leg edema improved within several days due to the use of an elastic bandage or elastic stocking and no recurrence was encountered. Regarding operation therapy, in group I, strong leg edema occurred on the first postoperative day. In group II, it occurred again on the seventh postoperative day after compression therapy. In group III, no leg edema occurred again. Our results have led us to conclude that walking and goig up and down steps as gait training soon after surgical procedures are very effective for decerasing lower leg edema

教室における肺癌症例の検討 : 病期分類,切除率,生存率からみた肺癌手術例の検分

昭和50年1月から昭和61年1月までの約11年間に当科に入院した原発性肺癌症例は121例で,これらの症例について病期分類,切除率,生存率等について検討を加えた.内訳は,男性88例,女性33例,年齢は22歳から83歳,平均67.0歳で,70歳代は24例(19.8%),80歳代は2例(0.2%)であった.病期分類はIa期32例(26.4%),Ib期8例(6.6%),II期5例(4.1%),III期45例(37.2%),IV期28例(23.1%)で,III・IV期を合わせると60%以上を占めていた.このうち切除例は78例(64.5%)で,治癒切除例は57例(73.1%)であり,II期症例までは全例治癒切除可能であったが,III期症例は45例のうち治癒切除は11例のみであった.121症例の組織型は,腺癌は59例(48.8%),類表皮癌は37例(30.6%),小細胞癌は10例(8.3%),大細胞癌は4例(3.3%)であった.全切除例の50%生存期間は36.4カ月であったが,病期別に比較するとla期の5年生存率は約71%であったのに対して,Ib期,II期,III期の50%生存期間はそれぞれ27.5カ月,31.4カ月,24.4カ月と,Ia期の生存率は有意に良好で(p<0.05),治癒切除,非治癒切除に分けて比較すると,50%生存期間はそれぞれ46.6カ月,20.4カ月で治癒切除可能例において有意に良好であった(p<0.05).また,当院呼吸器内科で非観血的療法をうけた切除不能94例の50%生存期間は約7.5カ月であり,切除例の36.4カ月と比べ明らかに不良であった.このように生存率は早期症例ほど良好で,肺癌予後を決定する因子としては病期分類が最も重要であり,さらに小細胞癌,III期肺癌に対しても積極的な拡大根治手術により生存率の向上が期待できるものと考えられる.One hundred and twenty-one patients with lung cancer were admitted to our division during the 11 years between January, 1975 and January, 1986. There were 88 men and 33 women, whose ages ranged from 22 to 83 years. Thirty-two patients were in Clinical Stage Ia of the disease (24.6%), 8 in Stage Ib (6.6%), 5 in Stage II (4.1%), 45 in Stage III (37.2%) and 28 in Stage IV (23.1%). Fifty-five patients had adenocarcinoma (48.8%), 37 epidermoid cell carcinoma (30.6%), 10 small cell carcinoma (8.3%), 4 large cell carcinoma (3.3%) and 11 had other forms of the disease. Of these, 78 patients underwent surgical resection. That group of patients was analyzed for long-term survival by clinical stage, and a survival curve was drawn according to the methods of KAPLAN & MEIER. The 50% survival period was at 36.4 months for all resected cases, at 27.5 months in patients with Stage Ib, at 31.4 months in those with Stage II, at 24.4 months in those with Stage III and at 7.5 months in non resected cases. On the other hand, the five-year survival rate was 71% in patients with Stage Ia. There was a significant difference in prognosis between Stage Ia and the other stages of the disease. In conclusion, the clinical stage is most important for prognosis in patients with lung cancer, and it can be effectively treated with prolonged survival to operated extensively for Stage III of the disease and for small cell carcinoma of the early stage

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This is a clinico-statistical study of 97 inpatients with maxillary antrum-related lesions with exception of traumas and malignant tumors in this hospital during the past 10 years. In this study, special emphasis was placed on the diagnosis and treatment in primary dental or medical facilities prior to our surgery. The results were as follows : 1) Most of the 97 cases were postoperative maxillary cysts (44 cases : 46%) or odontogenic maxillary sinusitis (34 cases : 35%). 2) 74 cases (76%) of the 97 were referred from the other dental or medical clinics to the hospital. 3) The average periods of the treatment till the patients with postoperative maxillary cysts visited to our hospital were 48 days and for odontogenic sinusitis it was 89 days, respectively. 4) The treatments for these two lesions before consultation with us were mostly antibiotic therapy and/or root canal treatment. 5) These results suggest the necessity of tight affiliation between primary medical facilities and secondary or tertiary medical facilities in investigation of maxillary antrum-related lesions too