Ansa-recurrent nerve anastomosis for vocal cord paralysis due to mediastinal lesions

Recurrent laryngeal or vagus nerve injuries in the mediastinum are repaired rarely because of technical difficulties. Impairment in phonation is especially severe in patients with respiratory dysfunction. We performed a simple and less invasive reconstruction, ansa cervicalis-recurrent laryngeal nerve anastomosis in the neck, to improve phonation in 2 patients. Although the reinnervated vocal cord did not regain normal movement, both of the patients obtained excellent improvement in phonation.

Carcinosarcoma of the lung. Report of a case and review of the literature

We describe a case of carcinosarcoma of the lung in a 60-year-old female who was admitted with complaints of productive cough and an abnormal shadow in the chest X-ray. Sputum cytology showed both squamous cell carcinoma and adenocarcinoma cells. Malignant nonepithelial cells were identified in the needle biopsy specimen. Right middle and lower lobectomy was performed to reveal a carcinosarcoma by microscopic and immunohistochemical examination. This case was histologically unusual because it presented multiple carcinomatous elements (squamous cell carcinoma and adenocarcinoma). It was classified as peripheral type according to the clinical classification, showing an extremely poor prognosis. The histogenesis and clinical features of this rare tumor are discussed.

[Evaluation by microneurography of muscle sympathetic nerve activity in myelopathic patients]

The purpose of this study was to observe the functional condition of the muscle sympathetic nerve activity (MSNA) in nine patients with mild myelopathy for which surgery was indicated [mean score 14/17 by Japanese Orthopaedic Association (JOA) cervical myelopathy and 7/11 for thoracic myelopathy]. The MSNA was obtained from the tibial nerve at the popliteal fossa by microneurography. The resting activities and the responses during handgripping were analyzed and compared with those of a control group of nine healthy volunteers and patients with disorders unrelated to myelopathy. The MSNA with the subjects supine was recorded first at rest for 5 min. (rest period), next during exertion of 20% of the maximum voluntary handgripping power for 5 min. (handgripping period), and last at rest for 5 min. (recovery period). The number of MSNA bursts per min. (burst rate) in the group with myelopathy was more than that in the control group (p < 0.05) in all three periods. The response by MSNA to handgripping in the group with myelopathy was higher than that in the control group at the start of handgripping (p < 0.01), and tended to be higher even 5 min. after handgripping ended. The results appeared to demonstrate that MSNA of patients with mild myelopathy for which surgery is indicated is increased in the lower extremities.

[Projects in surgery for lung transplantation]

Lung transplantation was simulated in 9 essential items in the surgical side. The possibility to utilize cardiac death donor instead of cerebral death donor was discussed. The transplant window was shown in a patient with primary pulmonary hypertension. The informed consent must be authorized at the specific meeting. For the pre- and postoperative care, it is essential for surgeon to treat on the team which is consisted of members from the specific regions. With donation, a method of the standardization for graft preservation was shown by statistical analysis of many factors. The level of surgical techniques in Japan have been evaluated to be on the current level. In postoperative care, reimplantation response, infection, and rejection are important factors which have been clinically overcome in preceding institutions. However, a practical method of established diagnosis for acute rejection remain unresolved. In addition, CMV infection will be an unavoidable problem in Japan. The research of immune tolerance has been successfully underwent in experiments to overcome chronic rejection.

Operative approaches for left-sided carinoplasty

Carinoplasty was performed in 42 patients: 7 with wedge pneumonectomy, 15 with sleeve pneumonectomy, 14 with one-stoma-type carinal reconstruction, 5 with montage-type carinal reconstruction, and 1 other. Diagnoses in the 42 patients consisted of lung cancer in 31 (73.8%), tuberculous stenosis in 10 (23.8%), and tracheobronchial injury in 1 (2.4%). The thoracotomy was on the right side for lung cancer in 77.4% and on the left side for tuberculous stenosis in 80.0% (p < 0.01). Left-sided carinoplasty was performed in 14 patients using four approaches: midline thoracotomy in 1, left thoracotomy in 10, midline sternotomy and left thoracotomy in 2, and bilateral thoracotomies in 1. Left wedge or sleeve pneumonectomy, without right thoracotomy, could be done by midline sternotomy and left thoracotomy but with limited tracheal resection. Left one-stoma-type carinoplasty was undertaken, sacrificing one lobe, as an alternative to pneumonectomy, where an approach drawing the carina down to an aortopulmonary window was considered to be preferable to the drawing-up approach.

Influence of temperature of flushing solution on lung preservation

For lung transplantation the technique of flushing the donor pulmonary vascular bed may provide advantages in lung preservation such as rapid cooling and washout of blood. However, rapid cooling of the ischemic lung may also produce adverse effects. The aim of this study was to compare methods of cold flushing and topical cooling, and to evaluate the effect of temperature of the flushing solution on lung preservation. A total of 25 rabbit lungs were studied. Using an ex vivo rabbit lung model, postischemic function was assessed by the ability of the lung to oxygenate perfused blood and by measurement of pulmonary artery and airway pressures. The lungs in group I were preserved with simple immersion at 10 degrees C for 30 hours. The lungs in groups II through V were flushed with solution containing phosphate-buffered dextran (LPD) at different temperatures (groups II and IV, 10 degrees C; groups III and V, 23 degrees C) and stored at 10 degrees C for various ischemic periods (groups II and III, 30 hours; groups IV and V, 36 hours). Pulmonary vascular resistance during flushing at 10 degrees C was significantly higher than that at 23 degrees C (p < 0.001). Flushing resulted in better preservation than topical hypothermia. Flushing at 23 degrees C resulted in superior postischemic function compared with flushing at 10 degrees C. We conclude that in lung preservation, uniform flushing with LPD solution improves the ischemic tolerance as compared with topical hypothermia, and that flushing with solutions at too low temperatures may have adverse effects on lung preservation.

[Diseases and operative modes of tracheobronchoplasty]

In 251 patients of tracheobronchoplasty, the disease distribution and the indicative expansion were analysed. The largest series was lung cancer encountered in 49%, followed by thyroid cancer in 20%, posttracheostomy tracheal stenoses, primary tracheobronchial tumors, and tuberculosis in 7-8% respectively, and others in remaining 4%. In lung cancer, two way of operative modes have been tried, which were carinal resection extensively and sleeve or wedge segmentectomy limitedly. Laryngotracheal anastomosis increased applicable cases in thyroid cancer and posttracheostomy subglottic stenosis. Preoperative irradiation for adenoid cystic carcinoma increased the cases for operation. A new carinal reconstruction via the subaortic arch approach for tuberculous stenosis was successfully underwent. End-to-end anastomosis instead of partial suture was advisable in the early stage of traumatic bronchial rupture. Congenital airway malformation is a disease to be divised some operations which might furthermore increase operative modes. In summary, 38 operative modes have been experienced so far, and these might increase in number depending to diseases.

A study on optimal temperature for isolated lung preservation

Fifty-two heart-lung blocks (grafts) of New Zealand white rabbits were used for determining optimal temperature in lung preservation. Grafts were inflated with room air and preserved by simple surface cooling at arbitrarily determined temperatures for 18 hours. Graft function was assessed by nonrecirculated perfusion with autologous blood. Segmented regression models between functional parameters and preservation temperature (T) were applied for determining optimal temperature. Graft ability was also assessed from the point of view of pulmonary circulation by indocyanine green dilution rate of effluent and histological distribution of carbon particles. Significant segmented regression curves and lines between parameters of effluent oxygen tension (PO2) and wet-dry weight ratio (W/D), and T were obtained as follows: PO2 = 150/(1 + 3208.1[e-1.17T]), p less than 0.01; PO2 = -13.8T + 222.6, p less than 0.05; W/D = 5.0 + 1.5/(1 + 0.0028[e0.94T]), p less than 0.01; W/D = 0.075T + 4.52, p less than 0.05. Optimal temperature for lung preservation by topical cooling was calculated as 8 degrees to 9 degrees C from each intersecting point of regression equations. Analysis of regression curves suggested that the most common hypothermic ischemic injury during preservation by topical cooling is pulmonary vascular obstruction, which might be induced at temperatures lower than the critical temperature of 6 degrees to 7 degrees C. Indocyanine green dilution rate and histological findings supported the results of graft functional parameters.

Evaluation of denture cleansers with and without enzymes against Candida albicans

The fungicidal effect on Candida albicans was evaluated for denture cleansers with and without enzymes (alkaline peroxide type). Three cleansers with proteolytic enzymes showed little yeast lytic ability, while one cleanser with yeast lytic and proteolytic enzymes and one cleanser without enzymes showed slight yeast lytic ability. The results suggested that the activity depended on alkaline peroxide rather than on enzymes. Five denture cleansers showed strong effects.

Receiver operating characteristic analysis on fasting plasma glucose, HbA1c, and fructosamine on diabetes screening

OBJECTIVE

To determine the efficacy of HbA1c and fructosamine as alternatives to fasting plasma glucose (FPG) for diabetes screening.

RESEARCH DESIGN AND METHODS

Receiver operating characteristic (ROC) analysis was conducted on the above tests. Comparison among tests was based on the area under ROC curve of a test. World Health Organization criteria for classifying glucose tolerance status of the subjects was used. The study consisted of subjects (n = 583) who visited the clinic from September to October 1989 and all diabetic cases (n = 36) from November 1989 to March 1990, after excluding those less than 40 yr of age or with hypoglycemic therapies (469 were normal, 88 with impaired glucose tolerance ( IGT], and 62 with diabetes).

RESULTS

Area under ROC curve of HbA1c was not different from that of FPG. Area under curve of fructosamine was significantly smaller than that of FPG. For all tests, overall efficacy of a test to detect IGT and diabetes was considerably diminished compared with detection of diabetes alone.

CONCLUSIONS

The discriminating ability of HbA1c is almost the same as that of FPG, therefore HbA1c is a good alternative to FPG. Fructosamine is not suitable for diabetes screening.

[Tracheobronchoplasty for endobronchial tuberculosis]

Out of thirty three cases of endobronchial tuberculosis we experienced, tracheobronchoplasty was performed on seventeen patients. The disease had the following characteristics, 1) young female preponderance (80% female and age 38 +/- 11), 2) multiple airway involvements (average 2.3), and 3) left main bronchus most commonly involved (64%). As to the operative procedure, carinal reconstruction (CR) with one stomal anastomosis between trachea and left lobar bronchus after partial carinal resection was initially performed without complications. In five patients with left main bronchus stenosis, pull down method for the subaortic arch anastomosis, a new operative approach for left sided one stomal CR, was attempted. Overall rate of post operative complications was 12%.

[Tracheobronchoplasty for functional restoration]

We have experienced 10 cases of terminal mediastinal tracheostomy (TMT), 7 cases of laryngotracheal anastomosis with subtotal resection of cricoid cartilage (LTT), 5 cases of sleeve or wedge segmentectomy (SS, WS) for lung cancer with low pulmonary function, and 5 cases of carinal reconstructions (CR) with one stomal anastomosis between left lobar bronchus and trachea after partial resection of carina for tuberculous stenosis of left main bronchus. Modified TMT which stomaplasty was constructed with cervical and anterior chest skin flap different from primary procedure by Grillo was performed in 3 cases without innominate artery rupture nor cicatricial stomal stenosis. LTT by Pearson's procedure caused telescoped anastomosis. Pulmonary function was reserved in all 5 cases of SS and WS. Salvaged left lung by single stomal CR in the cases of tuberculous stenosis functioned well. Two different approaches for subaortic arch anastomosis, namely Pull-down and Pull-up, were proposed in single stomal CR. Pull-down provided excellent exposure of the carina without sacrifice of intercostal arteries. Indication of plasty was extended by TMT and LTT for upper limits of airway resection, SS and WS for limited operation against lung cancer, and single stomal CR for tuberculous stenosis of left main bronchus.

Effects of crude drugs and berberine hydrochloride on the activities of fungi

The effects of crude drugs on fungi have been used for a thousand years in China and Japan. These drugs include: Saussureae radix, Magnoliae cortex, Cinnamomi cortex, Hydrangeae dulcis folium, and Artemisiae capillarius flos. The activity of Coptidis rhizoma and Phellodendri cortex was stronger than other crude drugs against the three fungi. Berberine hydrochloride, which is a component of the two crude drugs, was investigated. Minimal inhibitory concentration values of berberine hydrochloride were 1, 0.125, and 0.5 mg/ml against Candida albicans, C. tropicalis, and C. glabrata, respectively. In C. glabrata, compared with C. albicans and C. tropicalis, berberine hydrochloride greatly inhibited the growth of fungi.

Interaction of water-soluble Cu(II), Ni(II), and Co(III) porphyrins with polynucleotides

The interaction of the Cu(II), Ni(II) and Co(III) complexes of the following six water-soluble cationic porphyrins with calf thymus DNA, poly(dG-dC)2 and poly(dA-dT)2 was studied by UV-visible and resonance Raman spectroscopy: tetrakis(2-N-) and (3-N-methylpyridyl) porphyrin (1, 2); monophenyl-tris(4-N-methylpyridyl)porphyrin (4); cis- and trans-diphenyl-bis (4-N-methylpyridyl)porphyrin (5, 6). The binding to nucleic acids was compared with that of tetrakis(4-N-methylpyridyl)porphyrin (3). If the N(+)-CH3 group is moved from the para (3) to the meta position (2), binding of the free porphyrin as well as that of the metal complexes is only gradually modified; thus, the square-planar Cu- and Ni-2 are intercalated at the G-C site whereas Co-2 is groove-bound at A-T. Additionally, Ni-2 is probably also intercalated at the A-T site. When the N(+)-CH3 group is located at ortho position (1), the high rotation barrier of the 2-N-methylpyridyl group prevents intercalation of Cu- and Ni-1, resulting in weak outside binding. At ionic strength mu = 0.2, there is no evidence of significant interaction of Co-1 with any of the polynucleotides. When the charged N-methylpyridyl groups in 3 are subsequently replaced by phenyl groups (4, 5/6), the tendency of the Cu(II) and Ni(II) complexes to bind to the outside of the helix or to intercalate only partially increases at the expense of full intercalation. The coulombic attraction remains strong, no significant differences can be detected between 3, 4, 5, and 6. Ni-4 binds to poly(dA-dT)2 in the same complicated manner as Ni-3. The outside-binding in Co-4, -5 and -6 differs slightly from that in Co-2 and Co-3.

A porphyrin-DNA exciplex: resonance Raman spectra of electronically excited Cu(TMpy-P4) bound to poly(dA-dT).poly(dA-dT)

The resonance Raman spectra of water-soluble porphyrins, Cu(TMpy-P4) and Ni(TMpy-P4), and their mixtures with DNA, Poly(dG-dC).Poly(dG-dC), and Poly(dA-dT).Poly(dA-dT) were measured using 426 nm pulsed laser excitation (and 556 nm for some applications). At high laser power, the solution of Cu(TMpy-P4) mixed with DNA or Poly(dA-dT).Poly(dA-dT) exhibits new bands at 1550 and 1349 cm-1 that are not observed for Cu(TMpy-P4) alone or for Cu(TMpy-P4) mixed with Poly(dG-dC).Poly(dG-dC). These extra bands do not appear when the resonance Raman spectra are measured by a cw laser or by a pulsed laser with low power. Similar mixtures of M(TMpy-P4) (where M = Ni, Zn, Co, Mn, and H2) with these nucleic acids exhibit no such bands even by high power pulsed laser excitation. We attribute the new resonance Raman bands to an electronically excited Cu(TMpy-P4), stabilized by forming an exciplex with the A-T site of the nucleic acid. The minimum lifetime value of such an exciplex was estimated to be on the order of 10 ps.

IR and Raman spectroscopic studies on coulombic interaction between water-soluble porphyrins and nucleic acids

We have shown previously that the N-methylpyridyl group vibrations of water-soluble porphyrins, M(TMpy-P4), are shifted to lower frequencies (0.5-2.6 cm-1) as a result of coulombic interaction between the N(+)-CH3 group of M(TMpy-P4) and the PO2 group of a nucleic acid. We have now turned over our attention to the effect of this coulombic interaction on the PO2 group vibrations of nucleic acids. Using Fourier transform ir and Raman spectroscopy, we found that the va(PO2) at 1221 cm-1 is shifted 12 approximately 17 cm-1 to higher frequencies, whereas the vs(PO2) at 1087 cm-1 is shifted 18 approximately 26 cm-1 to lower frequencies, when DNA is mixed with M(TMpy-P4). These results indicate that the N(+)-CH3 group of M(TMpy-P4) interacts preferentially with one of the two oxygen atoms of the PO2 group of the DNA duplex.

[Tracheobroncho plasty: anastomotic technique with encircled placement of sutures]

Tracheobroncho plasty is currently carried out by a number of surgical techniques. Extraordinal plastic modes require special techniques. We prefer to anastomose the posterior site by tying sutures respectively, but at the anterior site by tying sutures after placing them. However, this procedure is difficult to apply in extraordinal plastic modes. Our preference in such cases is to place all anastomotic sutures clipped to field drapes, and then tie them down from front to back of the anastomotic site. This anastomotic technique was carried out in cases of 1) extreme tension in approximation of both anastomotic stumps, 2) subaortic arch anastomosis, and 3) end to side anastomosis. This technique prevents cutting with a suture through cartilage rings with a suture and enables anastomosis to be carried out even in the deep and narrow operative field. The usefulness of this technique was discussed.