[A case of spontaneous esophageal rupture successfully treated with a pedicled omental flap].

We experienced a case of spontaneous esophageal rupture. A 64-year-old male was admitted to the hospital with shock because of a severe epigastralgia after vomiting. We suspected spontaneous esophageal rupture by the mediastinal air and left pleural effusion of a chest X-ray film of first visit, and diagnosed it by esophagography, then operated 8 hours later the onset.

Primary neurilemoma of the thyroid gland: report of a case.

Neurilemoma, like other non-epithelial tumors, seldom occurs in the thyroid gland. A 57-year-old man was first referred to our hospital with an asymptomatic anterior neck tumor. A solid tumor was detected in the right lobe of the thyroid and an enucleation of the thyroid tumor was performed.

Scintiscanning demonstration of thymoma: comparative study on scintiscans using 201Tl, 67Ga and 75Se.

Thymus scintigraphy was performed using 201Tl-chloride, 67Ga-citrate and 75Se-selenomethionine on 30 thymoma patients with or without myasthenia gravis. Mass negativity was observed in 6 out of 17 (35.3 per cent) and 3 out of 13 cases (23.

Significance of renin-angiotensin system during and after surface-induced simple hypothermia in open-heart surgery.

The present studies were performed to investigate the metabolic role of the lungs in the renin-angiotensin system under hypothermia by measuring plasma renin activity, plasma angiotensin I (A I), plasma angiotensin II (A II), plasma aldosterone and plasma angiotensin converting enzyme activity on 14 patients who underwent open-heart surgery with surface-induced simple hypothermia. In addition, dog experiments were performed, in which changes of renal blood flow and angiotensin metabolism in lungs and kidneys under hypothermia were studied in vivo. The following results were obtained: 1) During and after open-heart surgery with surface-induced simple hypothermia, the homeostasis in the renin-angiotensin system is still maintained.

Inhibitory mechanisms of insulin secretion associated with hypothermic open-heart surgery.

In order to clarify the inhibitory mechanism of insulin secretion associated with open-heart surgery, the influence of insulin antagonistic hormones on insulin secretion was studied in 20 patients with congenital heart diseases undergoing open-heart surgery, under simple deep hypothermia. Despite a hyperglycemia, plasma immunoreactive insulin and C-peptide showed no change during the cooling period, while with the exception of plasma human growth hormone, dopamine-beta-hydroxylase, immunoreactive glucagon, cortisol and cyclic AMP in plasma, either showed no change, or a decrease during the cooling period. It is assumed that catecholamine, glucocorticoid and glucagon do not play an important role in the inhibitory mechanism of insulin secretion during hypothermic open-heart surgery, and a transient hypofunction of the pancreas as well as the liver and the adrenal gland is probably involved.

Somatic and psychomotor development of children after hypothermic open-heart surgery.

One hundred and seven patients with ventricular septal defect who survived one and a half to thirteen years after hypothermic open-heart surgery were reviewed with respect to somatic, intellectual, and psychomotor development. There were no negative effects associated with deep hypothermic arrest in any of these areas. Abnormal electroencephalograms were seen in one-half the number of patients examined, but there was no close relation between the circulatory arrest period and electroencephalographic findings.

Changes of kallikrein and serotonin in plasma during and after open-heart surgery.

Plasma kallikrein activity and plasma serotonin were studied during and after open-heart surgery in 15 patients with extracorporeal circulation and in 15 patients with surface-induced deep hypothermia. Following results were obtained: 1) Plasma kallikrein activity which reflects the activation of the kinin system, showed no significant change during extracorporeal circulation, and significantly increased three hours after the termination of perfusion. However, there was no significant difference in plasma kallikrein activity between the patients with and without low cardiac output syndrome (LOS).

Simple deep hypothermia for open-heart surgery.

Two hundred fifty patients more than 2 years of age having correction of congenital heart diseases by simple deep hypothermia alone were investigated in respect to metabolic abnormalities, post-operative complications, intellectual development and postoperative EEGs. LOS in lethal complications was attributed to the difficulty of resuscitation, indicating the application of this method is ideal for patients less than 6 years in age or less than 20 kg in weight. No impairment of intellectual development was observed when compared IQ before the operation and at the time of long term follow-up in serial study, but electroencephalographic assessment indicated that postoperative abnormalities might occur more frequently than previously suspected.