The use of free peritoneal patch was evaluated for the effect on protection against intestinal anastomotic leakage in dogs. Free peritoneal patch was found to be effective in preventing the anastomotic leakage of the alimentary tract in borderline situation. Free peritoneal patch was more effective when applied with the 'smooth side out' than with the "smooth side in'. The usefulness of free peritoneal patch was also demonstrated in the treatment of the already established fistula of the cervical esophagus.
A comparative study of four absorbable suture materials, namely; poly-N-acetylglucosamine (Chitin), polyglycolic acid (PGA), plain catgut and chromic catgut, in terms of strength, elongation, tensile strength retention and tissue reaction, was undertaken. The straight pull strength of USP 3-0 size Chitin was over 2.6 kg, compared with PGA, which was over 3.4 kg and the catguts, which were over 2.0 kg. Chitin showed the lowest elongation among the four. The tensile strength retention (TSR) of Chitin in muscle was 45 per cent at 14 days and 7 per cent at 25 days, which was similar to that of PGA. The TSR of Chitin was maintained by 35 per cent in gastric juice, 97 per cent in bile and 100 per cent in pancreatic juice after immersion for 30 days. The corresponding values for PGA were 54 per cent, 0 per cent and 0 per cent, respectively, whereas both catguts had dissolved within 30 days. The tissue reaction of Chitin was similar to that of PGA, whereas the catguts caused more intense tissue reaction.
A case of lymphangioma of the esophagus with symptoms of achalasia was presented. Compressible and folded intramural tumors were found from the middle to the lower part of the esophagus and the Mecholyl test was positive. After incisional biopsy at lower esophagus through full thickness of the wall, the opening was repaired with Thal-Hatafuku's fundic patch procedures to relieve achalasia. Postoperative course was uneventful and symptoms of achalasia completely disappeared.
An alternative method of anastomosis using a suture one layer inverting was proposed in which the sutures are placed the serosa, proper muscle layer, submucosal layer and muscularis mucosae, but not mucosa. An experimental study using canine intestine revealed that tensile strength as well as bursting pressure at the anastomotic site is significantly superior in our method to the end-on method.
A 28-year-old man was evaluated for complaining of dyspnea. Chest X-ray film revealed a right sided pneumothorax with complete collapse. A thoracic tube was inserted and slowly drainaged, because there was a possible occurrence of Reexpansion pulmonary edema (REPE) with a lapse of 42 days after the onset. About 3 hours after drainage, he complained of cough, dyspnea and chest pain. Chest X-ray film revealed glass-like shadows . Immediately, thoracic tube was connected to the continuous suction at the pressure of -12 cmH2O . At the same time, 0.2 supply and injection of steroid were started. On the next day, these symptoms were improved . His chest X-ray film returned to normal within a week.There were 12 cases of spontaneus pneumothorax during the past 3 years in our hospital , of which 3 were complicated by REPE. In all the 3 cases, complete collapse of the lung due to pneumothorax had existed for 3 days or more. In the treatment of these cases, it is necessary to consider REPE.
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