The authors reviewed the case records of 1050 familial adenomatous polyposis (FAP) patients who were registered at their institution. The organ-specific morbidity and mortality rates of malignant tumor in FAP patients were compared with those of the general population of Japan, and the prognosis after rectum-preserving operation also was calculated. The cumulative prevalence of colorectal carcinoma at the age of 44 years was 0.52 for men and 0.61 for women. The observed/expected morbidity ratio was 20.9 (95% confidence interval, 10.8-36.6) for thyroid carcinoma, 3.08 (2.03-7.75) for gastric carcinoma, and 295 (263-330) for colorectal carcinoma. The observed/expected mortality ratios was 250 (112-447) for periampullary and small intestinal carcinoma, 3.43 (1.77-6.0) for gastric carcinoma, and 210 (183-241) for colorectal carcinoma. The risk of rectal carcinoma after ileorectal anastomosis was 13% (8.5-17.5%) at 10 years and 37% at 20 years. The results clarified the impact of FAP on the carcinogenesis in several organs as a whole including preserved rectum, and suggested a direction of the rational treatment of FAP.
Based upon the detailed dissections of the lymphatic system of four adult cadavers, the lymphatic drainage of the gallbladder was divided into three pathways. 1) The cholecysto-retropancreatic pathway, which can be regarded as the main pathway, had two routes, one running spirally and posteriorly from the anterior surface of the common bile duct to the right, and the other running almost straight down from the posterior surface of the common bile duct. At the retroportal segment, these routes converged at a large lymph node, which appeared critical as the main terminal lymph node of this pathway. We designated this node the principal retroportal node. 2) The cholecysto-celiac pathway was the route by which some of the lymphatics from the gallbladder ran to the left through the hepatoduodenal ligament to reach the celiac nodes. 3) The cholecysto-mesenteric pathway was the route by which some of the lymphatics ran to the left in front of the portal vein and connected with the nodes at the superior mesenteric root. These three pathways converged with the abdomino-aortic lymph nodes near the left renal vein; in particular, the nodes in the interaortico-caval space were considered important.
A small-diameter vascular prosthesis with potential for clinical use was prepared from a Dacron prosthesis coated with nonthrombogenic polymeric materials. As a coating material, segmented poly(etherurethane) (SPU; Tecoflex 60) was blended with a phospholipid polymer, 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer, which has excellent blood compatibility. The Dacron prosthesis, 2 mm in diameter, was immersed in a solution of the SPU/MPC polymer blend and dried to evaporate the solvent. The SPU/MPC polymer prosthesis was nonwater permeable and could be sewn to a natural vessel by a microsurgical technique. The SPU solution was used instead of the SPU/MPC polymer blend solution to prepare a control prosthesis (SPU prosthesis). The SPU/MPC polymer prosthesis and the SPU prosthesis were placed as interposition grafts in rabbit carotid arteries. A massive red thrombus became attached to the surface of the SPU prosthesis as early as 90 min after implantation. In the SPU/MPC polymer prosthesis case, the surface was maintained clear even after 5-day implantation. These observations indicated that the MPC polymer in the SPU could improve the nonthrombogenicity of SPU, and the SPU/MPC polymer blend had potential for preparation of small-diameter vascular prostheses.
The clinical course and management of 494 patients with postoperative acute cholecystitis, encountered at 122 hospitals in Japan during the last decade, were reviewed. The incidence of the disease from the total operations was 0.06 per cent, and 445 patients (90 per cent) were acalculous. The mean age of the patients was 60 years, and the ratio of male to female was 2.8:1. Total gastrectomy, subtotal gastrectomy, and esophagectomy were the most common operations precipitating postoperative acute cholecystitis. Vagotomy, dissection of the upper abdominal lymph nodes, and prolonged fasting were prevalent among the risk factors. Clinical diagnosis was confirmed in most patients by ultrasonography. Among the various treatments, cholecystectomy brought the lowest mortality rate; the overall mortality rate being 23 per cent. When this disease is suspected, ultrasonography should be performed repeatedly and percutaneous transhepatic gallbladder drainage or cholecystectomy are recommended as being the treatments of choice.
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