Tetsunosuke Matsukawa

A case of sclerosing lymphocytic lobulitis of the breast associated with diabetes mellitus

AbstractBackground: The benign breast disease sclerosing lymphocytic lobulitis is thought to result from autoimmune diseases causing insulin-dependent diabetes mellitus (IDDM) due to insulinitis. In cases of sclerosing lymphocytic lobulitis accompanied by IDDM, the clinical term “diabetic fibrous breast disease” has been proposed. Methods: A case of sclerosing lymphocytic lobulitis of the breast is described. Results: The patient was a 43-year-old woman diagnosed with non insulin-dependent diabetes mellitus (NIDDM) 8 years previously. Insulin therapy was thought to be necessary because treatment with glibenclamide was not effective. She visited our facility complaining of a lump in her right breast that was 5 cm in diameter, painless, rock-hard, discrete, and irregularly outlined. Biopsy was performed because breast cancer was strongly suggested by its hardness and its irregular internal echo on ultrasonography. Histopathological findings demonstrated marked stromal sclerosis and lymphocyte infiltration in the perivascular and perilobular areas. Sclerosing lymphocytic lobulitis was diagnosed. Conclusions: Referring physicians should avoid performing unnecessary repeated biopsies by recognizing this disease entity, which often occurs bilaterally.

Transesophageal Echo-guided Balloon Dilatation for Postoperative Pulmonary Venous Obstruction

Pulmonary venous obstruction (PVO), or stenosis, is still a major complication of postoperative total anomalous pulmonary venous return, being very complex in its pathogenesis. For some types of PVO, surgery is effective, but a reoperation under cardiopulmonary bypass is generally difficult and carries a high risk. The operative balloon dilatation method performed under the guidance of transesophageal echography and fluoroscopic monitering is simple as well as safe. We describe herein the technique involved in performing this procedure through the case of a 10-month-old boy.

Muscle pH/PCO2 monitoring

The surface pH of skeletal muscle has been confirmed to be a sensitive indicator of peripheral muscle blood flow, but the development of a better electrode has been required. As a consequence, a unique and minute sensor was developed to measure muscle pH/PCO2. The purpose of this article was to evaluate this new monitoring device experimentally and clinically in order to clarify its effects, usefulness and specificity. Our experimental and clinical results showed that placement and measurements using the muscle pH/PCO2 monitor were easily and quickly accomplished without any complications. This small sensor provided an accurate assessment of vital physiologic functions and gave an early warning of clinical deterioration. The new monitor should be useful in pediatric surgery clinical management.

Reviews of corrective surgery in 126 csses of tetralogy of Fallot

One hundred and twenty-six cases , 68 male and 58 female, with tetralogy of Fallot (TF) were operated upon in this period, and 19 patients were less than 5 years of age, 52 being between 6 and 10 years of age, 37 being between 11 and 15 years of age and 18 being older than 16 years of age (Table 1). The Blalock-Taussigs systemic-pulmonary-artery anastomosis had been previously performed in 39 patients who were distributed in all age groups. Almost a l l patients but 12 showed cyanosis at rest and/or i n exercise. Of 126 cases, 17 demonstrated hemoglobin-levels were below 15 g/100 mL, 69 from 15 to 18 g/ 100 ml. and 40 more than 18 g/100 ml., respectively (Table 2). In all patients, a median sternotomy was used. A disc oxygenator was u~ed for the first 75 cases, but since 1969, cardiopulmonary bypass has been accomplished with a disposable bubble oxygenator and roller pumps utilizing the hemodilution technique. Flow rate was usually about 2.2 L/Min/M 2 and mild hypothermia from 33 to 29 degrees centigrade was applied. A transverse or a longitudinal right ventriculotomy was used according to the anatomical findings on t h e right ventricular outflow-tract, described later, and the course of the right coronary artery branches. Infundibular stenosis was removed by division and resection of the hypertrophied muscles and dilatation of the pulmonary annulus with a Tubbs-type dilator. Valvular stenosis was routinely corrected through the ventriculotomy by careful commissurotomy: However, the patients with a small pulmonary annulus and/or a hypoplastic pulmonary trunk received various types of the outflow patch, including the small Teflon fabric patch, the small or large pericardial patch and the valve retaining homoor heterologous pulmonary artery patch 2 (Fig. 1). A large ventricular septal defect was closed with a Teflon fabric patch fixed by interrupted and buttressed mattress-sutures and a specially designed clamp 5 was