Tsuneyuki Itano

Prediction of prognosis in open-heart-surgery by regional difference in leg surface temperature.

Change of the surface temperature of the leg during open-heart-surgery was determined in five patients, in whom either side of the femoral artery was ligated for cannulation. While the surface temperature at the patella was least influenced, that at the ankle paralleled closely the changes in the core body temperature and blood supply to the leg. Their difference(P-A difference) was studied to see if they can be used to predict prognosis of patients undergoing open-heart surgery. The P-A difference was followed for several hours after the open-heart surgery. It was marked positive when the surface temperature at the patella was higher than that at the ankle. Total of 54 patients were studied. Only one out of 29 patients with negative P-A difference succumbed. This is in sharp contrast to the 25 remaining patients with positive P-A difference, from whom as many as 12 died. In addition, the postoperative course of the 13 survivors from the latter group was more eventful. Since P-A difference seemed to indicate accurately cardiac output by reflecting the state of the peripheral circulation, it can be used as a useful parameter in prediction of the prognosis in open-heart surgery.

NODULAR SCLEROSING TYPE OF HODGKIN'S DISEASE IN THE MEDIASTINUM, WITH PARTICULAR REFERENCE TO ITS PATHOGENESIS

A 29‐year‐old female was proved to have nodular sclerosing type of Hodgkins disease in the mediastinum, apparently originating from the thymus and spreading to both supraclavicular lymph nodes. There has been a considerable dispute as to whether this kind of tumor should be regarded as Hodgkins disease or as a thymic carcinoua (granulomatous type). Based on the presumption, presented by Taylor and Steinet al. recently, that Hodgkins disease is a neoplasm of transformed lymphocytes and also on exclusion of a possible participation of epithelial components of the thymus, an effort was made in order to simplify an overall complexity of Hodgkins disease seen particularly in the thymus.