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One-hundred-one surgeries for aortic arch aneurysm were divided into 2 groups: 52 aortic dissection cases (AD) and 49 non-dissecting aneurysm (TA). In group AD, 30 cases were operated in acute phase (acute AD) and 22 were in chronic phase (chronic AD). Preoperative shock were observed in 21 cases (15 in acute AD mostly due to cardiac tamponade, 1 in chronic AD and 5 in TA due to rupture). Through median sternotomy, 59 total arch replacement and 25 hemi-arch replacement were carried out under deep hypothermia (16 degrees C:DH) and retrograde (RCP) or selective (SCP) cerebral perfusion or arch-first technique. Through thoracotomy, distal arch replacement were carried out with DH + RCP in 8 cases and with partial bypass in 9. Early mortality were observed in 7 patients (6.9%) and 24 months survival rates (Kaplan-Meier) were 86.1% overall, 76.1% in acute AD, 95.5% in chronic AD, 87.8% in TA. The survival rates in patients with preoperative shock was 61.2%, however, without shock, 92.9% in acute AD, 95.2% in chronic AD, and 91.4% in TA. Other than mortality, 4 re-operations for aortic arch, 4 operations for descending to abdominal aorta and 1 late hemiplegia were observed. Aortic event free ratio at 24 months was 55.4% in acute AD, 94.4% in chronic AD, and 75.7% in TA. For the further improvement of aortic arch surgery, early mortality and residual false lumen in acute aortic dissection and atherosclerotic aneurysm in descending to abdominal aorta are focused.

A newborn baby with d-TGA, straddling AV valve, large VSD, hypoplastic ascending aorta and coarctation of the aorta had congestive heart failure and oliguria on the 3rd day after birth. Van Praagh's operation (main pulmonary artery to descending aorta bypassing with synthetic graft) was performed on 4 days of age through a lateral thoracotomy. At the age of 2 months, the patient underwent left pulmonary artery banding because of respiratory insufficiency requiring prolonged ventilatory support. The patient subsequently underwent Damus-Kaye-Stansel procedure without enlargement of the arch, and the pulmonary patch angioplasty with right modified BT shunt on the age of 5 months. This baby was discharged on 4 months after the operation. Two-dimensional echocardiography has shown aortic and pulmonary competence postoperatively.

A case was presented of a 51-year-old woman who underwent aortic valve replacement with a St. Jude Medical prosthesis two and a half years before. The patient was initially placed on Warfarin potassium after the surgery. However she gradually developed jaundice during the period of two months Warfarin was replaced with ticlopidine hydrochloride as it was thought to be the most probable cause of jaundice. The prosthesis was subsequently thrombosed and had to be replaced with a Carpentier bovine pericardial valve. Warfarin potassium rarely induces the hepatic dysfunction as a result of drug allergy. However, the prompt diagnosis and adequate management are essential if it should occur.

A case of successful removal of a catheter fragment from the pulmonary artery is reported. We employed the loop snare designed for transcolonoscopic polypectomy through a 9F long sheath. The sheath was advanced into the pulmonary artery over the balloon catheter. Handling of the loop snare was smooth and safe because of there being enough inner diameter of the sheath. Other instruments such as grasping-forceps or basket stone-catcher were also able to be advanced through the sheath. We recommend the employment of the 9F long sheath for retrieval of intravenous foreign bodies.

It has recently been demonstrated that prostaglandins (PGs) play roles in human reproduction, especially in ovulation and menstruation. The purpose of this study is to elucidate the mechanism of the action of PGs upon the onset of menstruation. By measuring the concentration of PGs in human endometrium from the women with normal menstrual cycles, PGF2 alpha was present in large amounts in late luteal phase. The activity of PG-synthetase and phospholipase A, which are key enzymes of PG-biosynthesis, also increased in late luteal phase. PG-receptor which is thought to be important to biological action of PGs showed no remarkable change throughout human menstrual cycle. These studies clarify the possibility that there is apparent correlation between the onset of menstruation and PGs.

It has recently been demonstrated that prostaglandins play an important role in human reproductive system. The purpose of this study is to demonstrate the involvement of PGs in the onset of menstruation and in the cause of dysmenorrhea. In human endometrium PGF2 alpha were found in large amount in late luteal phase and especially in premenstrual period. PGE1 and PGF2 alpha concentrations in menstrual bloods were 3 to 4 times higher in dysmenorrheic subjects as compared to normal women. The high PGE1 and PGF2 alpha concentration of patients decreased to normal level in naproxen treated cycle. And the intensity of abdominal pain and lumbago decreased simultaneously. On the other hand, in normal woman, naproxen gave little effect on PGs concentration of menstrual fluids. High levels of PGs in dysmenorrheic subjects, decrease of PGs concentration by naproxen treatment and simultaneous alleviation of pain suggest the involvement of PGs in the cause of dysmenorrhea.