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Retrocaval ureter is a rare congenital anomaly resulting from anomalous development of inferior vena cava (IVC) and not from anomalous of the ureter. The anomaly always occurs on the right side due to regression of right supracardinal vein and persistence of right posterior cardinal vein. Retrocaval ureter tends to be associated with various vena cava anomalies because of the embryogenesis. We aimed to identify the prevalence of associated congenital venous anomalies (CVA) resulting from cardinal vein development in adults with retrocaval ureter using computed tomography (CT) images.The study included 22 adults with retrocaval ureter. We evaluated CT findings and determined the incidence of associated CVA using thin slice data sets from CT scanner with 64 or more detectors. We compared the prevalence of CVA in the retrocaval ureter group (mean age: 57±19 years) and in the control group of 6189 adults with normal ureter (mean age: 66±14 years).In the retrocaval ureter group, 4 adults (18.2 %) had CVA including double IVC, right double IVC, preisthmic IVC with horseshoe kidney, and preaortic iliac confluence. One of 2 adults with preaortic iliac confluence had right double right IVC. In the control group, 49 adults (0.79%) had CVA including 37 double IVCe, 11 left IVCe, and 1 IVC interruption azygos continuation. Fifteen horseshow kidneys were found. The prevalence of associated CVA in the retrocaval ureter group was higher than that in the control group (p0.001).Retrocaval ureter is frequently associated with CVA. Various CVA with retrocaval ureter could happen because of abnormal development of not only the right posterior or supra cardinal vein but also other cardinal veins.

The United States Department of Energy Grand Junction Office (DOE−GJO) recently developed and deployed a passive total-count γ-ray logging system to monitor subsurface plumes of nuclear waste at the DOE Hanford Site in the state of Washington. High count rate effects for the three thallium-activated sodium iodide (NaI(Tl)) detectors were investigated because zones of intense radiation are frequently encountered. Total count rates and “filtered” count rates were determined from γ-ray spectra collected by logging DOE−GJO natural-uranium-bearing calibration standards. Each filtered rate was calculated by dividing the counts in the part of the spectrum above 570 keV by the counting time. Filtered count rates were linear in relation to uranium concentration, even for high uranium concentrations, but total count rates for high uranium concentrations fell below the values predicted by extrapolating the count-rate-versus-uranium-concentration graphs that were nearly linear at lower concentrations. The physics of low energy photon absorption explains why the total count rate did not rise in proportion to the uranium concentration. Low energy photons contribute significantly to the total count and, within calibration standard media, the rate of creation of such photons is proportional to the uranium concentration. However, the low energy photon flux does not grow linearly with the uranium concentration because of the Z effect: An increase in the Z (average atomic number) of a medium is accompanied by a large increase in the fraction of low energy photons absorbed in the medium. Elevated Z values are obviously associated with elevated uranium concentrations because uranium has a high atomic number. Logging systems with high-purity germanium (HPGe) detectors that are also operated by DOE−GJO to assess nuclear waste at the Hanford Site are calibrated using DOE uranium-bearing standards. With spectra associated with uranium activities higher than about 2000 pCi/g, line intensities for γ-rays with energies below about 500 keV are not directly proportional to source concentration, and are not used for calibration.

Along the magnetopause skimming orbit on October 17, 1992, the Geotail spacecraft observed intense bursts of electron cyclotron harmonic waves called “totem pole” (TP) emissions which occurred sporadically arid intermittently in time in the dayside magnetosphere. The present paper focuses on the analysis of the electron environment associated with the TP emissions. Field analysis shows that, because of the occurrence of an intense Pc5 pulsation, there was E×B drift flow which was switching its direction in time near the magnetopause. The Geotail/comprehensive plasma instrumentation data show that the electron density fluctuated corresponding to the drift flow variation. Overall, TP emissions tend to occur during a transient time interval including a time when the density of cold electrons below 100 eV takes a minimum value. In the interval from 2225 to 2235 UT, TP emissions were well correlated with the density decrease of the cold electrons. In the interval including a stagnation time of the flow switching from the Sun-duskward to the tail-dawnward direction, the density of the cold electrons became minimum, and simultaneously, TP emissions were observed. Contrary to the decrease of the cold electrons, the electron density increased at energies higher than 100 eV in. association with the TP emissions. Namely, the TP emissions were observed when the density ratio of the hot electrons to the cold ones (nh/nc) increased. In the interval from 2252 to 2302 UT, TP emissions were found during a transition time of the cold electron density. We can conclude that the sporadic and intermittent signature of TP emissions can be due to the change of the electron environment driven by the intense field pulsation.

症例は77歳, 女性.6年前に当院にて右後縦隔の脂肪腫切除術を施行.以来, 近医通院中であったが難治性の乾性咳嗽を主訴に当院へ来院.胸部X線写真およびCTで両側後縦隔に広がる脂肪性腫瘤を認め, 脂肪腫再発の診断のもと, 二期的に腫瘍切除術を施行した.病理組織学検査では高分化型脂肪肉腫と診断された.術後, 放射線および化学療法は追加しなかった.術後3ヵ月経過したが再発の兆候はない.可及的な外科的切除が再発防止に重要であると考えられた.また今後の厳重な経過観察も要すると考えられた.

Construction of the 500 keV negative-ion-based NBI system (N-NBI) with its maximum capability of 10 MW and 10 s for NB current drive and plasma core heating in high-density plasmas in JT-60 was completed in March 1996. The neutral beam injection into JT-60 with N-NBI has been performed since then. One of the key issues in the injection was how to control the bending magnetic field for residual ion beams. In N-NBI for JT-60, a stray magnetic field from the tokamak was actively used for bending of the residual ion beams. Combination of the stray magnetic field from JT-60 and the magnetic field of the deflecting coils was controlled sufficiently to successfully deposit residual ion beams at a constant point on the ion dump surface. The deposited positive and negative beam profiles on the ion dump were measured with an array of thermocouples brazed on the dump surface. This report describes the performance test of bending the residual ion beams and the measurement of the heat load on the ion dump for JT-60 N-NBI experiments.

A beam injection experiment with the negative-ion based NBI system (N-NBI) started in March 1996 on JT-60U. After achieving the first neutral beam injection of 180 keV, ∼0.1 MW for 0.4 s into the JT-60U plasmas, the operation parameters of the ion source and power supply had been optimized for increasing the beam energy and beam current. In September 1996, a deuterium neutral beam of 2.5 MW at 350 keV was injected into JT-60U using two ion sources. In the operation with hydrogen at the beginning of 1997, a negative ion beam current of 18.4 A at 350 keV has been obtained, and a neutral beam of 3.2 MW at 350 keV for 1 s has been injected into the plasma with one ion source. A neutralization efficiency of negative ion beam has been confirmed to be about 60% at the beam energies of 250–385 keV as predicted theoretically.

Dynamic spectra obtained with the Plasma Wave Instrument (PWI) onboard the GEOTAIL spacecraft show a variety of electron cyclotron harmonic (ECH) waves in the dayside equatorial magnetosphere. To see the spatial distribution of these ECH waves in terms of field intensity, we statistically analyzed the wave data obtained in a period from September 18, 1992 to April 10, 1995. It is found that intense waves ( ≧ −130 dBV/m/Hz 1 2 ) mainly occur at the dawnside region near the magnetopause, while weak diffuse ECH waves broadly appear along the dayside magnetopause.

On the basis of recent progress in the research and development of a high current and high energy negative-ion source, the construction of a 500 keV negative-ion based neutral beam injection (NBI) system for JT-60U has begun to demonstrate a mega-amp level NB current drive at high plasma density and to study high energy beam heating in reactor-grade plasmas. The specification of the NBI system is as follows: a beam energy of 500 keV, an injection power of 10 MW, a beam duration time of 10 s, beam species of deuterium or hydrogen. The neutral beam of 10 MW is injected in a tangential codirection with a single beamline that has two negative ion sources. The construction of the negative-ion based NBI system will be completed in 1996, and NB current drive and plasma core heating experiments will start immediately in JT-60U.

The design of a negative-ion-based NBI system for JT-60U rated to inject neutral beams of 500 keV, 10 MW for 10 seconds is described. The neutral beam is injected tangentially from a beamline with two ion sources. The ion source is a cesium-seeded multicusp volume source. The acceleration current per source is 22 A with deuterium at a current density of 13 mA/cm2. The operating pressure of the plasma generator is less than 0.3 Pa. A three-stage multi-aperture electrostatic acceleration system is adopted as the accelerator. Residual ions are deflected horizontally by the combined magnetic fields produced by the deflecting coils and the stray field from the tokamak. The deflecting magnetic field is swept with a frequency of 2 Hz. An acceleration power supply of 490 kV, 64 A is inverter type power supply. The freauency of the inverters is 150 Hz. The system will be completed in 1996. The system will be the first negative-ion-based NBI system in the world.

Initial oxidation processes on Si(001) have been studied by means of surface differential reflectance (SDR). The time courses of the SDR spectra measured during thermal oxidation at 820 and 920 K allowed two different growth modes, Langmuir-type adsorption and two-dimensional island growth, to be distinguished. No photon energy dependence was observed in the time course of the SDR intensity at either temperature. On the other hand, different uptake curves were observed at different photon energies for oxidation at 300 K. The difference between the oxidation mechanisms at 300 K and at high temperatures was qualitatively apparent from SDR results, because significant photon energy dependence was observed only at 300 K. Possible assignments of the spectral components in the SDR spectra are discussed.

Chronic hemodialysis is associated with a high prevalence of peripheral artery disease (PAD), and patients on chronic hemodialysis with PAD have an increased risk of critical limb ischemia. The present study assessed the hemodynamic and clinical outcomes of stent placement in the superficial femoral artery (SFA) for patients on chronic hemodialysis.Between February 2005 to August 2008, 43 consecutive lower limbs in 42 patients with SFA lesions that were successfully treated by primary stent placement were included in this study. Those were divided into a dialysis group (18 limbs) and a nondialysis group (25 limbs). Outcome measures included primary patency, assisted primary patency, limb salvage, and survival.Patients were significantly younger and presented with significantly more symptomatic limb ischemia in the dialysis group compared to the nondialysis group, despite comparable TransAtlantic Inter-Society Consensus (TASC) classification scores of SFA lesions between the two groups. The primary patency, primary assisted patency, limb salvage, and survival rates of the dialysis group were similar to those of the nondialysis group.Stent placement in the SFA is a feasible, safe, and effective procedure in patients on chronic hemodialysis with PAD, and may be offered as a first-choice therapeutic option for these patients.

The authors described their three-year experience with hybrid surgical and endovascular therapy for multifocal peripheral TASC D lesions, involving both the aortoiliac and/or superficial femoral and common femoral arteries.From February 2005 to March 2008, 21 lower limbs in 20 patients with multifocal peripheral artery disease, involving the aortoiliac and/or superficial femoral as well as common femoral arteries, were treated by hybrid surgical and endovascular therapy, such as aortoiliac and/or superficial femoral artery stenting as an adjunct to common femoral artery endarterectomy. Technical and hemodynamic success as well as primary and primary assisted patency and limb salvage rates were determined in concordance with the Society for Vascular Surgery guidelines.All lower limbs successfully underwent successful hybrid surgical and endovascular therapy. The average ABPI before and after hybrid therapy significantly increased from 0.50 +/- 0.32 to 0.79 +/- 0.24 (P = 0.0022). The mean duration of follow-up was 357 days (range, 4 to 1400 days). Over all, the primary patency rates were 94%, 70% and 70% at 6, 12, and 24 months, respectively, and the primary assisted patency rates were 94% at 24 months. The limb salvage rate was 100% at 24 months. The survival rates were 95%, 88%, and 88% at 6, 12, and 24 months, respectively. The primary patency rate for intermittent claudication was significantly higher that that for critical limb ischemia, while no significant difference was found in the assisted primary patency and survival rates between intermittent claudication and critical limb ischemia.Hybrid surgical and endovascular therapy, such as aortoiliac and/or superficial femoral artery stenting as an adjunct to common femoral artery endarterectomy, can provide a less invasive yet effective and durable option to patients with multifocal peripheral artery disease.

Little slime layer was found to exist on the walls of sewer pipes in an anaerobic condition when the sewage flow rate was higher than approximately 30 cm/sec. Therefore, H2S is not produced from slime layers but from sediments which existed in the main trunk or the pressure main. The H2S production rates ranged from 5.5 to 64 pg-H2S/g·solid h depending on the contents of organic compounds and the cell numbers of sulfate reducing bacteria (SRB). The limiting nutrients are assumed to be fatty acids by the spike test. The pipe wall in the area just above the sewage level corroded severely, but the crown of the pipe was not heavily corroded. The corrosion rate of the concrete sewer pipe at the Ohmuta treatment plant was 4.3 to 4.7 mm/y in the area just above the sewage level and 1.9 mm/y at the crown. The experiments using mortar as a test specimen showed that the corrosion rate usually ranged from 3.7 to 7.7 ram per year. But an extremely high corrosion rate was observed when the mortar was placed on the stage of the manhole of the pipe at Ohmuta Treatment Plant at temperatures of 25 to 30°C and H2S concentrations of 3 to 400 ppm. Corroded materials found on the surface of the pipe wall and mortar specimens were gypsum at low pH. Ettringite appeared within cracks of the mortar specimens at high pH.

The net transfer of core lipids between lipoproteins is facilitated by cholesteryl ester transfer protein (CETP). We have recently documented CETP deficiency in a family with hyperalphalipoproteinemia, due to a CETP gene splicing defect. The purpose of the present study was to characterize the plasma lipoproteins within the low density lipoprotein (LDL) density range and also the cholesteryl ester fatty acid distribution amongst lipoproteins in CETP-deficient subjects. In CETP deficiency, the conventional LDL density range contained both an apoE-rich enlarged high density lipoprotein (HDL) (resembling HDLc), and also apoB-containing lipoproteins. Native gradient gel electrophoresis revealed clear speciation of LDL subclasses, including a distinct population larger in size than normal LDL. Anti-apoB affinity-purified LDL from the CETP-deficient subjects were shown to contain an elevated triglyceride to cholesteryl ester ratio, and also a high ratio of cholesteryl oleate to cholesteryl linoleate, compared to their own HDL or to LDL from normal subjects. Addition of purified CETP to CETP-deficient plasma results in equilibration of very low density lipoprotein (VLDL) cholesteryl esters with those of HDL. These data suggest that, in CETP-deficient humans, the cholesteryl esters of VLDL and its catabolic product, LDL, originate predominantly from intracellular acyl-CoA:cholesterol acyltransferase (ACAT). The CETP plays a role in the normal formation of LDL, removing triglyceride and transferring LCAT-derived cholesteryl esters into LDL precursors.

The middle mesenteric artery, a third mesenteric artery arising from the aorta that principally feeds the transverse colon, is an extremely rare anomaly. We identified a middle mesenteric artery branching into the ileocolic artery and into the right, middle, and accessory middle colic arteries. It supplied the cecum and the entire ascending and transverse colon. This anomaly was detected with computed tomographic angiography.

We describe the imaging features in a patient with pseudomyxoma retroperitonei arising from a mucinous carcinoma of the appendix with spontaneous development of a skin fistula. The thick wall and septa characteristic of pseudomyxoma were best demonstrated on gadolinium-enhanced magnetic resonance imaging. This patient illustrates (a) the potential of pseudomyxoma to cause skin fistula and (b) the possibility that this intraabdominal process can first present as a dermatologic complication.

Prior to surgery or endovascular therapy for the lower extremity varicose veins or deep venous thrombosis (DVT), ultrasonography provides useful information. But it depends on the operator's technique, each image is limited to a small field of view and interpretation may be subjective. On the other hand, magnetic resonance (MR) imaging is now available with several postprocessing techniques using workstations to demonstrate the gross and objective morphology of these lesions less invasively than the conventional ascending venography. As non-contrast MR venography, fat suppressed three-dimensional (3D) coronal balanced turbo field echo (bTFE) is mainly applied in the semisupine position. The varicose veins on the muscle fascia are easily recognized on volume rendering and the perforating veins can be identified on maximum intensity projection (MIP) and axial multiplanar reconstructions. Gadolinium-enhanced fluid attenuated inversion recovery-bTFE is added when coexisting joint effusion or edema masks the veins. For DVT, direct thrombus imaging (DTI) using fat suppressed 3D coronal inversion recovery-prepared blood suppressed gradient echo sequence is applied. However, the signal intensity of DVT depends on the clot's age on DTI and is sometimes confusing on bTFE. After gadolinium administration, blood shows higher signal intensity than clots regardless of the age and DVT can be easily depicted as filling defects on the axial reformations and summarized on the soap bubble-MIP.

The intermediate-term efficacy of angioscopy-assisted anterior valve sinus plication for primary deep venous insufficiency was evaluated.Twelve limbs in 11 patients had class 4 or higher disease on the SVS/ISCVS classification. Descending venography revealed grade-3 or 4-reflux in all limbs. The limbs were treated with angioscopy-assisted anterior valve sinus plication of the highest valve of the superficial femoral vein. Clinical evaluation and air plethysmography were performed at the final follow-up.The mean follow-up was 38.4 months with a range of 24 to 48 months. Postoperative descending venography revealed significant improvement of the reflux of the superficial femoral vein. At the final follow-up, all patients reported relief of subjective symptoms. The ulcers healed and did not recur in the single limb with class-6 disease, the ulcers did not recur in four class-5 limbs, and there was a distinct clinical improvement with resolution of skin changes in the seven class-4 limbs. The venous filling index measured by air plethysmography was in a normal range in 8 of the 12 limbs.Angioscopy-assisted anterior valve sinus plication may be a surgical technique that results in intermediate-term clinical and hemodynamic improvement in patients with primary deep venous insufficiency.

The purposes of this study were to determine if splenic perfusion measurements obtained using dynamic CT are useful in the evaluation of portal hypertension.Forty-four patients with chronic liver disease (29 men and 15 women, 49-81 years old) and 38 control subjects (17 men and 21 women, 21-79 years old) underwent dynamic CT of the spleen. Regions of interest were drawn on images of the spleen and aorta, and splenic perfusion was calculated by dividing the peak gradient of the splenic time-attenuation curve by the peak aortic CT measurement increase. In 11 patients with chronic liver disease and three patients with normal livers, we measured the wedged hepatic vein pressure (WHVP) of the right or right accessory hepatic vein to estimate portal vein pressure.Splenic perfusion was less in patients with chronic liver disease (0.894 +/- 0.324 ml/min) than in the control group (1.299 +/- 0.429 ml/min; p.0001). We found a significant negative correlation between splenic perfusion and WHVP (r = .741; p = .0024).A significant decrease in splenic perfusion in patients with chronic liver disease negatively correlated with WHVP. Measurement of splenic perfusion may be useful in the evaluation of portal hypertension.

The construction of 500 keV NBI system using negative-ions has started for studying of mega-ampere level NB current drive and plasma core heating experiments with a high density reactor-like plasma In JT-60U. The specification of the NBI system is; a beam energy of 500 keV, an injection power of 10 MW, a beam duration time of 10 sec with a duty cycle of 1/60, a beam species of deuterium or hydrogen. The power of 10 MW is injected toward tangential/co-direction with one beamline that has two negative-ion sources. The construction of the NBI system will be completed in 1996.

The negative-ion based NBI for JT-60U has been making efforts to increase beam power and beam energy since the operation started in March 1996. The NBI system has already operated negative ion beams of 14.3 A at 380 keV with deuterium and 18.4 A at 350 keV with hydrogen. In the beam injection into JT-60U, a deuterium neutral beam power of 3.6 MW at 350 keV has been injected for 0.9 sec, and plasma reactions against the high energy beam injection with the N-NBI have been confirmed to be in agreement with a theoretical prediction.

A 500 keV negative-ion based NBI system is under construction for NB current drive and plasma core heating in high density plasmas in JT-60U. Part of the beamline and the high voltage power supply required for a verification test of an ion source have completed in March 1995. After having done a high potential test of the power supply, the negative-ion generation and acceleration tests have started in June 1995 aiming at deuterium beams of 500 keV, 22 A. In initial experiment, deuterium negative-ion beams of 410 keV, 6.1 A (2.5 MW) for 0.2 sec, so far, have been achieved. This is the world highest D/sup -/ current and negative ion beam power. The construction of the total system will be completed by the beginning of 1996, and the beam injection will start in March 1996.

Osteogenesis imperfecta is a disease in which fragile bones readily cause fracture. Valvular disease concurrently develops. However, the surgery-related mortality rate is approximately 30%. In this study, we report 2 patients with osteogenesis imperfecta who underwent valvular heart surgery. Patient 1 was a 31-year-old male. He had previously been diagnosed as having osteogenesis imperfecta. Echocardiography suggested aortic valve insufficiency, and aortic valve replacement was performed. Patient 2 was a 59-year-old male. During admission, osteogenesis imperfecta was diagnosed. Echocardiography suggested mitral valve insufficiency, and mitral valve plasty was performed. In the 2 patients, intraoperative hemorrhage was marked. However, there were no fatal complications. We also reviewed the literature.

In redo coronary artery bypass grafting (CABG), graft selection and revascularization methods are major problems. We experienced a redo-CABG with occluded previous vein grafts. These grafts were to the circumflex artery and right coronary artery. We conducted operation using cardiopulmonary bypass. We at this operation, chose right internal thoracic artery (RITA) as a conduit and anastomosed it to the side of functioning left internal thoracic artery (LITA) graft, and then diogonal branch, posterolateral branch, and atrioventricular branch were revascularized with the RITA. Post operative course was uneventful. Internal thoracic artery (ITA) is superior to vein graft and other arterial graft as to long term patency. We believe composite Y graft with the use of bilateral ITA can be one of the revascularization strategy in redo CABG.

We report a giant coronary artery aneurysm occurred in the diagonal artery. A 44-year-old woman was referred to our institution for further examination of chest X-ray abnormality. Computed tomography revealed a 6 cm intracardiac mass adjacent to pulmonary artery. Cardiac catheterization revealed a giant coronary artery aneurysm with the large thrombus in the diagonal artery. A giant aneurysm 6 cm in diameter was exposed through a median sternotomy. Under beating heart with cardiopulmonary bypass, the aneurysm was opened and organized thrombus was removed. The influx and efflux of the aneurysm were identified and ligated. Under arrested heart with cardioplegia, the diagonal artery was bypassed with the left internal thoracic artery. Finally the aneurysm was obliterated with the running suture. The patient discharged at the 17th postoperative day without any complications. Histologic evaluation of the resected aneurysm revealed atherosclerotic change, destruction of vascular layers and infiltration of inflammatory cells. These findings suggested previous history of coronary arteritis. The coronary aneurysm in this case might be resulted from Kawasaki disease.

A 55-year-old woman was presented with large left-sided chest wall mass and spinal paralysis. She had undergone pleural plombage using paraffin for pulmonary tuberculosis at age 40 years. Thoracotomy was performed and all paraffin was removed. Paraffin provoked granulomatous change (paraffinoma) and invaded to vertebral canal. She remains well at 16 months postoperatively without spinal paralysis.

Our case is a 50-year-old man with angina and chronic renal failure. He underwent double vessel MIDCAB (LITA-LAD and GEA-SVG-RCA). Postoperative course was uneventful and postoperative angiography revealed patent grafts. MIDCAB is thought to be effective for patients who have chronic renal failure, because they are able to resume hemodialysis in early postoperative period for controlling water and electolyte.

Patients with end-stage renal disease (ESRD) have high mortality from atherosclerotic/atherothrombotic vascular disease (AVD). However, the role of an elevated plasma total homocysteine (tHcy) level as a risk factor is uncertain in ESRD.We enrolled 55 ESRD patients in a prospective follow-up study in order to evaluate the prognostic significance of their tHcy levels, common methylenetetrahydrofolate reductase (MTHFR) gene polymorphism, and other atherosclerotic risk factors, in combination with the results of B mode ultrasound for carotid arteries.Mean intima-media thickness of the common carotid artery (CCA-IMT) in ESRD patients was thicker than that in 102 age- and sex-matched healthy controls. Carotid plaque was more frequently present in patients compared with controls, as was calcified plaque more common in patients (p0.001). Plasma tHcy levels (mean +/- SD) in patients (39.1 +/- 27.2 nmol/ml) were higher than that (8.8 +/- 2.7 nmol/ml) in controls (p0.001). Folic acid was the major determinant of elevated tHcy levels in ESRD patients. During the follow-up period of 31 +/- 3 months, 14 patients had one or more AVD complications, and 10 consequently died from AVD causes. Proportional hazards modeling showed that 5-year intervals of age (relative risk of 2.95, 95% CI 1.62 - 5.37), 10 nmol/ml intervals of tHcy levels (relative risk of 2.31, 95% CI 1.31 - 4.08), and presence of diabetes mellitus (relative risk of 6.62, 95% CI 1.07 +/- 40.8) were independent predictors of future AVD events, and tHcy levels (relative risk of 2.67, 95% CI 1.29 - 5.52) and age (relative risk of 2.10, 95% CI 1.15 - 3.83) were those of AVD mortality. We also found a significant association between carotid plaque prevalence and AVD events (X(2) = 11.6, p = 0.001).Hyperhomocysteinemia, diabetes mellitus, and carotid atherosclerosis appeared to contribute independently to increase the risk of AVD outcome in Japanese patients with ESRD.

One hundred forty-six angiographic findings of malfunctioning internal arteriovenous fistulas without any history of interventional procedures were reviewed. Angiographies demonstrated 110 cases of stenosis, 72 of occlusion, 5 of venous varicosity, and 13 of venous aneurysm. Of 182 stenotic lesions, 118 (65%) lesions (74 venous stenoses: 67%; 44 venous occlusions: 61%) were revealed within five centimeters of anastomoses. In 4 of 5 cases of varicosity, proximal venous occlusions were demonstrated. On the other hand, interventional procedures were performed in 81 cases of stenoses and 14 of occlusions in the manner of PTA and fibrinolysis. The initial success rate was 90% in stenotic lesions and 71% in occlusive lesions, not a statistically significant difference. Furthermore, there was no statistically significant difference in initial success rates according to anatomical location and lesion length. Although there was no statistically significant difference according to the angiographic findings of lesions, we would like to emphasize the importance of correct understanding of anatomical changes in the dialysis shunt and of early intervention to improve the initial success rate of PTA.

We report a case with occlusion of multiple branches of the aorta and a pseudoaneurysm due to rupture of a severely calcified non-aneurysmal thoracoabdominal aorta in a patient with Takayasu's disease. The patient was successfully treated by endoluminal stent-grafting without mesenteric ischemia.

Homogentisic acid (HGA) causes oxidation of human oxyhemoglobin and reduction of methemoglobin. The rate of oxidation of oxyhemoglobin by HGA is greatly accelerated in the presence of myo-inositol hexakis-phosphate (P6-inositol) or superoxide dismutase (SOD), but is inhibited in the presence of catalase. The reduction rate of methemoglobin by HGA is accelerated in the presence of P6-inositol but is greatly inhibited in the presence of SOD. It is suggested that the semiquinone and quinone form of HGA and oxygen radicals may be involved in the mechanism of oxido-reductive reactions of human hemoglobin with HGA. In addition, a new anodic hemoglobin found by isoelectric focusing electrophoresis was produced during the reaction of oxyhemoglobin with HGA. When human erythrocytes were exposed to HGA for several hours at 37 degrees C (pH 7.4), the anodic oxyhemoglobin (HGA-modified hemoglobin) and its half met-form hemoglobin [(alpha3+beta2+)2 of HGA-modified hemoglobin] were produced in significant amounts. HGA-modified hemoglobin was stably purified and showed increased oxygen affinity, absence of titratable sulfhydryl groups, and the absorption spectrum of normal oxyhemoglobin. Our results demonstrate that HGA shows multiple effects on human hemoglobin and erythrocytic hemoglobin, which is consistent with the evidence that HGA is involved in various pathological conditions such as arthritis and carcinogenesis in humans.

A 13-year-old girl, who had undergone a modified Blalock-Park operation using an equine pericardial patch for a type A aortic arch interruption at 10 days of age, and patch repair of a ventricular septal defect at 1 year, presented with recurrent stenosis of the aorta. She underwent balloon angioplasty which resulted in a pseudoaneurysm at the distal suture line of the patch. Endovascular stent-grafting was employed. Soon after placement, the stent-graft had migrated into the distal portion of the descending aorta. The distal aortic arch and proximal descending thoracic aorta were replaced with a prosthetic graft. The migrated stent-graft was removed. The operation was performed through an anterior approach under hypothermic circulatory arrest and selective cerebral perfusion. The postoperative course was uneventful. The migration was likely caused by the limited ability to bend the stent-graft to match the curvature of the arch, the stiffness of the scarred equine pericardial patch, and the shape of the aorta.

Computed tomography during arterial portography (CTAP) under temporary balloon occlusion of the hepatic artery (BOHA-CTAP) was introduced to evaluate pseudolesions caused by portal venous impairments such as arterioportal shunt and tumor thrombus.BOHA-CTAP was performed in seven patients with hepatocellular carcinoma and correlated with clinical outcomes. For patients with wedge-shaped defects suggestive of pseudolesions, BOHA-CTAP was obtained by a 5-F balloon occlusion catheter into the proper hepatic artery through the second 5-F introducer inserted into the common femoral artery a few centimeters below the first 5-F sheath for CTAP.Eight pseudolesions were determined clinically on follow-up CT, ultrasonography, or magnetic resonance imagings. On BOHA-CTAP, five of the eight pseudolesions were eliminated, and two were diminished in comparision with conventional CTAP. One wedge-shaped defect due to tumor thrombus in the portal vein did not show any change.BOHA-CTAP can reduce pseudolesions caused by portal venous impairments and enable the demarcation of the true tumors.

The clinical efficacy of NK-104, a novel and totally synthetic hydroxymethylglutaryl-coenzyme A reductase inhibitor, was assessed in 30 patients (men/women = 15/15, mean age 51 years) with heterozygous familial hypercholesterolemia. After a placebo phase of4 weeks, NK-104 was given at an initial dose of 2 mg/day for 8 weeks, which was increased to 4 mg/day for a further 8 weeks. As a result of 2 mg/day of NK-104 treatment, mean +/- SD of total and low-density lipoprotein cholesterol levels decreased significantly (p0.0001) from baseline, namely from 8.80+/-1.38 to 6.11+/-1.09 mmol/L (-31%) and from 6.81+/-1.52 to 4.09+/-1.03 mmol/L (-40%), respectively. They decreased further (p0.0001) as a result of 4-mg/day administration, to 5.52+/-0.81 mmol/L (-37%) and 3.55+/-0.85 mmol/L (-48%), respectively. Changes in high-density lipoprotein cholesterol levels failed to reach statistical significance. Serum triglyceride levels decreased significantly (p0.0001) from baseline as a result of 4 mg/day of NK-104, from 1.99+/-1.72 to 1.35+/-0.90 mmol/L (-23%). Serum apolipoprotein B, CII, CIII, and E levels significantly decreased: mean changes from baseline at the end of the study were -41% (p0.0001), -27% (p0.0001), -19% (p = 0.002), and -37% (p0.0001), respectively. On the other hand, apolipoprotein AI and All levels significantly increased as a result of the treatment: + 10% (p = 0.002) and +6% (p = 0.008), respectively. There were no adverse events observed in either clinical or laboratory findings that could be attributed to the treatment. These results suggest that the potency of NK-104 appears to be dose-dependent, and that NK-104 is safe and well tolerated in the treatment of patients with heterozygous familial hypercholesterolemia, and thus also provides a new therapeutic choice for subjects requiring lipid-modifying therapy.

Since 1991, we have performed stent placement for 35 iliac artery lesions in 31 patients. The etiologic diseases were atherosclerotic in 34 patients and traumatic dissection in one. The indications of placement were total occlusion in 3, late restenosis after angioplasty in 5, dissection in 5, and residual stenosis due to inadequate angioplasty in 21. We also performed direct stent placement for one traumatic dissection. The stents used were Wallstents in 10, Palmaz stents in 14, Strecker stents in 9, and Memotherm stents in 2 lesions. Follow-up was performed clinically or angiographically with measurement of the ankle/arm pressure index. Stent placement was successful in all cases, and relief or improvement of symptoms was achieved. The follow-up period ranged from 6-85 months (mean, 37.3 months). Late stent stenosis or occlusion occurred in 6 cases, among which 4 occluded lesions were successfully recanalized by thrombolytic therapy with angioplasty or second stent placement. In total, the primary patency rates were 88% and 77% at two and four years, respectively, while the secondary patency rates were 94% and 94%. In conclusion, metallic stent placement may offer extended application of intravascular treatment for iliac artery occlusive disease, and good long-term patency rates can be expected.

A rare case of chronic localized thoracoabdominal aortic dissecting aneurysm was surgically treated. The patient was a 76-year-old woman. She was reffered to our hospital because of the abnormality of the chest roentogenogram. Chest CT and aortography revealed localized thoracoabdominal dissecting aneurysm 70 mm in diameter. Patch closure of intimal tear was carried out under partial cardiopulmonary femoro-femoral bypass. The patient discharged on the 23rd post operative day without any complications.

The patient was a 58-year-old woman given curative treatment (pancreatectomy (body and tail) + intraoperative irradiation (25 Gy)) on the basis of a diagnosis of pancreatic carcinoma. Having a favorable postoperative course, she was discharged 24 days after surgery. A week after discharge, she was readmitted for a hemorrhagic gastric ulcer. She was later discharged again on conservative treatment, and followed up at the outpatient clinic, but nine months postoperatively, was readmitted complaining of loss of appetite and abdominal pain. Subsequent tests revealed stricture of the horizontal portion of the duodenum with distension oral to the stricture. Around the celiac artery, the paraaortic lymph nodes were swollen, and a diagnosis of stricture due to recurrent pancreatic carcinoma was made. On the day before bypass surgery was scheduled, the patient vomited blood, so the operation was postponed, conservative treatment such as blood transfusion was administered, and emergency angiography was performed simultaneously. The findings were an aortic pseudoaneurym 1 cm in diameter immediately below the origin of the superior mesenteric artery and between the left and right renal arteries, and a hemorrhage, caused by an aortoduodenal fistula, issuing from the horizontal portion of the duodenum. Hemostasis via a laparotomy was judged difficult, and so an indwelling stent-graft in the aorta was tried to stanch the blood, but without success. Another stent then had to be inserted within the first, thus stopping the flow, but the blood supply to the celiac artery, the superior mesenteric arteries and the renal arteries was impaired, and the patient died about six hours later. Postmortem examination revealed aortoduodenal fistula without recurrence of the carcinoma. The duodenal wall around the fistulous tract showed delayed radiation changes with deep ulceration. The intraoperative radiation may have played an important part in the formation of the fistula.

To investigate the expression of growth factor mRNA and the level of growth factor protein in preserved human amniotic membrane (AM).RT-PCR was used to examine the expression of mRNA for eight growth factors (EGF, TGF-alpha, KGF, HGF, bFGF, TGF-beta1, -beta2, -beta3) and two growth factor receptors (KGFR and HGFR) in human AM preserved at -80 degrees C for one month. In addition, ELISAs were used to measure the protein concentrations of seven growth factors (EGF, TGF-alpha, KGF, HGF, bFGF, TGF-beta1, -beta2) in preserved human corneas and in AM both with and without amniotic epithelium.RT-PCR revealed that human AM expresses mRNA for EGF, TGF-alpha, KGF, HGF, bFGF, TGF-beta1, -beta2, -beta3, KGFR and HGFR, while ELISAs showed that it contains EGF, TGF-alpha, KGF, HGF, bFGF, TGF-beta1, -beta2. AM without amniotic epithelium also contains all seven growth factors examined, however, in this tissue the protein levels of EGF, KGF, HGF and bFGF were found to be significantly lower than in native AM.Preserved human AM expresses mRNAs for a number of growth factors and contains several growth factor proteins that might benefit epithelialization after AM transplantation. High levels of EGF, KGF, HGF and bFGF in AM with amniotic epithelium as compared to AM without amniotic epithelium suggest an epithelial origin for these growth factors. We feel that EGF, KGF and HGF in particular might play important roles in ocular surface wound healing after AM transplantation.

We report the case of a 56-year-old woman with a presyncopal episode followed by melena. A sentinel clot sign in the pancreatic duct on precontrast computed tomography and the presence of a splenic artery aneurysm on postcontrast computed tomography strongly suggested a fistula between the aneurysm and the duct, as visualized by magnetic resonance imaging. The patient was treated successfully by complete embolization of the splenic artery aneurysm.

A 39-year-old male heterozygous familial hypercholesterolemia patient with marked ectasia over the entire coronary artery tree had been treated with several kinds of lipid-lowering single or combined drug therapies using clofibrate, compactin, cholestyramine, probucol, and pravastatin, and LDL-apheresis. During the 19-year follow-up, he suffered myocardial infarction three times and some of the ectatic coronary segments became enlarged, others narrowed, and one of them occluded in spite of the treatment. At the age of 58, he died after a fourth cardiac attack and subsequent cardiogenic shock. The autopsy indicated that his three coronary arteries showed diffuse ectatic changes and the largest lumen diameter of the left anterior descending artery was 25 mm, of the circumflex artery 12 mm, and of the right coronary artery 13 mm. The ectatic artery wall was not thick and the major part of the lumen was occupied by organized thrombi. Microscopic examinations showed that the larger the diameter of the lumen, the more severe the structural damage of the intima and tunica media and the larger the number of infiltrated cells, including lymphocytes, macrophages, and plasma cells. Immunoreactivity against matrix metalloproteinase (MMP)-1, and MMP-2 was observed in smooth muscle cells, macrophages, lymphocytes, and endothelial cells of the vasa vasorum or neovasculature. MMP-9 immunoreactivity was also localized in intimal foamy macrophages and round cells (macrophages and lymphocytes) of the media and adventitia. MMP-1 increased with the lumen diameter of the ectatic arteries. The ratio of immunoreactivity against both MMP-2 and MMP-9 to that against tissue inhibitor of metalloproteinase (TIMP)-2 also increased with the lumen diameter, but it no longer increased when the diameter was over 10 mm. These observations suggest that the MMP-TIMP system appears to play a significant role in the development of coronary ectasia

Myelolipoma is a benign tumor composed of mature adipose tissue and hematopoietic tissue. It was mainly found in the adrenal grand, but there have been reports of extra-adrenal locations. Only 7 cases of mediastinal myelolipoma have been reported ever. We have experienced a case of mediastinal myelolipoma surgically resected from a 55-year-old-man. He has visited our department because of chest pain. Chest X-ray showed typical pneumothorax, but abnormal mediastinal shadow was remarked. Chest CT showed a well circumscribed mass with fat and soft-tissue attenuation in posterior mediastinum. Lung bullectomy and mediastinal tumor resection under VATS was performed. A blue-red tumor 4 cm in diameter was resected en bloc. Pathological examination showed its composition of mature adipose tissue and hematopoietic tissue. Diagnosis was extra-adrenal myelolipoma. No recurrent nor abnormality was found in 8 months since surgery.