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We have produced 90mNb and 99mTc in the reactions of natZr(p,xn)90mNb and 100Mo(γ,n)99Mo, followed by disintegration to 99mTc, respectively, and measured the half-lives of these nuclides by using a reference source method. In order to determine the short half-lives of 90mNb precisely, an on-line gas-jet system has been employed. As a result, the half-lives of these nuclides were determined with good precision on the order of magnitude of 0.1%.

Three different strains of pseudorabies (Aujeszky's disease) virus were inoculated into ligated closed loops in the jejunum and ileum of five specific-pathogen-free pigs. Infected areas were compared with respect to distribution of histologic lesions and pseudorabies virus antigen. Two wild-type strains of pseudorabies virus produced enteric lesions consisting of necrosis of the subepithelial macrophages in the basilar crypt epithelium, necrosis of the lymphoid follicles in the Peyer's patches, degeneration of the epithelial cells in the crypt and villi, degeneration of the neuronal cells in the myenteric plexuses, and formation of intranuclear inclusion bodies on postinoculation days 2–4. Pseudorabies virus antigen was initially detected in subepithelial macrophages of the dome of Peyer's patches on postinoculation day 2 and subsequently extended to superficial epithelium and deeper into the lymphoid follicles and myenteric plexuses on postinoculation days 3–4. Many pseudorabies virus particles were also detected in the center of their necrotic foci. However, 1 mutant strain (ara-T-resistant) of pseudorabies virus did not produce enteric lesions. The results suggest that the primary target of infection by wild-type strains of pseudorabies virus might be the macrophages distributed in the subepithelial area of the dome Peyer's patches.

To elucidate the mechanisms of insensitivity of hormone secretion to glucose in streptozotocin-induced diabetic rat islets, we investigated the effects of acetylcholine (ACh) and norepinephrine on insulin and glucagon secretion in response to changes in glucose concentration, using perfused pancreas preparations. Basal insulin secretion at a blood glucose level of 5.6 mmol/l was significantly higher and basal glucagon secretion significantly lower in streptozotocin-induced diabetic rats than in controls, and neither high (16.7 mmol/l) nor low (1.4 mmol/l) blood glucose concentrations influenced insulin or glucagon secretion. Addition of 10(-6) mol/l ACh to the perfusate increased glucose-stimulated insulin secretion. Also, 10(-6) mol/l ACh, 10(-7) mol/l norepinephrine, as well as a combination of both, induced marked glucagon secretion, this was suppressed by high blood glucose level. Although simultaneous addition of 10(-6) mol/l ACh and 10(-7) mol/l norepinephrine induced only a slight increase in glucagon secretion in response to glucopenia, there was a significant increase in glucagon secretion in conjunction with an ambient decrease in insulin. Histopathological examination revealed a marked decline in acetylcholinesterase and monoamine-oxidase activities in the islets of streptozotocin-induced diabetic rats. We speculate that reduction of the potentiating effects of ACh and norepinephrine lessens glucose sensitivity of islet beta and alpha cells in this rat model of diabetes.

The release profile of GnRH in cerebrospinal fluid (CSF) and its correlation with LH in peripheral blood of ovary-intact heifers during the estrous cycle were investigated. A silicon catheter was placed into the third ventricle of six heifers using ultrasonography. During the mid-luteal phase, the heifers were injected with prostaglandin F(2alpha) to induce luteolysis. Surges of CSF GnRH (66.7 h after prostaglandin F(2alpha) administration) and peripheral LH (66.3 h) occurred simultaneously and were coincident with the onset of estrus (67.0 h). Duration of elevated GnRH concentration considerably overlapped with the estrous phase in each of the heifers. Mean pulse frequencies of both GnRH and LH were significantly higher during the proestrous and early luteal phases than during the mid-luteal phase, while mean concentration and pulse amplitude of both GnRH and LH were not different between these three phases. Of all the GnRH pulses identified, more than 80% were accompanied by an LH pulse during the proestrous and early luteal phases. However, the proportion of GnRH pulses that were coincident with an LH pulse during the mid-luteal phase decreased to 60%. The results clearly demonstrate that a dynamic (pulse) and longer-term (surge) changes of GnRH release into CSF are physiologically expressed during the estrous cycle in heifers, and the pattern of pulsatile GnRH secretion in heifers depends upon their estrous cycle.

The objectives of the study reported here were to determine whether a change in the plasma arginine vasopressin (AVP) concentration occurred in lactating, compared with non-lactating rats and to examine the involvement of suckling with plasma AVP concentration.Experiments were performed on 86 female Wister Imamichi rats, 12 weeks old at parturition, with fast lactation. On day 13 of lactation, AVP concentration and plasma osmotic pressure were measured in lactating and non-lactating rats.Plasma AVP concentration was always higher in rats of the lactating groups than in non-lactating controls (1.06 +/- 0.28 pg/ml), and a conspicuous increase in AVP concentration was seen during the postsuckling period (1.70-0.61 pg/ml before vs. 2.56 +/- 1.31 pg/ml after suckling, P0.05). Plasma osmotic pressure in lactating rats with 12 pups (296.6 +/- 5.2 mOsmol/kg x H2O) was lower than that in rats of the removed control groups (306.7 +/- 5.7 mOsmol/kg x H2O).On the basis of these results, it appears that "low plasma osmotic pressure-high AVP status" develops in the lactating period, similar to pregnancy, through resetting of the regulatory mechanism of the AVP system. It was concluded that suckling stimulation could release AVP, which could dilute the blood with water resulting in the increase in circulating blood volume.

Coronary artery bypass grafting (CABG) on a beating heart has been successfully performed for high risk patients, and is known to be less invasive than conventional CABG using cardiopulmonary bypass (CPB). We expanded the indication of beating-heart CABG in patients requiring emergency coronary revascularization.A retrospective chart review was performed for patients who had undergone emergency CABG on a beating heart (EM-BH group), elective CABG on a beating heart (Elective-BH group) and emergency CABG under CPB (EM-CPB group), between January 1, 1997 and June 30, 1998.Four cases (1 male and 3 females with a mean age of 67.8 +/- 5.4) in the EM-BH group, 67 cases (48 males and 19 females with mean age of 67.3 +/- 7.8) in the Elective-BH group, and 41 cases (29 males and 12 females with mean age of 63.3 +/- 10.4) in the EM-CPB group were analyzed. The number of the grafts was 1.75 +/- 0.50 in EM-BH group, 1.37 +/- 0.55 in the Elective-BH group, and 2.95 +/- 1.07 in the EM-CPB group. The intubation period, ICU stay, and the postoperative hospital stay were significantly shorter in the EM-BH group (6.0 hours intubation, 1.5 days ICU stay, and 11.5 days postoperative hospital stay) and Elective-BH group (6.8 +/- 11.0 hours intubation, 1.6 +/- 1.5 days ICU stay, and 12.7 +/- 5.2 days postoperative hospital stay) than in the EM-CPB group (20.1 +/- 22.5 hours intubation, 3.6 +/- 2.4 days ICU stay, and 21.8 +/- 14.9 days postoperative hospital stay).The postoperative recovery period for EM-BH patients was almost the same as that for elective cases of beating-heart CABG, and was significantly shorter than that of conventional emergency CABG under CPB. Selected patients with coronary ischemia can be safely treated by beating-heart surgery.

Coronary artery fistulae (CAF) are infrequent congenital anomalies. The combination of coronary artery aneurysms and coronary artery fistulae (coronary artery aneurysm associated with fistula, CAAAF) is extremely rare, and only 50 cases, including the current case, have been reported. Coronary artery fistulae may result in coronary ischemia, congestive heart failure, and endocarditis. Complications of coronary artery aneurysms include thrombosis, distal emboli, and aneurysm rupture. Aneurysm repair, fistulous closure and/or coronary artery bypass grafts are definite treatments for CAAAF. We present here a 72-year-old female with CAAAF. Furthermore, all reported CAAAF cases are reviewed.

A new experimental rat model for suppression of release of arginine vasopressin (AVP) was evaluated. Release of AVP is potentiated by physiologic stimuli, but is suppressed by emotional stress. Rats were exposed to the aggressive behavior of other rats injected with 6-hydroxydopamine hydrochloride (6-OHDA) in both lateral ventricles and subjected to a pain stimulus applied to the tail. To ascertain whether emotional stress is induced by use of this method, plasma corticosterone, glucose, and AVP concentrations were measured in the stressed group of rats (n = 8) placed near a group of aggressive (fighting) rats. Characteristic changes in behavior, significant increases in plasma corticosterone and glucose values, and lack of increase in plasma AVP concentration in stressed rats confirmed that they experienced emotional stress. This new model meets the experimental requirements for suppression of AVP release in rats.

A new technique for collecting blood from conscious and unrestrained rats is reported. Plasma arginine vasopressin (AVP) concentration has been known to be influenced by various procedures used for blood collection (e.g., manual contact and anesthesia). In the study reported here, the improvement of the routine jugular vein cannula method was undertaken by extending the connection tubing to allow use of a swivel mechanism. Plasma AVP, glucose, and corticosterone concentrations in virgin rats were measured in blood samples collected by use of the new method and of two generally accepted methods (decapitation and routine jugular vein cannula methods). All values of the three parameters obtained were the lowest when the new method was used, suggesting that this new swivel method induced the least stress in the rats.

We examined the postoperative swallowing function of 12 tongue and oral floor cancer patients reconstructed with a recto-abdominal myocutaneous free flap after glossectomy. On the basis of the resection site, the present cases were classified into either anterior type or lateral type. Subjective evaluation of postoperative swallowing function was obtained from self-reports from patients. The movement of the reconstructed tissue was evaluated videofluorographically during swallowing, by tracking the movement of two small pellets temporarily attached to the anterior and central portions of the reconstructed tongue. The trajectory of the two pellets and the selected point of the hyoid bone were recorded together with the distance between the plate and the tongue dorsum, and between the posterior pharyngeal wall and the tongue base. Using a personal computer, a quantitative study of the video images was performed. The results were summarized as follows. 1) The movement pattern of the reconstructed tissue was generally saccadic rather than smooth. It was suggested that the swallowing pattern of the patients was different to that of normal controls. 2) Postoperative swallowing function was poorer in cases of the anterior type when compared to the lateral type. 3) In general, cases which showed relatively wide movement range appeared to achieve subjectively satisfactory swallowing function.

We investigate a U(1) chiral gauge model in 4+1 dimensions formulated on the lattice via the domain-wall method. We calculate an effective action for smooth background gauge fields at a fermion one loop level. From this calculation we discuss properties of the resulting 4 dimensional theory, such as gauge invariance of 2 point functions, gauge anomalies and an anomaly in the fermion number current., 39 pages incl. 9 figures, REVTeX+epsf, uuencoded Z-compressed .tar file

Although obesity is associated with insulin resistance, most obese humans and rodents remain normoglycemic because of compensatory hyperinsulinemia. This has been attributed to beta-cell hyperplasia and increased low Km glucose metabolism of islets. Since free fatty acids (FFA) can induce these same beta-cell changes in normal islets of Wistar rats and since plasma FFA are increased in obesity, FFA could be the signal from adipocytes that elicits beta-cell compensation sufficient to prevent diabetes. To determine if FFA-induced compensation is impaired in islets of rats with a diabetogenic mutation, the Zucker diabetic fatty (ZDF) rat, we cultured islets from 6-week-old obese (fa/fa) rats that had compensated for obesity and apparently normal islets from lean ZDF rats (fa/+) in 0, 1, or 2 mM FFA. Low Km glucose usage rose 2.5-fold in FFA-cultured control islets from age-matched Wistar rats, but failed to rise in either the precompensated islets of ZDF rats or in islets of lean ZDF rats. Bromodeoxyuridine incorporation increased 3.2-fold in Wistar islets but not in islets from obese or lean ZDF rats. Insulin secretion doubled in normal islets cultured in 2 mM FFA (p0.01) but increased only slightly in islets from lean ZDF rats (not significant) and declined in islets from obese ZDF rats (p0.05). We conclude that, unlike the islets of age-matched Wistar rats, islets of 6-week-old heterozygous and homozygous ZDF rats lack the capacity for FFA-induced enhancement of beta-cell function.

Glucose-stimulated insulin secretion is believed to require metabolism of the sugar via a high Km pathway in which glucokinase (hexokinase IV) is rate-limiting. In this study, we have used recombinant adenoviruses to overexpress the liver and islet isoforms of glucokinase as well as low Km hexokinase I in isolated rat islets of Langerhans. Glucose phosphorylating activity increased by up to 20-fold in extracts from islets treated with adenoviruses containing the cDNAs encoding either tissue isoform of glucokinase, but such cells exhibited no increase in 2- or 5-[3H]glucose usage, lactate production, glycogen content, or glucose oxidation. Furthermore, glucokinase overexpression enhanced insulin secretion in response to stimulatory glucose or glucose plus arginine by only 36-53% relative to control islets. In contrast to the minimal effects of overexpressed glucokinases, overexpression of hexokinase I caused a 2.5-4-fold enhancement in all metabolic parameters except glycogen content when measured at a basal glucose concentration (3 mM). Based on measurement of glucose phosphorylation in intact cells, overexpressed glucokinase is clearly active in a non-islet cell line (CV-1) but not within islet cells. That this result cannot be ascribed to the levels of glucokinase regulatory protein in islets is shown by direct measurement of its activity and mRNA. These data provide evidence for functional partitioning of glucokinase and hexokinase and suggest that overexpressed glucokinase must interact with factors found in limiting concentration in the islet cell in order to become activated and engage in productive metabolic signaling.

To elucidate the mechanism of the basal hyperinsulinemia of obesity, we perfused pancreata from obese Zucker and lean Wistar rats with substimulatory concentrations of glucose. Insulin secretion at 4.2 and 5.6 mM glucose was approximately 10 times that of controls, whereas beta-cell volume fraction was increased only 4-fold and DNA per islet 3.5-fold. We therefore compared glucose usage at 1.4, 2.8, and 5.6 mM. Usage was 8-11.4 times greater in Zucker islets at 1.4 and 2.8 mM and 4 times greater at 5.6 mM; glucose oxidation at 2.8 and 5.6 mM glucose was12 times lean controls. To determine if the high free fatty acid (FFA) levels of obesity induce these abnormalities, normal Wistar islets were cultured with 0, 1, or 2 mM long chain FFA for 7 days. Compared to islets cultured without FFA insulin secretion by FFA-cultured islets (2 mM) perifused with 1.4, 3, or 5.6 mM glucose was increased more than 2-fold, bromodeoxyuridine incorporation was increased 3-fold, and glucose usage at 2.8 and 5.6 mM glucose was increased approximately 2-fold (1 mM FFA) and 3-fold (2 mM FFA). We conclude that hypersecretion of insulin by islets of obese Zucker fatty rats is associated with, and probably caused by, enhanced low Km glucose metabolism and beta-cell hyperplasia, abnormalities that can be induced in normal islets by increased FFA.

Property of charged fermion states is investigated in the quenched U(1) chiral Wilson-Yukawa model. Fitting the charged fermion propagator with a single hyperbolic cosine does not yield reliable results. On the other hand the behavior of the propagator including large lattice size dependence is well described by the large Wilson-Yukawa coupling expansion, providing strong evidence that no charged fermion state exists as an asymptotic particle in this model., Comment: Latex 34 page (13 figures included), Uncompress file (original compress file can not be uncompressed), epsf.sty (included), UTHEP-256

Nature of charged fermion state is investigated in the quenched U(1) chiral Wilson-Yukawa model. Fitting the charged fermion propagator with a single hyperbolic cosine does not yield reliable result. On the other hand the behaviour of the propagator including large lattice size dependence is well described by the large Wilson-Yukawa coupling expansion, providing strong evidence that no charged state exists as an asymptotic particle in this model., 4 pages, Talk at Lattice '92, Amsterdam, Latex file( espcrc2.sty and epsf.sty are needed), 5 PostScript files for 5 figures are appended

Right ventricular function was assessed by regional wall motion analysis and by global function in 62 patients after repair for tetralogy of Fallot. Its relation to surgical procedures, with special attention to right ventriculotomy, was investigated. Patients were classified as follows: group Ia (n = 17), transpulmonary-transatrial repair without right ventriculotomy; group Ib (n = 22), transpulmonary-transatrial repair with minimal right ventriculotomy and small transannular patch; and group II (n = 23), transventricular repair with or without transannular patch. For regional wall motion analysis, fractional area change was used for three anterior parts obtained from hemiaxis area analysis of the lateral right ventriculogram. Ejection fractions were used for global right ventricular function. Functional assessment was done both at rest and during isoproterenol infusion, which is a stress test to evaluate cardiac functional reserve. At rest, group Ia showed better right ventricular anterior wall motion as well as global ejection fraction than did group II. Group Ib showed a global ejection fraction comparable to group Ia, with better regional wall motion in the middle anterior part of the right ventricle despite the depressed upper and lower anterior parts of the right ventricle. Group II showed depressed wall motion of the middle anterior part and the resultant impaired global ejection fraction. During isoproterenol infusion, group Ia showed significant increase in fractional area change of all anterior parts and in global ejection fraction. Group Ib showed significant increases in fractional area change at the middle and lower parts and in global ejection fraction comparable with group Ia. Otherwise, group II showed no significant change in fractional area change, or in global ejection fraction, at the upper and middle parts. These results indicated that transpulmonary-transatrial repair for tetralogy of Fallot provided better postoperative global right ventricular function and its reserve, with less impaired regional wall motion, than did the transventricular repair.

A new model of complete right heart bypass was devised in dogs. All systemic venous blood was directly led to the bilateral pulmonary arteries by end-to-side superior vena cava-right pulmonary anastomosis, diverting the inferior vena caval blood to the superior vena cava with a graft, ligating the inferior vena cava at its end and the pulmonary artery at its trunk, and shunting the coronary venous return from the right-ventricle to the left atrium. Nine consecutive dogs tolerated the procedures, and acute hemodynamic characteristics and responses to vasoactive drugs were observed for 5 hours throughout the following full studies. Cardiac output ranged from 66 to 102 ml/min/kg at a central venous pressure of 15 to 26 mm Hg. Norepinephrine, isoproterenol, and phentolamine were administered with the central venous pressure maintained constant at 18 mm Hg. Isoproterenol and phentolamine increased cardiac output while reducing pulmonary and/or systemic vascular resistance, with a possible concomitant inotropic effect in the former. Norepinephrine was detrimental, causing an increase in both pulmonary and systemic vascular resistance.

Research leading to the development of a separate-cooling sheet-winding gas-insulated transformer is described. Basic models and full-scale models were used to conduct tests on the structural strength of the transformer, and the structural integrity of a 300 MVA transformer was investigated. The sheet winding is shown to have excellent characteristics with respect to the electromagnetic forces occurring in it. The thrust force generated in the sheet winding is much lower than in conventional wire winding. The cooling panel is strong enough to withstand the coolant pressure rise under a short-circuit condition. It is also that the actual transformer has no possibility of resonance, because the natural frequency in it is higher than the vibration frequency that occurs in transit or during an earthquake. The structural integrity of the transformer is ensured by the fact that the sheet winding is supported at both its top and its bottom. >

The quenching of Einstein {ital A} coefficients was observed by measuring the branching ratio of visible and extreme-ultraviolet line intensities for C IV, C III, and N V ions.

FIR emissions in three directions from a FIR NH/sub 3/ laser cavity having a zig-zag axis were observed when radiation from a pump CO/sub 2/ laser with multiple or single modes was linearly injected into the cavity. The temporal variation and Fabry-Perot interferogram of these emissions showed that the FIR zig-zag emission is dominated by a laser process due to a population inversion, while the other forward and backward emissions are due to a Raman process. >

A compact CO 2 -NH 3 FIR laser system, with an NH 3 laser cavity inserted in the pump CO 2 laser cavity, was designed. Temporally smooth and reproducible single mode NH 3 laser pulses with an energy of 5 mJ (20 kW peak power) were obtained at the 152 μm line when optically pumped by the injection-locked single-mode CO 2 laser with a pulse energy of 0.3 J.

A consumer VCR local bus system for control signals called LANC, which allows a VCR to be integrated into a total system, has been developed. The LANC system can be applied to 8-mm, VHS, and beta-format VCRs, whether deck, camcorder, or portable model. With LANC, the VCR can communicate its status in detail to allow a fuller range of commands and perform a variety of complex operations. The LANC system utilizes a small, inexpensive dedicated interface block circuit and system-control microprocessor, making the system as a whole inexpensive and easy to install. >

The Report in the part dealing with the minor planets and satellites has been compiled at the Institute of Theoretical Astronomy in collaboration of S. G. Makover (minor planets) and V. A. Shor (satellites). Contributions to this report have been received from S. Arend, H. Debehogne, J. Dommanget, P. Herget, S. Herrick, G. M. Jannini, B. G. Marsden, V. V. Michkovitch, B. Milet, Z. M. Pereyra, B. Popovič, E. Rabe, E. Roemer, J. Schubart, W. Strobel, C. Torres, H. Wood. The part on comets has been prepared by E. Roemer.The main feature of minor planet research during this triennium has been the further application of modern electronic computing machines to the practice of computing. The time has gone when the computations of orbits and ephemerides were performed with the aid of logarithmic tables or with desk calculators. Therefore it is no wonder that all computational work in the field of the motion of minor planets is nowadays concentrated in a limited number of institutions provided with powerful up-to-date computing techniques, like the following.(1)Institute of Theoretical Astronomy, Leningrad has used till recently a computer BESM-2 and now has at its disposal a new more powerful computer BESM-4.(2)The Observatory of Cincinnati has used till recently a powerful computer NORC. Unfortunately this machine has been nowadays dismantled, but the observatory can perform some kinds of computations with an IBM-360 computer.(3)Latvian State University, Riga, has made a large amount of computations with the computer BESM-2.(4)University of California, Los Angeles, makes a large amount of computations with its own computer.

The author has observed phytoplanctonic algae collected in Abashiri Lake during the period of past several years. All the planctonic algae whose specific name were identified by the author are enumerated in the present report, containing those which have ever been published respectively by S. Takayasu and K. Tobishima, M. Higashi, K. Negoro, and S. Motoda and T. Ishida. Precise notes concerning those typical phytoplanctons belonging to the genus Aphanizomenon (Cyanophyceae) and Asterionella (Bacillariophyceae) are given, and the following two facts were revealed:-(1) both Aphanizomenon flos-aquae and its variety A. flos-aquae var. Klebahnii are encountered in the lake. (2) with respect to the genus Asterionella, the species which has ever been identified to be A. gracillima in Japan is presumably seperable into two species, namely one is A. gracillima proper and the other is A. zigzagostellata. The author could merely find a single species, A. zigzagostellata Elenkin from Abashiri Lake. Therefore, more throughgoing investigation upon the genus Asterionella became neccessary. Institute of Botany, Faculty of Science, Kobe, University, Kobe.

The relationship between the perfusion flow rate and cerebral oxygen consumption during deep hypothermic cardiopulmonary bypass at 20 degrees C was investigated in dogs. In 10 dogs the perfusion flow rate was decreased in steps from 100 to 60, 30, and 15 ml/kg/min every 30 minutes. Although cerebral blood flow decreased as perfusion flow rate decreased, the ratio of cerebral blood flow to the perfusion flow rate increased significantly (p less than 0.05) at a perfusion flow rate of 15 ml/kg/min compared to that at a perfusion flow rate of 100 or 60 ml/kg/min. The arterial-sagittal sinus blood oxygen content difference increased as perfusion flow rate decreased. Consequently, cerebral oxygen consumption did not vary significantly at perfusion flow rates of 100 (0.48 +/- 0.10), 60 (0.43 +/- 0.14), and 30 ml/kg/min (0.44 +/- 0.12 ml/100 gm/min), and it decreased significantly to 0.31 +/- 0.22 ml/100 gm/min at a perfusion flow rate of 15 ml/kg/min. In five dogs the perfusion flow rate was decreased in one step from 100 to 15 ml/kg/min, and after 60 minutes' perfusion at a perfusion flow rate of 15 ml/kg/min, the perfusion flow rate was returned to 100 ml/kg/min. Cerebral oxygen consumption decreased significantly during 60 minutes' perfusion at a perfusion flow rate of 15 ml/kg/min and did not return to its initial value after the perfusion flow rate was returned to 100 ml/kg/min. These data indicate that the optimal perfusion flow rate for the brain during deep hypothermic cardiopulmonary bypass at 20 degrees C appears to be 30 ml/kg/min, with a possible oxygen debt in the brain resulting in anaerobic metabolism if the perfusion flow rate is kept at 15 ml/kg/min or less.

Right ventricular volume measurements and hemodynamic studies were performed in 20 patients after total correction of tetralogy of Fallot. There were 6 patients with an extracardiac conduit and Hancock xenograft (G-1), 8 with an outflow tract patch (G-2) and 6 without or with a minimal right ventriculotomy and repair of pulmonary valve (G-3). The age at the time of operation was over 3 years in each patient and averaged 5 +/- 2 (mean +/- SD) years. Right ventricular systolic pressure averaged 81 +/- 22, 55 +/- 22 and 58 +/- 30 mmHg in G-1, G-2 and G-3, respectively. Right ventriculography showed no contraction of the right ventricular free wall at the anastomosis to the conduit and poor contraction around the anastomosis in G-1. The right ventricular enddiastolic volume index (RVEDVI) was 114 +/- 31, 155 +/- 57 and 115 +/- 28 ml/m2 in G-1, G-2 and G-3, respectively. The right ventricular ejection fraction (RVEF) was 0.42 +/- 0.11 in G-1, 0.53 +/- 0.04 in G-2 (p less than 0.05, vs G-1) and 0.57 +/- 0.04 in G-3 (p less than 0.02, vs G-1). Pulmonary regurgitation was evident in 17 patients, and RVEDVI correlated well with degrees of pulmonary incompetence. Fourteen patients in G-2 and G-3 were divided into G-A and G-B to evaluate right ventricular function with or without pressure overloading of the right ventricle. G-A consisted of 7 patients with a right ventricular systolic pressure of more than 50 mmHg (74 +/- 26) and G-B of 7 patients with a value less than 50 mmHg (39 +/- 4). There was no difference in RVEDVI and RVEF between G-A and G-B. RVEF was significantly lower in G-1 than G-A (p less than 0.02) and G-B (p less than 0.05). These results suggested that an extracardiac conduit with Hancock xenograft reduced the contraction of the right ventricular free wall and induced a depressed right ventricular pump function in patients with a high right ventricular pressure.

Thirteen patients (ages 4 to 16 years) with univentricular heart of right ventricular type, nine with double-inlet right ventricle (DIRV), and four with mitral atresia who underwent a modified Fontan operation were reviewed. Among those with DIRV, right isomerism with a common atrioventricular (AV) valve was found in eight and situs inversus in one; among those with mitral atresia, AV discordance was found in two and concordance in two. Intra-atrial routing using a baffle with atriopulmonary anastomosis was the main procedure (11 patients). There were two operative deaths (one DIRV, one mitral atresia) and three hospital deaths, with an early mortality of 38.5% overall (DIRV 44%, mitral atresia 25%). Low cardiac output was the main cause of death, with relatively high right atrial pressure and with tachyarrhythmias in most of the patients. Mortality was 75% for patients with DIRV who had total anomalous pulmonary venous drainage (n = 4) and 20% for those without (n = 5). Preoperative ventricular volume and ejection fraction were not different between those with severely low cardiac output (n = 4, three deaths) and the others, whereas ventricular mass/volume ratio was significantly lower in the former group. Two late deaths (one DIRV, one mitral atresia) related to the AV valve regurgitation. These results may indicate a relatively poor outcome after the modified Fontan operation for patients with univentricular heart of right ventricular type as a result of basic anatomic and hemodynamic problems.

Twenty-four patients with single ventricle, six with single left (SLV) and 18 with single right (SRV) ventricle, who received a Blalock-Taussig (BT) shunt at an average age of 3.2 years were studied. Ventricular function was assessed angiographically by end-diastolic volume index (EDVI) and ejection fraction (EF), and attempts were made to measure ventricular mass index (VMI) and VM/EDV. In 14 patients, the preoperative and postoperative results (average 2.4 years after placement of BT shunt) were compared in SLV (n = 5) and SRV (n = 9) groups. The SLV group showed significant increases in EDVI, VMI, and VM/EDV without a significant change in EF. The SRV group showed significant increases in EDVI and VMI, while EF decreased and VM/EDV was unchanged. Late death from congestive heart failure occurred in five patients with SRV. Three patients with atrioventricular valve regurgitation suffered late death. Among the patients with SRV, the late death group had significantly lower preoperative EF and VM/EDV compared with the survivors (n = 13). All of those with a preoperative EF of less than 0.50 and a VM/EDV of less than 0.35 g/ml suffered late death. In summary, patients with SRV appear to fail to develop adaptational hypertrophy to volume loading after the BT shunt procedure, with concomitant depression in ventricular pump function. Also, late cardiac failure seems likely to develop when low EF and VM/EDV are present preoperatively.

Four patients with presently uncorrectable cyanotic cardiac anomalies underwent a new operation, "total cavopulmonary shunt operation" or "total right heart bypass operation." These anomalies included single ventricle, single atrium, common atrioventricular valve with or without regurgitation, pulmonary stenosis, and most important, absent inferior vena cava with azygos or hemiazygos continuation. All patients had had previous systemic-pulmonary shunts. The new operation consisted of end-to-side anastomosis between the superior vena cava with azygos or hemiazygos continuation and the confluent pulmonary artery, division or ligation of the pulmonary artery trunk, and replacement of the common atrioventricular valve when regurgitation was present. Thus total venous return, except for hepatocardiac venous and coronary sinus flow, drains directly into the pulmonary artery, bypassing the right atrium and ventricle. Three patients survived the operation, and two of the three patients are now alive 4 years, 8 months and 2 years, 6 months after the operation. The two long-term survivors are in significantly improved condition, both clinically and hemodynamically. We believe that this new operation is promising in the treatment of the otherwise uncorrectable complex cardiac anomalies associated with azygos or hemiazygos continuation of the inferior vena cava. A longer follow-up is certainly mandatory before final conclusions can be reached.

Problems in myocardial revascularization for coronary impairment due to Kawasaki disease were assessed in five patients 1 to 4 years old. Each patient had significant stenosis or complete obstruction with aneurysm formation. There were no operative or late deaths in the follow-up period of 1 to 10 years after operation. The coronary arteries, including the first diagonal branch and obtuse marginal branch, were 1 to 1.5 mm in diameter. Eight saphenous vein grafts used were 2.5 to 3.5 mm in diameter and the internal mammary arteries used in two patients, ages 2 and 4 years, were 1 mm in diameter. All nine grafts examined in the early postoperative period were patent. However, only three of eight saphenous vein grafts were patent in the late postoperative studies. One saphenous vein graft to the right coronary artery was found patent 7 years after surgery in a patient who had been operated on at the age of 3 years. Internal mammary artery grafts used in the last two patients in the series were both patent throughout the late postoperative period. This experience suggests that myocardial revascularization is surgically feasible and beneficial even in young children and that further study is warranted.

In five patients (aged 5 to 11 years) with atrioventricular discordance, pulmonary stenosis or atresia, and origin of the aorta from the right ventricle, transaortic closure of the ventricular septal defect was performed. Double-outlet right ventricle was confirmed in four patients. All patients underwent placement of an extracardiac valved conduit from the anatomic left ventricle to the pulmonary artery. Neither operative death nor postoperative complete heart block resulted. Postoperative follow-up periods were from 3 months to 4 years (average 35 months), and one patient who had no evidence of complete heart block died suddenly 2 years postoperatively. Aortic regurgitation developed in two patients from possible trauma during the operation: Regurgitation was mild (causing symptoms) in one patient who had had poor surgical exposure with a subpulmonic ventricular septal defect and a well-developed subaortic conus; it was trivial (asymptomatic) in the other patient. Transaortic ventricular septal defect closure, suturing a patch on the anatomic left ventricular side in patients with atrioventricular discordance and double-outlet right ventricle or similar anomalies, might help to avoid postoperative complete heart block if the aorta is large and the subaortic conus is not well developed.

From January 1972 to December 1984, 347 consecutive patients underwent open mitral commissurotomy for mitral stenosis. Commissurotomy was performed in 86% of 404 patients undergoing mitral valve operations for stenosis during the same period. These 347 patients had three different types of mitral stenosis: type I, mobile cusps without subvalvular changes (43 patients); type II, thickened cusps with subvalvular changes (210 patients); type III, rigid cusps with severe subvalvular changes (94 patients). Concomitant mild mitral regurgitation was seen in 87 patients (25.1%) and mild to moderate valve calcification in 61 patients (17.6%). There were eight early deaths (2.3%) and 12 late deaths (3.5%), yielding an actuarial survival rate of 94.6% (excluding early deaths) 14 years after operation. There were 17 reoperations (5.0%) The actuarial rates of freedom from reoperation were as follows: 83.8% at 14 years for the entire series; 73.5% for type I stenosis; 88.9% for type II; 84.0% for type III; 91.7% for mitral stenosis with calcification; 82.6% for stenosis without calcification; 90.6% for pure mitral stenosis; and 52.5% for stenosis combined with regurgitation (p less than 0.05). Postoperative effective mitral valve areas calculated according to the hydraulic formula were 2.52 cm2 (mean) at rest and 3.06 cm2 during exercise in six patients with type I stenosis, 2.21 and 2.48 cm2, respectively, in 10 with type II, and 1.85 and 1.87 cm2, respectively, in 14 with type III. Our data clearly demonstrated that open mitral commissurotomy provided excellent long-term results with acceptable valve function and a low incidence of reoperation in patients with pure mitral stenosis not combined with regurgitation, even when associated with severe subvalvular changes with or without mild to moderate valve calcification.