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Accelerated demand for exploration of minerals and development of mining technologies over the past decade could lead to commercial mining of the deep seafloor in the near future. The campaign for conservation of biological diversity claims that there will be impacts of seabed mining to the deep-sea community and suggests a precautionary approach. In this chapter, we summarize the basic characteristics of communities in hydrothermal vent fields and describe the potential impact of resource mining as well as some previous observations on the effect of natural disturbances. We then introduce a model-based approach to determine the resilience of vent communities, thereby predicting if the communities will be vulnerable or robust to disturbances. Resilience of ecological systems is assessed by measuring the time required to recover to the original state prior to being disturbed. A mathematical model capable of predicting resilience would represent an important contribution to the management of these unique ecosystems. However, compared to most terrestrial and shallow water ecosystems, information regarding hydrothermal vent ecosystems, which are typically found at depths of over 1000 m, is limited. We thus focused on connectivity of vent communities through larval dispersal as a key factor for resilience. We will show how our framework can be used as a practical tool to characterize, understand, or predict resilience. The framework presented here can help assess ecological impacts and develop mitigation strategies associated with deep-sea resource mining. We also discuss what will need to be developed further to better achieve these objectives.

It remains unclear how cardioplegic arrest affects surgical results after coronary artery bypass grafting surgery (CABG). This study compares early outcomes after on-pump beating-heart CABG and conventional CABG.From 2002 to 2005, 114 patients underwent on-pump beating-heart CABG. Multivariate logistic regression revealed five characteristics according to which technique is liable to be used: history of cerebral infarction, urgent or emergent operation, lower ejection fraction, preoperative creatine kinase, and lower number of diseased vessels. The early clinical outcome for these patients was compared against 114 conventional CABG patients, matched using a propensity score constructed with these five significant variables and with two nonsignificant variables: history of diabetes mellitus and hypertension.On-pump beating-heart CABG significantly reduced the duration of operation and cardiopulmonary bypass, total blood loss, and peak creatine kinase (p0.05). The number of patients requiring additional intra-aortic balloon pump support was significantly lower in the on-pump beating-heart CABG group (2 versus 13, p0.01). No patients required percutaneous cardiopulmonary support after on-pump beating-heart CABG, whereas 4 patients needed it after conventional CABG. Complete revascularization was significantly lower (42.1% versus 77.2%, p0.0001), but in-hospital mortality was less in the on-pump beating-heart CABG group (2.6% versus 9.6%, p0.05). No significant difference was found in morbidity including stroke, renal failure, mediastinitis, and prolonged ventilation.On-pump beating-heart CABG can be performed safely, including on high-risk patients. Use of cardiopulmonary bypass and the elimination of cardioplegic arrest may be of most benefit to hemodynamically unstable patients.

A 39-year-old patient with cervical cancer, stage Ia, was successfully treated by total hysterectomy. Then, after sustained neutropenia for more than 4 years and coincident with its exacerbation, the serum lactate dehydrogenase (LD) level started to elevate and reached a plateau. A test for antineutrophil antibody was negative and LD-3-linked IgAkappa, which may be responsible for high LD activity, was confirmed. The absolute number of blood NK cells was reduced, and a diagnosis of nonimmune chronic idiopathic neutropenia of adult was made. The successive occurrence of these 3 disorders may be based on interrelated immunological abnormalities.

Myelodysplastic syndromes (MDS), especially refractory anemia (RA) are very heterogeneous diseases regarding their morphological, biological and clinical features. One important clinical problem is the difficulty of diagnosis. Soluble transferrin receptors (sTfRs) reflect the erythropoietic activity in the bone marrow (BM). To establish whether determination of serum sTfR could be useful for the differential diagnosis between RA and aplastic anemia (AA), we measured the serum sTfR concentrations, BM cellularity and BM erythroblast percentages in 14 untreated AA and 7 untreated RA patients. The serum sTfR levels of the RA patients (820.1 ± 402.8 ng/ml) were significantly higher than those of the AA patients (491.1 ± 195.2 ng/ml; p = 0.0207). However, the serum sTfR values of RA and AA patients also overlapped. A new index, the ‘sTfR-E index’ [the ratio of serum sTfR level (ng/ml) to BM cellularity (%) × BM erythroblasts (%)] is proposed, which is expected to reflect the number of transferrin receptors (TfR) on the cell membrane per BM erythroblast. The sTfR-E index values of the 7 RA patients (0.395 ± 0.234) were significantly lower than those of the 14 AA patients (2.669 ± 1.633; p = 0.0003). The sTfR-E index values of AA and RA patients overlapped only marginally. In conclusion, the sTfR-E index may be a useful new diagnostic tool to distinguish between AA and RA patients.

Mitoxantrone, etoposide and prednisone (MEP)-based regimens using granulocyte colony-stimulating factor (G-CSF) were designed for relapsed and CHOP-resistant diffuse large B-cell lymphomas in a single institution, and the therapeutic effects and adverse reactions were studied. In a total of 49 patients, the MEP regimen had a 41% (9/22) overall response rate compared with 48% (13/27) for the MEP plus carboplatin (C-MEP) regimen (Chi-squared test, P=0.602). Among 38 CHOP-resistant patients, however, the overall response rate to C-MEP [42% (10/24)] was significantly superior compared with MEP [7% (1/14)] (P=0.023), and the overall survival to C-MEP was superior compared with MEP (P=0.088). Taken together, our results, although non-randomized, suggest that a combination of MEP with carboplatin is better than MEP alone in CHOP-resistant diffuse large B-cell lymphomas.

Management of the small aortic root is a significant problem for the surgeon with regard to operative technique and selection of the prosthesis. We report on four adults with a small aortic root who underwent aortic valve replacement with a 16-mm CarboMedics bileaflet valve. All patients now lead normal lives. Postoperative Doppler measurements demonstrated an acceptable transprosthetic gradient.

Cardiopulmonary support (CPS) requires durability of the oxygenator. The life span of the oxygenator is affected by various clinical factors, including patient condition, perfusion condition, and equipment usage. Predictors for the durability of oxygenators were evaluated clinically in this study. Thirty-two patients, who had undergone CPS during the last 3 years in our institute were assigned to this study. Fifty oxygenators had been used (Capiox SX in 19, CB Maxima in 23, and AL-6000 in 8). Significant predictors for the durability of oxygenators were evaluated by nonparametric survival analysis and proportional hazards regression analysis. Univariate regression analysis revealed 6 significant predictors for the life span of oxygenators. These were the oxygenator type, type of centrifugal pump, acidosis with blood pH less than 7.35, base excess less than -5, blood glutamic-oxaloacetic transaminase (GOT) levels greater than 1,000 IU, and blood lactate dehydrogenase (LDH) levels greater than 3,000 IU. After multivariate analysis, there remained only 2 significant predictors. An oxygenator used with a noncoated CPS system (Capiox SX with Capiox EBS) proved to have a significantly shorter life span than one used with a heparin-coated system (CB Maxima or AL-6000 with CB BP-80) (hazards ratio, 3.588, p = 0.0065). Patient conditions, which revealed acidosis with less than -5 of base excess, significantly shortened the life of the oxygenator (hazards ratio, 3.595, p = 0.0188).

症例は,19歳男性,1992年9月急性リンパ性白血病(FAB分類ALL L2)と診断しJapan Adult Leukemia study Group (JAL-SG)プロトコールにて治療し完全寛解に到った後,1994年8月,再発しprednisolone, vincristineによる寛解導入療法を行った.その後,cytarabine,l-asparaginaseにて治療し長期間,骨髄抑制が起こり,発熱と潰瘍底を形成し中心部が壊死に陥った皮疹が全身に認められるようになった.皮膚生検を行い,培養の結果Fusarium solaniを検出した.そのため,granulocyte colony-stimulating factor (G-CSF) 350μgを連日静注し,amphotericin B (AMPH)を点滴静注し1mgから開始し40mgまで増量した.しかし,原疾患の悪化に伴いPseudomonas aeruginosaによる敗血症を併発し死亡した.剖検では全身各種臓器にもFusariumによる播種性病変が認められた.とくに肺,消化管,腎,心,膵,筋肉に多発性病変を,また腎は一部梗塞を伴う病変を認めた.今後,免疫不全患者の増加によりこのような弱毒真菌感染症が増加するものと思われた.

Background. Nafamostat mesilate (FUT-175) is a synthetic serine protease inhibitor that inactivates coagulation, fibrinolysis, and platelet aggregation. Nafamostat mesilate may suppress the blood-foreign surface reaction similar to biocompatible materials by blocking factor XIIa. Methods. We performed an in vitro study of cardiopulmonary bypass (CPB) with fresh human blood among the following three groups: standard CPB sets (C), biocompatible CPB sets (B), and standard CPB sets with FUT-175 (10 mg/L) (F). A clinical study using these same CPB groups also was performed in 45 patients undergoing aortocoronary bypass operations (15 patients each). We injected FUT-175 at 40 mg/h during CPB. Results. In the in vitro study, both groups B and F showed significantly lower levels of coagulation factors, thrombin-antithrombin III complex, fibrinopeptide A, β -thromboglobulin, complement C3a, granulocyte elastase, and free hemoglobin than group C at the conclusion of the study. Thrombin-antithrombin III complex and free hemoglobin in group F also were lower than in group B. The platelet count remained at a higher level in group F than in the other groups. Separation of bradykinin was suppressed most significantly in group F. In the clinical study, group F also showed significantly lower levels of α 2-plasmin inhibitor plasmin complex and C3a than both groups C and B. There were minimal levels of free hemoglobin in group F. Conclusions. Nafamostat mesilate may contribute major beneficial effects toward conservation of blood during CPB and prevention of coagulopathy after CPB.

The effects of calcium antagonists (nifedipine, nicardipine, diltiazem, and verapamil) and prostaglandin E1 (PGE1) on the tension of isolated canine coronary arterial strips were studies. In a solution containing 20 mEq/L of K+, 127 mEq/L of Na+, the tension was increased by 500–1,000 mg with 4 mEq/L of Ca2+. This increase in tension was suppressed by Ca-antagonists and PGE1 dose-dependently. Nifedipine 10−5M, nicardipine 3 X 10−7M, diltiazem 3 X 10−6M, and verapamil 3 X 10−6M completely suppressed the increased tension. The maximal suppression of the tension produced by PGE1 was about 40% at 10−10M. In 20 mEq/L K+ solution (0 mEq/L Ca2+, 37°C), the reduction of the Na+ concentrations from 127 mEq/L to 12 mEq/L increased the tension by 50 to 100 mg. This increase in tension was not suppressed by Ca-antagonists or PGEI. In conclusion, this study demonstrated that Ca-antagonists and PGE1 suppressed an increase in the tension caused by Ca2+ but did not suppress an increase in the tension caused by Na+ reduction.

The distribution of ofloxacin (OFLX) in the palatal tonsil and maxillary sinus mucosa was quantitatively analyzed. OFLX (100mg), lomefloxacin (100mg), and tosufloxacin (75mg) were administered orally 2 hours before surgery. The tissue concentration of OFLX was 1.61±0.46μg/ml on average and was higher than the serum concentration (0.72±0.21μg/ml), the tissue/serum ratio (2.24) was significant. The tissue concentration of OFLX was higher than that of lomefloxacin and tosufloxacin. In addition, clinical and bacteriological trials on patients with otorhinolaryngological infections was carried out. OFLX was administered orally at a dose 600mg for more than three days. The incidence of stains resistant to OFLX (MIC>3.13μg/ml) was 5.8%. The overall clinical efficacy rate was 86.7% and there were no safety problems. It was concluded that OFLX is a useful drug for treating otorhinolaryngological infections.

Adverse effects of cardiopulmonary bypass on cancer prognosis are expected but have not been confirmed. Seventy-four cancer patients who underwent cardiac surgery before cancer therapy were followed up for 42 ± 37 months; 45 had cardiac surgery with cardiopulmonary bypass. There was no significant difference in cancer recurrence (40.0%) and deaths (26.7%) among patients who had cardiopulmonary bypass and those who underwent off-pump cardiac surgery (27.6% and 24.1%). There were no significant differences in freedom from cancer-related death at 2 and 5 years after cardiac surgery (78.4% and 68.5%) in the cardiopulmonary bypass group compared to the 29 off-pump group (81.8% and 58.3%). Despite some limitations, this study detected no significant adverse effects of cardiopulmonary bypass on cancer prognosis. Although these results do not verify the safety of cardiopulmonary bypass from an oncologic aspect, they suggest it can be applied in cancer patients who require cardiac surgery.

Serum levels of T helper 1 (Th1)/T helper 2 (Th2) cytokines, angiogenic growth factors, and other prognostic factors were measured in 5 young adult patients with virus-associated hemophagocytic syndrome (HPS). Levels of 2 Th1 cytokines (interleukin [IL]-18 and tumor necrosis factor-alpha), 2 Th2 cytokines (IL-10 and IL-6), and 2 angiogenic growth factors (soluble intercellular adhesion molecule-1 and hepatocyte growth factor) were high in all of the patients examined, whereas those of Th1 cytokines such as IL-12 and macrophage inflammatory protein-1a were normal or low. Levels of IL-18 and IL-10 were highest in case 2, with a fatal outcome, and were lowest in case 4, with rapid recovery within 1 month. Although IFN-gamma levels were not elevated in 2 patients (cases 3 and 5), IL-18 levels were markedly high in both of these cases and the IL-6 level was highest in case 3. In contrast with the marked increase in the level of IL-10, the levels of IL-6, sIL-2R, and ferritin decreased rapidly and returned to normal within 2 months after therapy in case 3. The IL-18 level decreased somewhat, but remained elevated for 6 months, and the patient achieved a complete response within 11 months. Taken together, our findings suggest that both IL-18 and IL-10, but not IL-12, may play important roles in young adult patients with HPS via enhancing and suppressing Th1 immune responses, respectively.

In our previous study, approximately 60% of aplastic anemia (AA) and refractory anemia (RA) patients treated with recombinant human granulocyte colony-stimulating factor (rhG-CSF) and recombinant human erythropoietin (rhEpo) showed a multilineage response. In this study, we analyzed the long-term follow-up of the multilineage responders (multi-R). In the follow-up analysis of 11 multi-R (6 AA and 5 RA), 10 patients (5 AA and 5 RA) were evaluable. The range of time from the start of treatment to the final contact was 50 to 125 months. Analysis of survival times revealed a significant difference between multi-R and non-multi-R among AA patients given this treatment (P = .016). One AA and 1 RA patient among the multi-R developed acute leukemia. Of 7 living multi-R, 3 AA and 2 RA patients did not need transfusion at final contact. Four of them maintained the target hemoglobin concentration of more than 11 g/dL for quality-of-life benefit. The findings suggested that this result is an important advantage of this treatment.

A 56-year-old man admitted with dyspnea had undergone aortic valve replacement using a Starr-Edwards ball valve to treat aortic regurgitation 28 years earlier. Chest radiography showed moderate cardiomegaly, moderate pulmonary edema, and mild pleural effusion. Echocardiographic examination showed severe mitral regurgitation. The mitral valve was replaced using a St. Jude Medical prosthesis, and the Starr-Edwards aortic valve was replaced using a CarboMedics prosthetic valve. The cloth covering on the Starr-Edwards valve had worn away and pannus had formed. The patient's postoperative course was uneventful, and he was discharged on postoperative day 35.

Pulmonary stenosis caused by calcium deposits on pulmonary valve is relatively rare. We experienced such as case in a 67-year-old man. In March 1992 the patient developed heart failure and internal treatment resulted in remission. Cardiac catheterization study and echocardiography showed a valvular PS. Chest CT and cineangiogram showed the calcified pulmonary valve and annulus. In July pulmonary valve replacement with a bioprosthetic valve was performed under thoracotomy and ASD was closed by a patch. There were severe calcification of the pulmonary valve, adhered commissure and sclerotic valve ring. Postoperative course was uneventful, however, the patient developed cardiac tamponade on the 12th day after the operation. Reoperation was carried out. No clear hemorrhage was found and only drainage was done. The patient gradually became worse to develop renal failure and DIC, and died of MOF on 34th postoperative day.

This paper deals with active vibration control of two identical flexible structures arranged in parallel. One of the authors had presented a vibration control mechanism so that two or more structures are connected via non-contact actuators in which one structure is utilized as a reaction wall for another structure’s control mutually. However, in such a mechanism, the control performance reduces as the natural frequencies of structures become closer. In this report, authors present a modified mechanism in which actuators are connected to the structures with long arms so that the direction of vibration in a mode differs on each structure. In this way, the reaction force from the actuator on structure is introduced to another structure for dissipative force even if the properties of structures are identical. Computer simulation and control experiment are carried out and the effectiveness of presented mechanism is confirmed.

Before and after therapy, serum thymidine kinase (TK) and soluble interleukin-2 receptor (sIL-2R) were serially determined in 28 patients with malignant lymphoma (ML). In 15 patients achieving and maintaining complete remission (CR) for more than 2 years, serum TK and sIL-2R were unchanged or decreased gradually. In contrast, logarithmic linear increases of TK and sIL-2R were observed in 13 relapsed patients. The increments of the serum markers occurred more than 10 months before the relapse. A significant positive correlation between the slope of the line for TK and that for sIL-2R was noted. The doubling time for TK estimated from the slope also showed a positive correlation with that for sIL-2R. Taken together, serum TK and sIL-2R were shown to be quite sensitive and interrelated serum markers for the recurrence of ML. Slopes of logarithmic linear increase, which are proper and specific for the individual patients, are inversely correlated with the doubling time and reflect proliferation of ML. We conclude that serum TK and sIL-2R are better predictors of relapse than LDH and the international prognostic index (IPI).

Background: Nisoldipine, a calcium antagonist, was assessed for myocardial protection and the prevention of reperfusion injury in patients undergoing CABG.Methods: Of the 34 subjects undergoing CABG in this study, 20 were given nisoldipine orally at 10 mg/day for 2 weeks before surgery (N group) and the other 14 untreated controls (C group). Myocardial protection was conducted via antegrade cold blood cardioplegia at 20-minute intervals.Results: Myocardial blood flow was significantly higher in the N group (67.8±21.8 ml/100 g vs. 47.2±14.4 ml/100 g, p < 0.05) after cardiopulmonary bypass. Serum interleukin-6 levels were significantly lower in the N group 1 hour after reperfusion (116±58 vs. 409±362 pg/ml, p < 0.05), as were serum lactate dehydrogenase levels immediately after surgery (888±268 vs. 1350±486 IU/L, p < 0.05). The N Group showed a better left ventricle stroke work index 6 hours after surgery (43±8 vs. 36±9 g·m/m2). Dopamine dosage in the N group on postoperative day 1 was lower than in controls (5.3±1.9 vs. 3.0±2.4 μg/kg/min). Conclusions: Preoperative nisoldipine treatment increased blood flow in the postischemic myocardium and prevented myocardial damage and reperfusion injury to some extent.

Cannulation of the ascending aorta is the recognized method to achieve arterial return during cardiopulmonary bypass. Mediastinal infection after cardiac surgery can cause disruption at the point of insertion, and give rise to a pseudoaneurysm in the ascending aorta. Although rare, a pseudoaneurysm can occur without clear evidence of infection. Here we report two cases that received aortic valve replacement and that developed ascending aortic aneurysms after surgery. Based on our clinical findings, these aneurysms were related to the arterial cannulation into the aorta and not to any infection.

Currently, poststernotomy mediastinitis frequently is being treated by debridement and immediate closure with omental drainage. This method is useful, but subcutaneous infection occasionally occurs. Divided omental transfer to the presternal space may be helpful in preventing this complication.

We report herein the unusual case of a patient in whom postoperative angiography following coronary artery bypass grafting (CABG) revealed a lateral origin of the right internal thoracic artery (ITA) and a normal origin of the left ITA, both of which were demonstrated to be patent and did not follow a tortuous course. The CABG had involved revascularization of the left anterior descending artery (LAD) with the right ITA, and the obtuse marginal artery with the left ITA. The patient had an uneventful postoperative course and developed no respiratory symptoms.

We herein report the case of a 56-year-old man with idiopathic thrombocytopenic purpura who required an emergency aortic arch replacement. Intraoperatively, hemostasis was achieved using platelet transfusions. Postoperatively, the use of high-dose gamma-globulin therapy was able to maintain an adequate platelet count and good hemostasis.

The effects of magnesium on the tension of isolated canine coronary arterial strips were studied. In the solution containing K+ of 20 mEq·l −1, Ca2+ of 4 mEq·l −1, and Na+ of 127 mEq·l −1, the tension was 811±111 mg with Mg2+ of 1 mEq·l −1, 494±135 mg with Mg2+ of 10 mEq·l −1, 272±126 mg with Mg2+ of 20 mEq·l −1, −52±63 mg with Mg2+ of 30 mEq·l −1, −69 ±80 mg with Mg2+ of 40 mEq·l −1. In the solution containing K+ of 20 mEq·l −1, Na+ of 12 mEq·l −1 and Ca2+ of 0 mEq·l −1, the tension was 102±22 mg with Mg2+ of 1 mEq·l −1, 3±35 mg with Mg2+ of 10 mEq·l −1; −49±33 mg with Mg2+ of 20 mEq·l −1, −59±49 mg with Mg2+ of 30 mEq·l −1, −65±54 mg with Mg2+ of 40 mEq·l −1. The data demonstrated that Mg2+ above 30 mEq·l −1 inhibited the increase in tension caused by Ca2+ and Mg2+ above 20 mEq·l −1 inhibited the increase in tension caused by low Na+ concentration.

The effects of sodium and temperature on tension of isolated canine coronary arterial strips were studied. In 20 mEq ·l −1 K solution, the strength of tension was inversely related to the Na concentration. At 37°C, the tension was significantly increased at 70 mEq ·l −1 Na and below. The tension was gradually suppressed by lowering of the temperature from 37°C to 10°C. At 10°C, tension did not developed significantly at Na concentrations between 127 mEq ·l −1 and 12 mEq ·l −1. It was concluded that the decrease in Na concentrations increased the tension of the canine coronary artery and the lowering of temperature supressed the tension inducted by the decrease in Na concentrations.

A 23-year-old man underwent a tracheostomy. A massive hemorrhage from the tracheostomy site occurred 50 days later. An emergency operation was immediately performed and an erosion was noted on the innominate artery. The artery was divided and the hemorrhage was successfully stopped.

Rituximab-based chemotherapy for B-cell lymphoma is available in Japan since ‘01. We have treated twenty-eight B-cell lymphoma patients with rituximab and found four patients relapsed with posterior radiculopathy of the spinal cord due to lymphoma involvement. Because frequency of CNS lymphoma is reported to be 1~2%, we are surprised at the high incidence (14.2%) and thereafter we routinely repeat intrathecal cytarabine (Ara-C), methotrexate (MTX), and prednisolone (PDN) administrations during rituximab-based chemotherapy. Up to now, there is no new spinal cord relapse. The followings are the four spinal cord relapse cases we have experienced, which are characterized by severe back pain. (Case 1) A 46-years-old male with follicular lymphoma. Clinical stage (CS) was IIIB. He had cervical lymphadenopathy and breast involvement. He was treated with three courses of CHOP chemotherapy and achieved CR. Then he was treated with 1 course of rituximab alone and relapsed with severe neck and back pain five-days later. MRI imaging revealed posterior radiculopathy of the spinal cord between C2 and C4. (Case 2) A 48-years-old female with diffuse large B-cell lymphoma, CS IIIA. She had uterine cervix lymphoma and cervical lymphadenopathy four-years after acute lymphocytic leukemia (ALL) therapy. She was treated with 8 courses of biweekly R-CHOP and achieved CR. She relapsed with severe back and left arm pain with double vision six-months later. MRI imaging revealed posterior radiculopathy of the spinal cord between C5 and C6, and Th2 and Th3. She also had trigeminal radiculopathy and facial nerve oppression. The involved nerves were swollen like dumbbell. (Case 3) An 83-years-old female with MALToma, CSIIA. She had cervical lymphadenopathy. She was treated with 5 courses of rituximab alone and relapsed with severe back and lumbar pain one-month later. MRI imaging revealed posterior radiculopathy of the spinal cord between Th6 and Th7, and, Th12 and L1. (Case 4) A 63-years-old male with mantle cell lymphoma, CSIIIB. He had general lymphadenopathy. He was treated with 8 courses of CHOP, achieved CR, and relapsed with general lymphadenopathy and breast involvement thirteen-months later. He was treated with additional 7 courses of R-CHOP and relapsed again with severe oral, bilateral leg, and back pain seven-days later. MRI imaging revealed posterior radiculopathy of C2 and sacrum. All the patients except case 3 died due to lymphomas. When we treated the four patients with rituximab-based therapy, we did not repeat intrathecal Ara-C/MTX/PDN injections. Our data suggest that rituximab possibly induce posterior radiculopathy of spinal cord lymphoma involvement via some unknown pathway. In conclusion, we recommend repeated intra-thecal injections during rituximab administration.

Mitral valve replacement was performed through a right thoracotomy using femorofemoral bypass under profound systemic hypothermia in a 62-year-old man who had undergone coronary artery bypass grafting using both internal thoracic arteries. The right thoracotomy approach minimizes the risk of injury to the arterial grafts, and deep hypothermia obviates the need to interrupt the grafts to administer cardioplegia. This technique provides excellent exposure of the mitral valve while minimizing the operative risk.

The fecal bacterial flora was examined in multiple stool specimens from 14 subjects with gastrointestinal disorders before, during and after the oral administration of bifidobacterial preparation (BBG, viable B. breve and B. bifidum, 3 X 10(9) or 6 X 10(9) per day) for 2 or 3 weeks. Enumerations of fecal bacterial flora showed no conspicuous alterations in total anaerobic bacterial counts during the BBG therapy, however the total number of bifidobacteria in feces increased significantly, and of E. coli and other aerobacteria showed a tendency to decline. The administered B. breve and B. bifidum were recovered in the feces at a concentration of 10(8)/g and of 10(7) to 10(8)/g, respectively. Both species continued to be excreted over 2 weeks after completion of the medication in the feces at concentrations of 10(6) to 10(7)/g and of 10(5) to 10(6)/g respectively, and diminished rapidly in 5 patients and continued at essentially the same level as during the medication in 6 patients. During the treatment the pH, urease activity and ammonia content in feces became lowered and showed a rerise after therapy. Symptomatic discomforts including abdominal distension and pain, anorexia, edema and fever of undetermined origin were reduced during the therapy. Urinalysis, hematological examinations and blood biochemical tests including blood ammonia level, however revealed no significant change.

Cleiodocranial dysostosis is a rather rare bone development disease and is characterized by abnormalities of the skull, clavicles and teeth.We experienced a case of cleidocranial dysostosis in a 48-year-old man.The patient was of short stature and could bring his shoulders medially. The maxilla appeared underdeveloped, so that the mandible was relatively prognathous. In the oral cavity, the palate was high with a groove along the median palatine suture.Roentgenographic examinations revealed the following: The fontanels remained open and the sutures were unossified. The maxilla and mandible contained at least eighteen unerupted teech. A cyst involving the retained teeth was present in the mandibular premolar region on the right side. The lateral portions of the clavicles were absent. Spina bifida occult and coxa vara were present.

Gap or void discharge and Creeping discharge were measured in several kinds of gases at different pressures with model specimens, such as a gap model between two parallel plates of glass, a model of single plate of glass, epoxy-mica insulation coils, and a motorette degraded by a series of functional test., From the experimental results, it is made clear that discharges in open type (ventilated) void and creeping discharges are remarkably suppressed with increasing the gas pressure, and discharges in high voltage rotating machine winding are also suppressed in compressed gas due to the transition of included voids from closed type to open type. The latter was confirmed by the measurements of a turbine generator after long service. These effects are most distinguished in SF6 gas and hydrogen gas above 1.5 atg was superior in the discharge suppression effect to the air at O atg. Moreover, the breakdown voltage of epoxy mica insulation containing many ventilated voids rises remarkably with increasing gas pressure, approaches to that of epoxy vacuum-pressure impregnated coil when SF6 gas at 6 atg is filled. Based on these data, the authors proposed the availability of GF (gas filled) insulation system in the rotating machine.

63歳男性の黄疸を伴った粟粒結核の1例を報告する.本症例は黄疸,腰痛を訴え入院.胸部レ線にて陳旧性肺結核と肺野全体の粟粒陰影を認め,肝機能検査にて閉塞性黄疸像を示した.入院3日目に肝不全,吐血にて死亡した.剖検では,肺の陳旧性肺結核と肝,肺,腎など主要臓器の全身粟粒結核を認めた.肝ではグリソン鞘に多数の粟粒結核と肝細胞の著明な脂肪変性を認めた.肝の粟粒結核にて黄疸が出現することはきわめて稀なので文献的考察とともに報告する.

Motorette test based on IEEE Std. 275 have been usually adopted as a thermal evaluation method for rotating machinery insulation. There are some problems in performing thest tests. The tests required a considerably time. And, as the tests predict the life at an operational temperature by an extraporation method based on the data at higher temperatures, there is a possibility of missing a change in the temperature dependence of the thermal degradation mechanism. Therefore, the thermal life evaluation method by an EGA-GC (Evolved Gas Analysis-Gas Chromatograph) was examined in comparison with the motorette test method.

Transport of LMOX administered by intravenous drip infusion (1g/30 minutes) to the bone and soft tissues as well as the pus in the upper and lower jaws was examined in 77 oral surgery cases.The serum concentration of the agent was 102.2μg/ml after 30 minutes, 43.9μg/ml after 1 hour, and 13.1μg/ml after 4 hours. The maximum tissue concentrations were 17.6μg/g in the upper jaw bone, 9.8μg/g in the lower jaw bone, 37.4μg/g in the upper jaw soft tissue, 20.1μg/g in the lower jaw soft tissue, and 40.2μg/g in the pus. These concentrations relative to the serum concentration ranged from 20-50% despite a considerable variation among sites.As for the intraosseous concentration and MIC 80 values of bacteria, which are the most important indexes, the former exceeded the latter in most bacterial strains examined except P. aeruginosa. These results indicate that LMOX is a useful drug in oral surgery.

Thermal cyclic degradation of epoxy micaceous insulation for ac high voltage generators and motors was investigated. From the experimental results, it is made clear as follows. Thermal cyclic degradation begins with a separation of the innermost main insulation layer from the strand insulation at the end of the iron core. It propagates in a mode of mica delamination and the formation of cracks. This degradation condition agrees well with the measurement results of non-destructive insulation tests using divided electrodes. The compatibility between a strand insulation and a main insulation greatly affects thermal cyclic degradation. Thermal degradation cannot be ignored under certain thermal cycle condition. Thermal cyclic degradation increases with an increase in the peak conductor temperature. Even in the case of a post impregnated insulation system where the coil insulation adheres to the iron core, the thermal cyclic degradation is little for a core length below 1.4 m and a 160 °C hottest conductor temperature. Non-destructive insulation diagnoisis of hydrogen filled water-cooled turbine-driven generator insulation shows little thermal cyclic degradation after approximately 15 years normal operations. Lastly, it is proposed that a thermal cylce test under voltage application is important hereafter, to grasp the degradation of actual machines precisely.

HBs抗原の持続陽性者13例とその構成血縁者109例のHBs抗原,HBs抗体,HBs抗原subtypeおよびα1フェトプロテイン(以下AFPと略す)値を測定し,次の結果を得た.HBs抗原陽性率は34.8%,HBs抗体陽性率は30.3%であり,これらは日本人供血者の成績と比較して有意に高率であった.なお男女比はそれぞれ男48.2%:女20.8%および男20.8%:女39.6%であった.母親がHBs抗原陽性の場合,その子供のHBs抗原陽性率は70.6%であり,父親の31.6%と比しきわめて高く垂直感染の強いことを裏付けた.HBs抗原subtypeはadrが大部分をしめ,今回の調査では純粋なadwは認められず山陰地方のHBs抗原subtypeがadrに偏向していることをうかがわせた.AFP値異常はHBs抗原陽性者の41.2%にHBs抗体陽性18.2%に,HBs抗原,HBs抗体ともに陰性者の22.6%に認められた.

20歳代の若年者で高アンモニア血症,反復する意識障害,脳波異常などの臨床所見を示しながら,明瞭な肝機能障害や門脈大循環短絡を認めない2症例を経験した.これら症例についてアンモニア-尿素-アミノ酸代謝系の検索を行なった結果,それぞれ,Ornithine carbamoy-Itransferase, Argininosuccinate Synthetaseの部分欠損が推定された.

Objectives: Use of the free gastroepiploic artery graft for coronary revascularization has not been very popular because of its inclination toward vasospasm. We hypothesized that the cause of free gastroepiploic artery spasm was the graft damage caused by an interruption of venous drainage from the graft. To solve this problem, we developed a new method of free gastroepiploic artery grafting. Methods: From January 1997 to October 1999, 33 patients underwent coronary artery bypass grafting with the free gastroepiploic artery according to our new method. The gastroepiploic artery graft was harvested en bloc with its satellite veins. The gastroepiploic vein was anastomosed to the right atrial appendage for venous drainage simultaneously with the gastroepiploic artery being grafted in the aortocoronary position. Results: A total of 96 distal anastomoses were performed, including 33 free gastroepiploic artery grafts according to our method, 33 in situ left internal thoracic artery grafts, 26 saphenous vein grafts, and 4 radial artery grafts. Neither operative nor hospital death occurred. Early postoperative angiography revealed that all of the 33 free gastroepiploic artery grafts performed with our method were patent without spasm, and flow competition occurred only in 2 of those grafts. On late angiography, all 15 free gastroepiploic artery grafts were patent without spasm. Conclusions: The free gastroepiploic artery grafting with venous drainage technique we developed can prevent graft spasm, leading to improved patency rate. (J Thorac Cardiovasc Surg 2001;121:520-5)

Oral tryptophan loading tests were performed on patients with cirrhosis of the liver before and after treatment with an oral antibiotic practically unabsorbed from the gastrointestinal tract. After antibiotic therapy, neuropsychiatric manifestations evoked by the oral administration of tryptophan were reduced in duration by about 50% and in severity as well despite a slightly enhanced elevation of serum total and free tryptophan levels, compared to pre-treatment loading tests. The urinary indican output also showed a significantly greater decrease in the post-treatment test (p less than 0.05) whereas no appreciable difference was observed in urinary 5-hydroxy-indoleacetic acid excretion between the pre- and post-treatment tests. The data suggest that neuropsychiatric manifestations seen following oral administration of tryptophan may be attributed to intestinal tryptophan metabolites rather than to this aromatic amino acid itself and/or its metabolites in the brain.