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Following cryo surgery for retinal hole repair, visual effects in the senior author's eyes were caused by an epiretinal membrane. Subjectively, metamorphopsia was noted, and entoptically perceived radial striae were observed centred near fixation. After subsequent cataract surgery, metamorphopsia was not detectable. Several months later, the centre of the striate entoptic pattern was observed to be centered several degrees from fixation. Concurrently, loss of contrast in the central visual field was noted. In time, both the entoptic pattern and the contrast effects became less visible (contrast improved much faster). The epiretinal membrane had spontaneously separated from the fovea. Repeated measurements of aniseikonia were obtained before cataract surgery, and after cataract surgery both prior to, and after the separation of the epiretinal membrane. Inferences are drawn.

Three hundred and thirty-eight children (age range 3-5 years) were examined for the presence of mutans streptococci in their saliva. They were divided into four groups according to the prevalent species that were isolated: (1) Streptococcus mutans and Streptococcus sobrinus group (S. mutansor = 10(3) CFU/ml and S. sobrinusor = 10(3) CFU/ml); (2) S. mutans group (S. mutansor = 10(3) CFU/ml but S. sobrinus10(3) CFU/ml); (3) S. sobrinus group (S. sobrinusor = 10(3) CFU/ml but S. mutans10(3) CFU/ml), and (4) children with mutants streptococci absent or barely detectable (mutants streptococci10(3) CFU/ml). The previous caries experience was compared among the groups, as was the caries increment during a 6-month period after the bacterial examination. The subjects in the S. sobrinus group had both higher caries and higher decayed teeth and surface increments than the S. mutans group. The mean decayed smooth-surface increment (delta d-surface) for the S. sobrinus group was 2.6 and was significantly higher than 0.8 for the S. mutans group. For the subjects with delta d-surfaceor = 4, the mean number of S. sobrinus in the saliva was 4.29 x 10(5) CFU/ml and was significantly higher than 0.32 x 10(5) CFU/ml for the subjects without delta d-surface. There was no significant difference in the mean number of S. mutants in saliva between the subjects with and without delta d-surface. The prevalence of S. sobrinus in saliva was more closely associated with future caries activity, especially with smooth-surface caries increment, than the prevalence of S. mutants.

We report the clinical results of 799 cases of isolated coronary artery bypass grafting (CABG) performed during the recent 5 years. We performed off-pump CABG (OPCAB) as standard operation, in which arterial grafts were mainly used. The mean number of distal anastomoses was 3.6 +/- 1.4 per patient Four hundred and fifty-five cases (57.0%) were done only with arterial grafts. Bilateral internal thoracic arteries were used in 326 cases. The mean number of saphenous vein grafts was 1.6 +/- 0.8 per patient. Continuous hemodiafiltraion (CHDF) was performed in 22 cases (2.8%) postoperatively. Among the OPCAB cases, 10 cases (1.3%) were converted to on-pump CABG. There were 7 cases (0.9%) of hospital death. The mean length of postoperative hospital stay was 10.2 +/- 5.3 days. The ratio of the patients with left main trunk disease and that of the patients who required postoperative CHDF increased year by year. The mean length of postoperative hospital stay decreased every year, and the reduced length was 2.7 days in the 5 years (8.7+/- 3.6 days in 2007). It is expected that patients who have severe calcified lesions or who are on hemodialysis may increase in the near future. In such cases, CABG rather than percutaneous catheter intervention may be suitable for revascularization. Therefore, not only appropriate choice of treatment strategies, but also accurate surgical techniques may become more importance.

In both superficial and deep femoral artery involvement, where angioplasty of the former is not suitable or feasible, angioplasty of the latter seems to be the method of choice and is a less invasive and efficient treatment particularly for limb threatening ischemia, an appropriate obstruction morphology provided. The authors describe a case of a 73-year-old man, with a rest pain of the foot and intermittent cyanosis of the toe, who underwent stent placement with transluminal angioplasty for severe stenosis in the deep femoral artery with the occluded superficial femoral and popliteal artery. The patient's ankle brachial index was remarkably increased from 0.25 to 0.61, and the preoperative symptoms were improved.

To investigate the effect of continued stretching of affected arms in patients with cerebrovascular disease (CVD), F-wave was tested from the abductor pollicis brevis (APB) during relaxation (trial 1) and 3 different continued stretches: stretched position with shoulder abduction (trial 2), stretched position with shoulder abduction and elbow extension (trial 3), and stretched position with shoulder abduction, elbow extension and wrist extension (trial 4) of the affected arm for 1 min. in 20 hemiparesis patients with moderate hypertonus (modified Ashworth scale of 2 or 3) caused by CVD (mean age of 49.5 years). Persistence and amplitude ratio of F/M in trial 2 were the same as those in trial 1. Persistence and amplitude ratio of F/M in trials 3 and 4 were significantly lower than those in trial 1. It was suggested that excitability of spinal neural function of the distal part, the APB, of the affected arm was reduced during continued stretching of the proximal part, shoulder and elbow joints, or all of the shoulder, elbow and wrist joints in hemiparesis patients with moderate hypertonus caused by CVD.

We experienced H-reflex may be evoked with supramaximal stimulation in patients with cerebrovascular disease (CVD). In this study, we investigated the relationship between the characteristic appearances of H-reflex and F-wave with increased stimulus intensity and neurological signs. We examined the H-reflex and F-wave of the affected arm with increased stimulus intensity during muscle relaxation in 31 patients (17 males and 14 females) with hemiparesis caused by CVD. Mean patient age was 56.0 (range 30-82) years. 30 healthy subjects, mean age of 56.2 (range 28-80) were investigated using the same method as controlled group. H-reflex and F-wave with increased stimulus intensity after the median nerve stimulation at the wrist were recorded from the opponence pollicis muscle on the affected side in patients with CVD or right arm in the healthy subjects. Appearance patterns of the H-reflex and F-wave with increased stimulus intensity was separated into four types. Type 1: F-wave appeared with increased stimulus intensity, but there was no H-reflex. Type 2: H-reflex and F-wave both appeared with increased stimulus intensity, but the F-wave followed disappearance of the H-reflex with increased stimulus intensity. Type 3: H-reflex and F-wave both appeared with increased stimulus intensity, but the F-wave appeared during the H-reflex with increased stimulus intensity. Type 4: Only the H-reflex appeared with increased stimulus intensity, but there was no F-wave. Neurological findings including muscle tone and tendon reflex were also evaluated. Findings on muscle tone and tendon reflex were classified into increased (markedly, moderately and slightly), normal and decreased. Results were analyzed as follows; 1) The characteristic appearances of H-reflex and F-wave in the healthy subjects and 2) The relationship between characteristic appearances of waves with increased stimulus intensity and neurological signs in patients with CVD. 1) Pattern of the H-reflex and F-wave with increased stimulus intensity in all healthy subjects were type 1. 2) Patterns of the H-reflex and F-wave with increased stimulus intensity in patients with markedly increased muscle tone and tendon reflex were almost always type 4. Those with moderately increased signs in this parameter demonstrated type 2 or 3. Those with slightly increased signs in this parameter demonstrated type 1 or 2. Those with normal or decreased signs were type 1. These findings suggest that the characteristic appearances of the H-reflex and F-wave was influenced by grade of neurological signs.

We evaluated the pharmacological profiles of (2R)-N-[1-(6- aminopyridin-2-ylmethyl)piperidin-4-yl]-2-[(1R)-3,3-difluorocyclopentyl]-2-hydroxy-2-phenylacetamide(compound A), which is a novel muscarinic receptor antagonist with M(2)-sparing antagonistic activity. Compound A inhibited [(3)H]NMS binding to cloned human muscarinic m1, m2, m3, m4, and m5 receptors expressed in Chinese hamster ovary cells with K(i) values (nM) of 1.5, 540, 2.8, 15, and 7.7, respectively. In isolated rat tissues, compound A inhibited carbachol-induced responses with 540-fold selectivity for trachea (K(B) = 1.2 nM) over atria (K(B) = 650 nM). In in vivo rat assays, compound A inhibited acetylcholine-induced bronchoconstriction and bradycardia with intravenous ED(50) values of 0.022 mg/kg and/=10 mg/kg, respectively. Furthermore, in dogs, compound A (0.1-1 mg/kg p.o.) dose dependently shifted the methacholine concentration-respiratory resistance curves. In mice, compound A (10 mg/kg i.v.) did not inhibit oxotremorine-induced tremor. The brain/plasma ratio (K(p)) of compound A (3 mg/kg i.v.) was 0.13 in rats; this K(p) was less than that of scopolamine (1.7) and darifenacin (0.24). The inhibition of compound A (3 mg/kg i.v.) on ex vivo binding in rat cerebral cortex was almost similar to that of NMS. These findings demonstrate that compound A has high selectivity for M(3) receptors over M(2) receptors, displays a potent, oral M(3) antagonistic activity without inhibition of central muscarinic receptors because of low brain penetration. It is well known that central muscarinic antagonists may have diverse CNS effects, and M(2) receptors regulate cardiac pacing and act as autoreceptors in the lung and bladder. Thus, compound A may have fewer cardiac or CNS side effects than nonselective compounds.

Glycated lipoproteins, which elevate the blood in diabetic patients, cause direct attenuation of endothelial function. Increased glycation of apolipoproteins may play a trigger role in the accelerated development of atherosclerosis in the patient with diabetes. Here we assessed whether glycated lipoproteins affect on the endothelial function with particular emphasis on the role of reactive oxygen species in vitro. Incubation of human aortic endothelial cells(HAEC) with glycated LDL had little influence on the expression of antioxidant enzymes such as nitric oxide synthase(NOS), Cu2+Zn(2+)-superoxide dismutase (Cu2+Zn(2+)-SOD), catalase, and p22 phox in the cells. In contrast, exposure of glycated HDL induced a marked decrease of Cu2+Zn(2+)-SOD, catalase, and endothelial NOS as well as a slight increase of p22 phox in HAEC in term of both protein and mRNA expression, suggesting that increased formation of reactive oxygen species such as O2- and OH radical participate in the deterioration for the function of vascular endothelial cells in diabetic patients.

We reported a case of successful aortic arch replacement using selective cerebral perfusion for ruptured distal aortic arch aneurysm (DAAA) with cardiac tamponade. A 80-year-old man who had preoperative episode of severe chest pain. Computed tomography showed saccular DAAA and pericardial effusion. He was diagnosed as ruptured DAAA with hemorrhagic cardiac tamponade. We performed urgent graft replacement of the aortic arch using selective cerebral perfusion. Postoperatively he had no complication. Thirty days after the operation he was discharged from the hospital and he is now leading a normal life.

The report describes our experience in establishing CT image transmission of ruptured thoracic aortic aneurysm to Gifu university hospital on the Internet. In this emergent case CT image transmission to the cardiovascular surgent provided medical informations in detail, which is very useful to decide the operative method and to prepare the assist circulation devices for the operation before the patient get to the hospital by ambulance. The Internet may prove to be major vehicle for telemedicine, consulting the professionals located in remote clinical institute.

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.

We examined the levels of reactive oxygen-related enzymes in human umbilical vein endothelial cells cultured with high concentrations of glucose, in vitro. From the results, elevated levels of catalase mRNA and its protein were exhibited in the presence of higher glucose. In addition, the message level of p22-phox as the active center of NADPH oxidase, was slightly increased. Taken together, the endothelial injury induced by diabetes may associated to the elevated level of O2- production. However, the level of catalase as .OH scavenger was mainly increased, cooperatively.

During the period of investigation from Sept. 4, 1994 to Dec, 1996, a total of 11,446,534 overseas travellers were quarantined at Kansai Airport Quarantine Station, and 22,187 voluntarily reported of episodes suffering from diarrhoea. Bacteriological examination of the stools a total of 9,299 individuals' was performed, and the following results were obtained. 1) Various enteropathogenic bacteria were isolated from 33.3% of the stools examined. Bacterial species isolated were as follows: Plesiomonas shigelloides, 2,066 cases (66.7%); Vibrio parahaemolyticus, 358 cases (11.6%); Aeromonas sobria, 360 cases (11.6%); Shigella spp., 291 cases (9.4%); Salmonella spp., 183 cases (5.9%); A. hydrophila, 126 cases (4.1%); and V. cholerae non-O1, 121 cases (3.9%). However, ETEC was not done with an object of test. 2) In 502 cases (16.2%), plural enteropathogenic bacteria were isolated from single patient, suggesting high frequency of a mixed infections. 3) From Feb. to Mar. 1995, thirteen cases cholera were found from patients who had travelled to Bali, Indonesia. Cases with enteropathogenic bacteria other than V. cholerae O1 were found without any seasonal variation. 4) The major regions where the travellers were infected with the pathogens are as follows: Vibrio spp., were from only Asia; Shigella, widely distributed but especially in India and Indonesia; P. shigelloides and Salmonella, widely distributed. 5) Among the Shigella strains, S. sonnei were isolated the most, followed by S. flexneri, S. boydii and S. dysenteriae. A strain of S. boydii provisional serovar E 16553 was isolated from a patient infected in India. 6) Among the Salmonella serovars, Salmonella Enteritidis was isolated the most frequently (49 cases, 25.7%). 7) 265 (89.2%) of 297 Shigella strains, 52 (27.2%) of 19] Salmonella strains, and 19 (95.0%) of 20 V. cholerae O1 were resistant to one or more drugs tested (SM. CP. TC. KM. ABPC. NA. OFLX). 8) All of the 20 V. cholerae O1 strains were Ogawa, E1 Tor. All of them were toxigenic strains. 9) The most frequently isolated serovar of V. parahaemolyticus was O3: K6. 89.8% of all V. parahaemolyticus strains were positive for thermostable direct hemolysin (TDH) gene, and 14.6% of them were positive for TDH-related hemolysin (TRH) gene by DNA-probe or PCR method.

We report on a 31-year-old man with a mediastinal neurilemmoma originating in the right phrenic nerve. The patient was admitted because of abnormal chest X-ray shadows observed during a routine checkup. A preoperative diagnosis of bronchial cyst in the mediastinum was made. The tumor was resected by video-assisted thoracic surgery. It was 3 x 4 x 3 cm in size, weighted 15 g, and originated in the right phrenic nerve. The histopathologic diagnosis was mediastinal neurilemmoma. Only 14 cases have been reported in the Japanese literature.

Behçet's disease is a systemic disease characterized by oral aphta, genital ulcer, and ocular lesion. Arterial involvement is an uncommon complication of Behçet's disease, and it most frequently affects the abdominal aorta followed by the femoral artery and the pulmonary artery. Coronary lesions in Behçet's disease have been little reported in the literature. In this communication, we present a case with coronary artery stenosis and with subsequently developed supra-renal abdominal aortic aneurysm. The coronary lesions were revasculized with gastroepiploic artery, right internal mammary artery, and saphenous vein graft. Abdominal aortic repair was performed with partial cardiopulmonary stand by, because of the risk of coronary ischemia during the cross clamp including the celiac artery. To our knowledge, this is the first report of successful repair of combined lesions of the coronary and the abdominal aorta in a patient with Behçet's disease.

Reflecting a trend toward reconsideration of medical care which concentrates only on the treatment of disease, a new paradigm of "palliative care" has recently been developed with a focus on the treatment of cancer patients. As part of our palliative care program, we have provided an "outpatient salon" for outpatients in the Department of Radiology of this hospital. The goal of the outpatient salon is to assist patients who live at home in coping with their disease. We regard this outpatient salon as a preparatory step in establishing a palliative day care center to support patients and their families at home and to improve patient QOL. Currently, two staff members are acting as counselors at the salon, and most of the patients visiting the salon are breast cancer patients. The salon appears to provide the following benefits to patients: 1) self-assurance, by allowing them to talk to others about their problems, 2) development of self-help skills, through involvement with other patients, 3) a place to relax, and 4) comfort from focusing. We have two future goals: to develop the salon into a day care center, and to nurture a self-help group within the salon.

Regarding the changing trends in the concept, definition, etiological classification, and criteria for diagnosis of amblyopia, we reviewed a total of 4,693 cases of amblyopia seen during the past 37 years. The amblyopia was divided into four types: strabismic, anisometropic, ametropic, and form vision deprivative. There was a definite trend for the incidence to decrease and for the diagnosis to be made during earlier age in recent years. Although favorable recovery of visual acuity is obtained after treatment of amblyopia and strabismus, there are difficulties in obtaining good binocular functions in early-onset amblyopia and strabismus. This feature was evaluated in regard to motion perception asymmetry (MPA) and binocular depth from motion (DFM). Many cases of early-onset amblyopia and strabismus showed no disparity stereopsis, or position stereopsis, in spite of the presence of DFM. The MPA appeared to be closely related to early-onset esotropia regardless of age, while it disappeared and motion perception became symmetric 4 to 5 months after birth in normal infants. The DFM seemed to play an important role in maintaining good motor alignment for several years after surgery. I developed a checkerboard pattern stimulator in 1978. This method proved to be useful in developing binocular functions and motor alignment by applying simultaneous bifoveolar stimulation and anti-suppression. Extensive exposure to the stimulation was essential for therapeutic success.

A case of 48-year-old man, with diffuse arterioportal fistula (APF) considered congenital in origin, is described. The patient presented with recurring intractable variceal hemorrhage which was treated by endoscopic ligation or sclerotherapy. In this case, gastroduodenal artery and branches of mesenterial artery were diffusely involved, so these lesions could not be resected. Portocaval shunt between the superior mesenteric vein and the right iliac vein was successfully performed. Follow-up endoscopic examination one year later revealed no evidence of esophageal and gastric varices. To our knowledge, this is the second case in which a patient underwent portocaval shunt successfully for congenital APF.

A 20 year-old female was admitted to our department because of an abnormal shadow in chest roentgenogram on a physical check-up. The barium swallowing study revealed an oppression of the middle of the esophagus. Endoscopy, chest CT and MRI failed to distinguish submucosal tumor from mediastinal tumor. Endoscopic ultrasonography showed the mass originated from the esophagus and a diagnosis of esophageal smooth muscle tumor was obtained. The tumor was tried to resect by thoracoscopic surgery but was failed because of its shape like a tortoise shell. The tumor was resected through the right thoracotomy and the diagnosis was confirmed histopathologically.

Cases of constrictive pericarditis per a institute is few for decrease of this disease. Therefore for surgical management of constrictive pericarditis, it has not been clear whether cardiopulmonary bypass during operation is necessary or not, and the reports of long term results are few. We gathered information by questionnaires from thirty-four institutes, which constitute Tokai Cardiovascular Surgeons Conference in Shizuoka, Aichi, Mie and Gifu Prefecture, for surgical management of constrictive pericarditis, and investigated its results. Etiology of constrictive pericarditis is idiopathic (49%), tuberculosis (29%) or post open heart surgery (10%). Hospital death included operative death is 14%, and postoperative liver complications was many next to heart complications. The cases, whose NYHA functional class at discharge did not improve compared with preoperative state, was 33%. At one year after operation two third of them improved in NYHA functional class, but the others did not improved.

A 47-year-old female with localized fibrous pleural mesothelioma arising from the visceral pleura of S2 of rt-upper lobe is reported. We demonstrated an indirect radiographic sign of pedunculation which was the change in position of the mass with the change in patient's position. The tumor was completely extirpated with a partial resection of the adjacent lung tissues through thoracotomy. Histopathologically, the tumor consisted of collagen fibers and small amount of fibroblast. Localized fibrous mesothelioma was recognized as benign with good prognosis. However, a few cases showing recurrence after resection were reported among them. So it was considered that this patient should be followed up carefully.

We studied aging of the blue cone mechanism by measuring increment thresholds for detection of a small blue flash of light (439 nm, 1 degree, 50 ms duration) on a second flashed light of identical color, (139 nm, 2 degrees, 500 ms duration) in 30 subjects. Simultaneously, a large yellow adapting field was presented. Subjects, consisting of 17 normal cases, 13 cases with refraction errors under 3 diopters, 11 myopes, and 2 hyperopes, with 1.0 or better corrected visual acuity, were divided into 4 groups by age. The control group consisted of 11 cases under 30 years, group I, 7 cases in their forties, group II, 6 cases in their fifties, and group III, 6 cases over 60 years. Best fitting exponential curves were calculated for this phase of the blue mechanism and averaged threshold curves for each group were evaluated. The averaged threshold curve in group I showed an upper shift, that is, an increase in the threshold alone. Curves in groups II and III demonstrated an upper right shift, with increased thresholds in both the blue flash and the yellow background. Together with decreased function of the blue cone mechanism, the shift of curves in the elderly groups is probably caused largely by yellowing of the crystalline lens.

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.

In aortic arch replacement, cerebral protection has been achieved by means of deep hypothermia associated with complete circulatory arrest, selective cerebral perfusion (SCP), or retrograde cerebral perfusion (RCP). We describe our results of the investigation with questionnaire to the institutes registered with the Tokai Cardiovascular Surgeons Conference in 1994. In 23 institute, surgical procedures of aortic arch were performed for 333 cases from 1989 to 1994, which were consisted of 126 cases of true atherosclerotic aneurysm and 206 cases of dissecting aneurysm. Cerebral disorders occurred in 11% (37/333). The incidence of cerebral disorders was significantly higher in patients with RCP methods (16%, 18/111), than SCP method (7%, 15/204, p0.05). In patients who had dissecting aneurysm, the incidence of cerebral disorders was 6% with SCP method (7/126) and 21% with RCP methods (14.66), respectively (p0.05). The cerebral disorders with RCP methods were most frequently caused by the malperfusion. In atherosclerotic cases, the causes of the cerebral disorders were mainly the embolic disorders.

The association of Epstein-Barr virus (EBV) with 85 non-Hodgkin lymphomas of the digestive tract in nonimmunocompromised cases was investigated, using in situ hybridization technique to detect EBV encoded small RNAs in paraffin sections. 85 cases (83 B-cell type and 2 T-cell type) included 3 gingivas, 1 tongue, 3 palates, 10 tonsils, 43 stomachs, 2 jejunums, 12 ileums, 3 ileo-cecal regions, 5 colons and 3 rectums. Out of 85 cases, 4 (4.7%) were EBV-positive, comprising 1 B-cell lymphoma of the tonsil, 2 B-cell lymphomas of the stomach, and 1 T-cell lymphoma of the rectum. On the other hand, EBV-positive rate in nasal/nasopharyngeal lymphomas examined for comparison was very high, 81.8% (9 out of 11). These results show that EBV is associated with only a small proportion of lymphomas of the digestive tract in nonimmunocompromised case, suggesting the existence of the other oncogenetic factors in the pathogenesis of this group of lymphomas.

A 72-year-old woman was admitted to our hospital because of hemosputum. Enhanced CT showed ruptured true aortic arch aneurysm. True aortic arch aneurysm ruptured at distal portion of aneurysm. The aorta was chronically dissected from an entry proximal to ruptured portion, to ascending aorta. Ascending aorta to aortic arch was replaced with 20 mm gelatin sealed graft under selective cerebral perfusion with hypothermia. Post-operatively tracheostomy was done because of respiratory failure, and there was some leak from distal anastomosis portion which was 42 mm in diameter at the operation. So replacement of descending thoracic aorta was performed using elephant trunk of the previously replaced graft. Post-reoperative course has been uneventful. She weaned from respiratory support. True aortic arch aneurysm combined with Stanford type A dissection is very rare. We presented ruptured true aortic arch aneurysm in association with Stanford type A chronic dissection which had an entry in true aneurysm.

Reoperation of a pseudo aneurysm eroding the sternum was carried out in a 76-year-old female, using partial cardiopulmonary bypass and hypothermic circulatory arrest of the brain through left thoracotomy. The pulsating aneurysm protruding over the sternum was about 3.5 x 3.5 cm in size. Therefore, median sternotomy was thought to be risky. Cardiopulmonary bypass was established with left atrium and pulmonary artery for venous cannulation and femoral artery for arterial one. The patient was cooled and then the bypass discontinued. Previous patcth of the aneurysm was partially splitting and new patch was sutured. She awaked without cerebral injury of the operative day. This technique can be used as one of an alternative surgical method in the treatment of the distal aortic arch aneurysms.

During the last 2 years and 8 months before the closure of Osaka Airport Quarantine Station (from Jan. 1992 to Sep. 3, 1994), a total of 7,421,909 overseas travellers were quarantined. 15,919 reported themselves of suffering from diarrhoea. Bacteriological examination of a total of 6,031 individuals' stools were performed. 1) Various enteropathogenic bacteria were isolated from 31.2% of the stools examined. Isolated species were as follows: Plesiomonas shigelloides, 1,127 cases (59.9%); Vibrio parahaemolyticus, 293 cases (15.6%); Salmonella spp., 262 cases (13.9%); Shigella spp., 235 cases (12.5%); Aeromonas sobria, 93 cases (4.9%); V. cholerae non-O1, 69 cases (3.7%). 2) The enteropathogenic bacteria were isolated through out the year without any seasonal variation. 3) The major regions where the travellers were infected with the pathogens are as follows: V. cholerae non-O1 (NAG Vibrio) and enteropathogenic Escherichia coli, South-East and South-West Asia; Vibrio other than NAG, South-East and East Asia; Shigella, widely distributed but especially in India; P. shigelloides and Salmonella, widely distributed. 4) 2 strains of toxigenic (cholera toxin-producing) V. cholerae O139 were isolated from patients who had visited Indonesia and Thailand, respectively. 5) In 320 cases (17%), plural enteropathogenic bacteria were isolated from single patients, suggesting a high frequency of the mixed infections. 6) Among Shigella strains, S. sonnei were isolated the most, followed by S. flexneri (24.7%), S. boydii (8.8%) and S. dysenteriae (2.9%). 7) Among Salmonella serovers, Salmonella Enteritidis was isolated the most frequently (39 cases, 14.1%). 8) 218 (91.6%) of 238 Shigella strains and 103 (37.6%) of 276 Salmonella strains were resistant to one or more drugs tested (SM.CP.TC.KM.ABPC.NA.OFLX). 9) All of the 22 V. cholerae O1 strains were Ogawa, E1 Tor. Among them, 19 were toxigenic strains and 3 were non-toxigenic. 10) O4:K8 was the most frequently isolated serover of V. paraemolyticus. 87.4% of all V. parahaemolyticus strains were positive with thermostable direct hemolysin (TDH) gene, and 12.6% of them were positive with TDH-related hemolysin (TRH) gene by DNA-probe methods.

The vocal tract from the glottis to the lips is considered to he a resonator and the voice is changeable depending upon the shape of the vocal tract. In this report, we examined the change in pharyngeal size and acoustic feature of voice after tonsillectomy.Subjects were 20 patients. The distance between both anterior pillars (glossopalatine arches), and between both posterior pillars (pharyngopalatine arches) was measured weekly. For acoustic measurements, the five Japanese vowels and Japanese conversational sentences were recorded and analyzed.The distance between both anterior pillars became wider 2 weeks postoperatively, and tended to become narrower thereafter. The distance between both posterior pillars became wider even after 4 weeks postoperatively. No consistent changes in F0, F1 and F2 were found after surgery. Although there was a tendency for a decrease in F3, tonsillectomy did not appear to change the acoustical features of the Japanese vowels remarkably. It was assumed that the subject may adjust the shape of the vocal tract to produce consistent speech sounds after the surgery using auditory feedback.

Among 172 cases of coronary artery bypass grafting, 9 cases (5%) revealed severely atherosclerotic ascending aorta. In 3 of the 9 cases, total aortic cross-clamping in the distal anastomoses of saphenous vein graft (SVG) and partial aortic clamp in the proximal anastomoses of SVG were performed. In 1 case with this technique, cerebral infarction was occurred. In 4 cases, total aortic cross-clamping in the distal and proximal anastomoses of SVG was performed. In 2 of these cases with this technique, cerebral infarctions were occurred. Hypothermic circulatory arrest was performed in 2 of the rest. In one case that was predicted to have atherosclerosis of ascending aorta prior to operation, the left internal thoracic artery was anastomosed to the left anterior descending, and SVG to the right coronary artery with hypothermia and ventricular fibrillation. And during the proximal anastomoses of SVG, hypothermic circulatory arrest without aortic clamping was initiated. In another case, atherosclerosis of ascending aorta was noted after aortic cross-clamping. Then the aorta was declamped, hypothermic circulatory arrest was established, the aorta was opened, the diseased segment was resected, and proximal anastomoses of SVG was performed to Dacron patch which was implanted for aortic wall. There were no cerebral infarction in last two patients.

We reviewed our experience for 6 patients of chronic dissecting aortic aneurysm (DeBakey type IIIb) with the false lumen extending into the abdominal aorta and the renal arteries being perfused from the false lumen. In three cases, whose abdominal aorta presenting with large aneurysmal lesions, we performed graft replacement of the thoracic descending aorta and abdominal aorta simultaneously. In other three cases, whose abdominal aorta presenting without aneurysmal lesions, and moreover age advanced or perioperative conditions poor, we performed graft replacement of thoracic descending aorta, using double barreled distal anastomosis technique to ensure of enough blood flow into both true and false lumens. All patients survived and there were no early postoperative complications. In 3 cases of thoracic aortic replacement alone, the mean follow-up term was 38 months, postoperative computed tomography showed neither apparent expansion of the false lumen nor compression of the true lumen of the abdominal aorta, and postoperative renal function were maintained. In conclusion, in treatment of chronic dissecting aortic aneurysm (DeBakey type IIIb) presenting with compromised renal perfusion, we considered that replacement of the thoracic descending aorta and abdominal aorta brings patient the most radical improvements. But in the patients, who are elder or in poor perioperative conditions, the replacement of thoracic descending aorta using double barreled distal anastomosis technique is one easier applicable and safer procedure to preserve the renal perfusion.

A 73-year-old man with aortic arch aneurysm combined with atherosclerosis obliterance underwent aortic arch replacement. As he had bilateral femoral artery obstruction, we instituted ECC with arterial perfusion through the ascending aorta. Then, the left ventricle started dilating due to mild degree of aortic regurgitation. So with selective cerebral perfusion, we perfused the lower half of the body through a Foley balloon catheter which was inserted from the aortic arch antegradely. We could perfuse with the catheter for 20 minutes for core cooling and then during repair until the catheter disturbed the operation. The Foley catheter had given us some difficulties for handling during the procedure. Based on this experience, we have made a catheter which had both a balloon for aortic occlusion and a tube for perfusion and which we could keep away from operative fields, similar to the way we used antegradely insertable aortic occlusion balloon catheter.

This study evaluated (1) a screening method for ischemic heart disease (IHD) using transesophageal atrial pacing (TEP), and (2) the appropriate surgical therapy for patients with concomitant IHD which was evaluated on the basis of the coronary score (CS) by Leaman. Thirty-nine patients with arteriosclerosis obliterans of the lower extremities (ASO) and 35 with aortic aneurysm underwent TEP and coronary angiography (CAG). Coexistent IHD was diagnosed in 25 patients (64%) with ASO and in 14 (40%) with aortic aneurysm. Screening for IHD by TEP was 96% sensitive, 71% specific, and 87% accurate in patients with ASO, and 79% sensitive, 90% specific, and 86% accurate in patients with aortic aneurysm. Coronary artery bypass grafting (CABG) and peripheral arterial revascularization (PAR) were performed by one stage surgery in 3 patients with a CS of 16 or more. In 18 patients with a CS of 5.5 or less, only PAR was performed. One stage surgery was performed in 6 patients with aortic aneurysm. Four patients had a CS of 9.5 or more, and 2 patients with coexistent stenosis of the left anterior descending branch (LAD) had CS of 3.5 and 8, respectively. Repair of the aneurysm was undertaken in 5 patients with a CS of 8 or less without LAD disease. In patients with ASO showing a CS of 5.5 or less and in those with aortic aneurysm showing a CS of 8 or less (and without LAD disease), the only surgical procedure performed was either PAR or repair of the aneurysm. There were no complications attributable to IHD observed in these patients during the perioperative period.

The patient was a 42-year-old man whose main complaints were ptosis, diplopia and muscle weakness. Chest X-ray film revealed a right hilar mass and chest CT showed a solid mass at right anterior superior mediastinum. Laboratory studies revealed myasthenia gravis (MG) on EMG and pure red cell aplasia (PRCA) on hematology. An extended thymectomy, including the thymoma, was performed. Thrombocytopenia appeared postoperatively, but it improved when a platelet transfusion was given. Steroid was administered for postoperative adjuvant therapy, and the MG and PRCA were alleviated. This rare case of simultaneous MG and PRCA as complications of a thymoma is reported.

Partial splenic embolization was performed in a case of Felty's syndrome in 1980. The granulocyte count has since remained normal without serious infections for the 10 years after the procedure. This is the first report of partial splenic embolization in this syndrome. This treatment may have an advantage over splenectomy because the defense mechanisms of the spleen are preserved and overwhelming infections may occur less frequently.

Clinical treatment of urolithiasis with Alexandrite-laser which is a solid pulse laser system developed in Switzerland is reported. Two cases of renal stones, 3 cases of vesical stones, and 35 renal units in 34 cases of ureteral stones were treated. The approach to the aimed stone was, percutaneous to the renal stones, and transurethral to the vesical and ureteral stones. The clinical success rate was 92.5% (37/40), when we defined success as the endoscopically observed fragmentation. The uric acid stone in the bladder was not disintegrated even when the plasma occurred, but the ureteral uric acid stone was easily fragmented. The difference was thought to be attributed to the condition of the surface. The Alexandrite-laser system generates a 750 nm wavelength, and this wavelength is neither absorbed in water nor hemoglobin, so is thought to be harmless to the tissue. Actually, if misirradiation to the ureteral mucosa during lithotripsy was done, neither plasma formation nor perforation occurred. In conclusion, the Alexandrite-laser is thought to be safe and effective equipment for the treatment of urolithiasis.

A 38-year-old woman was admitted because of left pneumothorax on March 16, 1991. She had undergone modified radical mastectomy in Dec. 1986. Chest roentgenogram on admission show a tumor shadow in the left upper lobe. She was diagnosed to have pneumothorax due to metastatic lung tumor. She underwent left upper lobectomy. Histologically poorly differentiated papillotubular adenocarcinoma was found and the cause of pneumothorax was thought to be necrosis of the tumor and direct invasion of the pleura.

Profound hypothermia with elective ventricular fibrillation and total circulatory arrest was used in a patient undergoing coronary artery bypass grafting (CABG) with severe calcification of the ascending aorta. A 76-year-old woman with unstable angina was referred for coronary revascularization. Ascending aorta was severely calcified with the exception of limited region of proximal ascending aorta, and the coronary arteriography showed high-grade obstruction of the left anterior descending (LAD) and dominant right coronary artery (RCA). The left internal thoracic artery was anastomosed to the LAD, and the saphenous vein graft to the RCA under systemic moderate hypothermia and elective ventricular fibrillation. During the proximal anastomosis of the saphenous vein graft to the non-calcified ascending aorta, profound hypothermia and circulatory arrest was instituted for 11 minutes. The wean from extracorporeal circulation was successful, and the postoperative course was uneventful.

Swyer-James syndrome is considered to be a relatively uncommon disease entity presenting with unilateral hyperlucent lung due to hypoplasia of a pulmonary artery and bronchiectasis of the affected lung. Association of bronchogenic carcinoma with Swyer-James syndrome has not apparently been reported in any previous literature, except for one Japanese case. In the present paper, we describe a 48-year-old male individual, who developed poorly differentiated squamous cell carcinoma of the right upper lobe bronchus after he had been diagnosed to have Swyer-James syndrome with unilateral hyperradiancy of the left lung. It is suggested that the bronchial epithelium of the unaffected lung in Swyer-James syndrome is likely to be more exposed to extrinsic carcinogens than that of the affected, underventilated lung, hence resulting in a higher risk of developing bronchogenic carcinoma.

The threshold versus intensity curve with brief blue stimuli with a flashing background of the same wavelength was measured in normal subjects and subjects with several kinds of optic nerve and retinal diseases. In young normal subjects the threshold curve rose sharply away from the line measured under the same conditions but without flashing blue background, as has been reported in measurements with light of long wavelengths. In the convalescent stage of optic neuritis, diabetic retinopathy, and central serous chorioretinopathy, the threshold curves presented two patterns; one pattern was shifted upward and the other shifted upward and to the right. We suggest that this method with short wavelength light is useful in differentiating retinal diseases from the change of optic media, and for layer-by-layer diagnosis of retinal diseases.

There are few reports on the assessment of left ventricular contraction during cardiopulmonary bypass (CPB) in open heart surgery. LV Emax is thought to be a load-independent index of left ventricular function. We used a left ventricular conductance catheter to measure LV Emax from "non-working beating heart" during CPB in 16 patients who underwent open heart surgery. During CPB, at 45 minutes after aortic declamping, changes of heart rate with atrial pacing (120/min) did not change LV Emax, but after intravenous dobutamine administration (DOB, 10 micrograms/kg/min) LV Emax increased by 26% (p0.01). DOB increased LV Emax in 14 of 16 patients during CPB. These 14 patients were weaned from CPB without difficulty. But in 2 other patients DOB didn't increase LV Emax during CPB. In order to be weaned from CPB, the two patients needed epinephrine and intraaortic balloon pumping. We concluded that change of LV Emax made by intravenous administration of dobutamine is one of useful indexes to assess left ventricular contractility during cardiopulmonary bypass.

Primary tumors of the heart are rare, with the most common being myxoma, although myxoma of ventricular origin are uncommon. A careful review of the literature showed that 72 patients worldwide had cardiac myxomas located in the right ventricle. A 13-year-old asymptomatic girl with no previous history of cardiac disease was referred to a local hospital for evaluation of a heart murmur detected during a routine medical examination. Right ventricular myxoma was diagnosed and confirmed by echocardiogram, angiocardiography, CT, and MRI, MRI was firstly performed of right ventricular myxoma, and that showed right ventricular myxoma and the myocardium at the same intensity. Surgery was performed by first opening the right atrium. A lobulated mass was visualized through the tricuspid valve. Using a long needle, we confirmed that the wall was attached to the pedicle of the myxoma. Right ventriculotomy was subsequently performed in this region. The mass was passed through the tricuspid valve, and was reseated along with surrounding myocardium but with minimal excision of the right ventricular wall. The excised myxoma weighed 11 g, and had developed a short and small pedicle (5 mm x 5 mm) on the free wall and septum of the right ventricle. The patient recovered uneventfully and was discharged two weeks after the operation.

There are few reports on the assessment of the left ventricular function from left pressure-volume relationships intraoperatively in open heart surgery. LV Emax, Ea/Ees and EW/PVA efficiency were assessed intraoperatively by using a left ventricular conductance catheter in patients with aortocoronary bypass. After dobutamine administration (DOB, 10 micrograms/kg/min), LV Emax was increased by 33 +/- 23% during cardiopulmonary bypass (CPB) and 60 +/- 38% after weaning from CPB. Ea/Ees changed from 2.14 +/- 1.36 to 1.08 +/- 0.47 after weaning from CPB with dobutamine administration. EW/PVA efficiency changed from 52 +/- 12% to 66 +/- 10%. The change of LV Emax after dobutamine administration was correlated with the change of LV Emax after weaning from CPB and was correlated with Ea/Ees and EW/PVA efficiency after weaning from CPB. We concluded that measuring LV Emax before and after dobutamine administration during CPB is useful to assess left ventricular contraction clinically.

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 43-year-old man was pointed out an abnormal shadow on chest X-ray film. Chest CT showed a solid mass and a cyst at anterior superior mediastinum. Operation revealed a capsulated thymoma and a multilocular thymic cyst. PTH and CA19-9 level in the cystic fluid was elevated. Histological examination demonstrated the clear separation of the mixed type thymoma and the thymic cyst. There were few reports for cases of thymoma with a thymic cyst.