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A comparative study between left heart bypass with a centrifugal (BioMedicus) pump and with a temporary external shunt was performed to assess the efficacy of distal organ perfusion in the surgical treatment of 31 patients with aneurysm of the descending thoracic aorta. Eighteen patients were supported with a centrifugal pump, and the remaining 13 were supported by temporary shunt with either a Gott shunt or a Dacron graft. Heparinless bypass with a centrifugal pump provided a significant decrease of intraoperative blood loss and blood transfusion by the combined application of Cell-Saver. The pressure difference between upper and lower extremities decreased (p < 0.05) in the centrifugal pump group even with aortic cross-clamping, and the urine output increased during operation. Among 13 patients supported with the temporary shunt, 3 had postoperative renal failure, and 2 died of it. All patients with a centrifugal pump survived without any complications. It could be concluded that the left heart bypass with a centrifugal (BioMedicus) pump was safe and was favorable for support of the distal circulation during aortic cross-clamping and to prevent ischemic complications such as renal failure and spinal cord injury.

Thirty-four patients with arteriosclerotic aortic aneurysm including 25 of the descending aorta and 9 of the thoracoabdominal aneurysm were divided into two groups. Group 1 consisting of 12 patients over 70 years of age, and Group 2 consisting of 22 patients under 69 years of age were compared. Preoperative complications were not significantly different between the two groups. The diameter of the aneurysm was 7.3 +/- 0.7 cm in Group 1 and 6.7 +/- 1.6 cm in Group 2. Calcification of the aorta on CT was prominent in Group 1 (82%) with presumal marked intimal change. Aortic cross clamp time was 72.5 +/- 27.3 min in Group 1 and 60.3 +/- 25.2 min in Group 2. However, in Group 1, 50% required proximal clamping between the left common carotid artery and left subclavian artery. Overall operative mortality for Group 1 was 41% versus 13% in Group 2. The causes of death in Group 1 were intraoperative dissection of the aorta, intraoperative myocardial infarction, intraoperative cerebral infarction, acute embolism of the superior mesentric artery, and pneumonia. In Group 2, excluding two cases of rupture, only one patient died of acute renal failure. In conclusion, patients over 70 years of age died of embolism related to aortic clamping. Thus surgical results may be improved by devising an aortic cross clamp method.

A prostaglandin I2 (PGI2) analogue and superoxide dismutase (SOD) were administered to dogs with pulmonary denervation, and their effects on warm ischemic damage to the lung were studied. Twenty-seven adult mongrel dogs were divided into a control group (6 dogs), a PGI2 group (7 dogs), an SOD group (6 dogs), and a heparin group (8 dogs). The left pulmonary hilum was dissected, with PGI2 (1 microgram/kg) being administered to the PGI2 group and heparin (100 U/kg) to the heparin group. Then the left lung was placed in a warm ischemic state for 1 hour. The SOD group also received 20 mg/kg of SOD intravenously 1 minute before reperfusion. Before warm ischemia, immediately after reperfusion, and 1 hour and 2 hours afterward, the blood gases, left pulmonary vascular resistance, and other data were measured under right pulmonary artery clamping. Arterial oxygen tension showed significantly better values in the SOD and PGI2 groups than in the control and heparin groups. The left pulmonary vascular resistance increased with time in the control group but did not increase in the PGI2 group. Pulmonary microangiography showed that dilatation of the pulmonary arterioles was prominent in the PGI2 group. The quantity of pulmonary extravascular fluid was significantly less in the PGI2 and SOD groups than in the control and heparin groups. Histological examination showed marked collapse of capillaries, intraalveolar hemorrhage, and edema in the control and heparin groups, whereas these changes were only slight in the PGI2 and SOD groups.(ABSTRACT TRUNCATED AT 250 WORDS)

A surgical case of diverticulum in the left ventricular apex is presented. A two-dimensional echocardiogram and magnetic resonance image showed a calcified tumor buried in the marked hypertrophied apex of the left ventricle. Enucleation of the oval and hard tumor (4 x 2.5 x 2.5 cm) was performed through the apex, and the defect was anastomosed by buttress sutures. Histologic examination demonstrated that the tumor cavity was filled with a thrombus encapsulated by thickened and calcified endocardium that extended to the left ventricular cavity. In this report, the etiology of the diverticulum with a hypertrophied myocardium is discussed.

Two surgical cases of aortic arch aneurysms are presented. Retrograde (venoarterial) cerebral perfusion during circulatory arrest under deep hypothermia was performed to evacuate air and debris in cerebral vessels and preserve cerebral tissue. On postoperative day 1, the patients were conscious and alert with no neurological deficit. This technique is simple and can be applied during standard cardiopulmonary bypass. The technique is useful to avoid cerebral air and thromboembolisms.

It is not always easy to evaluate the preoperative liver functions exactly. In this paper we report a patient who died of fulminant hepatitis postoperatively in spite of careful examination of preoperative liver functions. A 60-year-old male had severe bleeding following total cystectomy, resulting in cardiac arrest. He was resuscitated successfully but developed multiple organ failure. He came through it but thereafter he had repeated infectious episodes from uretero-cutaneous fistula and fluctuation of liver functions. Seven months later he had repair of postoperative ventral hernia. His liver functions were within normal limits except for positive HBs antigen. But eventually the patient died of acute fulminant transfusion hepatitis B 30 days after the operation. A cause of his death was, we presume, loading stress of surgical operation on the acute stage of hepatitis B. Other possible causes or deteriorating factors were drug liver injury, alcoholic chronic hepatitis, and coincidence of non A-non B hepatitis. When HBs antigen is positive in spite of normal liver function test, differential diagnosis between asymptomatic carrier and the first stage of acute hepatitis B should be made carefully.

A 29-year-old woman was referred to our hospital at the 34th week of her first pregnancy with a diagnosis of severe pregnancy-induced hypertension. A diagnosis of pheochromocytoma was made by elevated values of serum and urinary noradrenaline. Ultrasonography and computed tomography revealed a left adrenal tumor. Caesarean section combined with removal of the tumor at the 36th week of gestation was performed with a satisfactory result obtaining a healthy mother and an infant. Current management of patients with a pheochromocytoma during pregnancy is discussed.

A procedure has been developed for the isolation of cone photoreceptors from the retina of the lizard Anolis carolinensis in order to study the effects of dark- and light-adaptation on the cyclic nucleotide metabolism of these visual cells. Incubation of the retina in N2 medium with hyaluronidase and DNAase allows us to obtain intact photoreceptors with good purity (85-90%), yields (greater than 2 x 10(5) cells per retina), and more than 95% of them excluding Trypan blue. cAMP levels are 20-fold higher than cGMP levels in cells from dark-adapted animals and are decreased by 35% upon exposure to light, whereas cGMP levels show no apparent change. However, both cAMP- and cGMP-phosphodiesterases, as well as adenylate and guanylate cyclase, are activated several-fold by light, but the enzymes involved in cGMP metabolism have higher Vmaxs than the cAMP related enzymes. The apparent constant levels of cGMP found in cone photoreceptors may result from our inability to detect the very fast changes that occur in these cells when they are exposed to light.

Transient impairment of the transplanted lung in early postoperative period is one of difficult problems in lung transplantation. It is likely that reperfusion injury of the warm ischemic lung is contributory. The purpose of this study is to evaluate the effects of superoxide dismutase (SOD) on reperfusion injury of warm ischemic lung. Thirty mongrel dogs were divided into four groups. In group I (n = 6), the left lung with complete hilar stripping was placed in warm ischemic state under deflation for 1 hour. In group II (n = 9), the left lung with complete hilar stripping was kept in warm ischemic condition under inflation. Group III (n = 6) animals with same manipulation as group I received superoxide dismutase (SOD 20 mg/kg) before reperfusion. Group IV (n = 9) animals underwent same manipulation as group II and received SOD (20 mg/kg) before reperfusion. Before warm ischemia, immediately after reperfusion, and 1 and 2 hours, blood gases, left pulmonary vascular resistance were measured under the occlusion of right pulmonary artery. Extra vascular lung water content (EVLW) was measured at autopsy and lung was processed for histology. In group II, III and IV, blood gases and EVLW showed significantly better values than group I. In group I and III, left pulmonary vascular resistance increased prominently after reperfusion, however did not change in group II and IV. From these results, we concluded that inflated lung reduced the extent of pulmonary edema after reperfusion and SOD was effective in preventing warm ischemic damage even in deflated lung.

We report the successful surgical resection of a saccular aneurysm of the suprarenal abdominal aorta adjacent to the origin of the superior mesenteric artery. Reconstruction of the superior mesenteric artery with the splenic artery was a useful technique for salvaging the ischemic small intestine. However, successful surgical treatment of this type of aneurysm remains a great challenge.

A 62-year-old woman was admitted to our hospital due to congestive heart failure. On the chest X-ray film, cardiomegaly and prominent pulmonary congestion were revealed. She became well with bed rest and medication of digitalis and diuretics. Echocardiogram established the diagnosis of severe mitral regurgitation. In addition, cineangiography of the left ventricule showed cystic left ventricular aneurysm which originated from below the posterior mitral annulus. Operation was performed on July 16, 1990. Under cardiopulmonary bypass, we reflected the apex of the LV upwards, but failed to identify the aneurysm. Then, left atrium was opened through Dubost incision. As regards mitral valve structures, there were no abnormal findings except moderate enlargement of it's orifice. After resection of the mitral valve, orifice of the aneurysm (0.5 X 2.0 cm) was recognized, which was closed with the buttressed sutures. Afterwards, MVR was performed with 25 mm Medtronic Hall valve. The patient had a smooth postoperative course without complication.

The present study was undertaken to examine the potential value of cetylmannoside-modified multilamellar liposomes (Man-MLV) as carriers for transfer of macrophage activators to blood monocytes. Highly purified blood monocytes were isolated by centrifugal elutriation from healthy donors under endotoxin-free conditions. Freshly prepared monocytes phagocytosed Man-MLV to a lesser extent than monocyte-derived macrophages, but they took up Man-MLV much more effectively than control liposomes without cetylmannoside (control MLV). Phagocytosis of Man-MLV, but not control MLV by monocytes was inhibited by addition of D-mannose, but not of D-galactose. Desmethyl-muramyl dipeptide (norMDP) entrapped in Man-MLV was far more effective than norMDP entrapped in MLV in activating monocytes to the tumoricidal state. The effect of encapsulation of recombinant human macrophage colony-stimulating factor (M-CSF) in Man-MLV on prolongation of survival of monocytes was examined. Blood monocytes that had been incubated for up to 21 days with Man-MLV containing 5-20 U of M-CSF per ml were effective in prolonging monocyte survival, but monocytes that had been incubated in medium with less than 50 U/ml of M-CSF or with control MLV containing 5-10 U of M-CSF showed no increase of monocyte survival over that in medium alone. Addition of rabbit anti-M-CSF antiserum did not affect survival prolongation of monocytes by M-CSF encapsulated in Man-MLV. We conclude that liposomes modified with cetylmannoside are far more effective than unmodified liposomes as a carrier to deliver biological response modifiers to human blood monocytes.

A 62-year-old man underwent aortic valve replacement with a Medtronic-Hall valve (21 mm) for aortic stenosis and regurgitation with normal coronary arteries. An intermittent selective coronary perfusion with metal tip cannula was employed for both the coronary arteries. Postoperative course was uneventful. However, he began to complain of chest pain six months later. Cardiac catheterization and coronary arteriography revealed a normally functioning valve with 75% stenosis at the main trunk of the left coronary artery. Coronary bypass grafting using a saphenous vein was successfully performed to the left anterior descending coronary artery and the circumflex of the coronary artery. Whenever this fatal complication of the coronary ostial stenosis is recognized, earlier coronary revascularization should be recommended to save the severely ill patient.

In order to improve the early postoperative pulmonary dysfunction caused by the reimplantation response after single lung transplantation, prostaglandin I2 (PGI2) and superoxide dismutase (SOD) were administered to dogs whose left lungs were subjected to complete hilar-stripping and then exposed to warm ischemia, or resected and replaced with allograft. Doppler flow probes were placed on the ascending aorta and on the left main pulmonary artery, and a Swan-Ganz catheter was introduced into the pulmonary trunk. Twenty five dogs were divided into 4 groups. Hilar stripping of the left lung with division and reanastomosis of the left main bronchus was performed in 7 dogs (Group 1). Hilar stripping of the left lung with division and reanastomosis of the left main bronchus was exposed to additional warm ischemia for one hour in 6 dogs (Group 2). Same surgical procedure as Group 2 with additional treatment by using PGI2 (1 micrograms/min/kg for 30 min). and SOD (20 mg/kg) was performed in 6 dogs (Group 3). Single lung transplantation with PGI2, SOD and immunosuppressive treatment (CyA 10 mg/kg and AZ 4 mg/kg daily for 2 weeks) was performed in 6 dogs (Group 4). The pulmonary arterial blood flow of the left lung and the cardiac output were serially measured by means of Doppler flow method for two weeks for studying the graft function in the early postoperative period. Findings of chest X-ray films and arterial blood gases were also studied for two weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

We experienced two patients of valvular heart disease associated with Behçet's disease. First patient presented aortic regurgitation (AR) due to perforation of left coronary cusp of the aortic valve and underwent valve replacement (AVR). Second patient showed AR due to shortening of the aortic valve along with mitral regurgitation caused by dilatation of the annulus, and received AVR as well as mitral annuloplasty by Kay's method. Each patient has been doing well for 5 and 2 years after operation, respectively. Patients with Behçet's disease often have perivalvular leakage after valve replacement. We treated our patients as follows to prevent this serious postoperative complication. 1. The operation was performed when the inflammatory signs and findings subsided with enough adrenal steroids. 2. At operation, the prosthetic valve of one size smaller than the size considered suitable was selected for valve replacement. 3. The adrenal steroids have been continuously administrated and adjusted according to the values of CRP and ESR as well as the cutaneous and mucous manifestations of this disease.

It is generally accepted that operative procedures of thoracic aneurysm requires the use of some type of temporary vascular bypass when cross clamp is necessary. Past 10 years, we have used three types of temporary bypass. From 1979 to 1989, 78 patients with thoracic aneurysm were treated. In these patients, 25 patients with descending thoracic and thoracoabdominal aneurysm were divided into three groups on the basis of the type of bypass and evaluated from the point of postoperative renal function. Temporary vascular bypass using artificial graft was applied to 9 patients. Gott's shunt tube in stead of graft was used in 5 patients. Left ventricular bypass with Bio-Medics centrifugal pump was used in 11 patient. Among three groups, differences in age, diameter of the aneurysm, preoperative renal function and aortic clamp time were statistically not significant. Mean arterial pressure gradient between upper and lower extremities were 42 +/- 14 mm Hg in artificial graft group, 31 +/- 7 mm Hg in Gott group and 9 +/- 10 mm Hg in Bio-Pump group. Urine volumes during temporary bypass were 98 +/- 43 ml in artificial graft group, 120 +/- 54 ml in Gott group, 255 +/- 269 ml in Bio-Pump group. Left ventricular bypass with Bio-Medics centrifugal pump is an extremely useful method to protect renal function in thoracic aneurysm surgery.

Three advanced or recurrent thyroid carcinomas invading the adjacent surrounding organs such as trachea, great vessels or anterior mediastinum were reviewed. In one patient, resection of subtotal thyroid combined with trachea including a part of cricoid cartilage was performed, and followed with end to end anastomosis. In the other two patients with SVC syndrome, a trans-sternal surgical approach was applied in order to resect a large tumor extending into the anterior mediastinum. Replacement of SVC with ringed PTFE graft and chest wall resection was performed in one patient. With these extended surgical intervention, more operative radicality, prolonged surviving time and better quality of life were expected.

The purpose of this study is to evaluate the effect of PGI2 analogue on the warm ischemic injury in the reimplantation model of the lung. Twenty-five mongrel dogs were subjected to this experiment in which the left thoracotomy and complete left hilar stripping were performed. The dogs were divided into 4 groups. The control group (8 dogs) did not have any medical treatment. I2 1 microgram group (7 dogs) received PGI2 analogue in the amount of 1 microgram/kg/min for 30 min during hilar dissection. I2 50 ng group (5 dogs) received PGI2 analogue in the amount of 50 ng/kg/min for 30 minutes. Heparin group (5 dogs) received 100 U/kg of heparin after hilar stripping. Then left, PA, PV, and Bronchus were clamped for 1 hour to make the left lung a warm ischemic state. To evaluate the function of the left lung subjected for a warm ischemia, right pulmonary artery was occluded for 10 minutes and PaO2, PaCO2, Qs/Qt, pulmonary artery pressure, pulmonary vascular resistance, thromboxane B2, and 6-keto-PGF1 alpha were measured. Two hours after reperfusion, pulmonary microangiography and histological investigation were performed. As a result of warm ischemia, PaO2 was 158 mmHg with 70% FiO2 1 hour after reperfusion in control group, whereas it was maintained at as high as 299 mmHg in I2 1 microgram group. PaCO2, Qs/Qt, pulmonary artery pressure, as well as the pulmonary vascular resistance were almost normal throughout the experiment in I2 1 microgram group, but they gradually elevated in control group during the experiments. In the other two groups these parameter are not so satisfactory as in I2 1 microgram group.(ABSTRACT TRUNCATED AT 250 WORDS)

Deficient cGMP-phosphodiesterase (cGMP-PDE) activity results in elevated levels of cGMP in the rd retina before any pathological signs are observed. Since the enzyme is present in rd retina, although it is barely activated by light, we determined whether its synthesis starts at the same time as that of cGMP-PDE in normal retina, or if either its synthesis is halted or degradation of the enzyme increases before the degeneration of the visual cells. We found that synthesis of cGMP-PDE in rd retina is comparable with that in normal retina while the photoreceptors are viable but that cGMP-PDE content is lower than that of normal retina before the visual cells begin to degenerate. Our results suggest that cGMP-PDE is more susceptible to degradation in rd than in normal photoreceptors or, alternatively, that proteolytic enzyme(s) involved in the degradation of cGMP-PDE are in higher concentration or more active in the defective than in the normal retina.

Twenty-eight patients with malignant tumors of the thymus were surgically treated during the 15-year period from 1969 to 1984. Twenty-six patients had far advanced disease when treatment was began. Of fifteen patients with malignant thymoma, the tumors were successfully removed in five patients by using the technique of combined resection of SVC. Of two patients with carcinoid, one is alive and another died two years after extended operation. Of two patients with malignant lymphoma, one with non Hodgkin's disease died three years after operation, and the other with Hodgkin's disease is alive with tumor bearing. It is important to distinguish malignant lymphoma from other types of thymic tumors, because chemo-radiotherapy is superior to surgical therapy. Of nine patients with germ cell tumor, two patients with seminoma have been well for 11 and 5 years. CDDP and radiotherapy were effective on their long survival. Three patients with embryonal carcinoma responded well to combined surgical and chemo-radiotherapy. But only one of them is alive with tumor free one year after operation. Prosthetic grafts were employed in 7 cases for replacement of the innominate and superior caval vein. Angiogram taken one month after operation disclosed the overall patency rate with 92% and the longest patent period confirmed was 4 years. Extended operation by using the prosthetic graft should be performed in the advanced cases to achieve a complete removal and to aim better prognosis for this kind of disease. In conclusion, aggressive surgical removal followed by radio-chemotherapy offers best cure of the malignant thymic tumor.

SVC syndrome is occurred by the occlusion or stenosis of the superior vena cava secondary to malignant mediastinal tumor. Up to this report, surgical intervention has been thought to be difficult. Recently, extent of the tumor has been diagnosed exactly by CT scan, NMR, and angiography. Several cases undergoing complete resection of the tumor with the technique of vascular surgery have been reported. During the past 10 years, we have experienced 21 cases of SVC syndrome. 16 patients had operations and 5 patients had radiation or chemotherapy. The methods of operations were as follows: complete resection of the tumor 1, complete resection of the tumor and reconstruction of SVC 2, subtotal resection of the tumor and reconstruction of SVC 2, bypass of SVC only 5, extra-anatomical bypass 3. PTFE grafts were placed between right subclavian vein and SVC or left subclavian vein and right atrium. Extra-anatomical bypass were placed between jugular vein and femoral vein. PTFE bypass graft provides effective treatment for SVC obstruction with immediate and long term relief of SVC syndrome.

Perry's hypothesis that hydrazine (Hz) derived from isoniazid (INH) treatment plays an important role in the elevation of brain gamma-aminobutyric acid (GABA) levels was reexamined by measuring Hz and GABA levels in the brain after the treatment with 50 mg/kg of INH or different doses of Hz. The treatment with 50 mg/kg of INH to rats resulted in the elevation of GABA levels in rat whole brain. The maximum levels of GABA increased about twice at 4 h from 2.06 +/- 0.4 mumol/g wet wt. in the control group to 3.61 +/- 0.4 mumol/g wet wt. in INH treated group. In this case, brain levels of Hz ranged from 25.6 to 80.8 ng/g wet wt. within 10 h. On the other hand, Hz levels after the treatment with 0.5 mg/kg of Hz were about five times higher than those after INH treatment. However, 0.5 mg/kg of Hz treatment did not increase brain GABA levels at all. Perry's hypothesis was denied by the fact that brain Hz levels after INH treatment were too low to elevate brain GABA levels.

Sixty-seven patients subjected to this study composed of 32 patients treated surgically, 15 patients treated medically and 20 patients examined by autopsy for the past 8 years. Out of 32 surgical cases, 16 were operated on in an acute stage, within 2 weeks after onset and 9 out of these 16 acute cases belonged to DeBakey type I or II and 11 out of 15 autopsy cases belonged to type I or II either. Contrarily most of the medical cases were type III. Both causes of death in the acute autopsy group and operative indications in the acute surgical group were cardiac tamponade, heart failure due to aortic insufficiency, myocardial infarction and aortic rupture. Operative mortality rate was 12.5% in the acute cases and 19% in the chronic cases, late mortality rate was 19% in the acute cases and 0% in the chronic cases. Two cases of operative death had massive bleeding due to aortic rupture and massive myocardial infarction. These were the most dangerous complications of acute aortic dissections. We conclude that all patients with type I or II dissections should be operated on before fatal complications occur.

Human blood monocytes isolated by centrifugal elutriation from healthy donors were tested for ability to produce membrane-associated IL-1 in response to activation stimuli such as various types of interferons (alpha, beta and gamma) and/or synthetic des-methyl muramyl dipeptide (norMDP). When monocytes were treated with norMDP or lipopolysaccharide (LPS) for 16 hr, they released IL-1 into their culture supernatant. When these activated monocytes were fixed with paraformaldehyde (PFA), they stimulated blastogenic responses of C3H/HeJ mouse thymocytes to PHA, suggesting that membrane-associated IL-1 could be induced by norMDP or LPS. Membrane-associated IL-1 was also found to be induced by the synergistic actions of suboptimal concentrations of rIFN-gamma and nor MDP, but not of rIFN-alpha A or rIFN-beta with norMDP. A specific anti-IL-1 alpha antiserum completely inhibited membrane-associated IL-1 activity, but did not affect the thymocyte-stimulating activity of fixed monocytes. IL-1 alpha was detected by fluorescence staining using the anti-IL-1 alpha antiserum on monocytes fixed after gamma IFN-gamma and norMDP. These results suggest that IFN-gamma may be important in expression of membrane-bound IL-1 alpha by the human blood monocytes responsible for regulation of immune responses in vivo.

A 64-year-old woman was admitted because of abnormal shadow in the chest X-ray film. A cystic aneurysm at the proximal portion of the descending aorta was clearly confirmed by CT and aortography. At the time of operation, an aneurysm of ductus arteriosus, of which lumen was filled by thrombus was recognized. The aneurysm was successfully resected and defect of the aortic wall was covered with Dacron patch. Postoperative course was uneventful. This is so rare disease that this patient is the second operated case in Japan.

We performed clinical analysis of 12 patients with renal cell carcinomas associated with tumor thrombosis in the inferior vena cava. Eleven cases were men, and one was a woman; their ages range from 48 to 76 years old with a mean of 58 years. Nine tumors were observed on the right side, the other 3 tumors were observed on the left side. In five cases, the distant metastases of the disease were noticed at the first visiting to our hospital. Lung metastases were found in five and bone or liver in each one. Chief complaints were macroscopic hematuria in 8 cases (67%), and were weight loss or general fatigue. The symptoms of obstruction of the inferior vena cava, such as venous dilatation of abdominal wall, edema of lower extremities and varicocele of the testes, were seen in 6 cases. The level of the tumor thrombosis was preoperatively determined by CT, echography, cavography or MRI. The level was near the right atrium in one, near the hepatic vein in 8 and near the renal vein in 3, although there was no case extending into the right atrium. Transperitoneal nephrectomy and thrombectomy in the inferior vena cava were performed in 9 cases. Surgery could not be performed in the other 3 patients of their poor general condition or severe heart disease. One patient died because of massive hemorrhage during the operation. The other complications were transient renal failure in 3 cases and postoperative bleeding in one case. In 4 patients without distant metastases or regional lymph nodes metastasis, two died of multiple metastasis of renal cell carcinomas and diabetic coma. The other two cases are alive without disease for 4 and 40 months after operation. For renal cell carcinoma extending into the inferior vena cava without metastasis, nephrectomy and thrombectomy should be performed using the extracorporeal circulation.

Dissecting aneurysm of the left atrium is extremely rare. A patient with such an aneurysm, which developed after mitral valve replacement is described. The diagnosis was established by cineventriculography of the left ventricle and two-dimensional echocardiography. The aneurysm was successfully treated by closure of the communicating opening through the left thoracotomy incision.

During past 15 years, 39 cases of thymoma were underwent surgical intervention. In these cases, invasive type, so called stage III and IV in Masaoka's classification were 19 cases. This report documents the results of extended operation in 19 patients treated for malignant thymoma. All patients had neoplasm which invaded adjacent structures; superior vena cava, pericardium, and lung. Eight patients had disseminated lesions in the pleural or pericardial cavities. All patients were underwent surgical exploration through median sternotomy (18 patients) or left thoracotomy (1 patient). Our surgical management to malignant thymoma is to have complete resection, even if tumor invades the great veins. Of 8 patients, superior vena cava and left innominate vein were resected with tumor and reconstructed with ringed PTFE. Mediastinal pleura and pericardium should be widely opened and intrapericardial or intrapleural disseminated lesions should be removed as far as possible. Malignant thymoma could be resected completely applying technique of vascular surgery. Good results were expected when tumor was resected with invading adjacent structures completely. Reoperation to the recurrent tumor is also important.

After the intravenous administration of isoniazid (INH; 0.37 mmol/kg) or hydrazine (Hz; 0.16 mmol/kg), the minor metabolite of INH, gamma-aminobutyric acid (GABA) and Hz were measured by means of gas chromatograph-mass spectrometer (GC-MS) using deuterium labeled GABA (d2-GABA) and nitrogen fifteen labeled Hz (15N-Hz) as internal standards. In both cases, we successfully detected Hz and GABA in the brain. The brain GABA elevating effect of Hz was much higher than that of INH in spite of low dose.

Distribution of the FT-207 and 5-FU between plasma and lung tissue as well as tumor tissue was studied in 28 patients with lung cancer after administration of FT-207 preoperatively. Two methods of administration were employed, one is intravenous drip infusion (IV Group) (800 mg/day for three days) and the other is suppository (Supp Group) (750 mg 2/day for three days). The level of FT-207 was higher in plasma than in normal lung tissue or tumor tissue in IV Group. There was no difference in the level of FT-207 between plasma, normal lung tissue and tumor tissue in Supp Group. The level of 5-FU was higher in tumor tissue than in plasma both in IV Group and Supp Group. Furthermore, intravenous drip infusion was more effective method to give FT-207 because of higher level of 5-FU in tumor tissue than in normal tissue. Comparison of the tissue level in IV Group between two histologic types of tumor, i.e. squamous cell carcinoma and adenocarcinoma, disclosed that there was no significant difference in the concentration of FT-207 and 5-FU both in normal lung tissue and in tumor tissue.