Search

Background . The right gastroepiploic artery (GEA) has been used as the second reliable arterial graft for coronary artery bypass grafting (CABG). However, concern regarding the flow competition with the recipient coronary artery has remained. Methods . An application of in situ GEA grafting to the right coronary artery (RCA) was studied by using a theoretical model. The theoretical model of CABG was given variables; ie, the diameters and the lengths of both in situ GEA and proximal segment of the RCA, and the degree of proximal stenosis in the RCA. According to the range of these variables obtained from clinical data, the ratio of the GEA flow to the flow of the RCA distal to the anastomosis was calculated. Results . Main factors to determine the flows in the two parallel paths were the inner diameters of both vessels, and the degree of the proximal stenosis. When the inner diameters of the GEA were 0.5 mm larger than that of the RCA, the GEA carried more than 50% of the total flow of the RCA distal to the anastomosis despite a moderate stenosis in the RCA. When the inner diameter of the GEA was equal to, or 0.5 mm smaller than, that of the RCA, the GEA flow was dominated by the native RCA flow unless the proximal stenosis was critical. Conclusions . If the inner diameter of the GEA is 0.5 mm larger than that of the RCA, CABG with the GEA can be applied more widely. If not, the application would basically be limited.

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.

A case of intravenous leiomyomatosis with extension into the right ventricle is described. A tumor in the inferior vena cava was detected 5 years after a hysterectomy had been performed for a myomatous uterus, but was misdiagnosed as an intracaval thrombus. Three years later this tumor was discovered after it had enlarged and intruded into the right ventricle. The correct diagnosis was made after a complete evaluation. The patient underwent surgery employing simultaneous sternotomy and laparotomy. Radical excision was achieved using cardiopulmonary bypass with hypothermic circulatory arrest. The diagnostic and surgical approaches are reviewed and discussed.

A new accessory instrument to the self-retaining internal mammary artery retractor was developed. This instrument presses the chest wall inward, relieves the concavity of the inner surface of the chest wall, and provides good exposure of the internal mammary artery.

We have established a long-lasting heart allograft tolerance in H-2-incompatible combinations by intravenous injection of 10 8 allogeneic spleen cells followed by the administration of 200 mg/kg of cyclophosphamide (CP). When C57BL/10 mice (B10, H-2 b ) were primed iv with 1 × 10 8 viable spleen cells from naive BALB/c mice (H-2 d ) and treated ip with 200 mg/kg CP 2 days later, BALB/c heart allografts were lasting in the recipients for as long as 8 weeks. On the other hand, B10 mice receiving either allogeneic spleen cells or CP rejected the heart allograft within 10 days after transplantation. A direct approach assessing the donor-reactive T cells for frequency and reactivity showed that the donor-reactive T cells were partially deleted and the rest were rendered unresponsive. CP-induced tolerance may be applied for the induction of antigen-specific tolerance to allogeneic heart transplantation.

An automated high-performance liquid chromatographic method for the determination of the diuretic drug furosemide has been established. Dog plasma was injected directly into a two-column system with a BSA-ODS (ODS column coated with bovine serum albumin) precolumn and a C18 analytical column for the separation of furosemide. The two columns were automatically switched. Furosemide remained trapped on the precolumn while proteins were eluted to waste. After column switching, furosemide was washed onto the analytical column and analysed without interference. The greatest advantage of the method is its easy performance without manual sample preparation; it requires no extraction or deproteinization. The method allows determination of 0.1-10 micrograms/ml of furosemide with accuracy and precision comparable with previously reported values. The coefficients of variation obtained from replicate measurements of 1 microgram/ml and 5 micrograms/ml samples were 1.65% and 2.40%, respectively. This method was used to measure the plasma levels of furosemide in beagle dogs to whom the drugs was administered, as a reference, in a toxicological study.

Hypothermic retrograde cerebral perfusion is a new technique for protecting the brain. Satisfactory cerebral protection should be possible even for periods of retrograde perfusion greater than 60 minutes. However, there are some concerns that functioning venous valves at the jugular-subclavian junction may impede retrograde flow to the brain and consequently cerebral protection may not be adequate. To overcome this obstacle, we have developed an easy and safe technique of selective jugular cannulation through the right atrium using a central venous catheter and a guidewire. We have employed this technique successfully in 15 patients who underwent operation on the aortic arch.

Resection of a false aneurysm of the aortic arch in a patient with Behcet's disease was safely performed using an "aortic no-touch" technique. This consisted of: (1) femoral artery and bicaval cannulation, (2) profound hypothermia (below 20 degrees C) by core cooling, (3) retrograde cardioplegia through the coronary sinus, and (4) total body retrograde perfusion via both venae cavae without aortic cross-clamping. The patient showed no evidence of neurological damage and the postoperative course was uneventful.

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.

New forceps were designed and manufactured which feature a 60° angle and a clay stand for fixing the forceps into the proper position, thus permitting a single surgeon to perform anastomoses more exactly and more quickly.

We have devised a new retractor for use in coronary artery bypass grafting that is made from three woven Teflon tapes. This method allows sufficient counterclockwise rotation of the heart, provides excellent exposure of the posterior and inferior coronary artery systems, and creates a horizontal surgical plane for the circumflex anastomosis.

A novel method of the circumflex coronary artery exposure by rotating the heart, using a Janke net and a silicone rubber tube, is described.

A 5 month-old female was brought to our clinic because of diarrhea and abdominal distension. A plain radiograph demonstrated a mass with a vertebral column in the right upper quadrant of the abdomen. At operation a mass was found to be retroperitoneal, well encapsulated, and connected to the abdominal aorta of the host by two small vessels; no other connections and adhesions were seen between the mass and the host. The ovaries, uterus, and other pelvic and abdominal viscera of the host were normal. The mass was diagnosed as a fetus-in-fetu. The fetus-in-fetu, encapsulated with an amniotic capsule, was covered with skin and had a top with long hair, two protuberances, an amniotic hernial sac, upper limbs with syndactylic fingers, a gluteal region, and lower limbs with polysyndactylic toes. A brain mass and a spinal cord were identified in the cranial cavity and the vertebral canal. Several spinal ganglia and a nerve plexus were found. A noselike structure, upper lip, maxillalike bone with teeth, tonguelike structure, intestines, ribs, bones of the extremities, and skeletal muscles were also identified. A cloacalike cyst was observed to have an opening in the external female genitalia. Microscopically, a small number of motor neurons were seen in the brain mass and the anterior horn of the spinal cord. In the spinal ganglia, ganglion cells were differentiated. The submucosal and myenteric plexuses were seen in the intestinal wall. Well-differentiated muscle fibers were often accompanied with myelinated nerve fibers. Hematopoiesis was observed in the cranial bone marrow. The presence of the sex chromatin was confirmed in the nuclei of motor neurons and polymorphonuclear leukocytes. Thus, the present fetus-in-fetu, which was connected to the abdominal aorta of the host by two vessels, was a monozygotic twin which developed within its own amniotic cavity.

Various polyclonal lymphocyte activators (PLA) such as capsular polysaccharide of Klebsiella pneumoniae (CPS-K), lipopolysaccharide of Escherichia coli (LPS), dextran sulfate (DS), concanavalin A (Con A), phytohemagglutinin (PHA), pokeweed mitogen (PWM), and polyadenylic-polycytidylic acid (poly A:U) were compared in their effects on antibody response to T-dependent antigen (bovine gamma globulin (BGG) and dinitrophenylated (DNP)-BGG) and T-independent antigen (DNP-Ficoll) and on induction of tolerance to T-dependent antigen. All of these PLA acted more or less to trigger the initiation of the antibody-forming mechanism for deaggregated BGG (DBGG) or DNP-BGG through their actions on the carrier-specific T-cell function. All of these PLA tested also acted more or less to inhibit the induction of the carrier-specific T-cell tolerance to DBGG. Moreover, some of these PLA could act to augment antibody response to DNP-Ficoll. The adjuvant action of PLA in the response to DNP-Ficoll worked as well in athymic nu/nu mice as in nu /+ mice, whereas that in the response to DNP-BGG did not occur in athymic nu/nu mice. The order of the strength of the action of PLA to trigger the initiation of the whole immune response to DBGG, that to trigger the carrier-specific T-cell function to DNP-BGG, and that to inhibit the induction of the whole tolerance to DBGG was very similar to each other: i.e., CPS-K ⪢ Con A > LPS, DS, poly A:U, PWM and PHA. By contrast, the order of the strength of the action to inhibit the induction of T-cell tolerance to DBGG was ≧ = LPS > Con A, PWM and poly A:U > DS and PHA, and that of the action to augment the antibody response to DNP-Ficoll was CPS-K > LPS > Con A. CPS-K was the most potent in all of these immunological activities. It was concluded that PLA act generally to stimulate the immune response at its initiation step in which T cells in the case of T-dependent antigen and B cells in the case of T-independent antigen play a predominant role, but that individual PLA share this adjuvant activity in different fashions.

1973年, 岐阜県で Hand, Foot and Mouth Disease (HFMD) が流行した. 42名の患者につきウイルス学的血清学的に検索した.患者の年齢は0歳から23歳に及んでいたが, 4歳以下の小児が71.4%を占めた. 42症例中, 中枢神経症状を合併した症例が20症例あった.ウイルスは38例中22例 (57.9%) より分離された. Enterovirus 71 (EV-71) が16症例 (42.1%), Coxsackievirus (Cox.) B-5が8症例 (21.1%), Cox. A-9が2症例 (5.2%), 同定不能ウイルスが1症例 (2.6%) より分離された. EV-71は Vero 細胞で18株, 乳のみマウスで1株分離された. 中枢神経症状を合併した症例より分離されたウイルスはEV-71とCox. B-5であった.分離されたEV-71は交差中和試験で, Cox. A-16とは交差がなく, EV-71標準株とは交差が認められたが, 標準株より抗原的に broad であった.ペア血清24例中, EV-71が25%, Cox. A-16が4%, 23例中 Cox. B-5が13%, 6例中 Cox. A-9が17%, それぞれ中和抗体の有意上昇が認められた.1973年岐阜県で流行したHFMDの主病原ウイルスはEV-71であると推定される. しかし, ほかの分離ウイルスも病因的役割を否定できない.

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)

Objective The mortality of conventional coronary artery bypass grafting after acute myocardial infarction remains high. This study compared the clinical outcomes of patients undergoing conventional and on-pump beating-heart coronary artery bypass grafting and evaluated the efficacy of an on-pump beating-heart technique for the surgical treatment of these critically ill patients. Methods Between January 1999 and March 2005, 61 patients underwent emergency coronary artery bypass grafting for acute myocardial infarction. In the first 23 patients, the conventional cardioplegic method was performed. In the most recent 38 patients, the on-pump beating-heart procedure was used without cardioplegic arrest. Results A significant reduction occurred in the observed mortality between the conventional and on-pump beating groups (21.7% vs 2.6%, P = .04), despite a higher predicted mortality risk calculated by using EuroSCORE (9.0 ± 1.6 vs 9.6 ± 1.6, P = .048) and a greater use of a preoperative intra-aortic balloon pump (43.5% vs 78.9%, P = .005). On-pump beating-heart patients received fewer bypass grafts than conventional patients (2.0 vs 2.9, P = .001), but the internal thoracic artery was used more often in on-pump beating-heart patients ( P = .014). Three patients in the conventional coronary artery bypass grafting group required new insertion of an intra-aortic balloon pump, whereas no patients required this in the on-pump beating-heart group ( P = .220). Postoperative renal failure requiring hemodialysis occurred in 2 patients in the conventional coronary artery bypass grafting group but in no patients in the on-pump beating-heart group ( P = .138). Conclusions On-pump beating-heart coronary artery bypass grafting is the preferred method of emergency myocardial revascularization for patients with acute myocardial infarction who might tolerate cardioplegic arrest poorly. It has lower postoperative mortality and morbidity than conventional coronary artery bypass grafting.

scribed in evaluating blunt thoracic trauma. 4 It can be performed safely and rapidly at the bedside, requires less time than aortography, and does not require contrast dyes. One report quoted sensitivity and specificity at 100% for recognizing traumatic aortic injury. 5 Transesophageal echocardiography can differentiate traumatic aortic rupture from ductus diverticulum, which can give a false positive aortogram. Its sensitivity in recognizing trauma to the innominate artery is unknown. A recent article in this JOUPdSAL discussed the use of a vascular pericardial flap placed between the Dacron graft and the innominate vein to protect the vein from the oscillating movement of the graft. 6 We believe this flap is necessary only when the graft is placed anterior to the innominate vein. If the graft is placed in its normal anatomic position (posterior to the vein), the oscillating movement of the graft should not produce a sawing motion against the vein. Delay in diagnosis may lead to permanent injury or disability in the hand from distal small vessel thrombosis or to neurologic sequelae caused by ipsilateral carotid occlusion. Further delay can lead to exsanguination after delayed rupture. Cardiopulmonary bypass and heparinization are not necessary in achieving successful repair. In summary, blunt injury involving the innominate artery is rare. Those patients who survive to reach the hospital may have minimal external signs of trauma. Surgical awareness, clinical suspicion, and aortography are essential in diagnosis.

A novel fluorometric assay method was established for latamoxef (LMOX), a new type of antibiotic. LMOX was converted into 1, 2, 4-dihydroxy-3-[(1-methyltetrazol-5-ylthio) methyl] but-2-enoic acid γ-lactone, in an acid solution. The lactone 1 reacted with 2, 6-diamino-3-nitrosopyridine to give the fluorophore, 3-(5-amino-3H-imidazo [4, 5-b] pyridin-2-yl)-2, 4-dihydroxybut-2-enoic acid γ-lactone. The fluorescence was measured at 460 nm with excitation at 392 nm. In plasma and urine, 1-15 μg/ml and 20-300 μg/ml of LMOX were determined, respectively, with good precision through a simple technique. The sample volume was 100 μl. The reaction mechanism of the fluorescence reaction is discussed.