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We investigated how long continuous ambulatory peritoneal dialysis (CAPD) could be continued in the face of peritoneal sclerosis. 15 CAPD patients with no experience of peritonitis were selected and the time limitation for CAPD was examined retrospectively, based on the dialysate osmolality, serum creatinine concentration, etc.. The values for the dialysate osmolality and serum creatinine concentration increased gradually with the duration of CAPD and were significantly increased from 6 months. 5 patients whose serum creatinine concentration during the first 6 months after initiation of CAPD increased more than 5 mg/dl, could not continue CAPD for more than 24 months because of the appearance of peritoneal membrane failure. When the time limitation for CAPD was assessed in 10 stable patients, close relationships between the mean dialysate osmolality and duration of CAPD (Y = 0.52X + 351.25, r = 0.83, P0.01), and between the mean serum creatinine concentration and duration of CAPD (Y = 0.18X + 6.84, r = 0.95, P0.001) were recognized. If the practical limitation for CAPD was set at 400 mOsm/l in terms of the dialysate osmolality or 20 mg/dl in terms of serum creatinine concentration, its value became 94.1 months or 73.1 months, respectively. It is concluded that the time limitation for CAPD can be expected to be approximately 6 to 8 years in stable CAPD patients, and we need to resolve CAPD-induced problems involving the peritoneal membrane in order to continue CAPD for more than 10 years.

A quantum spin system is seldom observed in f-electron compounds, probably because their magnetic ground states are represented by the total angular momentum J which is usually much larger than 1/2. One of exceptional cases is Yb4As3, which behaves as a one-dimensional S=1/2 Heisenberg antiferromagnet. Recently, a new candidate of the quantum spin system YbAl3C3 with the ScAl3C3 type crystal structure has been found, where a magnetic dimer ground state is realized at low temperatures. To investigate the mechanism of the magnetic dimer formation in YbAl3C3, we have prepared several rare earth compounds RAl3C3with the ScAl3C3 type crystal structure and compared their physical properties with those of YbAl3C3.

Three cases of bone sarcomas arising in fibrous dysplasia (FD) without prior radiation therapy were reported. One of the tumors was a conventional osteoblastic osteosarcoma (OS) and the other two were malignant fibrous histiocytomas (MFH). The lesion of FD was monostotic in two patients and polyostocic (monomelic) in one. Bone sarcomas and FD were detected simultaneously in all cases. One of the MFH cases died 6 months after diagnosis, and the other MFH case and the OS case are alive without disease 3 years and one and a half years after surgery, respectively. Conservative treatment has been selected in most of the patients of FD. We should closely follow up these patients, because bone sarcomas such as OS and MFH could arise at the site of FD. This is the first report of the cases of MFH of bone arising in FD.

A case of adamantinoma of the humerus with Ewing-like pathological features has been reported. In addition to the unusual pathological features, the apparently juxtacortical location of the lesion is of great interest--also a highly unusual feature for an adamantinoma.

A case of a 33-year-old man with anomalous origin of the left coronary artery from the pulmonary artery (ALCP) was reported with a referential consideration to the adult type of ALCP previously reported in Japan. The patient visited our hospital for further examination of cardiac murmur detected on a mass physical checkup. He was found to have a continuous murmur, the loudest in the left sternal border of 3rd intercostal space, and developed evidence of ischemia during the exercise stress test in the ECG leads of L2, L3, aVF, and V2 through V6. In addition, studies using echocardiography and color Doppler-echocardiography detected a hypertrophied intraventricular septum and a pattern of turbulent blood flow in the proximal pulmonary artery. Cardiac catheterization and aortography proved the existence of ALCP with a markedly developed collateral circulation from the right coronary artery to the left coronary artery. After surgical restoration by ligating the anomalous opening of the left coronary artery, and by bypass grafting to the left coronary artery, it was clear that dilation and kinking of the right coronary artery was lessened and hypoperfusion in the anterior left ventricular wall was improved. As far as we know, this case is the 35th of adult type ALCP reported in our country. Results from this case and others suggest that early detection and therapy for adult type ALCP is important from the point of view preventing ischemic progression, and indicate that restoration by ligation and bypass grafting may be one of the effective surgical procedures for ALCP.

We investigated changes in coronary venous oxygen saturation (CSO2-Sat) dynamics during intracoronary infusion of ergonovine (ERG) or acetylcholine (ACh) in patients with vasospastic angina. In 16 patients with suspected vasospasm in the left coronary artery, intracoronary ERG injection provoked vasospasm in 4 out of 6 patients, and intracoronary ACh in 6 out of 11 patients. A gradual decrease in CSO2-Sat, anteceding angina and ischemic ECG evidence, was characteristic in ERG-induced vasospastic patients, while no significant change of CSO2-Sat was observed in non ERG-induced patients. Intracoronary infusion of ACh was followed in all 11 patients by a transient increase in CSO2-Sat, suggesting decreased myocardial oxygen extraction due to increased coronary blood flow with ACh. However, earlier and sudden decreases in CSO2-Sat below the control levels were characteristic in 6 patients with ACh-induced vasospastic angina. These findings suggest that effects of ERG and ACh on coronary flow dynamics are essentially different although both drugs can provoke vasospasm.

Two semidwarfism-related proteins, SRP-1 and SRP-2, were detected as major spots in a long-culm rice cultivar, Norin 29 and its semidwarf near-isogenic line, SC-TN1, respectively, by two-dimensional gel electrophoresis (2D-PAGE). The testcross showed that SRP-1 and SRP-2 are controlled by codominant alleles, Srp-1 and Srp-2, respectively, at a single locus Srp. This locus was considered to be closely linked with the semidwarfing gene locus sd-1. SRP-1 and SRP-2 were separated by 2D-PAGE, electroblotted onto a polyvinylidene difluoride membrane, and sequenced by a gas-phase protein sequencer. The N-terminal amino acid sequences, however, could not be determined due to the blockage of the N-terminals of these proteins. After removal of the N-terminal residue with pyroglutamyl peptidase given to the membrane, the amino acid sequence in the N-terminal region was determined. The N-terminal and internal amino acid sequences of SRP-1 and SRP-2 were highly homologous with those of the glutelin α-subunits of seed endosperm storage protein, which were deduced by the cDNA sequences. In the seed endosperms of Norin 29 and SC-TN1, a total of eight glutelin α-subunits was identified by 2D-PAGE. The amino acid sequences in the N-terminal and internal regions of these proteins were determined. This experiment confirmed that SRP-1 and SRP-2 are almost identical in structure with the glutelin α5a- and α5b-subunits, respectively, which were identified in several organs such as endosperms, embryos, and leaves, unlike the other glutelin α-subunits.

Coronary sinus oxygen saturation (CSO2-Sat) was measured continuously using a fiberoptic catheter system during interventional catheterization, i.e., pacing stress test and ergonovine provocation test to determine whether such measurement can detect myocardial ischemia. Subjects consisted of 24 patients who underwent routine cardiac catheterization; 14 patients with effort angina, 3 with old myocardial infarction and 3 with valvular heart disease were assigned to pacing stress test, and 4 with vasospastic angina were assigned to ergonovine provocation test. The results were as follows: 1. Among 14 patients with effort angina, ischemic electrocardiographic changes occurred in 10 patients during pacing stress test. Of these 10 patients, CSO2-Sat decreased in 8 with ischemic electrocardiographic changes. All patients with decrease in CSO2-Sat had significant left coronary artery stenosis. CSO2-Sat continued to decrease throughout intervention and never came back to the baseline. Decrease in CSO2-Sat was more than 5% in most of the cases. 2. In all patients with vasospastic angina, coronary vasospasm was induced by the ergonovine provocation test. CSO2-Sat declined (5%) gradually, preceding anginal pain and ischemic ST segment changes. The present study suggests that continuous monitoring of coronary sinus oxygen saturation may be useful in detecting myocardial ischemia at its early stage, except for patients with right coronary artery disease.

To estimate myocardial oxygen extraction dynamics in the situation of increased myocardial oxygen requirement, we made a continuous measurement of coronary venous oxygen saturation (CSO2-Sat) using the fiberoptic catheter system and a measurement of myocardial lactate extraction ratio (MLER) in 14 patients. Ten patients showed ischemic ST depression and/or anginal episodes during the pacing loading, while 4 patients did not. Although transient decreases in CSO2-Sat were observed in the non-ischemic 4 patients immediately after the initiation of pacing or with the increase in pacing rate. CSO2-Sat and MLER remained almost unchanged from the start of pacing to the time of maximal pacing. However, in the 10 patients who developed ischemia, CSO2-Sat fell from 39.5 +/- 1.8% before pacing to 32.9 +/- 2.8% at the time of maximal pacing (p less than 0.05), with an average decrease of 6.6 +/- 2.8%. Data of MLER obviously indicated the appearance of myocardial ischemia (32.1 +/- 4.7% to 9.2 +/- 10.3%, p less than 0.05). These findings suggest that myocardial oxygen extraction will increase transiently or continuously to meet the myocardial oxygen demand when increase in coronary blood flow is limited. Continuous measurement of coronary venous saturation may be useful for the early detection of myocardial ischemia.

To investigate diastolic dynamics of the left ventricle in postextrasystolic (PES) beats during myocardial ischemia induced by rapid atrial pacing (RAP), transmitral blood flow velocity was evaluated using pulsed Doppler echocardiography in 13 subjects. The subjects consisted of eight patients with ischemic heart disease and five healthy subjects. An atrial extrasystole was artificially induced before and immediately after RAP, while the transmitral flow velocity was recorded continuously. The ratio of the early peak diastolic velocity to the peak atrial velocity (A/E) on PES beat was less than that in a basic beat without an extrasystole. The A/E increased in the PES beat in four patients who experienced myocardial ischemia; whereas, other patients and the normals showed a decrease in the A/E in the PES beat even after RAP. These findings indicated that left ventricular dynamics coupled with left atrial contraction are quite different in myocardial ischemic and nonischemic situations, and that postextrasystolic potentiation may be a useful means of detecting the ventricular diastolic dysfunction.

To determine whether patients with syndrome X suffer from myocardial ischemia, coronary sinus oxygen saturation was continuously measured during pacing loading in 31 patients. Subjects were categorized by groups as syndrome X (11 patients), effort angina (14), and old myocardial infarction and valvular heart disease (6). Pacing loading induced evidence of ischemia in all syndrome X patients and in eight of the 11 patients with effort angina, while there was no such evidence in those with old myocardial infarction and valvular heart disease. Coronary sinus oxygen saturation in syndrome X decreased significantly from 44.2 +/- 5.8% to 33.5 +/- 4.4% (p less than 0.01), and it decreased from 47.0 +/- 4.9% to 31.2 +/- 4.0% (p less than 0.01) in effort angina with induced ischemic evidence, indicating that a significant reduction in coronary sinus oxygen saturation reflects the presence of myocardial ischemia. In the group with old myocardial infarction and valvular heart disease, coronary sinus oxygen saturation remained nearly unchanged during pacing. The pattern of depression of coronary sinus oxygen saturation during pacing was steeper in effort angina than in syndrome X. Therefore, we conclude that, although syndrome-X may not be a homogeneous group of patients, most of them may develop myocardial ischemia due to reduced vasodilator reserves of the small coronary artery.

To evaluate left ventricular mechanical energy efficiency and ventriculo-arterial coupling in humans, left ventricular pressure-volume relations were determined using the conductance catheter technique in 20 patients undergoing cardiac catheterization. The results were as follows: 1. A convex, curvilinear relationship was observed between end-systolic pressure-volume relations (Emax) and left ventricular ejection fraction (EF), as shown in the equation of EF = 28.5 x log (Emax) + 39.6 (r = 0.67, p less than 0.01, n = 20); EF remained nearly constant in the range of Emax greater than or equal to 4 mmHg/ml/m2, whereas, EF decreased markedly under the Emax of 4 mmHg/ml/m2. 2. A convex, curvilinear relationship was observed between Emax and mechanical energy efficiency (EW/PVA), as shown in the equation of EW/PVA = 30.5 x log (Emax) + 54.8 (r = 0.83, p less than 0.01, n = 16). 3. A concave, curvilinear relationship was observed between Emax and ventriculo-arterial coupling (Ea/Emax), as shown in the equation of Ea/Emax = -0.8 x (Emax)0.5 + 2.6 (r = -0.85, p less than 0.01, n = 16). Accordingly, EW/PVA was markedly decreased with changes in Emax in the range less than 4 mmHg/ml/m2, although it remained slightly increased above 4 mmHg/ml/m2. Ea/Emax was maintained constant (p less than 0.5) in the range of Emax above 4 mmHg/ml/m2 but was abruptly decreased when Emax was reduced below 4 mmHg/ml/m2. These results indicate that depressed left ventricle attempts to work effectively at the risk of mechanical energy efficiency and with suitable matching by aortic property. Application of pressure-volume relationships provides a new framework for evaluation and treatment of the failing heart.

Ultrasonic measurements were made on a single crystal of the unfilled skutterudite compounds RhSb3 and IrSb3 and compare with that of the filled skutterudite PrOs4 Sb12 to elucidate the role of the guest ions Pr. A characteristic increase was observed around 30 K in the temperature dependence of elastic constants (C11-C12)/2 and C44 which is ascribed to unusual vibration rattling of Pr ions in an atomic cage formed by Sb-icosahedron. On the other hand, the elastic constants C11, (C11-C12)/2 and C44 increase monotonically with decreasing temperature in the case of RhSb3 and IrSb3. No such a characteristic increase was observed. These results give us a piece of evidence that the guest ions would play a crucial role for rattling motion in filled skutterudite compounds.

In this paper, we will present some weak formulations (variational formulations) for an eigenvalue problem in electromagnetism. In particular, mixed and penalty formulations are discussed, and some numerical results based on the mixed finite element method are given.

This paper presents a finite-element method for shell analysis based on the simplified hybrid displacement method. The formulation is given in the case of general isotropic shells in orthogonal curvilinear co-ordinates. The compatibility condition for the lateral deflection field is relaxed by the introduction of an element boundary parameter and the corresponding Lagrange multiplier. This method has an advantage over other methods since it is quite close to the standard compatible displacement method. Triangular finite elements are derived based on this approach and employing complete cubic polynomials for all displacement components. As numerical examples, shallow shells and a pinched circular cylindrical shell are analysed with generally satisfactory accuracy obtained.

This paper presents an iteration scheme for parameter dependent problems such as those which arise in the analysis of nearly incompressible continua. The proposed method is a generalization of the one previously given by one of the present authors, and may be also regarded as a generalization of the popular augmented Lagrangian method. We present the scheme and convergence theorems with some observations for convergence, and give comments on the applications of our approach to the mixed finite element method.

This paper presents a formulation and some calculations for the three dimensional analysis of RF electromagnetic fields by using the finite element method. We adopted the penalty method to obtain an approximate solution of the stationary Maxwell equations. The discussion is focused on the analysis of electromagnetic waves as a linear eigenvalue problem, for which a primitive variable approach based on the electric field, E, is given. We confirmed the validity of this method by two dimensional calculations and developed a three dimensional calculation code MAX3D. Satisfactory results are obtained for rectangular cavities, cylindrical cavities and those cavities with smoothly deformed parts.

We have developed a program which computes the resonant frequencies and fields in an arbitrary shaped three dimensional cavity by finite element method. We take electric field E = (Ex, Ey, Ez) as unknown variables and solve the eigenvalue problem for the Maxwell equations in time-harmonic case imposing boundary conditions. Divergence-free condition is treated approximately by penalty method. We show the formulation for three dimensional analysis of RF electromagnetic fields and some test calculations. Satisfactory results are obtained for rectangular cavities, cylindrical cavities and those with smoothly deformed parts. In the present calculations, number of the nodal points is limited to less than 1000 because of the memory size of the computer, which means about ten nodes in each direction. For very complicated boundary shape, errors become large because mesh size is coarse and therefore the condition div E = 0 is not fully satisfied. But this difficulty will be overcome with increasing available memory size.

Rhabdomyosarcoma manifested as a systemic disease is very rare and cases showing diffuse metastasis in the bone marrow are most unusual. Recently we encountered two cases of rhabdomyosarcoma with diffuse bone marrow metastasis which were clinically manifested as acute leukemia. The first patient was a 15-year-old female, who was admitted in 1982 with pancytopenia and many large primitive cells in bone marrow aspirates, hematological malignancy being diagnosed. Thereafter the bilateral breasts showed rapid swelling and a biopsy specimen revealed the histological features of typical alveolar rhabdomyosarcoma. The primary site of the neoplasm remained undetermined during the course. At autopsy, it was disclosed that the neoplasm originated from the left thigh and showed generalized metastasis. The second patient was a 38-year-old man, who was admitted in 1986 because of a nasal polyp obstructing the nasal cavity, and persistent nasal bleeding. Peripheral blood samples showed leukoerythroblastosis and thrombocytopenia, and large primitive cells were found in bone marrow aspirates, so that hematological malignancy was initially diagnosed. A biopsy specimen of the nasal polyp showed proliferation of large round cells and electron microscopy demonstrated the ultrastructural features of rhabdomyosarcoma.

A case of acute myocardial infarction due to the lesion in the left main coronary artery was reported. A 50-year male was referred to our department for suspected acute myocardial infarction. Physical examination on admission revealed slight cyanosis with cold sweating due to severe chest pain. Pulse was irregular and heart rate was 78 beats/min. Blood pressure was 100/80 mmHg. A series of electrocardiograms (ECG) and laboratory data provided the diagnosis of wide-ranged anterolateral infarction in the left ventricle. Emergency coronary angiograms taken without delay showed a subtotal occlusion (99% stenosis) of the left main coronary trunk (LMT) before the initiation of intracoronary thrombolysis (PTCR). Following the intracoronary infusion of urokinase of 1,200,000 units, symptoms and ECG changes transiently improved but worsened later, and LMT stenotic lesion and delayed filling of myocardium were similar with before PTCR. Emergency coronary-aorto bypass graft (CABG) was undertaken without a significant delay to both the left anterior descending artery (LAD) and left circumflex coronary artery (LCX). With these treatments, the patient could survive despite the wide area of infarction due to LMT lesion. Coronary angiograms performed 37 days after the CABG showed that the graft to LAD was completely occluded and the LCX graft was patent with partial stenosis. Treadmill test at this time induced an anginal episode with ischemic ECG changes on moderate exercise, indicating the presence of significant area of ischemic myocardium. For salvage of the ischemic myocardium, percutaneous transluminal coronary angioplasty (PTCA) was successfully performed for the LMT stenosis, resulting in no episode of angina nor ischemic ECG changes during exercise loading.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper presents a mixed finite element method for 3-D analysis of an electromagnetic eigenvalue problem for cavity resonators. We first propose a mixed variational principle for the problem which is well-suited to deal with the divergence-free condition. Then we give some mixed finite element models based on the Nedelec finite element spaces for the rotation operator. Finally, we show some elementary numerical results.

Recently reports of congenital coronary-pulmonary fistula have been increasing with the wide-spread use of coronary angiography. However, the cause of the angina sometimes seen as a chief complaint in coronary fistula has not been well demonstrated although it has been suggested that coronary steal phenomenon accounts for it. This report documented coronary hemodynamics in a patient who came to develop anterior chest pain in the middle age owing to congenital coronary-pulmonary fistula, measuring coronary flow before and after the fistula-closure operation. A 35-year-old woman suffered from a sudden onset of severe anterior chest pain in April, 1986. She was referred to our hospital on suspicion of ruptured aneurysm of Valsalva. Auscultation disclosed continuous murmur at 3 LSB, but no evidence of ruptured aneurysm of Valsalva was detected by echocardiography nor aortography. Coronary angiography showed both left and right coronary fistula into the stem of pulmonary artery and otherwise normal angiogram. Great cardiac vein flow (GCVF) measured with regional thermodilution method was 25 ml/min at rest (70 bpm) and 30 ml/min during rapid atrial pacing (150 bpm) before the operation, and 30 ml/min (78 bpm) and 58 ml/min (150 bpm) after the operation, respectively. Before the surgery, anterior coronary resistance (CRant) was higher than that in normal subjects at rest and remained almost steady during atrial pacing. After the surgery, CRant was still higher at rest but remarkably reduced during pacing of 150 bpm. These findings suggest that the gradual increase in peripheral coronary resistance for a long time may lead to the inducement of coronary steal in the middle-later age in patients with coronary fistula.

Epulis osteoplastica was examined with soft X-ray radiography, scanning electron microscopy (SEM) and electron probe X-ray microanalizer (EPMA). Extracted epulis tissue from the incisor region of mandible was offered to this examination. The soft X-ray radiograms showed well defined radiopaque trabecular structures in the soft tissue. The pathological findings with HE staining revealed that these structures were bone tissues. The SEM images demonstrated irregularly shaped trabecular structures with fine bone tissues. The EPMA images obtained from the same specimen supported the findings.

Right ventricular wall images of ischemic heart disease were evaluated during exercise myocardial scintigraphy using thallium-201. Among 33 subjects, ten were normal controls, 11 had left coronary artery disease (LAD group), 12 had right coronary artery disease (RCA group), all of whom received exercise myocardial scintigraphy. The submaximal or symptom-related ergometer exercise test was performed by the protocol being with 25 watt (W) loading, and then increased by 25 W every 3 min, while 3 mCi thallium-201 were injected intravenously at the maximal exercise point. Early imaging was obtained 5 min after exercise; delayed imagings, 1 and 4 hours after exercise. Early imaging and delayed imaging at 4 hours after exercise were obtained in the AP, lateral, LAO 30 degrees, LAO 45 degrees, and LAO 60 degrees projections. Only the LAO 45 degrees was obtained for delayed imaging 1 hour after exercise. To assess the radioactivity in the right ventricular wall, with regions of interest (ROI) in the upper part of the right ventricle [RV (U)] lower part of the right ventricle [RV (L)] and the most radioactive region in the left ventricle [LV (P)], we calculated the count ratio of the RV(U) or RV(L) to the LV(P) and defined it as the RV uptake ratio [RV(U)/LV(P)] or [RV(L)/LV(P)]. The results obtained were as follows: There were no significant changes in the RV uptake ratio between the early and delayed images both in the control and LAD groups, but the RV uptake ratio decreased significantly in the delayed images compared with an early image in the RCA group.(ABSTRACT TRUNCATED AT 250 WORDS)

Among 4,030 autopsies, 67 cases of fulminant hepatic failure were selected and studied from a pathological viewpoint. No sex difference in incidence was seen and the patients' age ranged very widely from 3 months to 78 years, showing comparatively high risk in the 20 s and 30 s in both sexes. Hepatitis virus was the most common cause, followed by toxic chemicals, shock, etc. Histopathological study revealed severe and extensive hepatic cell necrosis as the most conspicuous and common change of the liver, which was pathomorphologically quite similar to that experimentally produced by focal intravascular coagulation in rabbit. This evidence, as well as pathological findings of the other organs obtained at autopsy and the patients' reported clinical course, including laboratory data, were consistent with our proposal of a pathological disease entity, fulminant liver disease, which corresponds to the clinical symptom-complex known as fulminant hepatic failure. It is suggested that the characteristic feature of acute, severe and extensive hepatic cell necrosis which is seen in such cases is probably a result of an anoxic state caused in most instances by intrahepatic circulatory disturbances. Besides, we consider that fulminant liver disease can be regarded as a group of systemic diseases with the main focus of illness in the liver, rather than a specific disease of a single organ, the liver.

A case of epithelioid sarcoma was studied by electron microscopy and by light and electron microscopic enzyme histochemistry comparing with several control soft tissues. In addition to previously reported ultrastructural features, such as abundant 10 nm cytoplasmic filaments, desmosome-like cell junctions and small cystic spaces surrounded by filopodia or microvilli of the tumor cells, we encountered 10 nm cytoplasmic filaments showing electron dense condensation with a concentrically oriented or whorled pattern and a finger-print-like arrangement and 5'-nucleotidase activity of tumor cell membrane. Among the control soft tissues, 5'-nucleotidase activity was found only in synovial and endothelial cells. Both tumor and synovial cells showed no activity of adenosine triphosphatase, while marked activity of the enzyme was found in endothelial cells. These results support the concept that epithelioid sarcoma is derived from mesenchymal cells undergoing differentiation toward synovial cells during neoplastic transformation.

A 53-year woman, who had been under observation for combined valvular heart disease, was admitted to our hospital for further examination of embolic episodes to brain and kidney. Echocardiographic examination showed the evidence of free-moving ball thrombus in the left atrium, and emergent cardiac catheterization following the echocardiography confirmed the diagnosis of it as well as mitral stenosis, aortic regurgitation with stenosis, and tricuspid regurgitation. In addition, coronary angiography disclosed the anomalous coronary venous run. With these findings, the cause of embolic episodes was found to be due to the thrombus in the left atrium. In the surgery performed a ball thrombus of 40 x 35 x 36 mm and a mural thrombus of 15 x 35 x 20 mm in size in the left atrium were detected and removed, and both mitral and aortic valves were replaced to artificial ones. She had a good hospital course after the surgery and discharged without any complication. In this report, we discussed a case of left atrial thrombus observed in a combined valvular heart disease, with 29 literatures reported in our country.

A case of alveolar soft part sarcoma was studied by light and electron microscopy and by electron microscopic enzyme histochemistry of adenosine triphosphatase (ATPase) and 5'nucleotidase(5'Nase). The tumor showed distinct alveolar pattern and diastase resistant PAS positive crystalline inclusions were found in the cytoplasm. Ultrastructurally, characteristic rhomboid crystals and dense granules were observed and they were positive for Mg++- and Ca++-ATPases but negative for 5'Nase. Tumor cell membrane also showed positive activity of ATPase in addition to 5'Nase. These results would support the myogenous derivation of alveolar soft part sarcoma.