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Aims With no effective chemotherapy, the prognosis of unresectable intrahepatic cholangiocarcinoma is extremely poor. Hepatic arterial infusion of mitomycin C with degradable starch microspheres has been reported to be an effective treatment for unresectable liver metastasis. We retrospectively evaluated the efficacy and safety of this chemotherapy for treating unresectable intrahepatic cholangiocarcinoma. Materials and methods Hepatic arterial infusion chemotherapy through an implanted port system was carried out in 20 patients with unresectable intrahepatic cholangiocarcinoma. Degradable starch microspheres mixed with mitomycin C and contrast media were injected until either embolisation of the hepatic artery or influx to the gastroduodenal system was confirmed. This treatment was repeated weekly. Results Hepatic arterial infusion chemotherapy was carried out 204 times. The response rate was 50.0%. Twelve patients experienced transient epigastralgia and four experienced gastroduodenal ulcer. The time to progression was 8.3 months and the median survival time was 14.1 months. Conclusions This chemotherapy was effective and feasible for patients with unresectable intrahepatic cholangiocarcinoma. Further study with a larger number of patients is warranted.

A case of a 55-year-old man with descending necrotizing mediastinitis (DNM) after a tooth removal was reported. Chest computed tomography (CT) showed a fluid collection in the right thorax, in the cervical region and in the mediastinum. The patient underwent cervical drainage and thoracoscopic pleural dissective drainage. The cervical and right anterior thoracic drain was removed on the 6th day and posterior drain was removed on the 8th day after the operation. The patient was discharged on the postoperative day 13, and showed no recurrence.

Transmission characteristics of a directional coupler with a magnetic/dielectric thin film hybrid structure was analyzed on the basis of 3D electromagnetic field analysis. The device consisted of an inner dielectric/magnetic/dielectric sandwich structure, the top coupled signal lines, coupling capacitance composed of top rectangular electrode, and bottom ground plane. Both electric field coupling and magnetic field coupling between top signal lines were controllable by changing electrode size of coupling capacitance and spacing between top signal lines, respectively. From the numerical calculation of the signal transmission characteristics, an insertion loss was less than 0.6 dB, and signal directivity was more than 15 dB in the frequency range of 0.8-2 GHz used in the cellular phones.

In this paper, the authors have reported a new directional coupler for the cellular phones with an operating frequency of 0.8-2 GHz, which consisted of a coupled microstrip structure with an amorphous CoFeB magnetic thin film and a polyimide dielectric film.

In this study, the CoFeB/polyimide hybrid thin-film coplanar transmission-line for RF impedance matching was fabricated and its transmission characteristic was evaluated. The device has a thin-film coplanar structure with a CoFeB amorphous magnetic film with a relative permeability of 180, a polyimide dielectric film with a relative permittivity of 3.5, a top and bottom copper conductor film on a glass substrate. The quarter wavelength device with a 100 /spl mu/m width magnetic film consisting of 0.3 /spl mu/m /spl times/ 2 layers had an insertion loss of 2 dB and a line length of 6 mm. The device functioned as a low pass filter with a GHz cut-off frequency, which was due to the eddy current loss and FMR absorption in the magnetic film. Therefore, the hybrid thin-film coplanar-line is expected to apply for GSM cellular phone with non-linear power amplifier.

This paper describes a novel thin film type directional coupler using magnetic/dielectric hybrid transmission line device. The hybrid transmission line with a dielectric/magnetic/dielectric sandwich structure has a large effect of wavelength shortening. As a result of signal characteristics evaluation, the directivity of the signal in the device was higher than 18 dB, and insertion loss was less than 0.6 dB at the operating frequency of 0.8/spl sim/2 GHz of the cellular phones.

Objectives: To confirm the brain MR imaging characteristics with special reference to the brain surface images and the white matter abnormalities, in the various types of congenital muscular dystrophies (CMDs). Methods: The brain MR images including surface anatomy scans (SAS) were studied in 15 children with biopsy-proved CMDs. They were 8 cases with Fukuyama type CMD (FCMD; typical 6 and atypical 2), 2 cases with Muscle-eye-brain disease (MEB), 4 cases with merosin positive (M+) CMD and 1 case with merosin negative (M-) CMD. Genetic analysis confirmed the diagnosis in 2 cases with atypical FCMD and in 1 case with MEB. Results: SAS depicted abnormal gyri in 7 of 8 cases in FCMD, 2 of 2 cases in MEB, 1 of 4 cases in M(+)CMD and 0 of 1 case in M(-)CMD. Every case having cortical dysplasia showed bilateral distinctly wide superior frontal gyri in SAS, which was thought to be a characteristic finding in the CMD with abnormal gyrus formations. White matter abnormalities were observed in 6 of 8 cases in FCMD, 1 of 2 cases in MEB, 2 of 4 cases in M (+)CMD and 1 of 1 case in M(-)CMD. One case with genetically confirmed FCMD showed normal intelligence and no abnormal gyrus formations. One case with M (+) CMD showed the same SAS findings as typical FCMD and diffuse white matter abnormalities, having no FCMD founder mutations. Conclusion: Our data suggests that the neuroimaging findings in CMDs are not always disease specific. Further biochemical or genetic investigations should be required in cases showing atypical neuroimaging findings. Bilateral distinctly wide superior frontal gyri observed in SAS might be a characteristic finding of CMD with cortical dysplasia.

In this work, the Q value twice as high as the existing report at 2 GHz band using newly developed high-B and high-Hk FeCoB hetero amorphous thin film is demonstrated. The ferromagnetic thin film was deposited by RF magnetron sputtering. The value Q=9 was obtained for the 20/2 design and Q=10 for the 18/4 design at 2 GHz. This was possible because of high FMR frequency of the hetero amorphous Co/sub 27/Fe/sub 62/B/sub 11/ film and the smooth surface for the magnetic film deposition defined by the CMP process.

In this study, in order to obtain the larger anisotropy field, B was added to the CoFe phase (Co/sub 35/Fe/sub 65/, Co/sub 25/Fe/sub 75/, and Co/sub 15/Fe/sub 85/ with high saturation magnetization more than 20 kG) by using synchronous triple-RF magnetron sputtering. Dependence of B content on anisotropy field and crystal structure of CoFeB thin films was investigated. Very large anisotropy field of 500-700 Oe for obtaining higher FMR frequency was obtained. The result shows a good potential for obtaining magnetic cores driven at higher frequencies of several GHz.

In this paper, we present experimental evidences about the very large critical thickness of our films that makes eddy current loss practically negligible in GHz range.

The magnetic properties of ∼2500‐A‐thick Co films evaporated in various oxygen pressures have been studied. Our results show that as the saturation magnetization is reduced, the coercive force in the perpendicular direction (Hc⊥) increases to a maximum (1.6 kOe); this change is consistent with results of previous investigations. The sign of the effective perpendicular anisotropy field (Hk eff=2K/Ms−4πMs), as determined by ferromagnetic resonance (FMR), is always negative (

Summary form only given. We have previously reported that our hetero-amorphous structured films are an excellent candidate for the magnetic core materials for GHz frequency use because of their high resistivity (Munakata et al. (2001)). However, a further increase of the resistivity is desired for sufficient removal of eddy current loss. In the present work, (Co/sub 35/Fe/sub 50/B/sub 14.4/)-(SiO/sub 2/) soft magnetic films with ultra-high resistivity of 116,000 /spl mu//spl Omega/cm were fabricated, which is 30 times larger than the maximum published value at present. The microstructure of the film associated with the very high resistivity was investigated. The films with thickness of 0.5 /spl mu/m were deposited on glass substrates by synchronous triple-rf magnetron sputtering. The permeability in a few GHz range was measured by a permeance meter. The structure of the film was analyzed by transmission electron microscopy (TEM).

A 27-year-old male whose diagnoses were aortic dissection (Stanford A), aortic regurgitation, annulo-aortic ectasia, and Marfan syndrome underwent modified Bentall operation using composite graft and total arch replacement. Modification of proximal suture without resection of aortic valve like intravalvular implantation might have resulted in good recovery without blood transfusion. Another 63-year-old male who suffered from spontaneous aortic rupture with aortic regurgitation also underwent modified Bentall operation in the similar manner as the first case with good result. Spontaneous aortic rupture reported here is a rare case, and operation is thought to be prerequisite for the patient who suffers from this disease to survive.

A family of 3 patients with Marfan syndrome was reported. All of them had surgical interventions in cardiovascular disorders such as DeBakey type I, III aortic dissection and thoracoabdominal aortic aneurysm. In 2 patients, multiple surgical treatments were performed for aneurysmal dilatation of the distal false lumen or another lesions of the treated aorta. Since cardiovascular lesions of Marfan syndrome are systemic and progressive, the postoperative long term follow-up, including systemic evaluation of the arterial system, is essential to detect the latent cardiovascular complications. Careful examining the family with Marfan syndrome is necessary to discover any cardiovascular abnormalities in these people early.

Because of the decreased tolerance to ischemia and increased reperfusion injury in hypertrophied myocardium, myocardial hypertrophy is a well known risk factor for cardiac surgery. We have previously demonstrated in a left ventricular hypertrophy (LVH) model that a highly buffered cardioplegic solution (HBS) that provided glucose as a substrate and promoted anaerobic glycolysis during ischemia afforded superior myocardial protection when compared to standard formulations. And we reported the superiority of this cardioplegia in human cardiac surgery.In this study, 16 patients with aortic stenosis (AS) and LVH receiving HBS were reviewed and compared to another patient group with AS and LVH who received either cold blood cardioplegia (CBC; n=5) or glucose insulin potassium (GIK; n=6).Postoperative cardiac index was better in the HBS group than the other two groups with similar or lower catecholamine. CK-MB was lower in HBS group than GIK group, but this was not significant. Only one DC cardioversion was required in the HBS group, whereas 2 DC in the CBC group and total 7 DC in the GIK group.We found that histidine buffered cardioplegic solution provided comparable or better pump performance after surgery with relatively lower inotropic requirement, less DC cardioversion and homologous blood requirements for left ventricular hypertrophied heart associated with aortic stenosis.

The cellular mechanisms of abnormal calcium regulation and excitation-contraction coupling in relation to glucose metabolism in the hypertrophied heart are not well understood. The present study evaluated the myocardial mechanics of 6-7-week-old pressure overload hypertrophied rabbit hearts in response to dobutamine by (1) serial echocardiograms in vivo and (2) isolated Langendorff perfusion. Cytosolic Ca2+([Ca2+]i) and sarcoplasmic reticulum Ca2+-ATPase (SERCA2) expression were measured by fluorescence spectroscopy and Western immunoblotting, respectively. The effect of glycolytic inhibition by 2-deoxy-D-glucose +/- pyruvate was also evaluated. Both systolic and diastolic [Ca2+]i tended to be higher and diastolic calcium removal (tauCa) significantly slower in the hypertrophied heart. The myocardial response to dobutamine was blunted and dobutamine insignificantly improved tauCa. The SERCA2 protein level was higher in early hypertrophy, but was significantly reduced by 6 weeks of age, with progressive contractile failure. Inhibition of glycolysis or SERCA2 caused an increase in [Ca2+]i as well as a slower tauCa. Pyruvate completely preserved myocardial function and [Ca2+]i handling during glycolytic inhibition. It was concluded that in this model of advanced pressure overload hypertrophy, contractile failure and inotrope insensitivity are associated with increased [Ca2+]i, slower tauCa and reduced sensitivity of the contractile proteins to Ca2+. These changes occur in association with downregulation of the SERCA2, probably caused by impaired glucose metabolism.

In order to engineer materials suitable for micromagnetic inductor cores we have fabricated and investigated the properties of granular (CoFeB)-SiO2 amorphous thin films. The deposition method, synchronous triple-rf magnetron sputtering onto rotating substrates, induces anisotropy in the film plane. Here we present magnetic hysteresis loops, resistivity and magnetoresistance measurements of two of these films, with different amount of metallic content. Both films have anisotropic resistivity, which is higher for the film with less metallic content. The low-metallic-content film exhibits typical isotropic giant magnetoresistance (GMR), while the film with higher metallic content shows a mixture of GMR and anisotropic magnetoresistance (AMR). The AMR appears at fields below 500 Oe. We believe that this has not been observed before in amorphous samples. The behaviour of the resistivity versus temperature ρ (T) indicates that the sample with lower metallic content consists of isolated grains while the high-metallic-content sample consists of a percolated network. Experimental ρ (T) data for the low-metallic-content sample fit: to the variable-range hopping model at temperatures lower than 221 K and can be described by excitation of the carriers to the mobility edge at higher temperatures.

beta 2-adrenergic receptor gene is an intronless single gene coding 413 amino acid and is located on chromosome 5q31-33. This area is also noted as a candidate locus for asthma susceptibility genes. Up to now, 9 polymorphisms in the coding lesion and 10 polymorphisms in the 5' promotor lesion have been reported. Some of them have functional significance. In terms of both pathophysiological and pharmacogenetic view of asthma, these polymorphisms have been attracted an attention of many researchers. In this review, I will summarize the recent knowledge about this topic and discuss some future directions.

Three novel silver(I) complexes with benzopyrene derivatives were synthesized and characterized in this paper. Treatment of AgClO(4)*H(2)O with 7-methylbenzo[a]pyrene (L(1)) afforded [Ag(2)(L(1))(toluene)(0.5)(ClO(4))(2)](n)() (1) which exhibits a 2-D sheet structure with double-stranded helical motifs. Reaction of AgCF(3)SO(3) with dibenzo[b,def ]chrysene (L(2)) gave rise to an unprecedented cocrystallization structure, ([Ag(2)(L(2))(CF(3)SO(3))(2)][Ag(2)(toluene)(2)(CF(3)SO(3))(2)])(n)() (2), formed by a 2-D neutral lamellar polymer and a 1-D neutral rodlike one. The ligand benzo[e]pyrene (L(3)) coordinated to silver(I) ions generating a closed triple-decker tetranuclear complex [Ag(4)(L(3))(4)(p-xylene)(ClO(4))(4)] (3) which can be regarded as a stacking polymer owing to existing intermolecular pi-pi stack interactions. The structural diversity of the silver(I) coordination polymers with polycyclic aromatic hydrocarbons is not only related to the stacking patterns of free polycyclic aromatic hydrocarbons in the crystalline state, but also the geometric shapes of the molecules for these free ligands. In addition, the coordination of solvents to metal ions plays a crucial role in the formation of the unprecedented coordination polymeric architectures. The ESR spectroscopic results, conductivity, and synthesis properties are also discussed.

The hemorrhagic disorders associated with circulating anticoagulant are rare but well known as the disease derived from inhibitors(alloantibody or autoantibody), which arise against specific coagulation factors. We encountered a patient with hemorrhage at the lower limbs originating from an unknown coagulation pathway inhibitor. Activated partial thromboplastin time(APTT) prolonged and cross mixing test indicated a coagulation pathway inhibitor. Levels of coagulation factors VIII, IX, XI, and XII were extremely low. Predonine therapy was effective to stop the hemorrhage. To clarify the inhibitor, we treated the patient's plasma with protein A Sepharose, and the factor VIII activity was recovered to a normal level after passing through the column. Gel filtration of the patient's plasma and protein A Sepharose adsorbed fraction of the patient's plasma with Superdex 200 revealed that the inhibitor activity against blood coagulation eluted at the position of IgG, which was detected by the prolongation of APTT of normal pooled plasma. These data indicated that the inhibitor was IgG and its inhibitory spectrum was non-specific and broad. The results of laboratory tests and the clinical features in our patient were similar to those in a previous study by Dahlback(Blood 62, 218-225, 1983). The hemorrhagic abnormality of that patient was derived from the autoantibody to phospholipid, which inhibits the activation of prothrombin. An investigation into the effect of anti-phospholipid antibody in our patient is currently being performed in our laboratory.

Increasingly complex techniques of cardiac surgery often require prolonged myocardial ischemia. We previously reported a better myocardial preservation with histidine containing cardioplegia (HBS) in human open heart surgery. To see a safety margin of this cardioplegia for prolonged myocardial preservation, this study was retrospectively done. One hundred twenty-six patients received either intermittent multidose (20-30 minute) cold blood cardioplegia (CBC) plus topical cooling (aotric cross clamp time (ACC)120 minutes, n = 63) or HBS (n = 63). HBS group was divided into two groups with either short ACC (or = 120 minutes, HBS-S, n = 46) or long ACC (120 minutes, HBS-L, n = 17). Cardiac index (C.I.) and dopamin/dobutamine requirement were measured 3, 6, and 12 hours post-bypass. Incidence of homologous blood transfusion was also studied. There was two deaths due to LOS in HBS-S group; four patients in HBS group required 5 DC cardioversion, whereas six patients required a total of 12 DC cardioversion in CBC group. Functional recovery were significantly better with significantly lower inotropic requirements in HBS-S group than CBC group and HBS-L group. Although preoperative ejection fraction and C.I. were significantly lower in HBS-L group, post-operative cardiac function and inotropic requirements in HBS-L was comparable to that seen in CBC group. We conclude that the highly buffered histidine crystalloid cardioplegia solution provides effective myocardial preservation with a wider safety margin for prolonged myocardial preservation in open heart surgery.

The usefulness of three-dimensional echocardiography using intravascular ultrasound (3D-IVUS) for the measurement of plaque volume was evaluated by comparing plaque volume derived from 3D-IVUS with that directly measured in 10 autopsied iliac or femoral plaque models (5-15 mm long). Using IVUS (3.5 F, 30 MHz), sequential cross-sectional images for three-dimensional datasets were acquired with a motorized catheter pullback device connected to the three-dimensional reconstruction system. Three-dimensional reconstruction was performed from the sum of the two-dimensional cross-sectional views. Plaque volumes were calculated using a summation of disks algorithm based on the reconstructed multiple short-axis cross-sections from the three-dimensional data. Three-dimensional IVUS demonstrated a good correlation with direct measurement of plaque volume (y = 0.71x + 0.001, r = 0.80, SEE = 0.003 ml), so is useful for the measurement of plaque volumes in the experimental models.

Preoperative evaluation of the both right ventricular (RV) systolic and diastolic function using the pulsed Doppler echocardiogram were examined for 46 patients scheduled for the pulmonary resection of the pulmonary tumorous lesions. The parameters which included the RV inflow pattern at the tricuspid orifice and the RV ejection flow pattern at the RV outflow tract were obtained by the pulsed Doppler echocardiogram. Following results were obtained. 1) The RV afterload shown by the parameters of the acceleration time (AT, time beginning of RV ejection to peak velocity) were higher in the aged patients, the low FEV 1% populations, and the patients having the deteriorated left ventricular contraction. 2) The RV diastolic dysfunction were present preoperatively in aged patients over the 60 years old. This phenomenon was characterized by a high degree of atrial contraction and an increased ratio of the peak velocity in atrial contraction phase to that in early rapid filling phase (A/E). When we evaluate the RV inflow and ejection Doppler flow patterns after the major lung resection, these findings must be considerable thing.

We report the case of a 48-year-old man with asthma and pulmonary eosinophilia. He presented with coughing, dyspnea, and wheezing that began 6 months after he began keeping a rabbit in his house. He was referred to our department for further examination of pulmonary infiltrative shadows. An inhalation test with rabbit-fur antigen induced both immediate and late asthmatic responses. In addition, infiltrative shadows appeared in the right segments 2, 8, and 9 on chest CT films after the antigen inhalation. Examination of fluid obtained by bronchoalveolar lavage from the right S9 showed an increase in the fraction of eosinophils. Examination of a specimen obtained by transbronchial lung biopsy from those segments revealed infiltration of inflammatory cells into the alveolar septa and alveolar spaces, which was consistent with eosinophilic pneumonia. Our diagnosis was asthma and pulmonary eosinophilia due to rabbit-fur antigen.

We studied the relationship between the effectiveness of corticosteroid pulse treatment, clinical characteristics and outcomes in 17 patients with acute exacerbatin of idiopathic interstitial pneumonia. Acute exacerbation was defined as a decrease in PaO2 by more than 10 Torr, worsening of chest-radiographic findings, and deterioration of symptoms within 1 month. Effects of corticosteroid pulse treatment were judged 2 weeks and 3 months after the end of treatment. The change in AaD2 was computed and was used to determine whether the treatment had been effective, temporarily effective, or ineffective. The effects at three months were difficult to predict on the basis of those at two weeks. The treatment was often effective in patients who had not previously received steroids and in those with mild disease. Those in whom the treatment was effective at three months lived longer after the exacerbation than did those in whom it was ineffective, but the average lengths of survival through the whole clinical course were not significantly different among the three groups. We suggest that corticosteroid pulse treatment is effective in acute exacerbatins of idiopathic interstitial pneumonia and that effectiveness should be evaluated three months after treatment.

Background: Abrupt conditional changes can interfere with the harmony between the brain and the heart, thereby following impaired cardiovascular function. Stress cardiomyopathy (SC) is a typical sample. SC is a disorder associated with transient left ventricular apical ballooning that is induced by stress. The precise molecular mechanisms of SC remain unclear. Methods and results: (1) By analyzing a new animal model of SC in rodents inducing by epilepsy, we demonstrated hypothalamic activation due to Ccl2 causes LV dysfunction like SC. (2) Upstream sympathetic activation induces strong upregulation of neuropeptide Y (NPY) expression in the left stellate ganglion (LSG) and LV sympathetic nerves. (3) NPY reduced the frequency of Ca2+ sparks when co-injected with noradrenaline in the ventricular myocytes of adult rat. (4) We demonstreted that NPY reduced the contraction of ventricular myocytes of neonatal rat when co-incuvated with noradrenaline by using phase-contrast microscopy. (5) NPY injection into the LSG induces SC-like LV wall motion. (6) The incidence of SC was less frequent in NPY-/- mice than in NPY+/+ mice. Conclusions: Our results demonstrate how brain activation translates into molecular signals in the cardiac nervous system and leads to LV apical ballooning.

Clinically, threshold concentrations of agonist causing 20% decrease in FEV1 (PC20 FEV1) or 35% decrease in airway conductance (PC35Gaw) are usually used as parameters of airway hyperresponsiveness. In this session, what do these parameters mean was discussed based on theoretical analysis, experimental data and clinical observations. Theoretically, using these parameters, it seems very difficult to distinguish whether hyperresponsiveness is due to the change in sensitivity or maximum responses. Experimental and clinical observations suggest that these parameters are affected by multiple factors, for example, genetic vs. acquired factors and functional vs. structural factors. There may be differences in the degree of contributions of each factors on clinical parameters of airway responsiveness between asthmatics and control, and mild and chronic severe asthma. Clinically, considering such differences may be important in interpreting the changes of these parameters.

A case was 6-year-old female diagnosed as the cor triatriatum. The magnetic resonance imaging synchronized at R wave on the electrocardiogram was performed in order to see the abnormal septum in the left atrium. In the horizontal view, the abnormal septum that divides the left atrium into the accessory left atrial chamber and the true left atrium, was well visualized. This septum lied on the vertical portion. Operation was carried out with the approach through the accessory chamber and the fibromuscular membrane were excised. Preoperative imaging of the MRI was useful and helpful for us to reach to a decision of the surgical approach in this patient.

The assay for activated coagulation factors has recently been considered to be a useful tool for detecting hypercoagulable state. Measurement of activated factor XI and alpha 1 antitrypsin complex developed by us is the only one measure for detecting contact phase hypercoagulation. The ACTIVATED FACTOR XII kit (Shield Diagnostics) has recently been commercially available, and the reference range was reported in the instruction manual. However, because the recovery rate of purified factor XIIa (XIIa) in normal pooled plasma by this assay kit was strikingly decreased, the effects of inhibitors in plasma, such as low molecular weight serine proteinase inhibitor (diisopropyl fluoro-phosphate, DFP), the specific inhibitor for XIIa (corn trypsin inhibitor, CTI), the main inhibitor for XIIa (C1 inhibitor, C1I) were examined. These three inhibitors and XIIa were incubated for 18 hours, then the XIIa levels of these complexes and the recovery rate in the normal pooled plasma were assayed by this assay kit. The recovery ratios in the normal pooled plasma were; DFP-XIIa 82%, CTI-XIIa 63%, and C1I-XIIa 0%, XIIa without inhibitor 7%. These results suggest that this XIIa kit does not reflect the levels of complexed form of XIIa and inhibitors in plasma samples.

Topical cooling with iced slush has been applied as a conventional myocardial preservation in open heart surgery. However, there might be several disadvantages due to topical cooling with iced slush which melted to be liquid, because of membrane integrity decreased during ischemia. To understand more detailed mechanism of deterioration for myocardium by immersion in some liquid during ischemia, we subjected isolated crystalloid perfused rabbit hearts to a 30 minute of ischemia with immersion in Krebs-Henseleit (K-H) solution (I), K-H+hexamethlyamiloride which was Na+/H+ channel blocker (II) and histidine containing cardioplegia (HBS) designed to accelerate anaerobic glycolysis by a proton buffering (III), followed by a 30 minute of reperfusion. These groups were compared to the hearts hanging in air during ischemia (control). Phosphocreatine (PCr), ATP and intracellular pH were measured by 31 PNMR in group I, II, III. Developed pressure (Dev P) and diastolic pressure (EDP) with a intracavitary balloon were also evaluated with monitoring of 2 mmHg diastolic contracture during ischemia. Dev P declined to 46%, 54% of preischemic value in group I and group II, respectively, although % recovery of control heart was 74% after ischemia-reperfusion process. Diastolic function was severely deteriorated in group I and II, as compared to control heart. ATP and intracellular pH showed a similar decline as PCr in group I and II which was not seen in group III during ischemia. HBS prevented the deterioration of PCr, ATP and intracellular pH during ischemia along with excellent recovery of myocardial function. We therefore conclude that 1) significant deterioration of myocardium occurs with ischemia if the heart preserved in Krebs-Heseleit solution and the mechanism of injury by immersion in liquid on the heart appears to be due to proton accumulation caused by intracellular acidification and loss of high energy phosphate.

A 80-year-old woman underwent emergency operation for a type A early thrombosed aortic dissection associated with cardiac tamponade. Her preoperative chest CT (not enhanced) showed high density area in the false lumen that indicated early thrombosis and the projection of true lumen at antero-left-lateral portion of ascending aorta that means "ulcer-like projection" called on aortogram. After the relief of the cardiac tamponade by pericardiocenthesis, we emergently performed the graft replacement of the ascending aorta under the extracorporeal circulation combined with selective cerebral perfusion. Her postoperative course was uneventful and satisfactory.

Patient 1: A 64-year-old woman was admitted for further examination after reticulonodular shadows were found on a chest X-ray film. Idiopathic interstitial pneumonia (IIP) was diagnosed. Patient 2: The 60-year-old sister of patient 1 was admitted for further examination after reticulonodular shadows were found on a chest X-ray film. IIP was diagnosed. About half a year later, her proximal interphalangeal joints had become swollen and the result of a rheumatoid hemagglutination test was positive. Therefore, the pneumonia was suspected to have been caused by a collagen-vascular disease (CVD), rheumatoid arthritis. Patient 3: The 64-year-old brother of patient 1 was examined. A chest X-ray film revealed reticulonodular shadows that were strongly suggestive of IIP. The remaining three siblings were examined. In a 62-year-old sister, the chest X-ray film was normal, but the level of anti-nuclear antigen was elevated. The fact that the level of this antigen was high in these four siblings and that the 60-year-old sister later suffered from rheumatoid arthritis suggested the presence of a factor predisposing to CVD in these siblings. The interstitial pneumonia in these siblings may have been related to CVD.

Tumor necrosis factor alpha (TNF alpha) and lymphotoxin (TNF beta) are cytokines with numerous similar immunoregulatory effects. In pulmonary fibrosis, TNF alpha/beta appears to play a critical role in the regulation of the fibroproliferative response. The human TNF alpha/beta genes are located between the HLA-B and the HLA-DR region. In man 5.5 kb and 10.5 kb of TNF alpha/beta restriction fragment length polymorphic (RFLP) bands have recently been identified by means of enzyme NcoI. TNF alpha/beta production is reported to be correlated to the NcoI RFLP. In some collagen diseases, a decreasing frequency of the 10.5 kb band is reported. The two allele NcoI RFLP of the TNF alpha region, yielding bands of 5.5 kb and 10.5 kb, was investigated in normal Japanese subjects and patients with IIP. The frequency of these bands was not different between normal subjects and patients with IIP. However, in female patients, the frequency of the 5.5 kb band was significantly increased compared with those in the male patients and normal subjects. The increase of this band may have some relation to the pathogenesis of idiopathic interstitial pneumonia.

Nitric oxide (NO), discovered as an endothelium derived relaxing factor, is generated during conversion of L-arginine to L-citrulin by nitric oxide synthase (NOS). Now, genes for three isoforms of NOS (nNOS, eNOS, and iNOS) have been cloned and pulmonary expressions of these NOS isoforms have been studied extensively. Localization of these NOS isoforms in the lung and their functional roles are discussed.

Persistent coughing and bloody sputum developed in a 75-year-old man with mycosis fungoides. Chest X-ray films on admission showed combined patterns of alveolar and interstitial shadows in both lung fields. Histological examination of the transbronchial lung biopsy specimen revealed patchy infiltration of mycosis fungoides cells in alveolar septa. VEPA chemotherapy was ineffective against skin lesions and caused bacterial pneumonia, but combined treatment with etoposide (200 mg, once a week) and prednisolone (30 mg, 3 days per week) resulted in remission. The patient has been taking oral etoposide and prednisolone regularly, and has been free of skin and pulmonary lesions for two years. Combined therapy with low-dose etoposide and prednisolone may be worth trying in cases of advanced mycosis fungoides with pulmonary involvement.

Acyclovir, an anti-herpes virus drug, has been reported to affect aspirin-induced asthma (AIA). Acyclovir was reported to decrease the sensitivity to aspirin in some AIA patients. Although the hypothesis that AIA is related to viral infection has been stated, there is no proof that patients with AIA are infected with a specific virus. Therefore, whether the effect of acyclovir on AIA is due to an antiviral effect is not clear. We hypothesized that acyclovir directly affects airway smooth muscle. To test this hypothesis, we examined whether acyclovir can directly contract or relax guinea-pig airway strips, and whether it can modify contraction or relaxation induced with several agents in vitro. Acyclovir did not directly affect basal smooth muscle tone and did not affect the responses to leukotriene D4, prostaglandin E2, carbachol, or KCl. We conclude that acyclovir has no direct effect on the function of guinea-pig airway smooth muscle.

To evaluate the possibility that viral infections can trigger acute exacerbations of idiopathic interstitial pneumonia (IIP), we analyzed data from 105 patients with IIP. Acute exacerbation was defined as an increase in dyspnea, a decrease in PaO2 by more than 10 Torr, and worsening of chest radiographic findings within one month. Viral infection was said to be involved when patients had more than a 4-fold change in viral antibody titer or viral inclusion bodies in sputum during the acute exacerbation. Of the 105 patients with IIP, 30 had acute exacerbations. Among these 30 patients, viral infection was said to be involved in 11 (37%). Presumptive viruses were influenza virus (n = 6), parainfluenza virus (n = 1), herpes simplex virus (n = 1), RS virus (n = 1), and cytomegalovirus (n = 2). The levels of serum immunoglobulin A (IgA) before acute exacerbations were significantly lower (p0.05) in patients in whom viral infection was said to be involved. These results suggest that viral infection associated with a low value of serum IgA is an important trigger of acute exacerbations of IIP.

A 62-year-old woman was admitted to our institution for abnormal shadows on a screening chest roentgenogram. An immunoelectrophoresis test on admission revealed a polyclonal gammopathy. In her bronchoalveolar lavage fluid, the percentage of lymphocytes was found to be high: 47%. These results indicated an abnormal immunological state. A chest X-ray film showed multiple patchy shadows in both lungs. A chest CT scan revealed that the shadows were distributed peripherally, and abutted the pleura. Before treatment, the lesions enlarged toward the hilum concentrically, and cleared from the pleural side. This change is characteristic of cryptogenic organizing pneumonitis. The pathological finding at open lung biopsy was organizing pneumonitis. Bronchiolitis obliterans was not pathologically recognized. The shadows on the chest X-ray film almost completely disappeared after treatment with predonisolone at a daily dose of 30 mg. We diagnosed this as a case of cryptogenic organizing pneumonitis with typical shadows.

We examined patterns of airway response of thirty nine asthma patients who had positive responses on allergen inhalation tests. Six types of inhaled allergens were used: house dust mite, animal, pollen, plant, mold, and others. Three patterns of responses were found: isolated immediate asthmatic response (IAR), immediate and late response (Dual), and isolated late asthmatic response (LAR). No relationship was found between the pattern of response and pulmonary function, airway sensitivity, IgE RIST titers, numbers of eosinophils, or concentration of inhaled antigens. Animal antigens tended to cause a dual response, and molds did only rarely. Ten of 39 challenged patients had an isolated LAR, half of which were caused by mold antigen inhalation. RAST scores were lower in isolated LAR than in other responses. Changes in the number and proportion of peripheral leukocytes during the challenge tests were also studied. Total leukocyte count had increased significantly in the isolated LAR group by 24 hours after the inhalation. These results suggest that the pattern of airway response after inhalation depended in part on the type of inhaled antigen, and that non-IgE mediated immune reactions have some role in the isolated LAR.

We discussed the problems for autologous blood transfusion particularly in the preoperative blood donation about the patients over 70-year-old who underwent cardiac surgery in contrast with the younger patients. Following results were obtained: 1) Because aged patients have the tendency of anemia before predonation, full storage of blood donation could not be successed. 2 of 8 over 70-year-old patients were able to do the preoperative phlebotomy, and their mean volume were 355 gram as whole blood. On the other hand, 96% patients in younger group were phlebotomized preoperatively, and their mean value of storaged blood volume were 757 gram. 2) As the examinations about the iron-related parameters, not all aged patients were iron deficiency status. Their reticulocyte counts were nearly equal level to the younger group and plasma concentration of erythropoietin were higher in the aged patients than that in the younger group. These results indicate that erythropoiesis in the bone marrow was deteriorated in the aged patients. 3) In aged patients, all of them were required homologous blood transfusion at their perioperative terms. We thought that they have had the anemia before preoperation and our tolerable, allowable level to the postoperative anemia was not lower in the aged patients as against to the younger group. 4) We performed the autologous plasma donation with the membranous plasma separator added to the whole blood donation. It was easy and safe method, and circulatory indices were not changed before and after plasma-separation even in the aged patients. These autologous plasma were usefully administered as the volume expander postoperatively.

Background The prognosis of gastric cancer with peritoneal metastasis is extremely poor. Neither systemic chemotherapy nor surgery alone prolongs survival of patients significantly. Methods Patients diagnosed with advanced gastric cancer underwent staging laparoscopy and received chemotherapy when peritoneal dissemination and/or cancer cells on peritoneal cytology were confirmed. The chemotherapy regimen consisted of S-1, weekly intravenous and intraperitoneal paclitaxel, which was verified in our phase II trial (Ann Oncol 2009). S-1 was administered at 80 mg/m2/day for 14 consecutive days, followed by 7 days rest. Paclitaxel was administered intravenously at 50 mg/m2 and intraperitoneally at 20 mg/m2 on days 1 and 8. Clinical response of chemotherapy was assessed by computed tomography, gastroendoscopy, peritoneal cytology and second-look laparoscopy. Radical gastrectomy was carried out when macroscopic curative resection was made achievable by chemotherapy. Chemotherapy was restarted after operation as soon as possible. Overall survival, relapse free survival, morbidity and mortality of gastrectomy were evaluated. Results Out of 100 patients with peritoneal metastasis who received chemotherapy, 60 patients underwent gastrectomy after response to chemotherapy, including 54 with macroscopic metastasis and 6 with positive peritoneal cytology only. A median of three courses were administered preoperatively (range 1–16). Total or distal gastrectomy with lymphnode dissection was carried out in 54 or 6 patients, respectively. The median survival time was 34.5 months. The median relapse-free survival was 16.7 months. The first site of relapse was the peritoneum in 24 patients and the other organ site in 17 patients. Postoperative complications included anastomotic leakage and pancreatic fistula in two patients each, which were healed conservatively. There were no treatment-related deaths. Conclusions Gastrectomy combined with S-1, intravenous and intraperitoneal paclitaxel is safe and active for gastric cancer patients with peritoneal metastasis.

The present status of idiopathic interstitial pneumonia (IIP) was evaluated from data collected as part of the Financial Support Program for patients with IIP, conducted in Hokkaido since 1979. The prevalence of IIP in 1992 was 4.08/100,000, and the yearly incidence was 1.23/100,000. The ratio of men to women was 1.85/1.0. Under age 55, women were more numerous than men, and over age 55, men were more numerous than women. Clinical and epidemiological analyses of the patients with IIP, with collagen vascular disease-interstitial pneumonia suggested possible contribution of dust inhalation to the etiology IIP. A prospective study revealed that about 20% of the subjects had systemic signs and symptoms of collagen diseases from 2 months to 10 years after the diagnosis of IIP. In addition, about 15% of the subjects with IIP developed lung cancer during the follow-up period. This incidence was significantly higher than that in the patients with chronic obstructive pulmonary diseases and the same smoking history, which suggests that IIP itself is a risk factor for lung cancer.