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In this study, 110 consecutive patients who had undergone off-pump coronary artery bypass (OPCAB) in the past 2 years were evaluated for early results of OPCAB. Patients were classified as a high-risk group (H group: 68 patients consisting of 46 men and 22 women) and a low-risk group (L group: 42 patients consisting of 31 men and 11 women), respectively, and were evaluated for the early operative results. No differences were noted between the H and L groups in the mean number of bypass grafts (2.9 +/- 0.9 in the H group, 2.9 +/- 0.9 in the L group), the rates of complete revascularization (85% in the H group, 93% in the L group), those of various graft materials bypassed, or those of sequential bypass. In all patients, we were able to undergo coronary revascularization by the aortic no-touch technique using arterial grafts exclusively. In the H group, 1 patient (1.5%) died in hospital, but no patients developed cerebral infarction postoperatively, and the frequency of complications was similar to that in the L group. The results of OPCAB for high-risk patients were good, and it was suggested that OPCAB using in situ arterial grafts was very useful particularly in patients with cerebrovascular diseases.

We conducted ultrasonic decalcification on calcified annulus in patients with aortic stenosis (AS) using an ultrasonic operator, Sonopet (UST 2001) prior to aortic valve replacement (AVR). We studied the reliability of this method.From January 2002 to August 2005, AVR was conducted for AS using the Sonopet in 45 patients, comprising of 18 male and 27 female subjects. The mean age was 73.3 +/- 9.7.Artificial valves were successfully inserted at the intra-annular level in 37 patients and at the supra-annular level in 8 patients without conducting annular enlargement. In the patients with narrow annuli of less than 19 mm (23 patients), the preoperative mean annular diameter was 18.2 +/- 1.0 mm, but significantly larger artificial valves with an average diameter of 19.3 +/- 1.5 mm (p=0.003) were successfully inserted.AVR was proved to be safe and easy by previous ultrasonic decalcification of the annuls using the Sonopet. This method was very useful because it required no enlargement of aortic annulus.

[1] The fine structure of convective clouds leading to the generation of sprites and elves has been studied using radar images. Sprites and elves were observed on two days, 19 December 1998 and 27 January 1999, in lightning during winter thunderstorms on the Sea of Japan. Fractal analyses of the radar images (as an ensemble and as separate clusters) for those two days have been performed with respect to the occurrence of sprites and elves. We have found that a sprite and/or an elve is triggered when and just after the image cluster maximum size increases to a certain value (∼150 km) and the ensemble fractal dimension approaches a threshold (i.e., percolation threshold).

This paper presents a new method for speech extraction by a combined subband independent component analysis (subband ICA) and neural memory. In the method, subband ICA separates the signals obtained from microphones into the signal components of interest and the rest at each subband. Subband ICA approach has two fundamental problems. The neural memory represented by probabilistic neural networks (PNNs) is then used for identifying the signal components of interest among the separated components and thereby solved the permutation problem. Then we adjust the scale of each output signal to that of the corresponding input signal. Simulation results for both the instantaneous and delayed mixture cases show that the proposed subband ICA approach consistently yields the performance improvement in comparison with the conventional fullband/subband approaches.

Summary from only given. We have developed a compact and mass-production 40-channel power level monitor based on a planer lightwave circuit (PLC). We believe our method has the following advantages. The combination of directional coupler and gold micro pyramid mirror makes it possible to tap any amount and anywhere on PLC even between arrayed waveguides. Because this method basically consists of well-established PLC process, wire bonding process and flip-chip mounting process, it is suitable for mass production.

Immune and inflammatory systems are controlled by multiple cytokines, including interleukins (ILs) and interferons. These cytokines exert their biological functions through Janus tyrosine kinases (JAKs) and STAT transcription factors. The CIS (cytokine-inducible SH2 protein) and SOCS (suppressors of cytokine signaling) are a family of intracellular proteins, several of which have emerged as key physiological regulators of cytokine responses, including those that regulate the inflammatory systems. In this review, we focused on the molecular mechanism of the action of CIS/SOCS family proteins and their roles in inflammatory diseases. Furthermore, we illustrate several approaches for treating inflammatory diseases by modulating extracellular and intracellular signaling pathways.

Novel compact optical add-drop multiplexers for dense wavelength-division-multiplexing systems, which consist of directional couplers and Bragg gratings in silica waveguides, have been demonstrated. The devices have high fabrication tolerances, low polarization dependence and low crosstalk for both add and drop operations, simultaneously.

Internet and data traffic is rapidly stimulating the demand for higher information transmission capacity of the backbone optical network. To meet this capacity demand, the commercialization of erbium-doped fiber amplifiers (EDFA) have been the key technology for the massive development of wavelength-division multiplexing (WDM). Much effort has been performed to broaden and flatten the EDFA bandwidth to increase the capacity in the WDM system. Tellurite-based EDFA was recently reported to provide the wider signal amplification bandwidth than silica-based EDFA in the spectral range that includes the 1.6 /spl mu/m band. We have prepared novel Er-doped Bi/sub 2/O/sub 3/-B/sub 2/O/sub 3/-SiO/sub 2/ glasses which are expected to exhibit broadband emission because of high refractive index. In the paper, we report on broadband emission and concentration quenching properties of Er-doped bismuth-based glasses.

The temperature dependence of the resistivity and dielectric properties of carbon black-polyethylene composites was measured in the temperature range from room temperature to 95 /spl deg/C. The composites show a dielectric relaxation, which obeys a Cole-Cole circular arc law. The strength of relaxation, /spl delta/ /spl epsi/, and the parameter /spl beta/, a measure of the distribution of relaxation time, were estimated from the Cole-Cole plot. It is suggested that the rapid increase of resistivity observed about 70 /spl deg/C is due to a scission of conducting paths caused by the thermal expansion of the resin, because of the increase of /spl delta/ /spl epsi/ above 70 /spl deg/C. The decrement of /spl beta/ indicates that the scission makes the distribution of relaxation broader. In the temperature region below 70 /spl deg/C, /spl delta/, /spl epsi/ decreases with heating. It is concluded that branches likely combine to conducting paths, bringing about a mild increase in resistivity with increasing temperature. >

When a body is surrounded by a random medium, the radar cross-section (RCS) is expected to be sometimes remarkably different from that in free space. In general, the problem of wave scattering from a body in a random medium needs to be treated by taking account of the boundary conditions of incident and scattered waves on the body. Recently, the authors have presented a method for solving it as a boundary value problem and analyzed numerically RCS of a conducting elliptic cylinder in such a strong turbulent medium that an incident wave becomes incoherent. The numerical analysis shows that the spatial coherence length of an incident wave on the body plays a central role in determining RCS as well as the effect of double passage which results in backscattering enhancement. Through the analysis, they have made clear the characteristics of RCS for some elliptic cylinders: that is, some convex cylinders. When the spatial coherence length becomes comparable to an effective width of the illuminated surface of a body, RCS changes largely and is enhanced or diminished as compared with that in free space. In this case, the curvature of a body surface has also an important effect on RCS. This paper makes more clear the curvature effect on RCS in a random medium, by assuming the E wave incidence and analyzing numerically RCS of a conducting cylinder with a concave-convex surface.

We previously demonstrated that cultured rat dorsal root ganglion (DRG) cells respond to stimulation with interleukin-1 beta (IL-1 beta) by releasing substance P (SP), and this response is regulated via the cyclooxygenase (COX)-2 pathway. In this study, to ascertain the interaction between nitric oxide (NO) and prostaglandins in primary afferent neurons, we investigated the effect of NO on the IL-1 beta-induced release of SP in cultured DRG cells. An NO donor, S-nitroso-N-acetyl-DL-penicillamine (SNAP), did not in itself evoke SP release. However, it potentiated the IL-1 beta-induced release of SP. Similarly, while SNAP did not elicit the expression of COX-2 mRNA, it potentiated the expression induced by IL-1 beta in cultured DRG cells, and this potentiation was significantly suppressed by the NO scavenger, 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide (carboxy-PTIO). Moreover, SNAP also potentiated the expression of COX-2 protein induced by IL-1 beta in cultured DRG cells. The stimulatory effect of SNAP on the IL-1 beta-induced release of SP was completely inhibited on co-incubation with a selective COX-2 inhibitor, NS-398. 1H-[1,2,4]oxadiazolo[4,3-a]quinoxaline-1-one (ODQ), a potent inhibitor of soluble guanylate cyclase, did not suppress, and a membrane-permeable cGMP analogue, 8-Br-cGMP, did not mimic the stimulatory effects of SNAP in DRG cells. These results suggest that in cultured DRG cells, NO potentiates the IL-1 beta-induced increase in COX-2 expression via a soluble guanylate cyclase-cGMP-independent pathway, resulting in facilitation of SP release. The interaction between NO and COX in primary afferent neurons might contribute to the change in nociceptive perception in inflammatory hyperalgesia.

The satellite spectra of Ni Lα X-rays induced by 21.0 MeV/amu N 2+ ion bombardment were measured using a high-resolution soft X-ray spectrometer which was specially designed for the chemical state analysis by PIXE. We succeeded in observing two distinguished satellite lines, whose energies were estimated by the use of a relativistic self-consistent field program. Relative intensities of the satellites observed here were also well reproduced by theoretical values estimated from the semiclassical approximation after correcting the X-ray selfabsorption. The satellites were confirmed to originate from the multiply ionized states with one L 3 and n M electron vacancies.

Purpose: To develop the detector for the four-dimensional dose distribution measurement. Methods: We made the prototype detector for four-dimensional dose distribution measurement using a cylindrical plastic scintillator (5 cm diameter) and a conical reflection grass. The plastic scintillator is used as a phantom. When the plastic scintillator is irradiated, the scintillation light was emitted according to absorbed dose distribution. The conical reflection grass was arranged to surround the plastic scintillator, which project to downstream the projection images of the scintillation light. Then, the projection image was reflected to 45 degree direction by flat reflection grass, and was recorded by camcorder. By reconstructing the three-dimensional dose distribution from the projection image recorded in each frame, we could obtain the four-dimensional dose distribution. First, we tested the characteristic according to the amount of emitted light. Then we compared of the light profile and the dose profile calculated with the radiotherapy treatment planning system. Results: The dose dependency of the amount of light showed linearity. The pixel detecting smaller amount of light had high sensitivity than the pixel detecting larger amount of light. However the difference of the sensitivity could be corrected from the amount of light detected in each pixel. Both of the depth light profile through the conical reflection grass and the depth dose profile showed the same attenuation in the region deeper than peak depth. In lateral direction, the difference of the both profiles was shown at outside field and penumbra region. We consider that the difference is occurred due to the scatter of the scintillation light in the plastic scintillator block. Conclusion: It was possible to obtain the amount of light corresponding to the absorbed dose distribution from the prototype detector. Four-dimensional dose distributions can be reconstructed with high accuracy by the correction of the scattered light.

Metazoan mitochondrial (mt) tRNAs are structurally quite different from the canonical cloverleaf secondary structure. The mammalian mt tRNASerGCU for AGY codons (Y = C or U) lacks the entire D arm, whereas tRNASerUGA for UCN codons (N = A, G, C or U) has an extended anti-codon stem. It has been a long-standing problem to prove experimentally how these tRNAsSer work in the mt translation system.To solve the above-mentioned problem, we examined their translational abilities in an in vitro bovine mitochondrial translation system using transcripts of altered tRNASer analogues derived from bovine mitochondria. Both tRNASer analogues had almost the same ability to form ternary complexes with mt EF-Tu and GTP. The D-arm-lacking tRNASer GCU analogue had considerably lower translational activity than the tRNASerUGA analogue and produced mostly short oligopeptides, up to a tetramer. In addition, tRNASerGCU analogue was disfavoured by the ribosome when other tRNAs capable of decoding the cognate codon were available.Both mt tRNASerGCU and tRNASerUGA analogues with unusual secondary structure were found to be capable of translation on the ribosome. However, the tRNASerGCU analogue has some molecular disadvantage on the ribosome, which probably derives from the lack of a D arm.

The mammalian mitochondrial ribosome (mitoribosome) has a highly protein-rich composition with a small sedimentation coefficient of 55 S, consisting of 39 S large and 28 S small subunits. In the previous study, we analyzed 39 S large subunit proteins from bovine mitoribosome (Suzuki, T., Terasaki, M., Takemoto-Hori, C., Hanada, T., Ueda, T., Wada, A., and Watanabe, K. (2001) J. Biol. Chem. 276, 21724-21736). The results suggested structural compensation for the rRNA deficit through proteins of increased molecular mass in the mitoribosome. We report here the identification of 28 S small subunit proteins. Each protein was separated by radical-free high-reducing two-dimensional polyacrylamide gel electrophoresis and analyzed by liquid chromatography/mass spectrometry/mass spectrometry using electrospray ionization/ion trap mass spectrometer to identify cDNA sequence by expressed sequence tag data base searches in silico. Twenty one proteins from the small subunit were identified, including 11 new proteins along with their complete cDNA sequences from human and mouse. In addition to these proteins, three new proteins were also identified in the 55 S mitoribosome. We have clearly identified a mitochondrial homologue of S12, which is a key regulatory protein of translation fidelity and a candidate for the autosomal dominant deafness gene, DFNA4. The apoptosis-related protein DAP3 was found to be a component of the small subunit, indicating a new function for the mitoribosome in programmed cell death. In summary, we have mapped a total of 55 proteins from the 55 S mitoribosome on the two-dimensional polyacrylamide gels.

The mammalian mitochondrial ribosome (mitoribosome) is a highly protein-rich particle in which almost half of the rRNA contained in the bacterial ribosome is replaced with proteins. It is known that mitochondrial translation factors can function on both mitochondrial and Escherichia coli ribosomes, indicating that protein components in the mitoribosome compensate the reduced rRNA chain to make a bacteria-type ribosome. To elucidate the molecular basis of this compensation, we analyzed bovine mitoribosomal large subunit proteins; 31 proteins were identified including 15 newly identified proteins with their cDNA sequences from human and mouse. The results showed that the proteins with binding sites on rRNA shortened or lost in the mitoribosome were enlarged when compared with the E. coli counterparts; this suggests the structural compensation of the rRNA deficit by the enlarged proteins in the mitoribosome.

The films of dodecyl chain-linked C60 via ortho, meta and para positions on a phenyl group (o-C12, m-C12 and p-C12) were prepared by casting the carbon disulfide solutions on the amorphous carbon coated silicon substrates. Out-of-plane and in-plane structures of these cast films were characterized by X-ray diffraction (XRD) and grazing incidence X-ray diffraction (GIXD) methods, respectively. As a result of XRD measurement, it was revealed that all the cast films take multilayer structures and the period of the layer structure of the o-C12 film (32.5 A) is much larger than that of the m-C12 (23.2 A) or the p-C12 (23.3 A) film. By GIXD measurement, it was found that C60 moieties form two-dimensional arrangement of the square lattice (a=10.1 A,γ=90°) and pack densely in all the cast films.

Many cardiovascular complications have been described in systemic lupus erythematosus (SLE), however, aortic involvement is very rare. We are reporting abdominal aortic aneurysm rupture in a 47-year old woman with SLE. The patient was admitted to our hospital with severe abdominal pain. Emergency computed tomography of the abdomen demonstrated ruptured abdominal aortic aneurysm. The restoration of aortic flow with vascular prosthesis was performed in emergency. Postoperative course was uneventful.

Mitral valve prolapse (MVP) has been associated with several connective tissue disorders, including Marfan's syndrome, Ehlers-Danlos syndrome, and pseudoxanthoma elasticum. We present a case of MVP in a patient with epidermolysis bullosa. The authors are aware of only one previously reported case of this association. A 49-year-old man with a history of epidermolysis bullosa since childhood was admitted to our institution due to dyspnea on effort. On general examination he was observed to have alopecia, deformities in his nails, and fusions of his fingers. Transesophageal echocardiography confirmed the presence of MVP. In addition, coronary angiography showed three-vessel disease. Mitral valve replacement (ATS valve 25 mm) and coronary artery bypass grafting (left internal thoracic artery-LAD) were performed. The resected mitral valve (anterior leaflet) contained the area of the myxomatous lesion histologically. The pathological mechanism of epidermolysis bullosa is thought to be the destruction of collagen fibers due to increased levels of enzyme collagenase. Therefore there may be a common cause of MVP and epidermolysis bullosa based upon an abnormality of collagen metabolism.

Extended abstract of a paper presented at Microscopy and Microanalysis 2008 in Albuquerque, New Mexico, USA, August 3 – August 7, 2008

More than half of the electrical faults on transmission lines are caused by lightning in Japan. In order to improve their lightning performance, gapped type transmission line arresters have been installed in many service lines since 1986. It is general that the arresters are installed on three phases of one circuit of double-circuit transmission lines to prevent interruptions of supply due to lightning flashover. The authors developed a new lightning surge analysis method, which is able to simulate the actual faults, by reviewing the existing parameters. Using this analysis method, they have studied new application concept of the arrester on 500 kV transmission lines with high-speed reclosing systems. As a result, it is found that the application of two arresters per one circuit of double-circuit line is able to prevent interruptions of supply.

Publisher Summary This chapter reviews several structural characterizations of carbon nanotubes (CNTs) with the cylindrical graphite from the viewpoint of transmission electron microscopy (TEM). Especially, electron energy loss spectroscopy (EELS) by using an energy-filtered TEM is applied to reveal the dependence of fine structure of EELS on the diameter and the anisotropic features of CNTs. Although CNTs showed similar EELS pattern in plasmon-loss and core-loss regions to graphite, SWCNT and fine MWCNT with a diameter less than 5 nm had different features. Furthermore, it has been found out that the angular dependent EELS along the direction normal to the longitudinal axis of CNT shows stronger contribution from π electrons than a electrons. It has been confirmed that the anisotropy of CNT exists in the structure and electronic property. Although it is scarcely able to obtain a lattice image of the graphitic structure from a single-walled CNT (SWCNT), whole the CNT should be aligned normal to the incident electrons without any inclination and bending. Therefore, it is difficult to detect the helicity in a CNT from the images. Some investigations have been devoted to the structures at the end and around the bends of CNTs. There could be the presence of pentagons or heptagons, but it is also not easy to distinguish the individual polygons by TEM.

Among 64 cases of surgically resected primary lung cancer from 1991 to 1997, there were 5 cases of synchronous double cancers of the lung and digestive tract. They were consisted of 4 males and 1 female and the patient age at the time of the lung resection ranged from 65 to 81 years (average: 74.6). One male was diagnosed as having lung cancer (squamous cell carcinoma) along with sigmoid colon cancer (adenocarcinoma) and others were lung cancer (adenocarcinoma) and gastric cancer (adenocarcinoma). In two patients with early gastric cancer, lobectomies were performed following endoscopic resection of gastric cancer. In three patients including two old man and woman (over 80 years old), lobectomies and gastrectomies (or sigmoidectomy) were performed at the same time. We omitted mediastinal lymph nodes dissections in two old patients and no operative complications occurred. All patients are alive now. It can be concluded that in cases of synchronous double cancers of the lung and digestive tract, we must select the best treatment that is not invasive for the patient and that simultaneous operation for double cancer can be safely performed.

A rare case--only the fourth as known--of a nasal schwannoma with intracranial extension is presented. A 28-year-old Japanese man complained of right nasal obstruction and bleeding for one year. A biopsy indicated the presence of a nasal schwannoma. Computed tomography and magnetic resonance imaging demonstrated intracranial extension of the tumour. The patient underwent surgery with a combined intra- and extracranial approach. Reconstruction was performed using pericranial flaps. Surgical management of this tumour is also described.

Traumatic lung cyst is an uncommon lung injury due to closed chest trauma. A 5-year-old boy was admitted to our hospital after being run over by motor vehicle. Computed tomography of the chest demonstrated multiple cystic lesions. This case was diagnosed as traumatic lung cysts. Computed tomography taken 37 days after initial injury showed complete resolution of the cysts. Computed tomography was useful in diagnosing traumatic lung cyst and following its clinical course.

We reported two male and one female patient (17, 36 and 47 years old, respectively) who presented infectious endocarditis (IE) in association with ventricular septal defect (VSD). In all cases, surgical treatment was performed in the acute stage of IE for persistent sepsis, pulmonary embolisms, and for giant vegetations. Because the tricuspid valve apparatus was severely damaged, valve replacement with the Carpentier-Edwards pericardial bioprosthesis was done and small VSD was directly closed in all cases. In one case, a complete heart block occurred, which necessitated postoperative implantation of a permanent pacemaker. All patients recovered and resumed their original social activities without the relapse of endocarditis.

The effects of a soybean oil diet and a high-cholesterol oil (HC) diet, and an HC diet with eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) supplementation, on basal and postpreservative cardiac function of the hearts and on postpreservative renal function of the kidneys from older rats were examined.Groups 1 through 4 of 100-week-old rats were fed either soybean oil, HC, HC with EPA, or HC with DHA, respectively, for 12 weeks. Blood was collected for analysis of plasma fatty acids, and the heart and left kidney were removed from the rat. In experiment 1, the heart was perfused on a Langendorff apparatus. After evaluation of the cardiac function of each rat, the heart was stored in histidine-tryptophan-ketoglutarate solution for 8 hr at 4 degrees C. The heart was reperfused and the recovery of cardiac function was evaluated. The coronary perfusate during reperfusion was collected to measure 6-keto prostaglandin F1alpha and thromboxane B2. Coronary flow (CF) perfused with Krebs-Henseleit bicarbonate (KHB) solution containing 5-hydroxytryptamine (5-HT) and nitroglycerin were evaluated in the Langendorff mode with atrial pacing (330 beats/min). In experiment 2, the excised left kidney was immediately flushed and preserved with University of Wisconsin solution for 8 hr at 4 degrees C. The kidney was then reperfused with KHB solution and renal function was evaluated.The plasma and cardiac EPA levels in group 3 were significantly higher than the levels found in the other groups. The plasma and cardiac ratios of EPA to arachidonic acid were significantly higher in groups 3 and 4 than in groups 1 and 2. There were no significant differences in basal cardiac function among any of the diet-fed rats. The percentage values of the recovery of aortic flow, cardiac output (CO), and left ventricular max dp/dt in group 3 and CO in group 4 were significantly higher than in group 2. In addition, the recovery of CF in group 3 tended to be higher than in group 2 (P=0.07). The percentage values of the recovery of aortic flow, CF, CO, and left ventricular max dp/dt in group 1 were significantly lower than in the other dietary groups. CF reperfused with KHB solution containing 5-HT was significantly higher in group 3 than in groups 1 and 2. CF reperfused with KHB solution containing 5-HT was significantly higher in group 4 than in group 1. CF reperfused with KHB solution containing nitroglycerin in group 3 tended to be higher than in groups 1 and 2 (P=0.07). The thromboxame B2 concentrations in the coronary perfusate during reperfusion in groups 3 and 4 were significantly lower than in groups 1 and 2. Fractional sodium reabsorption in group 3 was significantly higher than in group 2. Inulin clearance in groups 3 and 4 was significantly higher than in group 1. The postpreservative urinary flow in group 3 was significantly higher than in groups 1 and 2. The urinary flow was significantly higher in group 4 than in group 1.These results suggest that EPA administration may attenuate preservation and reperfusion injury and improve the recovery of cardiac and renal functions in hyperlipidemic and older rats. DHA administration may also show beneficial effects on kidney preservation in hyperlipidemic rats.

A 64-year-old woman waiting for CABG for triple coronary artery disease admitted to our hospital due to chest oppression. One week after the admission, pericardiotomy was performed and blood in the pericardial effusion was found. Emergent chest CT scan revealed dissection of the ascending aorta (DeBakey II) with occluded false lumen. Because her condition was stable, concomitant operation of graft replacement of the ascending aorta and triple coronary artery bypass grafting were performed 3 months after the medical therapy. Her postoperative course was uneventful and the patient remains asymptomatic.

Dysprosium-doped borate glasses were prepared and their physical properties, optical absorption and fluorescence characteristics were investigated. Among three Judd-Ofelt parameters, the O2 increased and the O6 decreased with an increasing Na2O content. The Branching ratio of blue/yellow emission from the 4F9/2 level increased and its lifetime decreased with Na2O content. The lifetime of the 4F9/2 level increased with increasing temperature, which is unusual for most rare earth levels. Moreover, the branching ratio of blue/yellow emissions also changed with temperature. These behaviors could be explained by considering the temperature change of local structure and radiative transition probability of Dy3+ ions in the borate glasses.

A 41-year-old Japanese woman complained of a gradually enlarging swelling of her left cheek for seven months. She was diagnosed with osteopetrosis by standard skeletal radiographs, and her cheek swelling was diagnosed as maxillary osteomyelitis secondary to osteopetrosis. She underwent a left partial maxillectomy, and her post-operative course was stable with no complications. A literature review is also presented.

We compared the results of 19 mm SJM aortic valve replacements with those of 23 mm SJM aortic valve replacements conducted the same period. [MaterialMethod] The subjects were 21 patients who underwent valve replacement with a 19 mm SJM prosthesis (the SJM19A group). The age ranged among 16 and 65-year-old, mean of 51. The body surface area was 1.24 to 1.76 m2, mean of 1.48 m2. The post-operative follow-up period was 156 months at maximum and 44 months on average. We compared the SJM19A group with the SJM23A group by chest X-ray and echocardiography. [Results] Two patients in the SJM19A group died soon after surgery. Of the other patient, 19 were categorized NYHA I and one in NYHA II classification in their late phase. Arrhythmia of Lown IVa developed in one patient. The cardio-thoracic ratio decreased from preoperative 60% in the late phase after surgery (p0.002) in the SJM19A group, although there was no significant difference with that in the SJM23A group. Echocardiographic improvement in left ventricular hypertrophy was considerable between before and late after surgery in the SJM19A group, while it was not significantly different between the SJM19A and SJM23A group. The mean value of aorta-left ventricle pressure difference in the late stage was 32 mmHg in the SJM19A group and significantly different from the value in the SJM23A group (p0.001). This pressure difference tended to be greater as the follow-up period was progressed, while the percentage decrease in the myocardial mass of the left ventricle tended to decreased with longer follow-up period. This data suggests that an increasing level of aorta-left ventricle pressure difference should raise little problem in the mid-term late stage after surgery but possibly cause a serious problem in the long term. Clinical observation should be continued over a long period of time after surgery.

A 26-year-old man had a total repair of tetralogy of Fallot at 1 year of age, and had redo surgery for restenosis of the right ventricular outflow tract and small residual VSD at 11 years of age. After the second operation, AV block developed and an endocardial pacemaker system was implanted. For the last 3 years, he had mild febrile episodes, cough, occasional hemoptysis and paroxysmal ventricular tachycardia. Because of his refractory tachycardia and suspected infective endocarditis, he was admitted for further study. Blood culture revealed Peptostreptococcus, echocardiogram showed vegetation around intravenous pacing lead, and electrophysiological study demonstrated delayed potential on the left side of the right ventricular outflow tract. He underwent scartectomy and cryoablation of the focus of the tachycardia which was reconfirmed by epicardial and endocardial mapping during the operation, which involved removal of the endocardial lead and new outflow tract patch repair. His postoperative course was uneventful without any antiarrhythmic drugs. Pathological examination of the scar showed myocardial fibrosis and replacement by fatty tissue which was different from the pathological characters of the arrythmogenic right ventricular dysplasia.

A 1-year and 8-month-old girl admitted to our hospital because of wheeze and dyspnea. Echocardiogram and cardiac catheterization confirmed isolated congenital mitral insufficiency with pulmonary hypertension. She was treated with reconstructive surgery consisting of suture of clefted anterior mitral leaflet and annuloplasty. Her postoperative course was uneventual and mitral regurgitation was remarkably improved.

We describe a modification of the Elmslie-Trillat operation which includes a lateral retinacular release and medial realignment of the tibial tuberosity, but omits medial capsulorraphy. Seventy-five patients were reviewed with a follow up longer than 2 years and the results compared with the conventional Elmslie-Trillat procedure, which consists of lateral release, medial realignment of the tuberosity and medial capsulorraphy. The simpler operation can work as well and the period of rehabilitation is shorter. The incidence of injury to the saphenous nerve is reduced and the cosmetic appearance is more satisfactory. We conclude that medial capsulorraphy is usually unnecessary in this type of procedure.

We report a rare complication of endocardial pacing electrode implantation. A 64-year-old man, who was implanted transvenous pacemaker system by the other hospital one month ago, visited our outpatient clinic with the complaint of diaphragmatic twitching. Left ventricular pacing was highly suspected because of right bandle branch block pattern by 12 leads ECG. Pericardial effusion was observed by echocardiography, and angiography revealed the pacing electrode coursing through the coronary sinus and perforated the cardiac vein towards the posterior wall of the left ventricle. A new generator and a pacing electrode were implanted on the other side. Pericardial drainage was not performed because hemodynamics was stable. The patient discharged hospital on 18th postoperative day without any complication.

A one-year-old boy was admitted with refractory congestive biventricular heart failure for medical treatment. On echocardiogram and cardiac catheterization revealed severe mitral stenosis from parachute deformity with pulmonary hypertension. During the operation, a single round orifice of 7 mm in diameter was detected in the mitral valve and adhered chordae were attached to a large single papillary muscle which was located at the posteromedial portion of the left ventricle. An isolated muscle band which was not attached to the mitral valve was observed at the anterolateral wall of the left ventricle. The mitral valve was replaced with 16 mm Carbo-Medicus prosthesis. Postoperative catheterization revealed residual pulmonary hypertension which was responsive to Imidarine infusion. He was discharged from the hospital without any sequelae, and has been on regimen including anticoaglant and vasodilator.

The oral toxicity of ramosetron ((R)-5-[(1-methyl-3-indolyl) carbonyl]-4,5,6,7-tetrahydro-1H-benzimidazole hydrochloride, CAS 132907-72-3, YM060), a new compound having serotonin (5-HT)3 receptor antagonist activity was investigated in beagle dogs. To evaluate the acute toxicity, two groups of beagle dogs, each comprised of one male and one female, were given YM060 bulk powder in gelatin capsules at dose of 0, 3 mg/kg or 0, 30 and 60 mg/kg in ascending order in at least 7-day intervals. After the final dose, animals were observed for 2 weeks. No deaths were observed at any dose. At 60 mg/kg, the male exhibited frequent vomiting, salivation and prone position 1-3 h after administration, when the plasma concentration of the unchanged drug reached Cmax or was close to Cmax. The female exhibited no changes except vomiting. No effects on either the male or the female were detected in body weight, food consumption, electrocardiography, hematology, plasma biochemistry or urinalysis. To evaluate the subacute toxicity of YM060, three male and 3 female beagle dogs per group received doses of 0, 1, 3, 10 and 20 mg/kg/d for 13 weeks. YM060 was triturated 10-fold using lactose and filled in gelatin capsules before use. The plasma concentration of unchanged drug increased almost dose-dependently, peaked about 2 h post-dosing and subsequently decreased with time. The plasma concentration-time profile after the final dose at week 13 was not different from that after the initial dose. No treatment-related changes were observed up to 3 mg/kg/d.(ABSTRACT TRUNCATED AT 250 WORDS)

A 43-year-old woman was referred for examination because of an abnormal shadow on a chest X-ray film. She had a 12-year history of seropositive rheumatoid arthritis. Chest X-ray films and CT scans showed a pleurabased solitary nodule without a cavity. Cytological examination of a transbronchial biopsy specimen did not lead to a diagnosis, so thoracoscopic enucleation was performed. Histologically, the nodule consisted of lymphocytes and fibroblasts surrounding a central necrotic area, which indicated that it was a rheumatoid nodule. This solitary necrobiotic nodule was radiographically indistinguishable from lung adenocarcinoma, so histologic confirmation was necessary.

Two cases of coronary artery fistula with coronary artery aneurysm were reported. Coronary angiography showed dilated right coronary artery with the formation of aneurysm drained to the right atrium and to the right ventricle respectively. The inflow ostium from the coronary artery to the aneurysm were closed from inside adding aneurysmorraphy. Postoperative clinical courses were uneventful and residual shunts were not detected by angiography. We reported these cases with literature.

Two patients underwent surgical treatment for right-sided infective endocarditis with ventricular septal defect. In both cases, blood cultures showed Peptostreptococcus, and the operation was performed at non-active phase after antibiotics therapy. The case 1 was a 7-year-old girl who was observed a vegetation on the chorda of the anterior paillary muscle by echocardiography. The defect was directly closed and the vegetation was excised. The case 2 was 22-year-old female who had been diagnosed of VSD in her infancy. A high fever continued and echocardiography revealed a vegetation attached to the septal tricuspid leaflet. Partial excision of the leaflet and autopericard patch plasty was performed, and the VSD was directly closed. Postoperatively intravenous antibiotic therapy was given for periods of 6 weeks, and clinical course were uneventful in both cases. Local excision of vegetation and leaflet repair by autopericard patch plasty should be performed in cases with localized vegetation and minor valvular regurgitation.

The cost of designing and manufacturing fixtures, that can be easily justified in mass production, is a bottleneck for small batch production. Although the application of Flexible Manufacturing Systems (FMS) expects to lead to high-efficiency of manufacturing in high product mix and low volume quantity of components, preparing fixtures for mounting workpieces on machine tools is an unavoidable problem for the effective implementation of low-volume FMS. To solve this problem, the authors have suggested the concept of fixture-free machining, especially for block- and plate-like components. This concept is based on the new technologies of automated workpiece handling by special devices. It is possible to machine block-like components automatically by adopting bar-form material as the workpiece and adding special clamping device and automated workpiece holding vise to the machine tool. Automatic plate-like component machining can be performed by adding a special fixture and lifting device to the machine tool. The prototypes of these devices, based on the new technologies, have been developed and have demonstrated the possibility of unattended manufacturing for block- and plate-like components. By considering the results of the prototypes, two Block Machining Centers (M/Cs) and one Plate M/C have been developed. There is another consideration for the operation of FMS. That is to make NC data for Machine tools or M/Cs. M/Cs developed in this research need complex NC data to operate a holding device, automated workpiece holding vise, lifting device and a special fixture as well as the M/C. The authors have already developed CAD/CAM system for fully automated CAM processing for block- and plate-like components. By using this system, NC data is generated automatically and by combining the system and the M/Cs it is possible to perform fully automated manufacturing.

A very rare case of gliosarcoma with von Recklinghausen's disease is presented. A 51-year-old man was admitted to our hospital in March 1990, because of a 2-month history of personality change and left hemiparesis. Multiple neurofibroma over his whole body with many café au lait spots had been present since early childhood. His mother, brothers and children also had café au lait spots. Neurological examination on admission revealed memory disturbance, left homonymous hemianopsia and left hemiparesis. CT scan showed a large lobular lesion in the right temporoparietal region. The medial hypodense part was sharply demarcated by a ring-like enhancement, while the lateral isodense part was homogeneously enhanced. MRI showed a sharply demarcated high intensity lesion with Gd-EDTA enhancement corresponding to the enhanced area on CT. Faint staining on angiography revealed that the blood supply to the tumor was predominantly dural. At surgery, the tumor was solid and highly vascular, and adhered tightly to the dura. The superficial part of the tumor was well demarcated from the brain tissue, but the demarcation was obscure in the deeper part. Histological findings showed two clearly defined neoplastic components: a gliomatous component that was stained for GFAP, and a sarcomatous component that had spindle-shaped nuclei and eosinophilic fibers. The patient underwent radiotherapy after surgery, but the tumor soon recurred. A second operation was performed, but the tumor had infiltrated into the scalp and he died 10 months after the first operation. This combination is very rare and has not been reported previously.