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Progression to moderate or severe mitral regurgitation (MR) was studied after Inoue balloon percutaneous transvenous mitral commissurotomy (PTMC) using the stepwise inflation technique, performed at increments of 1 mm of balloon diameter, in 49 consecutive patients with rheumatic mitral stenosis (aged from 32-73 years; 8 males, 41 females). The patients were classified on the basis of the degree of MR after PTMC, compared with that before PTMC, into either Group A, development of moderate or more severe (or = grade 2) MR (n = 8) or Group B, no increase in MR or development of mild (grade 1) MR (n = 41). Progression to moderate or severe MR was significantly associated only with advanced age (60 +/- 8 vs 52 +/- 10 years, p0.05) and narrower mitral valve area (0.87 +/- 0.35 vs 1.11 +/- 0.29 cm2, p0.05), but other characteristics before PTMC were similar in both groups. There was no difference between the two groups in the total number and degree of balloon inflation. Immediately before the final inflation, the left atrial mean pressure and v wave pressure were decreased in smaller degrees in Group A compared with Group B (-2 +/- 2 vs -5 +/- 4 mmHg, p0.05; -2 +/- 2 vs -6 +/- 6 mmHg, p0.05, respectively). Thus, the stepwise inflations require careful monitoring of changes in the left atrial pressure and waveform to recognize the aggravation of MR, especially in older patients with severe stenosis. Patients who do not have a significant drop in left atrial mean pressure and v wave pressure during stepwise inflations of the balloon might be at risk of development of moderate or severe MR after further dilations.

We experienced 8 cases in which Coronary Artery Bypass Grafting (CABG) was performed by the arterial graft alone with radial artery (RA) and inferior epigastric artery (IEA) used in addition to internal thoracic artery (ITA) and right gastroepiploic artery (RGEA). All the patients were male ranging in age from 50 to 66 years (mean 57.5 year). The number of anastomosis was 3 to 5 branches (mean 3.6 branches). IEA was anastomosed with LITA and used as a composite graft in all cases. As for the proximal anastomosis of RA it was anastomosesd with ascending aorta. On postoperative radiography of graft, LITA, RITA, IEA and RA were all patent and RGEA was occluded only in one anastomosis where it was sequentially used (96.6%). All the patients followed a satisfactory postoperative course, and no case developed any major complications.The use of IEA and RA made it possible to perform CABG using only the artery with excellent postoperative results and early patency rate of the graft.

We started to perform MIDCAB for the cases of markedly low cardiac function from June, 1996 and obtained satisfactory results. So we expanded the indications to include only left anterior descending artery (LAD) lesion from June, 1997 and have since performed this operation on 14 cases. The 14 cases of MIDCAB were divided into two groups, Group L consisting of 6 low risk cases: 1 lesion alone without any complications involving other organ before operation and Group H made up of 8 high risk cases: multi branch lesion but rated as high risk because of the extracorporeal circulation being used. Both Group L and Group H were free of operation death and hospital death. In Group L, all the cases underwent operation without blood transfusion, the period of postoperative stay in ICU was not longer than 1 day, on catecholamine was required after operation and complications were not found either. The patency of the graft was 100 percent. The patients were discharged 13.7 days after operation. In Group H, 2 cases required blood transfusion and 3 cases required catecholamine after operation. Complication arising from operative wound were noted in 3 cases. One GEA graft to the right coronary artery and one LITA to the LAD buried in the muscle were occluded. After operation, hospital stay for 23.9 days was required. In Group L, the postoperative course was excellent, so MIDCAB was considered indicated well for this group. In Group H too, the selection of MIDCAB was considered adequate that the risk of conventional CABG is considered much higher.

The Carpentier-Edwards (CE) ring was developed to restore the normal 3:4 ratio between the anteroposterior and transverse diameters of the mitral valve orifice during systole. It is difficult to use in patients in whom the ratio is more than 3:4. To overcome this problem, we developed an adjustable obturator, the ratio of which may be changed by sliding apart its two components.Remodeling annuloplasty was performed using part of a flexible Duran ring or autologous pericardium and the adjustable obturator in 17 patients with severe MR, including two with high anterior leaflet.Physiologic remodeling annuloplasty was easily accomplished in all cases. Intraoperative echocardiography was performed in 14 patients, and it showed no regurgitant jet in 11 cases and only trivial jet in three.Physiologic remodeling annuloplasty to retain the natural shape of the anterior leaflet by using an adjustable obturator is a very useful technique that enables annuloplasty to be performed in all cases, irrespective of the shape of the anterior leaflet.

Our collaboration group have continued the research to develop the high performance photocathode and the guns to produce the highly polarized electron beam for high energy accelerator physics. In this report, the experimental results obtained from the photocathodes with superlattice structures, such as, AlGaAs-GaAs, InGaAs-GaAs and InGaAs-AlGaAs are described.

Early postoperative results were studied in 50 cases of coronary artery bypass graft (CABG) using a radial artery (RA). The patients ranged in age from 37 to 81 years, with the mean age of 61 years. Of them, 49 were male. An average of RA was 17.6 cm at completion of detachment and 15.6 cm when the graft was cut for use. The internal diameter before anastomosis an average of 3.7 mm on the proximal side and an average of 2.8 mm on the distal side. RA was anastomosed with ascending aorta in 47 cases, with the left internal thoracic artery in 2 cases and with the right internal thoracic artery in one case on the proximal side. RA was anastomosed with the left anterior descending branch area in 6 cases, with the left circumflex branch area in 40 cases and with the right coronary artery area in 4 cases on the distal side. There was no case of operative death, but one patient died while in hospital. The cumulative patency rate of the RA grafts was 95% (n = 40). Early postoperative results of the RA graft were satisfactory, therefore the RA graft were satisfactory, therefore the RA graft was an excellent alternative conduit for myocardial revascularization.

The clinical role of collateral vessels, which are transiently augmented during coronary artery spasm, remains controversial.To examine the correlation between coronary arteriographic and electrocardiographic features during spasm in the left anterior descending artery (LAD).We studied 45 patients in whom LAD spasms were induced by administration of acetylcholine or ergonovine maleate into the left coronary artery, or in whom spontaneous LAD spasms were documented during diagnostic cardiac catheterization.During spasm, only three patients had transient appearance or augmentation of collateral flow opacifying the LAD. In these three patients, electrocardiograms obtained from anterior precordial chest leads during LAD spasm showed ST-segment depression, ST-segment elevation followed by ST-segment depression, and only T-wave change, respectively. Except for these three patients, ST-segment elevations were observed in all other patients (31 of 34) with main-branch spasm of the LAD. However, ST-segment elevation was observed in only two of 11 patients in whom spasm of the diagonal branch alone was induced.Our observations suggest that the electrocardiographic changes during spasm are not always a sensitive indicator of LAD side branch spasm or LAD main-branch spasm associated with collateral circulation. From consideration of the angiographic features of the collaterals in the three patients with LAD main-branch spasm, we speculate that the balance of tonus of both the recipient and donor arteries, and the degree of organic stenosis of the recipient artery, may have important roles in the mechanism responsible for the change in the appearance of collaterals in patients with coronary spasm.

The histological characteristics were comparatively analyzed among biopsy specimens, surgically removed prostates and metastatic lymph nodes obtained from 60 patients with prostatic adenocarcinoma treated by radical prostatectomy. According to the WHO-Mostifi's classification, the proportion of the 6 histologic components, large and/or small simple glands (LSG), micro-glands (MIC), cribriorm (CRB), fused glands (FUS), medullary/solid (MED) and columns-cords/trabecular (C-C), was determined semiquantitatively. LSG, MIC, and CRB are androgen-sensitive components, while FUS, MED and C-C are androgen-refractory components. The proportions of 5 histologic components excluding MIC were similar in the biopsy and prostate specimens. In 78.3% of the patients, the presence (or absence) of androgen-refactory components in the biopsy specimens coincided with that in the prostate specimens. However, the histologic except for the C-C component. Metastatic lymph nodes contained androgen-refactory components in all cases and tended to have more CRB and FUS and fewer LSG. The histology of the needle biopsy specimens may reflect that of the prostate glands, and may serve as a valuable parameter for determining therapeutic modalities. In addition, androgen-refactory components are frequently present in lymph node metastasis.

Endothelin 1 (ET-1) production was examined in the rabbit nephron in acute renal failure (ARF) induced by uranyl acetate administration or by clamping the renal artery. Uranyl acetate dissolved in saline was injected intravenously at a dose of 0.8 mg/kg (n = 12). In the ischemic kidney experiment, 60 min of left renal artery clamping was carried out 1 week after removing the right kidney (n = 8). Plasma and urine concentrations of ET-1 were measured 0, 24, and 48 h after treatment, and immunohistochemical studies of renal tissues obtained 48 h after the experiments were carried out using ET-1 monoclonal antibody. The fractional excretion of ET-1 increased from 10 to 89% at 48 h in the uranyl acetate treated group and from 6 to 15% at 24 h in the renal artery clamping group, suggesting the existence of ET-1 secretion from the nephron in both types of ARF. By immunohistochemical examination, strong ET-1 expression was noted only in the collecting ducts. No staining was observed in other parts of the nephron in both types of ARF. The present study indicates that the increased expression of ET-1 probably reflects production by the collecting ducts in both rabbit ARF models.

Hemolytic anemia is a well-recognized complication of mechanical heart valve prosthesis but, as yet, has not been reported after mitral valve repair with chordal replacement. We report a case of severe hemolytic anemia after mitral valve repair with chordal replacement and Carpentier-Edwards annuloplasty ring insertion. Progressive prolapse of the anterior leaflet due to the artificial chordae being too long caused recurrent regurgitation which was responsible for the hemolysis. The patient also had idiopathic thrombocytopenic purpura, but successful second mitral valve repair was performed after high-dose gamma-globulin therapy.

Background According to our survey conducted on RA patients last year, it was suggested that although implementation of T2T has been realized on patients treated with biological products, for those who are not, T2T education is inadequate. In Japan, regular healthcare workers are not given opportunities for T2T training except for those RA care nurses and RA specialists who have received special training domestically or abroad. Objectives We examined ways in which we could establish a system in our hospital for all RA patients to receive T2T whether using biologics or not. Methods First, T2T workshops were given to all the healthcare workers at our hospital. After a 30 minute lecture and slideshow about RA classification standards, drugs, the concept of T2T, and patients’ thoughts and concerns, we checked the participants’ level of understanding for those topics on a scale of one to three. To further the study, we conducted a survey among the participants soliciting their opinions about how to realize complete T2T implementation regardless of treatment. Based on the results of the survey we considered making an RA handbook to distribute all RA patients in our facility. Results Among 57 participants (90% of all our medical staff), 70% were nurses, half of whom were in their thirties. Seventy-seven percent of the participants thought the workshop was useful and 98% understood the basics of the lecture. Ninety-three percent answered “Yes” to the question about patients knowing about T2T, and if so, if they thought their prognosis would change. For full implementation of T2T, 81% thought “continuing education for patients” is important, followed by “regular education for allied health professionals” (66%), “clarifying treatment goals for advanced RA patients” (59%), “making and distributing RA handbooks” (57%), and “altering the treatment course set by doctors” (54%). To an open question about T2T, answers were “need to have exclusive RA care nurses”, “agreement on the treatment course among doctors” and “extended care to elderly patients and those without enough information”. Thereafter to examine the concept of making handbooks and their contents, a session was held in which we discussed 3 types of checklists for the handbooks; one for patient background including history of diseases, treatment, and adverse events and the others for assessments done by patients themselves every 3 month and treatment goals that should be decided with doctors respectively. Along with those checklists, it is suggested that the book have a record for health checks (including cancer screening). Also we considered the possibility of hiring excusive RA care nurses for our patients. Conclusions In Japan, doctors usually can’t spare enough time for counseling with patient due to overloaded schedules. The reason patients treated with biologics are well educated about T2T is because they’ve had more opportunity for one to one counseling with medical staff. To do the same for every patient, help from allied health professionals is indispensable. In promoting T2T education, we believe it is very important to introduce one to one counseling for each patient regardless of their treatment path and distribute RA handbooks to them. Disclosure of Interest None Declared

The success rate of surgical treatment for blowout type free wall rupture of the left ventricle following myocardial infarction has been reported as 4 to 24%. A 64-year-old woman was admitted to our hospital for inferior acute myocardial infarction with cardiogenic shock. In the catheter laboratory, her hemodynamics disclosed electro-mechanical dissociation, and we had to perform an emergent operation there. In order to preserve left ventricular volume and reduce the risk of bleeding, we adopted a modified method using both patch and felt strip sandwich methods which obtained favorable result. The patient was sent to a rehabilitation hospital on the 43rd post operative day because of a mild cerebral complication and she is now doing well with only a slight speaking disturbance at a follow-up period of 10 months.

To circumvent the problems associated with a dilated aortic annulus we first reduced the diameter of the annulus with a short section of Dacron graft and then implanted a smaller size homograft within the graft. This procedure was successfully performed for complete homograft aortic root replacement in a 25-year-old man with severe aortic insufficiency due to a dilated aortic annulus. The indication for homograft replacement can thus be widened, even to patients with a dilated aortic annulus.

In 1986, a sub-committee was organized in Japan Society of Mechanical Engineers (JSME) to standardize a new scale effect formula by studying the outstanding problems of scale effect such as dependence of V (loss distribution coefficient) on specific speed, roughness effect and so on. Then the sub-committee established a new performance conversion method and published it as JSME S 008 in 1989 [11. After its publication, the second sub-committee has been organized to revise the conversion method by collecting the results of further study.

Between July 1991 and January 1995, 74 patients with pure mitral valve regurgitation (MR) underwent mitral valve plasty (MVP) at out institute. Our procedure includes chordal replacement of the anterior leaflet with PTFE sutures (42 patients). There were one hospital death (1.4%) and two late deaths (2.7%) in this series. Only 2 patients (2.7%) needed valve replacement after unsatisfactory repair during the same operation. Late postoperative doppler echocardiographic study (mean follow-up, 12.0 months) showed less than mild regurgitation in 66 patients (95.7%) of 69 patients who are alive. In April 1993 we decided to complete the repair with no or only trivial regurgitant flow by intraoperative transesophageal echodoppler study (TEE). The results have remarkably improved. Late postoperative echodoppler study revealed less than mild reguritant flow in all 49 patients having undergone mitral valve repair with no or trivial regurgitation by intraoperative TEE. It is clear than the TEE study has contributed to the better quality of mitral valve plasty, and we believe that it is important for better long term results to complete mitral valve plasty with no or only trivial regurgitant flow.

Aortic valve replacement combined with enlargement of the valvar ring by the Nicks method and coronary artery bypass grafting via the left internal thoracic artery were performed for an 11-year-old girl with occlusion of the left coronary ostium. The left coronary sinus was covered with membranous tissue, so the left coronary ostium was not found. Aortic valve replacement with 21 mm prosthetic valve was possible by enlarging the valvar ring. The internal thoracic artery which is expected to grow with development of the body was used as the graft.

We studied the magnetic interactions in the chain structures of A 2 Mn III F 5 by an ab initio MO method using cluster model molecules. The effective exchange integral (J) in the chain structures has been estimated from the total energy difference between the highest and lowest spin states in the alternant MO method. We calculated also a dependence of angle (Mn-F-Mn) of the J value in the cluster model. The calculated values are in agreement with the experimental ones. We also discuss a change of the overlap integral between d orbital of Mn and p orbital of F atom to confirm the dependence of angle for the exchange interaction.

We present a case report of a relapse to the mediastinal lymph node alone, 38 months after orchiectomy on surveillance for stage I typical seminoma. The patient, a 63-year-old man, was treated with high inguinal orchiectomy for left testicular tumor and close follow-up. After 38 months from the initial treatment, the chest X-ray film and CT scan revealed mediastinal tumor. Fine needle aspiration cytology performed under the bronchoscopy showed seminoma cells. Complete remission was achieved after three courses chemotherapy of cisplatin, vincristine, methotrexate, peplomycin and etoposide (COMPE). He has continued to be clinically disease-free 8 months after completion of the treatment. According to the available data in the literature, 94% of the recurrences was detected within 3 years after orchiectomy, and 92% involved retroperitoneal lymph node metastases. This is a rare case who had a late relapse in the mediastinum alone.

This study was undertaken to determine whether continuous warm blood cardioplegia (CWBCP) could be acceptable as an alternative method for myocardial preservation in cardiac surgery. Between December 1991 and June 1993, 100 consecutive patients underwent coronary artery bypass surgery. Four patients who received terminal warm blood cardioplegia were excluded in this study. Fourty-eight patients (Group C) served as historical controls, and fourty-eight patients (Group W) from October 1992 to June 1993 served as a prospective, consecutive cohort for statistical comparison. Two groups varied in the types of myocardial protection and cardiopulmonary bypass (CPB) used: intermittent cold blood cardioplegia and moderate hypothermic CPB were used in Group C and CWBCP and normothermic CPB in Group W. The groups had similar number of bypass grafting, aortic cross-clamping time and CPB time. No patients was died. The prevalence of intraoperative cerebral infarction was equal in both groups (4.2%). The incidence of spontaneous defibrillation at cross-clamp removal was higher in Group W (85.4% versus 8.3%; p0.01). Less inotrope (dopamine) at 6 hours after operation was required in Group W (3.27 +/- 2.48 versus 4.78 +/- 2.99 micrograms/kg/min; p0.01). The intraoperative urgent use of the intraaortic balloon pump was noticeably less prevalent in Group W (0% versus 12.5%; p0.05). Group W patients were more likely to be hemodynamically stable after CPB discontinuing. Serum potassium levels during CPB was higher in Group W (max. 5.67 +/- 0.96 versus 4.39 +/- 0.50 mEq/l), so excessive potassium was eliminated using extracorporeal ultrafiltration. The major drawback of CWBCP was that continuous coronary perfusate occasionally obscured anastomosis site.(ABSTRACT TRUNCATED AT 250 WORDS)

Eight hundred and seventy-two isolates of clinically significant methicillin-resistant Staphylococcus aureus (MRSA) with their clinical information were obtained between 1992 and 1993 from thirty-four hospitals in Japan. The isolation frequency of MRSA was high in sputum (42.9%), pus (33.1%) and blood (14.0%). Pseudomonas aeruginosa was a major bacterial species in polymicrobial infections with MRSA. Enterobacteriaceae and Candida sp. were also frequently isolated with MRSA. Four different coagulase types were identified. Coagulase type II was found in 85.6% of all MRSA strains tested. The isolation frequencies of coagulase type III, type IV and type VII were 3.1%, 3.6% and 3.2%, respectively. The strains of MRSA contained coagulase type II were prevalent in all geographical areas of Japan, but other coagulase types were limited in western areas of the country. The strains of MRSA were tested for their susceptibility to twelve antimicrobial agents and for production of penicillinase. More than 80% of MRSA strains were highly resistant to methicillin, and were also resistant to macrolide antibiotics and tobramycin. Frequencies of resistance to gentamicin, minocycline or ofloxacin were approximately 60%, 50% or 70%, respectively. But only a small percentage of strains were resistant to arbekacin and all of the MRSA tested were susceptible to vancomycin.

We surveyed 387 clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) obtained from 26 hospitals isolated in 1993 to determine whether they became resistant to arbekacin (ABK). Twenty-five ABK-resistant MRSA (6.5%) were isolated from 9 hospitals. Analysis of genomic DNA fingerprinting by pulsed-field gel electrophoresis was used to confirm the classification by resistance patterns, phage typing and other biological characters. After digestion with endonuclease SmaI, two or three types of restriction patterns were found in ABK-resistant MRSA isolated from each hospital. We concluded that ABK-resistant MRSA may spread through nosocomial MRSA infections.

Although various complications such as electrolyte imbalance and urinary infections are known to be induced, ureterosigmoidostomy may still prove to be useful on selected patients who desire a continent form of internal diversion. At our hospital, we performed nineteen ureterosigmoidostomy operations in the seven years between 1981 and 1987. Herein, we have reviewed the postoperative conditions of electrolytes, renal function and other complications. The patients (17 male, 2 female) were between 43 and 75 years old, the mean being 60.3 years. The primary disease was bladder tumor with histopathological findings of transitional cell carcinoma (17) and squamous cell carcinoma (2). Post-operative fluctuations in electrolyte values of Serum Na and Serum K were within the normal value. Hyperchloremia was initially detected in four cases (21.0%), but these were only slightly above the normal range and a year after the operations the conditions were stabilized. Although blood urea nitrogen had a tendency to elevate one or two years after the operation serum creatinine fluctuated within the normal range. After the operations, we administered 10% sodium potassium citrate solution to all patients to prevent hyperchloremic acidosis. During the observation period, only four out of nineteen cases (21.0%) exhibited pyelonephritis. No other complications were observed. Postoperative excretory urograms revealed slight to medium hydronephrosis two months after the operation in four out of nineteen cases but most of these conditions were normalized within a year. Nine patients died after leaving the hospital; seven due to the recurrence of cancer and two due to pneumonia. The ten remaining patients are enjoying normal lives without the use of any external urinary device.

Arbekacin has excellent antibacterial activity and is also effective against methicillin-resistant Staphylococcus aureus (MRSA) resistant to aminoglycosides such as gentamicin, tobramycin, and methicillin-susceptible Staphylococcus aureus (MSSA). By coagulase typing, four different coagulase types were identified from 358 strains out of 387 MRSA isolated during 1993 in Japan. Among isolates collected in the survey period, about 89% had type 2 coagulase, and only a few had type 3 (4.5%), 4 (2.5%) or 7 (3.6%) coagulase. The distribution of coagulase types in Japan is quite different from those outside Japan which had type 4 coagulase. More than 72% of strains with types 2, 7 and untyped coagulase had high resistance to methicillin. All of the isolates with types 2, 3, 4, and 7 coagulase were highly resistant to gentamicin and tobramycin. 89% of isolates with type 7 coagulase, 2.5% of those with type 2 coagulase and 6.3% of those with type 3 coagulase were found to be arbekacin-resistant. No arbekacin-resistant MRSA was detected among the isolates with type 4 coagulase. In the present study, the authors attempted to determine the strong antibiotic activity of arbekacin against MRSA and particularly gentamicin-resistant MRSA. Arbekacin is not modified by the aminoglycoside-modifying enzyme, ANT (4')-1. Although arbekacin is inactivated by the enzyme APH (2")/AAC (6') which can modify both gentamicin and tobramycin, the rate of modification of arbekacin by this enzyme is only 17% or less of that of gentamicin.

Lattice distortion at the interfaces between thin GaN layers with ∼400 nm in thickness and ZnO substrates with non-polar m-plane (10-10) and polar c-plane (0001) is studied using Rutherford backscattering/ion channeling techniques. The interface between GaN/m-plane ZnO is aligned clearly to m-axis, indicating no lattice distortion, while between GaN/c-plane ZnO causes the lattice distortion in the GaN layer due to the piezoelectric field. The range of distortion exceeds ∼90 nm from the interface of GaN/c-plane ZnO. These results are confirmed by x-ray diffraction and reflection high energy electron diffraction studies.

A 53-year-old man complaining of pain in his right upper abdomen was diagnosed as suffering from right renal cell carcinoma with tumor thrombus. Right nephrectomy was performed but curative operation was not possible because of the adhesion of the tumor to psoas muscle. The residual tumor spread to the second lumbar vertebra and the patient complained of lumbago. The tumor continued to grow and the patient suffered from paraplegia even after the administration of natural interferon for 32 weeks. The administration of 9 x 10(6) units of recombinant interferon alfa 2a three times a week, however, resulted in an 86.5% reduction of the tumor after 13 weeks and the patient between able to walk. The PR continued for 17 months.

A 56-year-old woman who had suffered from both aortic and mitral valve stenosis and regurgitation was treated by replacement of valves with 23 mm and 27 mm Björk-Shiley valves respectively. After weaning from cardiopulmonary bypass, the arterial systolic pressure rose to 100 mmHg but the diastolic pressure fell to 40 to 50 mmHg. Studies including transesophageal echocardiogram and fluoroscopy during operation revealed the valves functioning normally. Because low diastolic pressure and low cardiac output continued during postoperative period, fluoroscopy was carried out again. It showed incomplete diastolic closure of the disc of the prosthetic aortic valve. The emergency operation was performed. At reoperation, it was found that one of the end of suture knots located between the valve ring and the disc prevented the occluder from seating completely and caused aortic regurgitation. The suture end was cut shorter and the prosthesis within the sewing ring was rotated so that the occluder was kept away from the suture end.

A 68-year-old Japanese male (Case 1) and a 59-year-old Japanese male immigrant to Brazil (Case 2) who suffered from subcutaneous eosinophilic lymphoid granuloma (Kimura's disease) of several years duration, developed nephrotic syndrome. Renal biopsy demonstrated membranous nephropathy in Case 1 and minimal-change lesion in Case 2. Both patients were treated with prednisolone for several months. There was complete remission of nephrotic syndrome in eight years in Case 1 and in three months in Case 2. Proteinuria did not reappear after remission of nephrotic syndrome in either case. In contrast subcutaneous tumors subsided in both cases during steroid treatment but again became active immediately following discontinuation of the drug. These clinical observations suggest that, though some common factor(s) might mediate the development of both skin and renal lesions, the mechanism of action on these two target organs may differ, perhaps serving only as a "trigger" for the initiating mechanism of renal disease.

To clarify the precise of cellular immunity mechanism in pulmonary tuberculosis, we investigated the amount of IL-2 in patients with untreated active pulmonary tuberculosis. When serum adenosine deaminase (ADA) activity was examined using enzyme assay, an abnormally high level was observed in all patients (29.0 + 11.6 IU/ml, mean + SD; 4.5-17.8, normal range). Likewise, the level of serum-soluble interleukin-2 receptor (IL-2R) measured by ELISA showed abnormal high level in all patients (844.3 + 584.8 IU/ml; 80-300, normal range). When stimulated using PHA, the peripheral lymphocyte's ability to produce IL-2 revealed no difference between control subjects and patients. It was, however, noted that the lymphocytes of the patients significantly suppressed IL-2 responsiveness when compared to the control subjects (P less than 0.05). The serum IL-2 concentration measured using RIA could not be detected in any of the patients as was the same for control subject. All of the above mentioned results suggest that T-cell activation which caused increment in serum ADA activity and soluble IL-2R occurred in active pulmonary tuberculosis. The suppressed IL-2 responsiveness in the peripheral lymphocytes of patients proposes the possibility of soluble IL-2R reduction by the negative feedback mechanism in IL-2-sensitive lymphocytes.

The distal 2 cm end of guidewire was broken and retained in the right coronary artery (RCA), during percutaneous transluminal coronary angioplasty for 99% narrowing of the middle RCA in a 53-year-old male patient with effort angina. Because of the stable condition of the patient, elective A-C bypass surgery was performed successfully 2 weeks after this event. However, the broken end of guidewire was not found out in the opened RCA lumen. One and a half year postoperatively, the patient is doing well while the guidewire remains in the same position.

Publisher Summary Coal concentration of the feed slurry is one of the most important factors in determining the efficiency of the liquefaction process. It should be kept as high as possible to increase the volumetric efficiency of the reactors. If the coal to solvent ratio of the slurry can be increased, the process will be largely improved from the viewpoint of cost-saving and efficiency of the process. This chapter discusses a study to examine the effects of quantity and quality of solvent on reaction of brown coal liquefaction. Yallourn coal from Victoria, Australia, was liquefied with the Process Development Unit consisting of three stirred tank reactors in series. An increase in gas-flow rate through the reactors, by recycling the gas from the gas–liquid separator, provided a very high yield of distillate.

The second-order, two-electron Dyson propagator is derived using superoperator theory with a spin-adapted formulation. To include certain ladder diagrams to all orders, the shifted-denominator (SD2) approximation is made. Formal and computational comparisons with other approximations illustrate the advantages of the SD2 procedure. Vertical double ionization potentials (DIPs) for a set of closed-shell molecules are evaluated with the second-order propagator and the SD2 method. The results of the SD2 approximation are in good agreement with experiment. To systematically examine the quality of the results, we compared SD2 and equation-of-motion, coupled-cluster predictions. The average absolute discrepancy is 0.26 eV for 36 doubly ionized states.

This is the first report of re-aortocoronary bypass for Kawasaki's disease. The patient is a 22-year old female. She was afflicted with Kawasaki's disease at the age of 6 and had the symptom of angina pectoris at the age of 9. She went through the first aortocoronary bypass, to the left anterior descending artery (LAD) and the right coronary artery (RCA) with saphenous vein graft (SVG). After the first operation, the graft to LAD occluded totally, but she remained asymptomatic and well for 11 years. She had a sudden recurrence of anginal attack at the age of 20. The examinations confirmed ischemia of the anterior wall (LAD area) and the lateral wall (LCX area). Coronary angiography revealed patent SVG with a moderate sign of sclerotic change. We decided on re-aortocoronary bypass, left mammary artery to LAD and gastroepiploic artery to LCX, when she was 22-years old. LIMA was anastomosed to LAD, but LCX was not revascularized, because LCX was not identified and exposed in the operation. In spite of incomplete revascularization, postoperative stress ECG test was negative. Tl-myocardial scintigram confirmed no ischemia of the anterior wall and greatly reduced ischemia in the lateral wall. She became asymptomatic and returned to normal life.

We report a very rare case of jejunal lymphangioma. A 16-year-old male sustained injuries to abdominal internal organs in a traffic accident. During emergency operation, a cystic tumor was incidentally detected in the jejunum and adjoining mesenterium and treated by segmental resection of the jejunum. The cystic tumor (5.0 x 7.0 cm) was multilocular and demonstrated to be a cavernous lymphangioma by histopathological examination. The pathology, diagnosis, and treatment of this disease described in the literature are reported.

To clarify the immunological aspect of tuberculosis, we investigated serum adenosine deaminase (ADA) activity, T and B cell percentile in total peripheral mononuclear cells, peripheral T cell subpopulation and their relationship with other inflammatory parameters in 20 patients with active pulmonary tuberculosis. Serum ADA activity showed abnormal high level in all patients in nontreated phase with significant regression after three months treatment by anti-tuberculous drugs (P less than 0.05). In addition, significant positive correlation was observed between serum ADA activity and erythrocyte sedimentation rate at 1 hour (r = 0.56). Concerning about peripheral T cell subpopulation studied by two colour flow cytometry with FITC-conjugated anti-CD4 and phycoerythrin-conjugated anti-HLA-DR antibody, there was positive correlation between CD4(-) HLA-DR(+) T cell and serum ADA activity (r = 0.59) without any abnormal frequency of each T cell subpopulation. Additionally, after the treatment of pulmonary tuberculosis, significant increase of T cell percentile in total peripheral mononuclear cells were observed (P less than 0.005). In conclusion, these results may suggest serum ADA activity could be a parameter of activity of pulmonary tuberculosis and reflect the function of activated suppressor/cytotoxic T cell.

A case of SLE with moderately deteriorated renal function due to lupus nephritis developed cryptococcal meningitis. Long term administration of amphotericin B (cumulative dose 5 g) combined with 5-flucytosine eradicated this fungal infection. Throughout amphotericin B administration urinary excretions of Na and K, as well as plasma HCO3 concentration were monitored, and, Na, K and HCO3 were supplemented orally and intravenously so much as to replace their urinary losses. Neither prominent water-electrolyte disturbance nor severe azotemia, which are the most serious side effects of amphotericin B, did not ensue. This case study indicates that sufficient water.electrolytes supplementation is important to prevent the nephrotoxicity of amphotericin B.

A severe, post-mediansternotomy, mediastinitis was treated with pectoral muscle flap method. About 10 days after CABG this patient had purulent discharge, high fever, and unstable sternum. Under a diagnosis of mediastinitis, wound irrigation and systemic administration with antibiotics began, but these managements were ineffective. Therefore, we closed the chest primarily by the pectoral muscle flap method. Successful primary closure of the chest was accomplished.

It is of great importance to define the manner in which cells are damaged and how intracellular derangement becomes irreversible during shock. When supply of both oxygen and substrates to cells is limited during shock, cellular energy metabolism of vital organs is severely depressed. In this experiment, the relationship was clarified between the reversibility of shock and the cellular energy status, from the viewpoint of hepatic energy change, mitochondrial redox state, ATP synthesis of isolated mitochondria, and fragility of mitochondrial membrane in rat livers. The derangement of energy metabolism passed through a series of four stages during hemorrhagic shock. At Stage I (initial stage), the cellular energy level decreased greatly due to marked energy consumption, without any organic damages in the mitochondria. Stage II (cell distress stage) showed that cellular energy imbalance occurred due to the depressed mitochondrial activity in vivo, although it was reversible when the blood supply was restored. Stage III (transitional stage) was the phase at which mitochondrial fragility increased severely. At Stage IV (terminal stage), mitochondria were markedly damaged organically and cellular energy metabolism was not remedied by any intensive therapies, which inevitably meant the death of vital organs.

Fusion neutron streaming through bent ducts, bent slits, offset slits, and multi-holes in polyethylene shields was measured using TLD, CR-39, and miniature NE213 scintillators. The features of the experiment were the simplicity, and variety of shield geometries, accuracy of hydrogen density of the shield and use of the detectors covering wide energy ranges. The experimental data are very useful for verifying the accuracy of analytical methods. The analysis of the experiment by the three-dimensional TRISTAN code showed very good agreement with the fast neutron responses and fairly good agreement with the responses of the low energy neutrons.

An attempt was made to detect islet cell surface antibodies (ICSAb) using solubilized islet-cell glycoproteins as antigens. Isolated rat islets were labelled with 125I-wheat germ agglutinin (WGA) and solubilized by Nonidet P-40 with sonication. 125I-WGA-bound islet-cell proteins were incubated with test sera, and bound antibodies were precipitated with anti-human IgG or IgM immunobeads. Serum which had a bound percent beyond the mean plus 2SD of control sera was defined as antibody-positive. Results obtained by this method correlated well with those by the immunofluorescence method of detecting ICSAb. Prevalences of antibodies were 21/114 (18%) for IgG antibodies and 9/114 (8%) for IgM antibodies in patients with insulin-dependent diabetes mellitus (IDDM). The prevalence was highest for both IgG and IgM antibodies in patients within a year of the onset of disease (38 and 25%, respectively), and decreased thereafter. The prevalence of IgM antibodies was lower than that of IgG antibodies at all stages. In NIDDM patients, the prevalence of antibodies was 5/72 (7%) for both IgG and IgM antibodies. If these preliminary results are confirmed, this radioassay may be developed to detect antibodies against islet cell membrane proteins on a large scale.

An animal model [the nonobese diabetic (NOD) mouse] for type I diabetes features a striking infiltration of T cells into the pancreatic islets. This infiltration selectively destroys beta cells. Most of the T cells are Lyt-1+, but some are Lyt-2+,3+. Transfer experiments using parabiosis revealed that insulitis can be transferred within 2 weeks after parabiosis to immunoincompetent thymectomized mice. When NOD mice (6 mo old) were irradiated and reconstituted with bone marrow cells from young BALB/c nu/nu mice (less than 2 mo old), the NOD mice exhibited neither insulitis nor overt diabetes. Deposits of immunoglobulin in mesangial areas of the glomeruli disappeared within 3 mo after bone marrow transplantation in such irradiated allogeneic bone marrow reconstituted mice. Assays for immunological functions, including mitogen response and mixed lymphocyte reaction, revealed that both T- and B-cell functions were increased in NOD mice with overt diabetes. NOD mice reconstituted with BALB/c nu/nu bone marrow cells displayed normal T- and B-cell functions. The newly developed T cells in the allogeneic bone marrow recipients are tolerant to cells with both donor- and host-type major histocompatibility complex determinants. These results suggest that bone marrow transplantation may ultimately be developed as a component of a strategy to be employed for treatment of type I diabetes in humans.