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Recent progress in the study on magnetic properties of molecular soft ferromagnet TDAE-C60 (where TDAE is tetrakis(dimethylamino) ethylene) is reported. Both crystalline and thin film samples are prepared by the diffusion method and the temperature and field dependence of magnetization are studied by SQUID magnetometer. The magnetic behaviors of single crystals were found to vary from sample to sample. In best single crystals, the saturation magnetization as high as 1.0 μB/C60 has been observed. Spontaneous magnetization and its temperature dependence was evaluated from the Arrott plot. The ferromagnetic phase transition was also observed in TDAE-C60 thin films.

Mediastinitis after median stermotomy is a significant complication for a cardiovascular surgery. Prospective study of bacterial cultures of the anterior chest skin in cardiac and aortic surgery was performed with the comparison of two civilian hospitals. There were many ABPC-resistant bacteria including 26 to 67 percent of Staphylococcus epidermidis (SE). ABPC could not be chosen for the first drug of prophylaxis. Although there was a few CEZ-resistant SE, the efficacy of first-generation cephalosporins was acceptable in this series. If methicillin-resistant Staphylococcus aureus (MRSA) is detected in patient's preoperative bacterial cultures, vancomycin should be selected for prophylaxis. In patients with poor risk who required emergent cardiac surgery, combinational use of an first-generation cephalosporin and an amikacin or a minocycline should be recommended in our data.

A 66-year-old male with the congestive heart failure was diagnosed grade 4 aortic valve regurgitation due to quadricuspid valve associated with bacterial endocarditis, widely patent left coronary artery ostium, chronic renal failure, and secondary hyperparathyroidism. Coronary arteriography showed that the size of left coronary ostium was widely patent 10 mm in diameter, and trans-esophageal echo cardiogram revealed perforation and vegetations on the coronary cusps of the aortic valve.

The systemic use of prostaglandin E1 (PGE1) in the treatment of peripheral vascular disease is well documented. It is known that the liposomal formulation of some drugs enhances their transdermal absorption.The potential of topical application of lipid microspheres containing PGE1 (lipo-PGE1) to treat ischemic ulcers was evaluated.Lipo-PGE1 ointment (1 microgram/g) was applied topically to peripheral ischemic ulcers in 10 patients for 5.8 weeks (range 4-9 weeks). The patients were followed up for 6 months, and response was assessed comparing photographs of the lesions.Nine of 10 patients responded to treatment, but in 3 patients, the ulcers recurred after cessation of treatment.It is concluded that lipo-PGE1 ointment provides an alternative to the management of patients with incurable peripheral ischemic ulcers.

Among 176 pediatric patients who underwent open heart surgery from 1990 to 1996, 7 developed severe pulmonary hypertensive crisis (PHC) postoperatively. All patients were treated with conventional medical therapy consisting of hyperventilation and deep sedation. Prostaglandin E1 and/or amrinone were administered initially as a pulmonary vasodilator, and in 3 of the 7 patients this resulted in immediate improvement in hemodynamics. These patients subsequently weaned off ventilatory support and they were discharged from the hospital. In 4 other patients, pulmonary vasodilator therapy with prostaglandin E1 and amrinone had failed and they were treated with inhaled nitric oxide (NO). In all patients, inhalation of NO resulted in immediate decrease in pulmonary pressure without significant change in systemic arterial pressure. Two patients successfully weaned from the ventilator, whereas in 2 patients decrease in pulmonary pressure was transient. They developed airway bleeding and died as a result of respiratory insufficiency. Although inhaled NO effectively reduced pulmonary pressure in patients with PHC, this effect was not maintained over 12 hours in patients associated with bronchopulmonary dysplasia. In patients at risk for severe PHC, rapid treatment with NO inhalation after initial event as well as the prevention of lung injury caused by mechanical ventilation were found to be important in the postoperative management.

Two-year-old boy with Down's syndrome was treated with inhaled nitric oxide for pulmonary hypertensive crisis after correction of complete atrioventricular canal and persistent ductus arteriosus. The acute rise in pulmonary pressure and hemodynamic instability occurred on 3rd, 4th and 6th post operative days and pulmonary vasodilation with prostaglandin E1 and amrinone had failed. Twenty ppm of inhaled nitric oxide effectively reduced the pulmonary pressure and the patient was subsequently weaned from ventilation. Inhaled nitric oxide exerted a pulmonary vasodilation without decreasing systemic pressure in this patient with postoperative pulmonary hypertensive crisis.

Renal insufficiency and pulmonary disfunction are the major risk factors of surgical treatment for thoracic aortic aneurysm (TAA). The 1st case was 79-year-old female with ruptured TAA. The 2nd case was 76-year-old female with thoraco-abdominal aortic aneurysm. Both patients successfully treated with graft replacement using temporally shunt (12 mm Gore-Tex graft), tracheostomy and epidural analgesia.

Since 1987, we have been using home parenteral nutrition (HPN) for patients with peritonitis carcinomatosa, who had undergone surgery for cancer of the digestive tract and who could not take food orally. We have been inserted catheterization for HPN in 90 patients. Nine of them underwent the treatment as training, but HPN was possible in the remaining 81 patients (90%). The patients in whom the treatment failed to be transferred to HPN showed worsening of their general condition during hospitalization, because the period of training was long. As a result, they could not be discharge. We considered that the timing of transfer to HPN was inappropriate. The largest number of patients, 57, had undergone surgery for cancer of the stomach and esophagus, which was the underlying disease. The mean period of HPN was 108.2 days. According to the underlying disease, the period was longest, 115.7 days, for cancer of the stomach and esophagus, followed by 93.8 days for colorectal cancer. The performed rate of HPN for 60, 90, 180 and 270 days were 56.7, 36.0, 17.9 and 6.5%, respectively, with the one-year cumulative rate of 3.3%. HPN for terminal stage of cancer is an effective treatment for patients with peritonitis carcinomatosa, and it allowed improvement in the quality of life. Cooperation with various medical staff members is also necessary and a hospital system should be established for safe and smooth achievement of the treatment method.

We reported a case of supravalvular pulmonary stenosis with atrial septal defect (ASD) in 37-year-old man. Extended pulmonary arterioplasty with the technique of Doty's operation for supravalvular aortic stenosis was carried out with bovine pericardial patch. Pressure gradient between the right ventricle and the pulmonary artery reduced from 90 to 20 mmHg after this operation. Doty's technique could be modified and successfully applicable to supravalvular pulmonary stenosis.

A case of recurrent pleomorphic xanthoastrocytoma (PXA) was reported. A 46-year-old male underwent total removal of mural nodule from cystic tumor in the left temporal lobe in 1986. Histological diagnosis was astrocytoma. There were no abnormal neurological signs or symptoms after the operation. However, 6 years after the operation he complained of strong unpleasant smell as of rotten onions and was admitted to our hospital. MRI revealed a cystic tumor with a mural nodule which was enhanced markedly by Gd-DTPA in the same location as previous tumor site. He was operated upon again and tumor was removed with the cyst wall. Histological diagnosis was PXA. Surgical procedures for removal of cystic PXA has been controversial; removal of tumor only, tumor removal with biopsy of cyst wall, or tumor removal with resection of cyst wall. Real reason for recurrence of this tumor in our case is unknown. However, since astrocytoma cells were found in the biopsy specimen of the cyst wall at time of the first operation, the tumor might have recurred from these cells. Therefore, this time we removed not only the mural nodule but also the cyst wall, because the cyst wall peeled off easily. We would like to propose that PXA cyst walls should be resected, whenever possible, in order to accomplish total removal of tumor.

The control of optimum concentrations of ionized calcium Ca2+ during cardiopulmonary bypass is important in maintaining cardiac function and reducing reperfusion injury. Ca2+ may be in part dependent upon the serum level of citrate Cit in use of hemodiluted prime in pediatric cardiac surgery. The purpose of this study was to ascertain fluctuations of Ca2+ during bypass in relation to Cit and to study control of optimum Ca2+. Ca2+ and Cit was measured prior to and every 10 or 20 minutes during bypass in 12 children aged 21 days to 6 years. Of 6 patients (body weight less than 6 kg) received acid-citrate-dextrose (ACD) solution 20 ml before aortic declamp to give low Ca2+ for reducing reperfusion injury. Ca2+ showed initial drop and then gradually increased as the result of decreasing Cit. Ca2+ was inversely correlated with Cit (r = 0.85, p = 0.0001). When ACD 20 ml was added, Ca2+ significantly decreased from 1.00 +/- 0.13 to 0.65 +/- 0.13 mmol/l. However, Cit remained 24.3 +/- 13.3 mg/dl at the end of bypass. In conclusion, the results of this study suggest that gradually increasing Ca2+ during bypass may be related to the rate of citrate metabolism and the use of citrate for the control of Ca2+ remains questionable.

Problem with stenosis of the left bronchus was encountered in a patient with type B interrupted aortic arch complex after the arch reconstruction and pulmonary artery banding. Bronchoscopic study disclosed the intraluminal granulation of left bronchus and transendoscopic resection of the granulation successfully relieved the stenosis and brought the patient to full recovery.

A new large curved forceps was manufactured for trial with the object of taping in cardiovascular surgery. Widely used and commercially available forceps could be utilized on the taping of large vessel less than 5 to 5.8 cm in diameter. With this new forceps, aneurysmally dilate great vessels (less than 8 cm in diameter) could be safely taped without compression of aortic wall. This forceps has already applied not only for the major vascular surgery, but also for the wearing of cardiac net in coronary artery bypass grafting.

The jet which exhausts from the convergent nozzle becomes underexpanded when the pressure ratio p 0/p a (p 0: stagnation pressure of jet, p a : atmospheric pressure)is higher than the critical pressure ratio(≃ 1.89 in case of the air). The underexpanded jet is known to have the periodic ‘cell’ structure and, in case of the normal jet impingement on the flat plate, such periodicity can be seen to induces some interesting phenomena.

Many studies worldwide are currently developing interferometric methods for detecting gravitational waves and one of the challenges in such methods has been to sufficiently cool the mirror in interferometric detectors in order to reduce thermal noise. Although the mirror is surrounded by a radiation shield, a hole in the shield is necessary to allow the laser beam to pass. To reduce the thermal radiation caused by the presence of the hole, we will install a duct shield with baffles. To calculate the heat input through the duct shield, we applied a ray trace model whose results were consistent with those of an experiment without baffles. As an application of our model, the heat input in the case of KAGRA (a Japanese cryogenic gravitational wave detector project) was calculated. Our analysis suggests that baffles in the duct shield can considerably reduce the heat input in KAGRA.

A 76-year-old woman with abdominal aortic aneurysm was referred to our hospital with a complaint of abdominal pulsatile mass. CT and angiogram revealed infrarenal abdominal aortic aneurysm (AAA) with right common iliac aneurysm. AAA was replaced with the bifurcated Dacron graft and iliac aneurysm was resected concomitantly. A focal perforation of intima and medial wall hematoma were found in the iliac aneurysm. These findings corresponded with penetrating atherosclerotic ulcer (PAU). PAU in the abdominal aorta may form the abdominal aortic false aneurysm, and may cause the rupture of aneurysm. It is an critical sign of "aortic catastrophe".

Accurate repair of postinfarction ventricular septal perforation (VSP) has mainly depended on the technique for friable septal reinforcement. Modified closure of VSP with Xenomedica patch was performed in 63-year-old male. Friable border of the septum was successfully sandwiched between horse-shoe shape prejett (right side) and main patch (left side). The advantages of this modified surgical procedure are as follows: (1) septum can be seen through horse-shoe shape patch (even when tying the mattress sutures; (2) Xenomedica patch is flexible enough for avoiding the cutting for friable septum, and is strong enough for sandwiching the septum.

Nine patients aged 80 years or older underwent cardiac operations with cardiopulmonary bypass. Seven patients underwent coronary artery bypass surgery, one modified Bentall's operation and another patch closure of ventricular septal perforation. One patient died soon after operation (11 POD) and operative mortality was 11%. One died 7 months after operation because of rupture of dissecting thoracic aortic aneurysm. Seven patients are still alive within physical status of New York Heart Association Classes I or II. We conclude that cardiac operations should not be excluded in octogenarians because of their chronological age alone.

Prosthetic valve thrombosis is associated with high mortality. Thrombolytic therapy is a promising alternative to valve replacement in the management of prosthetic valve thrombosis. To determine the efficacy and safety of thrombolytic therapy for thrombosed Björk-Shiley aortic valve prosthesis, 4 patients who received urokinase intravenously for this disorder were analyzed. In 3 patients, the successful outcome was sustained in that they remained asymptomatic and did not require operative intervention during follow-up, which ranged from 17 to 101 months. In one patient clinical signs of mild congestive heart failure occurred. This patient was surgically treated by thrombectomy and debridement of the prosthetic valve. Failure of urokinase treatment to resolve the thrombus after 1 week indicates that tissue overgrowth or fibrous, organized thrombus is the cause of prosthetic malfunction. Surgical intervention for this problem should be considered only after thrombolytic therapy has been tried and has failed. Our experience with urokinase treatment of thrombosis of aortic Björk-shiley prostheses indicates that this form of treatment should always be applied before surgical intervention. We also attempted to define the optimum protocol of fibrinolytic therapy by clinical evaluation. A protocol for the safe treatment of thrombosed valve is urokinase in initially administered in the doses as 960,000 units for 24 hours, then followed by a maintenance infusion at the half dose every 24 or 48 hours later. Thrombolytic therapy should be continued for 1 week at least to prevent rethrombosis even normalization of valve function was documented clinically. Simultaneous heparin infusion of 10,000 units for 24 hours is then started to replaced by warfarin treatment adjusted to obtain optimal prothrombin times.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes of serum ionized calcium concentration (Ca2+) during cardiopulmonary bypass (CPB) were analyzed in 30 pediatric cardiac patients less than 15 kg body weight. Ca2+ decreased suddenly after the start of CPB, and it gradually increased to the normal value. Citrate added to the stored blood for priming and its metabolism might play a role in these changes of Ca2+. Addition of adequate volume of calcium chloride to the priming prevented sudden decrease of Ca2+. Although addition of citrate before aortic declamp effectively decreased Ca2+ and may prevent reperfusion cardiac injury associated with hypercalcemia, there were no correlation between predeclamp level of Ca2+ and serum CPK and GOT levels.

A 59-year-old man underwent CABG with left internal thoracic artery (LITA) to the first diagonal branch and saphenous vein graft (SVG) to the right coronary artery (RCA). Pump off was quite uneventful, but re-anastomosis was done because bypass graft flow measured before the closure of chest was 6 ml/min, which was most likely due to sclerotic right coronary artery and technical error. After re-anastomosis, bypass flow of SVG to RCA was measured 95 ml/min. Root mean square total (RMST) immediately after aortic declamp for the first time was 39% compared with that measured prior to operation, but improved to 49% after aortic declamp at the second time. It recovered to 127% 2 days after operation, and 137% at 7th postoperative day. RMST indicates the total electropotential per unit time from the beginning to the end of QRS. It has the specificity to predict VT and postoperative pump failure. In this case, it is suspected that RMST may be a predictor that revascularization would be complete or incomplete in operations for ischemic heart disease.

Two cases were operated on simultaneously for coronary revascularization and lung resections for cancer. Case 1 was a 79 year-old man, diagnosed with two vessels coronary artery disease and squamous cell carcinoma of left lower lobe. At the end of aortocoronary bypass grafting to LAD and first diagonal branch using saphenous vein, median sternotomy was closed, and lower lobectomy was performed through left posterolateral standard thoracotomy. Case 2 was a 65 year-old man who underwent aortocoronary bypass grafting to LAD first and left lingular segmentectomy via median sternotomy simultaneously. We concluded that a simultaneous operation was definitively and ideally a preferable method in most selected cases. The order of two operations for coronary artery and lung was also discussed.

Intragastric pH was continuously monitored in 21 patients who underwent colorectal surgery. Monitoring was started before surgery, and was continued for two days after surgery. Intragastric pH tended to increase during surgery, compared with measurements obtained before and after surgery, but was not affected by the duration of anesthesia or of the surgical procedure, or surgical position. After surgery, patients were divided into two groups: the cimetidine group (10 patients) received intravenous cimetidine 200 mg 4 times a day, while the control group (11 patients) received no treatment. Postoperative intragastric pH was higher than 3.0 throughout the study in the cimetidine group, but was approximately 1.3 in the control group. Upper gastrointestinal bleeding occurred in 2 patients in the control group, with intragastric pH falling abruptly during the bleeding episode. To prevent post-operative upper gastrointestinal bleeding, in addition to the administration of H2-blockers or antacids, appropriate treatments in response to changes in intragastric pH are necessary. Continuous monitoring of intragastric pH in surgical patients is considered to be of clinical importance.

A case of intracerebral tuberculoma treated surgically was reported. A 47-year-old man was admitted to our hospital because of progressive left hemiaparesis over the previous 5 months. A computerized tomography scan showed a well enhanced mass associated with a marked perifocal edema. T1 weighted magnetic resonance imaging (MRI) revealed an isosignal ring around the heterogenous low intensity mass. A low intensity area just interior to this ring was also visualized both in T1 and T2 weighted images. Although the clinical course was unusually long, this was diagnosed as a metastatic brain tumor. He underwent a right frontal craniotomy and a well circumscribed, yellowish, firm mass was totally extirpated. Pathohistologically, this mass was considered to be a tuberculoma though the tuberculous bacilli could not be identified in Ziehl-Neelsen staining. His hemiplegia improved much and his ambulation was restored. Since tuberclomas are quite rare in developed countries, the diagnosis of intracerebral tuberculomas would be extremely difficult unless tuberculosis was verified in some other organs. The auxiliary examinations even by using MRI have often given little information which would assist diagnosis. However, based on pathological findings, the ring appearance and low intensity area medial to the ring in the outer part of the tuberculoma shown in MRI of our patient seemed to represent a chronic granulomatous inflammation and gave a clue to rule out the suspicion of metastatic brain tumors. To make a correct diagnosis of intracerebral tuberculomas, multidisciplinary consideration is mandatory.

A novel siderophore, called acinetobactin, with both catecholate and hydroxamate functional groups was isolated from low-iron cultures of Acinetobacter baumannii ATCC 19606. The structure was elucidated by chemical degradation, fast-atom bombardment mass spectrometry and 1H and 13C NMR spectroscopy. Acinetobactin was composed of omega-N-hydroxyhistamine, threonine and 2,3-dihydroxybenzoic acid, the last two components forming an oxazoline ring. Acinetobactin was structurally related to anguibactin, a plasmid-encoded siderophore of Vibrio anguillarum. The only difference was that acinetobactin possessed an oxazoline ring instead of a thiazoline ring. Four of 12 other clinical A. baumannii strains examined produced acinetobactin, indicative of strain-to-strain variation in the ability to produce acinetobactin. In addition, a relatively small amount of acinetobactin was also detected in A. haemolyticus ATCC 17906.

A crossover clinical trial was carried out to compare the effectiveness and safety of granisetron alone (40 micrograms/kg) with that from a combination of granisetron plus methylprednisolone (MPL, 10 mg/kg) for control of emesis and vomiting induced by anticancer drugs in children with cancer. Complete control of emesis and vomiting were achieved in 95% (19/20 cases) of patients receiving the combination compared to 85% (17/20 cases) of patients receiving granisetron alone. There were no clinical toxicities or side effects in either treatment group. These data indicated that the combination of granisetron plus MPL was superior for control of emesis and vomiting in children receiving cytostatic anticancer drugs.

Seventeen children with various types of cancer were studied on the effectiveness of antiemetic drug, granisetron, by a crossover randomized trial; receiving granisetron (40 micrograms/kg; n = 53) or conventional antiemetics, during intensive chemotherapy. In the patients given granisetron nausea and vomiting were well controlled (83.0%), compared with 33.3% of conventional (non granisetron) group. The mean number of vomiting episodes for each 6h-period over 24h after chemotherapy was reduced markedly in the patients given granisetron, compared with conventional therapy. One patient developed paraesthesia of the hand after injection of granisetron as the adverse effect, which recovered to normal spontaneously after 3 hrs. Our data indicated that antiemetic effect of granisetron was superior to conventional antiemetic drugs, both in terms of clinical effectiveness and usefulness.

Although fast sodium current (INa) plays a major role in the generation and conduction of the cardiac impulse, the electrophysiological characteristics of INa in isolated human ventricular myocytes have not yet been fully described. We characterized the human ventricular INa of enzymatically isolated myocytes using whole cell voltage-clamp techniques. Sixty myocytes were isolated from ventricular specimens obtained from 22 patients undergoing open-heart surgery. A low temperature (17 degrees C) and Na+ concentration in the external solution (5 or 10 mM) allowed good voltage control and facilitated the measurement of INa. Cs+ was substituted for K+ in both internal and external solutions to block K+ currents, and F- was added to the internal solution to block Ca2+ current. INa was activated at a voltage threshold of approximately -70 mV, and maximal inward current was obtained at approximately -30 mV (holding potential = -140 mV). The voltage dependence of steady-state INa availability (h infinity) was sigmoidal with half inactivation occurring at -97.3 +/- 1.1 mV and a slope factor of 5.77 +/- 0.10 mV (n = 60). We did not detect any significant differences in these parameters in cells from patients with a variety of disease states, with or without congestive heart failure. The overlap in voltage dependence of h infinity and Na+ conductance suggested the presence of a Na+ "window" current. An inactivation time course was voltage dependent and was fitted best by the sum of two exponentials. The rate of recovery from inactivation also was voltage dependent and fitted by the sum of two exponentials.(ABSTRACT TRUNCATED AT 250 WORDS)

A new Escherichia coli mutant allele, named dnaR, that causes thermosensitive initiation of chromosome replication has been identified to be an allele of the prs gene, the gene for phosphoribosylpyrophosphate synthetase (Y. Sakakibara, J. Mol. Biol. 226:979-987, 1992; Y. Sakakibara, J. Mol. Biol. 226:989-996, 1992). The dnaR mutant became temperature resistant by acquisition of a mutation in the dnaA gene that did not affect the intrinsic activity for the initiation of replication. The suppressor mutant was capable of initiating replication from oriC at a high temperature restrictive for the dnaR single mutant. The thermoresistant DNA synthesis was inhibited by the presence of the wild-type dnaA allele at a high but not a low copy number. The synthesis was also inhibited by an elevated dose of a mutant dnaR allele retaining dnaR activity. Therefore, thermoresistant DNA synthesis in the suppressor mutant was dependent on both the dnaA and the dnaR functions. On the basis of these results, I conclude that the initiation of chromosome replication requires cooperation of the prs and dnaA products.

The appearance of a mediastinal mass in a patient with Hodgkin's disease in remission frequently indicates recurrence. However, benign processes such as rebound hyperplasia of the thymus gland should be included in the differential diagnosis. The authors present a case in which an anterior mediastinal mass was revealed by a routine chest radiograph 3 months after completion of combined modality treatment with low-dose radiation and MOPP chemotherapy for cervical Hodgkin's disease, stage I, nodular sclerosis. As the patient was clinically well with no other laboratory evidence of disease, recurrence was considered unlikely. Benign thymic enlargement was strongly suspected on the basis of striking resolution of the mediastinal mass after treatment with a short course of oral prednisolone. Thymic rebound in our case occurred coincidentally with the restoration of normal immune functions after removal of the stress imposed by antineoplastic treatment. The patient has remained free of disease recurrence for more than 20 months after cessation of therapy. Awareness of the possible benign etiology of a mediastinal mass may avert a diagnostic surgical exploration and also unnecessary adjuvant therapy.

A novel phenol sulfotransferase (PST) was detected in bovine liver microsomal membrane fraction. The enzyme was found to be capable of catalyzing the sulfation of simple phenolic compounds, with 3'-phosphoadenosine-5'-phosphosulfate as the sulfate donor. Detergent extracted PST showed a pH optimum of 5.7 and, among the simple phenols tested, the PST exhibited highest activity toward alpha-naphthol. No activities were detected when tyrosine and its derivatives were used as substrates. Both 2,6-dichloro-4-nitrophenol and chlorpromazine were capable of inhibiting the activity of the PST toward p-nitrophenol with inhibition Coefficient50 values of 100 nM and 4 mM, respectively.

How to optimize cerebral perfusion pressure and flow during selective extracorporeal circulation is a crucial problem for cerebral protection in surgical repair of aortic arch aneurysm. Among 47 cases of aortic arch replacement between 1980 and 1992, extracorporeal circulation (ECC) for the first 17 cases [group-1] were hypothermic ECC with selective cerebral perfusion (SCP) and 8 cases [group-2] with hypothermic ECC with hypothermic cardiac arrest. For the latest 16 cases [group-3] we introduced continuous O2 saturation monitoring by oximetry catheter placed in internal jugular bulb (SIJVO2) and maintained SIJVO2 value above 90% to effectively adjust pump flow to optimize cerebral perfusion pressure and flow for cerebral protection. We have retrospectively compared the effectiveness of SIJVO2 monitoring among these three groups. The mortality was 35% (6 cases: group-1), 37% (3 cases: group-2) and 6% (1 case: group-3) respectively. Cerebral dysfunction which were diagnosed in immediate postoperative period were 23% (4 cases: group-1), 0% (0 case: group-2) and 6% (1 case: group-3) respectively. We conclude continuous monitoring of SIJVO2 during selective ECC in aortic arch replacement is useful to optimize cerebral perfusion pressure and flow thereby reducing postoperative cerebral damage by selective ECC.

A forty-seven-year-old female with profound biventricular heart failure probably caused by coronary artery spasm after open mitral commissurotomy was successfully survived by mechanical circulatory support. Centrifugal and roller pumps were applied to left and right side circulatory assist respectively. Recovery of cardiac function was evaluated by transesophageal echocardiography and hemodynamic parameters during intentional low flow assist. Finally, she was weaned from assist after 136 hours. No systemic thromboembolism was recognized after pump removal. Combination of centrifugal and roller pumps could be applicable to biventricular heart assist without crucial complication.

Long-term clinical results of aortic valve replacement (AVR) with mechanical heart valves and mitral valve replacement (MVR) with porcine valves were analysed. Sixty-three patients received isolated AVR and 48 received isolated MVR. Sixty-eight patients with MVR including double or triple valve replacement were also added in order to evaluate the primary tissue failure (PTF). The patients with operative deaths were excluded. Survival rate at 11 years in AVR was 68 +/- 10% and 67 +/- 15% in MVR without statistical difference. At 11 years, 76 +/- 8% of the patients in AVR were free from valve-related complications in contrast with the poor result of 34 +/- 31% in MVR (p less than 0.01). Main cause of this poor result in MVR was PTF as indicated in following event free rates; 83 +/- 9% at 7 years, 61 +/- 25% at 10 years and 49 +/- 31% at 13 years. There was no statistical difference between patients of above 50 years and below 49 years in PTF. Valve-related death event free was 93 +/- 5% in AVR and 86 +/- 11% in MVR at 11 years (not significant), however, there was statistical difference in re-operation event free rate as 94 +/- 5% in AVR and 76 +/- 11% in MVR at 11 years (p less than 0.001). These results suggest that the use of porcine valves in mitral position is confined to the selected patients.

We investigated the relation between the synthesis of inducible form of heat-shock protein 70 (hsp70) and the development of thermotolerance using NRK (normal rat kidney) cells and their mutant cell line (39-1 cells). In NRK cells, hsp70 was clearly induced by conditioning treatments (42 degrees C for 2 h, 45 degrees C for 15 min or 100 microM sodium arsenite for 1 h). On the other hand, the induction of hsp70 in 39-1 cells was very low or not detectable by these treatments. Other high molecular weight hsps, hsc70 (constitutive form), hsp90 and hsp110 were induced in both cell lines. However, thermotolerance as defined by clonogenic survival was induced in both cell lines to a similar extent by the conditioning treatments. When cells were made thermotolerant by conditioning heating at 45 degrees C for 15 min, the inhibition of protein synthesis after challenge (second) heating was less in NRK cells than in 39-1 cells. This indicated that the extent of 'translational thermotolerance' was much higher in NRK cells than in 39-1 cells. From these results, it is suggested that the synthesis of inducible hsp70 is involved in the translational thermotolerance rather than the development of thermotolerance as defined by clonogenic survival.

A 8-year-old boy developed mediastinitis after direct closure of atrial septal defect. Methicillin-resistant Staphylococcus aureus (MRSA) was detected from the wound. Intermittent wound irrigation with povidone-iodine solution and vancomycin solution was protracted for two months. After the remission of MRSA infection, implantation of pectoralis major muscle flap was performed. Without recurrence of infection the wound was healed completely. Although pectoralis major muscle flap is an effective method of choice for mediastinitis, an appropriate timing of enforcing this method should be investigated hereafter.

From 1987 through 1990, 17 cases with tracheal and/or bronchial compression due to congenital cardiovascular malformations were experienced at our institutes. Respirator was required preoperatively in 10 patients (59%) due to severe respiratory symptoms by airway compression and narrowing. In all cases, bronchoscopy was carried out pre- or intra-operatively for the precise diagnosis and for the decision of operative procedures. Postoperatively 12 cases were successfully extubated and remained free of respiratory distress. We investigated the relationships among pre- and post-operative pressure ratio, preoperative flow ratio, requirement of preoperative respirator and indication for plication and suspension of pulmonary artery in the group of the patients, who had airway compression by the dilated pulmonary artery due to large left to right shunt. As a result of this investigation, these factors have no significant correlation. The severity of associated tracheomalacia might be a most susceptible cause, which required the preoperative managements with respirator and the surgical interventions to the dilated pulmonary artery. Infant with patent ductus arteriosus (PDA) could be surgically treated by the division of PDA through left lateral thoracotomy. If the left main bronchus shows complete obstruction after division of PDA, the additional surgical intervention like suspension of aortic arch is needed. Two cases were lost with reoperation and these suggested not only the priority of simultaneous repair of trachea and cardiovascular anomaly, but the necessity of minor intervention against adhesion (insertion of Gore-Tex sheet between suspended pulmonary artery and sternum) in the first-step palliative operation.(ABSTRACT TRUNCATED AT 250 WORDS)

A 48-year-old woman with chronic mid-descending thoracic aortic aneurysm was successfully repaired. She received a blunt chest trauma due to automobile accident at July in 1988. Left upper lobectomy was performed for her lung contusion. March 1990, she admitted our hospital with abnormal shadow revealed by a chest roentgenogram. A computed tomogram of the chest and an aortogram revealed two false aneurysms. One of them was located at mid-descending thoracic aorta and another was aortic isthmus. Under a partial femoral veno-arterial bypass, a Dacron graft replacement of mid-descending thoracic aorta was performed and aneurysm of isthmus was wrapped by Teflon mesh after the left pneumonectomy. 2 months after the operation, bronchopulmonary fistula occurred at the left bronchial stump. The fistula was successfully covered with major omentum. The mid-descending thoracic aortic aneurysm due to blunt chest trauma is rare. The traumatic aortic aneurysms commonly occur aortic isthmus or ascending aorta. Initial diagnosis of traumatic mid-descending thoracic aortic aneurysm is often missed or delayed. Careful follow up is need and when an abnormality is revealed by chest roentgenogram, computed tomogram and aortogram should be obtained to make diagnosis of chronic traumatic aneurysm.

We described two pediatric patients with acute promyelocytic leukemia (APL) who were successfully induced into complete remission with all-trans retinoic acid (ATRA, 45 mg/m2 per day) after failing on conventional chemotherapy. Initial response was observed as correction of DIC within a week of treatment. Hematologically, initial increase of maturing leukocytes reached a peak peripheral WBC count on the 16th and 20th day, respectively. However, these seemingly differentiated leukocytes retained Auer body and dysplastic features and there was no concomitant recovery of erythroid and megakaryocytic lineages at this point. A sudden drop of leukocyte counts after this peak made a brief period of leukopenia before the complete remission was finally attained morphologically in 4-5 weeks. Thus, remission of APL by ATRA therapy consisted of a two-phase course. In one patient, we observed an increase of histiocytes phagocytizing leukocytes in the marrow during the recovery from leukopenia. It is, therefore, postulated that the two-phase course of recovery may reflect the differentiation of leukemic cells by ATRA and subsequent clearance of senescent cells by the reticuloendothelial system followed by regeneration and differentiation of residual normal hematopoietic stem cells.

In vitro tyrosine sulfation of recombinant proteins would be a valuable tool in converting those proteins expressed in prokaryotic vectors to their natural form. For this purpose tyrosylprotein sulfotransferase (TPST), the enzyme responsible for tyrosine sulfation of proteins, was characterized from a bovine liver Golgi preparation. TPST was active in a acidic environment with a pH optimum of 6.25, and displayed a stimulation by the Mn2+, with the optimum activity in the presence of 5mM MnCl2. TPST was able to sulfate recombinant hirudin variant 1 (rHV-1) expressed in Escherichia coli and the C-terminal hirudin fragment 54-65 but not the N-terminal hirudin fragment 1-15 by using 3'-phosphoadenosine 5'-phosphosulfate (PAPS), indicating its specificity for the naturally sulfated tyrosine 63. Comparison of the reaction kinetics on synthetic peptides showed that the bovine liver TPST has a higher affinity and reaction rates for those peptides with a aspartyl residue on the N-terminal side of the tyrosine when compared with a glutamyl residue.

Numerical simulations using a computational model [1] are made for fully nonlinear two-dimensional irrotational free-surface flows over beds containing arbitrary submerged obstacles, to clarify the criteria of breaking of solitary waves caused by depth changes and formulate them.

Five cases of hypernatremic hyperosmolar delirium after open heart surgery were reviewed. Minimum serum osmolarity at the time of developing delirium in these cases was 336 mOsm/l. Blood glucose level did not reached to the levels of the typical criteria of hyperosmolar hyperglycemic nonketotic diabetic coma in all cases. The authors have shown that it was difficult to recognize this unique disorder in early postoperative stage. Because of its non-specific symptoms and the postoperative courses which required the patients' cares with much more dry side in water balance. In order to treat the patients with hypernatremic hyperosmolar delirium, the correction of serum osmolarity should be done very slowly, because water intoxication should be prevented. In all five cases in this paper were recovered from delirium as the time when serum natrium level and serum osmolarity were restored to the normal state. We concluded that in order to get a good prognosis of this characteristic disorder, we have shown early recognition of serum hypernatremia and hyperosmolarity state and consequently adequate treatment mentioned above are primarily important.

A 43-year-old woman underwent triple valve replacement for combined valvular disease complicated with protein-losing gastroenteropathy. alpha 1-antitrypsin clearance (indices of protein-losing) was improved and serum protein level was normalized after the operation. Although protein-losing gastroenteropathy has been described as a complication of constrictive pericarditis, it has been a rare occurrence in other congestive heart failure. In this case, congestion is demonstrated to be a possible cause for protein-losing gastroenteropathy. We attempt to compare this case with situation of constrictive pericarditis, and describe the cause for developing protein-losing gastroenteropathy.

Interleukin-1 (IL-1) is now generally accepted as an endogenous pyrogenic mediator of fever induction. IL-1 induces fever by means of activation of arachidonate metabolism in the brain. However, whether circulating IL-1 enters the brain or not, further, the question of where is the action site of circulating IL-1 on the brain, have not been clearly demonstrated. In the present study, to investigate the site of action of circulating IL-1 on the brain, recombinant rabbit interleukin-1 beta (IL-1 beta) was labeled with colloidal gold, injected into the carotid artery of anesthetized rabbits and traced in the brain tissue by means of electron microscopy. Dose-dependent increase in colonic temperature was induced by intravenous injection of used IL-1 in rabbits, while heated IL-1 beta lost the pyrogenicity. Injection of solution of colloidal gold per se did not affect the colonic temperature of afebrile conscious rabbits. However, the IL-1/gold conjugates induced fever; IL-1 beta retained its pyrogenic potency even after labeling with gold. By electron microscopy, the IL-1/gold conjugates were observed on the surface and in the vesicle of endothelial cells of the capillary in the region of the anteroventral third ventricle. This implies that circulating IL-1 acts, as the initial step to induce fever, on the endothelium in that region.

This paper reports the etiology and the findings of phonocardiograms and echocardiograms in four cases with mitral regurgitation caused by the redundant chordae. Redundancy of the chordae were determined by the surgeon during operation. The results were as follows: 1. The etiology of redundant chordae was either congenital, rheumatic, or mucoid degeneration. 2. Phonocardiographic findings of this condition are a holosystolic murmur accompanied by a diastolic rumble at the apex. 3. Two-dimensional echocardiogram shows holosystolic bulging of the mitral leaflet to which redundant chordae are attached. 4. The findings of the M-mode echocardiogram are multiple linear echoes and bowing of the mitral valve in systole.