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An 11-year-old girl had undergone an aortic valve replacement for congenital aortic stenosis with #17 Björk-Shiley valve and aortic ring enlargement by Nick's method eight years later, the pressure gradient across the prosthetic valve increased up to 100 mmHg. Re-aortic valve replacement was successfully performed with #21 St. Jude Medical valve, when aortic valve ring increased to accommodate #21 SJM valve.

Cardiac catheterization and submaximal exercise testing was performed in 38 patients after repair of tetralogy of Fallot (TF), and compared to 6 control patients who had functional murmurs. Cardiac index, heart rate, and stroke volume index were significantly lower in the TF group than in the control group. Right and left ventricular end-diastolic pressure increased significantly during exercise, which was not found in the control group. Total pulmonary vascular resistance (TPVR), which decreased significantly with exercise in the control group, did not change remarkably during exercise. TPVR was significantly higher in the TF group than in the control group both at rest and during exercise. Several factors were compared between patients with good cardiac index (5.0 l/min/m2; Group 1) and poor cardiac index (5.0 l/min/m2; Group 2) during exercise. Stroke volume index, right ventricular ejection fraction at rest were significantly higher in Group 1 than Group 2. TPVR, right and left ventricular end-diastolic and end-systolic volume index were significantly lower in Group 1 than in Group 2. There was no significant difference in heart rate, left ventricular ejection fraction, residual pulmonary stenosis, right to left ventricular systolic pressure ratio, and severity of pulmonary regurgitation between two groups. These findings indicate that abnormalities of exercise tolerance in patients after repair of TF were related to poor response of heart rate, pulmonary vascular resistance, and systolic and diastolic ventricular function.

We report a surgical case of hepatocellular carcinoma and solitary liver metastasis from papillary thyroid carcinoma in different lobes of the liver. The former, located in the right anterior superior segment, and the latter, in the left caudate lobe, were resected simultaneously. The hepatocellular carcinoma was a micro(thin)-trabecular, pseudoglandular type of Edmondson's grade II. The liver metastasis was a papillary carcinoma of follicular variant from the thyroid. This is the first report of hepatocellular carcinoma accompanying a solitary liver metastasis from papillary thyroid carcinoma without metastasis in other organs.

Results of surgical treatment of atherosclerotic aneurysm of the distal aortic arch, reported to date, are not satisfactory. We recently analyzed the surgical results in 119 patients with this condition who were treated at our department. There were 104 males and 15 females, ranging in age from 38 to 81 years (mean: 66 years). The arch was reconstructed by total replacement in 29 cases, partial replacement in 49 cases, patch reconstruction in 34 cases and extra-anatomic bypass in 7 cases. The lesion was approached by median sternotomy in 75 cases, median sternotomy+left thoracotomy in 9 cases and left thoracotomy in 35 cases. In cases where median sternotomy was used, selective cerebral perfusion was generally employed as an auxiliary procedure. After surgery, cerebral complications were observed in 19 cases (16.0%). In 15 of these 19 cases, postoperative cerebral damage was attributed to atheromatous emboli. Twenty-six patients (21.8%) died in the hospital. Major causes of death included respiratory insufficiency, multiple organ failure and low cardiac output syndrome. To improve surgical results for this type of aneurysm, the operative procedure needs to be modified so that these postoperative complications are prevented. Especially it is essential to prevent intraoperative embolisms of brain and coronary arteries, and a reconstruction by total arch replacement with median sternotomy has improved recent surgical results.

We experienced a case of constrictive pericarditis following replacement of the descending aorta. It has been pointed out that constrictive pericarditis can be developed following LV bypass using centrifugal pump due to the cardiotomy. But no actual case has reported so far. The case was a 61-year-old man for whom graft replacement of the descending aorta through left thoracotomy was performed. Fever and heart failure was elicited 3 weeks after the operation, and he was diagnosed as constrictive pericarditis by chest CT and echocardiography. The reoperation was performed 39 days after the graft replacement. Anterior wall of the both ventricle and postero-lateral wall of the left ventricle were strongly adhered to the pericardium. The adhesion was entirely dissected and the thickened pericardium was resected. The post-operative course was uneventful and the patient was discharged 42 days after the reoperation.

A 54-year-old male who had received an aortic valve replacement with SJM 23 about 3 years before suffered from an acute cardiac failure because of the valve detachment. From his clinical course, it was diagnosed that the aortic valve insufficiency was complicated by an aortitis. We operated on him by an aortic root replacement using a cryopreserved allograft which we prepared. A donor of the allograft was 35-year-old male, died of a subarachnoidal hemorrhage. We harvested his aortic root at an autopsy and dipped it into a nutrition medium with 10% dimethylsulfoxide. Within 10 hours from his death, we froze the tissue using a program freezer and stored it in a liquid nitrogen for 7 months. After thawing it in 37 degrees C water quickly, we rinsed the graft and used for the operation. The cell viability of the graft was confirmed by a tissue culture. Indication of the allograft valve to an aortitis case is still controversial. We think the allograft is recommendable to valve detachment case due to aortitis, because the softness of the graft decreases a compliance mismatch between the graft and the patient's annulus, which may prevent redetachment. Although we felt concern about redetachment of the conduit due to the weakness of the patient's aortic annulus, no complication regarding the allograft happened at all as yet.

The clinicopathological characteristics of small gliomas were investigated in nine patients with gliomas less than 2 cm in diameter. The tumor histology and proliferative activity were also examined. Three tumors occurred in the white matter and six at the corticomedullary junction. Histological diagnosis, Daumas-Duport''s grading, bromodeoxyuridine labeling index, and proliferating cell nuclear antigen counts were well correlated. Most small gliomas were histologically benign, localized, and removable if not in eloquent areas of the brain. However, some cases showed high-grade glioma and invasive character at the early stage, resulting in a poor outcome.

A successful operation for acute and severe aortic regurgitation after balloon valvuloplasty together with mitral regurgitation is described in a 9-month-old infant. Aortic root replacement was performed using a pulmonary autograft, while the right ventricular outflow tract was reconstructed with an interposed left atrial appendage posteriorly and a heterologous pericardial patch anteriorly. Mitral valve reconstruction was also effectively accomplished. This combination of right and left ventricular outflow tract reconstruction has a good potential for growth and may provide a solution for the future in infants.

Hypercholesterolemia is well known as a risk factor which had been shown to affect the long-term prognosis after coronary artery bypass grafting (CABG). The data were collected from multi-institutions documenting the long-term results of CABG in 61 hypercholesterolemic patients who received LDL-apheresis. Mean post-CABG period was 50 +/- 34 (+/- SD) months. Mean period of therapy by LDL-apheresis using Liposorber system after CABG was 25 +/- 17 months with a frequency of once per 2.6 +/- 1.3 weeks. Before initiating LDL-apheresis mean serum cholesterol (TC) and LDL-cholesterol (LDL-C) were 327 mg/dl and 261 mg/dl, respectively. With combined LDL-apheresis and lipid-lowering drug therapy mean TC and LDL-C were reduced to 247 mg/dl and 177 mg/dl immediately pre-apheresis and 106 mg/dl and 60 mg/dl immediately post-apheresis, respectively. Two of 61 patients had PTCA post CABG. Percent free from cardiac event during the long-term period post CABG as calculated by the life-table method was 97% at 3 years and 94% at 4 years and thereafter. While number of the patients is still small, the aggressive cholesterol-lowering therapy by LDL-apheresis is suggested to improve the prognosis of hypercholesterolemic patients with bypass grafts.

Since December 1967, more than 20,000 patients underwent cardiac transplantation in the world. The results have improved with time. The actuarial survival rate of the patients, operated upon in the last five years, is 80% at one year and 70% at five years after surgery. Today, new-born, infants as well as elderly persons of more than 70 years of age undergo surgery. The greatest problem in cardiac transplantation is the lack of donor hearts. The artificial heart, as well as, xenotransplantation is now under active investigation to overcome this problem. Cardiac transplantation has been started in Asian countries, such as, Formosa, Thailand, Singapore and Korea, the present situation in Japan must be unbearable for patients who require cardiac transplantation.

To test a hypothesis that reduction in pulmonary perfusion pressure and flow affect underlying vascular disease, pulmonary pathology was studied in monocrotaline-treated rats undergoing single lung transplantation. Inbred rats were treated with 40 mg/kg (group T1, n = 6) and 80 mg/kg of monocrotaline (group T2, n = 9), received a left lung isograft 2 and 4 weeks after medication, and were killed 4 and 6 weeks after single lung transplantation, respectively. For each group, rats receiving the same amount of monocrotaline (M1, M2) or vehicle (N1, N2) served as controls. Monocrotaline-treated rats developed pulmonary vascular disease and right heart failure, resulting in severe exercise intolerance in M1 or death in M2 unless single lung transplantation had been carried out. At death, pulmonary blood flow was directed toward the left lung isograft, and the retained right lung received a significantly reduced fraction of cardiac output. Right to left ventricular weight ratio was significantly reduced in both groups as compared to the respective control rats, suggesting reduced perfusion pressure. Although thickness of media in small pulmonary arteries (media/radius) was normal (34% +/- 4%) in the lung isografts, it was significantly increased in the contralateral lung (group T1, 45% +/- 5%; group T2, 48% +/- 3%), which was not significantly different from that of monocrotaline-treated control rats, respectively (group M1, 47% +/- 7%; group M2, 49% +/- 6%). Although single lung transplantation reduced perfusion pressure and flow toward the monocrotaline-treated native lung, it failed to affect vascular morphology significantly.

Tablets of acetaminophen as a model drug were prepared with low-substituted hydroxypropylcellulose (L-HPC) of various particle sizes at various loadings in the formulation. Drug release into an aqueous dissolution medium (pH 1.2) was remarkably sustained from tablets prepared with fine L-HPC (LH41) at loadings of more than 20%. Tablets prepared with less than 20% LH41 or with coarse L-HPCs (LH11, LH21, and LH31) disintegrated in the medium, resulting in rapid release of the drug. The difference in behavior could not be explained in terms of differences in tablet strength, but in swelling and water uptake abilities of the tablet's polymer. Swelling work (swelling force), water penetration speed, and water uptake of LH41 (4.4-microns average particle size) were much smaller than those of coarse L-HPCs. The formation of a continuous gel-like layer on the surface of tablets containing more than 20% LH41 was another factor to sustain the drug release rate.

A female infant weighing 2.4 kg had respiratory distress at birth. She became dyspneic and hypercapnic and required intubation with assisted ventilation 11 days after birth. Because cardiac failure and respiratory failure did not improve, she underwent total correction at 26 days old, which consisted of VSD closure, right ventricular outflow tract reconstruction with valved porcine pericardial roll (VPR) and plication of both pulmonary arteries. She was weaned from the ventilator 11 days after operation and discharged at 12 weeks of age. One year later, reoperation was successfully performed for the replacement of the stenotic VPR with a transannular patch.

In nine patients with central (thalamic) pain after stroke, X-CT, MRI, PET scan and intraoperative thalamic microrecordings were performed. The PET studies made use of Sokoloff's method with 18FDG and a steady-state method with C15O2-15O2. CT scan and MRI revealed definite thalamic damage (Th) in 3 cases, putaminal damage (Put) in 3 cases, combined damage (Th + Put) in one case, and cortical (parietal) damage in 2 cases. In patients with a subcortical lesion, the greater the severity of superficial pain, the higher was the relative value of regional cerebral glucose metabolism (rCMRGlu) as compared to oxygen metabolism (rCMRO2) in the cerebral cortex around the central sulcus on the damaged side. Also, in a case with combined (Th + Put) lesion, regional oxygen extraction ratio (rOEF) was increased in this area. Moreover, in another case, central pain disappeared after a small subcortical haemorrhage in the same structure. In all patients including those with a cortical lesion, rCMRGlu was decreased in the postero-lateral (sensory) thalamus on the invalued side. The possible role of the cerebral cortex around the central sulcus for the genesis of central pain is discussed.

Between November, 1987 and May, 1990, definitive operation was performed in 7 infants for tetralogy of Fallot with absent pulmonary valve. Preoperative respiratory failure was serious in 5 patients and semi-emergency operation was done. Surgical procedure consisted of closure of ventricular septal defect, reconstruction of right ventricular outflow tract using heterograft valved pericardial roll and plication of aneurysmally dilated pulmonary artery with or without pulmonary artery suspension in 5 infants with severe respiratory distress and heart failure, operated on 26 days to 5 months of age. In the other two less symptomatic infants, operated on at 13 months of age, reconstruction of right ventricular outflow tract was performed by transannular bovine pericardial patch with monocusp. There were no operative death and six infants are doing well 6 months to 3 years postoperatively, but one patient died of prolonged respiratory infection and respiratory failure one year after operation. Postoperative pulmonary arteriogram revealed a 42 to 61 (mean 54) percent reduction in right and left pulmonary artery size in 3 patients who underwent extensive plication of pulmonary artery. We suggest that definitive plication with or without suspension of pulmonary artery, together with closure of ventricular septal defect and reconstruction of right ventricular outflow tract is supposed to eliminate air way obstruction.

To prevent aneurysm rupture, avoid pseudoaneurysm formation, and preserve intercostal arteries, a new procedure for repair of DeBakey type 3 dissecting aneurysm was developed. Since January 1977, 28 patients have undergone repair of type 3 dissecting aneurysm. Fifteen patients with type 3b underwent this new procedure (group 1) and 13 patients with type 3a dissecting aneurysm underwent segmental graft replacement (group 2). In group 1 a permanent axillofemoral bypass was placed on the right side. Next the intrathoracic false lumen was opened longitudinally, the entry was closed, and the aneurysmal wall was sutured around the true lumen as tightly as possible. The operative mortality rate was 20% in group 1 and 31% in group 2. One of 15 patients in group 1 died of operation-related causes, whereas three patients in group 2 died. There were six late deaths: three in group 1 and three in group 2. Paraplegia occurred in neither group 1 nor group 2. The mean diameter of the plicated descending aorta was 24.0 +/- 2.7 mm 3 months after surgery. No recurrence was detected in group 1. These results suggested that this new surgical technique for repair of type 3 dissection reduces the incidence of paraplegia and pseudoaneurysm formation.

The thalamic zone mediating the rhythmic burst activity related to the contralateral tremor was studied by microelectrodes in clinical cases with tremor and in monkeys with experimental tremor. The rhythmic burst time-locked with the tremor was found in a restricted area of the ventrointermedius nucleus (Vim) in humans and also in VPLo nucleus in monkeys. In both cases, only the lateral and ventrocaudal part of each nucleus, which was defined as the kinesthetic zone, was involved. A possible tremor-mediating neural circuit is postulated.

The effect of conventional irradiation on primitive gliomas and medulloblastomas was examined for 21 patients and a role for radiosurgery was evaluated. Five patients survived more than 8 years after treatment. However, side effects were recognized not only on neuronal and hormonal functions but also on neurovascular structures in the developing brain. The remaining patients died due to tumor recurrence, dissemination and/or metastases. Although these tumors were radioresponsive, conventional irradiation was inadequate in more than half the cases. A role for Gamma Knife radiosurgery should be considered, especially for young children and recurrences. Radiosurgery could also conceivably contribute to the prevention of tumor dissemination. In all events a multidisciplinary treatment should be considered.

In nine patients with central (thalamic) pain after stroke, X-CT, MRI, PET scan and intraoperative thalamic microrecordings were performed. The PET studies made use of Sokoloffs method with 18FDG and a steady-state method with C15O2-15O2. CT scan and MRI revealed definite thalamic damage (Th) in 3 cases, putaminal damage (Put) in 3 cases, combined damage (Th + Put) in one case, and cortical (parietal) damage in 2 cases.

A 27-year-old woman with Turner syndrome was admitted to NCVC for congestive heart failure. 2-D echocardiography and magnetic resonance imaging (MRI) disclosed annuloaortic ectasia with severe aortic regurgitation and coarctation of the aorta. One staged operation by a modified Bentall procedure and extra-anatomical bypass grafting from the ascending aorta to the infrarenal abdominal aorta was successfully performed. The postoperative course was uneventful. The pressure gradient between upper and lower extremities decreased as to be 30 mmHg compared with preoperative 60 mmHg.

A 31-year-old male with tetralogy of Fallot (TF) and total occlusion of the right coronary orifice complicated with infective endocarditis successfully underwent total repair of TF and coronary artery bypass graft (CABG). The patient had severely suffered from symptoms including breathlessness, palpitation (SVT) and chest pain. The coronary arteriography revealed occlusion of the right coronary orifice. The preoperative course was further complicated by endocarditis with vegetation of the aortic valve that did not respond to antibiotics. Concomitant surgical procedures consisting of TF repair, CABG to the right coronary artery with saphenous vein graft and vegetectomy of the aortic valve were carried out. The postoperative course was uneventful though he underwent cholecystectomy for symptomatic gall stones after TF repair. The patient is now in NYHA class II.

The effects of potassium in reperfusion solution (RS) and the influence of sodium on this effect were studied. Experimental time course was as followed: 20 min working perfusion, 3 min cardioplegic infusion with St. Thomas Cardioplegic Solution followed by global ischemia for 33 or 35 min at 37.5 degrees C, 15 min early Langendorff reperfusion with several different potassium concentration modified with Krebs Henseleit Bicarbonate Buffer (KHBB) containing 145 mM and 110 mM sodium and 5 min late reperfusion with KHBB, followed by 20 min working perfusion. Potassium in RS possessed bell shaped dose response nature with optimal concentration of 10 mM in the condition of 145 mM sodium but 6 m in the condition of 110 mM in terms of percent recovery of aortic flow. Although higher potassium reperfusion produced less Creatine Kinase leakage.

The 23 patients who underwent aortic valve replacement (AVR) for aortic regurgitation (AR) from 1977 to 1990 were studied with pulsed Doppler echocardiography. The patients were divided into two groups. The A group consisted of 5 patients whose end-systolic volume index (ESVI) were more than 200 ml/m2 and/or left ventricular ejection fraction (EF) were less than 0.35 before AVR. The B group consisted of 18 patients whose ESVI were less than 200 ml/m2 and EF were more than 0.35 before AVR. A Doppler volume sampler was placed at the center of mitral orifice to measure the transmitral inflow velocity after AVR (mean 28 months). Left ventricular filling dynamics were assessed by the peak velocity in the rapid filling phase (R), the peak velocity in the atrial contraction phase (A) and the ratio of A by R (A/R ratio) of mitral flow velocity pattern. The deceleration rate of early diastolic rapid inflow (DeR) determined as the slope a straight line drawn between the peak of early diastolic inflow and a point at half peak velocity on the fall side of the envelope. Result was as follows; 1) The DeR showed significant correlation with the EF (r = 0.56, p0.01). The DeR showed significant inverse correlation with the ESVI (r = -0.52, p0.05). 2) The R velocity (mean 43.9 +/- 7.9 cm/sec) in group A was significantly lower than in group B (mean 61.4 +/- 18.6 cm/sec), (p0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

In surgery for chronic mitral regurgitation, the mitral subvalvular apparatus, including annulus, may play an important role in preserving left ventricular (LV) performance. The suture annuloplasty for mitral regurgitation allows annular contraction of the mitral valve. The potential effects of suture annuloplasty on the postoperative LV performance have not been fully defined.Global and regional LV function in 12 patients with suture annuloplasty were compared with 12 patients with conventional mitral valve replacement (MVR). Cineangiography and echocardiography were obtained before and 10.8 months after surgery. End-diastolic volume index and end-systolic volume index decreased significantly in both groups after surgery (p0.01). Ejection fraction remained unchanged in the suture annuloplasty group, whereas it decreased significantly in the MVR group after surgery (p0.01). There was a significant inverse relation between ejection fraction and end-systolic wall stress in the two groups after surgery (suture annuloplasty group, r = -0.69, p = 0.01; MVR group, r = -0.60, p = 0.04). The intercept on the y axis was significantly (p0.005) higher in the suture annuloplasty group than in the MVR group. In the suture annuloplasty group, cross-sectional area ejection fraction at the mitral valve level and at the papillary muscle level by LV two-dimensional echocardiography remained unchanged after surgery. In the MVR group, they decreased significantly after surgery (p0.01). There was a significant correlation between the cross-sectional area ejection fraction and the global ejection fraction at both levels after surgery. Therefore, the improvement of the regional wall motion can be attributed to the improvement of the global LV performance after suture annuloplasty.These data suggest that suture annuloplasty can provide more desirable postoperative LV systolic performance than conventional MVR by preserving both the contraction of the mitral annulus and the mitral valvular-ventricular interaction.

The purpose of the study is to investigate the effects of protease inhibitor (Nafamostat mesilate: NM) upon myocardial protection. Hearts were subjected to 20 min working control perfusion followed by 3 min cardioplegic infusion with the St. Thomas Cardioplegic Solution (ST) contained various concentrations of NM, and global ischemia for 33 min at 37 degrees C (Exp. 1) or 150 min at 20 degrees C (Exp. 2). Hearts were then converted to Langendorff reperfusion (the leakage of Creatine Kinase (CK) and Cathepsin B (Cat-B) ware measured) and 20 min working reperfusion. Various concentrations of NM added during Langendorff reperfusion (Exp. 3). During working perfusion cardiac functions (aortic flow (AoF), coronary flow (CoF), heart rate (HR), aortic pressure (AoP)) were measured, and expressed as the percent recovery of pre-ischemic control value. Post-ischemic recovery of AoF (%AoF) showed the bell-shaped dose-response curve, and the optimal dose was 3 microM (Exp. 1) and 10 microM (Exp. 2) respectively. There was a significant (p0.05) increase of %AoF in optimal dose compared with that in controls (64.2 +/- 1.2% vs 52.3 +/- 2.5% in Exp. 1, 68.9 +/- 3.1% vs 54.1 +/- 1.4% in Exp. 2). These increase of functional recovery reflected in the values for CK and Cat-B leakage. The addition of NM in ST reduced CK and Cat-B leakage significantly in the concentration of 5 microM (in Exp. 1) and 10 microM (in Exp. 2) respectively. But the addition of NM in reperfusate did not reduced CK leakage significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Right ventricular function was assessed by regional wall motion analysis and by global function in 62 patients after repair for tetralogy of Fallot. Its relation to surgical procedures, with special attention to right ventriculotomy, was investigated. Patients were classified as follows: group Ia (n = 17), transpulmonary-transatrial repair without right ventriculotomy; group Ib (n = 22), transpulmonary-transatrial repair with minimal right ventriculotomy and small transannular patch; and group II (n = 23), transventricular repair with or without transannular patch. For regional wall motion analysis, fractional area change was used for three anterior parts obtained from hemiaxis area analysis of the lateral right ventriculogram. Ejection fractions were used for global right ventricular function. Functional assessment was done both at rest and during isoproterenol infusion, which is a stress test to evaluate cardiac functional reserve. At rest, group Ia showed better right ventricular anterior wall motion as well as global ejection fraction than did group II. Group Ib showed a global ejection fraction comparable to group Ia, with better regional wall motion in the middle anterior part of the right ventricle despite the depressed upper and lower anterior parts of the right ventricle. Group II showed depressed wall motion of the middle anterior part and the resultant impaired global ejection fraction. During isoproterenol infusion, group Ia showed significant increase in fractional area change of all anterior parts and in global ejection fraction. Group Ib showed significant increases in fractional area change at the middle and lower parts and in global ejection fraction comparable with group Ia. Otherwise, group II showed no significant change in fractional area change, or in global ejection fraction, at the upper and middle parts. These results indicated that transpulmonary-transatrial repair for tetralogy of Fallot provided better postoperative global right ventricular function and its reserve, with less impaired regional wall motion, than did the transventricular repair.

Ten patients underwent open heart surgery for mitral valve after PTMC because of post PTMC MS (n = 4) and MR (n = 6) out of 150 patients undergoing PTMC in our hospital between June 1987 and October 1991. Intraoperative findings of 4 patients with residual mitral stenosis included severe thickening, stiffening and calcification on anterior and posterior leaflets, commissures and subvalvular apparatus. Mitral valve repair was possible in 2 and mitral valve replacement (MVR) was necessary in the other 2. In all 6 cases who massive mitral regurgitation after PTMC, in repairable tears in the mitral leaflets necessitated MVR. Since in these cases changes in the leaflets were less severe than those of the commissures or subvalvular apparatus, surgical repair could have been possible if open mitral commissurotomy (OMC) was done primarily. Patients selection for PTMC versus OMC based on precise morphological evaluation of mitral valve would reduce occurrence of massive MR resulting in surgical replacement.

The authors reported the first case of acute spinal epidural hematoma (SEH) developed after open heart surgery. The patient was noticed that her legs felt weak and numb on the first postoperative day evening. On the next day morning, neurological examination revealed that flaccid paralysis of both legs and also loss of all sensory perception below the level of Th-6 spine bilaterally. The prolonged effect of anesthesia and painless onset made delayed recognition of the lesion. SEH (Th5-7) was diagnosed with MRI and decompressive surgery was immediately done, sixty hours after the beginning of cardiac operation. But in this case neurological deficits were not changed. We concluded that a routine diagnostic approach was very important procedure to find out this serious complication for all patients underwent open heart surgery in early period of its onset.

On the bases of the initial and follow-up results of patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and percutaneous transvenous mitral commissurotomy (PTMC), the proper applications of these interventional therapies were discussed. The efficacy of PTMC on valvotomy was comparable to open mitral commissurotomy and the procedural safety was noticed. Our results supported the use of PTMC for patients with plicable mitral valve. Despite the good and acceptable results of elective PTCA, low initial success rate and high incidence of major cardiac events including mortality was noted in the group of urgent PTCA for patients with multivessel lesions. The urgent use of PTCA for refractory unstable angina should be restricted to selected patients without high-risk multivessel lesions.

Alterations induced by p-chlorophenoxyisobutyric acid (clofibric acid) in the composition of phosphatidylcholine and cholesterol esters in serum and their influence on the composition of phosphatidylcholine in the kidney were studied. Rats of different ages responded differently to the drug in terms of the levels of arachidonic acid (20:4) and linoleic acid (18:2) in the phosphatidylcholine and cholesterol esters in the serum. Administration of clofibric acid to 26-week-old rats for 2 weeks caused a marked decreased in the relative level of 20:4 in phosphatidylcholine and cholesterol esters in serum, whereas similar treatment of 6-week-old rats resulted in a reduction of 18:2 and, to a lesser extent, of 20:4 in serum lipids. The decrease in phosphatidylcholine that contained 20:4 in the serum of old rats was mainly due to a decrease in the concentration of stearoyl-arachidonoyl (18:0-20:4) species. The decrease in cholesterol arachidonate in serum caused by the treatment of old rats with clofibric acid seemed to be due to a reduction in the relative level of serum phosphatidylcholine containing 20:4. The marked reduction in serum lipids that contained 20:4 caused a decrease in the relative level of 20:4 in renal phospholipids, in particular, a decrease in the proportion of palmitoyl-arachidonoyl (16:0-20:4) and 18:0-20:4 phosphatidylcholine.

Eleven patients with syndromes of asplenia and polysplenia associated with total anomalous pulmonary venous drainage (TAPVD) were underwent Blalock-Taussig (B-T) shunt operation for reduction of pulmonary blood flow. The age of patients at operation were 6 days to 5 years (average 19.5 +/- 18.7 month). There were seven patients in supracardiac type and four in cardiac type of TAPVD. All patients didn't present obstruction to pulmonary venous return (PVO) before B-T shunt operation. There were one early (9%) and two late deaths (20%) after surgery. Although the hospital death was related to perioperative errors. Two late deaths were not due to the PVO. One of infants had moderately pulmonary congestion and cardiac failure after shunt procedure. Two patients were measured pressure gradient (3 to 4 mmHg) between common pulmonary vein to atrium chamber before shunt procedure. Repeated catheterization revealed that 6 of them could be measured pressure gradient, 3 to 7 mmHg, and no patients had clinical sign of the PVO. Our results demonstrated that B-T shunt operation could be satisfactory for syndromes of asplenia and polysplenia associated with reduced pulmonary blood flow and TAPVD.

The effects of several different osmolarity in reperfusion solution were studied. Experimental time course was as follows: 20 min working perfusion, 3 min cardioplegic infusion with St. Thomas Cardioplegic Solution (STS) followed by global ischemia for 33 min at 37.5 degrees C, 15 min early Langendorff reperfusion with different osmolarity by adding sucrose and 5 min late reperfusion with Krebs Henseleit bicarbonate buffer, followed by 20 min working perfusion. Percent recoveries of aortic flow showed that 290 mOsm/L in reperfusion solution possessed optimal protective properties with bell shaped dose response characteristics.

A 5-years old boy, whose thoracic situs was right isomerism, was diagnosed as transposition of great arteries, common atrioventricular canal (intermediate type), severe tricuspid valve regurgitation, pulmonary valve stenosis, bilateral superior vena cava and left sided inferior vena cava. The preoperative RVEDV was 95% and LVEDV 160%, and LV/RV pressure ratio was 0.54. Atrial rerouting using pericardial patch, replacement of tricuspid valve and pulmonary valvotomy were performed. Postoperative course was uneventful. This was a rare case of right isomerism who received biventricular repair.

We purified CA125 antigen from the conditioned media (CM) of eutopic and heterotopic endometrial epithelial cells (EC) as well as ovarian cancer cell lines, SHIN-3 and HOC-I, to determine what molecular weight forms of CA125 antigen were identifiable. Treatment of the high-molecular-weight CA125 antigen with 6M urea yielded a much lower molecular mass peak. After purification by OC125 affinity column chromatography, samples were applied to 3 to 7% polyacrylamide gradient gel and analyzed by Western blot. A single band with a molecular weight (MW) of 200KDa was identified in eutopic EC materials. The CA125 polypeptide of the 110KDa molecule could be detected in all of the CM obtained from heterotopic EC, irrespective of the length of time in the cell culture. A MW of approximately 200 KDa was also observed in some heterotopic EC samples. On the other hand, although the multiple bands with a MW equal to orless than 200KDa were observed in the CM of two ovarian cancer cells, the CA125 polypeptide of 110KDa molecules could not be detected. This preliminary finding offers promise that the 110KDa molecule detection method may be a useful adjunct in the differential diagnosis of heterotopic EC and ovarian cancer.

The effects of several sodium concentrations in reperfusion solution (RS) were studied. Experimental time course was as follows: 20 min working perfusion, 3 min cardioplegic infusion with St. Thomas Cardioplegic Solution followed by global ischemia for 33 min at 37.5 degrees C, 15 min early Langendorff reperfusion with various sodium concentrations modified with Krebs Henseleit Bicarbonate Buffer (KHBB) and 5 min late reperfusion with KHBB, followed by 20 min working perfusion. Percent recoveries of aortic flow and Creatine Kinase leakage showed that 110 mM sodium of RS possessed optimal protective properties with bell shaped dose response characteristics.

UFT was administered to 27 patients with superficial bladder cancer and adriamycin administered intravesically to 26 patients with the same cancer as a measure to prevent the recurrence of the tumor following transurethral resection, and the rate of recurrence was compared between the two groups of patients. There was no significant difference between the two groups in background factors (e.g., primary or recurrent, single or multiple), histological malignancy and degree of infiltration. The non-relapsers accounted for 88.9% of patients at one year, 64.3% at two years, and 64.3% at three years in the UFT group and 96.2%, 76.8%, and 65.5%, respectively, in the adriamycin group. There was no significant difference in the rate of non-recurrence between the two groups; nor was there significant difference in the non-recurrence rate between them with respect to any of the background factors. UFT showed results which compared with those of adriamycin administered intravesically, and UFT was considered useful for preventing recurrence of superficial bladder cancer.

We have established an in vitro system in which epithelial cells (EC) and stromal cells (SC) from the human endometrium are placed in culture to examine the production of CA125. There was a much greater amount of CA125 in heterotopic EC after culture cells reached confluence than during the logarithmic growth phase. Heterotopic EC in culture secreted nine times as much CA125 constitutively after reaching confluence as eutopic EC. Flow cytometry (FCM) analysis indicated that the changes in CA125 expression correlated with the cell cycle. The CA125 expression was mainly observed in the G0/G1-phase in the cell cycle. There was no amplification of the CA125 expression in heterotopic EC membranes. The results of SDS-PAGE and Western blot indicated that the 110 KDa molecule of CA125 might be specific for adenomyosis. The biochemical and physical nature of CA125 was examined to characterize the antigenic determinant of this antigen. These results strongly suggested that the CA125 antigenic determinant from EC was composed of conformationally dependent peptides. We conclude that significantly increased secretion of CA125 from heterotopic EC could be attributed to the increase in serum CA125 in patients with adenomyosis.

Six tumor-associated antigens, cancer antigen 125 (CA125), tissue polypeptide antigen (TPA), ferritin (Fr), carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), and sialyl Lex-i (SLX) were measured simultaneously for the early detection of ovarian cancer. To decrease the number of both false positive and false negative cases in the combination assay, statistical discrimination analysis employing the serum values for appropriate tumor markers has been studied with respect to ovarian cancer by the method of Mahalanobis' generalized distance. The new "ovarian cancer screening test" designed by us has been used in Shizuoka Prefecture since 1988, and 23,307 serum samples have been analyzed. One hundred twenty-seven of 165 ovarian cancer patients were suspected as having cancer by such clinical procedures as pelvic examination and/or ultrasonography, while in 150 patients cancer was detected by the statistical discrimination method. Thirty-one of 38 patients with ovarian cancer overlooked by the clinical procedures could be found by the statistical method. We conclude that clinical procedures and the statistical method can be complementary in detecting patients with this malignancy.

This study examined the effect of experimental diabetes mellitus on the dorsal tongue of rats which were made diabetic by tail-vein injections of streptozotocin (50 mg/kg) and then raised for either 5 or 10 months. Lingual papillae were observed by scanning electron microscopy (SEM) and light microscopy. Morphological changes in lingual mucosal capillaries in 10-month diabetic rats were observed by electron microscopy (TEM). In the study of cellular movement in the lingual dorsal epithelium, bromodeoxyuridine (BrdU) was applied as a tracer for studying DNA replication. In diabetic rats, lingual papillae showed morphological atrophic changes. The lingual mucosal capillaries' alterations included endothelial cells with numerous cell projections into the lumen, degenerated cell organs, increased basement membrane width, and narrowed capillary lumen. BrdU labeling index among the basal cells was reduced in diabetic rats which indicates a possible retardation of their epithelial-tissue activity. In diabetes mellitus, direct metabolic disturbances to the epithelia because of insulin deficiency first occurred, successively diabetic microangiopathy appeared on the lingual mucosal capillaries. The appearance of diabetic microangiopathy caused tissue hypoxia, which induced atrophic changes to the epithelia.

In 28 children with congenital cardiac lesions, open heart surgery was attempted without homologous blood transfusion using extreme hemodilution for cardiopulmonary bypass (CPB) and moderate to profound hypothermia. The entry criteria for this study were preoperative hemoglobin value above 10 g/dl and expected CPB time of less than 120 minutes. Acyanotic heart diseases such as ventricular or atrial septal defect were the main lesion, but some cases of tetralogy of Fallot and single ventricle were also included in this study. Intraoperative saving of autologous blood and autotransfusion using cell saver were carried out in a part of the subjects. Acceptable lowest values for hemoglobin was 4-5 g/dl and 40% for mixed venous oxygen saturation. As the results, 18 patients tolerated CPB without transfusion and eventually 16 patients were discharged without transfusion at all. The body weight for those without transfusion was 13.9 kg in average and the lowest was 6.8 kg. The significant factor affecting the needs for homologous blood transfusion was prolonged CPB time over 120 minutes. Although there was a tendency that the patients with body weight less than 15 kg received transfusion more frequently than those with body weight more than 15 kg, the body weight was not necessarily a limiting factor. Pre-CPB blood saving and intraoperative autotransfusion were the positive factors for successful non-transfusion open heart surgery.

Six hundred forty-eight serial graded exercise tests were performed on 400 patients up to 10 years after coronary bypass graftings (CABG). The maximal attained exercise tolerance, over 10 METS, were observed in 60% of patients and the negative response to exercise test in 43% of patients. The positive response in various parameters were observed at the following rates: graft occlusion-30% vs graft patent-46% (p less than 0.01); incomplete revascularization-39% vs complete revascularization-22% (p less than 0.01); and less than or equal to 8 METS 4-45% vs greater than or equal to 10 METS-28% (p less than 0.01), respectively. However, no significant difference was observed among number of vessels diseased, number of graftings, and presence of old myocardial infarction. The maximal attained stage of exercise, over 10 METS, in various parameters were at the following rates: less than or equal to 59 years old-70% vs greater than or equal to 60 years old-44% (p less than 0.01); male-63% vs female-32% (p less than 0.01); and graft patent-63% vs graft occlusion-50% (p less than 0.05), respectively. The serial analysis of exercise test demonstrated that improved exercise tolerance appears to persist for at least 5 years after CABG. However, the patients in complete revascularization had a tendency to increase the rate of positive response. In conclusion, the completeness of revascularization as well as graft patency was the main factor limiting exercise tolerance, and correlates with the extent and the duration of improvement after CABG.

We have assessed the long-term prognosis about cardiac death of isolated coronary artery bypass surgery from 1972 to 1988 in 361 consecutive patients. The duration of follow-up were from 0.4 years to 14.6 (mean 5.7) years. Of the 361 study patients, the operative morality was 4.7% (17 patients) and 29 patients (8.0%) died during follow-up, 11 (3.0%) of which were from cardiac causes. Actuarial survival rate was 85.2% at 10 years after surgery. The 10 year-survival rate was similar for patients with single, double, triple vessel disease, and left main trunk disease (94.5%, 83.7%, 75.1% and 89.1%, respectively). For patients with and without old myocardial infarction, the 10 year-survival rate was significantly different (75.4% and 93.3%, respectively) (p less than 0.005). In order to detect which factors of preoperative cardiac function among cardiac index, LV end-diastolic pressure, LV end-diastolic volume index, LV end-systolic volume index, and LV ejection fraction influenced the long-term prognosis, multivariant regression analysis was performed. Only LV end-systolic volume index was a significant factor, and the discriminative point was 50 ml/m2. For patients with LV end-systolic volume index less than 50 ml/m2 and greater than or equal to 50 ml/m2, the 10 year-survival rate was significantly different (88.3% and 32.9%, respectively) (p less than 0.005). In conclusion, the most significant factor influencing longterm prognosis after coronary artery bypass surgery was left ventricular end-systolic volume, indicating the importance of preventing preoperative dilatation of left ventricle.

Circulating serum sialyl Tn (STN) antigen levels were measured in 89 patients with epithelial ovarian cancer, 157 benign disease, and in 126 healthy controls. Serum antigen levels were increased in 48.3% of patients with ovarian cancer. The false positive rate is significantly low (4.0% in healthy controls and 9.6% in benign disease). The levels of STN antigen were significantly higher in sera of patients with cancer than in those in benign and healthy controls (p less than 0.05). The rise in serum STN antigen levels correlated to the size of the primary tumors. Of the histological type, it is interesting to note the high sensitivity in mucinous-type ovarian cancer. Survival at 1, 2, 3, 4 and 5 years for patients with STN-negative (serum STN levels less than 50 U/ml) versus STN-positive (serum STN levels greater than or equal to 50 U/mol) was 96.2, 92.3, 86.5, 82.7, and 76.9% versus 59.5, 29.7, 18.9, 10.8, and 10.8%, respectively (p less than 0.05). The overall survival probability was worse in patients with STN-positive sera. Percent progression-free survival at 1, 2, 3, 4 and 5 years for patients with STN-negative versus STN-positive was 90.4, 86.5, 76.9, 59.6, and 51.9% versus 35.1, 16.2, 8.1, 8.1, and 5.4%, respectively (p less than 0.05). The overall progression-free period of survival was shorter in patients with STN-positive sera. Multivariate regression analysis revealed that positive STN, stage, PS and histologic grade were the four variables of most importance in predicting survival. These results indicate that a positive STN antigen level in sera is an independent predictor of poor prognosis in ovarian cancer.

A 5-year-old boy with double inlet left ventricle and ventriculoarterial discordance (SDD type) underwent ventricular septation with arterial switch procedure. Previously he had received pulmonary arterial banding at 3 months-old. Preoperative cardiac catheterization revealed Qp/Qs 1.26, Pp/Ps 0.19 and LVEDV was 315% of normal (as left ventricle). Arterial switch with Lecompte modification was performed in order to separate ventricle with straight patch could be done. Post operative course was uneventful and patient was extubated 4 post operative day. These procedures had employed in this patient as follows; 1) systemic ventricle could be constructed with morphological left ventricle with mitral valve. 2) left ventricular outflow tract stenosis due to ventricular outlet foramen occasionally observed in conventional procedure such as intraventricular rerouting could be prevented, and 3) ventricular septation could be easy and simple with straight patch.

Experimental time course was as follows: 20 min working perfusion, 3 min cardioplegic infusion with St Thomas Cardioplegic Solution followed by global ischemia for 35 min at 37.5 degrees C, 15 min first Langendorff reperfusion with reperfusion solution (RS) with various concentrations of Mg and 5 min second reperfusion with KHBB, followed by 20 min working. Cardiac functions were measured during pre and post working perfusion and CK leakage were measured during reperfusion. Percent recoveries of aortic flow at the Mg concentration of 0, 0.6, 1.2, 3.0, 6.0, 12 mM were 21 +/- 5, 22 +/- 3, 48 +/- 2, 37 +/- 4, 28 +/- 3, 15 +/- 3 (%) (mean +/- SEM), respectively. Our data indicated that 1.2 mM Mg of RS possessed protective properties with bell shaped dose response characteristics.

The effects of "pulsatile" bidirectional cavopulmonary shunt (BCPS) produced by the flow from the ventricle or Blalock-Taussig (B-T) shunt on ventricular function and pulmonary circulation were evaluated in 10 patients with univentricular heart from 3 to 37 months (mean, 16.6 +/- 9.5 months) after surgery. Age at operation ranged from 7 months to 15 years (mean, 5.5 +/- 4.5 years). In addition to the BCPS, pulmonary flow was supplied from a B-T shunt on the contralateral side of the BCPS in five patients, from the ventricle through the stenotic pulmonary valve in four patients, and from both the ventricle and a B-T shunt in one patient. There were no operative deaths; however, there were two late deaths from acute respiratory infection 10 and 13 months after operation. Mean pulmonary arterial pressure measured the first day after operation ranged from 10 to 19 mm Hg (mean, 14 +/- 3 mm Hg). Mean pulmonary arterial pressure at postoperative cardiac catheterization was less than 15 mm Hg (mean, 12 +/- 4 mm Hg). Pulse pressure ranged from 3 to 12 mm Hg (mean, 7 +/- 4 mm Hg). Arterial oxygen saturation increased significantly from 77 +/- 5% before BCPS to 86 +/- 4% immediately after discharge from the intensive care unit (p less than 0.005) and 85 +/- 3% (p less than 0.025) at late cardiac catheterization. Pulmonary arteriovenous fistula was not detected in contrast echocardiography and pulmonary arteriography. Systemic ventricular end-diastolic volume index decreased significantly (p less than 0.01) from 141 +/- 54 ml/m2 before BCPS to 98 +/- 35 ml/m2 1 month after BCPS by echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Tricuspid regurgitation was evaluated in 133 patients with tetralogy of Fallot after corrective operations for a real-time Doppler flow imaging system. Moderate or severe tricuspid regurgitation was found in 15% (10/66) of patients in whom the ventricular septal defect was closed through the right atrium and tricuspid valve, 13% (2/15) through the pulmonary artery, and 25% (13/52) through the right ventricle. These differences were not significant. Right ventricular systolic pressure was significantly higher (66 +/- 27 mm Hg) in patients with moderate or severe tricuspid regurgitation (group A) than in patients with mild or no tricuspid regurgitation (group B) (41 +/- 13 mm Hg) (p less than 0.01). Right ventricular end-diastolic pressure was significantly higher in group A (7.7 +/- 2.2 mm Hg) than in group B (6.1 +/- 2.9 mm Hg) (p less than 0.01). Significant pulmonary regurgitation (angiographic grades 3/4 to 4/4) was more frequent in group A (8/18; 44%) than in group B (14/64; 22%) (p less than 0.05). Residual ventricular septal defect (pulmonary/systemic flow ratio greater than 1.3) was also more frequent in group A (5/18; 28%) than in group B (0/64; 0%) (p less than 0.01). Right ventricular end-diastolic volume was significantly higher in group A (202% +/- 79% of the normal right ventricle) than in group B (158% +/- 38% of normal) (p less than 0.01). Thus significant tricuspid regurgitation was associated with high right ventricular systolic pressure, high right ventricular end-diastolic pressure, and significant pulmonary regurgitation and residual ventricular septal defect, which increased the right ventricular end-diastolic volume. Operative procedure for closing the ventricular septal defect was not related to the development of significant tricuspid regurgitation.