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This study evaluated the efficacy of a new patient-triggered ventilator that triggered the patient's inspiratory effort by detecting the change in airflow by means of a 'hot wire' anemometer. This ventilator was used in both the conventional and the synchronized intermittent mandatory ventilation (SIMV) modes in seven neonates. Values for blood gas, spontaneous breathing rate, tidal volume of spontaneous breaths and minute volume were compared in all seven neonates. The resistive work of spontaneous breathing in five neonates, obtained with synchronized intermittent mandatory ventilation was compared with the values obtained using conventional mechanical ventilation on the previous day of weaning from the ventilator. At each the inflation time studied (0.4, 0.3, 0.24 s), all mechanical breath occurred synchronously with infants' inspiratory efforts. The median trigger delay was 80 ms. Oxygenation was improved on the new system compared with the conventional system. Tidal volume of spontaneous breathing and minute volume were increased with SIMV compared with conventional mechanical ventilation, although the resistive work of spontaneous breathing was decreased with SIMV. The tidal volume of spontaneous breaths was more constant with SIMV versus conventional mechanical ventilation. Thus, the airway flow-triggered SIMV may lessen inspiratory muscle fatigue during weaning process. We conclude that the SIMV is useful in weaning neonates from the ventilator.

To construct standard growth curves for Japanese infants of very low birthweight, longitudinal data provided by 47 neonatal centers in Japan were reviewed. Data were collected on the growth of infants admitted to those units during 1986 and 1987 and who survived beyond 3 years of age. A total of 379 singleton infants, who were free of neurological sequelae and appropriate for gestational age, were enrolled. Those whose birthweights were more than 600 g and less than 1,500 g were grouped into nine weight categories separated by increments of 100 g. Data on the increase in weight and head circumference were compiled and analyzed until more than half the infants in each weight category had been discharged from each site. Growth curves of bodyweight and head circumference in the nine groups were constructed using polynomial regression analysis to define the curve of best fit. With increasing prematurity, significant trends of greater weight loss (P < 0.05), longer time to reach the lowest weight (P < 0.01) and a longer time to regain birthweight (P < 0.01) were observed. In addition, there was a significantly higher incidence of chronic lung disease in such groups (P < 0.0001). Growth curves were characterized by the average clinical profiles in each of the nine groups. We believe that these data will be useful in evaluating the growth of very low birthweight infants being cared for in modern neonatal intensive care units in Japan.

The effects of mean airway pressure (MAP) on bronchial mucosal blood flow at the carina in nine anesthetized adult rabbits undergoing high frequency ventilation were studied. The animals were given oleic acid to diminish lung compliance and to exclude the influences of increasing MAP on systemic venous return. Mucosal blood flow decreased significantly when MAP exceeded 14 cmH2O. Mucosal blood velocity tended to decrease as higher levels of MAP were applied. Mucosal blood volume decreased significantly when MAP exceeded 20 cmH2O. Hemodynamics, arterial blood gas values and pH were not changed significantly. Our data demonstrate that bronchial mucosal blood flow decreases at high levels of MAP even if cardiac output remains constant. Hence this decrease of bronchial mucosal blood flow may be due to the transmission of pressure to submucosal bronchial capillaries.

We studied the nutritional effects of two types of human milk fortifiers for very low birth weight infants. These studies suggest that fortified human milk provides nutritional advantages for very low birth weight infants. However, providing calcium and phosphorus with supplementation is necessary for the improvement of bone density.

A case of membranous septal aneurysm with aortic regurgitation (AR) in a 13-year-old male was reported. As AR was progressed rapidly in this case, aneurysmorrhaphy of membranous septal aneurysm and aortic valve plication were performed. The postoperative coarse was uneventful. It was considered that the course of AR was prolapse of aortic valve related with membranous septal aneurysm.

Serial changes in phosphorus metabolites after intravenous administration of fructose were compared between five healthy volunteers and five patients with chronic hepatitis by means of phosphorus-31 magnetic resonance (MR) spectroscopy. P-31 spectra were obtained every 5 minutes after intravenous drip infusion of 20% fructose at a dose of 0.5 g/kg of body weight. In the healthy volunteers, phosphomonoesters (PME) increased to 338% +/- 76% of the preadministration value at 15-20 minutes. Inorganic phosphate (Pi) was depleted in the first 15 minutes, then rebounded to 260% +/- 67% of the initial value. beta-adenosine triphosphate decreased to less than 50% of its initial value and then gradually recovered. In patients with chronic hepatitis, the increase of PME at 15-20 minutes (151% +/- 49% of the preadministration value) was significantly less than that in healthy volunteers (P less than .05). In addition, the rebound of Pi at 35-40 minutes (126% +/- 42%) was significantly less than that in healthy volunteers (P less than .05). In conclusion, P-31 MR spectroscopy with fructose administration is valuable in the functional evaluation of diffuse liver diseases.

An 82-year-old woman was admitted to Iwamizawa Rosai Hospital, Cardiovascular Medicine, for detailed examination of an aneurysm of abdominal aorta. CT scan revealed marked swelling of para-aortic lymph nodes which regressed spontaneously in three months. She was re-admitted to our hospital because of general malaise and gait disturbance. Her chest X-ray on the second admission revealed miliary disseminated shadows, which were confirmed to be tuberculous granuloma by lung biopsy. She was initially well controlled with anti-tuberculosis drugs, followed by severe liver dysfunction and pancytopenia, and died of respiratory and cardiac failure. At autopsy, wide-spread malignant lymphoma and miliary tuberculosis of the lung were found. The cause of liver dysfunction was strongly suspected to be due to infiltration of the lymphoma cells to portal triads of the liver. Hemophagocytosis found in the bone marrow, spleen and liver might be consistent with clinically so-called "hemophagocytic syndrome", causing pancytopenia, associated with infection.

It has been reported that MR imaging of the spleen is unsuccessful in detecting focal lesions because there is not a significant difference in relaxation times between most tumors and surrounding normal spleen. We reviewed the MR imaging of 15 patients (5 cysts, 2 abscesses, 1 hemangioma, 5 malignant lymphomas, 2 metastatic tumors). In all cases, the difference in signal intensities between splenic tissue and mass lesions permitted detection of splenic lesions on MR images. But, malignant lesions were less visible than benign lesions.

A case of a 66 year-old female with aortitis syndrome with right coronary arterial obstruction, was reported. The coronary arteriogram showed total occlusion of the right coronary artery (segment 2). On the aortogram, stenosis of the left common carotid artery, kinking and aneurysm of the descending thoracic aorta were revealed. Because she developed frequent attacks of effort angina and the descending thoracic aneurysm was small in diameter 38 mm, coronary bypass grafting to the right coronary artery was performed using the in situ right gastroepiploic artery. Postoperative course was not eventful and chest pain disappeared. In such cases, the right gastroepiploic artery is useful for coronary artery bypass grafting.

Sixty-one CT scans in 20 patients who had undergone head and neck reconstructive surgery using a pectoralis major myocutaneous (PM-MC) flap were retrospectively evaluated to assess the usefulness of Ct in the follow-up of these patients. The normal CT findings in patients with PM-MC flaps are described. Of 13 cases with tumor recurrence, CT examination correctly detected recurrent masses in all cases, including 3 in which there was no clinical sign of recurrence. Postoperative masses mimicking tumor recurrence included deformed breast tissue, hematomas, lymphoceles, and abscesses. Computed tomography was of great value in the detection of tumor recurrence, but careful interpretation is required because a postoperative complication or anatomic alteration may lead to the erroneous diagnosis of tumor recurrence.

Anomalous coronary artery originating from the aorta without complicated congenital cardiac anomaly is rare. We describe a case with the left coronary artery originating from the right sinus of Valsalva. Cardiac catheterization revealed a left coronary artery transverse between the aorta and the pulmonary artery. Severe atherosclerotic stenosis was present at segment 3 of the right coronary artery. Electrocardiogram and myocardial scintigraphy revealed that the angina occurred due to stenosis of the right coronary artery. We tried PTCA, but could not pass the catheter through the stenosis. After PTCA, he complained of anterior chest pain frequently, so we performed an aortocoronary bypass operation to the right coronary artery with saphenous vein graft. Postoperative course was not eventful and angina disappeared.

The patient was 63-year-old man, who underwent patch closure of VSP 37 days after onset. LVAD was required for weaning from CPB. Mediastinitis occurred after LVAD was removed. The mediastinum was irrigated using diluted antibiotics through the retrosternal drain. He discharged on 79th day postoperatively. False aortic aneurysm and marked AR was pointed out by cineangiography and enhanced CT scan two years after operation. AVR was performed through right thoracotomy, because false aortic aneurysm invaded the sternum. The aneurysmal wall was repaired with patch. Postoperatively, peritoneal dialysis was performed for two days. Flail chest made difficult weaning from the respirator. He died 11 days postoperatively due to respiratory failure. There remains the possibility that mediastinitis resulted in false aortic aneurysm and AR. It was esseutial to remove the foreign materials placed on the aorta for eradication of infection.

The relationship between the cytomorphologic features, the nuclear DNA patterns and the clinical prognosis of patients with small cell carcinoma of the lung was studied. In cases in the long-survival group (greater than or equal to 24 months), bronchial brushing smears contained a relatively high frequency of nuclei with large, irregular shapes and finely granular chromatin patterns, in comparison with patients in the short-survival group (less than or equal to 9 months); the correlation was not statistically significant, however. The incidence of cells with round or oval nuclei and finely granular chromatin patterns was higher in patients whose cells had hyperdiploid DNA patterns than for patients whose cells had near-diploid patterns; again, the difference was not statistically significant. Patients whose tumor cells had hyperdiploid DNA patterns had significantly shorter survival times than did patients whose tumor cells had near-diploid patterns. These results indicate that (1) judging the nuclear DNA pattern from the cytomorphologic features of small cell carcinoma is unreliable and (2) the nuclear DNA patterns are related to the clinical prognosis of patients with small cell carcinoma of the lung.

The relationship between the nuclear DNA histogram patterns of tumor cells obtained by brushing via bronchoscopy and the survival time of 39 patients with small cell carcinoma of the lung was investigated. The brushing smears were stained by a modified Feulgen method. The nuclear DNA content was measured at 550 nm using a microspectrophotometer. The DNA histogram pattern was classified into type I, which contained a higher proportion of G0G1-phase cells, and type II, which contained a higher proportion of S, G2M-phase cells. The median survival times for the patients with limited disease of type I, type II and the patients with extensive disease of type I, type II were 17.2 months, 10.2 months, 10.0 months, and 5.6 months, respectively. Patients with limited disease of type I had a significantly longer survival time than patients with limited disease of type II. A distinct correlation was found between the histogram pattern and the survival of the patients. These results indicated that the nuclear DNA histogram pattern may be an indicator to allow speculation as to the prognosis of patients with small cell carcinoma of the lung.

Characteristics of the nuclei in histopathologic preparations obtained from a patient with bronchial carcinoma and two patients with microinvasive bronchial carcinoma were studied by transmission electron microscopy. In carcinoma in situ, the nuclei showed slight or moderate irregularity in the nuclear outline. The number of perichromatin granules was usually one to 10 per nucleus section. Formation of fibrillar centers was not marked. In microinvasive carcinoma, the nuclei were more irregular in nuclear outline than in carcinoma in situ. The number of perichromatin granule was usually more than 11 per nucleus section. Formation of fibrillar centers was predominant.

The relationship between the nuclear DNA content and the focal relapse of 17 patients with small-cell carcinoma completely responsive to treatment was studied. The nuclear DNA content was measured at 550 nm using a microspectrophotometer. The nuclear DNA histogram pattern was classified as either "Type A" (near-diploid) or "Type B" (hyperdiploid). Of the nine patients with type A, only one was found to have focal relapse of the intrathoracic lesion. However, of the eight patients with type B, focal relapse was observed in six (75%). No significant difference was discerned between the metastasis to other organs and the nuclear DNA histogram patterns. The nuclear DNA histogram patterns in small-cell carcinoma of the lung are correlated to the outcome of the patients.

The relationship between the nuclear DNA histogram pattern of tumor cells obtained by bronchoscopic brushing and the response to combination chemotherapy (Cytoxan + Adriamycin + Vincristine) was studied in 28 patients with small-cell carcinoma of the lung. Microspectrophotometric analysis of the tumor cells showed a near-diploid nuclear DNA pattern in 18 patients and a hyperdiploid pattern in 10 patients. Eight of the ten patients with the hyperdiploid pattern showed a good response (complete or partial response) to the chemotherapy. However, of the 18 patients with the near-diploid DNA pattern, only 2 displayed a good response; the remaining 16 patients exhibited no response. The hyperdiploid DNA pattern of tumor cells was thus associated with a better response to chemotherapy than was the near-diploid pattern. These results indicate that the nuclear DNA histogram pattern may be an indicator for predicting the degree of response to chemotherapy in small-cell carcinoma of the lung.