Search

Importance: Sodium glucose cotransporter 2 inhibitors reduce morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Clinicians may find estimates of the projected long-term benefits of sodium glucose cotransporter 2 inhibitors a helpful addition to clinical trial results when communicating the benefits of this class of drug to patients. Objective: To estimate the projected long-term treatment effects of dapagliflozin in patients with HFrEF over the duration of a patient’s lifetime. Design, Setting, and Participants: Exploratory analysis was performed of Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF), a phase 3 randomized, placebo-controlled clinical trial conducted at 410 sites in 20 countries. Patients with an ejection fraction less than or equal to 40% in New York Heart Association functional classification II to IV and elevated plasma levels of N-terminal pro B-type natriuretic peptide were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. Mean (SD) duration of follow-up was 17.6 (5.2) months. Interventions: Dapagliflozin, 10 mg, once daily vs placebo in addition to standard therapy. Main Outcomes and Measures: The primary composite outcome was time to first hospitalization for heart failure, urgent heart failure visit requiring intravenous therapy, or cardiovascular death. The trial results were extrapolated to estimate the projected long-term treatment effects of dapagliflozin over the duration of a patient’s lifetime for the primary outcome and the secondary outcome of death from any cause. Results: A total of 4744 patients (1109 women [23.4%]; 3635 men [76.6%]) were randomized in DAPA-HF, with a mean (SD) age of 66.3 (10.9) years. The extrapolated mean event-free survival for an individual aged 65 years from a primary composite end point event was 6.2 years for placebo and 8.3 years for dapagliflozin, representing an event-free survival time gain of 2.1 years (95% CI, 0.8-3.3 years; P = .002). When considering death from any cause, mean extrapolated life expectancy for an individual aged 65 years was 9.1 years for placebo and 10.8 years for dapagliflozin, with a gain in survival of 1.7 years (95% CI, 0.1-3.3; P = .03) with dapagliflozin. Similar results were seen when extrapolated across the age range studied. In analyses of subgroups of patients in DAPA-HF, consistent benefits were seen with dapagliflozin on both event-free and overall survival. Conclusions and Relevance: These findings indicate that dapagliflozin provides clinically meaningful gains in extrapolated event-free and overall survival. These findings may be helpful in communicating the benefits of this treatment to patients with HFrEF. Trial registration: ClinicalTrials.gov Identifier: NCT03036124.

The Kashima Rinkai Specified Sewage Works (KRSSW) is located at the northern side of the Kashima Coastal Industrial Zone, facing the Sea of Kashimanada (Pacific Ocean). It straddles one city and two townships: the city of Kashima, which boasts Kashima Port, a transportation center that was constructed on Kashimanada Beach by digging into the virgin sands, and the towns of Kamisu and Hasaki. The industries located there include steel, petrochemicals, chemicals, foodstuffs, livestock feeds, electric power and machinery metals. Industrial wastewaters with public sewage, except steel industry, are treated by the Fukashiba Treatment Plant which is managed by the Ibaraki Prefectural Government. The financial management of KRSSW is analysed to show its stand-alone condition.

A multistage incremental sheet metal bulging machine using spherical and cylindrical rollers has been developed for vertical wall surface forming of rectangular shallow shells. The multistage incremental forming comprises three operations: bulging with a spherical roller, right-angle forming and flattening with cylindrical rollers. The hand-operated bulging machine formed a vertical wall surface, which is highly precise and preferred by designers. A method of calculating for the approximate distribution of thickness strain and the maximum bulging height of the rectangular panel was proposed using the deformation limit diagram obtained from the incremental bulging test with a ball roller and a geometrical plane-strain deformation model with a constant strain gradient. The predictions for the rectangular shell were reasonably in good agreement with experimental values for the annealed aluminum sheet.

A flexible and incremental sheet metal bulging machine using a path-controlled spherical roller performed a wide range of sheet metal shaping of complex shapes, e.g., pyramidal shells, shells of the frustum of a pyramid, shallow pans and embossed panels. The deformation analysis on the incremental forming of sheet metal becomes a very useful method for the planning of shell products, the choice of material, the design of the forming process and the planning of the non-traditional machine tool. In this article, firstly, an approximate deformation analysis for the bulging height, the strain distributions and the forming load of the shell is proposed, using a plane-strain deformation model and a forming-limit diagram. Secondly, the FEM based on the shell theory is applied to the calculation of the bulging height, the strain and the stress distributions and to an explanation of the plane-strain deformation, which is a unique phenomenon in incremental forming. The predictions by the approximate deformation analysis and the FEM analysis for the shell of the frustum of a quadrangular pyramid were in reasonably good agreement with experimental values for annealed aluminum sheet.

In cardiomyoplasty (CMP), the strength of a skeletal muscle increases as the stimulating voltage in creases. On the other hand, timing of stimulation in CMP is a problem not yet solved. This experiment assessed the relationship between stimulating voltage and time characteristics in the contraction of skeletal muscles. In acute experiments using rabbits, the time required to reach maximal muscle contraction did not change significantly with voltage. In conclusion, stimulation voltage does not affect time characteristics. Thus, the best timing of stimulation in CMP can be assessed independently of voltage.

Interaction of tetradecylpyridinium bromide with poly(vinylpyrrolidone) was studied by use of an electrode sensitive to the cationic surfactant. In a neutral medium, there was no sign of interaction: potentiometric titration response was in agreement with Nernst equation irrespective of absence and presence of the polymer. But in a medium with pH 11.3, deviation from Nernst response appeared in a PVP solution showing binding of the cationic surfactant onto the polymer which had been thought indifferent to cationic surfactants in spite of strong affinity to anionic surfactants. The result is interpreted in terms of deprotonation from PVP at higher pH media.

Recently, a, number of studies on the 3-D reconstruction of the ultrasound echography are described and published. 3-D Ultrasound echography, compared with other three dimensional medical images, e. g., MR(magnetic resonance)imaging, computed tomography(CT)and positron emission tomography(PET), is effective as an intraoperative use. However, the reconstruction requires computational power and that makes this study not applied to the sufficient clinical use. The authors developed a compact, mobile and less costly ultrasound computer reconstruction system for stereotactic neurosurgery. The system consists of sector probe(Aloka, 20mm in diameter)actuator for its rotation, ultrasound imaging system and personal computer for reconstruction. The probe is guided through a burr hole and automatically rotates in half circle and images gained among this movement are transferred to the personal computer. Then the computer reconstructs the four transverse images and displays on the extension monitor. With the us age of this system, the operator can obtain an ultrasound image on planes perpendicular to a trajectory; they are effective as an guidance for the surgical operation. Computational time scale is enough short(20 sec.)for the usage during the operation. The most attractive feature is that the cost is lower because the system needs only existing ultrasound imaging system and personal computer.

Sufficient data have now been generated to assess the influence of material, process, and tooling variables on the limiting drawing ratio, when deep drawing cylindrical cups from circular blanks. The influence of these parameters is less well understood in the deep drawing of nonaxisymmetric cups, and the data that exist have generally been collected from drawing tests. A theoretical approach is presented for predicting the limiting drawing ratio when deep drawing prismatic cups. For a given blank geometry, the drawing load is calculated to plastically deform the flange, overcome friction between the flange and the blank holder, and to bend the material over the die radius. Deformation in the cup wall is ignored. The onset of yielding in the flange is determined using a finite-element code. The calculated drawing load is compared to a theoretical maximum, and when the two values coincide, this yields the limiting blank size under the assumed processing conditions, i.e., blank holder force, die radius, blank shape, and coefficient of friction. The theoretical predictions were compared with experimental results when deep drawing square cups from optimum blank shapes, and the correspondence was found to be acceptable.

1986年1月から1991年12月までの6年間に当科で施行した真性大動脈瘤手術数は214例であり, うち15例 (7%) に重複大動脈瘤を認め, 9例に対し一期的手術を施行した. 補助手段は一時的バイパス4例, 遠心ポンプ4例, 部分体外循環1例で, 入院死および遠隔死を認めず経過は良好であった. 一過性の腎機能障害を一時的バイパス群に認め, 本症例の場合の補助手段としては, 至適灌流量が調節可能な遠心ポンプや部分体外循環が有効と考えられた. 一方, 二期的手術としての初回手術を6例に施行し, うち1例は二期的に他部位の手術を行った. 二期的手術としての初回手術を行い, 残存瘤を外来にて観察中の5例中1例に, 破裂によると思われる突然死を認めた. 重複大動脈瘤症例では全身的な血管病変の存在が予想されるが, risk factor や補助手段を考慮した上での一期的手術は十分可能であり, とくに胸部下行と胸腹部, 腹部などの合併の場合, 手術視野の点などからもほぼ安全に一期的手術が可能であり, 選択されうる術式と考えられる.

In recent years there has been an ever increasing amount of research and development of technologies and methods to improve the quality and the performance of advanced surgery. In several fields, such as laparoscopy, various training methods and metrics have been proposed, both to improve the surgeon's abilities and also to assess her/his skills. For neurosurgery, however, the extremely small movements and target operating space involved have prevented until now the development of similar methodologies and systems. In this paper we present the development of an ultra-miniaturized Inertial Measurement Unit (IMU) and its application for neurosurgery skill assessment in a simple pick and place scenario. This analysis is a preliminary yet fundamental step to realize a better training/evaluation system for neurosurgeons, and to objectively evaluate and understand how the neurosurgery is performed.

This paper describes the development and experimental results of a master manipulator for the Workspace-creation manipulator for minimally invasive surgery. The master manipulator was developed for the purpose of maximizing the doctor's facility for performing operations. Therefore, the master manipulator needs to be easy to use for the doctor. This master manipulator which was developed has three degrees of freedom to control the Workspace-creation manipulator that has eleven degrees of freedom. And the authors studied new operation system with image of MRI.

Radical resection of gliomas can increase patient's survival. There is known concern, however, that aggressive tumour removal can result in neurological morbidity. The objective of the present study was to evaluate the usefulness of low magnetic field strength (0.3 Tesla) open intraoperative magnetic resonance imaging (iMRI) for complete resection of glioma with emphasis on functional outcome.From 2000 to 2004, 96 patients with intracranial gliomas underwent tumour resection with the use of iMRI in Tokyo Women's Medical University. There were 50 men and 46 women; mean age was 39 years. Tumour volume varied from 1.2 ml to 198 ml (median: 36.5 mL). Resection rate and postoperative neurological status were compared between control group (46 cases, operated on during the initial period after installation of iMRI), and study group (50 most recent cases, in whom surgery was done using established treatment algorithm and improved image quality).Overall, mean resection rate was 93%, and medial residual tumour volume was 0.17 ml. Total tumour removal was achieved in 44 cases (46%). Compared to control group, resection rate in the study group was significantly higher (91%, vs. 95%; P0.05), whereas residual tumour volume was significantly smaller (1.7 mL vs. 0.025 mL; P0.001). Nine patients in the control group (20%) and 24 in the study group (48%) experienced temporary postoperative neurological deterioration (P0.01), however, the rate of permanent morbidity evaluated 3 months after surgery did not differ significantly between the groups investigated (13% vs. 14%).Use of iMRI during surgery for intracranial gliomas permits to attain aggressive tumour resection with good functional outcome. Nevertheless, surgical experience with the iMRI system, establishment of treatment algorithm, and improvement of image quality are of paramount importance for optimal results.

Minimally invasive surgery has recently become a key word in medical engineering. In this operation, to introduce surgical instruments, spatulas which push tissues aside and retain the approach path to the affected area as well as workspace for the insertion of such instruments are necessary. Therefore, a new type of hydraulically-driven flexible manipulator for neurosurgery has been developed. With an attached balloon and using only physiological saline for the drive system, safety of the brain tissue, especially in terms of pressure, is assured as is the simplicity of the mechanism. In addition, this provides the advantage of MRI compatibility. From the results of several evaluations, this manipulator has been proved effective as a new type of medical device.

A wearable multi-channel sensing unit was successfully developed as pre-evaluation or research tool for a healthcare system. Three-axis acceleration sensors were installed in the unit. Eight analogue signals for bio or environmental information and two serial signals through RS232C I/O ports for GPS could be recorded to a compact flash interface compatible removable memory (for example, IBM Microdrive/spl trade/, 1GB HDD). Size and weight of the unit were 207 cm/sup 3/ (W 9 cm, L 7.2 cm, H 3.2 cm) and 260 grams. Continuous ECG waveforms could be clearly recorded for more than 150 minutes using a lithium-ion battery (7.2 V, 2700 mAh).

The final goal of this study is to establish a method of measuring precisely the seismocardiogram (SCG) of a patient who lying in an open magnetic resonance imaging (openMRI) machine for myocardial ischemia monitoring during surgery. Vibration isolation from the gantry vibration during MRI scan is essential for clinical use. Authors previously reported the comparison between the SCG and the gantry vibration. A damper to decrease vibration below 30 Hz should be designed. In this paper, authors fabricated a damper model to check the feasibility of the damping effect, and compared with the patient bed mat. Experiment using a vibrator showed 1) the viscosity damping coefficient of the current damper was 2 kN s/m, 2) owing to the damper, peak ratio between input and output amplitude decreased from 2.5 to 1.2, and 3) natural frequency decreased from 12 Hz to 5 Hz. Damping below 30 Hz was successfully achieved. The maximum S/N ratio was calculated 6, improving from 1.8. Simulation showed that the maximum S/N would be 75 under the viscosity damping coefficient of 1 N s/m.

A CMOS signal processor capable of recognizing 95% of small vocabularies independent of the speaker will be reported. An analog preprocessor chip for feature extraction followed by a pipelined digital processor for template matching comprise the chip set.

The constant hard work of providing nursing care, including handling emergencies, often causes medical accidents in hospitals. We have prototyped a wearable auto-event-recording system for medical nursing in order to capture the events that cannot be overlooked in analyzing such accidents. Our system consists of wearable sensors that record the footsteps and the posture tilt of the nurse in addition to the voice. We conducted experiments, and the results show that, without disturbing nurses' work, our sensors can record data and reconstruct nursing histories, including the important events that cannot be overlooked for analyzing medical accidents. In this paper, we show the results of sensor data analysis comparing a nurse's data taken in AM hours with those in the PM hours in order to study the effect of her fatigue on her motion. Also, we discuss on the possibility of detecting the nurse's fatigue by using our sensor system.

Information-guided stereotaxis, assisted by visualization of medical information, will become the next generation of neurosurgical systems. We performed 76 open MRI surgeries at Tokyo Women's Medical University between March 3, 2000 and April 12, 2001. Of them, comparisons of pre- and post-operative MR images for malignant gliomas in 21 cases revealed an average resection rate of 90.3% (the maximum 100%, the minimum 55%). In this article we describe real time updated navigation, augmented reality navigation, three-dimensional navigation, chemical navigation, information-guided navigation system (High definition visual Computer Aided Surgery System: HivisCAS), and open MRI-guided surgery that we are developing.

Leukocytes are important in the occurrence of reperfusion injury in coronary intervention for acute myocardial infarction (AMI). This study compared reperfusion injury caused by reperfusion using leukocyte-depleted blood (LD) and that by conventional angioplasty (control) through the reperfusion phenomenon including reperfusion arrhythmia and additional ST elevation during direct percutaneous transluminal coronary angioplasty (PTCA) in 41 patients with 21 left anterior descending artery (LAD) lesions and 20 right coronary artery (RCA) lesions. LD was prepared from 20 ml of venous blood, 20 ml of mixed blood and 60 ml of arterial blood from the patients (LD group; LAD-LD: n = 10, RCA-LD: n = 10) which was passed through a leukocyte removal filter. The blood was injected from the tip of the balloon catheter at 10 ml/min during inflation for 10 min before balloon deflation. The control group (LAD-control: n = 11, RCA-control: n = 10) underwent conventional angioplasty. The appearance of reperfusion arrhythmia [atrioventricular block (AVB)II, accelerated idioventricular rhythm (AIVR), ventricular tachycardia (VT), ventricular fibrillation (Vf)] and measurements of STmax deviation before and after reperfusion, the differences of the STmax deviation (delta ST) and additional ST elevation (LAD:or = 0.5 mV increase of sigma ST in lead V1-V6, RCA:or = 0.3 mV increase of sigma ST in lead II, III and aVF) were studied. The appearance of reperfusion arrhythmias was as follows; LAD-LD: AVB 0, AIVR 1, VT 1, Vf 0, LAD-control: AVB 0, AIVR 4, VT 2, Vf 1, NS, and RCA-LD: AVB 0, AIVR 0, VT 0, Vf 0, RCA-control: AVB 2, AIVR 0, VT 1, Vf 0, NS. There was no reperfusion arrhythmia in the RCA-LD group. There was no significant difference in the appearance of reperfusion arrhythmias between the LAD-LD and LAD-control or RCA-LD and RCA-control groups. Before reperfusion the STmax deviation (mV) was LAD-LD 0.86 +/- 0.46 vs LAD-control 0.74 +/- 0.49 and RCA-LD 0.29 +/- 0.18 vs RCA-control 0.15 +/- 0.09 and after reperfusion LAD-LD 0.63 +/- 0.35 vs LAD-control 0.81 +/- 0.49 and RCA-LD 0.13 +/- 0.15 vs RCA-control 0.20 +/- 0.12, respectively. There were no significant differences between LAD-LD and LAD-control or RCA-LD and RCA-control groups. delta ST (mV) was LAD-LD 0.23 +/- 0.56 vs LAD-control 0.07 +/- 0.60, p = 0.09 and RCA-LD 0.16 +/- 0.12 vs RCA-control 0.06 +/- 0.14, p = 0.002, respectively. The number of patients with additional ST elevation soon after reperfusion was LAD-LD 3 vs LAD-control 10, p0.05 and RCA-LD 0 vs RCA-control 8, p0.001, respectively.

Effective clinical therapy to augment intestinal absorption of water and electrolytes does not exist; the gut hormone, peptide YY (PYY), is a potent proabsorptive agent in animal models. The purpose of our study was to evaluate the effects of two novel PYY analogs, BIM-43073D and BIM-43004C, on intestinal absorption. Dogs with ileal Thiry-Vella fistulae (TVF) were treated with either PYY, BIM-43073D, or BIM-43004C. Administration of BIM-43073D significantly increased water and sodium absorption over baseline and maintained this level of increased absorption for a longer duration than an equimolar dose of PYY. Administration of BIM-43004C significantly increased sodium and water absorption over baseline at a level equal to that of PYY. The novel PYY analogs, BIM-43073D and BIM-43004C, are effective proabsorptive agents with BIM-43073D producing more sustained effects than PYY. These compounds may be clinically useful in the treatment of gut malabsorption in conditions such as cholera, Crohn's disease, and the short-bowel syndrome.

Patients with laterocollis or rotatory type torticollis tend to show abnormal contraction of the levator scapulae muscle and the scalene muscles. These muscles are innervated from the anterior branches of the cervical spinal nerves. Because of this, the traditional Bertrand operation dealing with posterior branches does not adequately affect the symptoms of laterocollis. The authors report selective denervation of the levator scapulae muscle in three patients and discuss its rationale. All the three patients underwent denervation of both the C1-C6 posterior spinal rami and the branches from the C3 and C4 anterior rami to the levator scapulae muscle. We added myotomy of the scalene muscle in one patient, and denervation of the omohyoid muscle which is innervated from the ansa cervicalis and the descending branch of the hypoglossal nerve. The pre/post-operative Tsui scores were 12/4, 15/1, and 14/3 respectively. There were no complications. We conclude that selective peripheral denervation of the levator scapulae muscle is safe and effective in the treatment of laterocollic type torticollis.

The photon radiosurgery system is a miniature X-ray generator that can be placed stereotactically and intraoperatively into intracranial tumors to deliver a single fraction of high-dose interstitial irradiation. This battery-powered device produces low energy X-ray photons in a spherical and symmetrical pattern at the probe tip. Dose rates of up to 200 cGy/Mim are possible, allowing for the administration of 15 Gy to a lesion 3 cm in diameter in less than 1 hr. Background exposure is minimal, and no special shielding of the patient or health care personnel is required. Thirty-nine patients with brain tumor were treated in this method. There were no adverse effects. During the follow-up period of 1-30 months, 3 cases with 5 metastatic brain tumors died about 8 months after this treatment. Five recurrent cases of 21 malignant gliomas died about 4 months after treatment. Interstitial radiotherapy using photon the radiosurgery system promises to be a useful treatment for brain tumors.

The authors evaluated the results of selective peripheral denervation (SPD) of posterior rami of the cervical spinal nerves and/or the accessory nerve for spasmodic torticollis. Five patients underwent seven operations in total and the results were evaluated with the modified Tsui's score which was used in the clinical trial of botulinum toxin (BTX) for torticollis in Japan. The preoperative score was 10.8 +/- 2.2 (mean +/- S.D.) and the postoperative score was 1.4 +/- 1.7. The score changes indicated the effects of the operation as "excellent" in four cases and "good" in one case. These results indicate that SPD is superior to BTX in terms of control of symptoms in spasmodic torticollis. After the initial operation, however, two patients showed the so-called "mole-hitting game phenomenon" in which normal muscles develop abnormal contraction after denervation of abnormal muscles. This forced us to perform the second operations. Although this phenomenon was first described in botulinum toxin treatment, this is probably the first report in surgically denervated cases.

We have developed an overlaid three-dimensional image (Volumegraph)-guided navigation system that allows navigation during operative procedures. The three-dimensional image is superimposed on the patient's head and body via a semi-transparent mirror. The Volumegraph can display three-dimensional images in the air by a light beam which is based on CT/MRI.The system consists of a Volumegraph (thin plate of three-dimensional recorded medium), a Volumegraphscope and an original designed triangular-shaped marker system for registration. The three-dimensional data obtained from CT and MRI before the operation were processed by a computer. Such image data are applied for preoperative investigation to recognize the three-dimensional structure of organs and tumor. These reconstructed three-dimensional images were superimposed and registered at the patient's head according to a fiducial marker (registration). Then the operator can operate with this three-dimensional-image-guided navigation system.Based on clinical application in 7 cases, the system was found to be advantageous because the surgical procedures could be navigated easily by augmented reality in the surgical field. Invisible parts of the surgical field were supplemented with the overlaid three-dimensional images (Volumegraph) as if it were the virtual operative field. At another time, spatial positioning and overlaid visualization by the Volumegraph was useful for identifying anatomical structures and functional location in the image.This preliminary study of overlaid three-dimensional-image-guided navigation demonstrated its clinical usefulness. The application of augmented reality in the surgical field makes it possible to do a neurosurgical intervention easily and accurately.

The superior septal approach (SSA) for mitral valve surgery is a useful approach, but it may bring about demage to sinus node function or an atrial electrical vulnerable condition because the sinus node artery is divided and a large portion of both atria is incised. From April 1992 to December 1994, we used this approach in 17 patients. There was no hospital death and none had perioperative complications associated with the approach. All nine patients in sinus rhythm preoperatively returned to sinus rhythm before discharge from the hospital and remained so at late follow-up. Five of 9 patients with sinus rhythm had electrophysiological examination preoperatively and all 9 patients had the examination postoperatively. Atrial vulnerability was not deteriorated after the operation in all cases. Under pharmacologic autonomic blockade, sinoatrial conduction time (SACT), sinus node recovery time (SNRT) after overdrive atrial pacing, and corrected SNRT were 73 +/- 35 msec, 1142 +/- 168 msec, and 365 +/- 122 msec, respectively. All these values were with in normal range and these were no significant differences between before and after the operation. All patients with sinus rhythm had 3 minutes of Bruce stage 1 exercise 9 months after the operation. The heart rate response to the exercise was as good as in healthy control people. In conclusion, as far as the midterm postoperative period, the effect of SSA on sinus node function and atrial vulnerability was acceptable.

We examined whether lymphatic metastasis was inhibited by the potent angiogenesis inhibitor AGM-1470 [O-(chloroacetyl-carbamoyl)fumagillol, TNP-470] using a rat lymphatic metastasis model. Clone A of the rat fibrosarcoma AS653HM, when inoculated into the footpads of syngeneic rats, highly and preferentially metastasized to lymph nodes. In contrast, when AGM-1470 was administered subcutaneously to rats bearing the tumor cells, the tumor growth and incidence of metastasis in the lymph nodes were reduced in a dose- and schedule-dependent manner. Similar inhibition of lymphatic metastasis was also observed in the rats in which treatment with AGM-1470 was initiated following resection of the primary tumor in the foot, indicating that the treatment with AGM-1470 inhibited the progression of lymphatic metastasis at the metastatic sites of the lymph nodes. These results suggest that AGM-1470 can be a potential agent to prevent lymphatic metastasis.

Extraaortic counterpulsation using skeletal muscle powered ventricles (SMPVs) has been studied mainly for the purpose of assisting the systemic circulation. The purpose of this study was to investigate the possibility of assisting both the systemic and pulmonary circulations using a single SMPV. An SMPV that counterpulses the systemic circulation is placed beside the right atrium (RA) or the right ventricle (RV), the former after procedures such as a Fontan operation, and the latter in cases of biventricular failure. Because the SMPV dilates passively during cardiac systole, it is designed to press the RA or the RV directly from outside. This study is a preliminary report, and only the ability of a specially constructed SMPV to dilate was assessed. Using seven dogs with heart failure, the SMPV dilated with an internal pressure of 88 mmHg and 1.0 cm, while the volume inside increased by 10.8 ml. From these results, it is suggested that the SMPV has enough dilating power to press the RA or to assist the RV while counterpulsing the systemic circulation.

We investigated the short-term effects of an intrathecal bolus injection of baclofen on central pain due to stroke or spinal cord injury. Pain relief was obtained in 64% of the patients. The effects developed 1-2 hours after the injection and continued for 10-24 hours. Both spinal segmental and supraspinal mechanisms may be involved in the production of baclofen-analgesia.

The extension of the left ventricular outflow tract is provoked by a partial atrioventricular canal, and is easy to cause stenosis after a radical operation and/or a replacement of the left atrioventricular valve because of its anatomical structure. This report shows a case of a partial atrioventricular canal with a discrete subvalvular aortic stenosis which was worsened three years after the replacement of mitral valve. In this case the left ventricular outflow tract obstruction (LVOTO) had been found before the replacement of mitral valve but it was kept observing without surgical treatment because the degree was judged slight. Subvalvular aortic stenosis was worsened three years after the replacement. It was suspected that the stenosis developed because of the proliferation of heterologous tissue by a turbulent flow of a site of stenosis. For this diagnosis, the transesophageal echocardiography was very effective, and in this case the cause of LVOTO is uncertain, so a careful observation is necessary for it.

2069 Background: Autologous formalin-fixed tumor vaccine (AFTV) has been shown to have a potential role in effective adjuvant therapy for hepatocellular carcinoma and recurrent malignant glioma. We...

We have used an alternative technique in Total Cavopulmonary Connection without using any prosthetic material. The technique is a modification of Senning operation in which a flap of right atrial wall is used to create a tunnel between inferior vena cava and superior vena cava. We used this modified technique in two cases, and they showed excellent postoperative convalescence.

Rostral mesencephalic reticulotomy (RMR) for pain relief was performed in 34 patients with intractable pain. Most of these patients have been followed for a long period of time postoperatively, the longest follow-up period being 11 years. Contrary to the commonly prevailed bias in the past that mesencephalotomy may be a surgical intervention with potential risk, these patients of RMR have continued to substantial improvement postoperatively in terms of their preoperative intractable painful dysesthesia after a long period of time. The results of pain relief for denervation pain as well as for nondenervation pain are surprisingly good even after unilateral procedures. There was no operative mortality. Postoperative disturbance of ocular motility has been reduced. RMR has its scientific basis in that the medial part of the reticular formation rather than the classical lateral spinothalamic tract has more significance in the central conduction of nociceptive impulses through the midbrain level, which was verified by intraoperative neuronal recording with a tungsten microelectrode. The present report emphasizes that stereotactic mesencephalotomy, if performed meticulously and precisely, is a safe surgical procedure for pain relief. Results of MRI and sensory manifestations of a patient 11 years after RMR are also presented.

Seven patients with brain abscess underwent CT-guided stereotactic aspiration using Iseki's stereotactic apparatus. Three of them were under the age of fifteen and four were older than thirty. The lesions were single and round in four cases, multilobular in two and multiple in one patient. Operations were performed after systemic administration of antibiotics for more than two weeks and after capsule formation was confirmed on CTs. Preoperative volume of the abscesses was estimated from CTs. The target point chosen was the center of the ring of the largest diameter in the enhanced lesion. Abscess was aspirated under monitoring with intraoperative CT scan. No continuous drainage was performed and no antibiotics were given directly into the abscess cavity. In all cases the center of the abscess was punctured with a single trial. Average volume of the preoperative brain abscesses was 18.8ml. Aspirated volume at the time of the operation averaged 16.9ml and all the abscesses decreased to unmeasurable size on CTs. In five of seven patients abscesses were cured after a single aspiration, and in one case after the second operation. One case required extirpation of the lesion. During the follow-up period of four months to five and a half years six patients showed no recurrence. One patient died of unrelated cause four and a half years after the operation. No operative complication was noted. There was no operative morbidity or mortality. Using a CT guided stereotactic method, brain abscess is punctured so accurately, regardless of its location and size, that damage to the surrounding brain during operation can be minimized. Therefore it is highly possible to aspirate abscesses completely.(ABSTRACT TRUNCATED AT 250 WORDS)

One of disadvantages of conventional stereotactic operation for intracranial mass lesions is that it is basically a blind procedure even if the operation is performed in a gantry of a CT scan. High resolution ultrasound image gives real-time information on intracranial pathology such as bleeding, remaining cyst fluid or haematoma. The authors report an ultrasound guided stereotactic apparatus which gives real-time images of the lesion during operation.

The present report is concerned with the results of bilateral percutaneous high cervical cordotomy (60 patients) compared with those of unilateral cordotomy (161 patients). The result of pain relief is classified into 4 grades based on Hitchcock's criteria; grade 1: complete pain relief, grade 2: almost complete pain relief with slight residual pain, grade 3: persisting pain, but tolerable, grade 4: persisting pain, untolerable. In cases of bilateral cordotomy (60 patients), 76% of the cases showed grade 1, 19% being grade 2, 3% being grade 3 and 2% being grade 4. On the contrary, the unilateral cordotomy (161 patients) showed less impressive results, particularly in grade 1, namely, grade 1 being 64%, grade 2 being 18%, grade 3 being 14% and grade 4 being 4%. Clinically acceptable results (grade 1 plus grade 2) were, therefore, obtained in bilateral cordotomy (95%) as compared with unilateral cordotomy (82%). The difference in pain relief between bilateral and unilateral procedure observed in the present investigation is contrary to that reported previously by others. The possible explanation for less impressive result in regard to grade 1 of unilateral cordotomy is that unilateral cordotomy was performed in this series to alleviate the major side of patient's pain, followed by latent pain on the other side postoperatively, which is not uncommon phenomenon in cancer pain. Whereas all of the bilateral cordotomies were done either for midline pain or bilateral pain, unilateral cordotomy gave satisfactory pain relief in some cases of midline pain. Midline pain, therefore, does not necessarily require bilateral cordotomies from a clinical point of view.(ABSTRACT TRUNCATED AT 250 WORDS)

One of disadvantages of conventional stereotactic operation for intracranial mass lesions is that it is basically a blind procedure even if the operation is performed in a gantry of a CT scan. High resolution ultrasound image gives real-time information on intracranial pathology such as bleeding, remaining cyst fluid or haematoma. The authors report an ultrasound guided stereotactic apparatus which gives real-time images of the lesion during operation.

Late results in 139 patients undergoing open repair of tetralogy of Fallot from 1965 to December 1975 were analyzed. Their ages ranged from 1 year to 35 years. All patients were repaired through a right ventricular approach. One hundred two patients had infundibulectomy alone (non-patch group) and 14 required right ventricular outflow patch (RV-patch group) and 23 trans-annular patch. The hospital mortality rate was 18.7% (26 cases) and 103 patients were discharged and have been followed until death or for 13-24 years. Cardiac catheterizations were performed in 80 patients an average of 1.8 years after correction. Right ventricular systolic pressure was 49.8 +/- 22.4 mmHg in non-patch group, 41 +/- 16.5 mmHg in RV-patch group and 54.5 +/- 14.2 mmHg in PA-patch group. Seven in 11 patients of PA-patch group had over an 8 mmHg of right ventricular end diastolic pressure. Six patients died during the follow up: four deaths in the first 5 years, 2 between 5 and 15 years. The causes of death were congestive heart failure (3), sudden (1), pneumonia (1) and accidental (1). Late complications were 3 arrhythmias and 2 reoperations. Event free rate at 24 years was 74.8 +/- 3.8%.

A 55-year-old man who had both aortic root aneurysm with severe aortic regurgitation and enlarging abdominal aortic aneurysm was admitted to our hospital. We employed the combined composite valve graft replacement of the aortic root and Y-graft replacement of the infrarenal abdominal aorta at one stage operation. At the operation, median sternotomy was made and the composite graft replacement of the aortic root was performed under cardiopulmonary bypass prior to the abdominal procedure. After cardiopulmonary bypass was removed, abdominal incision was made. Although ventricular arrhythmias and mild hypotension transiently occurred when the abdominal aorta was clamped, the Y-graft replacement was also completed uneventfully, and no complication occurred postoperatively. We conclude that the combined operation of the aortic root and the abdominal aorta is clinically feasible in certain situation.