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[Objective]Patients with coronary artery disease (CAD) often have prior stroke or concomitant extra-cardiac vascular disease (EVD) such as cerebral, aortic, or peripheral vascular disease. However, clinical outcomes after coronary revascularization in patients with polyvascular disease have not been fully elucidated. [Methods]Among 15, 263 patients undergoing first coronary revascularization enrolled in the CREDO-Kyoto registry Cohort-2 from January 2005 to December 2007, there were 1443 patients with prior stroke (stroke + CAD group), 974 patients with EVD (EVD + CAD group), 253 patients with both prior stroke and EVD (stroke/EVD/CAD group) and 12, 593 patients with neither prior stroke nor EVD (CAD alone group [reference]). [Results]The cumulative incidence of major adverse cardiovascular events (MACE: composite of cardiovascular death, myocardial infarction and stroke) through 3 years was significantly higher in patients with polyvascular disease compared with reference patients (19.9% in the stroke + CAD group, 18.5% in the EVD + CAD group, 20.1% in the stroke/EVD/CAD group, and 11.2% in the CAD alone group, P < 0.0001). After adjusting confounders, the presence of EVD and/or stroke was independently associated with higher risk for MACE compared with the reference group (adjusted HR [95%CI]: 1.34 [1.17–1.54], P < 0.0001 in the stroke + CAD group, 1.56 [1.32–1.84], P < 0.0001 in the EVD + CAD group, and 1.66 [1.24–2.23], P = 0.0007 in the stroke/EVD/CAD group). However, the presence of EVD and/or stroke was not associated with higher risk for myocardial infarction. [Conclusions]Clinical outcome after coronary revascularization was worse in patients with prior stroke and/or EVD, which was mainly driven by the increased risk for non-coronary cardiovascular events.

Summary Reconstruction following pharyngolaryngectomy with total esophagectomy is a challenging surgery to perform. Between April 2008 and August 2012, three types of modified gastric pull-up reconstruction procedures, including a gastric tube creation combined with a free jejunal transfer (n = 7), elongated gastric tube creation with vascular anastomoses (n = 2) and pedunculated gastric tube creation with Roux-en-Y anastomosis (n = 5), were performed after pharyngolaryngectomy with total esophagectomy. To clarify feasibility of these reconstructive methods, we retrospectively analyzed the short-term outcomes. There were no graft failures. Salivary fistulae were observed in two cases after high pharyngoenteral anastomoses due to oropharyngeal extension of hypopharyngeal cancers. Overall morbidity rate was 21.4%, and no deaths occurred. Although the operation time was shortest for pedunculated gastric tube reconstructions, morbidity rates were similar among all methods. All three types of modified gastric pull-up reconstruction procedures can be performed safely. We can choose one of these methods according to the tumor status and the patient condition, understanding advantages and disadvantages of each procedure.

Much attention is currently focused on the role of perivascular adipose tissue in development of cardiovascular disease (CVD). Some researchers view it as promoting CVD through secretion of cytokines and growth factors called adipokines, while recent reports reveal that perivascular adipose tissue can exert a protective effect on CVD development. Furthermore, adiponectin, an anti-inflammatory adipokine, reportedly suppresses neointimal hyperplasia after endovascular injury, whereas such vascular remodeling is enhanced by pro-inflammatory adipokines secreted by perivascular adipose, such as tumor necrosis factor-α (TNF-α). These findings suggest that extent of vascular remodeling, a pathological process associated with CVD development, depends on the balance between pro- and anti-inflammatory adipokines secreted from perivascular adipose tissue. We previously demonstrated that angiopoietin-like protein 2 (Angptl2), a pro-inflammatory factor secreted by adipose tissue, promotes adipose tissue inflammation and subsequent systemic insulin resistance in obesity. Here, we examined whether Angptl2 secreted by perivascular adipose tissue contributes to vascular remodeling after endovascular injury in studies of transgenic mice expressing Angptl2 in adipose tissue (aP2-Angptl2 transgenic mice) and Angptl2 knockout mice (Angptl2(-/-) mice). To assess the role of Angptl2 secreted by perivascular adipose tissue on vascular remodeling after endovascular injury, we performed adipose tissue transplantation experiments using these mice. Wild-type mice with perivascular adipose tissue derived from aP2-Angptl2 mice exhibited accelerated neointimal hyperplasia after endovascular injury compared to wild-type mice transplanted with wild-type tissue. Conversely, vascular inflammation and neointimal hyperplasia after endovascular injury were significantly attenuated in wild-type mice transplanted with Angptl2(-/-) mouse-derived perivascular adipose tissue compared to wild-type mice transplanted with wild-type tissue. RT-PCR analysis revealed that mouse Angptl2 expression in perivascular adipose tissue was significantly increased by aging, hypercholesterolemia, and endovascular injury, all risk factors for coronary heart disease (CHD). Immunohistochemical and RT-PCR analysis of tissues from patients with CHD and from non-CHD patients indicated that ANGPTL2 expression in epicardial adipose tissue was unchanged. Interestingly, that analysis also revealed a positive correlation in ANGPTL2 and ADIPONECTIN expression in epicardial adipose tissue of non-CHD patients, a correlation not seen in CHD patients. However, in epicardial adipose tissue from CHD patients, ANGPTL2 expression was positively correlated with that of TNF-α, a correlation was not seen in non-CHD patients. These findings suggest that pro-inflammatory adipokines cooperatively accelerate CHD development and that maintaining a balance between pro- and anti-inflammatory adipokines likely protects non-CHD patients from developing CHD. Overall, our studies demonstrate that perivascular adipose tissue-secreted Angptl2 accelerates vascular inflammation and the subsequent CVD development.

The damage to the intervalvular fibrous trigone (IVFT) by infective endocarditis makes combined aortic and mitral valve replacement difficult. We performed Manouguian's double valve replacement for such a case and obtained a good result. A 81-year-old male underwent emergency operation due to active prosthetic valve endocarditis. He had a history of receiving combined aortic and mitral valve replacement because of active infective endocarditis at the age of 74 and redo aortic valve replacement 3 years after that. The infectious lesion extended from the mitral annulus to the IVFT and the aortic annulus, and it caused the prosthetic valve detachment from the aortic annulus. Manouguian's double valve replacement was required for radical resection and reconstruction of the IVFT. No recurrent infection or paravalvular leakage was observed during 49months follow up period. Manouguian's procedure is useful for complete resection of the infected IVFT and makes combined aortic and mitral valve replacement safer.

左冠動脈主幹部にステントが留置された重度大動脈弁不全症に対し，生体弁による弁置換術を施行した症例を経験したので報告する．症例は76歳男性で，心不全症状にて当院入院となった．術前検査にて，重度大動脈弁閉鎖不全症と，左冠動脈口より大動脈内へ飛び出すようにステントが留置されていることがわかった．逆行性心筋保護法にて心停止を得た．ステントの位置を十分に観察し，人工弁を傷つけないように留置した．術後の経過は良好であり，術後心エコーでも，弁機能は良好であった．

We herein report a rare case of an intravascular papillary endothelial hyperplasia in an aneurysm of the superficial temporal artery. The patient was a 67-year-old Japanese female. She noticed a throbbing swelling in her left forehead, which had gradually been increasing in size. She had no previous history of head trauma. The ultrasound and three-dimensional computed tomography angiography revealed an aneurysm with a mural thrombus measuring 10mm in diameter fed by the frontal branch of the left superficial temporal artery. The aneurysm of the superficial temporal artery was dissected from the surrounding tissues, and was resected after ligation of feeding vessels. A microscopic examination revealed papillary endothelial hyperplasia in a true aneurysm. Non-traumatic aneurysms of the superficial temporal artery are quite rare. In the previous English literature, there have only been a few reports of papillary endothelial hyperplasia in an artery, and none in an aneurysm of the superficial temporal artery.

Nifedipine, an L-type calcium (Ca) channel blocker, is one of the most widely used Ca channel-blocking medications for hypertension. Previous studies have reported an association of nifedipine hypertensive treatment with decreased body weight in obese hypertensive humans and rat models. However, the precise mechanism underlying how nifedipine functions metabolically has not been elucidated. Here, we investigated the long-term effect of a non-hypotensive nifedipine dose using a mildly obese, endothelial NO synthase-deficient mouse model. Treating these mice with nifedipine decreased their body weight gain ratio, and white adipose tissue weight compared with the untreated controls. Metabolic analyses indicated that nifedipine treatment upregulated whole-body energy expenditure through increasing oxygen consumption and reducing the respiratory exchange ratio, suggesting that nifedipine promotes lipid oxidation rather than carbohydrate utilization. Furthermore, nifedipine treatment upregulated the expression of the peroxisome proliferator-activated receptor-γ coactivator -1α (PGC-1α) in skeletal muscle. Overall, these results suggest that a non-hypotensive dose of nifedipine has pleiotropic effects on energy expenditure that could ameliorate obesity.

Foxo1, a member of the Foxo subfamily of forkhead box transcription factors, is known to be essential for progression of normal vascular development in the mouse embryos. In the cultures of endothelial cells derived from embryonic stem cells, Foxo1-deficient endothelial cells exhibit an abnormal morphological response to vascular endothelial growth factor-A (VEGF-A), which is characterized by a lack of cell elongation, yet the molecular mechanisms governing endothelial cell morphology under angiogenic stimulation remain unknown. Here, we report that transforming growth actor-beta also induces endothelial cell elongation in collaboration with Foxo1 and VEGF-A. Furthermore, tetracycline-regulated induction of Foxo3, another member of the Foxo subfamily, into Foxo1-null endothelial cells failed to restore abnormal morphological response to VEGF-A at an early differentiation stage. In contrast, Foxo1 and Foxo3 exerted the same function at a late differentiation stage, i.e. enhancement of VEGF responsiveness and promotion of cell elongation. Our results provide evidence that endothelial cell morphology is regulated by several mechanisms in which Foxo1 and Foxo3 express distinct functional properties depending on differentiation stages.

敗血症性肺塞栓は稀な疾患であり，胸部レントゲン像も非特異的で診断が遅れることが多い．今回われわれは，ペースメーカー感染から敗血症性肺塞栓を発症し，術前より長期挿管を要した症例を経験したので報告する．症例は76歳，女性．1年前に完全房室ブロックによりペースメーカー植込み術を受けていた．前医にて感染性腸炎の診断で治療を受けていたが，敗血症性ショックとDICを発症したため当院紹介となった．入院後の血液培養および右前胸部ペースメーカー植込み部の穿刺液培養からはMRSAが検出され，心エコーでは三尖弁位に尤腫が認められた．入院直後から徐々に呼吸状態が悪化し，胸部CTで末梢優位の空洞形成を伴う結節影が認められた．敗血症性肺塞栓による呼吸不全と診断し，人工呼吸管理と併行して抗菌薬投与による感染制御とDICの改善を図った．挿管から23日目にペースメーカー抜去，三尖弁後尖切除・形成術，心外膜リード式ペースメーカー植込み術を施行した．術後は気管切開と16日間に及ぶ人工呼吸管理を要したが，その他の合併症なく術後48日目に退院した．呼吸不全を伴うペースメーカー感染においては，敗血症性肺塞栓の鑑別と術前管理が重要と思われた．

The overall purpose of circulatory assistance utilizing skeletal muscle is the most efficient application of muscle power. From the histological viewpoint, hot-knife dissection of the latissimus dorsi muscle (LDM) is presented to preserve muscle tissue. The shaw hemostatic scalpel could be used similarly to standard surgical blades, and its hemostatic performance was efficient in sealing collateral vessels from the thoracic wall. Muscular and nervous twitching was never observed throughout dissecting the LDM. Histological findings revealed that muscle fibers could be preserved by hot-knife dissection rather than by electrocautery. This technique may reduce the inconvenience of the operators, and, therefore, shorten the operation time in dynamic cardiomyoplasty and other experiments.

Bacterial endopthalmitis is associated with risk for poor visual prognosis, however, it is rarely combined with infective endocarditis. A 66-year-old man underwent pacemaker implantation and received antibiotic therapy due to persistent fever. A month after the pacemaker implantation, he was admitted to our hospital because of disturbance of vision and consciousness. Disseminated intravascular coagulation (DIC) with decrease of platelet count was also present. His eyes were reddish and swelled, and the conjunctiva were turbid and edematous in both sides. Transesophageal echocardiography demonstrated 18×13mm pendulous verruca originating from the tricuspid annulus. The patient underwent concomitant resection and repair of the tricuspid valve and removal of both infected eyes after DIC treatment. The postoperative course was uneventful and he was discharged from the hospital 43 days after the operation. We conclude that careful observation of the eyes may be needed for patients with infective endocarditis when they have some visual symptoms., 細菌性眼内炎は予後不良で失明にいたることが多いが,感染性心内膜炎と眼内炎の合併は希であり文献的にも報告は少ない.今回われわれは,眼内炎と三尖弁位感染性心内膜炎を合併した症例を経験したので報告する.症例は66歳,男性.Adams-Stokes発作を伴う完全房室ブロックの診断でペースメーカー植込み術を受けたあと,発熱のため再入院し抗菌薬を投与されていた.植込み術1カ月後に視力障害,意識障害,血小板数低下を認めたため当院紹介となった. 入院時に両眼周囲発赤・腫脹と著明な結膜浮腫を認め,経食道心エコーでは三尖弁輪部に18×13mmの可動性に富むvegetationを認めた.DIC 治療後にペースメーカー抜去,三尖弁後尖切除・形成術と同時に両側眼球摘出術を施行した.ペースメーカーは心外膜リード式とした.経過は良好で術後43日目に退院した.感染性心内膜炎は失明の危険が高い細菌性眼内炎を合併することがあり,治療経過中の眼症状出現に注意する必要があると思われた.

Methylated DNA binding domain (MBD) proteins and Polycomb group (PcG) proteins maintain epigenetic silencing of transcriptional activity. We report that the DNA methylation-mediated repressor MBD1 interacts with Ring1b and hPc2, the major components of Polycomb repressive complex 1. The cysteine-rich CXXC domains of MBD1 bound to Ring1b and the chromodomain of hPc2. Chromatin immunoprecipitation analysis revealed that MBD1 and hPc2 were present in silenced Homeobox A (HOXA) genes which could be reactivated by knockdown of either MBD1 or hPc2, suggesting that MBD1 and hPc2 cooperate for transcriptional repression of HOXA genes. In the nuclei of HeLa cells, MBD1 existed in close association with these PcG proteins in some heterochromatin foci, whereas an MBD1 mutant lacking the CXXC domains or an hPc2 mutant lacking the chromodomain lost this colocalization in foci. Use of the DNA demethylating agent 5-azadeoxycytidine abolished the formation of MBD1 foci but not PcG foci. Knockdown of MBD1 by small interfering RNAs did not affect the foci containing hPc2 and Ring1b, whereas the MBD1 foci were not influenced by knockdown of hPc2. These indicate that the heterochromatin foci showing MBD1 and hPc2 colocalization arise through the interaction of MBD1 and hPc2 and that the foci of MBD1 are separable from those of the PcG proteins per se. Our present findings suggest that MBD1 and PcG proteins have overlapping roles in epigenetic gene silencing and heterochromatin foci formation through their interactions.

To clarify the role of macrophage class A scavenger receptors (SR-A, CD204) in oxidative lung injury, we examined lung tissue of SR-A deficient (SR-A(-/-)) and wild-type (SR-A(+/+)) mice in response to hyperoxic treatment. Protein levels of bronchoalveolar lavage fluid (BALF) and pulmonary oedema (wet : dry weight ratios) were higher in SR-A(-/-) mice than those in SR-A(+/+) mice. Cumulative survival was significantly decreased in SR-A(-/-) mice. However, there were no differences in BALF macrophage and neutrophil count between the two groups. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) revealed that messenger RNA (mRNA) levels of the inducible nitric oxide synthase (iNOS) were increased during hyperoxic injury, and this increase was more prominent in SR-A(-/-) mice. Expression levels of iNOS in alveolar macrophages after hyperoxia in vivo and in vitro were higher in SR-A(-/-) macrophages compared with SR-A(+/+) macrophages. Immunohistochemistry using anti-nitrotyrosine antibodies revealed distinctive oxidative stress in the injured lung in both groups, but it was more remarkable in the SR-A(-/-) mice. After hyperoxic treatment, pulmonary mRNA levels of tumour necrosis factor-alpha(TNF-alpha) were elevated more rapidly in SR-A(-/-) mice than in SR-A(+/+) mice. Together these results suggest that SR-A expression attenuates hyperoxia-induced lung injury by reducing macrophage activation.

Background Adjunctive thrombus aspiration ( TA ) during primary percutaneous coronary intervention ( PCI ) was reported to promote better coronary and myocardial reperfusion. However, long‐term mortality benefit of TA remains controversial. The objective of this study is to investigate the clinical impact of TA on long‐term clinical outcomes in patients with ST ‐segment elevation myocardial infarction (STEMI) undergoing primary PCI . Methods and Results The CREDO ‐Kyoto AMI Registry is a large‐scale cohort study of acute myocardial infarction patients undergoing coronary revascularization in 2005–2007 at 26 hospitals in Japan. Among 5429 patients enrolled in the registry, the current study population consisted of 3536 patients who arrived at the hospital within 12 hours after the symptom onset and underwent primary PCI . Clinical outcomes were compared between the 2 patient groups with or without TA . During primary PCI procedures, 2239 out of 3536 (63%) patients underwent TA ( TA group). The cumulative 5‐year incidence of all‐cause death was significantly lower in the TA group than in the non‐ TA group (18.5% versus 23.9%, log‐rank P TA group was not significantly lower than that in the non‐ TA group (hazard ratio: 0.90, 95% CI : 0.76 to 1.06, P =0.21). The adjusted risks for cardiac death, myocardial infarction, stroke, and target‐lesion revascularization were also not significantly different between the 2 groups. Conclusions Adjunctive TA during primary PCI was not associated with better 5‐year mortality in STEMI patients.

Sox2 is a member of the high mobility group (HMG) domain DNA-binding proteins for transcriptional control and chromatin architecture. The HMG domain of Sox2 binds the DNA to facilitate transactivation by the cooperative transcription factors such as Oct3/4. We report that mouse Sox2 is modified by SUMO at lysine 247. Substitution of the target lysine to arginine lost the sumoylation but little affected transcriptional potential or nuclear localization of Sox2. By contrast with the unmodified form, Sox2 fused to SUMO-1 did not augment transcription via the Fgf4 enhancer in the presence of Oct3/4. Further, SUMO-1-conjugated Sox2 at the lysine 247 or at the carboxyl terminus reduced the binding to the Fgf4 enhancer. These indicate that Sox2 sumoylation negatively regulates its transcriptional role through impairing the DNA binding.

To elucidate the molecular mechanism inducing monocyte/macrophage infiltration in the atherosclerotic lesion, we measured the monocyte chemotactic capacity in the extracts of aortic lesions. Five out of seven extracts exhibited significant chemotactic activities. Immunohistochemical examination with an anti-CD68 monoclonal antibody demonstrated that the five positive lesions possessed obvious monocyte/macrophage infiltrations at the intima, whereas the two negative lesions did so at significantly lower intensities. We subjected the chemotactic extracts to immunological analyses to identify the monocyte chemoattractant in them. The monocyte chemotactic capacities of all positive extracts were removed with anti-S19 ribosomal protein (RP S19) antibody beads and antimonocyte chemoattractant protein-1 (MCP-1) antibody beads. In three of the five extracts, the anti-RP S19 antibody beads were more effective than the anti-MCP-1 antibody beads for removal, while in the remaining two extracts, the opposite was observed. A combined immunoabsorption with these beads depleted the monocyte chemotactic capacity of a representative sample of each group. Consistently, the chemotactic capacity of an apparently RP S19 dimer-predominant extract was strongly inhibited by the presence of a C5a receptor antagonist. These results suggest that the RP S19 dimer and MCP-1 play a major role in the monocyte/macrophage infiltration of the atherosclerotic vascular lesion.

We report a successfully treated case of double valve replacement for mucopolysaccharosis in a 27-year-old woman. Mucopolysaccharosis had been suspected since she was aged 11. Symptoms of heart failure and chest pain suggested valvular disease and she was referred to us. Echocardiography, aortography and cardioangiography showed aortic regurgitation (grade IV/IV) and mitral regurgitation (grade III/IV). She received double valve replacement and was discharged on the 38th postoperative day with symptom improvement. Although urinalysis was positive for heparan-sulfate, this case could not be diagnosed definitively as mucopolysaccharosis due to normal lymphocytic enzyme-activity. However, large amounts of mucopolysaccharoid deposits were present in her removed aortic and mitral valve leaflets, and her clinical picture corresponded with mucopolysaccharosis. Thus, it was considered that her ultimate diagnosis was combined cardiac valvular disease due to mucopolysaccharosis., 今回われわれはムコ多糖症に対する2弁置換術の1例を経験したので報告する.症例は27歳, 女性, 11歳時よりムコ多糖症を疑われていたが, 平成13年9月ころより連合弁膜症による心不全症状と胸痛発作が出現し, 手術目的で当科に紹介された.心エコーおよび心臓カテーテル検査上, IV度の大動脈弁閉鎖不全症とIII度の僧帽弁閉鎖不全症が認められた.手術は2弁置換術を施行し, 術後経過順調で術後38日目に退院となった.術前の尿検査でヘパラン硫酸陽性を示したが, リンパ球酵素活性は正常でムコ多糖症の確定診断にはいたらなかった.しかし, 摘出した大動脈弁弁尖と僧帽弁弁尖の組織所見上はムコ多糖の高度沈着を認め, 臨床所見も含めるとムコ多糖症による心臓連合弁膜症と考えられた.

A 71-year-old man with exertional chest pain was admitted to the hospital. A chest roentgenogram exhibited levoposition of the heart. An electrocardiogram showed clockwise rotation in the precordial leads and ST depression in V6, V7, V8, and V9 as well as in II, III, aVF leads associated with chest pain in a treadmill exercise test. The congenital complete left-sided pericardial defect could not be diagnosed preoperatively, but it was confirmed by thoracotomy.

Defects in chromosomes or mitotic spindles activate the spindle checkpoint, resulting in cell cycle arrest at prometaphase. The prolonged activation of spindle checkpoint generally leads to mitotic exit without segregation after a transient mitotic arrest and the consequent formation of tetraploid G(1) cells. These tetraploid cells are usually blocked to enter the subsequent S phase by the activation of p53/pRb pathway, which is referred to as the G(1) tetraploidy checkpoint. A human homologue of the Drosophila warts tumor suppressor, WARTS, is an evolutionarily conserved serine-threonine kinase and implicated in development of human tumors. We previously showed that WARTS plays a crucial role in controlling mitotic progression by forming a regulatory complex with zyxin, a regulator of actin filament assembly, on mitotic apparatus. However, when WARTS is activated during cell cycle and how the loss of WARTS function leads to tumorigenesis have not been elucidated. Here we show that WARTS is activated during mitosis in mammalian cells, and that overexpression of a kinase-inactive WARTS in Rat1 fibroblasts significantly induced mitotic delay. This delay resulted from prolonged activation of the spindle assembly checkpoint and was frequently followed by mitotic slippage and the development of tetraploidy. The resulting tetraploid cells then abrogated the G(1) tetraploidy checkpoint and entered S phase to achieve a DNA content of 8N. This impairment of G(1) tetraploidy checkpoint was caused as a consequence of failure to induce p53 expression by expressing a kinase-inactive WARTS. WARTS thus plays a critical role in maintenance of ploidy through its actions in both mitotic progression and the G(1) tetraploidy checkpoint.

Background Hepatic resection has been indicated to eliminate cancer at the surgical margin in cases of advanced gallbladder carcinoma, but there is considerable controversy about the reasonable extent of liver resection. A new on‐table dye injection technique has been introduced to determine the venous drainage of the gallbladder and ascertain the amount of liver to remove. Methods In four hepatic resections for pT2 gallbladder cancer, indocyanine green solution (25 mg/20 ml) was injected over a period of 30 seconds through the cystic artery. The stained area of the liver surface was completely resected, maintaining a margin of at least 2 cm from the gallbladder. Results The entire serosal surface of the gallbladder takes on a light green stain immediately after dye injection, and then the liver surface around the gallbladder gradually becomes stained with a clear demarcation line. The distance between the demarcation line and the gallbladder ranged from 1.0 to 5.0 cm. The extent of the stained area differed from one individual to another. Histopathological examination of resected liver specimens revealed that one of the four resected livers had micrometastasis in the portal area 27 mm from the gallbladder wall and there were no cancer cells at the surgical margins. No recurrence has been seen in any of our 4 patients at 16–26 months after operation. Discussion The dye injection method is useful in determining the appropriate extent of hepatic resection for advanced gallbladder cancer, as it is possible to determine the necessary and sufficient amount of liver parenchyma that should be removed according to the perfusion area of the cystic veins in each individual patient.

重症筋無力症症例に胸腺摘出術を行い, 2例の気管切開に関連した創感染を経験した.症例1は68歳, 女性.歩行困難で発症.1997年5月クリーゼを生じ, 気管内挿管した.免疫吸着後, 胸骨縦切開下に拡大胸腺摘出術を施行.人工呼吸より離脱できず, 術後11日目に気管切開を施行.その後, 創感染を認め, 持続吸引・間欠洗浄を施行.徐々に感染消退し, 1ヵ月後に人工呼吸から離脱できた.症例2は60歳, 男性.1993年胸腺腫摘出術を受けた.2002年8月クリーゼに陥り, 気管切開を受けた.免疫吸着後, 胸骨縦切開下に拡大胸腺胸腺腫摘出術を施行.当初は良好に経過したが, 3週間後に創感染を生じた.同部の掻爬等を行い, 4ヵ月後に治癒に至った.当科の胸腺摘出後創感染はすべて気管切開例で生じており, 気管切開の施行には十分な検討すべきであり, 避けられない場合は厳重な気管切開管理が必要と考えられた.

全身性エリテマトーデス(SLE)に合併した冠動脈病変に対する冠動脈バイパス術(CABG)を報告する.症例は24歳女性,SLEに対しステロイドおよび免疫抑制剤を使用されていた.安静時の胸部圧迫感が出現し,冠動脈造影で,左前下行枝(7番)の完全閉塞があり,右冠動脈より側副血行路を認めた.左回旋枝(11番)に90%狭窄を認めた.狭心症発作が頻発したため,両側内胸動脈を用いたCABGを施行した.3D-CTによる術後検査にてグラフトは開存しており,経過は良好であった.今後も,ステロイド,免疫抑制剤の継続のもと,十分な経過観察が必要である.

Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor, and it needs complete surgical resection for cure. In addition, the reconstruction of IVC is necessary in many cases. Herein, we indicate the case of a 57-year-old female with leiomyosarcoma in segment I of the IVC, which grew deep into vascular lumen. She underwent complete en bloc resection of the tumor and IVC reconstruction by an artificial pericardium patch.

The methyl–CpG dinucleotide containing a symmetrical 5-methylcytosine (mC) is involved in gene regulation and genome stability. We report here that methylation-mediated transcriptional repressor methylated DNA-binding domain 1 (MBD1) interacts with methylpurine–DNA glycosylase (MPG), which excises damaged bases from substrate DNA. MPG itself actively represses transcription and has a synergistic effect on gene silencing together with MBD1. Chromatin immunoprecipitation analysis reveals the molecular movement of MBD1 and MPG in vivo : ( i ) The MBD1–MPG complex normally exists on the methylated gene promoter; ( ii ) treatment of cells with alkylating agent methylmethanesulfonate (MMS) induces the dissociation of MBD1 from the methylated promoter, and MPG is located on both methylated and unmethylated promoters; and ( iii ) after completion of the repair, the MBD1–MPG complex is restored on the methylated promoter. Mobility-shift and structural analyses show that the MBD of MBD1 binds a methyl–CpG pair (mCpG × mCpG) but not the methyl–CpG pair containing a single 7-methylguanine (N) (mCpG × mCpN) that is known as one of the major lesions caused by MMS. We further demonstrate that knockdown of MBD1 by specific small interfering RNAs significantly increases cell sensitivity to MMS. These data suggest that MBD1 cooperates with MPG for transcriptional repression and DNA repair. We hypothesize that MBD1 functions as a reservoir for MPG and senses the base damage in chromatin.

症例は14歳, 男性.8歳時に左S6の肺動静脈瘻を指摘され, 経カテーテルコイル塞栓術を受けた.経過良好であったが, 6年後CT上, 再発が疑われた.精査にて, 左S6に大きさ4cmおよび右S2に大きさ5mmの肺動静脈瘻が発見された.CT, DSAでは, 左S6に, 3本の流入血管と2本の流出血管を有する瘻を認めた.その内の1本は肺底区静脈に還流していた.頭部MRIでは脳梗塞等を思わせる所見は認めなかった.手術はまず胸腔鏡下に右S2の病変を部分切除した.体位変換後, 左側方開胸をし, 下葉S6および葉間面に血管怒張が著明で, 左肺葉切除が必要と判断した.切除に際し, 血管処理および葉間形成に残存コイルの悪影響はなかった.なお, 周術期合併症は認めなかった.手術によりPaO2は, 術前73.7mmHgから術後94.2mmHgに上昇し, 肺内シャントの改善が認められた.塞栓療法後の再発性肺動静脈瘻は, 一般的な再手術と同様, 肺実質温存が難しい場合があり, 手術選択には注意が必要である.

十二指腸乳頭部癌に対する幽門輪温存膵頭十二指腸切除後5年目に発生した残膵癌に対し残膵全摘を行い根治切除をしえた1 例を経験したので報告する. 患者は75 歳の女性で, 1994年9月十二指腸乳頭部癌に対して幽門輪温存膵頭十二指腸切除術を施行し, 膵断端は組織学的に癌浸潤陰性であり, 膵胃吻合により再建した. 術後経過良好であったが5年後の1999年11月検診目的で施行した胃内視鏡検査で胃体中部後壁の膵胃吻合部に中心陥凹を有する隆起性病変を認め生検ではtubular adenocarcinomaであった. 隆起の主座は残膵吻合部にあったので残膵癌と判断し残膵全摘, 胃幽門側切除, 摘脾を行い胃空腸吻合で再建した. 最終病理組織診断は膵乳頭腺癌で (ts4, s0, rpo, pv0, a0, t1b, n0, stage II) であった. 十二指腸乳頭部癌切除術後の残膵癌の切除報告は極めてまれであり, 根治切除ができた貴重な症例と考えられるので重複癌や転移再発癌との鑑別も含めて報告する.

SUMMARY. This study relates to an adult case of squamous cell carcinoma arising on congenital esophageal stenosis. The patient was a 65-year-old man who had suffered from dysphagia and vomiting since birth and was diagnosed as having congenital esophageal stenosis. The patient had not received any treatment because his symptoms were mild. The patients suffered from severe dysphagia since he was 20 years old and had received balloon therapies several times; however, the effects were transient. After admission to our hospital, he underwent a transhiatal esophagectomy without thoracotomy. Histopathological examination of the resected specimen revealed a thick muscular mucosae associated with hypertrophic fibromuscular components and poorly to moderately differentiated squamous cell carcinoma in the region of stenosis. This case report is the first of a patient with squamous cell carcinoma arising on congenital esophageal stenosis.

Background and aim of the study A congenital coronary artery fistula (CAF) is a relatively rare congenital anomaly and is defined as an abnormal direct communication between any coronary artery and any of the cardiac chambers. This article reviews our experience over the past 27 years, as well as other literature, and discusses the surgical indications and methods relating to CAF. Methods From 1973, 25 patients aged from 2 to 69 years underwent surgical treatment for congenital CAF. Seventeen patients were diagnosed as isolated CAF. All patients under 19 years of age with isolated CAF were asymptomatic. Twenty fistulas originated from the left coronary artery and 9 from the right. The pulmonary artery was the most dominant drainage site. Four patients among the isolated CAF cases were surgically treated without a cardiopulmonary bypass. Results All patients were discharged from hospital without any perioperative complications. Postoperative coronary angiography was done on all patients with only one slightly residual CAF flow. The average follow-up time was 9.6 years and all patients were asymptomatic and doing well. Conclusions Definitive surgical correction is safe and effective, with good results. Therefore, it should be considered even in asymptomatic patients because of the risk of future complications.

Purpose. The face scale has not been used as a global parameter of quality of life (QOL). The aims of this study were to assess the QOL of patients after esophagectomy for cancer and to examine whether a face scale is useful as a global parameter of QOL. Method. Seventy-one patients without postoperative recurrence after curative esophagectomy answered the questionnaire with the face scale and food intake. We calculated the QOL score (its full mark: 85) and examined the correlation between the QOL score and other parameters including the face scale. Result. The duration of the postoperative period ranged from 8 to 253 months (median 87 months). Gastric pullups at the left cervix were selected in 66 patients. The retrosternal route was performed in 55 patients. The mean QOL score was 64.2 (range 33–84). There was the significant positive correlation between QOL score and the face scale (P < 0.0001). The quantity of meal intake decreased in 55 patients (77.55%) by more than 50% compared with their healthy state. About a half of the subjects still suffered from the swallowing problems and a decreased food intake. Conclusion. The face scale is correlative with the total QOL score after an esophagectomy and is useful as a global parameter of the QOL.

症例は53歳の男性. 突然の上腹部痛を主訴に某院に入院. 急性膵炎の診断にて治療を受けていたが症状軽快せず, 血管造影にて膵動静脈奇形と診断された. 一時症状軽快するが, 再び上腹部痛出現し, 加療目的で当科に入院となった. 腹部造影CTで膵体尾部がenhanceされ, MRI T1強調画像で同部に多数のsignal void signを認め, 速い血流の血管の存在が示唆された. カラードップラーエコーでは脾静脈に流入する動脈を認め, 血管造影では動脈相で膵体尾部に網目状異常動脈が描出され, 同時に門脈と脾静脈も描出された. 膵体尾部動静脈奇形と診断し, 膵体尾部, 脾合併切除を行った. 術中血行遮断に伴い門脈圧と門脈血中酸素分圧の低下を認め治療効果が確認できた.

In patients with Wolff-Parkinson-White syndrome, the right anteroseptal accessory conduction pathway is rare, and exists from the atrium to the ventricle in close anatomic proximity to the normal atrioventricular conduction system. Catheter ablation of this lesion is reported to interrupt atrioventricular node-His bundle conduction more easily than that of other lesions. At our institute, there were 10 patients with right anteroseptal accessory conduction pathway among 454 patients (2.2%) who underwent the surgical division of the accessory pathway. Our procedure involved the the endocardial approach with knife dissection and cryocoagulation. With the heart beating under normothermal cardiopulmonary bypass, delta wave disappearance was easily noted. Neither complete atrioventricular block nor recurrent conduction occurred. Cryoablation used by our endocardial surgical division, is a safe and accurate procedure.

症例は59歳女性．8年前から多発性筋炎と間質性肺炎の治療中であり，3年前に人工透析を導入されていた．BNP値の異常を精査中に，心エコーで中等度の大動脈弁狭窄兼閉鎖不全症と左室流出路の腫瘤性病変を指摘され当科紹介となった．手術では，大動脈弁直下の僧帽弁輪石灰化部分と連続するように約7 mmの可動性のある腫瘤を認め，これを摘出後にSJM Regent19 mmを用いた大動脈弁置換術を行った．病理では，腫瘤内に腫瘍成分や炎症細胞の浸潤はなく単なる石灰沈着物との診断であり，僧帽弁前尖弁輪を起源とする乾酪様石灰化腫瘤が最も考えられた．経過は良好で術後20日目に退院した．急速に増大する乾酪様石灰化病変の多くは後尖弁輪に発生する心内腫瘤として報告されており，前尖弁輪を起源とするものは稀である．

A 44-year-old woman who had undergone aortic valve replacement with intravalvular implantation technique due to aortitis syndrome 13 years before, required Bentall procedure and hemiarch replacement because of the tissue valve dysfunction and the root and ascending aortic aneurysms. The exposed native aortic cusps sandwiched between the felt pledgets and the tissue valve seemed to be useful in reinforcing the proximal anastomosis of the composite graft. A combination of an intravalvular implantation technique and a skirted composite graft technique was applied, and her postoperative course has been uneventful for more than 2 and a half years.

To examine the clinical features of primary cardiac tumors, 34 patients who underwent surgical treatment from 1973 to 2000 at the Kanazawa University Hospital were analyzed and the literature was reviewed. The 34 patients were divided into 3 categories: (i) myxomas; (ii) benign non-myxomas; and (iii) malignant tumors. Twenty-three patients (70%) were diagnosed with myxomas, including 22 left atrial myxomas and 1 right atrial myxoma. Seven patients (18%) were diagnosed with benign non-myxoma tumors, including 3 hemangiomas, 1 fibroma, 1 rhabdomyoma, 1 pheochromocytoma, and 1 lipoma. Four patients (12%) were diagnosed with malignant tumors, including 2 angiosarcomas, 1 rhabdomyosarcoma, and 1 malignant fibrous histiocytoma. Among the myxoma patients, in-hospital mortality was 9% (2/23), late mortality was 10% (2/21), and no recurrent myxomas have been identified. Among benign non-myxoma patients there were no perioperative deaths; however, 1 patient died 11 years after surgery, with no linked cause. No recurrent tumors have been identified. Among malignant tumor patients, 1 patient died the day following surgery and the rest died within 14 months. Early and late results of surgery were acceptable for those patients with benign tumors, while the prognosis for patients with malignant tumors was very poor.

Objective: Familial hypercholesterolemia is a dominantly inherited disorder caused by mutations at the locus for the low-density lipoprotein receptor and is frequently associated with premature coronary artery disease. This study was performed to determine whether arterial grafting was associated with long-term benefits for patients with familial hypercholesterolemia. Methods: During the past 18 years, 101 patients with heterozygous familial hypercholesterolemia underwent primary coronary artery bypass grafting, with one hospital death. Group 1 patients (n = 31) received only saphenous vein grafts. Group 2A patients (n = 47) received one internal thoracic artery graft and supplemental vein grafts, and group 2B patients (n = 23) had multiple arterial grafts. After operation, all patients received diet therapy and intensive cholesterol-lowering drug therapy. Thirteen patients received low-density lipoprotein apheresis. Results: During a mean follow-up period of 95 months, 8 patients died, 9 underwent reoperation, and 12 received catheter intervention. The overall survival was 82% (95% confidence limits, 65%-97%) at 18 years after operation. The survival in group 2 was higher than that found in group 1 ( P = .01). The overall freedom from major cardiac events (myocardial infarction, cardiac death, reoperation, and catheter intervention) was 57% (95% confidence limits, 40%-74%) at 16 years after operation. The freedom from reoperation in group 2 was higher than that found in group 1 ( P = .03). There was no difference in the survival or freedom from major cardiac events between groups 2A and 2B. Conclusion: Arterial grafting improved the long-term freedom from reoperation in patients with familial hypercholesterolemia. Additional benefit of multiple arterial grafting could not be identified. (J Thorac Cardiovasc Surg 2000;119:1008-14)

Basic fibroblast growth factor (bFGF) induces endothelial cell and smooth muscle cell proliferation and stimulates angiogenesis. This study was designed to evaluate the effects of intramyocardial administration of bFGF on myocardial blood flow, angiogenesis, and ventricular function in a canine acute infarction model.Myocardial infarction was induced in 12 dogs by ligation of the left anterior descending coronary artery. Within 5 minutes after coronary occlusion, 100 microg of human recombinant bFGF in 1 mL of saline was injected into the infarct and border zone in 6 dogs, whereas saline alone was used in 6 control dogs. Myocardial blood flow was determined with colored microspheres before and immediately after coronary ligation and again 3, 7, 14, and 28 days after treatment and it was expressed as percent of normal. Angiogenesis was evaluated by immunohistochemical studies 28 days later. Cardiac function was evaluated by repeated echocardiographic measurement.Treatment with bFGF significantly increased the endocardial blood flow in the border zone (7 days after infarction, 75%+/-7% and 41% +/-7% in the bFGF and control groups, respectively, p0.01) as well as epicardial blood flow in the infarcted zone. Treatment with bFGF significantly increased the capillary density (39.7+/-2.3 and 22.7+/-1.1 vessels per visual field in the bFGF and control groups, respectively, p0.01) as well as arteriolar density in the border zone. Treatment with bFGF significantly reduced the change in ratio of thickness of the infarcted wall to the normal wall (44%+/-6% and 26% +/-5% in the bFGF and control groups, respectively, p0.05). It improved the left ventricular ejection fraction (7 days after infarction, 0.54+/-0.02 and 0.37+/-0.03 in the bFGF and control groups, respectively, p0.01).Intramyocardial administration of bFGF increased the regional myocardial blood flow, reduced thinning of the infarcted region, and improved ventricular function in acute myocardial infarction. Intramyocardial administration of bFGF may be a new therapeutic approach for patients with acute myocardial infarction.

Familial hypercholesterolemia is characterized by a high plasma level of cholesterol and is frequently associated with rapidly progressing coronary heart disease. The internal thoracic artery is recognized as the conduit of choice for coronary artery bypass grafting. This study was performed to determine whether multiple arterial grafting was associated or not with additional benefits for patients with familial hypercholesterolemia. Between June 1980 and March 1998, 95 patients with familial hypercholesterolemia. underwent a total of 103 coronary artery bypass procedures with one hospital death. The patients were divided into 3 groups according to the type of bypass graft. Group 1 included 31 patients with only saphenous vein grafts; Group 2,48 patients with one arterial graft and supplemental vein grafts; and Group 3, 24 patients with multiple arterial grafts. The overall actuarial survival rate was 90.9% at 10 years and 81.8% at 18 years. The overall actuarial freedom from recurrent angina was 68.9% at 10 years and 55.8% at 16 years. The actuarial survival rate in group 2 was higher than that in Group 1 (p < 0.05). There was no difference in the actuarial survival or in the freedom from cardiac events between Group 2 and Group 3. Single arterial grafting improved the long-term survival in patients with familial hypercholesterolemia. However, no additional benefit from multiple arterial grafting was identified.

We experimentally studied a new technique for anastomosis of small arteries which involves the telescoping method and a surgical adhesive with the objective of examining its clinical potential. This technique was applied to the unilateral femoral arteries of 27 mongrel dogs. After division of the artery, the distal artery was incised longitudinally, and the proximal end was invaginated into the opened artery. One stay suture and the elastomeric adhesive PUP201 were placed in the anastomotic site. The bursting and tensile strength and the patency were examined, and a histopathological study was performed at various intervals up to 1 year after the operation. The bursting strength exceeded 500 mm Hg. The patency rate of the anastomosed arteries was 100%. The mean percentage of stenosis to diameter of the proximal normal lumen was 20% one year after operation. The luminal surface of the anastomosed line was healed smoothly, and thrombi between the telescoped arteries were replaced by elastofibrotic union. In conclusion, small arterial anastomosis using the telescoping method and an elastomeric adhesive is easy and safe and provides good patency.

Ultrastructural changes in the myocardium during intermittent warm blood cardioplegia were studied in 12 dogs. During cardiopulmonary bypass, dogs received three 5-minute periods of warm blood cardioplegia, interrupted by three 10-minute episodes of ischemia in group A or three 20-minute episodes of ischemia in group B. Biopsy specimens were taken from the right ventricle before each cardioplegic infusion and at the end of the aortic cross-clamp period to analyze ultrastructural changes. Functional recovery was measured after cardiopulmonary bypass. Mild and principally reversible ultrastructural changes were observed in group A. In group B, moderate ultrastructural changes were observed, and these changes suggested cumulative ischemic injury. Functional recovery was good in group A, but significantly deteriorated in group B. We concluded that three 10-minute interruptions of warm blood cardioplegia cause mild ultrastructural changes and seem to be safe, but three 20-minute interruptions cause cumulative ischemic injury in normal dog hearts.

Objective: This study was performed to examine the ability of near-infrared spectroscopy to monitor tissue oxygenation in the cardioplegically arrested heart and to assess myocardial oxygen metabolism during intermittent warm blood cardioplegia. Methods: Using a three-wavelength near-infrared spectroscopy, we continuously measured myocardial tissue oxygen saturation and the tissue hemoglobin concentration during intermittent warm blood cardioplegia. Under normothermic cardiopulmonary bypass, 20 dogs received three 5-min periods of antegrade warm blood cardioplegia, interrupted by three 10-min episodes of ischemia in group 1 (n7), three 15-min episodes of ischemia in group 2 (n 6), or three 20-min episodes of ischemia in group 3( n7). Results: Myocardial oxygen saturation during beating and ventricular fibrillation was 809 1 and 599 1%, respectively. Myocardial oxygen saturation rapidly increased to 8291% at blood cardioplegic infusion and decreased to 589 1% 3 min after cardioplegic interruption. The time required to reach the peak oxygen saturation level decreased significantly at the second and third infusions compared to the first infusion in group 1, whereas the time increased significantly at the third infusion in groups 2 and 3. The slower rate of increase in oxygen saturation suggested reduced coronary vasodilator reserve due to microvascular abnormalities. Reperfusion ventricular fibrillation occurred in none of group 1, one of group 2 and three of group 3. Conclusions: Near-infrared spectroscopy is a useful method of continuously monitoring myocardial oxygenation and ischemia during warm heart surgery. Episodes of ischemia longer than 10 min during warm blood cardioplegia resulted in less-than-optimal myocardial preservation and should be avoided. © 1997 Elsevier Science B.V.

Grafting an internal thoracic artery to a coronary artery with moderate stenosis remains controversial. Competitive flow from the native coronary artery has been proposed as the cause of distal narrowing and ultimate failure of the internal thoracic artery graft. We investigated intraoperative phasic blood flow in internal thoracic arteries grafted to coronary arteries with various degrees of stenosis and the influence of stenosis on postoperative angiographic findings. One hundred patients who underwent coronary artery bypass grafting of an internal thoracic artery to the left anterior descending coronary artery were divided into three groups according to degree of coronary stenosis. Group 1 included 39 patients who had 75% or less stenosis, group 2 included 34 patients with stenosis from 76% to 90%, and group 3 included 27 patients with stenosis greater than 90%. Mean flow and peak systolic flow of internal thoracic artery graft in group 1 were lower than those in group 2 ( p < 0.01, p < 0.05). Peak diastolic flow in group 1 showed no difference from flows in groups 2 and 3. In eight patients in group 1, internal thoracic artery flow showed a predominant diastolic peak with characteristic systolic reversal as a result of competitive flow from the native coronary artery. Angiography at 1 month showed that the internal thoracic artery graft was patent in every case. Relative contributions of native coronary artery and internal thoracic artery flow to distal perfusion differed among the three groups ( p < 0.001). In group 1, 15% of patients showed native-dominant flow, 62% showed balanced flow, and 23% showed internal thoracic artery–dependent flow. In group 2, 9% of patients showed native-dominant flow, 29% showed balanced flow, and 62% showed internal thoracic artery–dependent flow. In group 3, 96% of patients showed internal thoracic artery–dependent flow. String sign of the internal thoracic artery graft developed in only three patients; in two of these patients internal thoracic arteries were grafted to coronary arteries with stenosis of 50% or less and in the other patient there was competitive flow from a diagonal vein graft. Eleven of 13 internal thoracic arteries grafted to coronary arteries with stenosis of 50% or less did not show string sign. Competitive flow from a moderately stenotic coronary artery did not predispose the patient toward string sign of the internal thoracic artery graft in the presence of substantial diastolic internal thoracic artery flow. We conclude that internal thoracic artery grafting is acceptable for a moderately stenotic coronary artery. (J Thorac Cardiovasc Surg 1996;112:253-9)

The surgical therapy for Wolff-Parkinson-White syndrome in patients with bronchial asthma was studied. Between 1974 and 1992, 447 patients with Wolff-Parkinson-White syndrome were treated, seven of whom had associated severe bronchial asthma. Supraventricular tachyarrhythmias were induced on occasion by bronchodilating agents such as beta-receptor agonists or theophylline preparations. High-dose steroids were required for acute bronchospasm in three patients, despite possibly leading to cardiac dysfunction. Beta-blockers therapy for Wolff-Parkinson-White syndrome can induce bronchospasm; in patients with Wolff-Parkinson-White syndrome and bronchial asthma, pharmacological agents used to treat one condition may exacerbate the other. Therefore, a non-pharmacological therapy was performed, namely surgical division of the accessory conduction pathway via an endocardial approach, in all seven asthmatic patients with Wolff-Parkinson- White syndrome. In all cases, division of the accessory conduction pathway resulted in disappearance of the delta wave, and there were no further tachyarrhythmias either at rest or after administration of bronchodilators. Since surgery, bronchial asthma has been effectively controlled with standard drug therapy in all patients. Non-pharmacological therapy is recommended for patients with Wolff-Parkinson-White syndrome and bronchial asthma.

In this study, we examined the capability of a skeletal muscle-powered, dynamic patch to provide left ventricular assistance. An actuator was developed that used linear traction power furnished by the latissimus dorsi muscle and liquid as the medium for power transfer. The proximal portion of the muscle was dissected and was reattached to the actuator. The left ventricular apex was excised, and the dynamic patch lined with autologous pericardium was implanted during cardiopulmonary bypass. Hemodynamic studies were performed in 8 dogs after weaning from cardiopulmonary bypass. Muscle stimulation was found to significantly increase the systolic aortic pressure (91.6 versus 112.1 mm Hg; p < 0.01), the mean aortic pressure (65.2 versus 73.0 mm Hg; p < 0.01), and aortic blood flow (0.77 versus 0.92 L/min; p < 0.01). The left atrial pressure decreased from 17.9 to 16.6 mm Hg (p < 0.01). This "hybrid" left ventricular assist device possesses notable clinical advantages because of its remarkable efficacy in assisting circulation. Further experimental studies using preconditioned skeletal muscle are necessary to assess the long-term effects of this technique.

心筋梗塞は腹部大動脈瘤の術中術後の合併症で最も重篤なものの一つである. ジピリダモール負荷心筋スキャン, 冠状動脈造影により評価を行い, 必要な症例には冠状動脈再建を行う方針を開始した1983年以降と, それ以前の腹部大動脈瘤の待機手術例を比較検討した. 1982年までの前半の10年間の症例は25例で術前併存症としての虚血性心疾患を1例に認めた. 1983年以降の後半の10年間の症例は85例で, 術前併存症としての虚血性心疾患を14例に認め, 全例冠状動脈造影にて評価した. 後半において高血圧や高脂血症などの危険因子もしくは心電図異常を認める32例にジピリグモール負荷心筋スキャン等を施行し, うち8例に冠状動脈造影を施行した. 前半の25例において術後心筋梗塞を2例に認め, うち1例が死亡した. 後半の85例中5例に冠状動脈バイパスを施行した. 後半の85例において術後心筋梗塞は認めなかった. 腹部大動脈瘤手術では積極的な虚血性心疾患対策が必要である.

J Thorac Cardiovasc Surg Takaji, Yukihiro Katayama and Michio Kawasuji Ryuji Kunitomo, Shigeyuki Tsurusaki, Hisashi Sakaguchi, Ichiro Ideta, Kentaro arch aneurysm A simple method of intraoperative preparation of a stent graft for distal aortic http://jtcs.ctsnetjournals.org/cgi/content/full/125/6/1535 located on the World Wide Web at: The online version of this article, along with updated information and services, is