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大腸癌肺転移切除例21例 (24回手術) について長期予後を検討した. 対象の性別は男13例, 女8例で, 大腸癌切除から肺転移巣出現までの無病再発期間は平均25カ月 (0-85カ月) であった. 転移巣の個数は, 1個のみ17例, 2個以上4例, 一側性19例, 両側性2例で, 大腸癌の術後病期はII期3例, III a期5例, III b期8例, IV期5例であった. 術式は部分切除9例, 区域切除1例, 肺葉切除11例で, 術後の平均観察期間は48カ月で術後5年, 10生存率はそれぞれ46.9%, 23.4%であった. 術後5年以上再発なく生存した4例は, すべて単発例かつ区域切除以上の完全切除例であったが, 2個以上の多発例や肝転移の合併例は, ほとんどが2年以内に再発癌死し予後不良であった. また, 初回再発から60カ月生存した例もあり, 大腸癌肺転移の予後については, 術後5年以上の最終転帰を含めた長期間のfollow-upが重要と考えられた.

1987年から1999年までの肺縦隔手術例1, 005例を対象に術後合併症とその背景因子を検討した.術後合併症は106例 (10.5%) にみられ, その内訳は喀痰喀出不能33例, 肺瘻14例, 心房細動13例, 後出血11例, 術後膿胸6例, 気管支血管瘻1例, 冠動脈攣縮による急性心筋梗塞1例, 術後肺炎ARDS1例, 他35例であった.このうち心筋梗塞や気管支血管瘻など5例が手術死亡となった.1ヵ月以降の在院死亡の3例は気管支瘻後膿胸2例と肺癌の進行による癌死であった.これら手術死亡と在院死亡を合わせた術後死亡 (8例) はすべて肺癌症例で全手術例の0.8%, 肺癌手術例の1.6%であった.術式別では葉切除術の0.8%に対し肺全摘術11.1%と肺全摘術での術後死亡が高率であった.しかし, 1994年以降は高齢者の肺全摘の際に有茎心膜脂肪織の被覆を行い気管支瘻の例はなくなった.また, 最近の異型狭心症の例には周術期のリスクを評価する目的で術前に冠動脈攣縮誘発試験を導入した.

1994年7月までの原発性肺癌切除例299例を対象に術後5年以降の経過と10年以上の長期生存例について検討した. 術後5年以上の生存が130例 (44%) あり, その後の転帰は現在も生存中89, 再発癌死14, 他癌死13, 他病死9, 事故死1, 不明4であった. さらに術後10年以上の長期生存が24例 (同時期手術の22%) あった. 10年以上長期生存例の臨床病期はIA期とIB期の例が19例と大部分であったが, IIIA期 (pN2の扁平上皮癌) の2例とIIIB期 (同一肺葉内転移, 腺癌) の1例もみられた. 肺癌術後5年以内は肺炎など高齢者の他病死が多かったが, 術後5年以降は他病死より第二肺癌や消化器癌などの他癌死が多かったことより, 定期的な胸部単純写真に加えて消化器癌に対する検索も必要と考えられた.

髄膜腫はくも膜細胞由来の腫瘍であり, 中枢神経系以外に発生するのは稀である.本症例は他疾患経過観察中の54歳の女性で, 検診にて胸部異常陰影を指摘され, 胸腔鏡下左肺S6部分切除を行い, 病理組織学的および免疫組織化学的診断にて, 髄膜上皮腫型髄膜腫と診断された.脳, 脊髄腫瘍の手術既往がなく, MRI等の諸検査にて中枢神経系に腫瘍を認めないことから, 原発性肺髄膜腫と診断された.現在までに報告されている原発性肺髄膜腫は, 本症例を含めて19例と極めて稀な疾患である.

Using the two-dimensional time-dependent Ginzburg-Landau equation, we analysed the relationships between the propagation powers and the attenuations of Nb-SiO2-Nb and Nb-AlN-Nb structure superconducting striplines. An analytical solution was derived by the iteration method under the assumptions that the propagation mode was the TEM mode and that the vector potential exponentially decayed in the superconductor.

Synthesis of a multilayer structure made of superconducting thin films and normal metal or dielectric thin films is an important technology in the superconducting electronics. For example, an S–N–S Josephson junction as a superconducting quantum well device, a superconducting microstrip line and a Josephson transmission line are promising in the future. In this paper, we report on in situ growth of superconductor–dielectric multilayers such as Nb–AlN and NbN–AlN on Si substrate using the off-axial DC magnetron sputtering apparatus and their structural analysis by the Auger electron spectroscopy. We found that Nb, Al and N 2 diffused each other at arbitrary substrate temperatures in the Nb–AlN system. On the other hand, in the NbN–AlN system, Nb and Al slightly diffused when the substrate temperature was low (room temperature), while Nb and Al highly diffused each other when the substrate temperature was high (400°C). NbN–AlN multilayers grown at low substrate temperature were found to be promising in the application such as a superconducting microstrip line. It was also found by the resistivity measurement of AlN thin films that their resistivities were dependent on the input power and partial pressure of N 2 gas during sputtering.

The responsivity of the series-connected Josephson array in the submillimeter wave region was analyzed by using the one-dimensional time-dependent Ginzburg–Landau equation. From responsivity analysis, we found that the relative responsivity of the series-connected Josephson array decreased about 16 dB when the deviation of the normal resistance was 5% in the case of the 10 junctions series-connected array. It was also found that the deviation of the normal resistance of each junction should be less than 1% in order to realize the Josephson coherent array.

前縦隔に発生した悪性リンパ腫 (ポジキン病) の1例について報告した.症例は36歳女性で胸部異常陰影のため当院入院となった.胸部CT写真では腫瘤は前縦隔にあり, 上大静脈と右肺に浸潤しており, 浸潤性胸腺腫が疑われた.経皮針細胞診にて診断がつかなかつたため, 前側方切開による開胸生検が行われ, 組織標本より悪性リンパ腫ポジキン病 (結節硬化型) と診断された.その後化学療法 (ABVD療法) が10クール行われ, 腫瘍は著明に縮小しCR (completeremission) と判定された.本邦では縦隔発生の悪性リンパ腫の報告は非ポジキンリンパ腫が大部分で, ポジキン病の報告はまれである.放射線が有効な浸潤型胸腺腫と化学療法が治療の主体となるリンパ腫では, 治療方法が異なることからその鑑別は重要である.

胸部異常陰影で受診した76歳の女性.胸部CTで左S6に胸膜嵌入像を伴った直径約10mmの腫瘤影を認めた.18F fluorodeoxy glucose positron emission tomography (FDG-PET) 検査では, 腫瘤影に一致して高い集積像を示し, 肺癌が疑われた.胸腔鏡下肺部分切除を行った結果, 原発性肺クリプトコッカス症と診断された.術後は髄膜炎の予防のために抗真菌薬を12ヵ月にわたって投与された.FDG-PETは肺癌の診断に有効な検査であるが, 孤立性の腫瘤を形成した原発性肺クリプトコッカス症では, 偽陽性を示すことがあり, 肺癌との鑑別がしばしば困難である.

von Recklinghausen病に合併した神経原性悪性腫瘍の2例を報告する. 症例1は16歳, 女性. 右前胸部痛にて, 近医を受診し, 右胸腔内に大量の血性胸水が認められた. 胸腔ドレナージ後の胸部レントゲン写真にて, 右後縦隔の腫瘤が明らかとなり, 腫瘍摘出を試みたが, 腫瘍からの出血が著しく, 試験開胸に終わった. 悪性神経鞘腫の病理診断にて術後3ヵ月後に癌死した. 症例2は, 39歳, 女性.呼吸困難にて入院. 胸部CT検査にて上縦隔に直径12cm大の辺縁明瞭な腫瘤が認められ, 上大静脈, 気管および左右主気管支を圧排していた. 通常の気管内挿管では呼吸管理できず部分体外循環下に腫瘍を摘出した. 病理学的に悪性神経鞘腫に横紋筋肉腫の成分が混在する悪性triton腫瘍と診断された. 術後, 左副腎に再発し開腹摘出術を受けたがその後は再発なく外来通院中である. von Recklinghausen病は神経原性腫瘍の合併が多く, 悪性化も稀ではなく注意が必要である.

Cardiopulmonary support (CPS) requires durability of the oxygenator. The life span of the oxygenator is affected by various clinical factors, including patient condition, perfusion condition, and equipment usage. Predictors for the durability of oxygenators were evaluated clinically in this study. Thirty-two patients, who had undergone CPS during the last 3 years in our institute were assigned to this study. Fifty oxygenators had been used (Capiox SX in 19, CB Maxima in 23, and AL-6000 in 8). Significant predictors for the durability of oxygenators were evaluated by nonparametric survival analysis and proportional hazards regression analysis. Univariate regression analysis revealed 6 significant predictors for the life span of oxygenators. These were the oxygenator type, type of centrifugal pump, acidosis with blood pH less than 7.35, base excess less than -5, blood glutamic-oxaloacetic transaminase (GOT) levels greater than 1,000 IU, and blood lactate dehydrogenase (LDH) levels greater than 3,000 IU. After multivariate analysis, there remained only 2 significant predictors. An oxygenator used with a noncoated CPS system (Capiox SX with Capiox EBS) proved to have a significantly shorter life span than one used with a heparin-coated system (CB Maxima or AL-6000 with CB BP-80) (hazards ratio, 3.588, p = 0.0065). Patient conditions, which revealed acidosis with less than -5 of base excess, significantly shortened the life of the oxygenator (hazards ratio, 3.595, p = 0.0188).

We have developed a low negative pressure vacuum suction system in which cardiotomy suction is performed by the negative pressure of the venous reservoir controlled by a vacuum controller. We have employed this vacuum suction system with a centrifugal pump as a totally roller pumpless cardiopulmonary bypass (CPB) system. In this study, the clinical availability and hemocompatibility of our totally roller pumpless CPB system were evaluated by a randomized prospective study. Thirty patients undergoing aortocoronary bypass grafting were assigned to the study. Data from seventeen patients treated with a totally roller pumpless CPB system were compared with data from 13 treated with a conventional roller pump CPB system. Totally roller pumpless CPB reduces hemolysis, showing lower plasma free hemoglobin levels (81.8 +/- 25.0 versus 42.0 +/- 16.3 at 30 min after CPB initiation, p < 0.05), higher plasma haptoglobin levels (37.8 +/- 36.6 versus 77.2 +/- 31.3 at 120 min after CPB, p < 0.05), and lower blood lactate dehydrogenase (LDH) levels (1391 +/- 497 versus 972 +/- 187, p < 0.01) than those of CPB with a roller pump suction with no significant difference between platelet counts. Arterial blood oxygen tension after using a totally roller pumpless CPB system was slightly better than that with a roller pump (396 +/- 48 versus 437 +/- 43, p = 0.069); however, there was no significant difference in intubation times between groups. A totally roller pumpless CPB system provides sufficient biocompatibility for the blood to reduce hemolysis significantly and simplifies and miniaturizes the entire CPB system to achieve good visuality and handling for control as well.

Background. Nafamostat mesilate (FUT-175) is a synthetic serine protease inhibitor that inactivates coagulation, fibrinolysis, and platelet aggregation. Nafamostat mesilate may suppress the blood-foreign surface reaction similar to biocompatible materials by blocking factor XIIa. Methods. We performed an in vitro study of cardiopulmonary bypass (CPB) with fresh human blood among the following three groups: standard CPB sets (C), biocompatible CPB sets (B), and standard CPB sets with FUT-175 (10 mg/L) (F). A clinical study using these same CPB groups also was performed in 45 patients undergoing aortocoronary bypass operations (15 patients each). We injected FUT-175 at 40 mg/h during CPB. Results. In the in vitro study, both groups B and F showed significantly lower levels of coagulation factors, thrombin-antithrombin III complex, fibrinopeptide A, β -thromboglobulin, complement C3a, granulocyte elastase, and free hemoglobin than group C at the conclusion of the study. Thrombin-antithrombin III complex and free hemoglobin in group F also were lower than in group B. The platelet count remained at a higher level in group F than in the other groups. Separation of bradykinin was suppressed most significantly in group F. In the clinical study, group F also showed significantly lower levels of α 2-plasmin inhibitor plasmin complex and C3a than both groups C and B. There were minimal levels of free hemoglobin in group F. Conclusions. Nafamostat mesilate may contribute major beneficial effects toward conservation of blood during CPB and prevention of coagulopathy after CPB.

Multilayers made of superconducting thin film (S) and normal metal thin film (N) can be applied to various superconducting devices such as a multilayered Josephson junction. In this paper, S - N metallic multilayers were synthesized by using off-axial DC magnetron sputtering apparatus. Structures of S - N multilayer samples such as Nb - Al - Si were analysed by use of the Auger electron spectroscopy. X-ray photoelectron spectroscopy and x-ray diffraction analyses of the interface were also carried out.

In this study, we investigated a noncontact method of measuring plastic strain of metals using laser speckle. This method is based on observation of the change in laser speckle pattern with surface profile change due to plastic deformation. Analysis of the laser speckle pattern is performed on a computer-based image processing system. The relationships between speckle pattern and surface roughness and frequency characteristics of the surface profile were investigated. Surface roughness and surface profile were observed for steel specimens polished with emery paper or plastically deformed. The surface profile diagram was analyzed by means of the fast Fourier transform with a computer and distribution of the spatial frequencies was obtained. The results showed that distribution of light intensity of the speckle is related to frequency distribution of the surface profile, but it is not always related to surface roughness. It was also clarified that the laser speckle pattern is closely related to the magnitude of plastic strain.

For the X-ray free electron laser using stimulated transition radiation in periodic stacks of metal foils or polymer films, the effects considered are those that are due to: (1) the space charge of the relativistic electron beam; (2) multiple scattering of the electron beam passing through the stacks; and (3) both the space charge and multiple scattering simultaneously. Taking these respective effects into account in a Boltzmann transport equation, dispersion relations are derived and gain coefficients of the laser are calculated and compared. As a result, it is found that the effect of multiple scattering is large and it depends also on the magnitude of the electron beam energy, e.g., for the case of 50 GeV, the gain coefficient is decreased by several dB. The effect of the space charge is relatively small. Also, the gain coefficient generally decreases with the beam energy.

The effects of calcium antagonists (nifedipine, nicardipine, diltiazem, and verapamil) and prostaglandin E1 (PGE1) on the tension of isolated canine coronary arterial strips were studies. In a solution containing 20 mEq/L of K+, 127 mEq/L of Na+, the tension was increased by 500–1,000 mg with 4 mEq/L of Ca2+. This increase in tension was suppressed by Ca-antagonists and PGE1 dose-dependently. Nifedipine 10−5M, nicardipine 3 X 10−7M, diltiazem 3 X 10−6M, and verapamil 3 X 10−6M completely suppressed the increased tension. The maximal suppression of the tension produced by PGE1 was about 40% at 10−10M. In 20 mEq/L K+ solution (0 mEq/L Ca2+, 37°C), the reduction of the Na+ concentrations from 127 mEq/L to 12 mEq/L increased the tension by 50 to 100 mg. This increase in tension was not suppressed by Ca-antagonists or PGEI. In conclusion, this study demonstrated that Ca-antagonists and PGE1 suppressed an increase in the tension caused by Ca2+ but did not suppress an increase in the tension caused by Na+ reduction.

症例は, 32歳, 女性, 多発性でかつ増大傾向を示していた胸部腫瘤影を指摘されて紹介入院となった.右上葉切除を施行し, 軟骨性成分が主体の多発性肺過誤腫と診断された.この症例は, 13歳の時に胃平滑筋肉腫にて胃全摘術を施行された既往歴があったことから, Carney's triad (gastric epitheloidleiomyosarcoma, pulmonary chondroma, functioning extra-adrenal paraganglioma) の2項目を満たし, 極めて稀なCamay's syndrome の1例 (本邦2例目) と考えられた.今後, paraganglioma の発生に関して厳重な経過観察が必要と思われる.

1992年12月より1993年12月まで, 確定診断のつかなかった肺末梢腫瘤影を有する17例の患者に胸腔鏡下楔状切除, 迅速組織診を施行した. 17例の性別は, 男9, 女8で, 年齢は34-76歳 (平均56歳) であった. 最終病理診断は, 肺癌7 (腺癌4, 扁平上皮癌2, 小細胞癌1), 肺結核7, 肺化膿症1, 器質化肺炎1, 転移性肺癌 (腎細胞癌) 1であった. 肺癌7例のうち4例は開胸し, 定型的肺葉切除, 縦隔リンパ節郭清を追加したが, 3例はCOPDなどの合併症により部分切除のまま終了した. 肺結核と診断された例には抗結核剤の投与を追加した. 手技上の問題として自動縫合器のトラブルや切離断端からの出血の例を認めた. 胸腔鏡下懊状切除の適応は, 従来の開胸生検の適応としていたものと基本的に同じであるが, 創痛が軽く回復も速やかであることから, 開胸生検にとって代る診断手技と思われる.

We present a case of pulmonary varices in a 44-year-old man. The patient's chest X-ray films revealed well-delineated shadows in the right lower lung field. An enhanced chest CT scan with three-dimensional volumetric imaging demonstrated a vascular malformation in the right lower lobe. Both the arterial and parenchymal phases of digital subtraction of the right pulmonary angiography were normal. However, the venous phase showed serpiginous right lower pulmonary veins draining into the left atrium, and a delayed pooling of contrast in dilated pulmonary veins confirmed a diagnosis of pulmonary varices. No echocardiographic findings of valvular disease were recognized. He remained asymptomatic and returned to work, but radiological follow-up was continued annually.

A copolymer of methyl methacrylate (MMA) and 3-triethoxysilylpropyl methacrylate (ESPMA) was proposed as a positive-working electron beam (EB) resist of a new type. It was found that it had 4–10 times the resistance of polymethylmethacrylate (PMMA) against CBrF3 plasma damage. The mechanism of etching Nb in reactive-ion-etching (RIE) was deciphered. Using the new EB resist and nanometer process technology, an all-Nb thin film microbridge was fabricated. It shows the a.c. Josephson effect, i.e. the Shapiro steps upto the 11th were observed under millimeter-wave (70 GHz) radiation. In addition the coherently working performance of the series array of these thin-film microbridges were observed definitively.

An important role in the future of superconducting electronics will be the development of key technology to synthesize a multilayer structure made of superconducting thin film (S) and normal metal (N) or dielectric thin film. An S - N - S Josephson junction is applicable as a superconducting quantum well device and a superconducting microstrip line is promising in submillimetre wave-transmission technology. In this paper, NbN - Nb multilayers were synthesized in situ by using off-axial DC magnetron sputtering apparatus. Structures of the multilayer samples were analysed using Auger electron spectroscopy (AES). The AES analysis showed that an N atom in an NbN layer rarely diffused into the Nb layer during growth of NbN on the Nb layer at arbitrary substrate temperatures. It was found by x-ray diffraction (XRD) analysis that NbN(111) could grow on Nb(110) even though the substrate temperature was low. XRD analysis also showed that the grain size of NbN thin film on Nb thin film monotonically increased with increase of the substrate temperature.

Objective: A prospective randomized trial was performed to investigate the prognostic advantage of postoperative adjuvant chemotherapy in patients with resected stage I–II non-small cell lung cancer (NSCLC). Patients and methods: From March 1992 to December 1994, 221 patients with completely resected stage I–II primary NSCLC were enrolled and randomly assigned to two groups, as follows: 2-year oral administration of Uracil plus Tegafur (UFT) (adjuvant group, 109 patients), and surgical treatment alone (control group, 110 patients). Results: The overall 5-year survival rates were 79% for the adjuvant group and 75% for the control group, and there was no statistical significance. The 5-year disease-free survival rates were 78% for the adjuvant group and 71% for the control group, and there was also no statistical significance. There have been seen no severe complications in the adjuvant group. The mean total dosages of UFT were about 75% of maximum basic amount. Conclusions: The UFT regimen was feasible. However, we have not observed any survival benefit in the adjuvant group. Larger trials are needed to confirm the effect of UFT to patients with resected NSCLC.

Pulmonary stenosis caused by calcium deposits on pulmonary valve is relatively rare. We experienced such as case in a 67-year-old man. In March 1992 the patient developed heart failure and internal treatment resulted in remission. Cardiac catheterization study and echocardiography showed a valvular PS. Chest CT and cineangiogram showed the calcified pulmonary valve and annulus. In July pulmonary valve replacement with a bioprosthetic valve was performed under thoracotomy and ASD was closed by a patch. There were severe calcification of the pulmonary valve, adhered commissure and sclerotic valve ring. Postoperative course was uneventful, however, the patient developed cardiac tamponade on the 12th day after the operation. Reoperation was carried out. No clear hemorrhage was found and only drainage was done. The patient gradually became worse to develop renal failure and DIC, and died of MOF on 34th postoperative day.

Background: Nisoldipine, a calcium antagonist, was assessed for myocardial protection and the prevention of reperfusion injury in patients undergoing CABG.Methods: Of the 34 subjects undergoing CABG in this study, 20 were given nisoldipine orally at 10 mg/day for 2 weeks before surgery (N group) and the other 14 untreated controls (C group). Myocardial protection was conducted via antegrade cold blood cardioplegia at 20-minute intervals.Results: Myocardial blood flow was significantly higher in the N group (67.8±21.8 ml/100 g vs. 47.2±14.4 ml/100 g, p < 0.05) after cardiopulmonary bypass. Serum interleukin-6 levels were significantly lower in the N group 1 hour after reperfusion (116±58 vs. 409±362 pg/ml, p < 0.05), as were serum lactate dehydrogenase levels immediately after surgery (888±268 vs. 1350±486 IU/L, p < 0.05). The N Group showed a better left ventricle stroke work index 6 hours after surgery (43±8 vs. 36±9 g·m/m2). Dopamine dosage in the N group on postoperative day 1 was lower than in controls (5.3±1.9 vs. 3.0±2.4 μg/kg/min). Conclusions: Preoperative nisoldipine treatment increased blood flow in the postischemic myocardium and prevented myocardial damage and reperfusion injury to some extent.

Acomparative study was performed between a noncoated and heparin-coated cardiopulmonary support (CPS) systems with the same design and structure (Terumo Corporation, Capiox-SX series) to evaluate whether or not heparin coating extends oxygenator service life. Fifty patients underwent CPS from January 1993 until December 1997, and 54 oxygenators (Capiox-SX series) were used. There were 35 noncoated oxygenators (Group NC) and 19 heparin-coated ones (Group HC). Significant predictors for the durability of oxygenators were evaluated by a nonparametric survival analysis and a proportional hazards regression analysis. Thirteen of 35 Capiox-SX and only 2 of 19 Capiox SX-HP revealed gas transfer failure and had to be exchanged. The average life span of the Capiox-SX and Capiox-SX-HP were calculated to be 78.6 +/- 16.8 and 168 +/- 15.4 h, respectively. Group HP showed significantly longer durability than Group NC (p = 0.0017), although there were differences of perfusion index and platelet counts between the 2 groups. Heparin coating of the CPS system remained one of the 2 significant predictors (hazards ratio 8. 871, p = 0.0449) to determine the durability of oxygenators by increasing stepwise multivariate proportional hazards regression analysis, along with anemia with less than 8 g/dl hemoglobin (hazards ratio 9.438, p = 0.0173). Heparin coating of the CPS system assures improved durability because heparin-coated oxygenators have a longer service life than noncoated ones.

Cannulation of the ascending aorta is the recognized method to achieve arterial return during cardiopulmonary bypass. Mediastinal infection after cardiac surgery can cause disruption at the point of insertion, and give rise to a pseudoaneurysm in the ascending aorta. Although rare, a pseudoaneurysm can occur without clear evidence of infection. Here we report two cases that received aortic valve replacement and that developed ascending aortic aneurysms after surgery. Based on our clinical findings, these aneurysms were related to the arterial cannulation into the aorta and not to any infection.

To evaluate the value of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans, we performed FDG-PET scans in 23 patients with indeterminate pulmonary nodules less than 3 cm in size and analyzed these scans qualitatively and semiquantitatively. Histologie specimens were obtained by thoracoscopic excisional biopsy in 16 patients, CT-guided needle aspiration cytology in three, and bronchoscopic brushing cytology in four. Pathological diagnoses were lung cancer in 16 patients, benign inflammation in six, and malignant lymphoma in one. Sensitivity, specificity and accuracy of the FDG-PET scans were 88% (15/17), 67% (4/6) and 83% (19/23), respectively. There were two false-positive cases (organizing pneumonia and cryptococcosis) and two false-negative ones (slow-growing adenocarcinoma and malignant lymphoma). Although a few false-positive cases of granulomatous disease were yielded, the FDG-PET scans were highly sensitive in the detection of lung cancer. We conclude that the FDG-PET scanning in a useful diagnostic imaging modailty in the management of indeterminate pulmonary nodules.

This study compared the cerebral microcirculation during retrograde cerebral perfusion with that during antegrade cardiopulmonary bypass under normothermic and hypothermic conditions.Brain tissue blood flow was measured with the hydrogen-clearance and colored microsphere (15 and 50 microns) methods during antegrade cardiopulmonary bypass and retrograde cerebral perfusion. Measurements were performed during normothermia (37 degrees C), moderate hypothermia (28 degrees C) and deep hypothermia (20 degrees C) in groups of mongrel dogs (n = 8).During antegrade cardiopulmonary bypass, the microsphere method showed a significant decrease in cerebral blood flow as body temperature decreased (40.1 +/- 20.8 ml/min/100 gm at 37 degrees C, 16.2 +/- 18.0 ml/min/100 gm at 20 degrees C with 50 microns microspheres) At 20 degrees C, the cerebral blood flow measured with the 15 microns microspheres was significantly lower than that assessed with the hydrogen-clearance method (11.3 +/- 7.0 vs 24.8 +/- 7.0 ml/min/100 gm). During retrograde cerebral perfusion, the microsphere method also showed a significant decrease in cerebral blood flow with cooling. At 37 degrees C, the cerebral blood flow measured with the 15 microns microspheres (0.8 +/- 0.7 ml/min/100 gm) was significantly lower than that assessed with the hydrogen-clearance method (10.1 +/- 3.5 ml/min/100 gm). At both 28 degrees and 20 degrees C, the hydrogen-clearance method showed significantly higher cerebral blood flow (10.1 +/- 5.8 and 8.2 +/- 3.7 ml/min/100 gm) than did the 50 microns microspheres (1.8 +/- 0.6 and 1.0 +/- 0.8 ml/min/100 gm) and 15 microns microspheres (0.23 +/- 0.14 and 0.18 +/- 0.15 ml/min/100 gm).(1) Cerebral blood flow that shunts to capillaries is increased during antegrade cardiopulmonary bypass under deep hypothermia. (2) During retrograde perfusion, the majority of the blood flow shunts away from brain capillaries, even under normothermic conditions, and blood flow through large venoarterial shunts increases as body temperature decreases. Although the cerebral microcirculation during retrograde perfusion is decreased, retrograde perfusion provides some degree of oxygenation to the body.

Currently, poststernotomy mediastinitis frequently is being treated by debridement and immediate closure with omental drainage. This method is useful, but subcutaneous infection occasionally occurs. Divided omental transfer to the presternal space may be helpful in preventing this complication.

We report herein the unusual case of a patient in whom postoperative angiography following coronary artery bypass grafting (CABG) revealed a lateral origin of the right internal thoracic artery (ITA) and a normal origin of the left ITA, both of which were demonstrated to be patent and did not follow a tortuous course. The CABG had involved revascularization of the left anterior descending artery (LAD) with the right ITA, and the obtuse marginal artery with the left ITA. The patient had an uneventful postoperative course and developed no respiratory symptoms.

Reimplantation of all intercostal arteries was performed with a T-shaped graft for spinal cord protection in a 64-year-old man who required long-segment replacement of the descending thoracic aorta. The T-shaped graft maintained blood flow to the intercostal arteries, and no neurologic deficits developed.

We herein report the case of a 56-year-old man with idiopathic thrombocytopenic purpura who required an emergency aortic arch replacement. Intraoperatively, hemostasis was achieved using platelet transfusions. Postoperatively, the use of high-dose gamma-globulin therapy was able to maintain an adequate platelet count and good hemostasis.

The effects of magnesium on the tension of isolated canine coronary arterial strips were studied. In the solution containing K+ of 20 mEq·l −1, Ca2+ of 4 mEq·l −1, and Na+ of 127 mEq·l −1, the tension was 811±111 mg with Mg2+ of 1 mEq·l −1, 494±135 mg with Mg2+ of 10 mEq·l −1, 272±126 mg with Mg2+ of 20 mEq·l −1, −52±63 mg with Mg2+ of 30 mEq·l −1, −69 ±80 mg with Mg2+ of 40 mEq·l −1. In the solution containing K+ of 20 mEq·l −1, Na+ of 12 mEq·l −1 and Ca2+ of 0 mEq·l −1, the tension was 102±22 mg with Mg2+ of 1 mEq·l −1, 3±35 mg with Mg2+ of 10 mEq·l −1; −49±33 mg with Mg2+ of 20 mEq·l −1, −59±49 mg with Mg2+ of 30 mEq·l −1, −65±54 mg with Mg2+ of 40 mEq·l −1. The data demonstrated that Mg2+ above 30 mEq·l −1 inhibited the increase in tension caused by Ca2+ and Mg2+ above 20 mEq·l −1 inhibited the increase in tension caused by low Na+ concentration.

A 23-year-old man underwent a tracheostomy. A massive hemorrhage from the tracheostomy site occurred 50 days later. An emergency operation was immediately performed and an erosion was noted on the innominate artery. The artery was divided and the hemorrhage was successfully stopped.

Mitral valve replacement was performed through a right thoracotomy using femorofemoral bypass under profound systemic hypothermia in a 62-year-old man who had undergone coronary artery bypass grafting using both internal thoracic arteries. The right thoracotomy approach minimizes the risk of injury to the arterial grafts, and deep hypothermia obviates the need to interrupt the grafts to administer cardioplegia. This technique provides excellent exposure of the mitral valve while minimizing the operative risk.

Copolymers of methyl methacrylate (MMA) and 3-triethoxysilylpropyl methacrylate (ESPMA) were synthesized and employed as an electron beam (EB) resist. The copolymer with a content of 10 mol% ESPMA worked as a positive EB resist and had 4-10 times as strong a resistance as poly(methylmethacrylate) (PMMA) to CBrF 3 plasma etching. The resolution and sensitivity were almost the same as those of PMMA. From experimental results concerning the insolubility of the plasma-irradiated copolymer and measurement of IR spectra, the enhanced resistance to plasma etching appears to be caused by formation of a cross-linking structure based on the Si-O-Si linkage

We have fabricated all-Nb thin film microbridges by using newly developed nanometer process. These microbridges show the high sensitivity of the radiation detection. We have investigated the properties of microbridges by changing the bridge-region parameters.

Experimental studies of an inductively coupled RF-excited CW-HCN laser have been carried out. A maximum output power of 160mW in CW at 337 μm has been obtained using a laser tube 1 m long and 55mm inner dia.

An experiment in video signal detection at 70 GHz was conducted with a Pb micro-bridge prepared by electron-beam exposure and the lift-off method. It was found that for the dc Josephson effect the external noise is dominant over the internal noise of the specimen and that the equivalent noise becomes large near the critical temperature. The response to 100 kHz amplitude-modulated signals was found to be ten times more rapid than that of the superconductor bolometer. Theoretically the maximum responsivity is obtained near the first Shapiro step, which, however, does not give a stable bias; maximum responsivity was actually observed near the zeroth Shapiro step, where it exceeded 6.3 × 104 V/W. The responsivity was found to increase with increasing IcRn.

The Josephson junction is an oscillator driven by constant current. Therefore, the integrated device of the weak-link type Josephson junction for detecting electromagnetic waves using the junction as a local oscillator can be considered. The superconducting device proposed by Likharev based on this concept is the Josephson triode consisting of three Josephson junctions. This paper describes the analysis of the Josephson triode which is the superconducting device for the heterodyne detection. First, the static characteristics are analyzed by use of the equivalent circuit and the fundamental equations. The necessary conditions for the normal resistances are derived. It is shown by numerical analysis that the millimeter wave heterodyne detection characteristics of the triode are identical with the theory and experiment for a tunnel junction. Moreover, the results analyzed numerically can be explained by analytical considerations and the simplified equivalent circuit of the Josephson triode is derived. The relations between the intermediate frequency output power and the local oscillator power are represented analytically via the simplified equivalent circuit of the triode.

肺腺癌切除例42例を対象に核内封入体の頻度および形態を細胞診所見, 組織所見, 電子顕微鏡所見について検討し, 核内封入体観察の意義について考察した.核内封入体は, 細胞診で71%, 組織診で67%, 電顕で76%とかなり高率にみられた. その大部分は, 単に核膜が核内に彎入したもの (偽核封入体) で, 細胞診59%, 組織診40%, 電顕73%であり, 微小管状封入体および微細顆粒状物質のみられるもの (真の封入体) は, 細胞診27%, 組織診40%, 電顕9.8%とやや少ない. 分化度別にみると, 細胞診で高分化32%, 中分化22%, 低分化18%, 組織診で高分化59%, 中分化11%, 低分化27%とあまり差はみられないが, やや高分化腺癌で多くみられた. 真の封入体の起源に関しては不明な点が多いが, II型肺胞上皮型またはクララ型との関係が示唆されており, 予後との関係もみられている.以上より, 核内封入体を, 切除標本, 気管支生検および擦過細胞診などで観察することは, 組織亜型および予後の推定のうえからも重要であると思われる.