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Background It has been reported that severe tricuspid regurgitation may demonstrate constrictive pericarditis-like hemodynamics. In this article, we report a surgical case of solitary severe tricuspid regurgitation in which the hemodynamic features are consistent with constrictive pericarditis. Case presentation The patient was a 78-year-old man with chronic atrial fibrillation and tricuspid regurgitation. He was admitted to our hospital with complaints of edema and dyspnea, and transthoracic echocardiography showed severe tricuspid regurgitation and enlargement of the bilateral atrium. A right heart catheterization revealed “dip and plateau” patterns in the biventricular pressure waveforms, and both right and left ventricle endo-diastolic pressure had increased to 30 mmHg. Although there were no signs of calcification or thickening of the pericardium in computed tomography, we diagnosed the patient with constrictive pericarditis with severe tricuspid regurgitation and underwent surgical intervention since his heart failure symptoms were resistant to medication. The surgical findings did not show any pericardial thickening or adhesions either; therefore, we diagnosed the patient with solitary severe tricuspid regurgitation showing constrictive pericarditis-like hemodynamics. We performed tricuspid valve replacement with a bioprosthetic valve and his heart failure symptoms improved postoperatively. Conclusions To determine the best timing for surgery, it is essential to recognize the existence of severe tricuspid regurgitation mimicking constrictive pericarditis.

Purpose To examine the effect of 3% diquafosol ophthalmic solution (DQS) on ocular surface disorders in diabetic model rats maintained in a continuous airflow condition. Methods Goto-Kakizaki (GK) rats, a spontaneous model of type 2 diabetes, were exposed to constant airflow for 8 weeks. After the establishment of the animal model in this environment, DQS or saline was instilled six times a day into GK rat eyes for 6 weeks. Schirmer's test was performed before and after 6-week instillations. Corneal fluorescein staining was scored at 2-, 4-, and 6-week instillations. Touch thresholds for the cornea were also determined using a Cochet-Bonnet esthesiometer before and after 6-week instillations. Results The mean Schirmer's test score after instillation of DQS was twice higher than that recorded for saline alone. DQS significantly decreased corneal staining scores at 4- and 6-week instillations. No changes in touch thresholds were observed before and after 6-week instillations. Conclusion These results suggest that DQS improves corneal epithelial damage by stimulating tear secretion without influencing corneal sensation in diabetic keratopathy. Thus, DQS may have potential for treatment of diabetic patients with dry eye.

We report a case of an 80-year-old man complaining of dysphagia followed by aspiration pneumonia. Computed tomography of the chest revealed Kommerell's diverticulum associated with the right-sided aortic arch and the vascular ring which was formed by the aortic arch, the left subclavian artery, the ductus arteriosus, and the pulmonary artery around the esophagus and the trachea. Enlargement of the diverticulum was considered to be the cause of dysphagia. The surgery was performed at 20 ℃ under deep hypothermic circulatory arrest. We performed resection of the Kommerell's diverticulum, reconstruction of the left subclavian artery, and transection of the ductus arteriosus to relieve the compression by the esophagus and the trachea. The postoperative course was uneventful and dysphagia disappeared.

Purpose To examine the effect of 3% diquafosol ophthalmic solution (DQS) on ocular surface disorders in diabetic model rats maintained in a continuous airflow condition. Methods Goto–Kakizaki (GK) rats, a spontaneous model of type 2 diabetes, were exposed to constant airflow for 8 weeks. After the establishment of the animal model in this environment, DQS or saline was instilled six times a day into GK rat eyes for 6 weeks. Schirmer’s test was performed before and after 6-week instillations. Corneal fluorescein staining was scored at 2-, 4-, and 6-week instillations. Touch thresholds for the cornea were also determined using a Cochet–Bonnet esthesiometer before and after 6-week instillations. Results The mean Schirmer’s test score after instillation of DQS was twice higher than that recorded for saline alone. DQS significantly decreased corneal staining scores at 4- and 6-week instillations. No changes in touch thresholds were observed before and after 6-week instillations. Conclusion These results suggest that DQS improves corneal epithelial damage by stimulating tear secretion without influencing corneal sensation in diabetic keratopathy. Thus, DQS may have potential for treatment of diabetic patients with dry eye.

We investigated the role of leukotriene (LT) B(4) in 5-lipoxygenase metabolite- and allergy-induced itch-associated responses using SA6541, an LTA(4) hydrolase inhibitor. Itch-associated responses were induced by intradermal injection of 5-hydroperoxyeicosatetraenoic acid (HPETE), a precursor of 5-lipoxygenase metabolites, and passive cutaneous anaphylaxis in ICR mice. By screening molecules related to arachidonic acid metabolism or pruritus, SA6541 was found to be a specific inhibitor of LTA(4) hydrolase. Pharmacokinetic studies confirmed the specificity of SA6541 at an oral dose of 100 mg/kg in mice. 5-HPETE induced scratching behavior, which was inhibited by SA6541 (100 mg/kg). However, SA6541 (100 mg/kg) hardly attenuated the 5-HPETE-induced increase in vascular permeability. Moreover, SA6541 (100 mg/kg) partially attenuated scratching behavior, but did not affect the increase in vascular permeability caused by passive cutaneous anaphylaxis. On the other hand, ketotifen fumarate, a histamine H1 antagonist, strongly inhibited the scratching behavior and the increase in vascular permeability caused by passive cutaneous anaphylaxis. These results suggest that LTB(4) is an endogenous itch mediator in the skin and is involved in the pruritus response in allergic reactions.

〔目的〕深部感覚障害を定量的に測定できるように工夫した「指あわせ試験」の再現性について検討すること。〔対象〕初発脳卒中片麻痺患者30名（脳梗塞20名，脳出血10名）とした。〔方法〕「指あわせ試験」は，対象者を端座位にて閉眼させ，検者が麻痺側上肢を他動的に動かして任意の位置に固定した後，対象者に非麻痺側示指先端を麻痺側示指先端にあわせるよう指示し，この際に両示指間のずれた距離を1 cm単位で測定する方法である。2名の検者（検者A，B）が1名の対象者に対して施行し，検者内および検者間再現性を級内相関係数（intraclass correlation coefficient；ICC）を求めて検討した。〔結果〕検者内再現性を示すICCは0.91，検者間再現性はICCが0.90であった。〔結語〕「指あわせ試験」の再現性は良好なものであった。

The purpose of the present study was to understand the mechanisms of action of diquafosol, a stable derivative of uridine 5′-triphosphate, on Cl– transport across the isolated rabbit conjunctiva. Rabbit conjunctivas were isolated and mounted in a modified Ussing chamber. Under short-circuit conditions, the effects were determined of mucosal (tear) side diquafosol application on the short-circuit current (Isc). Diquafosol rapidly and dose-dependently increased the Isc at concentrations ranging from 0.1 to 968 µM when added to the mucosal side of the conjunctiva. In the absence of the serosal Cl–, the Isc induced by 10 µM diquafosol was substantially reduced. On the contrary, in the absence of mucosal side Na+, the diquafosol-induced increases in Isc were unchanged. Following 45-min preincubation, the P2Y2 antagonist suramin inhibited the diquafosol-induced increases in the Isc whereas the P2Y1 antagonist pyridoxal-phosphate-6-azophenyl-2′4′-disulfonic acid had no effect. These studies suggest that diquafosol stimulates net Cl– secretion from the serosal to the mucosal side via stimulation of P2Y2 receptors in the rabbit conjunctiva.

We investigated in vivo whether UTP and ATP increased periodic acid and Schiff's reagent (PAS)-positive glycoprotein release from rabbit conjunctival goblet cells. Fifty microL of UTP or ATP at the concentrations of 0.003, 0.03, 0.3, 3.0, 8.5% (54 microM-154 mM) or saline were applied to rabbit eyes. Impression cytology was performed on the upper nasal bulbar conjunctiva and the cells were stained with PAS. To clarify purinergic receptor-mediated involvement in this response, suramin (1%; 7 mM), P2Y(2) antagonist and pyridoxal-phosphate-6-azophenyl-2',4'-disulphonic acid (PPADS, 0.01%; 167 microM), P2Y(1) antagonist were applied in the rabbit conjunctival sac for 10 min. before UTP or ATP application. Images of the specimens were taken with a digital camera mounted on a microscope and the PAS staining area was measured using an image analyzing system. UTP or ATP eye drop instillation transiently decreased the PAS staining area in a dose-dependent manner, but it gradually recovered after another 30 min. Saline instillation had no effect until 60 min. later. All of the agonists-induced declines were inhibited by pretreatment with 1% (7 mM) suramin but not 0.01% (167 microM) PPADS. UTP and ATP stimulate PAS-positive glycoprotein secretion via P2Y(2) receptor on goblet cells in the rabbit bulbar conjunctiva in vivo.

症例は58歳,男性.脳梗塞にて入院した際心電図上冠動脈疾患を疑われた.心臓カテーテル検査の結果,3枝病変を認め手術目的にて当科入院となった.本例は47歳時,食道癌のため胸骨後経路胃管再建による根治術を受けており,胸骨正中切開は困難と考え左開胸下に人工心肺を用い手術を施行した.左内胸動脈は再建胃管の癒着が強固で剥離できないため左橈骨動脈をY-グラフトとした.鈍縁枝は心筋内走行をしていることから,上行大動脈遮断,心停止下に左前下行枝,鈍縁枝へ吻合し,中枢側は上行大動脈に吻合した.右冠動脈は露出が難しく血行再建は行わなかったが,術後経過はとくに問題なく術後17日目に軽快退院した.左開胸下冠動脈バイパス術は胸骨正中切開がより困難な食道癌術後症例であっても左冠動脈の露出が容易であり,再建胃管損傷の危険も少なく適切であると考えられたが,症例に応じて開胸部位,補助手段,使用グラフト,中枢側吻合部位を選択することが必要と考えられた.

P2Y2 receptor agonists, like UTP and ATP, stimulate mucin secretion from goblet cells in vitro. Therefore, mucin stimulants could be good candidates for the treatment of dry eye syndrome because mucin increases the tear film stability and protects against desiccation of ocular surface. INS365 is a more stable P2Y2 receptor agonist than UTP. In the present study, we evaluated, in normal rabbit eyes, its effectiveness to release mucin from goblet cells and to protect the corneal damage induced by desiccation. For mucin secretion, impression cytology was performed following the instillation of INS365 solution or saline into the conjunctival sac. The specimens were stained with periodic acid and Schiff (PAS) reagent, and then the staining area was calculated using computer software. INS365 dose-dependently decreased the PAS staining area of conjunctival goblet cells from 2 to 15 min post-application. Furthermore, we utilized the rabbit short-term dry eye model to evaluate if INS365 eyedrops could protect against any of the damage produced by blockage of blinking with ocular speculum. INS365 significantly suppressed corneal damage at concentrations of more than 0.1% w/v. These results suggest that this P2Y2 agonist is a good candidate for the treatment of dry eye disease.

We describe a novel, high-resolution and noninvasive method for measuring tear volume changes in cats. The method entails photographing at the lid margin the tear meniscus area defined by instillation of 0.1% fluorescein solution into the cul-de-sac. The inferior tear meniscus area was obtained from the digitized images with computer-assisted software. The tear meniscus area increased in proportion to the saline volume applied into the conjunctival sac, which validates the technique. Furthermore, this technique detected with high sensitivity previously described increases in tear fluid secretion induced by the P2Y2 agonist. We demonstrate in cats that changes in conjunctival sac tear volume can be evaluated by measurement of its inferior tear meniscus area.

The purinergic P2Y(2) receptor agonists stimulate active Cl-transport across the excised rabbit conjunctival tissue in vitro. We determined whether UTP or ATP could increase the tear volume and change tear fluid composition in normal rabbits in vivo.Fifty mL was applied to rabbit eyes of UTP, ATP at concentrations of 0.1, 0.3, 1, 3, 8.5% (1.8-154 mM) or saline. A modified Schirmer test with topical anesthesia was performed 5, 15, 30 and 60 min after the instillation. In studies lasting 30 days, 50 microL of 0.5% UTP was applied 6 times a day for 4 weeks. Tear samples were collected from the conjunctival sac with a glass microcapillary. The protein profile of the tear fluid was analyzed by SDS-polyacrylamide gel electrophoresis and total protein was measured with the Bradford assay. The Easy-Titer rabbit IgG assay kit was used for the determination of immunoglobulin G (IgG).UTP had dose-dependent stimulatory effects on tear secretion. It maximally increased tear secretion about 4-fold 15 min after its application. Similar effects were obtained with ATP. Repeated treatment with UTP reproducibly increased tear volume. Furthermore, UTP did not decrease total protein and IgG concentration in tear fluid and it had no effect on the protein profile.These data indicate that activation of P2Y(2) receptor increases tear fluid secretion accompanied with some proteins in normal rabbits. The purinergic agonists, UTP and ATP, have potential therapeutic value in the treatment of dry eye.

To identify and localize the dopamine receptor subtypes in rabbit lacrimal gland which mediate protein secretion, the effects were determined of different dopamine receptor subtype agonists, antagonists, and a beta adrenergic antagonist on this process. Protein secretion into the medium was quantified with the Bradford assay. Dopamine increased protein secretion between 10(-7) and 10(-4)M, and it could be maintained for a subsequent 80 min. The relatively selective D1-like receptor agonist, SKF-38393 (10(-4)M) had a similar effect which was suppressed by the D1-like receptor antagonist, SCH-23390. However, neither the D2-like receptor agonist, quinpirole (10(-4)M), nor the selective D2-like receptor antagonist, sulpiride (10(-4)M) altered either the basal level or the stimulated response to dopamine. The dopamine (10(-4)M)-elicited increases in protein secretion were completely suppressed in the presence of either 10(-4)M propranolol or 10(-4)M bretylium. Protein secretion in rabbit lacrimal gland is mediated by dopaminergic nerves through stimulation of the presynaptic D1-like receptor.

The quantum yield of photochemical conversion of 2-hydroxy-4′-dimethylaminochalcone into 4′-dimethylaminoflavylium ion is approximately 0.23 in tetrahydrofuran solution in the presence of 5 mM p -toluenesulphonic acid on irradiation with UV light. The quantum yield is essentially constant as a function of the reaction conditions, such as the reaction time, temperature, substrate concentration and light intensity, but the absorption spectra of the reactant and product are well separated. These features are favourable for use as a chemical actinometer.

Cardiac papillary fibroelastoma is an uncommon tumor, and especially the one located in the left ventricular outflow tract wall is rare. The patient is a 69-year-old female. Multi-detector-row computed tomography (MDCT) revealed a 20×15 mm tumor attached to the left ventricular outflow tract wall under the left coronary cusp. The tumor was surgically removed with a slight margin. The tumor was milk-white in color, and had an egg-like appearance. The histological findings revealed papillary fibroelastoma. The postoperative course was uneventful.

胸部鈍性外傷後の心室中隔穿孔に対して急性期に手術を行い救命しえたので報告する.症例は25歳,男性.バイク事故による胸部鈍性外傷にて緊急入院となった.入院時には心雑音を聴取しなかったが,受傷2日後に胸骨左縁に汎収縮期雑音を聴取するようになった.心エコー検査で左室-右室短絡を認め,外傷性心室中隔穿孔と診断した.肺挫傷による気道内出血を合併していたため血行動態の許す限り手術待機とした.肺対体血流量比が4.6と上昇してきたため,受傷後8日目に手術を施行した.術中心表面からの超音波検査にて穿孔部を確認し,右室切開にて到達した.心尖部寄りの筋性中隔部に4cmの亀裂を認めパッチ閉鎖した.術後一時的に右心不全症状を呈した以外は著変なく経過した.遺残短絡は認められず良好な結果が得られた.

Prosthetic valve endocarditis (PVE) caused by Pseudomonas aeruginosa is a rare but life-threatening complication. Early surgical intervention, as well as appropriate antimicrobial therapy, is usually necessary. Recently, problems have arisen regarding infection with P. aeruginosa, which produces metallo-beta-lactamase (MBL) and is resistant to virtually all beta-lactams. This organism has rapidly spread through many countries. Here, we report the first case of successful redo aortic valve replacement using a Prima Plus stentless valve (Edwards Lifesciences, Irvine, CA, USA) followed by a 6-week course of ciprofloxacin and gentamicin for early PVE caused by MBL-producing P. aeruginosa.

Sludge melting furnaces have been applied recently to the treatment of a great deal of sludge generated from the sewage treatment plant. In this report, an explanation is provided of the history of system introduction, outline of treatment flow, sludge properties, operation results and effective utilization of slag generated at the reflector melting furnace, which began operation in July 1988 at the Futakami Sewage Treatment Plant in Toyama Prefecture. The melting furnace almost totally satisfies the needs of its design, and the properties of the generated melted slag exhibit the features that fully enable its effective utilization.

This retrospective study was conducted to evaluate the effects of coronary artery disease (CAD) on short- and long-term survival after abdominal aortic aneurysm (AAA) repair. One hundred consecutive patients underwent elective AAA repair between 1991 and 2002. Coronary angiography was performed in all patients, revealing significant coronary artery lesions in 47 (47%). Percutaneous transluminal coronary angioplasty (PTCA) was performed in 11 patients, 20 (median) days before the abdominal surgery. Abdominal aortic aneurysm repair was performed 60 (median) days after coronary artery bypass grafting (CABG) in five patients, and both procedures were performed simultaneously in two patients. The in-hospital mortality rate for AAA repair was 1.0%, but there was no cardiac-related operative morbidity or mortality. The 96 patients discharged were followed up for a mean period of 2.9 years (range 3–143 months). The cumulative survival rates after 1, 2, 3, and 5 years were 98%, 95%, 88%, and 77%, respectively. Only one patient (1%) died of myocardial infarction. There was no significant difference in the long-term survival of the CAD and non-CAD patients. These results emphasize the importance of routine coronary angiography and subsequent coronary revascularization to improve early and late survival rates after AAA repair.

We assessed the characteristics of composite branch conduits attached proximally to an in-situ left internal thoracic artery (LITA).Sixty nine patients underwent coronary artery bypass grafting (CABG) using composite branch conduits. Overall 35 distal LITAs, 4 RITAs, 18 radial artery grafts (RAG), and 13 inferior epigastric artery grafts (IEA) (both the distal LITA and IEA were used in one patient) were used. Clinical and angiographic results were assessed.Patency of branch conduit was 97.1% in distal LITAs, 100% in RITAs, 100% in RAGs, and 90.9% in IEAs. All in-situ LITAs were patent. Ten branch conduits exhibited the string sign. The string sign was caused by competitive flow in seven patients. In three of seven patients with competitive flow, the string sign had resolved at one year after operation as the proximal stenosis of the native coronary artery increased in severity.The results of CABG using branch conduits were satisfactory. It is feasible to observe and follow patients with composite grafts exhibiting the string sign in the absence of ischemia.

A 67-year-old man, with a history of pulmonary tuberculosis since 18 years old, presented shortness of breath because of severe mitral regurgitation. Magnetic resonance imaging showed that the heart was displaced into the left thoracic cavity and rotated clockwise around its long axis. The forced expiratory volume per second was 1.06 l (46.7% of the predicted value) and the vital capacity was 2.48 l (72.1% of predicted value). Surgery was performed through a median sternotomy. An internal mammary artery harvest retractor was used to obtain operative exposure. Extensive pericardial suspension was used to push the over-inflated right lung across the midline. Extracorporeal circulation was established. The mitral valve was replaced with a mechanical prosthesis. The patient was weaned easily from extracorporeal circulation and was extubated on the day of surgery. If preoperative respiratory function is adequate, cardiac surgery can be performed safely in a patient with only one functional lung.

In this paper, mechanical behaviors of the Elbow and Tee fittings connected to pipes by screw threads under internal pressure, external tensile loads and bending moment are analyzed using the Finite Element Method (FEM). FEM code employed is MARC. The maximum Mises stress of the Elbow and Tee fittings are obtained when the wall thickness is changed while the internal working maximum pressure is held constant at 20bar. The elasto-plastic stress states of screw threads the fittings and the pipes are obtained under internal pressure and external loads. Under the assumptions that nodal points are released when the strain of the elements reaches the rupture strain of the fitting’s material, the load when the rupture occurs at the screw thread is analyzed. The safety factor for the wall thickness of the Elbow and Tee fittings used in the experiment is found to be about 5. The results indicate deduced that the dimensions of Elbow and Tee fittings can be reduced. The strength of the fittings under internal pressure and external loads is obtained. It is found that the stress concentrates at the first root of male thread and expected that a fracture initiates at the first root. The strain of the Elbow and Tee fittings subjected to internal pressure were measured by using strain gauges. The numerical results are in a fairly good agreement with the experimental results.