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The authors analyzed the 5-year and 9-year survival in 134 of 165 patients who underwent total knee arthroplasties from 1989 to 1996 in our department. Patients were followed until December 31, 1998, or until the time of death. Diagnoses were rheumatoid arthritis in 81 patients (132 knees) and osteoarthritis in 53 patients (79 knees). The survival of the patients was compared to that of the age- and sex-adjusted general population. Kaplan-Meier survival curves were constructed. Twenty-two patients in the study died before the end of the follow-up. The cumulative 5-year patient survival was 88.7%, and 9-year patient survival was 64.4% for total knee arthroplasty patients. The standardized mortality ratio was 0.11 (95% confidence interval: 0.02-0.40) for the patients with osteoarthritis, and 0.81 (95% confidence interval: 0.52-1.25) for the patients with rheumatoid arthritis. The Cox proportional hazards model showed that the factors of male sex and rheumatoid arthritis were related to a higher mortality rate in the total knee arthroplasty group.

We investigated the degree of local heat and swelling of the thigh muscles produced by exercise. Eleven university athletes aged from 19 to 23 years old performed isokinetic exercise of the right knee on a Cybex II. Then serial determination of thigh circumference and thigh temperature (up to 120 min after exercise) as well as serial magnetic resonance (MR) imaging (up to 60 min after exercise) was performed on both thighs. The circumference of the right thigh peaked at 5.6 +/- 2.1 min after exercise and returned to normal at 38.6 +/- 9.2 min. The temperature of the right thigh peaked at 14.2 +/- 5.7 min after exercise and was not normalized after 120 min except in two subjects. T2-weighted MR images showed a marked increase in the signal intensity of the right knee flexor and extensor muscles. The signal intensity peaked immediately after exercise and subsequently decreased gradually but did not return to normal after 60 min in some muscles. Changes in the thigh circumference were closely correlated with changes in the MR findings. The changes in the thigh muscles after knee exercise could be demonstrated using MR imaging, thigh circumference, and thigh temperature data. These parameters may provide indicators for managing muscle fatigue and recovery.

The FADEC (full authority digital electronic engine control) technology in Japan has matured substantially within the TRDI's JEC-series FADEC R&D programs. The aspects of engineering practice described in this paper have been addressed by the Third Research Center, TRDI (Technical Research and Development Institute), in the R&D process of the JEC-series aircraft engine control systems. It is shown that the analysis of rotor speed fuel control systems as non-linear servomechanisms has contributed the improvement of control performance, and that the incorporation of the derivative term within the afterburner control loop has decreased the interaction between the low-pressure rotor speed and the exhaust gas temperature. Furthermore, current important topics are described, that are absorbing the group's research effort, in accordance with the TRDI's objectives.

This study was conducted 1) to determine if the secretion of progesterone, as an index of ovarian activity, during the estrous cycle of nonseasonal Shiba goats is affected by seasonal changes, and 2) to learn if the pulsatile secretion of ovarian progesterone can be estimated from samples obtained by cannulation into the caudal vena cava via the femoral vein. Progesterone concentrations in jugular venous plasma during the estrous cycle in spring (May) were similar to those in autumn (November). Plasma progesterone concentrations in the jugular vein and caudal vena cava monitored for 10 h on Day 12 of the estrous cycle in spring were similar to those in autumn. The mean concentration (21.9 to 28.9 ng/ml) and the pulse frequency (6.2 to 7.4 pulses/10 h) of plasma progesterone in the caudal vena cava during both seasons were 3.1- to 4.7-fold and 1.7- to 2.4-fold those in the jugular vein, respectively. The degree of change in the peak magnitude and the base-line concentration of progesterone were higher in the caudal vena cava than in the jugular vein. These results indicate that progesterone secretion during the estrous cycle in nonseasonal goats is not affected by seasonal changes, and suggest that the pulsatile secretion of ovarian progesterone can be evaluated better from samples obtained from the caudal vena cava, near where progesterone is released, than from those obtained from the jugular vein.

Waste water from wheat starch production was treated by a membrane combined two phase methane fermentation system with 20kg/m 3 d of COD loading. The following satisfactory results were obtained: BOD and SS concentration in the system effluent was under 50 mg/l and 90 mg/l respectively. More than 99% of organic matter was removed. About 40,000 kcal of methane gas energy was recovered in an operation of 12–22 kg/m 3 d, and the average methane gasification rate and sludge yield rate were 0.33Nm 3 CH 4 /kg COD removed, and 0.12kg VSS/kg COD removed respectively.

The aim of this study was to investigate the relationship between the strength of the foot muscles that control the toes and disorders such as shin splint. In order to this, we designed and built a toe dynamometer to compare the muscle power exerted through the toes in top female marathon runners and age-matched women not involved in sports. The subjects were 12 top-level female marathon runners (Group A) and 37 student nurses who were not involved in sports (Group B). We devised a dynamometer to measure the total power exerted by the flexor muscles of the 5 toes of a single foot (total flexor power) and the combined power of the abductors of the big (1st) and little (5th) toes (abductor power). In Group A, the total flexor power was 14.3 +/- 5.3 kg in the right foot and 15.4 +/- 4.7 kg in the left foot. The abductor power was 1.9 +/- 1.8 kg in the right foot and 2.2 +/- 1.9 kg in the left foot. In Group B, total flexor power was 18.3 +/- 6.7 kg in the right foot, while the abductor power was 1.9 +/- 1.7 kg. The subjects from Group A with an arch index < 1.0 (n = 8) or > 1.0 (n = 4) were respectively classified as Group I and Group II. In Group I, total flexor power was 14.9 +/- 5.3 kg (right) and 15.5 +/- 5.2 kg (left), while the abductor power was 2.6 +/- 1.9 kg (right), and 3.1 +/- 1.7 kg (left). In Group II, the total flexor power was 13.2 +/- 5.8 kg (right) and 15.1 +/- 4.2 kg (left), while the abductor power was 0.7 +/- 0.6 kg (right) and 0.3 +/- 0.2 kg (left). The abductor power of toes was significantly lower in Group II than in Group I. The incidence of posteromedial shin pain was higher in Group II (75.0%) than in Group I (12.5%).

In the treatment of acute type A aortic dissection, it is important to cope effectively with cerebral ischemia due to preoperative acute occlusion of arch branches and intraoperative cerebral malperfusion under extracorporeal circulation. The validity of our surgical strategy for such cases was evaluated. Our surgical strategies are as follow; for cases with preoperative cerebral infarction and disturbance of consciousness total aortic arch replacement is performed after the improvement of brain edema, and for cases of transient cerebral ischemia, emergency operation is performed. In the emergency operation, selective cerebral perfusion through the carotid artery of the diseased side is initiated as soon as possible. In conclusion, our surgical strategy for acute type A aortic dissection with cerebral ischemia due to acute occlusion of aortic arch branches is acceptable. There was no significant difference between the cerebral ischemia group and the control group concerning hospital mortality, cerebral complication and the 5-year survival rate.

This paper introduces the model theory approach to solver development for a management information system and presents its extension by the multi-level systems concept. The extension is demonstrated by an example.

An automatic maps and drawing recognition method in which recognition processes are executed in parallel is described. First, the image is divided up according to its particular features, then each layer of candidate elements is recognized under the paralleled processing environment composed of automatic recognition, and man-machine oriented semi-automatic recognition, and finally the relationships between separate elements are settled using a rule-based matching process. This method is applied to the system for constructing electric power distribution databases. This system achieves a higher processing speed with better recognition precision than conventional systems. >

This paper introduces a DSS generator-actDSS, its principle and implementation approach. ActDSS is formalized based an a hierarchical goal seeking system model of general system theory (GST), and has been successfully used to solve many actual decision problems.

From June 1994 to July 2001, 92 consecutive patients underwent total aortic arch replacement using hypothermic selective cerebral perfusion. Forty-four patients had nondissecting fusiform or saccular aneurysms (non-ruptured 34, ruptured 10), and 48 patients had dissection (acute 37, chronic 11). Hospital mortality rate was 6.8% in the nondissecting group and 6.3% in the dissecting group. No major operative cerebral complications were observed. There were 9 late deaths in the nondissecting group and 5 late deaths in the dissecting group. The actuarial survival rate was 61.6% after 100 months in the nondissecting group and 82.5% after 86 months in the dissecting group (p = 0.5128). In the postoperative aortic accidents, there were 2 cases of the descending aortic rupture and 2 cases of cholesterol crystal embolization in the nondissecting group and 3 cases of thoracoabdominal grafting, 2 cases of re-operation in the ascending aorta and 1 case of descending aortic rupture in the dissection group. The actuarial freedom from aortic accidents was 88% after 100 months in the nondissecting group and 80% after 86 months in the dissecting group (p = 0.6908). Our surgical outcome of total aortic arch replacement using hypothermic selective cerebral perfusion are satisfactory.

A 31-year-old man was diagnosed with acute ascending aortic dissection and massive aortic regurgitation following acute type B dissection during drug treatment. Although the aortic arch was not dissected, we performed aortic replacement from the aortic root to the proximal portion of the descending aorta. The aim of the operation was the prevention of aortic arch dissection, and closure of initial entry of type B dissection.

To prevent neurological complications during cardiopulmonary bypass, cerebrovascular screenings by magnetic resonance angiography and computed tomographic scan of the brain were performed preoperatively in patients who had ischemic heart disease and all patients aged 60 years or older. From 1996 to 1999, 173 adult patients (mean age 65.1+/-7.7 y) were evaluated. Forty-one patients were considered to be at high risk from the screening tests and pulsatile cardiopulmonary bypass was applied. The remaining 132 patients were placed in the control group. Postoperative cerebral infarction caused by embolism was encountered in three patients (3/173, 1.7%), two in the high-risk group (2/41, 4.8%) and one in the control group (1/132, 0.8%), but the difference between these incidences was not statistically significant. Cerebral infarctions caused by brain hypoperfusion did not occur in this series. A neuropsychological test (Hasegawa's dementia scale, HDS) was done pre- and postoperatively. No one was diagnosed with dementia preoperatively, whereas 7 patients were diagnosed with dementia postoperatively. Among these 7 patients, 6 patients were in the high-risk group (17.1%, 6/35) and one patient was in the control group (0.9%, 1/113). Under these circumstances, using cerebrovascular screening and pulsatile cardiopulmonary bypass, cerebral infarction due to hypoperfusion did not occur, but cerebral infarction due to embolism was encountered, and neuropsychological dysfunction was not prevented.

Some reports have observed the response of cerebral blood flow to PaCO2 during hypothermic cardiopulmonary bypass. We studied the effect of PaCO2 on the cerebral circulation during hypothermic selective cerebral perfusion.Between June 1992 and January 1998, 35 patients underwent aortic arch grafting using hypothermic selective cerebral perfusion (20 degrees C). In the earlier four patient (Group 1), carbon dioxide gas was not added. In the latter 31 patient (Group 2), carbon dioxide gas was added to the cerebral perfusion. The hemodynamics and rates of change in cerebral oxygen saturation were evaluated.In Group 1, the index of cerebral arterial resistance was 9.2+/-2.2 at the start of selective cerebral perfusion and increased to 15.7+/-0.1 at the re-warming stage (p0.05), and there was a significant decrease in cerebral oxygen saturation at the re-warming stage (p0.001). In Group 2, the index of cerebral arterial resistance was 4.7+/-1.7 at the start of selective cerebral perfusion and 4.3+/-1.5 at the re-warming stage, a non-significant change. The change in cerebral oxygen saturation was also nonsignificant between the start of selective cerebral perfusion and the re-warming stage. Among the neurological outcomes, there was only one small cerebral infarction in Group 2; however, no delayed conscious recovery was observed.The addition of CO2 to cerebral perfusion was a factor in inhibiting the increase in the cerebral vascular resistance at the re-warming stage.

We report the choice of aortic valve reconstruction, surgical results and postoperative results in 22 patients who underwent aortic root replacement between June 1996 and October 1999. We chose the replacement using bio-prosthesis in six patients over 65 years of age and valve preservation or replacement using mechanical prosthesis in sixteen patients under 65 years of age. Ten patients underwent valve replacement using mechanical prosthesis. There was one hospital death and one late death. Six patients underwent valve replacement using bio-prosthesis. There was no hospital death and no late death. Six patients underwent valve preservation. There was one hospital death. There was no event among five patients in the mid-term follow-up, although a longer follow-up must be necessary.

Recombinant human interleukin-6 (hIL-6), a pleiotropic cytokine containing two intramolecular disulfide bonds, was expressed in Escherichia coli as an insoluble inclusion body, before being refolded and purified in high yield providing sufficient qualities for clinical use. Quantitative reconstitution of the native disulfide bonds of hIL-6 from the fully denatured E. coli extracts could be performed by glutathione-assisted oxidation in a completely denaturating condition (6M guanidinium chloride) at protein concentrations higher than 1 mg/mL, preventing aggregation of reduced hIL-6. Oxidation in 6M guanidinium chloride (GdnHCl) required remarkably low concentrations of glutathione (reduced form, 0.01 mM; oxidized form, 0.002 mM) to be added to the solubilized hIL-6 before the incubation at pH 8.5, and 22 degrees C for 16 h. After completion of refolding by rapid transfer of oxidized hIL-6 into acetate buffer by gel filtration chromatography, residual contaminants including endotoxin and E. coli proteins were efficiently removed by successive steps of chromatography. The amount of dimeric hIL-6s, thought to be purification artifacts, was decreased by optimizing the salt concentrations of the loading materials in the ion-exchange chromatography, and gradually removing organic solvents from the collected fractions of the preparative reverse-phase HPLC. These refolding and purification processes, which give an overall yield as high as 17%, seem to be appropriate for the commercial scale production of hIL-6 for therapeutic use.

A case of "aggressive fibromatosis" which appeared in posterior mediastinum is reported. A 50-year-old woman was admitted to our hospital with right shoulder pain. The tumor surrounded the right vertebral artery and infiltrated into the right sympathetic nerve, brachial plexus and muscle tissue. It was suspected of neurogenic tumor by percutaneous needle biopsy. Removal of the tumor and partial resection of the invaded vertebral artery and brachial plexus were made in Aug. 10, 1996. In postoperative examination, the tumor was 6.2 x 6.5 x 4.5 cm in size and diagnosed pathologically as "aggressive fibromatosis". Postoperative course was uneventful, but Horner's symptoms and motor disturbances of IV, V, fingers of the right hand were slightly occurred. Radiotherapy of 60 Gy was done after operation. There is no recurrence to date 17 months after surgery. As for the character of this disease, it seldom metastasizes, but grows infiltratively and the recurrence after operation is an important problem. In particular, the neck and the head are important because surgical margin is not provided enough, anatomically. Therefore, chemotherapy or radiotherapy after operation is needed. In this case, radiotherapy was done after operation. So, there is not the recurrence and passes to date 17 months after surgery. But, follow-up of long terms is necessary because it may recur after postoperative therapies.

A 14-year-old boy with corrected transposition of the great arteries (I.D.D.), atrial septal defect, ventricular septal defect, pulmonary stenosis, mitral atresia and hypoplastic left ventricle was successfully operated. He had undergone modified Blalock-Taussig shunt at the age of two. After atrial septal defect was closed with bovine pericardial patch, small ventricular septal defects were closed directly through left ventricular incision. Then the incisional line on the left ventricle was extended to pulmonary artery. The stenotic and thickened pulmonary valve was excised. The upper part of the incisional line on the right atrium and that on the left ventricle were anastomosed. Consequently the connection between the right atrium and the pulmonary artery was able to be made through hypoplastic left ventricle. This case is extremely rare type in terms of mitral atresia and is classified as Group II, type B according to Eliot's classification. This type of repair is similar to Björk's method, however, we could not make use of left ventricular contraction because it was weak. The merit of this procedure was to be able to reconstruct blood tract without using artificial conduits.

A 28-year-old woman with heart failure was hospitalized at 21 weeks of gestation. Nine years previously mitral regurgitation was diagnosed, and she underwent mitral valve replacement with a Carpentier-Edwards pericardial valve. Echocardiography revealed primary tissue failure of the mitral prosthesis. Emergent mitral valve replacement was performed. Normothermic high-flow high-pressure pulsatile perfusion was performed during cardiopulmonary bypass. Fetal heart rate was monitored, and it remained above 150 bpm throughout the operation. No bradycardia was observed. The degenerated prosthetic valve was replaced with another Carpentier-Edwards pericardial valve to ensure a safe pregnancy and delivery. Pregnancy was carried to term, and a healthy baby was delivered vaginally.

A 55-year-old female afflicted with mitral valve stenosis and atrial fibrillation was admitted to our hospital complaining of chest pain, ST elevation of ECG (V2-5) and elevated CPK value were recognized. She was diagnosed as having acute myocardial infarction, and percutaneous transluminal coronary recanalization was performed immediately. The coronary angiogram showed occlusion by the thrombus at the proximal left anterior descending branch (#7), even, left ventriculogram showed ventricular aneurysm on the anterior wall. But these lesions could not be recanalized by 960,000 IU urokinase administration. She underwent aneurysmectomy and mitral valve replacement with 27 mm SJM prosthesis. When mitral valve stenosis accompanied with left ventricular aneurysm we considered in order to improve left ventricular function, it is necessary to undergo not only mitral valve operation but left ventricular aneurysmectomy aggressively.

A five-year-old boy was admitted to our hospital because of a cardiac murmur and an abnormal electrocardiogram. He had a distinct pattern of facial features and mild mental and developmental retardation. An aortogram revealed that the aorta was hypoplastic from just above the Valsalva sinuses to the aortic arch. Moreover, the basal portions of the arch vessels were also hypoplastic. A diagnosis of diffuse supravalvular aortic stenosis was made. The pressure gradient between the left ventricle and the descending aorta was 74 mmHg on catheter examination. Surgical therapy was therefore indicated. The hypoplastic lesions of the aorta and arch vessels were enlarged with a Dacron patch under cardiopulmonary bypass and deep hypothermic circulatory arrest. The postoperative course was uneventful. The pressure gradient decreased to 7 mmHg on catheter examination. This type of supravalvular aortic stenosis is quite rare. Further follow-up is required to evaluate long-term outcome.

A 59-year-old man came to our hospital because of hoarseness and chest pain. On initial examination, a chest roentgenogram showed no abnormality. Three weeks later, while the patient was waiting to undergo a computed tomographic (CT) scan, shock suddenly developed. A chest roentgenogram revealed an extremely wide mediastinal shadow. A CT scan revealed rupture of the aortic arch near the base of the left subclavian artery, although there was no aneurysm. An emergency operation was performed. The ruptured aortic arch was replaced with an artificial graft during cardiopulmonary bypass with selective cerebral perfusion. A diagnosis of infectious aortitis was not made until a pathologist discovered colonies of gram-positive cocci in the resected specimen of the aortic arch. Postoperatively, antibiotics were administered for only four days. The patient is well about two years after the operation. Infectious aortitis had a very low prevalence and rarely involves the thoracic aorta. However, we should be aware of that it may cause aortic rupture even in the absence of aneurysmal dilatation.

We used retrograde cerebral perfusion (RCP) to protect the brain in patients undergoing aortic arch replacement from May 1991 to July 1992. Subsequently, we have been using selective cerebral perfusion (SCP). In this study, a group of six patients undergoing RPC were compared with 5 patients undergoing SCP with regard to the intraoperative electroencepharogram (EEG) and post operative clinical course. There were no deaths in either group, but transient palsy of the right arm developed in one patient in the RCP group. The amplitude of intraoperative EEG was examined at four points: before cardiopulmonary bypass, during RCP or SCP, at 30 degrees C and at 35 degrees C during rewarming. The EEG amplitude at these four points was expressed as a ratio to the value before cardiopulmonary bypass. The ratios at these four points were 1, 0, 0.08, and 0.19 in the RCP group and 1, 0, 0.70, and 0.90 in the SCP group, respectively. In the SCP group, EEG recovered rapidly, whereas in the RCP group EEG did not recover until the completion of cardiopulmonary bypass in all but one patient. These results indicated that RCP does not provide reliable protection of the brain.

Long-term follow up results of valve replacement with Carpentier-Edwards pericardial bioprosthesis were analysed. From April 1985 to March 1994, a total of 99 bioprostheses were implanted in 92 patients. Aortic valve replacement was performed in 27, mitral valve replacement in 43, combined aortic-mitral valve replacement in 7 and tricuspid valve replacement in 15 patients. The actuarial survival rates at 9 years were 84% (aortic), 59% (mitral), 69% (aortic-mitral) and 76% (tricuspid) respectively. One patient sustained a thromboembolic event after mitral valve replacement, however, none of that complication occurred after aortic or tricuspid valve replacement. Two patients with mitral valve replacement required reoperation because of structural deterioration after 8 years. Five cases of bioprosthetic infection encountered, and three died. Actuarial freedom from overall valve-related complications at 9 years was 97% for aortic, 72% for mitral and 100% for tricuspid valve replacement respectively. There was no structural deterioration of the aortic and tricuspid valve. Actuarial freedom from structural deterioration of the mitral valve was 84% at 9 years. We conclude that the Carpentier-Edwards pericardial bioprosthesis has low incidence of valve related complication within the 9 years time frame of this study.

A 60-year-old man who undergone uneventful mitral valve replacement 9 years and 5 months previously was referred to us because his chest roentgenogram showed rapidly growing abnormal shadow. Two-dimensional echo cardiography revealed a left ventricular pseudoaneurysm. Emergent surgery was performed under the cardiopulmonary bypass. The aneurysm, which arose posteriorly from the base of the left ventricle, had a thin wall that could be separated from the pericardium. It was therefore diagnosed to be a subepicardial aneurysm. Examination of his previously implanted mitral prosthesis (a Duromedicus valve) revealed that the mitral orifice was partially occluded by a thrombus. The Duromecicus valve was therefore removed, and the ruptured left ventricular wall was closed from both outside and inside. A St. Jude Medical valve was then placed in the mitral position. Pseudoaneurysm or subepicardial aneurysm formation is a possible late complication after mitral valve replacement. Physicians and surgeons should be aware of this late complication in patients who had undergone mitral valve replacement because it urgently requires surgical correction.

Background: Pancreatic cancer still remains one of the most lethal diseases among all malignancies. One of the major reasons of this lethality is its invasive and metastatic behavior. Nevertheless, little is known about the molecular mechanisms regulating cell migration in pancreatic cancer cells. CD44 is a family of adhesion molecules and is implicated in the diverse physiological process including cell migration, growth, survival and differentiation. The purpose of this study is to investigate the clinical value of CD44 expression in pancreatic cancer tissues and reveal the detailed roles of this molecule in cancer cells. Materials and methods:We examined the CD44 expression pattern in resected cancer tissues obtained from patients with pancreatic cancer by immunohistochemistry. We investigated the expression of CD44 isoforms in pancreatic cancer using RT-PCR and the influence of inhibition of CD44 in a pancreatic cancer cell line using siRNA. Results:CD44 standard isoform, but not variant isoforms, wasmainly expressed in the lateral membrane of cancer cells. In 87 patients, 68 patients (78.2 %) showed strong CD44 expression in cancer cells, while 19 patients (21.8%) showed weak expression. Patients of strong CD44 expression group showed significantly better prognosis in disease free (p1⁄40.034) as well as overall survival (p1⁄40.002) compared with those in weak CD44 expression group. AsPC-1 cells treated with CD44 siRNA showed significantly more rapid cell migration ability than cells treated with negative control siRNA (p1⁄40.04). Cells inhibited CD44 expression by siRNA showed flat sheet like actin structure forming lamillipodia at the leading edge of the cell, whereas no such structure was seen in cells treated with negative control siRNA. Conclusions: These data suggest that CD44s expression in pancreatic cancer cells inhibits cell migration by the interference with lamillipodia formation, leading to favorable prognosis of the patient. Regulation of CD44 splicing may lead to the discovery of new therapeutic approaches for pancreatic cancer.

Generally speaking, it is difficult to know the occurrence of brain complication until the patient becomes awake from anesthesia. But if we can detect the occurrence of of brain complication during the operation, we can start its therapy even during the operation. In order to detect the occurrence of brain complication during the operation under extracorporeal circulation (ECC), we monitored intraoperative electroencephalogram (EEG). Since June 1992, forty-two patients were operated on using ECC. Usual ECC was applied in 39 cases (Group-A), and circulatory arrest with retrograde cerebral perfusion was applied in remaining three cases (Group-B). We studied the amplitude of EEG using actual value (by Fujimori method), and compressed EEG acquired by slow-paper-feed recording. In terms of the frequency of EEG, we studied compressed spectral array (CSA). In Group-A, there was no brain complication identified after operation. Actual values of amplitude were 23 +/- 4.0 microV (before ECC), 19 +/- 4.0 microV (during ECC), 23 +/- 4.9 microV (after ECC). There was a significant decrease (p0.001) of amplitude during ECC compared with that before ECC. The ratio of amplitude during ECC to that before ECC (D/B ratio) was 0.82 +/- 0.16. The ratio of amplitude after ECC to that before ECC (A/B ratio) was 1.01 +/- 0.15. According to compressed EEG, it was observed that the amplitude changes following the up-down of esophageal temperature. In CSA, influence of esophageal temperature on the power spectrum of alpha and delta wave band was recognized. In Group-B, there was one brain complication identified after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

The majority of infants born with truncus arteriosus associated with truncal valve regurgitation are seen within the first week of life with the manifestation of severe congestive heart failure. The patient reported herein was a 6-day-old male with severe congestive heart failure due to massive truncal valve regurgitation. Rastelli operation with simultaneous truncal valve plasty was undertaken. The truncal valve consisted of four cusps. One left cusp was small and prolapsed. The valvuloannuloplasty was performed to the small cusp. The patient was discharged and doing well at six months postoperatively, though mild degree of the truncal valve regurgitation was recognized. We believe that the plasty of truncal valve is an effective surgical procedure for the correction of sever truncal valve regurgitation in neonate.

The effectiveness of wood vinegars was studied for controlling offensive odors from piggery wastes. Odorant chemicals and the sense of odors from piggery farm, covered with polyvinylchloride film to prevent the volatilization to ambient air, were measured in both laboratory and in situ in order to evaluate the degree of deodorization. The results obtained were as follows: 1. The odorant chemicals from piggery wastes were identified as ammonia, methyl sulfide, hydrogen sulfide, butyric acid and valeric acid. Among them, the major chemicals being responsible for the sense of odor were butyric acid and valeric acid. 2. In a laboratory experiment using an air tight vessel, the amount of wood vinegars needed for deodorization of piggery wastes was 6.6%; The removal efficiency of the odorant chemicals volatilized from the wastes was from 70 to 90% of control levels. 3. In situ test at a piggery farm showed that removal efficiency of odorant chemicals was similar to that of the laboratory experiment. In sensory tests, authorized by the Environmental Protection Agency of Japan, minimal offensive odors were observed with the addition of 6.6% wood vinegars. Furthermore, flies were rarely observed, indicating that wood vinegars may play an important role as a repellent.

Fifteen patients with small aortic annuli underwent aortic valve replacement either isolated or combined with other procedures. All patients had aortic valve replacement with Björk-Shiley prosthesis larger than the aortic annulus. The prosthesis was sutured in a supraannular position in the area corresponding to the noncoronary sinus. There was no hospital and late death. In the long term follow up, 21 mm prosthetic gradients by doppler method ranged from 17 to 43 (29.9 +/- 7.3) mmHg in patients with supraannular aortic valve replacement and from 20 to 45 (27.4 +/- 7.1) mmHg in patients with standard aortic valve replacement, which showed statistically no significant difference. Because this technique allows the insertion of prosthetic valves one sizes larger than the size of aortic annulus, it will produce stable hemodynamic result. As a consequence, those procedure such as transannular patch reconstruction will be avoided.

Aortico-left ventricular tunnel is an extremely rare congenital heart disease. Although there are dozens of English-written literature about this condition, we could not find any report in Japanese. Our patient was a boy whose illness was diagnosed as aortico-left ventricular tunnel when he was three years old. Soon after the diagnosis was made he underwent surgical correction. The orifice of tunnel was closed using EPTFE patch at the aortic side and at the left ventricular side was closed directly. Postoperatively moderate degree of aortic valvular regurgitation was remained. Three years after the surgical correction, now the boy is six years old and doing well. But we anticipate that he man need aortic valve replacement in the near future.

This is the case report of a 52 years old female patient operated with Cabrol's method for the inflammatory lesion of the aortic root in Behçet's disease. The diagnosis of incomplete type of Behçet's disease had already been established 4 years ago and the patient had been taking regular check-up since then. About one year ago, newly developed cardiac murmur compatible with aortic regurgitation was detected and the patient was subsequently referred to us for the surgical repair. Although aortic valve replacement (AVR) was attempted first, Cabrol's method was lastly chosen, since inflammatory features on the surface of the ascending aorta associated with slight aortic annular dilatation were observed during the procedure and it was easily anticipated that these might induce postoperative paravalvular leakage and pseudoaneurysm, if AVR were performed. Two weeks after the surgery, the patient developed aphthous stomatitis associated with several other evidences of inflammatory recurrence, the steroid therapy was instituted with prednisolone. Post operative progress was uneventful and the patient has been completely well at the 6th month after the surgery. In conclusion, it is strongly recommended the Cabrol's method should be chosen to prevent post operative unfavourable complications, whenever any evidence of inflammation is observed around the aortic root area.

The effectiveness of wood vinegars reducing or eliminating offensive odors, associated with cattle breeding, was studied. The results obtained were as follows: 1. Analyzed were 0.7-7.2% acetic acid and 0.5-1.8% methyl alcohol as main contents. 2. Gaseous odorants, such as ammonia, trimethylamine, n-butyric acid were almost eliminated through absorption using 1-20% wood vinegar solutions. 3. The same gaseous odorants, mentioned above, when confined to an airtight vessel, were eliminated in a short time by adding a little volume of wood vinegars to it. The effect was maintained for 2 weeks. 4. A sensory test was performed to evaluate the degree of deodorization, such as odor intensity and odor acceptability. Results showed that wood vinegars have a good deodorant effect on the offensive odors.

A new method for optical microscopy with super-resolution exceeding the Rayleigh limit was developed to observe the shape of particles contaminating the LSI patterned wafer in the far- field. The principle of the new method is as follows. The optical spot being smaller than the measured particles has to be scanned on the particle to measure the shape of particles on the wafer. The phase-shifting mask making small optical spot consists of the checkered mask which has been coated with a transparent layer patterned to ensure that the optical phases of the nearest apertures are opposite. The destructive interference between the two opposite phases of light waves from adjacent apertures cancels some diffraction effects and increases the spatial resolution, so that the size and resolution of the coherent laser spots can exceed the size limit of the Airy disk and resolution of Rayleigh limit. The new method for optical microscope with super resolution was examined theoretically and experimentally. The coherent beam generated from 15 mW He-Ne laser projected to the phase-shifting checkered mask forms small laser spots of which size are under 0.1 micrometers in diameter. It is clarified that in the far-field, the scattered light from two spots with opposite phases on the wafer can be observed in exceeding with Rayleigh limit.

The retroviral gene transfer system is a powerful tool for somatic gene therapy. A retroviral stock with a high viral titer and lacking replication-competent virus (RCV) is desirable for this type of gene transfer. To fulfill these requirements, we made a new packaging cell line, designated ampli-GPE. To reduce the homology between proviral DNA in the packaging cell and retroviral vector, the gag-pol and env genes of Moloney murine leukemia virus were separated onto two different plasmids, pGP-KV and pENV-KV, respectively, in which the 5' long terminal repeat and the 3' long terminal repeat had been replaced by the mouse metallothionein I promoter or the human beta-globin gene containing the polyadenylation site as control units for the gag-pol and env genes. In addition, these plasmids contained 69% of the bovine papillomavirus gene for gene amplification to obtain production of virus at a high titer. NIH 3T3 clones containing approximately 20 to 50 copies of the gag-pol and env genes were selected and designated ampli-GPE. When ampli-GPE was transfected with the N2 vector or pZipNeoSV(DHFR) derived from pZipNeoSV(X)1, we established clones producing titers of 5 x 10(6) and 1 x 10(6) CFU/ml, respectively. There was no sign of RCV generation in any virus-producing cells from ampli-GPE. However, virus-producing cells derived from psi 2 cells transfected with N2 did generate RCV. Thus, we showed that ampli-GPE, possessing the minimum complement of proviral genes, has potential for the development of a gene transfer system.

A twelve-year-old boy associated with Noonan's syndrome is reported. He had supravalvular pulmonary stenosis with a very high right-ventricular pressure, higher than that of systemic. Surgical treatment was performed to the supravalvular pulmonary stenosis with the technique of Doty's operation for supravalvular aortic stenosis, brought an excellent results. The gradient between the right ventricle and the pulmonary artery fell from 97 mmHg to 30 mmHg. The residual gradient is caused by functional infundibular stenosis. Doty's operation is a useful method for the operation of severe supravalvular pulmonary stenosis, too.

Since December 1985, we used Greenfield filter in 8 patients to prevent pulmonary embolism. Mean follow-up period was 42 month. Recurrence of pulmonary embolism was suspected in one patient after perfusion lung scan. Another patient died from other reasons. Occlusion of the inferior vena cava was not suspected in any patient clinically. Tilting and distal migration of the filters occurred frequently. 3 filters tilted greater than 5 degrees compared with the position immediately after their placement. 5 filters migrated distally more than half the length of a lumbar vertebra. Although there was no severe complications in our series, we should pay attention especially to the position and angle of the filters, since an extreme tilting position of the filter could be a possible cause of serious complications.

Two reoperative cases of annuloaortic ectasia are reported. Since they have problems such as adhesion and friability of tissues, bleeding from each anastomosed sites must be watched carefully. Especially, anastomoses of aortic annulus and the composite graft, coronary ostia and the interposed conduit are important. Appropriate anastomosis of aortic annulus needs flexibility at the proximal edge of the composite graft. It can be achieved by sewing Björk-Shiley prosthetic valve about 5 mm distant from the proximal edge of the composite graft. Cabrol's method is good for anastomoses of coronary ostia because easily visualized and less stressed anastomoses can be performed. Therefore Cabrol's method with flexible edge of the composite graft at the proximal site is a useful technique in the reoperation of annuloaortic ectasia.

A 60-year-old female with mitral stenosis developed prosthetic valve endocarditis due to methicillin resistant staphylococcus aureus septicemia 3 weeks after mitral valve replacement. In vitro test disclosed susceptibility to minocycline and clindamycin. Despite large amount of intravenous administration, progressive heart failure due to massive perivalvular leakage occurred as a consequence of persisting infection. An emergent operation revealed valve detachment of the posterior portion resulting from ring abscess formation. A mitral prosthesis with a Gore-Tex flange was implanted partially in the left atrium just above the mitral ring and sutured to the atrial wall. Postoperative relapse was not detected even after discontinuing antibiotics. Prosthetic valve endocarditis due to methicillin resistant staphylococcus aureus is highly resistant to antibiotic therapy and likely to develop valve ring abscess. Prompt surgical treatment is mandatory in this situation.

We have intended to improve gene-transfer technique into hematopoietic stem cells for somatic gene therapy. 1) We have developed a new packaging cell line, ampGPE for retroviral production. LTR-less gag, pol or env genes from Moloney murine leukemia virus were separately inserted into BMGNeo vector. Packaging cell lines containing 20-50 copies of these two kinds of plasmid were obtained. Retrovirus stock for gene-transfer have been produced at a high titer (10(5)-10(6) cfu/ml) and without replication-competent viruses by using ampGPE. 2) Retrovirus-transduced murine CFU-GM have been found to selectively proliferate (5-10 fold/week) in liquid capture with recombinant murine IL-3, human IL-6 and G418 to consequently obtain enough amount of, highly concentrated (70-100%), and gene-transferred murine CFU-GM for gene-delivery system.

A 47-years old man presented with life-threatening paroxysmal supraventricular tachycardia. Electrophysiological study revealed both paroxysmal atrial tachycardia and atrioventricular reentrant tachycardia. The earliest site of activation during paroxysmal atrial tachycardia was located on the cranial portion of the left atrium and just behind the aorta. The atrioventricular accessory passway was located at the posterolateral wall of the left ventricle. Cryosurgical ablation was performed to the cranial portion of the left atrium and the accessory passway was interrupted from inside of the left atrium under the cardiopulmonary bypass. In the postoperative electrophysiological study, neither atrial tachycardia nor atrioventricular reentrant tachycardias was inducible. Since then he has never experienced tachycardia attack for one year.