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In the autonomous driving era, automotive architecture has been rapidly progressing toward electronic control unit (ECU) integration and centralization. Advanced vehicle control is becoming increasingly important for safe driving. It requires microcontroller unit (MCU) integration, the highest automotive safety integrity level (ASIL), and network performance improvement. A 28-nm 600-MHz automotive flash MCU has been developed for next-generation automotive architecture. The MCU for vehicle control integrates three key features: a virtualization-assisted processor (VAP) for functional safety, a built-in self-test in the field (field-BIST) at a sleep resume (SR) BIST for functional safety, and a serial gigabit media independent interface (SGMII) for the in-vehicle network. The VAP helps the hypervisor to realize real-time virtualization to execute several different virtual machines without interference. The SR-BIST realizes random hardware failures per hour of 10−8 in various automotive applications. In the SGMII circuit, we used 5-V transistors for high reliability despite their narrow bandwidth. The automotive MCU satisfies the ISO26262 ASIL D system requirements with a low power consumption of 0.52 W. The VAP can realize the severe automotive control hard real time capability.

It is getting mandatory to comply with ISO26262 in the recent automotive development. The implementation of safety mechanism to detect faults is one of the keys in ISO26262. The fault prediction will make the automotive system more reliable. The SoC in this paper introduces two features: hardware built-in self-test (BIST) for safety mechanism supporting automotive safety integrity level (ASIL) B and killer-droop monitor for fault prediction. In addition, time slicing is introduced to the testing with hardware BIST during runtime so that each test session can be shorter than the required interrupt response time in the application. The killer-droop monitor can predict the voltage droop and stop the clock supply for a certain period of time to mitigate the droop for preventing delay faults on the SoC. The monitor samples the voltage based on time-to-digital converter at CPU operation clock and predicts the voltage from the history of sampled voltage. With that prediction feature, the minimum operation voltage can be improved by 50 mV at 2.02 GHz CPU operation, and the maximum frequency can be improved by 140 MHz under 0.82 V power supply in 16 nm process.

Automotive architecture has been rapidly progressing toward integration and centralization [1]. Integration of multiple electronic control units (ECUs) reduces vehicle weight by deleting the wire harness between ECUs and the cooperative control of multiple functions, resulting in energy savings. The power consumption of automotive MCUs must be single-digit Watts under thermal constraints, and many functions have to be squeezed into one MCU. Adoption of a 28nm process is necessary for speed, power and density, because a conventional 40nm embedded flash process is insufficient on these axes. Furthermore, the integration of ECUs also mixes software components with varying safety integrity levels in one MCU. Resource isolation is inevitable for functional safety to avoid latent faults. In the autonomous driving era, data size and performance requirements will increase owing to the number and complexity of sensors requiring fusion in real time. Fast networks within vehicles are vital. With the evolution of sensor fusion, information centralization, and control decentralization, automotive architectures have been progressing toward increased integration and centralization.

The seven papers in this session highlight developments in security building blocks and clock generation. Improvements to random number generators and physically unclonable functions provide lower error rates and lower susceptibility to side-channel attacks. The digital PLLs presented are designed with synthesized logic, and incorporate a variety of features, including dynamic self adjustment to optimize noise and power, a noise-isolation LDO, and seamless lock ranges.

Electric Vehicle / Hybrid-Electric Vehicle (EV/HEV) technologies are becoming increasingly important for realizing fuel-efficient vehicles. In particular, maximizing the energy efficiency of motors, while enhancing power and speed requires high-performance semiconductor devices, such as microcontrollers (MCU) and power devices. However, high-performance MCUs suitable for EV/HEV applications have yet to be reported, while attractive power devices, such as SiC devices, are becoming commonplace [1]. In this paper, we have designed an MCU architecture with intelligent motor-timer system (IMTS), including 0.8µs high-speed field-oriented-control (FOC) processing and an angle-tuning circuit (ATC). We have also designed a functional safety mechanism essential for automotive use [2].

We propose low-leakage current embedded SRAMs with high-performance for mobile applications. The proposed SRAM has two standby modes depending on temperature; one is a low-voltage resume-standby mode to reduce the standby current (ISTBY) more effectively at room temperature, and the other is the conventional resume-standby to reduce ISTBY effectively at high temperature. These schemes are implemented in a single SRAM macro with an all-digital current comparator (ADCC) that chooses either mode by monitoring ISTBY automatically. ADCC has a time to digital converter (TDC) which is suitable for leakage measurement. Moreover, the proposed monitoring sequence can compensate the error of the measurement caused by the variation of the MOSFETs. A test chip was fabricated using 28 nm HKMG CMOS technology. The proposed 32 kb SRAM achieves 0.41 μA standby leakage which is half of the conventional value. This SRAM also realizes a high-speed operation with an access time of 420 ps.

The role of car information systems (commonly referred to as car infotainment) is expanding from dedicated navigation systems to joint car-cockpit systems, including the dashboard meter, telematics for the internet/cloud, and advanced driver-assistance systems (ADASs), such as adaptive cruise control and a pre-crash safety system. The expanding role for car information systems requires higher computational performance, but also safety mechanisms which prevent serious accidents. This paper presents an SoC for the next generation of car infotainment, achieving high performance powered by nine heterogeneous CPUs and a high level of safety, complying with ISO26262 ASIL-B. It has two key features: 1) Run-time test for functional safety, which can detect wear-out faults, such as random fault, time-dependent dielectric breakdown, and electromigration; 2) A killer-droop (critical voltage droop) monitor with droop prediction, which can avoid a delay fault caused by voltage droop.

Aneurysm of the ductus diverticulum in the adult is rare and its rupture is fatal. A 75-year-old man presented with congestive heart failure that suddenly occurred with a continuous murmur. Angiography showed a left-to-right shunt through a large thrombosed aneurysm of the ductus diverticulum (6 cm), and the pulmonary-to-systemic flow ratio was 2.6. Patch closure of the orifice (3x4 cm) of the aneurysm and repair of the perforated pulmonary artery were done emergently under hypothermic cardiopulmonary bypass with selective cerebral perfusion. He recovered uneventfully. Early recognition and early intervention should be indicated in this otherwise fatal condition.

This paper describes a three-dimensional (3-D) system integration of a full-fledged processor chip and two memory chips using inductive coupling. To attain a 3-D communication link with a smaller area and lower power-consumption, shortening the link distance and preventing signal degradation due to unused inductors are important challenges. Therefore, we developed a new 3D-integrated wire-penetrated multi-layer structure for a shorter link distance and an open-skipped-inductor scheme for suppressing signal degradation. In addition, to avoid undefined-value propagation in stacking multi-memories using an inductive-coupling link, we proposed a memory-access-control scheme with a pinpoint-data-capture scheme. We demonstrate that three fabricated chips can be successfully AC-coupled using inductive coupling. The power and area efficiency of the link are 1 pj/b and 0.15 mm2 /Gbps, respectively, which are the same as those of two-chip integration.

In aortic arch surgery, two pumps are required for systemic perfusion and selective cerebral perfusion (SCP). A new technique with a single centrifugal pump for systemic perfusion and SCP was developed and its efficacy and safety evaluated. This technique was adopted for total arch replacement in 22 consecutive patients with true aneurysms (13) and aortic dissection (nine) from January 2005 to January 2008. Cerebral perfusion lines branched from the main perfusion line. During SCP, right radial arterial pressure was maintained at 50 mm Hg and left common carotid arterial pressure at 60 mm Hg, and the regional cerebral oxygen saturation (rSO(2)) values were maintained at approximately >80% of the baseline value. Two operative deaths (9%) occurred due to pneumonia and hemorrhage in the left lung, respectively. Stroke occurred in one patient (5%). This simple circuit system can thus be easily and safely applied for aortic arch surgery.

左室心筋緻密化障害は胎生期に左室心筋の緻密化が障害された先天性の心筋症であり，心不全が進行する予後不良の疾患である．最近では成人例の報告も散見されるようになり，成人例左室心筋緻密化障害に開心術を施行した報告もされている．今回著者らは，成人例左室心筋緻密化障害に陳旧性心筋梗塞を合併した症例に対して冠動脈バイパス術を施行したので報告する．症例は54歳男性．労作時呼吸苦を主訴に入院となり，心エコーにて左室緻密化障害を伴う左心機能障害（LVEF 25%）を認めた．また，冠動脈造影では#1，#6の完全閉塞を含む3枝病変を認めた．心筋シンチ，心臓MRIでは前壁心尖部のviabilityはないものの，前壁基部から中部にかけてはviabilityが存在した．保存的に心不全をコントロールした後，冠動脈バイパス術を施行した．術後の経過は良好で，術後7日目に退院した．術後1カ月時のLVEFは52%に改善していた．左室緻密化障害は進行性に心機能の低下をきたす可能性があり，本症例においても今後は綿密に経過観察していく必要があると考えられた．

症例は80歳男性，両側の下腿浮腫を主訴に当院を受診した．精査の心エコーにて右房内に可動性を有する33mm大の腫瘍ならびに三尖弁閉鎖不全を認めた．塞栓症の危険性を考慮し，準緊急的に手術を施行した．体外循環下に右房自由壁を含めて腫瘍摘出および三尖弁輪縫縮術を施行した．術後の病理検査では脂肪腫と診断され悪性所見は認めなかった．術後経過は良好で下腿浮腫も消失し術後12日目に軽快退院した．術後遠隔期には術前から存在していた心房細動も消失した．

Hierarchical power distribution with a power tree has been developed. The key features are a power-tree structure with three power-tree management rules and a distributed common power domain implementation. The hierarchical power distribution supports a fine-grained power gating with dozens of power domains, which is analogous to a fine-grained clock gating. Leakage currents of a 1 000 000-gate power domain were effectively reduced to 1/4000 in multi-CPU SoCs with minimal area overhead

We have developed an application processor optimized for 3G cellular phones. It provides high energy efficiency by using various low power techniques. For low active power consumption, we use a hierarchical clock gating technique with a static clock gating controlled by software and a two-level dynamic clock gating controlled by hardware. This technique reduces clock power consumption by 35%. And we also apply a pointerbased pipeline to in the CPU core, which reduces the pipeline latch power by 25%. This processor contains 256 kB of on-chip user RAM (URAM) to reduce the external memory access power. The URAM read buffer (URB) enables high-throughput, low latency access to the URAM while keeping the CPU clock frequency high because the URAM read data is transferred to the URB in 256-bit widths at half the frequency of the CPU. The average miss penalty is 3.5 cycles at the CPU clock frequency, hit rate is 89% and the energy used for URAM reads is 8% less that what it would be for URAM without a URB. These techniques reduce the power consumption of the CPU core, and achieve 4500 MIPS/W at 1.0V power supply (Dhrystone 2.1). For the low leakage requirements, we use internal power switches, and provides resume-standby (R-standby) and ultra-standby (U-standby) modes. Signals across a power boundary are transmitted through μI/O circuits to prevent invalid signal transmission. in the R-standby mode, the power supply to almost all the CPU core area, except for the URAM is cut off and the URAM is set to a retention mode. In (he U-standby mode, (he power supply to the URAM is also turned oil for less leakage current. The leakage currents in the R-standby and in the U-standby modes are respectively only 98 and 12 μA. For quick recovery from the R-standby mode, the boot address register (BAR) and control register contents needed immediately after wake-up are saved by hardware into backup latches. The other contents are saved by software into URAM. It takes 2.8 ms to fully recover from R-standby.

An on-chip 1-Mb SRAM suitable for embedding in the application processor used in mobile cellular phones was developed. This SRAM supports three operating modes - high-speed active mode, low-leakage low-speed active mode, and standby mode - and uses a subdivisional power-line control (SPC) scheme. The combination of three operating modes and the SPC scheme realizes low-power operation under actual usage conditions. It operates at 300 MHz, with leakage of 25 /spl mu/A/Mb in standby mode, and 50 /spl mu/A/Mb at the low-leakage active mode. This SRAM also uses a self-bias write scheme that decreases of minimum operating voltage by about 100 mV.

A shared n-well layout technique is developed for the design of dual-supply-voltage logic blocks. It is demonstrated on a design of a 64-bit arithmetic logic unit (ALU) module in domino logic. The second supply voltage is used to lower the power of noncritical paths in the sparse, radix-4 64-bit carry-lookahead adder and in the loopback bus. A 3 mm/sup 2/ test chip in 0.18-/spl mu/m 1.8-V five-metal with local interconnect CMOS technology that contains six ALUs and test circuitry operates at 1.16 GHz at the nominal supply. For target delay increase of 2.8% energy savings are 25.3% using dual supplies, while for 8.3% increase in delay, 33.3% can be saved.

Ductus arteriosus aneurysm is rare in adults and preoperative diagnosis has not been usually done. We report 2 cases of adult type ductus arteriosus aneurysm. In both cases, 3D computed tomographic scanning showed a saccular aneurysm originating from the distal aortic arch toward the left pulmonary artery, which had a notching in the orifice of the aortic side. They were successfully treated surgically though one was a ruptured aneurysm to the left pulmonary artery. In these cases, 3D-CT scan was of great value in the preoperative diagnosis of the ductus arteriosus aneurysm.

This paper reviewed aortic root replacement with a stentless xenograft for Stanford Type A aortic dissection. Total aortic arch replacement plus aortic root reconstruction with a stentless xenograft was conducted in 2 patients with acute aortic dissection. In another 2 patients, aortic root replacement with a bioprosthesis was performed for chronic redissection of the aortic root which might be associated with the previous use of gelatin-resorcin-formalin glue. Full root replacement using this device is safe, reliable, reproducible, and technically less demanding. This device also provides a radical option for acute aortic dissection even in patients requiring concomitant aortic arch and root replacement.

One of the serious problems in longer size tracheal transplantation is severe stenosis of the graft, probably caused by an inadequate blood supply. We have previously reported that removal of some cartilage rings of the graft and omentopexy helps to provide sufficient blood flow to the graft mucosal tissue and results in satisfactory survival and non-significant graft stenosis in extended tracheal autotransplantation. However, it is unclear whether this method can be applied to extended tracheal allotransplantation that requires immunosuppression. In this report, we describe midterm results of extended tracheal allotransplantation with the technique.Twenty-four adult mongrel dogs were used. In 18 dogs, a nine-cartilage-ring length of the trachea was allotransplanted when five cartilage rings of the graft were removed, leaving two rings intact at both ends of the graft for simple fixing to the recipient. Two artificial tracheal rings outside the graft and a stent inside the graft were used for maintaining the lumen width. Omentopexy was done for sufficient blood supply to the graft. FK 506 (0.1 mg/kg) was given on each day after the operation in Group A (n = 10), but was not given at all in Group B (n = 8). In Group C (n = 6), a nine-cartilage-ring length of the trachea, without removal of any cartilage ring, was transplanted into the recipient dog and covered with an omental pedicle flap. The same dose of FK 506 as that used in Group A dogs was given to Group C dogs.In Group A, 2 dogs died of graft stenosis within 9 weeks after surgery and 1 died of emaciation without tracheal stenosis. Seven dogs (70%) survived until time of killing. Among the 8 dogs in Group B, 6 died of graft stenosis within 9 weeks after surgery, with 1 dying of pneumonia and only 1 (13%) surviving for1 year until killing. In Group C, all 6 dogs died of graft stenosis within 6 weeks after surgery. Survival at 16 weeks after surgery was 70% in Group A, 13% in Group B and 0% in Group C (p0.01, A vs B and C). No significant graft stenosis was found in 6 dogs and mild stenosis was found in 2 dogs at the time of death or killing in Group A (80%), whereas mild stenosis was found in only 2 dogs in Group B (25%) (p0.05). Mucosal blood flow of the graft in Group A was higher than that in Group C and was the same as that in Group B within 4 weeks after surgery; however, it remained unchanged to ultimately be higher than in Group B at 6 and 8 weeks after surgery.Removal of some cartilage rings, omentopexy and immunosuppression improved blood supply to the graft and resulted in good survival and non-significant tracheal stenosis in extended tracheal allotransplantation.

Epidemiological studies have demonstrated a causal link between tobacco smoking and lung cancer. We investigated the association between inactivation of the p16 gene and tobacco smoking in 51 non-small cell lung cancers (NSCLCs). Aberrations of the p16 gene were studied by PCR single-strand conformation polymorphism analysis, followed by direct sequencing, microsatellite analysis, methylation-specific PCR, and immunohistochemistry. Mutations were detected in 3.9% (2/51) of the tumors; the tumors carrying mutations were from smokers. The incidences of loss of heterozygosity, homozygous deletion, and promoter methylation in 37 smokers vs. 14 non-smokers were; 45.9% vs. 28.6%, 16.2% vs. 7.1%, and 35.1% vs. 7.1%, respectively. Among these, only the association between promoter methylation and tobacco smoking was statistically significant (P < 0.05). Therefore, epigenetic aberration is considered to be a major causative event in p16 silencing by tobacco smoking. Loss of p16 protein expression was apparent in 49% (25/51) of the tumors, and was associated with tobacco smoking (P < 0.05) and with histological type (P < 0.05). These findings suggest that tobacco smoking leads to inactivation of the p16 gene mainly through the epigenetic mechanism, ultimately increasing the risk of NSCLC, especially the squamous cell histological type.

The four papers in this session highlight developments in system-on-chip (SoC) blocks essential to continue scaling trends. These include fabrics required for high throughput, as well as blocks needed for secure systems and temperature sensors to achieve target power requirements. These designs are demonstrated in recent technologies with low area and low power overhead that enables ease of use in SoC design.

The effects of Duraflo II heparin coated cardiopulmonary bypass circuits, low-dose aprotinin, and steroids on the coagulation system, endothelial damage, and cytokine release were evaluated by comparing those treated with low-dose aprotinin and steroids. Twenty-four adult patients undergoing coronary artery bypass grafting, aortic valve replacement, or valve repair surgery were randomly assigned to 2 groups: either heparin-coated (Duraflo group, n = 12) or noncoated equipment (noncoated group, n = 12) groups. In the Duraflo group, the cardiopulmonary reservoir was also coated with heparin. There were no significant differences in age at the time of operation, aortic cross-clamp time, cardiopulmonary bypass time, and rectal temperature during cardiopulmonary bypass. Standard systemic heparinization was performed. Methylpredonisolone and low-dose aprotinin were given in both groups of patients. Serum XIIa factor, TAT, and IL-6 were significantly higher in the control group than in the Duraflo group during cardiopulmonary bypass (p < 0.01). Serum IL-8 was significantly higher in the control group than in the Duraflo group at 24 h after cardiopulmonary bypass (p < 0.05). No significant difference was found in serum thrombomodulin and TNF-alpha; both were within normal during the study period. These results indicate that the use of Duraflo II heparin coated equipment and a heparin-coated cardiopulmonary reservoir suppressed excess coagulation and inflammatory reaction induced by cardiopulmonary bypass.

Background . Optimal conditions for deep hypothermic perfusion and protective brain blood flow remain unclear. Methods . Dogs (n = 52) underwent 120 minutes of cardiopulmonary bypass at 20°C with perfusion flow rates of 2.5, 5, 10, 20, 40, and 100 mL · kg −1 · min −1 . We examined the effect of the various flow rates and different perfusion pressures on brain blood flow, metabolism, and intracellular pH. Results . The brain was ischemic and acidotic when the perfusion flow rate was less than 5 mL · kg −1 · min −1 and pressure was less than 10 mm Hg. When perfusion pressure was higher than 10 mm Hg, cerebral cortex blood flow was more than 9 mL · 100 g −1 · min −1 and intracellular pH, higher than 6.95. The cerebral metabolic rate for oxygen decreased at a flow rate of 2.5 mL · kg −1 · min −1 . The cerebral metabolic ratio of glucose to oxygen and the cerebral vascular resistance were lowest when perfusion pressure was 10 to 30 mm Hg. Full-flow (100 mL · kg −1 · min −1 ) perfusion caused paradoxical brain acidosis; a flow of 40 mL · kg −1 · min −1 provided the best results. Conclusions . Both extremely low-flow perfusion and excessive perfusion cause brain acidosis. Low-flow perfusion at a pressure of 20 mm Hg provides cerebral vasorelaxation and aerobic metabolism during operations at 20°C.

In this study, a detection algorithm for suction and regurgitation of the centrifugal pump during left heart bypass without relying on external flow or pressure sensors was developed and evaluated in acute studies using adult goats. The detection scheme relies on power spectral density (PSD) analysis of the motor current waveform through which the waveform deformation index (WDI) is obtained. This index is defined as the ratio of the fundamental component of the PSD to the higher PSD components, and its value increases with the deformation of the basic waveform. By assuming that the undistorted motor current waveform can be represented by a pure sine waveform, we theoretically synthesized various waveforms which have different second harmonic components. We were able to synthesize the waveform whose shape was close to the distorted motor current waveform under varying suction levels obtained in a mock loop study. From this study, we came to the conclusion that the WDI value of 0.2 can serve as a threshold level in deciding the suction and regurgitation speeds (rpm) during left heart bypass. In the study using adult goats, we were successful in minimizing both regurgitation and suction when the centrifugal pump speed was adjusted based on the WDI algorithm. The resultant bypass flow ranged from 1.5 to 2.0 L/min which was around 60% of the total flow. Further study is underway to evaluate the applicability of the WDI method in optimizing bypass pump flow.

A 37-year-old woman presented severe cough for several years. Chest X-ray showed an abnormal shadow in the right upper lung field. That was absent but hyperlucent before onset. Chest CT scan revealed a mass shadow with mucoid impaction in the right S2. Thoracoscopic right upper lobectomy dramatically improved her complaints. Histological examination revealed the dilated bronchus containing mucoid impaction and confirmed a diagnosis of congenital bronchial atresia. It was suggested that organizing pneumonia resulting from repeated infection caused severe cough. Thoracoscopic surgery for congenital bronchial atresia should be recommended in young patients.

症例は40歳女性, 月経周期に一致して2度の右気胸を発症した.胸部CT等にて明らかなブラ, ブレブを認めず, 月経随伴性気胸を疑い胸腔鏡下手術を施行した.肺に病変を認めず, 横隔膜腱中心前方に数個の小孔を認め, 胸腔鏡下に同病変を切除した.術後の病理学的検査にて子宮内膜間質組織が証明された.術後14ヵ月の現在, 気胸の再発を認めず支障のない日常生活を送っている.

Deep hypothermic retrograde brain perfusion is used to protect the brain during aortic arch operations. However, all experiments have failed to demonstrate retrograde blood flow in the brain tissue. We developed an experimental model of sagittal sinus and simultaneous superior vena cava perfusion. Brain tissue blood flow was mapped with colored microspheres during deep hypothermic retrograde brain perfusion in 9 dogs. Regional brain pH was mapped photometrically using neutral red as a pH-indicating dye after 90 min of retrograde brain perfusion in 28 dogs and after 60 min of circulatory arrest in 8 dogs. Cerebral surface blood flow was also measured during retrograde brain perfusion. They were analyzed as functions of driving pressure between sagittal sinus and aorta. Total brain blood flow (ml/min/100 g) was 1.4 +/- 1.3, 3.8 +/- 2.6, and 4.6 +/- 2.6 when the driving pressure was 15, 25, and 35 mmHg, respectively (P < 0.05, 15 mmHg vs 25 mmHg). Regional cerebral blood flow (ml/min/100 g) with a driving pressure of 25 mmHg was 12.1 +/- 9.4, 7.0 +/- 5.6, 4.4 +/- 2.8, and 2.2 +/- 1.4 in the frontal cortex, anterior, mid, and posterior cerebrum, respectively. Cerebral cortex pH was 6.86 +/- 0.23, 7.15 +/- 0.18, and 6.46 +/- 0.13 after 90 min of retrograde brain perfusion with driving pressure of less than 20 mmHg, after that of above 20 mmHg, and after 60 min of circulatory arrest, respectively. Brain tissue pH, blood flows measured with microspheres, and laser flowmetry were highest when driving pressure was between 25 and 35 mmHg. We conclude that retrograde brain perfusion may provide maximum brain protection with driving pressure of 25 to 35 mmHg.

症例は71歳男性, 左上葉肺癌の診断で左上葉切除術, R2aリンパ節郭清術を行い, 術後病理ではT2N0M0, Stage I の扁平上皮癌巣を伴った中分化型腺癌との診断であった.術後8ヵ月後頃より食欲不振出現, 精査にて小腸腫瘍による腫重積症と診断し, 小腸切除を行った.病理診断は当初平滑筋肉腫であった.本症例は初回手術後10ヵ月で癌性心嚢炎を併発し死亡した.病理解剖の結果, 原発巣の肺癌組織は肉腫像を含む中分化型腺癌, 小腸腫瘍は肺癌の小腸転移と結論づけられた.

経過中に腫瘍径が縮小した胸腺カルチノイドの1例を経験したので報告する.症例は65歳, 男性.発熱, 胸痛にて発症した前縦隔腫瘍で抗生剤投与の間に腫瘍長径が60mmから15mmへと縮小した.CT 下生検で確定診断は得られなかったが拡大胸腺摘出術を施行した.腫瘍は被膜内に限局しており, 周囲臓器への浸潤は認められなかった.病理診断にて胸腺原発のカルチノイドと診断した.術後5年経過するが再発の徴候は認めていない.

Background In the repair of total anomalous pulmonary venous return (TAPVR) under cardiopulmonary bypass, esmolol, ultra short acting beta blocker, was applied to obtain low heart rate and weak ventricular contraction under mild hypothermic cardiopulmonary bypass. Methods Five infants aged from 14 to 158 days with an average of 70 days, underwent a primary or palliative repair of TAPVR. The type of anomalous return was supracardiac type (2), infracardiac (2), and intracardiac (1). A primary repair was done in three for isolated TAPVR with bypass time of 65 to 76 minutes, and a palliative repair for two with complex anomalies with bypass time of 64 and 87 minutes. Results There was one operative death from cerebral bleeding in an infant with complex TAPVR who underwent simultaneous pulmonary banding. Conclusion This strategy seems to be applicable in pediatric cardiac surgery when aortic cross-clamping is better to be avoided and the surgery is mainly limited to the atrial level.

A rare case of congenital duodenal atresia (DA) associated with a choledochal cyst (CC) is reported. At 38 weeks of gestation, a 1,610-g girl was born by cesarean section with a prenatal diagnosis of congenital DA. After the disease was confirmed by radiographs, she underwent a duodenoduodenostomy for complete separation of the duodenum with an annular pancreas. Thirty-two months after the initial operation, she developed upper abdominal pain and acholic stools. Abdominal ultrasonography demonstrated a CC and dilated intrahepatic bile ducts. Magnetic resonance cholangiopancreatography showed an anomalous arrangement of the choledochus and the main pancreatic duct. A diffusely dilated extrahepatic bile duct was resected, and a hepaticoduodenostomy was performed after a cholecystectomy. The patient was discharged without complications. We could not find a similar case report in the English literature. Although it is not reported that there is a close relation of DA and CC in embryologic development, the presence of this combination should be considered.

The histopathological features of chronic rejection and its initiation were assessed using rat heterotopic heart transplantation and retransplantation models. Fully allogeneic or minor, non-MHC antigen-mismatch heart grafts transplanted into recipient rats treated with a short course of FK506 showed long-term survival but developed graft atherosclerosis after 40 days posttransplantation. Retransplantation of allografts back into the original donor strain did not prevent graft atherosclerosis if the grafts had resided in the primary recipient for up to 5 days; residence in the primary allogeneic recipient for less than 4 days did not result in graft atherosclerosis in the secondary recipient. Short-course administration of FK506 did not affect the production of these changes. Graft coronary arteriosclerosis begins between 3 and 5 days posttransplantation and progresses without continuous allogeneic immunological drive. The present findings will provide a new means by which to approach the analysis of development of chronic allograft rejection.