Batista procedure with the aid of intraoperative epicardial echocardiography

Abstract Introduction: The number of cases for which the Batista procedure is indicated is small, but some patients with appropriate indication can achieve good therapeutic results. Objective: To avoid incorrect left ventricular incision and obtain good surgical results in patients with dilated cardiomyopathy suitable for partial left ventriculectomy, we employed intraoperative direct echocardiography to determine the exact extent and position of the myocardial incision, even for surgeons who are not very experienced with the Batista procedure. Methods: A 72-year-old man with dilated cardiomyopathy underwent the Batista procedure with the aid of epicardial echocardiography to confirm the location of both the papillary muscles and the diseased myocardium. Results: We were able to accurately perform left ventricular incision and remove the diseased lateral ventricular wall. Two years later, the patient had no symptoms of heart failure, and his brain natriuretic peptide (BNP) level decreased from 1155 to 49.3 pg/mL. Conclusions: We believe that the use of intraoperative echocardiography may have the potential to make the Batista procedure less technically demanding and more reproducible for surgeons with little experience in the procedure.

Dietary patterns and stomach cancer among middle-aged male workers in Tokyo.

Many epidemiological studies have examined the associations of nutrients and foods with risk of stomach cancer. Few studies have addressed the dietary patterns that reflect various components of food consumption and their interactions. We identified major four dietary patterns; "vegetable and fruit", "Western breakfast", "meat", and "rice/snack" with principal component analysis using food consumption questionnaire in a prospective study of 5,765 middle-aged male workers in Tokyo. After 10 years of follow-up between September 1988 and August 1998, 84 incident cases of stomach cancer were documented. Using proportional hazards regression to estimate risk ratios, we found no clear association between each of dietary pattern and stomach cancer risk. After adjustment for age and other potential confounding factors and after exclusion of the cases diagnosed in first follow-up year, the risk ratio (RR) associated with high tertile compared to low tertile was 0.78(95%CI 0.42-1.44) for "vegetable and fruit" pattern and 0.71(95%CI 0.40-1.24) for "Western breakfast" pattern. The V-shaped associations between dietary patterns and stomach cancer risk were appeared in the "meat" (RR=1.00, 0.55, and 1.10) and the "rice/snack" (RR=1.00, 0.52, and 1.19) patterns, while the linear trend of these associations was statistically on borderline. The roll of overall dietary patterns in predicting stomach cancer risk requires further investigation.