[Total arch replacement for intrathoracic left subclavian artery aneurysm; report of a case].

A 65-year-old man with left subclavian artery aneurysm, detected by enhanced computed tomography (CT), was referred to our hospital. The CT revealed intrathoracic left subclavian artery aneurysm (maximum diameter, 5 cm) at the takeoff of the aortic arch. Surgery was indicated considering the risks of rupture and embolism. The aneurysm was exposed through median sternotomy. Cardiopulmonary bypass was established with cannulation of the right axillary artery, left femoral artery, superior vena cava (SVC), and inferior vena cava (IVC). Circulatory arrest and isolated cerebral perfusion were achieved at a core temperature of 23 degrees C. Total arch replacement was performed using a 26 mm 4-branched Triplex graft, and the left subclavian artery was reconstructed by branch-left axillary artery bypass. The postoperative course was uneventful. He was discharged on the 22nd postoperative day.

[Subdural hematoma following cardiac surgery].

We report 3 cases of subdural hematoma following open heart surgery under cardiopulmonary bypass. In 2 patients, emergency removal and drainage of a subdural hematoma was performed by neurosurgeons, and conservative management was performed in the remaining one. All patients belonged to a high risk group of bleeding due to anticoagulation therapy, and they had no episode of head trauma. Subdural hematomas may have been due to rapid alterations in cerebral volume, leading to a tearing of the dural bridging veins under cardiopulmonary bypass. Although early diagnosis and prompt treatment is very important, it is often difficult to examine neurological findings after cardiac surgery. We consider that patients who need long-term sedation under anticoagulation therapy must have their neurological status checked at least once in a few days.

[Bilateral partial anomalous pulmonary venous connection; report of a case].

We have experienced a case of bilateral partial anomalous pulmonary venous connection with a fossa ovalis type of atrial septal defect and pulmonary stenosis. The right upper pulmonary vein returned to the superior vena cava and the left upper pulmonary vein returned to the left innominate vein via the vertical vein. The atrial septal defect was enlarged and the right upper pulmonary vein was baffled into the left atrium with an equine pericardial patch. The left upper pulmonary vein was divided and anastomosed to the left atrial appendage. Pulmonary commissurotomy was also done for concomitant pulmonary stenosis. Postoperative course of the patient was excellent with constantly normal sinus rhythm. Angiography 2 weeks after operation showed no evidence of pulmonary venous obstructions on both sides.

Circulating antibodies to common food antigens in Japanese children with IDDM.

OBJECTIVE: To investigate the humoral immune response to common food antigens in Japanese children with IDDM. RESEARCH DESIGN AND METHODS: IgG antibodies to cow's milk, beta-lactoglobulin, bovine serum albumin (BSA), alpha-lactalbumin, and hens egg ovalbumin were examined by enzyme-linked immunosorbent assay in the sera of 33 patients with IDDM, ages 11.8 +/- 3.4 years. The data were compared with that of 50 normal subjects, ages 10.3 +/- 5.1 years, who acted as control subjects. A positive antibody to a food antigen was defined as an antibody titer greater than the 95th percentile value in normal subjects. RESULTS: Children with IDDM had significantly higher median titers of IgG antibodies to beta-lactoglobulin and ovalbumin (P = 0.03 and P = 0.0005 respectively). More children with IDDM than control subjects had positive IgG antibody to ovalbumin (21 vs. 6%, P = 0.04). Titers, as well as the number of positive antibodies to other food antigens, including BSA, did not differ between the two groups. CONCLUSIONS: Japanese children with IDDM show an enhanced humoral immune response to beta-lactoglobulin and ovalbumin, a phenomenon that may be related to the pathogenesis of the disease.

Primary ornithine transcarbamylase deficiency. A case report and electron microscopic study.

Histological and ultrastructural findings obtained upon examination of a liver biopsy specimen from a 2-year-old girl with primary ornithine transcarbamylase (OTC) deficiency are presented. The OTC activity in the hepatic tissue of the patient was 7% that of the normal level. Light microscopic observation showed diffusely swollen hepatocytes with pale or empty cytoplasm due to accumulation of glycogen. Neither fat degeneration nor necrosis was evident. Electron microscopy revealed strikingly abnormal hepatocyte mitochondria, which showed marked polymorphism with elongation and enlargement, ring- or dumbbell-shaped configurations, and irregular distribution and shortening of the cristae. Mitochondria showing degenerative alterations such as swelling and rarefaction, which have been reported in cases of Reye's syndrome, were present, but their number was very small. Other organelles showed no remarkable change. It is suggested that the mitochondrial changes seen in OTC deficiency are essentially different from those in Reye's syndrome, which otherwise is clinically and biochemically very similar to OTC deficiency.