[A case of bilateral partial anomalous pulmonary venous connections with the right upper pulmonary vein draining to the high superior vena cava].

A 10-year-old girl with bilateral partial anomalous pulmonary venous connections (PAPVC) was referred to us. The right upper pulmonary vein (PV) drained to the high superior vena cava (SVC) and the left upper PV to the left innominate vein. The left upper PV was directly anastomosed to the right atrial appendage. The SVC was divided distal to the orifice of the right upper PV and anastomosed to the right atrial appendage. A Xenomedica patch was placed within the right atrium to divert the pulmonary venous blood from the SVC orifice across the surgically enlarged ASD to the left atrium. The postoperative course was satisfactory without arrhythmia, and cineangiography revealed no obstruction at the SVC and the right upper PV pathways. We thought that this method is advantageous in preserving the sinus node and its feeding artery, as well as being applicable to the PAPVC to the high SVC.

[A successful repair of anomalous origin of right pulmonary artery from ascending aorta complicated with subdural hematoma, MRSA infection and postoperative intestinal perforation].

A 2-month-old male infant with anomalous origin of right pulmonary artery from ascending aorta who had subdural hematoma and MRSA infection due to the hemodynamic deterioration after cardiac catheterization was reported. The cardiac anomaly was successfully corrected by bypass grafting between the right pulmonary artery and the pulmonary trunk with an expanded polytetrafluoroethylene tube. This procedure without cardiopulmonary bypass was selected because of the presence of subdural hematoma and poor general conditions, and no signs of mediastinitis were noticed postoperatively in spite of the use of artificial material. But he had colostomy and drainage due to postoperative intestinal perforation. The complicated postoperative course of this patient recommends us the surgical correction of this anomaly without cardiac catheterization.

[An elder case of common atrium: surgical repair at a 56-year-old man].

A 56-year-old man was admitted to our hospital with dyspnea. The ultrasonographic and hemodynamic features proved complete absence of atrial septum. The data of catheterization showed right to left shunt (59%) and QP/QS value of 1.7 and also, oxygen saturation of pulmonary arterial blood (87%) was almost as same as that of systemic arterial blood (90%). The radical operation was performed of making a new atrial septum with artificial patch. He did not have the cleft of atrioventricular valves and anomalies of systemic venous drainages. We reported a case of common atrium, which was diagnosed for the first time at the age of 56.

[A case of an operation for lung cancer after PTCA].

A 64-year-old lung cancer patient combined with angina pectoris was admitted to our hospital. Chest roentgenogram showed a coin lesion in the left upper lobe. Broncho-fiberscopic examination proved adenocarcinoma. Coronary angiography revealed 90% stenosis of the left circumflex artery. Percutaneous transluminal coronary angioplasty (PTCA) was done and resulted in success. Eight days after PTCA, left upper lobectomy for lung cancer was undergone. Postoperative course was uneventful. Compared with coronary artery bypass grafting, PTCA was very useful for the patient having malignant disease combined with angina pectoris because of little surgical stress and no delay of operation.

Comparative metabolic responses to prolonged cooling in precocial duck (Anas domestica) and altricial pigeon (Columba domestica) embryos.

1. Embryos and hatchlings of the duck and pigeon were exposed to a lowered temperature for 6 hr. The oxygen consumption (MO2) was measured before and after cooling and the ratio of the two was compared with that predicted for a temperature coefficient of 2 (Arrhenius value). 2. Late prenatal ducks kept the MO2 above the Arrhenius value at 28 degrees C, while the MO2 of pigeon hatchlings became the same as the Arrhenius value even at 32 degrees C. 3. Thus, incipient homeothermic ability appears in the duck during prenatal development, but it is not evident in the pigeon even after emergence from the shell. The precocial chicken and semi-precocial noddy previously studied are intermediate in their metabolic response between the duck and the pigeon.

[Acute massive mediastinal hemorrhage three weeks after mitral valve replacement in a patient with systemic lupus erythematosus].

Systemic lupus erythematosus (SLE) is one of the most common autoimmune diseases and patients suffering from this disease often died of massive hemorrhage. We report the case of a patient who died of acute massive hemorrhage three weeks after mitral valve replacement. The patient, a 42 year-old woman, had been diagnosed as having valvular heart disease at the age of 10. She underwent mitral commissurotomy at the ages of 18 and 32. SLE was diagnosed 8 years previously and corticosteroid therapy was initiated. The patient was experiencing exertional dyspnea again 1 year ago and mitral valve replacement was performed for recurrent stenosis. The postoperative course seemed to be uneventful, but on the 21st postoperative day, acute massive mediastinal hemorrhage occurred, and the patient eventually died of septicemia. Massive hemorrhage in SLE patients usually occur in the central nervous system or alimentary tract. However, bleeding can occur anywhere, so great care must be taken in regulating anticoagulant therapy.

[Idiopathic chylothorax in an adult--a case report and a review of 14 cases in Japan].

A 30-year-old female with an idiopathic chylothorax who underwent successful surgical treatment was reported. The patient was referred to our hospital because of massive right pleural effusion found by chance on the X-ray. Thoracocentesis revealed chyle but the etiology was not known by examinations. Conservative treatments such as fasting, intravenous hyper-alimentation and a continuous drainage were performed for 10 weeks without remarkable improvement. A right thoracotomy revealed nothing abnormal except for the oozing of lymph from mediastinal pleura, which was sutured by 3-0 nylon. Postoperative course was uneventful and no recurrent pleural effusion has been recognized for 3 years since then. Adult chylothorax with unknown etiology like this is rare and only 13 cases have been reported in Japan. Such "idiopathic chylothorax" cases, including our case, were reviewed and discussed.

[Postoperative complications of abdominal aortic aneurysm--with special reference to postoperative renal hypofunction].

Effects of various factors before and during operation on postoperative renal hypofunction were studied in 34 preoperatively evaluated surgical cases of non-ruptured abdominal aneurysm. The cases were divided into two groups, with and without postoperative renal hypofunction. The two groups showed no differences with respect to age, sex, preoperative serum Crn or Ccr level, presence or absence of treatment with antihypertensives or diabetes mellitus, duration of intraoperative aortic clamping, or the volume of blood loss or transfusion. However, the group with postoperative renal hypofunction included many cases of preoperative hypertension. The incidence of postoperative renal hypofunction was high among cases which exhibited preoperative hypertension, but was low among those with preoperative normal blood pressure. Further, renal hypofunction occurred in few of the patients whose blood pressure had been controlled by the use of antihypertensives. The possibility was suggested that in palliative operations, preoperative blood pressure control, was useful for the prevention of postoperative renal hypofunction.

Analysis of the effects of the Blalock-Taussig shunt on ventricular function and the prognosis in patients with single ventricle.

Twenty-four patients with single ventricle, six with single left (SLV) and 18 with single right (SRV) ventricle, who received a Blalock-Taussig (BT) shunt at an average age of 3.2 years were studied. Ventricular function was assessed angiographically by end-diastolic volume index (EDVI) and ejection fraction (EF), and attempts were made to measure ventricular mass index (VMI) and VM/EDV. In 14 patients, the preoperative and postoperative results (average 2.4 years after placement of BT shunt) were compared in SLV (n = 5) and SRV (n = 9) groups. The SLV group showed significant increases in EDVI, VMI, and VM/EDV without a significant change in EF. The SRV group showed significant increases in EDVI and VMI, while EF decreased and VM/EDV was unchanged. Late death from congestive heart failure occurred in five patients with SRV. Three patients with atrioventricular valve regurgitation suffered late death. Among the patients with SRV, the late death group had significantly lower preoperative EF and VM/EDV compared with the survivors (n = 13). All of those with a preoperative EF of less than 0.50 and a VM/EDV of less than 0.35 g/ml suffered late death. In summary, patients with SRV appear to fail to develop adaptational hypertrophy to volume loading after the BT shunt procedure, with concomitant depression in ventricular pump function. Also, late cardiac failure seems likely to develop when low EF and VM/EDV are present preoperatively.