[A modified Fontan operation in the presence of a supracardiac total anomalous pulmonary venous connection].

We report a case of 2-year-old girl with asplenia syndrome who successfully underwent modified Fontan procedure and concomitant repair of supracardiac total anomalous pulmonary venous connection (TAPVC). The preoperative diagnosis included a common atrioventricular canal (type C), a double outlet right ventricle, a common atrium, common atrioventricular valve regurgitation, pulmonary stenosis, and a bilateral superior vena cava (SVC). Cardiac catheterization revealed a Qp/Qs of 1.3, mean PA pressure of 16 mmHg and an Rp of 1.3. The TAPVC drained to left SVC (LSVC) at a position proximal to the hemiazygos vein with an ostium of 5 mm in diameter. The LSVC was divided distal to its connection to the common pulmonary vein (CPV). The TAPVC ostium was cut back into the CPV, then it was anastmosed with posterior aspect of the atrial wall in an effort to provide a wide anastomosis. The postoperative course was uneventful and the patient was discharged from hospital on the 35th postoperative day.

[Phase I study of TAT-59 (a new antiestrogen) in breast cancer. TAT-59 Study Group].

Phase I study of TAT-59 (Miproxifen), an antiestrogen developed in Japan for breast cancer, was conducted with the collaboration of 12 hospitals. A single dose of 1.25, 5, 10, 20, 40 and 80 mg, or 5 consecutive daily doses of 1.25, 5, 10, 20 and 40 mg/day, were given orally. After single dosing, no clinical adverse effects were found. Decrease of serum Na, Cl, Ca level and increase of serum LDH level were observed in one patient after a single dose of 5 mg of TAT. An increase in the serum LDH level was also observed in one patient after a single dose in the of 10 mg of TAT. An increase in the serum LDH level and total bilirubin, increase of eosinophil, K and milky serum were also observed in one patient after a single dose of 40 mg of TAT, respectively. All of these abnormal values returned to the normal level within 26 days after final administration of TAT. No adverse clinical findings nor abnormal laboratory findings were observed after consecutive administration of TAT. After postprandial single dosing, the time to reach the maximum serum concentration (Tmax) of DP-TAT, dephosphorylated metabolite of TAT, and its demethylated metabolite, DMDP, ranged from 5.0 to 7.3 hr and from 17.0 to 42.8 hr, respectively. The maximum serum concentration (Cmax) and AUC of DP and DMDP elevated in a dose-dependent manner. T1/2 of DP and DMDP ranged from 24.2 to 41.5, and from 91.9 to 214.7 hr, respectively. There were no significant differences between pharmacokinetics of TAT before and after food intake. Based on the above results, we concluded that a Phase II study should be conducted to evaluate the efficacy, safety and optimal dose of TAT.

[Mass screening for colorectal cancer by occult blood testing under restricted diet].

We conducted a mass screening survey for colorectal cancer by the combination of fecal occult blood tests under a restricted diet and a medical questionnaire in 7,392 healthy volunteers. Further diagnostic work-up was needed in 1,934 (26.2%) individuals. Of these, 1,409 (72.9%) showed occult blood in at least one slide, 245 (12.7%) had symptoms and 306 (15.8%) had a positive family history. Proctosigmoidoscopy, barium enema and flexible colonoscopy were performed in 1,251, 779 and 95 persons, respectively. Colorectal cancers were detected in 10 individuals (0.14%); 5 of these were in the early stage.

[Intra-arterial infusion chemotherapy for metastatic hepatic tumor of colo-rectal cancer].

Effect of intraarterial infusion chemotherapy on metastatic liver tumor (28 cases) of colo-rectal cancer was compared with that of oral or intravenous chemotherapy (8 cases). The efficacy of the selective intraarterial chemotherapy was 40%, non-selective intraarterial chemotherapy, 11.1% and oral or intravenous chemotherapy 0%, respectively. Mean survival time of the intraarterial chemotherapy was 11.1 months, and that of oral or intravenous chemotherapy was 6.0 months, suggesting greater efficacy of the intraarterial infusion chemotherapy. Especially, the selective intraarterial infusion chemotherapy will be an effective therapy for inoperable metastatic liver tumor.