[Ascending aortic aneurysm and aortic valve regurgitation long after operative repair of coarctation of the aorta: report of a case].

We report a case of surgical treatment for ascending aortic aneurysm and aortic valve regurgitation (AR) 24 years after operative repair of coarctation of the aorta (CoA). The patient was a 32-year-old man who had undergone operative repair of CoA and patent ductus arteriosus (PDA) ligation when 8 years old, and was followed since then. However, since 14 years after the operation, dilation of his ascending aorta and AR was observed. Then the AR deteriorated and the ascending aorta dilated, and at 24 years after operation he had symptoms of heart failure. So we performed ascending aorta replacement and aortic root replacement (reimplantation). Despite primary success of the operative repair of CoA, however. 9% of patients develop aortic aneurysms long after the operation. Therefore, long-term follow-up is needed after repair of coarctation of the aorta.

[Ventricular septal defect with aortic valvular regurgitation complicated with infective endocarditis; report of a case].

We report a case of ventricular septal defect (VSD) associated with infective endocarditis complication of aortic and pulmonary valvular regurgitation. He received treatment for pyelonephritis and after 2 months he was suffering from congestive heart failure. Echocardiography showed vegetation on the aortic valve and the anterior semilunar cusp of the pulmonary valve. He was referred to our department for surgical repair. Aortic valvular replacement, pulmonary valvular repair and direct closure of VSD were performed. The postoperative course was uneventful and the patient discharged at 28 postoperative day.

[Noonan syndrome with atrial septal defect and hypertrophic cardiomyopathy].

Noonan syndrome is one of the most common nonchromosomal syndromes seen in children with congenital heart disease. The major cause of death is congestive heart failure. We report a case of Noonan syndrome with hypertrophic cardiomyopathy and arterial septal defect (ASD). Since 10 years old he had been suffering from congestive heart failure. ASD patch closure with a fenestrated flap valve patch was performed at 12 years of age. After operation, left-to-right shunt flow through the patch gradually decreased and he was discharged at 19 postoperative day in good condition.

[A low birth weight infant (904 g) associated with ventricular septal defect].

Published data has suggested that low body weight is risk factor for surgical intervention in congenital heart disease. We report a case of a low birth weight infant with ventricular septal defect (VSD) and pulmonary hypertension (PH). A female infant was born at 31 weeks' gestation. The birth weight was 904 g. At birth she was suffering from congestive heart failure. We diagnosed VSD and PH. We performed pulmonary artery banding at 23 days of age. She accepted the band at a circumference of 15.5 mm. And we performed VSD patch closure and de-banding at 175 days of age. After operation she was on good course and discharged at 19 postoperative day.

[Aortoesophageal fistula due to thoracic aortic aneurysm; report of a case].

We report a 74-year-old man with aortoesophageal fistula due to aotic aneurysm. He underwent 2 stage operations. At the 1st operation the graft replacement of thoracic aorta and esophagectomy were performed. Inflammatory reactions improved with systemic administration of antibiotics and continuous irrigation of the thoracic cavity. On the 21st postoperative day, the esophagus was reconstructed by gastrointestinal interposition technique via ante-thoracic route. On the 58th post operative day he was discharged.

[Angiographic findings of right gastroepiploic artery grafts in early and late phases].

Five hundred and eighty-nine patients underwent isolated coronary artery bypass grafting (CABG) using the right gastroepiploic artery (GEA) in our institute from 1993 to 2004. Early and late results were reviewed retrospectively. Early results: Patients were divided into 2 groups according to target vessel stenosis (group A: degree of stenosis 75% , n=98, 82 men and 16 women, mean age 61.4+/-8.0. Group B: degree of stenosis more than 90%, n=491, 409 men and 82 women, mean age 62.3+/-8.8). Mortality is 0% in group A and 1.0% in group B. Coronary angiography (CAG) revealed patent grafts without stenosis or string sign were 49% in group A and 96% in group B. Forty % of grafts in group A showed string sign. Neither free flow nor harvesting fashion affected the occurrence of string sign. Late results: Twenty-five patients in group A and 53 patients in group B underwent CAG in the late phase (mean interval from CABG to CAG was 4.7+/-2.0 years). Eight grafts were patent but 14 grafts showed string sign in group A. Among the 53 grafts in group B, 49 were patent without stenosis or string sign in the early phase. Forty-seven of them remained patent in the late phase. In conclusion, GEA can achieve good results when target vessels have severe stenosis.

Measurement of the adhesive force of fine particles on tablet surfaces and method of their removal.

The adhesion force of fine particles on the surface of tablets was measured by a centrifugal force and impact separation method. A Finededuster (FDD) was employed to remove fine particles from the tablet surface. The centrifugal force and impact separation method was suggested to be effective for measuring the adhesive forces between particles and the tablet surface, and effective disjoining force in the FDD could be estimated by comparison of the results obtained using these two methods. The FDD showed high removal efficiency regardless of how many tablets were processed at the same time. In either of these methods, critical particle size was about 10-20 microns, and larger particles were removed more efficiently. This critical particle size was similar to that observed for other mechanical properties of powders, such as angle of repose and flowability. We simulated particle residual percentage under various operation conditions by ANN (artificial neural network) analysis and multiple regression analysis. This simulation enabled us to predict how the efficiency of particle removal is affected by the interaction of the experimental and material factors.

Paraganglioma associated with hypoglycemia.

A 63-year-old female had frequent attacks of palpitations with sweating and occasional loss of consciousness for 7 years before admission. These symptoms and documented hypoglycemia (blood glucose: 46 mg/dl) suggested insulinoma, but computed tomography demonstrated a retroperitoneal tumor which was diagnosed as a paraganglioma by histological examination of the resected specimen.

[Study on the diagnosis of the deciduous tooth pulpitis by the blood picture in the dental pulp].

The purpose of this study was to investigate the method of diagnosis of deciduous tooth pulpitis to make sure of the extent of the inflammation for more appropriate pulp therapy. The subjects were 100 decayed deciduous teeth of the 81 normal healthy children aged from 2y9m to 11y2m, which justified the vital pulp amputation therapy according to Nagasaka's deciduous tooth pulpitis diagnosis criteria. The blood picture was compared with the histological structure of the coronal pulp and then observed after treatment. The diagnosis of the deciduous tooth pulpitis was considered by the blood picture in the dental pulp. The results were as follows. 1. As to the blood picture in the deciduous dental pulp, it was suggested that the lymphocyte ratio was able to be taken for the discrimination of the deciduous tooth pulpitis, because ratio of lymphocyte in the coronal pulp was higher than its normal values in the peripheral blood picture regardless of the age. 2. As to the histological structure of the removed coronal pulp, the inflammatory degree was divided into 4 types; (-) no evidence of inflammation, (+) slightly confined infiltration of the inflammatory cells, (++) slightly or moderately diffused infiltration, ( ) severely diffused infiltration, when the numbers of the case at each degree type were (-) 0, (+) 37, (++) 47 and ( ) 16 cases. 3. As to the ratio of the lymphocyte ratio over 60% against all at each degree type, (+) 86.5% and (++) 61.7% were much higher than ( ) 0%. 4. The ratio of cases in which it was difficult to control bleeding at ratios of the coronal pulp amputations were type (+) 32.4% and (++) 25.5% in type, however, type ( ) showed high rate (62.5%). 5. As a result of the clinical and X-ray examination after vital pulp amputation therapy, the number of poor case was 12 of 42 cases (28.6%) in type (+) (++) and 4 of 4 cases (100%) in type ( ). 6. This result suggests that the vital pulp amputation therapy is not adequate when it is hard to control bleeding and the lymphocyte ratio of blood picture in the coronal pulp shows under 57%.

[Clinical and radiographic follow up examination on direct pulp capping in primary teeth].

The purpose of this investigation was to evaluate direct pulp capping in primary teeth with calcium hydroxide agents. All utilized datas were selected from all the charts of the 3,675 patients at Pediatric Dentistry clinic of the School of Dentistry, Hiroshima University. The results obtained were as follows: 1) The number of all primary teeth where direct pulp capping, pulpotomy and pulpectomy were performed, was 2,511, and direct pulp capping was performed on 124 primary teeth (4.9%). Out of the 124 primary teeth, 100 were clinically evaluated. 2) At the time of the final follow up examination for each treated tooth, the ratio of teeth judged as being clinically successful were 94 (94.0%) and 6 (6.0%) as being unsuccessful. In the first year after treatment, the majority of unsuccessful cases were found. 3) We had many unsuccessful cases of anterior teeth on which composite resin and glassinomer cement had been filled after direct pulp capping. 4) Of 6 teeth judged as being clinically unsuccessful, 2 showed spontaneous pain, 1 discoloration of the tooth, 1 gingival swelling and 2 abscess formation. 5) Out of 100 primary teeth in the clinical examination, 66 became available for radiographic evaluation, and the ratio of teeth judged as being successful were 58 (87.9%) and 8 (12.1%) as being unsuccessful. During the two years following the treatment, we found most of unsuccessful cases.

Reticuloendothelial cell function in autoimmune hemolytic anemia (AIHA): studies on the mechanism of peripheral monocyte activation.

We examined the activity of peripheral blood monocytes in patients with autoimmune hemolytic anemia (AIHA) using an in vitro assay of monocyte-macrophage interaction with erythrocytes and an antibody-dependent cell-mediated cytotoxicity (ADCC) assay. The monocytes of AIHA patients in the hemolyzing period phagocytized autologous sensitized red cells and anti-D coated red cells more avidly than normal control monocytes. There was no significant relationship between phagocytic activity and ADCC activity. The activated monocytes phagocytized autologous sensitized red cells, but had no ADCC activity in a short time 51Cr release assay. Phagocytic activity of the patients' monocytes against autologous erythrocytes rapidly decreased after treatment with prednisolone even though the red cell sensitization with antibody remained almost the same as during the hemolyzing period. We postulated that the activation of monocytes in AIHA was due to the "arming" effect of anti-erythrocyte antibody, but we think that other mechanisms may also be involved in the activation of monocytes.

Antibody-dependent cell-mediated cytotoxicity (ADCC) toward human O+ red cells coated with anti-D antibody: comparison between lymphocyte and monocyte ADCC activity.

We investigated the antibody dependent cell-mediated cytotoxicity (ADCC) of lymphocytes and monocytes toward human O+ red cells coated with anti-D antibody using a 51Cr release assay. Lysis of sensitized red cells by lymphocytes occurred rapidly, but monocyte-mediated lysis occurred slowly. This difference might be due to postphagocytic 51Cr release by monocytes. ADCC of lymphocytes increased in proportion to the effector cell number, but large amounts of antibodies were required. In contrast, ADCC of monocytes was independent of the effector/target ratio and very small amounts of antibodies could produce red cell lysis. Large amounts of fluid phase IgG were required to inhibit the lymphocyte ADCC, whereas the monocyte ADCC was markedly inhibited by small amounts of IgG. Monocyte-mediated lysis was completely inhibited by the addition of 10% human AB serum, but lymphocyte-mediated lysis was only slightly inhibited. Purified IgG1 and IgG3 were much more inhibitory to the lysis by both effectors than IgG2 and IgG4 (IgG2 greater than IgG4). Erythrophagocytosis also was inhibited by IgG1 and IgG3. These studies demonstrate that lymphocytes as well as monocytes can cause the lysis of antibody sensitized red cells, and IgG1 and IgG3 subclasses are more important than IgG2 and IgG4 in causing lysis of anti-D coated red cells.

[Thallium-201 chloride dynamic analysis using thallium-201 chloride and sodium iodide-131 thyroid subtraction scintigraphy].

The mechanism of 201Tl chloride accumulation is unclear in thyroid gland and thyroid tumor. This report examines 108 patients that received thyroid scintigraphy examinations with both 201Tl chloride and sodium 131I. The patients were diagnosed clinically and histologically whenever possible. The ROI were obtained by subtraction imaging with both isotopes and by subtraction positive and negative areas of imaging. Dynamic curves were obtained for 201Tl chloride per square unit of each ROI. The dynamic curve in the radioiodide-accumulated area was examined. The data indicate that the clearance rate of 201Tl chloride (T15) was correlated with the sodium 131I uptake rate at 24 h (r = 0.70).

Protective mechanism of beta-cyclodextrin for the hemolysis induced with phenothiazine neuroleptics in vitro.

beta-Cyclodextrin (beta-CyD) was found to protect the human erythrocytes from the hemolysis induced with ten phenothiazine neuroleptics in isotonic solution. The hemolytic activities of the phenothiazine-beta-CyD systems appeared to depend upon the free phenothiazine concentration, suggesting that the complexed form of phenothiazines is essentially inactive to cause hemolysis. The binding abilities and surface activities of the complexed form of phenothiazines were much smaller than those of free phenothiazines. These results indicate that the protective effect of beta-CyD may be due to the decrease in the effective hemolytic concentration of phenothiazines by inclusion complexation rather than the stabilizing effect of beta-CyD on the erythrocyte membrane.