Virus-mediated oncolysis induces danger signal and stimulates cytotoxic T-lymphocyte activity via proteasome activator upregulation.

Dendritic cells (DCs) are the most potent antigen-presenting cells and acquire cellular antigens and danger signals from dying cells to initiate antitumor immune responses via direct cell-to-cell interaction and cytokine production. The optimal forms of tumor cell death for priming DCs for the release of danger signals are not fully understood. OBP-301 (Telomelysin) is a telomerase-specific replication-competent adenovirus that induces selective E1 expression and exclusively kills human cancer cells. Here, we show that OBP-301 replication produced the endogenous danger signaling molecule, uric acid, in infected human tumor cells, which in turn stimulated DCs to produce interferon-gamma (IFN-gamma) and interleukin 12 (IL-12). Subsequently, IFN-gamma release upregulated the endogenous expression of the proteasome activator PA28 in tumor cells and resulted in the induction of cytotoxic T-lymphocytes. Our data suggest that virus-mediated oncolysis might be the effective stimulus for immature DCs to induce specific activity against human cancer cells.

[Left ventriculoplasty for ischemic cardiomyopathy with a left ventricular aneurysm].

We report 3 cases of left ventriculoplasty (LVP). They were chosen according to classification of the preoperative left venticle (LV) shape; an apex type and anteroseptal type. We think that an apex type has an indication for a Dor operation and the treatment of an anteroseptal type should be chosen between the following 2 methods. One is an overlapping method. It has the advantage of having to use no intracardiac patch which would remain akinetic area. It is therefore suitable for relatively small LV aneurysms without involvement of the proximal diagonal branches. However, it has the disadvantage of having to cut some distal diagonal branches in order to perform the volume reduction. The other method is a septal anterior ventricular exclusion (SAVE) operation. It is suitable for larger LV aneurysms which involve the proximal diagonal branches due to its advantage of being able to perform the LVP without cutting the diagonal branches. However, it has the disadvantage of leaving an akinetic area that corresponds to the intracardiac patch. We believe that choice of the LVP method according to the preoperative LV shape will bring about a better postoperative LV function and shape.

Aneurysm of the left sinus of Valsalva causing aortic, mitral regurgitation and myocardial ischemia.

An aneurysm of the left sinus of Valsalva producing aortic and mitral regurgitation with myocardial ischemia was treated successfully by reconstructing the left coronary sinus while preserving the aortic cusp combined with coronary artery bypass grafting. Aortic and mitral regurgitation occurred due to distortion of the left aortic cusp by a huge aneurysm that also compressed and obstructed the main trunk of the left coronary artery. The postoperative course was uneventful and follow-up showed aortic and mitral regurgitation to be absent and the coronary graft to be patent. Aortic valve-sparing surgery thus proved to be an appropriate procedure for this case.

Early experience of minimally invasive valve surgery.

In this paper we report on our early results of minimally invasive cardiac valve surgery. A series of 6 consecutive patients with valvular disease underwent valve repair and valve replacement via a right parasternal incision; aortic valve replacement 3, mitral valve replacement 1, mitral valve repair 2. There were no intraoperative complications requiring median sternotomy. Five patients had no blood transfusion. There was only one postoperative event; this patient had a sudden massive bleeding from the chest tube after extubation of the endotracheal tube, an immediate re-suture of the aortotomy was performed. The reoperative course was uneventful. Minimally invasive cardiac surgery for aortic and mital valves is an excellent option for most patients affected by isolated valvular disease.

Prevention of postoperative pericardial adhesions with a defibrinogenating agent.

Pericardial adhesions pose a major problem during re-operative cardiac surgical procedures. The purpose of this study was to determine the effect of Batroxobin, a fibrinogen depleting agent, on the incidence of experimental pericardial adhesions. Twenty-four rabbits were divided into 3 groups of 8 rabbits each and pericardial mesothelial injury was induced by abrasion. Group A included rabbits receiving no further treatment, Group B included rabbits receiving intrapericardial injection of Ringer's solution, and Group C included rabbits receiving intrapericardial injection of Batroxobin. Three weeks after surgery, the incidence of adhesions in Groups B and C was compared with that in Group A. Pericardial adhesions found in 80% of the rabbits in Groups A and B. However, only 14% of the rabbits in Group C had pericardial adhesions (p < 0.05). Our findings demonstrated that intrapericardial Batroxobin reduced the incidence of pericardial adhesions in an animal model.

[A case of far-advanced gastric cancer treated with neoadjuvant combination chemotherapy of UFT, low-dose CDDP and leucovorin, followed by subtotal gastrectomy with curative intent].

We herein present a case of a 70-year-old man with the tentative diagnosis of far-advanced gastric cancer supposed to be beyond surgical intervention. Neoadjuvant chemotherapy enabled us to perform subtotal gastrectomy with curative intent. The man was admitted to our hospital with the chief complaint of poor appetite. Because preoperative examinations revealed a mass adjacent to the portal vein and common bile duct, which was suspected to be lymphnode metastasis or gastric cancer directly invading those vital structures, 4 weeks of neoadjuvant combination chemotherapy (NACC) (CDDP 10 mg/body, day 1 through day 5/week, UFT 600 mg/body, every day, Leucovorin 15 mg/body, every day) was given with resultant curative resection of the tumor one month after completion of NACC.

[Total repair of tetoralogy of Fallot in an adult: report of a case without prior treatment at 59 years of age].

We reported successful repair of tetoralogy of Fallot of a male case aged 59 years old. There was no palliative operation prior to this correction. The preoperative clinical features were as follows: dyspnea on effort and at rest, cyanosis and clubbing, multiple cerebral thrombosis without symptoms. Polycytemia was remarkable at Hb 23.3 g/dl and Ht 73.8%. PaO2 was 39.2 mmHg and hypoxemia was recognized. CTR was 59% and pulmonary vascular shadows were decreased but bilateral pulmonary arteries were well developed. Cardiac catheterization showed that high RV systolic pressure equal to that of LV and severe RV outflow obstruction. Pulmonary artery was well developed (the diameter ratio of PA and aorta: 0.84). Collateral arteries to the pulmonary vascular system were not significant by aortography. The surgical procedures were performed under conventional method. Pulmonary valvular stenosis was released by comissurotomy and RV outflow tract obstruction was also released through minimal right ventriculotomy. The conus branch of coronary artery crossed the outflow tract, so that we preserved this artery for preventing right ventricular failure post-operatively. There was no need to use trans-annular patch for reconstruction of the outflow tract. In post operative course, only a low dosage of catecholamin was required but no other special treatment was needed. Ventricular and supraventricular arrhythmia had appeared in short period but after administration of anti arrhythmic drugs, heart rhythm was converted to sinus rhythm easily. Pathological findings of RV muscle which resected at the operation showed marked fibrous degeneration and irregularity of cells, and it suggested that sever hypoxia and high pressure for long time affected the ventricular muscle. We concluded that even older patients of tetralogy of Fallot were corrected safely and were able to get good quality of life after operation.

The endoscopic removal of a foreign body in the pericardial cavity following cardiac surgery.

We were able to successfully remove a needle and suture through a pericardial drain following cardiac surgery by means of a simple method using a bronchofiberscope without having to perform a re-median sternotomy. The technique of endoscopic removal of cardiac surgical misplacement is described.

[Briefly summarized nursing card for patients with advanced cancer receiving out hospital management].

Briefly summarized nursing card to perform adequate nursing for readmission patients with advanced cancer receiving outhospital management was developed and its clinical usefulness for nursing is discussed. The card is 18 cm x 13 cm, differential colored for diseases, and written only necessary summarized informations for adequate nursing at the patient's emergent readmission. By using this card for 24 patients, it was very useful because of its very selected, brief and summarized information. This card has much usefulness for nursing of such patients.

Congenital aortic regurgitation caused by a rudimentary noncoronary cusp: report of a case.

A 14-year-old asymptomatic boy was admitted to our department for investigation of a diastolic murmur which had been discovered by his family doctor during a routine examination. Echocardiography showed aortic regurgitation with dilatation of the left ventricle. Inspection of the aortic valve at the time of operation revealed normal left and right cusps with a rudimentary noncoronary cusp. An aortic commissuro-plication was performed and a new bicuspid aortic valve successfully reconstructed. His postoperative course was uneventful and he has been well and leading an active life since his discharge from hospital.

[A case of partial anomalous pulmonary venous return to inferior vena cava and left atrium (Scimitar syndrome)].

Scimitar syndrome is relatively uncommon syndrome. A 14-year-old female referred to our hospital for abnormal shadow of chest fluoroscopic examination. She had no symptom except cough due to bronchial asthma. Chest X-ray film showed Scimitar sign. Cardiac catheterization revealed 30% left to right shunt without atrial septal defect. Pulmonary angiography showed anomalous pulmonary vein was drained to inferior vena cava and left atrium. Surgical correction was attempted monitoring the pulmonary arterial pressure. Anomalous pulmonary vein and systemic arteries were ligated and divided at the level of diaphragm. Postoperative course was smooth. We have found 4 similar operated cases previously reported in the world.

Successful combined operation for mitral stenosis and atrial fibrillation.

Simultaneous surgical treatment of mitral stenosis and atrial fibrillation was performed. The patient's postoperative course was uneventful, the rhythm changed to sinus rhythm, and the patient was discharged on the 21st postoperative day in stable condition.

[Combined superior-transseptal approach to the mitral valve].

We report a technique to improve exposure of the mitral valve apparatus. This technique that combines superior left atriotomy and interatrial septotomy can be helpful in patients with a small left atrium and reoperation. It has been used effectively in five patients and potential complication with this procedure has not occurred. The operative technique and indication are discussed in this paper.

Stereotactic radiosurgery using a linear accelerator.

A basic and clinical study of radiosurgery using the linear accelerator (Linac) system for unremovable deep-seated brain tumors is reported. A Komai stereotactic ring was used to locate the target coordinates. The patient was laid on the Linac treatment table and held in the head fixation system. Irradiation was given in five positions. The dose profile by film dosimetry and Rando phantom was satisfactory. Seventeen tumors in 14 patients were treated. Clinical or histological diagnoses were nine metastases, one benign and two malignant gliomas, one meningioma, and one craniopharyngioma. Tumor sizes were between 8 and 30 mm. Doses were between 12 and 30 Gy. Computed tomographic evaluation after 3 months of 12 tumors in 11 survivors showed one complete remission, three partial remission, six no change, and two partial deterioration. For progressive tumors, Linac radiosurgery results are excellent.

[A successful case report of ruptured abdominal aortic aneurysm with isolated left-sided inferior vena cava].

A 68-year-old man was admitted to our hospital because of shock. CT scan revealed ruptured abdominal aortic aneurysm (AAA) with isolated left-sided inferior vena cava (L-IVC). After emergent laparotomy, maintaining blood pressure stable, we clamped the aorta at the level of the supra-celiac region. An AAA (8.5cm in diameter) leaking from the posterior wall with a retroperitoneal hematoma was found, and L-IVC pressed by AAA was identified. The AAA was dissected with caution so as not to injure L-IVC and replaced with a woven Dacron bifurcated graft. The postoperative course was uneventful. The embryonic development and clinical significance of this rare anomaly are discussed. This is the first successful case in the Japanese literature by our survey.