[Novel coronary transfer technique for transposition of the great arteries with Planché type II coronary anatomy].

The arterial switch operation has evolved to become the treatment of choice for most of transposition of the great arteries and some types of double outlet right ventricle. Technical improvement in the coronary transfer is the major contribution to the evolution of this procedure. We proposed a novel technique of coronary transfer for the patients with rare but difficult coronary anatomy of Planché type II. We believe it could become one of the options of coronary transfer technique and contribute to the completion of arterial switch operation with uncommon coronary artery patterns.

[Emergency operation due to complications of cardiac catheterization].

From January 2001 to July 2005, 4,741 cardiac catheterizations were performed on adult patients at our institute. Five of them underwent emergency operation due to complications of cardiac catheterization. The causes of operations were acute coronary occlusion due to coronary arterial dissection in 3 patients and bleeding due to perforation of the coronary artery in 2. Intra-aortic balloon pumping was used preoperatively in 4 patients and percutaneous cardio-pulmonary support in 2. Coronary artery bypass grafting was performed on all patients. Perforation sites of the coronary arteries were closed. One patient died 4 months after surgery, due to neurological damage, but the other 4 patients recovered and have been doing well. As coronary artery disruption is one of the main complications of cardiac catheterization, it is necessary to recognize the risk of hemodynamic derangement and to give prompt and appropriate treatment.

Establishment of a GIS monitoring system for schistosomiasis japonica in Kofu, Japan.

Although the incidence of human infection with Schistosoma japonicum in Japan fell to zero in 1977, the threat of the possible re-emergence of the disease caused by this trematode still exists. Surveillance of the parasite's intermediate host, Oncomelania nosophora, in Kofu basin therefore began in 1996. A simple, new method for monitoring O. nosophora in an at-risk area in Kofu, which is based on a geographical information system (GIS), was established. At each monitoring site (of which there were 120 from 1996 until 2000, and 60 from 2001 until 2003), the O. nosophora in two quadrats, each measuring 25 x 25 cm, were collected. During the study, the exact location of each site was determined using a hand-held global-positioning system (GPS). This allowed all the sites to be digitally mapped, so that anyone with a hand-held GPS could and can reach each site. The snail and location data were processed using commercial GPS/GIS software packages and used to create a risk map for schistosomiasis re-emergence. Although all snails collected between 1996 and 2003 were uninfected, the proportion of investigated sites in which O. nosophora was detected increased from 36.7% in 1996 to 56.7% in 2003. The mean number of O. nosophora collected per snail-positive site fluctuated widely, between 8.2 and 57.4, in each calendar year. Over the study period there appeared to be a shift southwards in the areas with high densities of O. nosophora. The present results indicate that it is possible to utilize a GIS-based method for the long-term monitoring of the possible re-emergence of schistosomiasis japonica in Japan.

Early and late results of total correction of congenital cardiac anomalies in infancy.

OBJECTIVE: We evaluated long-term results of surgical correction of congenital cardiac anomalies in infancy. METHODS: We reviewed cases of 856 patients who underwent complete correction of major cardiac anomalies in the first year of life during last 24 years at our institution, and analyzed results. Surgery involved ventricular septal defect (n = 453), tetralogy of Fallot (n = 92), atrioventricular canal defect (n = 93), and complete transposition of the great arteries (n = 218). RESULTS: Operative mortality was 2.2% in ventricular septal defect, 0% in tetralogy of Fallot, 8.6% in atrioventricular canal defect, and 4.1% in complete transposition of the great arteries. Freedom from reoperation at 20 years was 96.5 +/- 2.0% and actuarial survival was 94.2 +/- 1.3% in ventricular septal defect. Freedom from reoperation at 15 years was 90.5 +/- 3.9% in tetralogy of Fallot and 86.6 +/- 4.4% in atrioventricular canal defect. Actuarial survival at 15 years was 97.8 +/- 1.6% in tetralogy of Fallot, 85.7 +/- 3.7% in atrioventricular canal defect, and 89.9 +/- 2.2% in complete transposition of the great arteries. Actuarial survival in complete transposition of the great arteries was significantly better in arterial than in atrial switch operations. CONCLUSIONS: Total correction of ventricular septal defect, tetralogy of Fallot, atrioventricular canal defect, and complete transposition of the great arteries in infancy was conducted safely, but the incidence of reoperation in late follow-up must be reduced.

[Early and mid-term results after cardiac or thoracic aortic surgery in patients aged 70 years and older--survival and quality of life].

The early and mid-term survival after cardiac or thoracic aortic surgery and influence of age to the operative mortality were examined in 168 consecutive patients aged 70 years and older from August 1994 to December 1998, together with assessment of postoperative quality of life (QOL). The mean age was 74.1 +/- 3.7 years old (70 to 86 years). 80 patients had IHD, 59 had VHD, 28 had TAA. Preoperative risk score was classified in 5 groups (good, fair, poor, high, extremely high) based on Parsonnet method. Current QOL of the survivors was assessed using Asanoi method with questionnaire by a letter. There were 9 early deaths (5.4%). Following the Parsonnet model observed mortality was absolutely lower than predicted mortality. When age score was excluded in the Parsonnet model, the observed mortality became almost equal with the predicted mortality. There were 22 late deaths (6.9%/P-Y). The actuarial survival rate of age 70 to 74 group was significantly higher than the age 75 years and older group (p = 0.0021). The actuarial survival rate of TAA group was significantly lower than the VHD or IHD group (p < 0.02). Postoperative NYHA and activity score of TAA group were better than VHD or IHD group. We got satisfactory answers for operation in 95% current survivors. Patients aged 70 years and older will be undergone cardiac or thoracic aortic surgery at a reasonable risk and well satisfaction.

[Patching of the raw surface of the posterior right ventricular wall in Ross procedure to prevent bleeding and to confirm anastomosis of the conduit].

An 8-year-old boy underwent Ross procedure to repair aortic regurgitation and subaortic stenosis. In reconstruction of the right ventricular outflow tract, the raw surface of the right ventricular posterior wall was covered with autologous pericardial patch to prevent bleeding and to confirm the anastomosis of the pulmonary tract conduit made of expanded polytetrafluoroethylene. Bleeding from the posterior wall was absent and he led uneventful postoperative course. Same technique was used in 4 other patients, and satisfactory results were obtained. This technique, first reported from India, seems very useful in Ross procedure.

[A prospective study on the timing of discontinuation of aspirin before coronary artery bypass grafting].

The effects of the timing of discontinuation of aspirin before coronary artery bypass grafting (CABG) on postoperative blood loss and blood requirements were examined in 22 patients undergoing elective CABG, who were randomly assigned into two groups. In Group I (11 patients), aspirin was discontinued two days before the operation and in Group II (11 patients), aspirin was continued up to the operation. The other 40 patients, who did not take aspirin for at least seven days before the operation, served as a control Group. There were no differences in preoperative data including the platelet count and the hemoglobin concentration, nor in operative variables such as operation time, cardiopulmonary bypass duration and aortic crossclamp time among the groups. Although postoperative blood loss (six hours' loss; Group I 218 ml, Group II 183 ml and control Group 172 ml) and red blood cells transfusion requirements were not different among the groups, platelet concentrates transfusion was more frequently required in Group II (54.5%) as compared with control Group (7.5%) and Group I (9.1%). The difference between Group II and the control Group reached statistical significance (p < 0.01), but there was no significant difference between Group I and control Group. This fact suggests that preoperative two days' discontinuation of aspirin works as effectively as seven days' discontinuation.

[Acute retrograde dissection of the aorta is a formidable complication in retrograde perfusion through the femoral artery].

To avoid this complication, we applied a Nelaton catheter (Imamura, Tokyo, Japan: standard type) as a guide to insert an arterial perfusion cannula (Bardic) into the femoral artery. Initially, the Nelaton catheter is accurately placed into the femoral artery through a purse string suture without applying vascular clamps on the artery or its branches. Then the perfusion cannula is advanced using the Nelaton catheter as a guide. We believe this procedure will avoid acute retrograde dissection of the aorta since it protects the femoral artery from injuries caused by the vascular clamps or the tip of the perfusion cannula.

Assessment of the molluscicidal activities of Tribromosalan, Cartap and Chlorothalonil against Oncomelania hupensis.

Molluscicidal activities of Tribromosalan, Cartap and Chlorothalonil were evaluated in the laboratory and the field against Oncomelania hupensis, the intermediate host of Schistosoma japonicum in China. The three chemicals were very effective against O. hupensis in the laboratory. The molluscicidal activities found in the field trials suggest that Tribromosalan and Cartap may be used as practical molluscicides. Dosage of 10 g/m2 of Tribromosalan in spring only and 20 g/m2 of Cartap in both spring and autumn would be recommendable as practical mollusciciding doses for the control of O. hupensis.

[Studies on the diagnosis of schistosomiasis japonica. (4). Effects of serum dialysis and anthelmintic treatment of the patients on the determination of COP value with special reference to the black eggs].

Eggs of Schistosoma japonicum were obtained from the livers and intestines of the mice infected subcutaneously 50 cercaria 7 weeks previously. A dialyzing celophane tube containing 1 ml of serum was immersed and stirred in 500 ml NaCl solution with different molar concentrations and dialyzed for 24 hrs at 4C. Thereafter, the sera of infected human and animals were incubated with an equal volume of egg-suspension (average 100 eggs per drop). The results indicated that a close relationship between a decrease in the molar concentration of dialyzing solution and an increase of COP value. COP value in a given dialyzed serum sample was dependent on the molar concentration of the solution and independent of the different salt solution with KCl, CaCl2 and MgCl2. COP values were observed in 44 patients in 12 months after treatment with niridazole. The results were as follows; unchanged 1 case, turned to negative 1 case, moderately decreased 3 cases and marked decreased 39 cases. Re-dialysis of these sera with 0.15 M NaCl solution resulted in the equal COP value in all cases. Blackeggs showed a marked reactivity against antisera in COP test as well as those of normal matured eggs.

[Studies on the diagnosis of schistosomiasis japonica. (3) An immediate intradermal test on the inhabitants of an endemic area and an epidemiologic study based on the analysis of a dermal reaction (author's transl)].

The intradermal test of this disease was performed by injecting 0.02 ml of the antigen into the middle third of the volar surface of the forearm; the reaction was judged after 15 minutes and a diameter of 9 mm or more in wheal and/or 20 mm or more in erythema were regarded as the positives. The following results are presented on this basis. (1) The percentages of the dermal reactors for the subgroup by age were shown in Table 1. Age was important in the sensitivity of the intradermal test with schistosome antigen; the percentage of positive reactors was significantly higher in the adult group compared with the younger three groups as Minor 1, 2 and 3. The rates of dermal reactors were reduced in the adult group from 40.5% in 1973 to 17.8% in 1976. Lowering the concentration of nitrogen to 10 micrograms per ml in the antigen showed a decrease of the sensitivity in the intradermal test in all age groups. (2) Sex was important in the sensitivity of the intradermal test and males had a higher positive rate than did females; there was a significant difference in the percentage of the positive reactors between the sexes in the same age groups in both West and East parts of the survey area (Table 2). (3) It was noted that the percentages of the dermal reactors were higher for those in the West part than those for the East part as shown in Tables 3 and 4 and Figures 1 to 5. There was a close correlation between the distribution pattern of the wheal diameter and the positive rate for the intradermal test in the same area; this was shown in Figure 6 and also evidenced by a shift to the right of the frequency distribution curves in Figure 9. (4) These results indicate that the intradermal test with schistosome antigen proved to be satisfactory for observing epidemiological status of this parasitic disease in the endemic areas. It was also suggested that such snail-control practices as cementing irrigation ditches and periodic application of molluscicide, and the mass-treatment of infected persons might be effective in reducing transmission among peoples over a considerable area in Yamanashi Prefecture.

Field assessment of B-2 as a new molluscicide for the control of Oncomelania nosophora.

Sodium 2,5-dichloro-4-bromophenol named B-2 was evaluated for application in the field as a molluscicde against Oncomelania nosophora. A dosage of 10 g/m2 as 25% liquid form or 25 g/m2 as 10% granular form of B-2 was suggested as a standard dose for the control of O. nosophora. The residual concentration of B-2 in the soil after application was observed to decrease more rapidly than did that of NaPCP. The residual level of B-2 in the rice grains harvested from the paddy field in which the chemical was applied at most 4 times during the planting season did not exceed 0.03 ppm.

Laboratory assessment of the molluscicidal activity of B-2, a new chemical against Oncomelania nosophora.

Laboratory trials of sodium 2.5 dichloro-4-bromophenol named B-2 for the molluscicidal effect against Oncomelania nasophora were carried out by Komiya's immersion technique. The values of LC50 of B-2 varied from 0.38 ppm to 0.54 ppm depending on the collection time of the snail. They were almost equal to those of NaPCP, but lower than those of Niclosamide. In the tests of toxicity to carp, rainbow trout and killifish, B-2 showed lower toxicity than NaPCP. Some aspects of mollusciciding application of the chemical were discussed.

[Studies on the diagnosis of schistosomiasis japonica. (1) Circumoval precipitin (COP) test as a method of screening of the subjects for fecal examination (author's transl)].

Examinations were performed on 351 individuals of Shikishima village, Yamanashi Prefecture. Three fecal samples were collected at one-week intervals and examined by MIFC method without iodine. Reactions with a diameter of 9 mm or more in wheal and/or 20 mm or more in erythema were regarded as the positive for the intradermal reaction using Melcher's antigen (1 : 1,000). For the COP test, each one drop of serum and a saline suspension of eggs were mixed on a microscope slide and sealed a coverslip with vaseline. The number of eggs showing precipitates were counted after 48 hrs at 37 degrees C. The results showed that all the precipitates were small in size in the COP titer less than 40%. Medium precipitates appear first in the cases of a 40.% class and the percentage increased thereafter as the COP titer increased. Large precipitate was found in 10% of the eggs affected in a 50% class and found in 40% in the titer of a 80% class. Of 351 tested, a significant higher rate of egg-passers (42.7%, 41/96) was obtained in the COP reactors, as compared with other two groups; 19.4% (41/211) in the dermal reactors, 11.7% (41/351) in the total subjects. Moreover, the egg-passers were recovered in 60--70% of the cases in the COP titer of more than 70%. It was considered that the COP test was a useful diagnostic method for schistosomiasis japonica and the sensitivity and efficiency of this test were superior to those of intradermal test with regarded to the screening of the subjects for fecal examination.