[An adult case of anomalous origin of the left coronary artery from the pulmonary artery]

An adult case of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was presented. A 37-year-old male was admitted for ventricular arrhythmia and chest pain. The catheterization, left ventriculography and coronary arteriography revealed ALCAPA with anterolateral ventricular aneurysm and mild mitral regurgitation. An operation using Takeuchi procedure was performed. The postoperative course was uneventful and the results of the catheterization, left ventriculography and coronary arteriography performed immediately and five years after the operation were excellent except mild supravalvular pulmonary stenosis. Six years later, the patient is asymptomatic and well.

Molecular diagnosis of Borrelia burgdorferi infection (Lyme disease)

In spite of significant advances in immunologically based testing, accurate diagnosis of Lyme borreliosis remains problematic. To address this issue, a DNA amplification-based diagnostic test was developed utilizing the polymerase chain reaction (PCR) and oligonucleotide primers specific for the OspA and OspB genes of Borrelia burgdorferi. In this approach, a relatively large DNA fragment is amplified with an outer set of primers, and a "nested" internal sequence of the PCR product subsequently reamplified with an inner set of primers. This nested approach coupled with simple differential centrifugation allowed specific detection of as few as four B. burgdorferi organisms mixed in 2 ml of blood. This methodology was utilized on patients' samples, and it allowed detection of B. burgdorferi in the peripheral blood and urine of several individuals with clinical evidence of Lyme borreliosis. PCR became negative and symptoms improved following antibiotic therapy of treated individuals. These studies suggest that direct detection of Borrelia in infected individuals can aid in diagnosis and evaluation of therapy for Lyme borreliosis.

[A case report of aortic stenosis complicated with complete atrioventricular block]

A case of aortic stenosis complicated with complete atrioventricular block preoperatively was reported. The patient was a 73-year-old woman who had been suffering from dyspnea and fatigability. Preoperative echocardiography revealed severe left ventricular hypertrophy, marked left ventricular-aortic pressure gradient (144 mmHg), and the impairment of left ventricular distensibility. Therefore, DDD pacemaker was implanted in addition to aortic valve replacement. Postoperative cardiac catheterization revealed that cardiac output was increased about 25% by DDD pacing compared with VVI pacing. It is more reasonable to employ DDD pacemaker to the case of which distensibility is impaired.

Simultaneous determination of morazone and phenmetrazine in rat plasma and urine using an on-column injection technique with fused-silica capillary column gas chromatography

The simultaneous determination of morazone and its major metabolite, phenmetrazine, using an on-column injection technique with fused-silica capillary column gas chromatography is described. The on-column injection technique prevents the decomposition of morazone. The limit of quantitation in 0.1 mL of rat plasma for morazone and phenmetrazine is 5 ng/mL and that in 1.0 mL of rat urine is 1 ng/mL. The within run precisions (%CV) at the concentration of 0.5 micrograms/mL are 3.27% for morazone and 3.09% for phenmetrazine.

[Surgical treatment of thoracoabdominal aortic aneurysms]

Between February, 1981, and April, 1989, 20 patients underwent surgical treatment of thoracoabdominal aortic aneurysms. Most of the patients were operated under temporary external bypass. For Group I and III aneurysms without reconstruction of renal arteries, a modified Crawford's graft inclusion technique was employed to shorten abdominal visceral ischemic time. This modification consists of (1) using adjuncts to perfuse the distal aorta during aortic clamp, (2) starting the first anasistomosis from the distal end of the graft, and (3) shifting the distal aortic clamp on the graft after completing the anastomosis in order to restore abdominal visceral circulation as soon as possible. For Group III and IV aneurysms with reconstruction of renal arteries as well as celiac and superior mesenteric arteries, a modified DeBakey's procedure was employed. This modification consists of (1) using the spiral opening method, (2) doing end-to-end anastomosis at the proximal aortic site, and (3) maintaining the circulation of abdominal organs and spinal cord by using adjuncts during the anastomosis of the proximal end. There were one operative death and two hospital deaths. Paraplegia developed in two cases, one of which was a ruptured case. Renal dysfunction was not found in any case. The survivors were followed from 5 to 103 months, and there was no late death. The results suggest that our modified procedures for thoracoabdominal aortic aneurysms are useful and reliable ones.

[A case of pulmonary infarction secondary to subacute bacterial endocarditis with subpulmonary VSD]

A case of pulmonary infarction secondary to subacute bacterial endocarditis of pulmonary valve which is associated with subpulmonary VSD is presented. The jet stream of blood through the subpulmonary VSD made damage to the pulmonary valve, which may be one of the reasons why subacute bacterial endocarditis was associated with the subpulmonary VSD. Echocardiography of the right-sided valves will be very useful in order to detect the pulmonary valve endocarditis in congenital heart disease presenting with fever.

[A case of biventricular assist with centrifugal pumps after operation of ventricular septal perforation following acute myocardial infarction]

We applied biventricular assist using centrifugal pumps on a 64-year-old male who has undergone an operation against post-myocardial infarction with ventricular septal perforation. The pump flow was maintained at the level of 2.5 l/m2 in CI, and the pulse pressure 30 to 50 mmHg with IAPB. Complete hemostasis has been achieved prior to use heparin to control the patient's ACT around 200 sec. on the third pumping day. The patient's cardiac function improved in a few days at the beginning, but did not recover enough for weaning from the assist devices. He died on the 8th pumping day, and the autopsy revealed massive old myocardial infarction which is considered to be the major obstacle against the recovery of the cardiac function. There was no edema in any organs. Centrifugal pumps are very useful for ventricular assist in availability and in economy. Its efficacy is comparable with pulsatile ventricular assist devices especially when applied with IABP though there still exists controversy as for the superiority of pulsatile flow in ventricular assist.

Posterior ciliary-artery occlusion after subcutaneous silicone-oil injection

Visual loss occurred after subcutaneous silicone-oil injection for cosmetic purposes. To our knowledge, this is the first instance of amaurosis caused by a subcutaneous foreign-material injection that spared the central retinal artery and affected portions of the posterior ciliary-artery distribution, including a probable cilioretinal artery. The visual-field defects produced allow a rare opportunity to view the distribution of the human posterior ciliary-artery circulation by means of this in vivo pathologic embolic process. The facial arterial anatomy pertinent to ocular embolism is also discussed.

Seroepidemiologic studies on rubella in Fukuoka in southern Japan during 1965-1981: rubella epidemic pattern, endemicity and immunity gap

The epidemiology of rubella in most areas of Asia has not been defined. In Fukuoka city in southern Japan, rubella epidemics occurred in 1956-58, in 1966 and in 1976-77. During the first halves of the 1960s and 1970s, neither epidemic nor endemic clinical rubella occurred. Rubella mass vaccination for girls of 14 years of age started in 1978. Rubella seroepidemiologic studies were performed in 1965, 1974, 1978-79 and 1981 in Fukuoka city. Current studies indicated that children of 6-10 years of age during the epidemics of 1956-58, 1966 and 1976-77 were infected with rubella in 72%, 37% and 57% of cases, respectively. Just before the epidemics of 1966 and 1976-77 100% of the children under nine years of age had no antibodies to rubella indicating absence of recent outbreaks. Whereas 95% of the population (young women of 15-18 years of age in 1981) which participated in the rubella mass vaccination programme since 1978 have rubella Hl antibodies, 46% of the nonparticipating population (19-23 years of age in 1981) remains susceptible to rubella. These facts indicate that rubella epidemics occurred in 1956-58, 1966 and 1976-77, that the magnitude of each epidemic was different, and that there were intervals without endemicity in the inter-epidemic periods. However, after the nation wide rubella epidemic in 1975-77, endemic rubella continued, and rubella epidemics again occurred in 1980-82. The unique rubella epidemic pattern in Japan may be changing in the 1980s to that which existed in most areas of the world where rubella was endemic with periodic increased incidence of epidemicity.(ABSTRACT TRUNCATED AT 250 WORDS)

Repair of large chest wall defects using pedicle flaps

Three cases of chest wall resection illustrate the use of three different full thickness pedicle flaps which can be used to cover almost any area of the anterior chest wall. The medially based acromiothoracic flap was swung inferiorly to cover a lateral defect. Laterally based abdominal wall and axillary flaps were used to cover more medial defects. In case III bilateral axillary flaps were necessary to cover a huge central defect after resection of the anterior sternum and anterior cartilages of seven ribs for a sebaceous carcinoma.

Lack of cytochalasin E-induced superoxide release by polymorphonuclear leucocytes of patients with chronic granulomatous disease: a new diagnostic test

Reduction of exogenous cytochrome c was induced by the treatment of human polymorphonuclear leucocytes with cytochalasin E. The reduction was completely inhibited by superoxide, dismutase, indicating that superoxide anions were released from the cells. The leucocytes from two patients with chronic granulomatous disease did not show the release reaction that should have been brought on by the treatment. The cytochalasin-induced reduction of exogenous cytochrome c by polymorphonuclear leucocytes is so specific and sensitive that it seems to be useful for diagnosis of chronic granulomatous disease.

ON THE EFFECT OF AN ATTRACTIVE MORSE POTENTIAL ON THE VIBRATIONAL ENERGY TRANSFER

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