[Candida mediastinitis after double closure technique for repairing ventricular septal perforation]

A 69-year-old man was referred to our hospital due to acute myocardial infarction. Systolic heart murmur was first noted on the 23rd day after the onset, but no cardiac shunt flow was detected by echocardiography at that time. Six days later, cardiac function deteriorated rapidly, followed by oliguria and shock. Re-do echocardiography showed ventricular septal perforation. Emergency operation was performed, and septal perforation was seen on the anterior portion of the septum. In addition to infarct-exclusion-technique (Komeda-David method) with the equine pericardial patch, direct closure of the septal defect was performed (double closure technique). Fibrin glue was applied between the ventricular septum and the patch. After surgery, he suffered from Candida mediastinitis and received omentum plombage. Furthermore tracheotomy was performed for pneumonia. He recovered gradually, and was discharged about 3 months after surgery. Echocardiography showed no residual shunt.

[Effect of left ventricular assist device (LVAD) after myocardial infarction: study of reinfarction model]

The effect of the left ventricular assist device (LVAD) after myocardial infarction was studied in 10 mongrel dogs. In the first experiment, the left anterior descending coronary artery (LAD) was occluded for one hour, then the LAD was reperfused. Two weeks later, the dogs were divided into two groups. In group I (control, n = 5), the LAD was occluded for 120 minutes, but the LVAD, implanted between left atrium and aorta, was not driven. In group II (pumping, n = 5), the LVAD was started 15 minutes after LAD occlusion, and continued for 115 minutes, then reperfused after 120 minutes of occlusion. The left ventricular segment length was monitored continuously by a pair of titanate-zirconate piezoelectric crystal. End-diastolic length (EDL) and end-systolic length (ESL) were identified. To describe segmental motion, % shortening was defined as follows: %shortening = (EDL-ESL)/EDL x 100. Just after sacrifice, the hearts were removed and sectioned transversely. Area of infarction was measured by planimetry as identified by incubation of heart slices in nitroblue tetrazolium dye. After LAD occlusion, % shortening decreased significantly in both groups. After reperfusion, % shortening increased, but was significantly low in the group I at 30 minutes of reperfusion.(p < 0.05). The EDL of ischemic region increased after coronary occlusion and remained high during LAD occlusion. The EDL was almost the same in both groups at 30 minutes of reperfusion. Area of infarction evaluated weight ratio and transmurality were 10.9 +/- 3.9% versus 11.3 +/- 1.4% and 81.2 +/- 8.9% versus 61.0 +/- 5.1% in comparison of group I versus group II.(ABSTRACT TRUNCATED AT 250 WORDS)

[Decision analysis in therapeutic strategies for small bowel obstructions]

Clinical decision analysis was applied in therapeutic decision-making regarding small bowel obstructions. For strangulation obstruction, the three strategies of immediate surgery, observation of clinical course, and decision according to ultrasonographic findings were analyzed. When mortality rate, morbidity rate, or duration of hospital stay was used as the utility value, decision on the basis of ultrasonographic findings was selected as the most effective strategy, while the strategy of immediate surgery was selected when the rate of intestinal necrosis was used as the utility value. For adhesive obstructions, the three strategies of immediate surgery, conservative treatment with long tube decompression, and long tube decompression with enteroclysis (infusion contrast radiography) were analyzed. The strategy of enteroclysis was selected when morbidity rate and duration of hospital stay were used as utility values, while immediate surgery was selected when recurrence rate of adhesive obstruction was used as the utility value. For obstruction caused by intraabdominal recurrent cancer, operative treatment and conservative treatment were analyzed. The strategy of surgery was selected when rate of obstruction resolved and number of months of survival were used as utility values. Clinical decision analysis is valuable in quantitatively assessing individual variables affecting therapeutic decision-making.

[Case report of periodontal disease with periodic neutropenia]

A case of periodic neutropenia with specific symptoms of gingiva and alveolar bone loss in primary dentition is reported. The patient was a boy, and it was followed between the ages of 3- and 9 years-old. At the period of neutropenia he was suffered from recurrent redness, swelling and bleeding of the gingiva, and also with cold-like symptoms with fever. Although the cause of these symptoms was not definite at first, even in medical exploration, we could diagnose this disease as periodic neutropenia by the process of dental therapy. By alveolar bone resorption, pocket formation and severe tooth mobility, the patient had lost more than half of his primary teeth at the end of 2 years after the initial examination. However throughout this period we motivated and instructed the patient and his mother how to brush his teeth. His oral hygiene was improved in the mixed and permanent dentition stages. Then there was no evidence of bone resorption around the teeth of the permanent dentition stage, but recurrent gingival symptoms are continuing now. The specific feature of this case is found in the gingival findings. There was no ulceration of the oral mucosa, but a bright red jelly-like appearance was found periodically in the area of the marginal and attached gingiva. The junction between the reddened attached gingiva and the alveolar mucosa was well-defined. The serial examination of peripheral blood in this case revealed the cycle of neutropenia as 16 to 21 days. During this examination, and at the almost time of neutropenia of this patient, hyperplasia of monocytes and lymphocytes occurred. In this situation there was no clinical signs except for gingival redness. However at other times, generally marked signs were recurrent. This may have occurred due to the lack of both neutrophils and monocytes. From the above results we think that periodic neutropenia may be diagnosed first in the dental clinic by the distinctive redness in the gingival area as one specific sign of this disease. We also think that plaque control procedures may retain the teeth.

Development of a ceramic heart valve

A durable and thromboresistant ceramic heart valve comprised of a single crystal alumina disk and titanium nitride (TiN) valve ring has been developed. Blood compatibility was examined by scanning electron microscopy (SEM) examinations of the valves implanted in sheep for 35 (#1), 26 (#2), 20 (#3), 23 (#4), and 26 (#5) days. The single crystal alumina and TiN surfaces were free of platelet aggregation or fibrin networks, except for some depositions of fibrin and platelets on the outflow TiN ring in #3, and isolated red cells on the outflow TiN ring in #5. Durability testing under high pressure (1750 mmHg = 233 KPa) pulsatile conditions showed that the safety factor of the ceramic valve was more than seven times greater than anticipated. The ceramic valve is promising as an artificial heart valve.

[Application of beta-tricalcium phosphate to periodontal therapy. Part 1. Fundamental studies and biological tests of beta-TCP prepared by mechanochemical method]

Physical, chemical, biological and implant tests on calcium phosphate prepared by the mechanochemical method with wet milling were performed to determine their applicability for periodontal therapy. 1. Materials synthesized by the new method had a stoichiometric ratio of Ca/P = 1.50 and a density of 3.70 g/cm3 and coincided with the standard pattern of beta-TCP (ASTM Card) very well. 2. The surface structure of dense type sintered at 1,100 degrees C showed fewer fine pores than the dense type sintered at 1,050 degrees C. The surface structure of the porous type sintered at 1,050 degrees C showed finer pores, except for a continuous large pore than the porous type sintered at 1,000 degrees C. 3. Specific conductivity tests should higher solubilities of the porous type than of the dense type in pure water, and of materials sintered at low temperature than at high temperature. 4. Cytotoxicity studies with V-79 cells showed no significant differences from the controls, and other biological tests revealed no abnormalities. 5. At three and six weeks after implantation in muscles, all of beta-TCP was enclosed with collagen fiber. The porous type of beta-TCP was almost completely fused to cranical bone in rabbits three weeks after implantation. The dense type of beta-TCP was completely fused to cranical bone six weeks after implantation. From these results, it can be concluded that beta-TCP prepared by the new method is of high purity and biocompatibility. Consequently beta-TCP is expected to be effective in clinical use.

Four cases with complex Philadelphia translocations, including one with appearance de novo of a "masked" Ph

Four cases of chronic myelogenous leukemia (CML) with complex Philadelphia (Ph) translocations are described. The first case was that of a 50-year-old woman in the chronic phase of CML. Her leukemic cells showed a complex Ph translocation involving chromosomes #9, #11, and #22 [i.e., t(9;9;22;11)(11qter----11q11::9q11----9q34:: 9p11----9pter;22qter----22q11::9q34?;11 pter----11q11::22q11----22qter)]. In addition to the complex Ph translocation, the leukemic cells contained del(10)(p13). The second case was that of a 21-year-old man whose leukemic cells contained a translocation involving chromosomes #5, #9, and #22 [i.e., t(5;22;9)(q31;q11;q34)], resulting in a "masked" Ph chromosome. The third case was that of a 37-year-old man whose leukemic cells had a complex Ph translocation involving chromosomes #8, #9, and #22 [i.e., t(8;9;22)(q13;q34;q11)]. The fourth patient was a 41-year-old woman diagnosed as having CML in myeloid blastic phase, at which time the first specimen was examined by us. This blood sample showed a karyotype of 45,XX, -9, -17, -22, +mar1, +mar2,9q+. No Ph chromosome was present. A standard Ph translocation was detected in the cells obtained from the spleen, when the patient underwent splenectomy for treatment of the blastic crisis. Subsequent specimens obtained from the blood and bone marrow showed that the leukemic cells contained three clones: 45,XX, -9, -17, -22, +mar1, +mar2,9q+/46,XX, -17, +mar1,t(9;22)(q34;q11)/46,XX,t(9;22)(q34;q11). Cells with the "masked" Ph chromosome were thought to have been derived from the clone with the standard Ph translocation. We postulate that some variant Ph translocations, including those with a "masked" Ph chromosome, may be generated by a stepwise process following the genesis of a standard Ph translocation.