[A Successful Surgical Treatment of Hemolytic Anemia Caused by Aortic Valve Perivalvular Leakage and Severely Kinked Elephant Trunk:Report of a Case]

Both perivalvular leakage and kinked prosthetic graft may cause hemolysis. A 72-year-old man was refereed to our hospital because of hemolytic anemia. He has past histories of total aortic arch replacement and repeat aortic valve replacement for aortic aneurysm and prosthetic valve endocarditis. Pre-operative examinations demonstrated aortic valve perivalvular leakage and severe graft kinking of the elephant trunk. Repeat aortic valve replacement and axillo-femoral bypass were performed successfully. Hemolysis got better after the operation and the patient discharged home in stable condition.

Association between outpatient cardiac rehabilitation and all-cause mortality after cardiovascular surgery: A propensity score-matched analysis

Objectives

Cardiac rehabilitation (CR) is a class I recommendation in the treatment guidelines for cardiovascular disease; however, its postoperative prognostic effects after surgery are not fully understood. Therefore, this study aimed to examine the effect of multidisciplinary outpatient CR on postdischarge all-cause mortality in patients who underwent cardiovascular surgery.

Methods

This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between April 2015 and March 2021. Patients were categorized into CR and non-CR groups. The primary outcome measure was all-cause mortality. Propensity score-matching analysis was performed to minimize selection bias and differences in clinical characteristics. The propensity score for each patient was produced using logistic regression analysis, with the CR group and the subsequent 27 variables as the dependent and independent variables, respectively.

Results

In our cohort (n = 1095), 51 patients (4.7%) died during the follow-up period (mean, 1042 days). The CR group had a significantly lower mortality rate than the non-CR group (hazard ratio, 0.45; 95% CI, 0.21-0.95; P = .036). After propensity score matching adjusted for confounders, the association between CR and reduced risk of all-cause mortality remained (hazard ratio, 0.35; 95% CI, 0.14-0.85; P = .02).

Conclusions

Postdischarge multidisciplinary outpatient CR in patients who underwent cardiovascular surgery was associated with a substantial survival benefit, which persisted after adjusting for variables, including age, operative factors, physical and cognitive functions, and nutritional status.

Delayed bowel necrosis due to inferior mesenteric artery occlusion in Stanford type A acute aortic dissection

Although inferior mesenteric artery occlusion due to acute aortic dissection sometimes occurs, it is usually not considered an important finding. Herein, we present an extremely rare case of delayed bowel ischaemia due to inferior mesenteric artery occlusion in Stanford type A acute aortic dissection that highlights the need for cardiac surgeons to be mindful of inferior mesenteric artery occlusion in patients with superior mesenteric artery dissection or vascular anomalies in the mesenteric arteries.

Surgical glue-induced left main trunk stenosis removed by directional coronary atherectomy

A 55-year-old man underwent aortic repair for acute aortic dissection. The pseudolumen of the Valsalva sinus was reapproximated with BioGlue by placing a sponge inside of it to prevent the BioGlue from entering. Postoperative contrast-enhanced computed tomography showed stenosis of the left main trunk. Directional coronary atherectomy was performed; complete release of the stenosis was achieved. Various fragments retrieved from the left main trunk were pathologically consistent with BioGlue. When we reapproximated the dissected aortic wall, inserting a sponge into the aorta did not prevent the surgical glue from entering. Directional coronary atherectomy was a good therapeutic option to treat glue-induced coronary artery stenosis.

Results of off-pump coronary artery bypass grafting with off-pump first strategy in octogenarian

Background and Aim

Ischemic heart disease is the leading cause of death around the world. Coronary artery bypass grafting offers efficient surgical revascularization for ischemic disease. Both on‐ or off‐pump coronary artery bypass methods provide promising results to octogenarians, once complete vascularization is achieved. However, off‐pump bypass requires a certain level of experience to achieve sufficient results. We have applied an off‐pump coronary artery bypass‐first strategy to all generations since 2008. This study investigated early and long‐term results of surgical revascularization for octogenarians by a team with an off‐pump‐first strategy.

Methods

All cases of isolated coronary artery bypass grafting performed since 2008 were identified and divided into a young group (age < 80 years) and an old group (age ≥ 80 years). Peri‐operative results were investigated retrospectively in both groups and long‐term results for the old group were assessed.

Results

Among the 707 patients, 97% underwent off‐pump bypass, and 94 cases were classified to the old group. Distal anastomoses and ventilator time were identical between groups (young vs. old: 3.3 vs. 3.2; 3.7 h vs. 3.7 h). In‐hospital death rates were 0.5% and 0% in the young and old groups, respectively. With a mean follow‐up of 1318 days, actual 1‐, 3‐, and 5‐year survival rates for octogenarians were 92.1%, 81.2%, and 68.3%, respectively. Nearly half of the patients reached their nineties, which was close to the life expectancy of the national general octogenarian.

Conclusions

An experienced team with an off‐pump‐first strategy could provide valid therapeutic options for octogenarians.

Aortic Valve Replacement by a Transaxillary Anterior Minithoracotomy Approach

A modified transaxillary approach for aortic valve disease to obtain the same exposure as the anterior minithoracotomy approach and to preserve the pectoralis major muscle is presented. When the patient's right shoulder is adducted horizontally, or the right arm is flexed anteriorly 90 degrees and adducted to the left, the right axilla comes close to the chest midline. That means that a right anterior thoracotomy can be made through the right axilla when the arm position is adjusted appropriately. The modified new approach is safe and faster than the conventional transaxillary approach, and it provides cosmetic advantages to the patient.

Successful Endovascular Repair for Abdominal Aortic Aneurysm Presenting as Aortoduodenal Syndrome

Aortoduodenal syndrome is a rare duodenal obstruction caused by an abdominal aortic aneurysm. Current treatment involves open aneurysmal repair according to the theory that this procedure releases the duodenum from mechanical compression. However, the mechanism of duodenal blockage remains unclear and reports of endovascular aneurysm repair (EVAR) for aortoduodenal syndrome are quite rare. We report our successful case of EVAR for aortoduodenal syndrome without aneurysmal shrinkage and discuss the mechanism of duodenal obstruction.

Thoracic endovascular aneurysm repair to treat recurrent lower limb ischemia secondary to occlusion of axillofemoral bypass

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One of the complications of type B aortic dissection is organ ischemia.

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TEVAR was performed for entry closure.

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TEVAR improved malperfusion.

Introduction

A case of malperfusion in which the patient presented with aortic dissection is presented.

Presentation of case

A 69-year-old man with an acute aortic dissection (Stanford type B) had lower limb ischemia. Axillary-femoral bypass was performed, and his lower limb ischemia improved. Eight months after the onset of acute aortic dissection, he again had lower limb ischemia. Contrast-enhanced computed tomography showed axillary-femoral bypass occlusion and true lumen collapse, compressed by the increased false lumen pressure in the aorta. Thoracic endovascular aortic repair (TEVAR) was performed for entry closure. His lower limb ischemia was improved by TEVAR.

Discussion

One of the complications of type B aortic dissection is malperfusion. Endovascular therapy is a first step in treating the malperfusion of type B aortic dissection. It is important to seal the entry for the treatment of malperfusion.

Conclusion

If there is an entry, it is important to seal it for the treatment of malperfusion.

How to anastomose a patch to avoid residual leak in the infarct exclusion method

BACKGROUND AND AIM

Postinfarction ventricular septal defect is a potentially lethal complication of acute myocardial infarction for which surgical repair is mandatory. The infarct exclusion method has contributed to improving surgical outcomes, but a certain percentage of residual leakage continues to be reported. We considered possible mechanisms of residual leakage and modified the sewing method to overcome these mechanisms.

METHOD

A bovine pericardial patch and a Teflon felt strip between the patch and endocardium to achieve good fit were used. The patch and felt were anchored with U stay sutures and reinforced with a running suture.

RESULTS

Use of the modified method in seven cases showed improved outcomes. Only one patient had trivial leakage, compared to nine cases using the older method; six of nine patients had residual leaks, including three minor ones.

CONCLUSIONS

Our method is a rational approach that effectively reduces residual leakage.

A mycotic aortic aneurysm treated by thoracic endovascular aneurysm repair

An 88-year-old man was admitted with general fatigue. Computed tomography (CT) showed a descending aortic aneurysm. The laboratory data indicated severe infection. Despite negative blood cultures, broad-spectrum intravenous antibiotic therapy was started. Though antibiotic therapy was continued for about 2 weeks, the aneurysm extended 20 mm. Thoracic endovascular aortic repair was performed, and antibiotic therapy was continued for 4 weeks after the procedure, followed by oral antibiotics for 1 year. CT showed regression of the aneurysm 15 months after reconstruction. Antibiotic therapy, preoperatively and postoperatively, is important for a mycotic aortic aneurysm.

Early and long-term results of surgery for secondary mitral regurgitation with a damaged heart

BACKGROUND

Surgery for secondary mitral regurgitation is still controversial, especially when the left ventricle is damaged. The Mitra Clip has been shown to be safe and effective for certain patient groups but does not offer superior control of mitral regurgitation compared with the surgery. If performed safely, the surgery can provide greater benefits over the long-term. The objective of this study was to retrospectively investigate the early and long-term results of mitral valve surgery for secondary mitral valve regurgitation with a damaged, dilated left ventricle.

METHODS

Patients with ejection fraction <40% and left ventricular end-diastolic/systolic diameter >50/40 mm who underwent mitral valve surgery for secondary mitral regurgitation were investigated retrospectively.

RESULTS

The mean age of the 80 identified cases was 65.7 years, and 63 patients were male. Preoperative echocardiograms showed a mean ejection fraction of 25.2% and mean left ventricular diameters in diastole/systole of 64.5/56.9 mm, respectively. Mitral valve replacement was performed in 39 cases, and mitral valve plasty in 41 cases. The most common concomitant procedures were coronary artery bypass grafting and tricuspid valve surgery (41.3% each). Mitral regurgitation improved significantly from 3.5 to 0.83, and no operative or in-hospital deaths were encountered. Long-term results showed actual 1-, 3- and 5-year survival rates of 93.1%, 80.0%, and 64.7%, respectively (mean follow-up, 1264 days).

CONCLUSIONS

Early results of this study were good and long-term results were acceptable. Our results suggest that mitral valve surgery is feasible for secondary mitral valve regurgitation even in dilated, damaged hearts.

A technique to prevent recurrence after the repair of pacemaker lead-induced tricuspid regurgitation

This article describes how to repair pacemaker lead-induced tricuspid regurgitation without removing the pacing leads. Our technique can eliminate the lead contact with the tricuspid leaflets and the tricuspid apparatus and is effective in preventing recurrence.

A drainage catheter tangled around a closed left atrial appendage

A 70-year-old man underwent cardiac surgery including left atrial appendage closure. A pigtail catheter was inserted into the pericardial sac because of delayed tamponade. Removal of the catheter was planned for 2 days after drain insertion. However, the resistance was high and pulsatile. The patient was transferred to the catheterization laboratory and a guide wire was inserted through the catheter, revealing the catheter route around the left atrial appendage. The wire was exchanged for a stiff wire to uncurl the catheter as much as possible, then the catheter was removed. The left atrial appendage does not usually represent an obstacle to catheter removal because it is soft and shrinkable. However, once the left atrial appendage becomes closed off, it can become hard, unshrinkable and an obstacle that might be caught by the drainage catheter.

The second offshore production of methane hydrate in the Nankai Trough and gas production behavior from a heterogeneous methane hydrate reservoir

Following the first attempt at producing gas from a naturally occurring methane hydrate (MH) deposit in the Daini–Atsumi Knoll in the eastern Nankai Trough area off Honshu Island, Japan in 2013, a second attempt was made in April to June of 2017 at a nearby location using two producer wells sequentially and applying the depressurization method. The operation in the first borehole (AT1-P3) continued for 12 days with a stable drawdown of around 7.5 MPa and 41 000 m³ of methane gas being produced despite intermittent sand-production events. The operation of the other borehole (AT1-P2) followed, with a total of 24 days of flow and 222 500 m³ of methane gas being produced without sand problems. However, the degree of drawdown was limited to 5 MPa because of a higher water production rate than expected in the second hole. The pressure and temperature sensors deployed in the two producers, along with the two monitoring holes drilled nearby, gathered reservoir response data and information about the long-term MH dissociation processes in the vicinity of the production holes in the temporal and spatial domains. Although the ratio of energy return to the input was considerably larger than that for the depressurization operation, some observations (e.g., the high contrast in the production rates between the two holes and the almost constant or slightly reduced gas production rates) were not predicted by the numerical models. This failure in prediction raises questions about the veracity of the reservoir characteristics modeled in the numerical simulations. This paper presents the operation summaries and data obtained with thought-experiment based-anticipated production behaviors and preliminary analysis of the obtained data as the comparison with expected behaviors. Detailed observations of gas and water production, as well as the pressure and temperature data recorded during the gas flow tests, indicate that the heterogeneous MH distribution within the reservoir was mainly responsible for the discrepancies observed between the anticipated and actual behaviors. Furthermore, the motion of the water that does not originate from MH dissociation introduces complexity, such as the occurrence of concentrated water-producing intervals and unexpected gas production responses to decreases in pressure, into the production behavior. The influence of heterogeneity should be clearly understood for the accurate prediction of gas production behavior based on MH reservoirs.

The second gas production attempt from a methane hydrate (MH) deposit in the eastern Nankai Trough area was made in 2017 with the intensive data acquisition program, and it revealed effects of reservoir characters on the MH dissociation behaviors.

Effect of Perioperative Neuromuscular Electrical Stimulation in Patients Undergoing Cardiovascular Surgery: A Pilot Randomized Controlled Trial

A randomized, controlled trial was conducted to examine the effects of perioperative neuromuscular electrical stimulation on muscle proteolysis and physical function using blinded assessment of physical function. Consecutive patients undergoing cardiovascular surgery were screened for eligibility as study subjects. Participants were randomly assigned to receive either neuromuscular electrical stimulation or the usual postoperative mobilization program. The intervention group received neuromuscular electrical stimulation on bilateral legs 8 times before and after surgery. The primary outcomes were the mean 3-methylhistidine concentration corrected for urinary creatinine content from baseline to postoperative day 6, and knee extensor isometric muscle strength on postoperative day 7. Secondary outcomes were usual walking speed and grip strength. Physical therapists blinded to patient allocation performed measurements of physical function. Of 498 consecutive patients screened for eligibility, 119 participants (intervention group, n = 60; control group, n = 59) were enrolled. In the overall subjects, there were no differences in any outcomes between the intervention and control groups. The results demonstrated no significant effects of neuromuscular electrical stimulation on muscle proteolysis and physical function after cardiovascular surgery, suggesting the need to explore indications for neuromuscular electrical stimulation and to clarify the effects in terms of the dose-response relationship.

Effectiveness and safety of a new regimen of polyethylene glycol plus ascorbic acid for same-day bowel cleansing in constipated patients

BACKGROUND AND STUDY AIMS

In an exploratory study we compared a new regimen of low-volume polyethylene glycol plus ascorbic acid (PEG-Asc) with the standard regimen for same-day bowel cleansing in constipated patients.

PATIENTS AND METHODS

Between January and June 2015 we studied consecutive patients with constipation (Rome III constipation criteria) scheduled for colonoscopy. The initial group received the standard regimen of PEG-Asc. The subsequent group received the new regimen. The new regimen involved ingestion of 10 mL of sodium picosulfate and 50g of magnesium citrate dissolved in 0.2 L of water followed by 0.2 L of PEG-Asc +0.2 L of water given 6 or 7 times over 3 hours. Bowel cleansing was prospectively evaluated using the Boston bowel preparation scale (BBPS). Bowel cleansing, adenoma detection rates and adverse events were reviewed using electronic medical records and endoscopic filing system.

RESULTS

Sixty-two patients used the standard regimen and sixty used the new regimen. The basic characteristics of the two groups were similar. The mean volume of PEG-Asc and total liquid intake was less with the new regimen compared to the standard regimen (1.3 L vs. 2.0 L, P<0.001; 2.6 L vs. 3.0 L, P<0.001). The proportion of patients with a BBPS score ≥ 6 was significantly greater with the new than the standard regimen (93% vs. 76%, P=0.008). Nausea and/or vomiting was also significantly less frequent than with the standard regimen (5% vs. 16%, P=0.046).

CONCLUSIONS

The new regimen of PEG-Asc gave improved same-day bowel cleansing for colonoscopy in constipated patients.

Left main coronary malperfusion from acute non-communicating aortic dissection

A 64-year-old man was admitted with sudden back and chest pain. He had undergone aortic valve replacement 5 years earlier. Enhanced computed tomography showed acute type A non-communicating aortic dissection. He was initially treated with supportive medical therapy. Since he was restless, he was placed on a respirator. He went into sudden shock 6 h after onset. Percutaneous cardiopulmonary support was administered, and coronary arteriography showed progression of the dissection to the left main trunk. Percutaneous coronary intervention was performed. He recovered from shock and then underwent ascending aorta replacement. He was discharged from hospital without any major complications.

Assessment of biological, psychological and adherence factors in the prediction of step-down treatment for patients with well-controlled asthma

BACKGROUND AND OBJECTIVE

Inhaled corticosteroids (ICS) and inhaled corticosteroids combined with long-acting beta2-agonist (ICS/LABA) are standard treatments for asthma. However, factors that might help reduce medication in well-controlled asthma are unknown. We classified problems of asthma patients into biological, psychological and adherence factors, and investigated factors associated with the indication and failure of a medication step-down treatment.

METHODS

Two hundred twenty two well-controlled asthma patients receiving ICS or ICS/LABA were assessed for physical and psychiatric problems and followed up for one year from adjustment of their treatment step. Factor B was defined as a presence of chronic upper airway complications. Factor P was defined as presence of psychiatric complications such as sleep disorder, depression, anxiety and somatoform disorders. Factor A was defined as poor adherence to ICS or ICS/LABA inhaler of 75% or less. Success in step-down treatment was defined as maintenance of well-controlled status for over one year after step-down.

RESULTS

Factor B was the most important single negative predictive factor for indication for step-down treatment (Odds ratio; 0.19). Factor A increased the risk of failure to maintain step-down treatment most significantly by 23-fold, and factor B increased it by 11-fold. The combination of factors B and A increased failure by 24-fold, factors P and A by 21-fold, all three factors by 36-fold. Factor P only interacted with the other factors to reduce chances of stepping down, but did not constitute a problem factor when present alone.

CONCLUSION AND CLINICAL RELEVANCE

The evaluation of biological, psychological and adherence problems may lead to a more proactive and targeted approach to step-down treatment for patients with well-controlled asthma.

Thermal responses of a gas hydrate-bearing sediment to a depressurization operation

As a part of a research program aiming to mobilize marine gas hydrate deposits as an energy resource, the worlds' first gas production attempt was performed in early 2013 in the Daini Atsumi Knoll, Eastern Nankai Trough, off Honshu Island, Japan.

Recognizing both the maximum and the second maximum of a sequence

We consider the situation in which the decision-maker is allowed to have two choices and he must choose both the best and the second best from a group of N applicants. The optimal stopping rule and the maximum probability of choosing both of them are derived.

Importance of early detection of oesophageal complications after aortic stent graft repair

Oesophageal complications after endovascular aortic stent repair are rare, but may lead to catastrophic consequences. Early detection is mandatory, but is sometimes difficult because of a lack of specific signs in the early stages. We report 2 cases with opposing results of oesophageal complications after aortic stent graft repair, and discuss the early signs of this disastrous complication and potential methods for early detection.

Aneurysm of the sinus of Valsalva dissecting into the intraventricular septum

Aneurysm of the sinus of Valsalva is an uncommon entity and especially rare when it dissects into the intraventricular septum. This uncommon clinical manifestation often takes a drastic clinical course with life-threatening arrhythmia, coronary ischemia, rupture, and heart failure. We present the case of a 36-year-old man with an aneurysm of the sinus of Valsalva dissecting into the intraventricular septum, which induced severe aortic insufficiency and heart block.

Uncoupling Action of Antibiotic Sporaviridins with Rat-liver Mitochondria

The effects of the glycoside antibiotic sporaviridins (SVDs) on oxidative phosphorylation of rat-liver mitochondria were examined. SVDs released state 4 respiration, dissipated transmembrane electrical potential, and accelerated ATPase activity. These facts demonstrated that SVDs are potent uncouplers of oxidative phosphorylation. During the uncoupling caused by SVDs, large amplitude swelling and oxidation of intramitochondrial NAD(P)H occurred, suggesting that SVDs greatly enhanced nonspecific permeability of the inner mitochondrial membrane. It is suggested that the uncoupling action of SVDs might be caused by dissipation of proton electrochemical potential due to an increase in the permeability of inner mitochondrial membrane.

Retinoic acids up-regulate functional eosinophil-driving receptor CCR3

Eotaxins and their receptor CCR3 have a definitive role for tissue accumulation of eosinophils both under homeostatic and pathologic conditions. However, physiological stimuli that can up-regulate CCR3 in blood-derived human eosinophils have not been recognized. As a prior gene microarray study revealed up-regulation of CCR3 in eosinophils stimulated with retinoic acids (RAs), the expression of functional CCR3 was examined. We found that 9-cis RA and all-trans RA (ATRA) significantly induced surface CCR3 expression regardless of the presence of IL-3 or IL-5. Pharmacological manipulations with receptor-specific agonists and antagonists indicated that retinoic acid receptor-α activation is critical for CCR3 up-regulation. RA-induced CCR3 was associated with its functional capacity, in terms of the calcium mobilization and chemotactic response to eotaxin-1 (CCL11). Our study suggests an important role of vitamin A derivatives in the tissue accumulation of eosinophils.

Neural decoding of visual imagery during sleep

Visual imagery during sleep has long been a topic of persistent speculation, but its private nature has hampered objective analysis. Here we present a neural decoding approach in which machine-learning models predict the contents of visual imagery during the sleep-onset period, given measured brain activity, by discovering links between human functional magnetic resonance imaging patterns and verbal reports with the assistance of lexical and image databases. Decoding models trained on stimulus-induced brain activity in visual cortical areas showed accurate classification, detection, and identification of contents. Our findings demonstrate that specific visual experience during sleep is represented by brain activity patterns shared by stimulus perception, providing a means to uncover subjective contents of dreaming using objective neural measurement.

Ozone microbubble treatment at various water temperatures for the removal of residual pesticides with negligible effects on the physical properties of lettuce and cherry tomatoes

In this study, the effects of ozone microbubbles (OMCB) treatment at various water temperatures on the removal of residual fenitrothion (FT) pesticides and on the physical properties of lettuce and cherry tomatoes was examined. The residual FT percentage in lettuce and cherry tomatoes was shown decreased by using higher water temperatures, particularly at 30 °C, resulting in a decrease within the range of 32% to 52%, after the 20-min treatment. In addition, bubbling OMCB treatment did not alter the color and pulling strength of lettuce and cherry tomatoes. These results indicate that bubbling OMCB treatment at 30 °C is a highly effective method for the removal of FT residues in lettuce and cherry tomatoes, with relatively little effect on crop quality.

PRACTICAL APPLICATION

The bubbling OMCB has a potential of reducing the FT reduces on vegetables with no adverse effect on the sensory quality of vegetables.

Removal of residual pesticides in vegetables using ozone microbubbles

The removal of fenitrothion (FT) pesticide residues from vegetables by immersion in ozone-microbubbled solution was demonstrated. FT-treated lettuce, cherry tomatoes, and strawberries were immersed in ozone-microbubbled, ozone-millibubbled, and dechlorinated water. After that the percentage of residual FT in the vegetables was determined. Residual FT was efficiently removed from lettuce by immersing it in ozone-microbubbled solution containing more than 1.0 ppm dissolved ozone, or continuously generated ozone-microbubbled solution containing 2.0 ppm dissolved ozone. Similarly, for cherry tomatoes and strawberries, the continuously generated ozone-microbubbled solution containing 2.0 ppm dissolved ozone was highly effective. These results showed that ozone microbubbles effectively removed residual pesticides not only from leafy vegetables but also from fruity vegetables.

[Repeated catamenial pneumothorax with pleural and diaphragmatic endometriosis; report of a case]

A 31-year-old female with 2 episodes of right pneumothorax related to onset of menstruation was reported. Thoracoscopy revealed the presence of some cystic lesions in the diaphragm. Partial resection of the diaphragm including the lesions was performed. Histologial findings of the resected diaphragm showed stromal endometriosis. One month after operation, she had a recurrent right pneumothorax related to onset of menstruation. A pinhole perforation of the lower lobe was noted at 2nd surgery. Microscopic examination of the resected lung disclosed endometrial stroma in the macroscopically normal lung tissue. Since air leakage from chest tube continued after surgery, the hormonal therapy with a gonadotropin-releasing hormone analogue was started, and she was discharged from the hospital 3 weeks after hormonal therapy. Report of the demonstration of endmetriosis in the visceral pleura and diaphragm is very rare and the present case is very suggestive is considering the mechanism of the development of this disease.

[Giant left atrial myxoma with ossification on having a fever; report of a case]

A 37-year-old female with a fever had a medical examination, and was pointed out cardiac murmur. She was referred to our hospital for a further examination. Blood cultures were positive for Streptococcus milleri group. Thoracic echocardiogram demonstrated a giant left atrial tumor, arising from the portion of the interatrial septum, and mitral insufficiency. We removed the tumor completely and performed mitral annuloplasty. The tumor was diagnosed as myxoma with ossification by histopathological examination. She discharged from our hospital 25 days after the operation without complication and does not recur for 3 years. We consider our case as extremely rare, because it revealed giant left atrial myxoma with ossification and mitral insufficiency at the same time.

[Mediastinal lymph node carcinoma of unknown primary site; report of a case]

A 44-year-old woman was admitted to our hospital because of mediastinal mass. Serum levels of carcinoembryonic antigen (CEA) were found to be elevated. No preoperative examination could detect the primary lesion. The tumor was resected through right thoracotomy. Histological examination revealed poorly differentiated adenocarcinoma. She was diagonosed as metastatic mediastinal lymph node carcinoma of unknown primary site. She received radiotherapy and chemotherapy and is desease free 29 months after operation. Good results may be obtained by multimodality therapies for cancer in mediastinal lymph node of unknown primary site.

Development of large deformation in 62Cr

The structure of neutron-rich isotopes 60Cr and 62Cr was studied via proton inelastic scattering in inverse kinematics. The deformation lengths (delta) for 60Cr and 62Cr were extracted as 1.12(16) and 1.36(14) fm, respectively, providing evidence for enhanced collectivity in these nuclei. An excited state at 1180(10) keV in 62Cr was identified for the first time. We adopted 4;{+} as its spin and parity, leading to the rapid increase of the Ex(4;{+})/E_{x}(2;{+}) ratio, which indicates the development of large deformation in 62Cr near N=40. Importance of the admixture of the gd-shell component above N=40 is also discussed by comparing with a modern shell model calculation.

[Congenital chylothorax treated with video-assisted thoracic surgery]

A 35-day-old female was referred to our department because of congenital chylothorax. Medical treatment with dietary restriction was undertaken for 5 weeks without resolution of the effusion. A video-assisted thoracic surgery was performed. The mediastinal pleura was covered with fibrin glue. The postoperative course was satisfactory. She was discharged with resolution of the effusion. Video-assisted thoracic surgery offers an effective means of treating chylothorax.

A new control scheme of multilevel quantum system based on effective decomposition by intense CW lasers

We propose a new scheme for quantum dynamics control of multilevel system using intense lasers. To do so, we apply intense CW lasers to create a strongly coupled subsystem with which one can make the complementary space effectively isolated, and we apply the established control schemes to the isolated subsystem. We have also obtained an effective Hamiltonian for the target subsystem with the help of the second-order perturbation theory. Numerical demonstrations on model systems show that the present decomposition scheme effectively works for population dynamics control. It is also found that relaxation processes can be suppressed under the proposed scheme.