P6524The comparison of radial artery occlusion rate after distal radial artery puncture between hemodialysis and non-hemodialysis patients

Background

In recent years it has been attempted to use a distal radial artery (DRA) as a puncture site for cardiac catheterization and intervention. A patency of radial artery is important in hemodialysis patients because the radial artery is source as an arteriovenous shunt. However, the incidence of radial artery occlusion (RAO) is not known after DRA puncture.

Purpose

To compare RAO rates after DRA puncture between dialysis and non-dialysis patients.

Method

This was retrospective, observational and single center study. All consecutive 1,533 patients undergoing DRA puncture were analyzed. The primary endpoint is RAO rates. The secondary endpoint is composite bleeding adverse event rates. These endpoints were evaluated by a vascular echocardiography several hours or the next day after the procedure.

Result

Among 1,533 patients, 26 were dialysis patients and 1,504 were non-dialysis patients. 1,386 people (90.5%) succeeded in puncture. Radial artery occlusion occurred in 7 patients (0.4%), all of whom were non-dialysis patients. There was no significant difference of RAO rate in dialysis patients and non-dialysis patients.

Conclusion

When performing DRA puncture, the probability of radial artery occlusion is not higher in dialysis patients than non-dialysis patients. The DRA puncture may be one of the option as puncture site even in dialysis patients.

Zorotypus pecten, a new species of Zoraptera (Insecta) from mid-Cretaceous Burmese amber

A new species of the order Zoraptera, Zorotypus pecten sp. n., is described from mid-Cretaceous Burmese amber. It is tentatively assigned to the subgenus Octozoros based on 8-segmented antenna. A Gondwanan origin for Zoraptera is discussed based on the geographic distribution of extant and fossil zorapterans.

Evolutionary history of Polyneoptera and its implications for our understanding of early winged insects

Polyneoptera represents one of the major lineages of winged insects, comprising around 40,000 extant species in 10 traditional orders, including grasshoppers, roaches, and stoneflies. Many important aspects of polyneopteran evolution, such as their phylogenetic relationships, changes in their external appearance, their habitat preferences, and social behavior, are unresolved and are a major enigma in entomology. These ambiguities also have direct consequences for our understanding of the evolution of winged insects in general; for example, with respect to the ancestral habitats of adults and juveniles. We addressed these issues with a large-scale phylogenomic analysis and used the reconstructed phylogenetic relationships to trace the evolution of 112 characters associated with the external appearance and the lifestyle of winged insects. Our inferences suggest that the last common ancestors of Polyneoptera and of the winged insects were terrestrial throughout their lives, implying that wings did not evolve in an aquatic environment. The appearance of the first polyneopteran insect was mainly characterized by ancestral traits such as long segmented abdominal appendages and biting mouthparts held below the head capsule. This ancestor lived in association with the ground, which led to various specializations including hardened forewings and unique tarsal attachment structures. However, within Polyneoptera, several groups switched separately to a life on plants. In contrast to a previous hypothesis, we found that social behavior was not part of the polyneopteran ground plan. In other traits, such as the biting mouthparts, Polyneoptera shows a high degree of evolutionary conservatism unique among the major lineages of winged insects.

The "hairy beast"-Zorotypus hirsutus sp. n., an unusual new species of Zoraptera (Insecta) from Burmese amber

A new species of the order Zoraptera, Zorotypus hirsutus Mashimo sp. n., is described from mid-Cretaceous Burmese amber. The specimen is tentatively assigned to the subgenus Octozoros Engel based on number of antennomeres reduced from nine to eight. It is characterized by an unusually strong setation, appearing much more hirsute than other extant or extinct species of the order. Other unusual autapomorphic features are an elongated head capsule with a concave genal region and very slender, elongate antennomeres. The discovery of this aberrant species suggests that the morphological diversity of Zoraptera was much higher than previously expected. For a reliable placement of Zorotypus hirsutus the discovery of males and a robust species level phylogeny would be required.

A remarkable new species of Zoraptera, Zorotypus asymmetristernum sp. n., from Kenya (Insecta, Zoraptera, Zorotypidae)

A new species of order Zoraptera, Zorotypus asymmetristernum Mashimo, n. sp., is described from Kakamega, Kenya, with its major diagnostic features and characteristics of the egg described and illustrated. The new species represents the sixth zorapteran species from the Afrotropic ecozone. A brief discussion on vestigial eye spots of apteron individuals and a key to the species of the Afrotropic ecozone are provided.

Egg structure and outline of embryonic development of the basal mantodean, Metallyticus splendidus Westwood, 1835 (Insecta, Mantodea, Metallyticidae)

The egg structure and outline of the embryonic development of Metallyticus splendidus of one of the basal Mantodea representatives, Metallyticidae, were described in the present study. The results obtained were compared with those from the previous studies, to reconstruct and discuss the groundplan of Mantodea and Dictyoptera. In M. splendidus, the egg is spheroidal, it has a convex ventral side at the center in which numerous micropyles are grouped, and it possesses a conspicuous hatching line in its anterior half. These are the groundplan features of mantodean eggs and the "grouped micropyles in the ventral side of the egg" are regarded as an apomorphic groundplan feature of Dictyoptera. A small circular embryo is formed by a simple concentration of blastoderm cells, which then undergoes embryogenesis of the typical short germ band type. Blastokinesis is of the "non-reversion type" and the embryo keeps its original superficial position and original orientation throughout embryonic development. During the middle stages of development, the embryo undergoes rotation around the egg's anteroposterior axis. These features are a part of the groundplan of Mantodea. It is uncertain whether sharing of the "non-reversion type" of blastokinesis by Mantodea and blaberoidean Blattodea can be regarded as homology or homoplasy.

Embryological evidence substantiates the subcoxal theory on the origin of pleuron in insects

The lateral body plate pleuron is a significant structure in insects that contributes to the development and elaboration of wings and limbs (appendages). Although the pleuron is thought to originate from the proximal-most appendicular segment, the subcoxa, details remain unclear, and the morphological boundary between the dorsal body plate tergum and appendage (BTA) has not been clearly specified. Employing low-vacuum scanning electron microscopy (SEM) and the nano-suit method for SEM, we followed, in detail, the development of the thoracic segments of the two-spotted cricket Gryllus bimaculatus and succeeded in clearly defining the BTA. This study demonstrates the subcoxal origin of the pleuron, suggests the tergal origin of spiracles, and reveals that the wing proper originates exclusively from the tergum, whereas the wing hinge and direct muscles may be appendicular in origin, suggesting the dual origin (i.e., tergal plus appendicular origin) of wings.

The morphology and ultrastructure of salivary glands of Zoraptera (Insecta)

The salivary glands of two species of Zoraptera, Zorotypus caudelli and Zorotypus hubbardi, were examined and documented mainly using transmission electron microscopy (TEM). The results obtained for males and females of the two species are compared and functional aspects related to ultrastructural features are discussed. The salivary glands are divided into two regions: the secretory cell region and the long efferent duct, the latter with its distal end opening in the salivarium below the hypopharyngeal base. The secretory region consists of a complex of secretory cells provided with microvillated cavities connected by short ectodermal ducts to large ones, which are connected with the long efferent duct. The secretory cell cytoplasm contains a large system of rough endoplasmic reticulum and Golgi apparatus producing numerous dense secretions. The cells of the efferent duct, characterized by reduced cytoplasm and the presence of long membrane infoldings associated with mitochondria, are possibly involved in fluid uptaking from the duct lumen.

Egg structure and ultrastructure of Paterdecolyus yanbarensis (Insecta, Orthoptera, Anostostomatidae, Anabropsinae)

The egg structure of Paterdecolyus yanbarensis was examined using light, scanning electron and transmission electron microscopy. The egg surface shows a distinct honeycomb pattern formed by exochorionic ridges. Several micropyles are clustered on the ventral side of the egg. The egg membrane is composed of an exochorion penetrated with numerous aeropyles, an endochorion, and an extremely thin vitelline membrane. The endochorion is thickened at the posterior egg pole, probably associated with water absorption. A comparison of egg structure among Orthoptera revealed that the micropylar distribution pattern is conserved in Ensifera and Caelifera and might be regarded as a groundplan feature for each group; in Ensifera, multiple micropyles are clustered on the ventral side of the egg, whereas in Caelifera, micropyles are arranged circularly around the posterior pole of the egg.

The fine structure of the rectal pads of Zorotypus caudelli Karny (Zoraptera, Insecta)

The rectal pads of a species of the controversial polyneopteran order Zoraptera were examined using histological sections and TEM micrographs. Six pads are present along the thin rectal epithelium. Each pad consists of a few large principal cells surrounded by flattened junctional cells, which extend also beneath the principal cells. The cells are lined by a thin apical cuticle. No basal cells and no cavity have been observed beneath the pad. Principal cells have a regular layer of apical microvilli and are joined by intercellular septate junctions, which are interrupted by short dilatations of the intercellular space. At these levels the two adjacent plasma membranes are joined by short zonulae adhaerentes. In the cytoplasm, a rich system of strict associations between lateral plasma membranes and mitochondria forms scalariform junctions. Rectal pads share ultrastructural features with similar excretory organs of several neopteran groups, in particular with Blattodea (roaches and termites) and Thysanoptera, and are involved in fluid reabsorption and ion regulation.

The morphology of the eggs of three species of Zoraptera (Insecta)

The egg structure of Zorotypus magnicaudelli, Zorotypus hubbardi and Zorotypus impolitus was examined and described in detail. Major characteristics of zorapteran eggs previously reported were confirmed in these species, with the partial exception of Z. impolitus: 1) a pair of micropyles at the equator of the egg's ventral side, 2) a honeycomb pattern on the egg surface, 3) a two-layered chorion, 4) micropylar canals running laterally, 5) a flap covering the inner opening of the micropylar canal and 6) no region specialized for hatching. These features are probably part of the groundplan of the order. Three groups (A-C) and two subgroups (A1 and A2) of Zoraptera can be distinguished based on characters of the reproductive apparatus including eggs. However, information for more species is needed for a reliable interpretation of the complex and apparently fast evolving character system. The egg of Z. impolitus presumably shows apomorphic characteristics not occurring in other species, a chorion without layered construction and polygonal surface compartments with different sculptures on the dorsal and ventral sides of the egg. Another feature found in this species, distinct enlargement of the micropyles, is also found in Z. hubbardi. The increased micropylar size is likely correlated with the giant spermatozoa produced by males of these two species. These two features combined with the large size of the spermatheca are arguably a complex synapomorphy of Z. hubbardi and Z. impolitus. The phylogenetic placement of Zoraptera is discussed based on the egg structure. A clade of Zoraptera + Eukinolabia appears most plausible, but the issue remains an open question.

Comparative morphology of spermatozoa and reproductive systems of zorapteran species from different world regions (Insecta, Zoraptera)

The male and female reproductive apparatus of Zorotypus magnicaudelli (Malaysia), Zorotypus huxleyi (Ecuador) and Zorotypus weidneri (Brazil) were examined and documented in detail. The genital apparatus and sperm of the three species show only minor differences. The testes are larger in Z. magnicaudelli. Z. huxleyi lacks the helical appendage in the accessory glands. A long cuticular flagellum is present in Z. magnicaudelli and in the previously studied Zorotypus caudelli like in several other species, whereas it is absent in Z. weidneri, Z. huxleyi, Zorotypus hubbardi, Zorotypus impolitus and Zorotypus guineensis. Characteristic features of the very similar sperm are the presence of: a) two dense arches above the axoneme; b) a 9 + 9+2 axoneme with detached subtubules A and B of doublets 1 and 6; c) the axonemal end degenerating with enlarging accessory tubules; d) accessory tubules with 17 protofilaments; e) three accessory bodies beneath the axoneme; and f) two mitochondrial derivatives of equal shape. The first characteristic (a) is unknown outside of Zoraptera and possibly autapomorphic. The sperm structure differs distinctly in Z. impolitus and Z. hubbardi, which produce giant sperm and possess a huge spermatheca. The presence of the same sperm type in species either provided with a sclerotized coiled flagellum in males or lacking this structure indicates that a different organization of the genital apparatus does not necessarily affect the sperm structure. The flagellum and its pouch has probably evolved within Zoraptera, but it cannot be excluded that it is a groundplan feature and was reduced several times. The fossil evidence and our findings suggest that distinct modifications in the genital apparatus occurred before the fragmentation of the Gondwanan landmass in the middle Cretaceous.

Giant spermatozoa and a huge spermatheca: a case of coevolution of male and female reproductive organs in the ground louse Zorotypus impolitus (Insecta, Zoraptera)

The male and female genital apparatus of the recently discovered ground louse Zorotypus impolitus were examined using light and electron microscopy. The rounded testes and a large seminal vesicle are connected with a complex of four accessory glands by a long tapering ejaculatory duct. Two accessory glands have the same whitish coloration, whereas the third one is pale blue, and the elongated and cylindrical fourth one translucent. The sperm are the largest known in Hexapoda, 3mm long and 3μm wide, with a volume of ca. 21,000μm(3); the ratio between the diameter of the axoneme and the width of the main body of the sperm ranges between 1:10 and 1:13. The exceptional width of the spermatozoa is due to an extreme enlargement of the mitochondrial derivatives and accessory bodies. A single sperm is contained in a small globular spermatophore (100μm). The highly unusual external transfer correlates with an atypical mating behavior. The male produces several to many spermatophores during the mating process. As in other zorapterans the ovaries are panoistic and the eggs bear two micropyles. An exceptionally large apical spermathecal receptacle is present; it is connected with the vagina by a long spermathecal duct, which varies structurally along its course. A correlation between the sperm size and the size of the spermatheca is likely. Ultrastructural features of different species support two strikingly different models of male and female reproductive apparatus in the small order Zoraptera. This is in stark contrast to the extreme uniformity of their external morphology. It is likely that sexual selection played a decisive role in the evolution of the reproductive system.

Functional variants in the thromboxane A2 receptor gene are associated with lung function in childhood-onset asthma

BACKGROUND

The thromboxane A2 receptor (TBXA2R) gene is associated with asthma, but no functional genetic variations are known to associate with the disease or its related phenotypes.

OBJECTIVE

To investigate the association of TBXA2R polymorphisms with asthma susceptibility and related phenotypes and to identify functionally relevant polymorphisms.

METHODS

We performed comprehensive sequencing of the TBXA2R gene in 48 Japanese control subjects and found a set of variants (SNP1 G>T rs2238634, SNP2 T>G rs2238633, SNP3 C>T rs2238632 and SNP4 G>A rs2238631) in intron 1 in linkage disequilibrium with c.795 T>C rs1131882, which was previously reported to be associated with asthma and related phenotypes. To investigate the effect of four common haplotypes (H1, H2, H3 and H4) on transcriptional activity, we performed a luciferase assay in primary bronchial smooth muscle cells (BSMCs) and human airway epithelial cells (BEAS-2B). We also studied the haplotype association with lung function, TBXA2R mRNA levels, and eosinophil fraction/count in peripheral blood in childhood-onset asthma patients and/or controls.

RESULTS

H2 and H4, containing minor alleles of SNP2 and SNP3, had significantly higher transcriptional activities than H1 consisting of major alleles (P < 0.001 in BSMCs and BEAS-2B). Homozygotes for redefined haplotype h2 corresponding to minor alleles of SNP2 and SNP3 were associated with lower lung function in childhood-onset asthma patients compared to other zygotes (baseline Forced expiratory volume in one second (FEV1)/ Forced vital capacity (FVC) and Forced expiratory flow between 25% and 75% of the FVC (%FEF(25-75%)): P = 0.00201 and 0.0128, respectively, and post-bronchodilator FEV1/FVC and %FEF(25-75%): P = 0.00224 and 0.0393 respectively). Haplotype h2 was also associated with higher mRNA levels in control peripheral blood cells and higher blood eosinophil fractions and counts in female controls.

CONCLUSIONS AND CLINICAL RELEVANCE

Genetic variants were identified in the TBXA2R gene that influenced transcriptional activity and were associated with asthma-related phenotypes. Thromboxane pathways may therefore play important roles in airway inflammation and remodelling in asthma patients.

The male and female reproductive systems of Zorotypus hubbardi Caudell, 1918 (Zoraptera)

Here we present an ultrastructural study of the male and female reproductive systems of Zorotypus hubbardi and compare the findings to those presented in an earlier study. The male reproductive system consists of small testes and thin and short deferent ducts opening into a huge seminal vesicle. At the end of the deferent duct a wiredrawer structure is present which initiates the spermatophore formation. A long ejaculatory duct, originating from the seminal vesicle, receives the secretions of three accessory glands. The copulatory organ is a relatively stout structure consisting of two cuticular claspers connected to a ventral sclerite. The testes contain very large and few germ cells (32 sperm in each cyst) which give rise to large sperm characterized by two giant mitochondrial derivatives, two large accessory bodies, and an axoneme with accessory tubules with 17 protofilaments in their tubular wall. In the seminal vesicle the sperm are joined by a secretion to form an elongate spermatophore. The female system consists of panoistic ovarioles, two lateral oviducts, and a common oviduct which receives the spermathecal duct of a huge spermathecal sac in the terminal part of the vagina. The duct is an anterior prolongation of the sac. Its distal part turns back twisting around its proximal portion. At this level a conspicuous muscle layer gives rise to a valve. The bent spermatophore is hosted in the spermathecal sac, with the sperm heads placed in the proximal part of the spermathecal duct. The opening of the duct is close to the female genital opening. The reproductive systems of Zorotypus caudelli and Z. hubbardi, apart from a distinctly different general organization, also have a different sperm structure: those of the former species are free long-moving cells, while the sperm of Z. hubbardi are giant cells joined in a spermatophore. This allows to hypothesize and discuss a different reproductive behaviour in the two species: monandric in Z. hubbardi and polyandric in Z. caudelli. Apparently different forms of selection have resulted in a very uniform general morphology in Zoraptera, and in highly divergent features related to the reproductive system. The presence of 17 protofilaments in the accessory microtubules of the flagellar axoneme is a potential synapomorphy of Zoraptera and Phasmatodea.

The fine structure of the female reproductive system of Zorotypus caudelli Karny (Zoraptera)

The general structure of the female genital system of Zorotypus caudelli is described. The ovarioles are of the panoistic type. Due to the reduction of the envelope (tunica externa) the ovarioles are in direct contact with the hemolymph like in some other insect groups, Plecoptera included. The calices are much larger in Z. caudelli then in Zorotypus hubbardi and their epithelial cells produce large amounts of secretions, probably protecting the surface of the eggs deposited on the substrate. Eggs taken from the calyx bear a series of long fringes, which are missing in the eggs found in the ovariole, and in other zorapteran species. The long sperm of Z. caudelli and the long spermathecal duct are likely related to a sexual isolating mechanism (cryptic female choice), impeding female re-mating. The apical receptacle and the spermathecal duct - both of ectodermal origin - consist of three cell types. In addition to the cells beneath the cuticle lining the lumen, two other cell types are visible: secretory and canal cells. The cytoplasm of the former is rich in rough endoplasmic reticulum cisterns and Golgi complexes, which produce numerous discrete dense secretory bodies. These products are released into the receiving canal crossing the extracellular cavity of secretory cells, extending over a series of long microvilli. The secretion is transported towards the lumen of the apical receptacle of the spermatheca or to that of the spermathecal duct by a connecting canal formed by the canal cells. It is enriched by material produced by the slender canal cells. Before mating, the sperm cells are enveloped by a thick glycocalyx produced at the level of the male accessory glands, but it is absent when they have reached the apical receptacle, and also in the spermathecal duct lumen. It is likely removed by secretions of the spermatheca. The eggs are fertilized at the level of the common oviduct where the spermathecal duct opens. Two micropyles at the dorsal side of the equator level possibly facilitate fertilization. The presence of these two micropyles is a presumably derived feature shared with Phasmatodea. The fine structure of the female reproductive system of Z. caudelli does not allow to assess the phylogenetic position at the present stage of knowledge. The enlarged calyx and the temporary presence of long fringes on the eggs are potential autapomorphies of Z. caudelli or may indicate relationships with other Zorotypus species.

The male reproductive system of Zorotypus caudelli Karny (Zoraptera): Sperm structure and spermiogenesis

Considering the overall uniformity of the morphology of Zoraptera, the structural diversity of the male genital system is remarkable. Structures related to the male reproductive system of Zorotypus caudelli differ profoundly from those of Zorotypus hubbardi. The testes are elongated rather than spherical, the seminal vesicle is apparently absent, and the deferent ducts are very long. A feature shared by these two species and other zorapterans examined is that the two accessory glands are closely adherent to each other and form a single large structure, from which the ejaculatory duct originates. This is a potential zorapteran autapomorphy. Another feature possibly present in the groundplan of the order is the strong elongation of the sperm cells. This may be connected with a reproductive strategy of males trying to avoid re-mating of females with other males after the first copulation. The extremely long and coiled spermathecal duct of Z. caudelli and other zorapteran species is possibly correlated with the sperm elongation, and both features combined may result in a sexual isolating mechanism. The short duration of mating of Zorotypus barberi and Zorotypus gurneyi suggests that the male introduces sperm into the female tract up to the opening of the spermathecal duct using their long coiled aedeagus. A thick glycocalyx around the sperm in the distal part of the deferent ducts probably protects the sperm cells during their forward progression towards the long spermathecal duct, and is removed when they reach the apical receptacle. The spermatogenesis of Z. caudelli follows a pattern commonly found in insects, but differs distinctly from that of Z. hubbardi in the number of spermatids in each sperm cyst. An unusual and possibly autapomorphic feature of Z. caudelli is a disconnection of sub-tubules A and B at the level of microtubule doublets 1 and 6 of the mature sperm cells. It is conceivable that this results in a shorter period of sperm motility. The character combination found in different zorapteran species supports the view that the sperm, a very compact functional unit, does not evolve as a unit, but like in other more complex body regions, sperm components can also be modified independently from each other. This results in different mosaic patterns of plesiomorphic and derived features in a very compact entity in different species of the very small and otherwise uniform order Zoraptera. In Z. caudelli, for instance, the bi-layered acrosome and small accessory bodies are plesiomorphic states among several others, whereas the mitochondrial derivatives and the elongate nucleus are apparently derived conditions. Other combinations likely occur in other zorapteran species. Only few but noteworthy sperm characters indicate possible phylogenetic affinities of Zoraptera. A possible synapomorphic feature, the presence of dense laminae radiating in a cartwheel array between neighbouring centriolar triplets, is shared with Phasmatodea and Embioptera. Another potential synapomorphy shared with Phasmatodea is the presence of 17 protofilaments in the tubular wall of the outer accessory microtubules.

Apoptosis in dissociation between DNA synthesis and cellular functions of activated hepatic stellate cells--a study with carbon tetrachloride-induced rat liver injury

It is widely believed that DNA synthesis and expressions of smooth muscle alpha actin and TGF-beta are all together increased in activated hepatic stellate cells both in vitro and in vivo. Our previous reports disclosed that these increases did not always coexist under experimental conditions. Liver necrosis was induced in rats by oral administration of carbon tetrachloride. Hepatic stellate cells were isolated from these rats 2 days later. When these cells were cultured on plastic dishes for 3 days, they showed marked DNA synthesis and smooth muscle alpha actin and TGF-beta mRNA expressions assessed by (3)H-thymidine incorporation and Northern blotting, respectively. In the cells further cultured for 7 days, the DNA synthesis was decreased, whereas both smooth muscle alpha actin and TGF-beta mRNA expressions were increased, compared to the cells cultured for 3 days. The cells cultured for 10 days showed apoptotic nuclei positive for nick-end labeling, and DNA extracted from the cells revealed laddering patterns on agarose gels by electrophoresis. Apoptotic nuclei were also immunohistochemically found in stellate cells in the liver of rats 4 days after the intoxication. We conclude that apoptosis developed in activated hepatic stellate cells both in vitro and in vivo, and this may contribute to the discrepancy between DNA synthesis and cellular functions of the cells.

[Dissecting aortic aneurysm associated with myonephropathic-metabolic syndrome and hypercalcemia]

A forty-two years old male underwent an aortic arch replacement for an emergency treatment of dissecting aortic aneurysm (DeBakey type I). Separate cardiopulmonary bypass was used with main arterial inflow cannula inserted to right femoral artery. After the operation, ischemia of the right lower extremity led to acute renal failure due to myonephropathic-metabolic syndrome. Peritoneal dialysis, hemodialysis, and continuous arterio-venous hemofiltration were performed. Renal failure improved gradually. At the diuretic phase serum calcium concentration began to rise. Inspite of large amount of fluid and furosemide injection it became higher and finally reached to 20 mg/dl level. Calcitonin injection (320 mu/day) was very effective. In 2 months after surgery serum creatinine and calcium concentrations went down to normal range. Abnormalities in calcium metabolism are frequent in rhabdomyolysis-induced acute renal failure. However, it is rare to encounter such a remarkable hypercalcemia as seen in this patient. When treating MNMS we should pay attention to the changes of serum calcium concentration.

[An aorto-coronary bypass graft operation of left coronary ostial stenosis due to aortitis syndrome]

A 24-year-old female with unstable angina due to aortitis syndrome was reported. The coronary-arteriogram in hospital showed 75 percent stenosis of the left coronary ostium. Following two months' steroid therapy for active inflammation, aortocoronary bypass graft was implanted. After the operation. This patient became free from angina attack. Steroid therapy was continued postoperatively as well. The coronary-arteriogram taken seven months after the operation, revealed the patency of the graft.

[Evaluation of the thromboexclusion technique for thoracic aortic aneurysms]

From 1981 to 1987 most of DeBakey III type dissecting aneurysms and a part of descending aortic aneurysms were treated by thromboexclusion technique. The effects of the operation by thromboexclusion technique on the patients were compared with those of the operation by temporary bypass technique. Blood loss during an operation was smaller and blood pressure during an operation was more stable in the thromboexclusion technique group, although the difference was not statistically significant. Furthermore, no paraplegia was observed in the thromboexclusion technique group. The respiratory support period was longer and the number of patients with postoperative myocardial injury was greater in the thromboexclusion technique group, although the difference was not statistically significant. Ten patients treated by thromboexclusion techniques were examined by computed tomography. In 7 out of 10 patients (70%), thrombosis occurred in the false lumen of dissecting aneurysm or in the aneurysmal lumen of descending aortic aneurysm. When only the patients without the leakage of blood into the aneurysm through the permanent aortic clamp were examined, thrombosis was observed in 100% of them. Even though the blood flow was reversed, thromboexclusion technique did not have a bad effect on renal function in the long-term. Postoperatively, however, progressive hypertrophy of the left ventricle was recognized, and furthermore, an injury to the aortic wall caused by permanent aortic clamp was observed at an autopsy. This suggests that further long-term follow-up of patients treated by thromboexclusion technique is necessary.

[Brachiocephalic arterial aplasia of the right aortic arch with subclavian steal syndrome]

A 44-year-old man was admitted to our hospital with complaint of weakness in his left upper extremity, vertigo, and diplopia. After aortic root injection of contrast medium, a right aortic arch was visualized. The left brachiocephalic artery was not found, however. An operation was performed through a midline sternotomy. The first branch of the aortic arch was the right common carotid artery, and the second branch was the right subclavian artery. The left brachiocephalic arterial aplasia was recognized. An E-PTFE graft was anastomosed proximally to the ascending aorta and distally to the junction of the left common carotid and left subclavian arteries. After the operation, some of the symptoms were improved and the others were removed.