Dynamics of the Vortex-Particle Complexes Bound to the Free Surface of Superfluid Helium

We present an experimental and theoretical study of the 2D dynamics of electrically charged nanoparticles trapped under a free surface of superfluid helium in a static vertical electric field. We focus on the dynamics of particles driven by the interaction with quantized vortices terminating at the free surface. We identify two types of particle trajectories and the associated vortex structures: vertical linear vortices pinned at the bottom of the container and half-ring vortices traveling along the free surface of the liquid.

Response measurement of single-crystal chemical vapor deposition diamond radiation detector for intense X-rays aiming at neutron bang-time and neutron burn-history measurement on an inertial confinement fusion with fast ignition

A neutron bang time and burn history monitor in inertial confinement fusion with fast ignition are necessary for plasma diagnostics. In the FIREX project, however, no detector attained those capabilities because high-intensity X-rays accompanied fast electrons used for plasma heating. To solve this problem, single-crystal CVD diamond was grown and fabricated into a radiation detector. The detector, which had excellent charge transportation property, was tested to obtain a response function for intense X-rays. The applicability for neutron bang time and burn history monitor was verified experimentally. Charge collection efficiency of 99.5% ± 0.8% and 97.1% ± 1.4% for holes and electrons were obtained using 5.486 MeV alpha particles. The drift velocity at electric field which saturates charge collection efficiency was 1.1 ± 0.4 × 10(7) cm/s and 1.0 ± 0.3 × 10(7) cm/s for holes and electrons. Fast response of several ns pulse width for intense X-ray was obtained at the GEKKO XII experiment, which is sufficiently fast for ToF measurements to obtain a neutron signal separately from X-rays. Based on these results, we confirmed that the single-crystal CVD diamond detector obtained neutron signal with good S/N under ion temperature 0.5-1 keV and neutron yield of more than 10(9) neutrons/shot.

Formation of NaCl-type monodeuteride LaD by the disproportionation reaction of LaD2

Previous x-ray diffraction measurements revealed the pressure-induced decomposition of an fcc LaH2.3 into H-rich and H-poor fcc phases around 11 GPa. The present neutron diffraction measurements on LaD2 confirm the formation of NaCl-type LaD as a counterpart of the D-rich LaD2+δ by disproportionation. First-principles enthalpy and lattice dynamic calculations demonstrate that the NaCl-type LaH is stabilized at high pressures and can be recovered at ambient conditions. Finding the NaCl-type LaH will pave the way for investigations on the site-dependent nature of hydrogen-metal interactions.

An ultrahigh-vacuum apparatus for resonant diffraction experiments using soft x rays (hnu=300-2000 eV)

We have developed an ultrahigh-vacuum instrument for resonant diffraction experiments using polarized soft x rays in the energy range of hnu=300-2000 eV at beamline BL17SU of SPring-8. The diffractometer consists of modified differentially pumped rotary feedthroughs for theta-2theta stages, a sample manipulator with motor-controlled x-y-z-, tilt (chi)-, and azimuth (phi)-axes, and a liquid helium flow-type cryostat for temperature dependent measurements between 30 and 300 K. Test results indicate that the diffractometer exhibits high reproducibility (better than 0.001 degrees ) for a Bragg reflection of alpha-quartz 100 at a photon energy of hnu=1950 eV. Typical off- and on-resonance Bragg reflections in the energy range of 530-1950 eV could be measured using the apparatus. The results show that x-ray diffraction experiments with energy-, azimuth-, and incident photon polarization-dependence can be reliably measured using soft x rays in the energy range of approximately 300-2000 eV. The facility can be used for resonant diffraction experiments across the L-edge of transition metals, M-edge of lanthanides, and up to the Si K-edge of materials.

Turbulence in boundary flow of superfluid 4He triggered by free vortex rings

The transition to turbulence in the boundary flow of superfluid 4He is investigated using a vortex-free vibrating wire. At high wire vibration velocities, we found that stable alternating flow around the wire enters a turbulent phase triggered by free vortex rings. Numerical simulations of vortex dynamics demonstrate that vortex rings can attach to the surface of an oscillating obstacle and expand unstably due to the boundary flow of the superfluid, forming turbulence. Experimental investigations indicate that the turbulent phase continues even after stopping the injection of vortex rings, which is also confirmed by the simulations.

Terahertz conductivity of localized photoinduced carriers in a Mott insulator YTiO(3) at low excitation density, contrasted with the metallic nature in a band semiconductor Si

We performed optical-pump terahertz-probe measurements of a Mott insulator YTiO(3) and a band semiconductor Si using a laser diode (1.47 eV) and a femtosecond-pulse laser (1.55 eV). Both samples possess long energy-relaxation times (1.5 ms for YTiO(3) and 15 µs for Si); therefore, it is possible to extract terahertz complex conductivities of photoinduced carriers under equilibrium. We observed highly contrasting behaviour-Drude conductivity in Si and localized conductivity possibly obeying the Jonscher law in YTiO(3). The carrier number at the highest carrier-concentration layer in YTiO(3) is estimated to be 0.015 per Ti site. Anisotropic conductivity of YTiO(3) is determined. Our study indicates that localized carriers might play an important role in the incipient formation of photoinduced metallic phases in Mott insulators. In addition, this study shows that the transfer-matrix method is effective for extracting an optical constant of a sample with a spatially inhomogeneous carrier distribution.

Anomalous translational velocity of vortex ring with finite-amplitude Kelvin waves

We consider finite-amplitude Kelvin waves on an inviscid vortex assuming that the vortex core has infinitesimal thickness. By numerically solving the governing Biot-Savart equation of motion, we study how the frequency of the Kelvin waves and the velocity of the perturbed ring depend on the Kelvin wave amplitude. In particular, we show that, if the amplitude of the Kelvin waves is sufficiently large, the perturbed vortex ring moves backwards.

Twisted vortex state

We study a twisted vortex bundle where quantized vortices form helices circling around the axis of the bundle in a "force-free" configuration. Such a state is created by injecting vortices into a rotating vortex-free superfluid. Using continuum theory we determine the structure and the relaxation of the twisted state. This is confirmed by numerical calculations. We also present experimental evidence of the twisted vortex state in superfluid 3He-B.

Vortex multiplication in applied flow: A precursor to superfluid turbulence

A surface-mediated process is identified in 3He-B which generates vortices at a roughly constant rate. It precedes a faster form of turbulence where intervortex interactions dominate. This precursor becomes observable when vortex loops are introduced in low-velocity rotating flow at sufficiently low mutual friction dissipation at temperatures below 0.5Tc. Our measurements indicate that the formation of new loops is associated with a single vortex interacting in the applied flow with the sample boundary. Numerical calculations show that the single-vortex instability arises when a helical Kelvin wave expands from a reconnection kink at the wall and then intersects again with the wall.

Momentum dependence of charge excitations in the electron-doped superconductor Nd1.85 Ce0.15 CuO4: a resonant inelastic x-ray scattering study

We report a resonant inelastic x-ray scattering (RIXS) study of charge excitations in the electron-doped high-T(c) superconductor Nd1.85 Ce0.15 CuO4. The intraband and interband excitations across the Fermi energy are separated for the first time by tuning the experimental conditions properly to measure charge excitations at low energy. A dispersion relation with q-dependent width emerges clearly in the intraband excitation, while the intensity of the interband excitation is concentrated around 2 eV near the zone center. The experimental results are consistent with theoretical calculation of the RIXS spectra based on the Hubbard model.

Determination of the orbital polarization in YTiO3 by using soft X-ray linear dichroism

We report measurements of linear dichroism in x-ray absorption at Ti L(2,3) edges of a Mott-insulating ferromagnet YTiO3, where orbital ordering occurs in the triply degenerate Ti 3d t(2g) states. Dichroic spectra and their integrated intensities are obtained for the incident electric field with polarizations parallel to a, b, and c axes. The comparison of the spectra with atomic multiplet calculations removes the ambiguity about the orbital polarization, i.e., the relative weights of |xy>, |yz>, and |zx> orbits, which are crucial for the origin of ferromagnetism. The result is consistent with the previous analysis of nuclear magnetic resonance in the Mizokawa-Fujimori scheme.

An intrinsic velocity-independent criterion for superfluid turbulence

Hydrodynamic flow in classical and quantum fluids can be either laminar or turbulent. Vorticity in turbulent flow is often modelled with vortex filaments. While this represents an idealization in classical fluids, vortices are topologically stable quantized objects in superfluids. Superfluid turbulence is therefore thought to be important for the understanding of turbulence more generally. The fermionic 3He superfluids are attractive systems to study because their characteristics vary widely over the experimentally accessible temperature regime. Here we report nuclear magnetic resonance measurements and numerical simulations indicating the existence of sharp transition to turbulence in the B phase of superfluid 3He. Above 0.60T(c) (where T(c) is the transition temperature for superfluidity) the hydrodynamics are regular, while below this temperature we see turbulent behaviour. The transition is insensitive to the fluid velocity, in striking contrast to current textbook knowledge of turbulence. Rather, it is controlled by an intrinsic parameter of the superfluid: the mutual friction between the normal and superfluid components of the flow, which causes damping of the vortex motion.

Expression of MMP-8 and MMP-13 mRNAs in rat periodontium during tooth eruption

The present study was designed to investigate mRNA expression of matrix metalloproteinase-8 (MMP-8) and MMP-13 in forming periodontium during tooth eruption in the rat. RT-PCR for the decalcified paraffin sections indicated expression of MMP-8 and MMP-13 in the periodontal tissues. In situ hydridization demonstrated expression of MMP-8 in osteoblasts, osteocytes, periodontal ligament cells, cementoblasts, and cementocytes along with collagen types I and III. In contrast, transcripts of MMP-13 were confined to a small population of osteoblasts and osteocytes in alveolar bone. The results suggested that MMP-8 may be involved in remodeling the periodontium during tooth eruption, and its expression may be coordinated with that of collagen types I and III, whereas the participation of MMP-13 may be rather limited.

Two cases of off-pump coronary artery bypass grafting combined with abdominal aortic aneurysm repair

Two cases of coronary artery disease coexisting with abdominal aortic aneurysm were treated with off-pump coronary artery bypass grafting combined with repair of the aneurysm. The first patient was a 67-year-old man exhibiting a large pulsating abdominal mass. Abdominal computed tomography demonstrated a 9-cm aneurysm and coronary angiogram revealed a 90% stenosis of the obtuse marginal branch for which percutaneous transluminal angioplasty could not be performed. He underwent simultaneous single coronary artery bypass grafting without cardiopulmonary bypass, and bifurcated graft replacement. The second patient was a 71-year-old man who had acute myocardial infarction, and one month later underwent coronary angiogram which revealed three vessel disease in the coronary artery. Computed tomography revealed a 4-cm aneurysm, and angiography showed a 90% stenosis of the left renal artery. He underwent a single stage operation that involved three coronary artery bypass grafting without cardiopulmonary bypass, straight graft replacement, and reconstruction of the left renal artery using the saphenous vein graft. The postoperative course was uneventful in both cases. We currently recommend a single stage operation involving off-pump coronary artery bypass grafting.

[Malignant cardiac lymphoma]

A 65-year-old male was admitted to the hospital in shock. The transesophageal echocardiography showed cardiac tumor in the right atrium. The tumor was resected under cardiopulmonary bypass. It was diagnosed as malignant lymphoma of B-cell type by histological examination. After operation, his general condition became satisfactory. Then he received chemotherapy. Twenty days after operation, however, a mass appeared in the right side of chin. It was diagnosed as malignant lymphoma of the same cell type as in the heart. We searched his body with CT and Ga-scanning. No other lesions were found. After the chemotherapy (CHOP, 6 cycles), the mass disappeared. No recurrence was been observed for six months.

Significance of percutaneous cardiopulmonary bypass support for volume reduction surgery with severe hypercapnia

In patients with reduced respiratory function, lung resection is associated with high risk because separate ventilation is generally needed for safe management. For patients with end-stage emphysema, intraoperative respiratory management is important and particularly difficult because neither incomplete oxygenation nor selective ventilation can be performed, so the operation may be interrupted. In this study, we assess the effectiveness of the percutaneous cardiopulmonary support (PCPS) system for lung volume reduction surgery in patients with severe hypercapnia (arterial carbon dioxide tension >50 mm Hg) and discuss the significance of PCPS for patients who are beyond the standard criteria for lung volume reduction surgery (LVRS). We studied 3 patients with severe hypercapnia due to emphysema who underwent volume reduction surgery. One patient was previously treated surgically for contralateral pneumothorax. All patients had a severe smoking history and were suspected to have fragile lungs. During the operation. PCPS provided sufficient support flow. Intraoperative management using PCPS was easy, and no severe complications were observed. One patient exhibited severe hemodynamic deterioration on postoperative Day 15. Other patients' PaCO2 improved postoperatively. One had a calcification of a femoral artery, but there was no trouble inserting a cannula. Bilateral or unilateral volume reduction surgery was performed under PCPS in patients with end-stage emphysema. We conclude that PCPS is an adjunct to LVRS, useful for intraoperative management of some patients with severe hypercapnea, and the LVRS indications can be extended.

[Treatment of mediastinal infection by continuous closed irrigation with an antibiotic solution in a new bone baby]

The patient was a three-week-old girl. Four days after thoracic surgery, mild fever developed, and turbid fluid was drained from the incision. Culture of the discharge showed Pseudomonas aeruginosa and Serratia marcescens. Débridement was immediately performed and continuous closed irrigation with an antibiotic solution started and maintained for 17 days. During this period, the upper half of the body was elevated. Ten days after irrigation started culture of the drainage fluid became negative. We emphasize early diagnosis, and the usefulness of continuous closed irrigation with an antibiotic solution in neonates.

[Significance of systemic inflammatory response syndrome after surgical treatment for thoracic esophageal cancer]

We studied the significance of Systemic Inflammatory Response Syndrome (SIRS) state after surgical treatment of thoracic esophageal cancer. From January 1991 to December 1995, 35 patients received thoracic esophageal cancer surgery. Thirty three patients (94.3%) were in the SIRS state after surgery and mean duration of SIRS was 3.4 days. Duration of SIRS was statistically longer in patients with pulmonary complications. Patients with hyperbilirubinemia (> or = 3.0 mg/dl) after surgery had longer duration of SIRS. Induction therapy did not affect the duration of SIRS. Collectively, duration of SIRS is an indication of complications, especially of pulmonary complications, after surgical treatment of thoracic esophageal cancer, and blood bililubin score after surgery correlates to duration of SIRS. These suggest that we must pay special attention to patients with long duration of SIRS or hyperbilirubinemia after thoracic esophageal surgery.

[A case of surgical treatment for Löffler's endomyocarditis]

We performed surgical treatment in a case of löffler's endocarditis. The patient was a 32-year-old male whose first symptom was easy fatigability. Blood count showed eosinophilia (eosinocyte count 6720/mm3). Echocardiography and vetriculography showed thickened bilateral endocardium and extension disturbance. We diagnosed this case as löffler's endocarditis and performed surgical treatment because medical treatment was unsuccessful. Removal of the thrombus the bilateral ventricles, endocardectomy and mitral valve replacement were performed. Endocardectomy required close attention because the border between thickened endocardium and normal myocardium was obscure. The patient survived surgery, but postoperative echocardiography (15 days) revealed slightly thickened endocardium of the right ventricle. He died of left heart failure 1 month after surgery. At that time, eosinocyte count was 110,000/mm3.

[Advantages and disadvantages of harmonic scalpel in thoracic surgery]

We evaluated the usefulness of Harmonic Scalpel in thoracic surgery. Harmonic Scalpel is an ultrasonically activated surgical device which can coagulate and cut the vessels or tissues. The instrument made thoracoscopic resection of the neurogenic tumor and the mediastinal lymph node and thoracoscopic sympatectomy safetier and easier, because it does not conduct an electric current to the nerve and has high ability of hemostasis. Harmonic Scalpel will be very useful device in the future if its shapes of blades or handpieces are improved.

[A case of mediastinal angiomyolipoma]

A 53-year-old woman was referred to our hospital for further evaluation of a mediastinal tumor. The tumor was diagnosed as a mediastinal angiomyolipoma by computed tomography and angiographic findings. Transarterial embolization was performed three times, then the tumor was completely organized. Although angiomyolipomas are often found in the kidney, those in the mediastinum are very rare. Angiomyolipoma is a benign tumor, then small asymptomatic tumor may be conserved. When the tumor is large in size and has a high risk of spontaneous rupture, arterial embolization is valuable for treatment of the tumor.

[A case of Ellis-van Creveld syndrome with partial atrioventricular septal defect and double orifice mitral valve]

Ellis-van Creveld Syndrome (ECS) is characterized by chondrodysplasia, ectodermal dysplasia, polydactyly, and congenital cardiac defects. As congenital cardiac defects, single atrium and endocardial cusion defect are frequent in literatures. We described a case, a 68-year-old woman, presenting with ECS with partial atrioventricular septal defect and double orifice mitral valve. The partial atrioventricular septal defect was repaired by closure with a Dacron patch. The accessory orifice was located at the anterior cusp of the mitral valve, which was left, untouched, because no regurgitation had been detected preoperatively. Her postoperative course was uneventful, and the patient was discharged on 25th postoperative day.

Advantages of using the midline incision right retroperitoneal approach for abdominal aortic aneurysm repair

This study was conducted to compare the midline incision right retroperitoneal approach for repairing abdominal aortic aneurysms (AAA) with the transperitoneal approach. The intra- and postoperative course of 15 patients who underwent AAA repair using the transperitoneal approach between 1987 and 1991 and another 15 patients who underwent AAA repair using the retroperitoneal approach between 1991 and 1994 were evaluated. The incidence of postoperative wound complications was also assessed. There was no operative or hospital death in either group. Although a significantly longer interval was required from the incision to the aortic clamp using the extraperitoneal method, there were no statistical differences in the aortic clamping time, total operation time, or blood loss between the two groups. On the other hand, there was a statistically significant improvement in bowel function and a significant reduction in the length of postoperative hospitalization following the extraperitoneal procedure. Furthermore, no wound complications such as those associated with the left flank incision developed after the extraperitoneal procedure. Thus, we recommend the midline incision right retroperitoneal approach for AAA as it does not involve muscle division and is associated with fewer complications.

A new nucleophilic ring opening of an activated cyclopropane and a formal synthesis of (+/-)-carbovir

The reaction of bicyclo[3.1.0]hexane 1, possessing a doubly activated cyclopropane ring, with acetic acid and potassium acetate in DMSO proceeded smoothly to give the adduct 2 in good yield. A formal total synthesis of the potent anti-HIV agent (+/-)-carbovir (9) was done by converting 2 into a known precursor 8 in 8 steps via allyl alcohol 7 including the regioselective introduction of a double bond (4 to 5) and attachment of the nucleobase using the Mitsunobu reaction (7 to 8).

[A successfully treated case of thoracoabdominal aortic aneurysm complicated with the coagulation disorder]

We could performed the safe operation for thoracoabdominal aortic aneurysm complicated with pre-DIC. A diagnosis of pre-DIC was made by laboratory data. Low heparin pretreatment was performed for the short term because we presumed the cause for pre-DIC was thromboses in aneurysm. That treatment was effective for the temporal remission of pre-DIC. In addition, during partial ECC low heparin (1 mg/kg) and nafamostat mesilate (2 mg/kg/h) were used. As a result, during and after the operation blood loss was a little. In summary heparin pretreatment is useful therapy for DIC and pre-DIC in aortic aneurysm patients.

Long-term outcome of operative treatment of focal atrial tachycardia

BACKGROUND

This study examined the long-term clinical outcome of patients with focal atrial tachycardia who were treated surgically. Focal atrial tachycardia is a relatively rare arrhythmia that is often difficult to control with conventional medical therapy. Therapeutic modalities are not well defined because of the scarcity of long-term data of treated patients, including pathologic findings.

STUDY DESIGN

Nine patients, six men and three women, ranging in age from 16 to 50 years (mean of 34 +/- 14 years), underwent operative treatment for focal atrial tachycardia. The average rate of tachycardia was 167 +/- 22 beats per minute. All patients were treated with antiarrhythmic drugs (mean 2.9 drugs per patient). Concomitant operative procedures were performed upon four patients, including division of the accessory atrioventricular pathway for the Wolff-Parkinson-White syndrome in two patients, plication of the right atrium for idiopathic right atrial dilatation in one patient, and a closure of the atrial septal defect in one patient. Focal ablation was performed in all instances.

RESULTS

There was no early or late death nor postoperative complications. Atrial tachycardia disappeared and there were no episodes of recurrent tachycardia postoperatively during the mean follow-up period of 67 +/- 38 months. Histopathologic findings from four patients revealed a sinus node-like structure, diffuse chronic epimyocarditis, focal myocarditis, and fascicular disarray lesions.

CONCLUSIONS

Excellent long-term result were obtained in patients with focal atrial tachycardia who were treated operatively. Early operative intervention is preferable before the occurrence of impaired ventricular function. From the histopathologic findings, operative therapy should be selected in patients with diffuse atrial lesions.

[Two cases of tuberculous constrictive pericarditis]

Case 1 was a 79-year-old male suspected of tuberculous constrictive pericarditis. He was admitted to our hospital because of surgical treatment. His heart failure was NYHA IV. Culture of pleural effusion and pericardial effusion was negative. But ADA level in pericardial effusion was found to be increased. So tuberculosis was suspected. Cardiac catheterization date was compatible with constrictive pericarditis. Case 2 was a 73-year-old female. She was admitted because of heart failure (NYHA IV). As RVP wave indicated dip & platou at cardiac catheterization, she was diagnosed as constrictive pericarditis. ADA level in pleural effusion increased. So tuberculosis was suspected as etiology of constrictive pericarditis. In both cases, after pericardiectomy, heart failure improved to NYHA I. Results of pathological examination were tuberculous inflammation.

Surgical treatment of arrhythmogenic right ventricular dysplasia: long-term outcome

Eight male patients ranging from 15 to 51 years old (mean age, 36.3 years) underwent surgical treatment of ventricular tachycardia (VT) associated with arrhythmogenic right ventricular dysplasia. One patient had an associated left ventricular aneurysm. The earliest activation site was detected for 15 lesions, and delayed potentials were recorded during sinus rhythm in all patients. On the basis of the epicardial mapping, the origins of the VT foci in the right ventricle were resected. Cryoablation on the surrounding myocardium was performed. There were no surgical deaths or postoperative fatal complications. During long-term follow-up, there has been no recurrence of VT and no congestive heart failure in the 6 patients without left ventricular involvement. The 2 patients with LV involvement died late of either congestive heart failure or development of VT originating from the left ventricle. In conclusion, a surgical approach consisting of myocardial excision and cryocoagulation offers a curative treatment of VT associated with arrhythmogenic right ventricular dysplasia and yields excellent long-term results when the VT origin is well identified in the right ventricle.

Myocardial coagulation by intraoperative Nd:YAG laser ablation and its dependence on blood perfusion

To investigate whether the efficacy of intraoperative laser ablation therapy is affected by myocardial blood perfusion, we irradiated 11 canine hearts through the epicardium with a Nd:YAG laser (10, 20, and 30 J/mm2) using air as the medium. Compared coagulated myocardial depth, width, and volume obtained in the red beating heart was compared with those in the white nonbeating heart infused with 0 degrees C saline (cardioplegic model) via the coronary artery. Histologically, the macro- and microscopical findings were very similar. At each level of energy, the width and volume of red myocardium coagulated were significantly larger than those of white myocardium (P < 0.01). At 30 J/mm2, the depth of coagulation of red myocardium was significantly larger than that of white myocardium (P < 0.01). The coagulated volume of the white myocardium was about 60% of that of the red myocardium. Nd:YAG laser energy was absorbed by blood (red color = hemoglobin), and more energy was transferred in the higher temperature myocardium. During intraoperative Nd:YAG laser ablation, the presence of blood perfusion in cardiac tissue is thought to be an important factor affecting safe irradiation.

Surgical treatment of patients with Wolff-Parkinson-White syndrome and associated acquired valvular heart disease

Between November 1973 and March 1993, 454 patients underwent surgical division of an accessory pathway. The surgical and electrophysiologic data for 15 of these patients who underwent concomitant operation for acquired valvular heart disease were examined. This subgroup consisted of 10 male and 5 female patients whose ages ranged from 11 to 62 years (mean 51.6 +/- 9.7 years). The primary surgical indication was congestive heart failure in all cases; a concomitant history of cardiopulmonary resuscitation was present in two cases. Nine of these patients had mitral valve disease, three had aortic valve disease, two had combined aortic and mitral valve disease, and one had tricuspid valve disease. The surgical technique used for the treatment of Wolff-Parkinson-White syndrome included (1) an endocardial approach with the use of cardioplegic arrest, (2) a sharp dissection of the involved valve anulus, and (3) cryoablation. Concomitant surgical treatments of valvular heart disease included open mitral commissurotomy in five cases, mitral valve replacement in four cases, aortic valve replacement in three cases, aortic valve replacement with mitral valve commissurotomy in two cases, and tricuspid valvuloplasty (De Vega technique) in one case. Other concomitant surgical procedures included tricuspid annuloplasty with atrialized right ventricle and replacement of the ascending aorta in one case and left ventricular myectomy for hypertrophic obstructive cardiomyopathy in one case. No early deaths occurred. A successful disappearance of the delta wave and episodes of recurrent tachycardia were achieved in all 15 patients. Long-term surgical follow-up, averaging 86.2 +/- 54.8 months also demonstrated no late instances or recurrence of either a delta wave or tachycardia.

Surgical treatment of ventricular tachycardia after surgical repair of tetralogy of Fallot. Relation between intraoperative mapping and histological findings

BACKGROUND

The mechanism of ventricular tachycardia (VT) after correction of tetralogy of Fallot (TF) is poorly understood. The purpose of this study was to examine the histopathology of the arrhythmogenic area detected by intraoperative mapping.

METHODS AND RESULTS

The patients were three men who underwent radical surgery for TF at age 3, 3, or 5 years, respectively. VT developed at 8, 9, or 11 years, respectively, after surgery, and shock developed during VT in every case. The ECG revealed monomorphic VT in two cases and polymorphic VT in one case. Induction of VT resulted in a wide left-axis deviation-pattern QRS with cycle lengths varying between 260 and 330 milliseconds. The VT origin was identified at the right ventricular outflow tract (RVOT). A radical operation was performed with the patient under cardiopulmonary bypass. On epicardial mapping, delayed activation of the RVOT was recorded during sinus rhythm, and clockwise circus movement of the macroreentry current during VT on the right ventricular free wall was documented in each case. The VTs were treated successfully by surgical resection and cryoablation of the myocardium. In every patient, histology of the myocardial specimens showed degeneration, adiposis, fibrosis, inflammatory cell infiltration, and scattered myocyte islets. These lesions corresponded anatomically to the area of myocardium in which delayed activation was evident during epicardial mapping.

CONCLUSIONS

The results of this study indicate that patients with VT after radical correction of the TF have abnormal histopathological findings at the site of the prior right ventriculotomy scar. These lesions were noted within the region of delayed activation found during epicardial mapping and were found to be a part of the reentrant circuit.

Surgical treatment of Wolff-Parkinson-White syndrome in infants and children

Electrophysiologic features and surgical results were examined in 55 pediatric patients who underwent surgical accessory pathway division for Wolff-Parkinson-White syndrome. There were 31 male and 24 female patients ranging in age from 4 months to 15 years (mean age, 9.8 +/- 4.2 years; 25 patients were less than 10 years old; 4 patients were less than 12 months). Eleven of these patients had associated congenital heart disease and underwent concomitant surgical procedures to treat those conditions. Preoperative effective refractory period of antegrade accessory pathways, the right atrium, atrioventricular node, and cycle length during reentrant tachycardia were shorter in pediatric patients than in adult patients. Antegrade accessory pathways showed right predominance more frequently in the pediatric group than in the adult group. Surgical techniques included an endocardial approach (an epicardial approach was used in 1 patient) and concomitant operation for combined heart disease. The early mortality rate was 3.6%, whereas no late deaths occurred during the follow-up period of 96.8 +/- 54.9 months (maximum follow-up, 205 months). The absolute cure rate was 92%. There were no significant differences in early and late mortality between pediatric and adult patients. Surgical treatment of the Wolff-Parkinson-White syndrome in pediatric patients is as safe and effective as in adults. Considering the potential complications from prolonged fluoroscopic exposure during catheter ablation, surgical division of accessory pathways in children is a promising modality for the treatment of Wolff-Parkinson-White syndrome in selected cases.

[A case of anterior mediastinal mature teratoma containing air because of penetration to the lung]

A case of anterior mediastinal mature teratoma containing air because of penetrating to the lung was reported. The patient was a 28-year-old woman. The chest X-ray film on admission showed a homogeneous mass in the anterior mediastinum. This shadow changed to cystic one after ten days later. The tumor was removed together with adhering part of the left lung and pericardium through median sternotomy. Histologically, the wall of cysts contained sebaseous glands, bronchial glands and pancreatic tissue containing both exocrine and endocrine elements.

[Injury of pulmonary artery and intrathoracic artery--a surgical case report]

The patient was a 52-year-old man. Tube drainage was performed to the right traumatic hemothorax. Then, 2,000 ml of blood flowed out and bleeding stopped for a time. Four hours later after injury, massive bleeding occurred again. So emergency thoracotomy was performed and we found a laceration in the main pulmonary artery and injury of intrathoracic artery. Pulmonary artery disruption from blunt chest trauma is rare. Further discussion was made by reviewing the related literature.

Comparative study of eight sets of ECG criteria for the localization of the accessory pathway in Wolff-Parkinson-White syndrome

Eight sets of electrocardiographic (ECG) criteria for the localization of accessory conduction pathway (ACP) were evaluated on 182 patients with a single ACP. The Rosenbaum criteria identified 78.6% of the left-sided and 94.0% of the right-sided ACPs. Four of the other seven sets of criteria demonstrated a sensitivity higher than 70.9% and six showed a specificity higher than 74.9% in the 4-region ACP localization. The ECG feature of the delta wave polarity in lead V1 correctly localized the ACP to one of three broad regions in 162 of 182 patients with an overall specificity of 94.5%. The study indicates that (1) the 12-lead ECG is of practical value for initial ACP localization; (2) a type A ECG is almost invariably associated with a left-sided ACP, while type B may occur with any ACP location; (3) the polarity of the delta wave is the most important ECG feature, and the polarities of the delta wave and main QRS complex in lead V1 play an important role in ACP localization.

Structural analysis of nucleic acids by precise denaturing gradient gel electrophoresis: II. Applications to the analysis of subtle and drastic mobility changes of oligo- and polynucleotides

Precise denaturing gradient gel electrophoresis was effectively applied to various kinds of oligo- and polynucleotides. The analyses on oligonucleotides revealed that every oligonucleotide has its own characteristic normalized mobility profile (NMP), which can be used to identify, characterize and classify the molecules. The precise system also enabled us to obtain unequivocally the mobility transitions corresponding to the melting of hairpin structures of oligonucleotides, single-stranded (ss) DNAs, and RNAs. Another application to co-migration and separate migration experiments demonstrated that there were significant binding interactions between two species of ss molecules of similar mobility, even when they have little complementarity with each other. When the precise temperature gradient gel electrophoresis was applied to double-stranded DNAs, it could be confirmed with high reliability that the mobility transitions observed correspond to cooperative meltings and strand dissociations. Through these experiments, mu m, a parameter defined as a mobility transition point, was shown to be effective to deal with those phenomena quantitatively.

Structural analysis of nucleic acids by precise denaturing gradient gel electrophoresis: I. Methodology

A method to convert the conventional denaturing gradient gel electrophoresis into a highly reproducible experimental system was developed. It was based on the following experimental findings; (i) dyes, which are small molecules, do not exhibit mobility changes attributed to their conformational change while nucleic acids do; and (ii) most of the mobility shifts caused by experimental fluctuations could be cancelled by normalizing the mobility of a sample with respect to the corresponding one of a dye. The method involves co-migration of internal reference dyes with samples (nucleic acids), and computer-aided data processing, allowing us to obtain the relative mobility of nucleic acids with respect to a dye throughout the denaturing gradient. The overall pattern of the relative mobilities thus obtained, named the normalized mobility profile (NMP), corresponded well to conformational changes of a macromolecule induced by denaturing effects. This method provides us with objective data without using internal macromolecular references, which not only guarantees the precision but also extends the range of application of the denaturing gradient method.

Diagnosis and treatment of left ventricular false aneurysm

Three patients are presented in whom a false aneurysm of the left ventricle was surgically treated. False aneurysm of the left ventricle is an unusual consequence of ventricular wall rupture with containment of the resulting hematoma. Most false aneurysms of the left ventricle develop following myocardial infarction. The false aneurysm wall contains no myocardium. The false aneurysm has a great tendency to rupture, regardless of its size. One patient developed progressive congestive heart failure following a myocardial infarction. The other two patients were asymptomatic following myocardial infarction. Preoperative magnetic resonance imaging showed characteristics of a false aneurysm. These included a distinct discontinuance of the myocardium at the neck of the aneurysm and a narrow neck relative to the diameter of the aneurysm. Two patients underwent successful closure of the orifice of the false aneurysms. One patient underwent emergency surgery because of acute rupture while awaiting surgery but died of cerebral damage. Surgical correction of a false aneurysm is clearly advisable even in the absence of symptoms.

Long-term results of surgery for non-ischemic ventricular tachycardia

Drug resistant, non-ischemic ventricular tachycardia (VT) was treated in 43 patients by direct surgery based on electrophysiological data. Two main surgical techniques were employed: myocardium was resected followed by cryocoagulation with a special probe in 23 patients with VT originating from the right ventricle. The myocardium was incised followed by cryocoagulation in 10 patients with VT from the left ventricle. The follow-up period ranged from 1 week to 10 years, 4 weeks (mean 3 years, 8 months). After operation, 36 patients (83%) showed complete disappearance of VT without antiarrhythmic therapy. Of these 2 patients died of congestive heart failure not related to VT in the postoperative period at 1 year 4 months, and 2 years 4 months, respectively. In 7 patients, VT remained. In 2, VT disappeared after catheter ablation. In 3 patients, VT became controllable with antiarrhythmic therapy. Operation was not successful in 2 patients (5%); 1 with a giant left ventricular aneurysm died of low cardiac output syndrome due to VT 1 week after operation; the other with arrhythmogenic right ventricular dysplasia originating from both ventricles died suddenly 5 months after operation. The 10-year survival is 89%, and the 10-year freedom from recurrent VT is 83%. These results indicate that surgical management for non-ischemic VT is safe and effective with a high chance of cure.