[Evaluation of blood absorption, hemostatic ability and purity of a polyepoxy compound cross-linked cotton type collagen hemostat]

A polyepoxy compound cross-linked cotton type collagen hemostat (CCH) made of highly purified atelocollagen in a fine filament shape was developed. To evaluate blood absorption, hemostatic ability and purity of the CCH, Avitene and Oxycel were used for comparison. Blood absorption speed of the CCH was faster than Avitene and Oxycel. The handling characteristics of the CCH were much better than those of Avitene and Oxycel. Hemostatic ability was better in the CCH compared to Avitene in a canine study. The purity of the CCH was better than in Avitene which contained albumin and other proteins. Those results suggest that the developed hemostat with excellent blood absorption, handling characteristics, hemostatic ability and purity, could be useful in clinicals.

Postischemic functional recovery and BMIPP uptake after primary percutaneous transluminal coronary angioplasty in acute myocardial infarction

To correlate asynergic wall motion after primary percutaneous transluminal coronary angioplasty with myocardial perfusion and fatty acid metabolism, quantitative tomographies using thallium and radioiodinated 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) were performed during the acute and recovery stages in 56 consecutive patients with acute myocardial infarction, of whom 32 underwent primary percutaneous transluminal coronary angioplasty (group A) and 24 were conservatively treated (group B); 44 patients (79%) had 1-vessel disease. Reduced myocardial uptakes of thallium and BMIPP and regional wall motion were quantified with a bull's eye technique and a centerline method using contrast left ventriculography, respectively. BMIPP activity was significantly lower than that of thallium at an acute stage in both groups. Abnormal BMIPP activities and the difference in thallium and BMIPP abnormalities (perfusion metabolism mismatch) at an acute stage decreased significantly during follow-up in group A (111 +/- 13 to 99 +/- 12 and 30 +/- 10 to 15 +/- 10, respectively), and not in group B (129 +/- 31 vs 118 +/- 29 and 29 +/- 13 vs 30 +/- 10, respectively). Improvement in regional wall motion abnormality correlated closely with the improved uptakes of thallium and BMIPP (y = 0.64x + 26.4, r = 0.56, p < 0.05; y = 1.1x + 11.1, r = 0.81, p < 0.001; respectively). The mismatched uptake of both tracers at an acute stage was significantly related to recovery from asynergic wall motion during follow-up in group A (y = 0.45x + 13.9, r = 0.65, p < 0.005). In conclusion, despite restored myocardial perfusion by primary coronary angioplasty, BMIPP uptake is impaired in salvaged myocardium at an acute stage of infarction. However, the degree and improvement of perfusion metabolism mismatch in acute myocardial infarction may reflect subsequent recovery from postischemic wall motion abnormality in metabolically impaired but viable myocardium after coronary reperfusion.

A recombinant baculovirus 42-kilodalton C-terminal fragment of Plasmodium falciparum merozoite surface protein 1 protects Aotus monkeys against malaria

The immunogenicity and protective efficacy of baculovirus recombinant polypeptide based on the Plasmodium falciparum merozoite surface protein 1 (MSP-1) has been evaluated in Aotus lemurinus griseimembra monkeys. The MSP-1-based polypeptide, BVp42, corresponds to the 42-kDa C-terminal processing fragment of the precursor molecule. Immunization of Aotus monkeys with BVp42 in complete Freund's adjuvant resulted in high antibody titers against the immunogen as well as parasite MSP-1. Fine specificity studies indicated that major epitopes recognized by these antibodies localize to conserved determinants of the 19-kDa C-terminal fragment derived from cleavage of the 42-kDa processing fragment. Effective priming of MSP-1-specific T cells was also demonstrated in lymphocyte proliferation assays. All three Aotus monkeys immunized with BVp42 in complete Freund's adjuvant showed evidence of protection of protection against blood-stage challenge with P. falciparum. Two animals were completely protected, with only one parasite being detected in thick blood films on a single days after injection. The third animal had a modified course of infection, controlling its parasite infection to levels below detection by thick blood smears for an extended period in comparison with adjuvant control animals. All vaccinated, protected Aotus monkeys produced antibodies which inhibited in vitro parasite growth, indicating that this assay may be a useful correlate of protective immunity and that immunity induced by BVp42 immunization is mediated, at least in part, by a direct effect of antibodies against the MSP-1 C-terminal region. The high level of protection obtained in these studies supports further development of BVp42 as a candidate malaria vaccine.

Left ventricular function on exercise after surgical treatment of small aortic annuli

To evaluate left ventricular function during exercise after aortic annular enlargement 15 patients with either aortic (group I, n = 8) or aortomitral (group II, n = 7) annuloplasty for small aortic annuli and eight patients (group III) with standard valve replacement for aortic stenosis without small aortic annuli received gated cardiac pool imagining by technetium-99m-labelled red blood cells at rest and during exercise at a mean of 23 months after operation. Left ventricular ejection fraction, preload requitable stroke work and stroke power index (preload requitable stroke work/systolic ejection period) were measured. Compared with resting values, left ventricular performance and stroke work rate on exercise after aortic annular enlargements increased significantly, as did those after standard aortic valve replacement. These results suggest that aortic annular enlargement can be indicated for surgical treatment of valvular heart diseases associated with small aortic annuli.

[Selection of the surgical methods and surgical outcome of the distal arch aneurysm]

Between January, 1985, and December, 1993, 20 patients (18 males, 2 females; median age 65 years) underwent repair of aneurysms of the distal arch. fourteen patients had sacciform aneurysms and 6 patients had fusiform aneurysms. The approaching methods to the aneurysms were left thoracotomy in 3 patients and median sternotomy in 17 patients, including the so-called "door open method" in 2 patients. The supportive methods during surgery were left heart bypass using a centrifugal pump in 3 patients cardiopulmonary bypass with selective cerebral perfusion in 11 patients, and cardiopulmonary bypass with retrograde cerebral perfusion in 6 patients. The operative methods were patch closure in 4 patients, graft replacement using the inclusion technique in 13 patients, and total arch replacement using the exclusion technique in 3 patients. One patient who underwent left heart bypass died intraoperatively from intractable bleeding, one who had undergone selective cerebral perfusion died postoperatively of rupture of the distal anastomosis and two patients, who were supported with retrograde cerebral perfusion, died postoperatively because of perioperative myocardial infarction or rupture of the dissection arising from the aneurysm. There were three cases with cerebral complications postoperatively. These three patients were supported with selective cerebral perfusion. Graft exclusion technique using a prosthetic graft with three branches under the retrograde cerebral perfusion shortened cardiopulmonary bypass time and heart and brain ischemic time, so that this technique might reduce cerebral complications and should be a promising surgical treatment for the distal arch aneurysm.

Long-term results of aortic valve translocation for mycotic periannular abscess: comparative study of Danielson's original method and our threadless method

Between June, 1983, and October, 1992, we performed Danielson's original translocation method in four patients (group I) and our translocation method in seven patients (group II), for the treatment of active periannular abscess. There were no perioperative or hospital deaths in either group. The long-term results of these two groups are compared in this report. There were four late deaths (mortality rate 100%) in group I, and three late deaths (mortality rate 43%) in group II. The causes of death were cardiac in six patients and noncardiac in one patient. Vein graft failure occurred in one group I patient (25%) and in two group II patients (28%). Rupture or aortic pseudoaneurysm formation occurred in three group I patients (75%). These findings suggest that our threadless method may be superior to Danielson's original translocation method. Therefore, with close observation, especially of saphenons vein great (SVG) failure, arterial graft use could be acceptable for translocation.

[Successful graft replacement of a thoracic aortic aneurysm in a patient with Ehlers-Danlos syndrome]

We have experienced graft replacement of a thoracic aortic aneurysm in a 42-year-old man with Ehlers-Danlos syndrome. The patient received graft replacement of the abdominal aortic aneurysm 1 year before this thoracic operation but had no abnormality in his outside appearance. Thoracic CT scan revealed a thoracic aortic aneurysm of 80 mm in maximal diameter. We performed a graft replacement of the thoracic aorta from the ascending aorta to the proximal descending thoracic aorta using deep hypothermia and retrograde cerebral perfusion. The aortic wall was so thin that we used Teflon felt for reinforcement of graft anastomosis at the outside wall of the aortic stump. Type III collagen stain of the resected aortic wall showed deficiency of type III collage, which was consistent with Ehlers-Danlos syndrome (type IV). Postoperative course was uneventful, and the patient returned to his ordinary life.

[Clinical implications of mismatched uptakes of beta-methyl fatty acid analogue and thallium in infarcted myocardium: correlations with coronary stenosis and regional wall motion abnormality]

Myocardial perfusion and fatty acid metabolism were assessed by using myocardial single-photon emission computed tomography with thallium and beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) during acute and/or late stages of myocardial infarction in 157 infarcted segments of 100 patients. The incidence of reduced thallium perfusion relative to BMIPP uptake ("T-type" mismatch) was significantly (p < 0.05) lower (9%) compared to that of reduced BMIPP uptake relative to thallium perfusion ("B-type" mismatch) (59%) or non-mismatched segment (32%). In an anteroseptal region, B-type dissociation had a significantly higher incidence compared to no or T-type mismatch; 68% vs. 27% vs. 5%, respectively, whereas the incidence of T-type uptake was relatively high in inferior and posterolateral regions; 13%, 11%, respectively. Severe coronary stenosis was observed in 76% of B-type segments and 72% of non-mismatched segments but in only 43% of T-type segments. The incidence of regional wall motion abnormality was significantly lower (46%) in the T-type mismatch segments when compared to the B-type (91%) or non-mismatched segments (96%). In conclusion, myocardial fatty acid metabolism was more markedly impaired compared to an involved coronary perfusion, resulting in the mismatch of perfusion and fatty acid metabolism. Coronary stenosis and regional wall motion abnormality are more closely related to "B-type" mismatch but not necessarily to "T-type" dissociation, probably because of attenuation artifacts in inferior and posterolateral regions in thallium scan.

[Clinical characteristics of pancreatitis after cardiovascular surgery]

Increases in pancreatic enzyme levels after cardiovascular surgery were studied, and their clinical characteristics evaluated. The subjects were 128 patients who had undergone cardiovascular surgery (65 patients after valve replacement, 32 after coronary bypass surgery and 31 after aortic artificial graft replacement). The pancreatic enzyme (serum amylase and lypase) levels were monitored serially before and after operation, and amylase fractions were measured at their peaks. The relationships of the peak lypase level with underlying cardiac diseases, background factors, factors related to surgery, factors related to the extracorporeal circulation, presence or absence of symptoms, and treatments were examined. The amylase level exhibited biphasic changes consisting of a peak in which salivary glands amylase (S type) was dominant and a peak in which pancreatic amylase (P type) was dominant. The second peak coincided with the peak lypase and occurred mostly 3 to 10 days after operation. The peak lypase level exceeded the normal range in 78% of all the patients. It exceeded 564 U/l, 4 times the normal value in 28% of the patients, many of whom were symptomatic. So, we recommended that these cases should be treated as "postoperative pancreatitis". A high peak lypase level showed a significant correlation with the history of gallbladder and pancreatic diseases and diabetes mellitus among the background factors and emergency operation and the use of IABP among the surgery-related factors.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical results of aortic stenosis with or without left ventricular dysfunction--postoperative change of left ventricular function]

Between January 1980 and December 1992, 82 patients with aortic stenosis underwent isolated aortic valve replacement at our institution. Age of the patients ranged from 26 to 72 (58 +/- 6.4) years, and 58 were men and 24 were women. The patients were divided into two groups according to preoperative left ventricular ejection fraction (LVEF): 23 patients (LVEF < 50%, mean 39.7%; Group D) and 59 patients (LVEF > or = 50%, mean 62.6%; Group N). By means of echocardiography, LV function were evaluated before and at one month after operation in terms of left ventricular fractional shortening (LVFS), left ventricular systolic internal diameter (LVIDs), left ventricular mass index (LVMI), and left ventricular end systolic wall stress (ESWS). Postoperative early mortality including hospital death was 8.7% in group D (2 cases; myocardial infarction 1, cerebral complication 1) and 3.3% in group N (2 cases; myocardial infarction 1, low output syndrome 1), and this difference was not significant (NS) between two groups. The 5- and 12-year actuarial survival rate were 87.8% and 87.8% in group D, 91.5% and 87.6% in group N, respectively (NS). LVFS (pre/post) was 0.25 %/- 0/08/0.24 +/- 0.10 in group D, 0.38 +/- 0.10/0.32 +/- 0.10 in group N. The difference were significant before (p < 0.0005) and after (p < 0.005) operation between two groups. LVIDs (mm; pre/post) were 39.0 +/- 7.9/35.0 +/- 9.6 in group D, 28.7 +/- 7.3/229.3 +/- 7.6 in group N. The difference were significant before (p < 0.0005) and after (p < 0.01) operation.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case report of prosthetic valve replacement for malfunction of the Hancock valve in mitral position associated with recurrent peptic ulcer and renal dysfunction]

A 62-year-old woman was admitted with malfunction of the Hancock valve in mitral position. She had been suffering from gastroduodenal ulcer for about ten years. She couldn't take warfarin after 5 years later of the initial operation due to recurrent gastrointestinal bleeding. Judging from her age and renal dysfunction, we preferred mechanical valve to avoid the risks for the reoperation. After confirming the healed ulcer with administering omeprazole, we performed prosthetic valve replacement with SJM 29 M successfully. Postoperative course was uneventful and recurrence of the ulcer was not observed.

[Surgical results of aortitis syndrome (Takayasu disease) combined with annuloaortic ectasia]

From March 1973 to December 1994, 8 patients (2 males and 6 females) aged 34.4 +/- 7.8 years, underwent composite graft replacement (CGR) for aortitis syndrome combined with annuloaortic ectasia (AAE) in our institute. Five patients showed active aortitis syndrome and steroid therapy was administrated to 2 of them. The mean value of the C-reactive protein (CRP) was 1.6 +/- 1.8 before the operation. The maximum diameter of the ascending aorta was 67.1 +/- 10.3 mm (range 53 to 85 mm). Stenosis and/or ectasia of the neck vessels were recognized in 5 cases, as well as the coronary artery in 2 cases. Isolated CGR was performed in 6 cases, and combined with single CABG to LAD in 1 case and with total arch replacement in 1 case. The enlarged ascending aorta was replaced with main graft using the exclusion method and interposed grafts for coronary arteries were sutured with pledgetted mattress sutures all around the coronary ostia. In patients with stenosis of neck vessels, oxygen saturation of the jugular vein was monitored during extracorporeal circulation for surveillance of cerebral ischemia. There was 1 early death due to pulmonary failure. Seven cases survived without any complications during 4-132 months (mean 83.4 months) of the follow-up period. After the operation, 3 cases required steroid therapy during 4-50 months. We concluded that preoperative control of active inflammation, selection of operative procedures, timing for the operation, and the long-term precise management of the intractable disease were essential for successful treatment of aortitis syndrome with AAE.

Preliminary efficacy trial of Cymelarsan in mice artificially infected with Trypanosoma brucei brucei isolated from a dog in Zambia

An efficacy trial of Cymelarsan on a Zambian strain of Trypanosoma brucei brucei was done. Twenty-five male mice were infected intraperitoneally with 10(6) of T. b. brucei isolated from a dog. Five groups of 5 mice were treated with 0 (control), 0.25, 0.5, 1.0 and 2.0 mg/kg Cymelarsan, respectively. The target was to achieve aparasitaemia for 30 days post-treatment, euthanising those that remained parasitaemic or relapsed before then. The 0.25 and 0.5 mg/kg groups remained parasitaemic although the parasitaemic levels were reduced. The 1.0 mg/kg group had a proportion of aparasitaemic mice. However, all mice in the 2.0 mg/kg group remained aparasitaemic until day 20 when 2 mice relapsed. These results suggested that more than 2.0 mg/kg was required to eliminate this strain.

[Quality of life, subjective health status and health and life satisfaction in rheumatoid arthritis]

A Japanese version of Arthritis Impact Measurement Scales (AIMS) was developed after the original AIMS Version 2 and utilized for Quality of Life (QOL) measurement in 691 patients with Rheumatoid Arthritis (RA). Various medical (physical and laboratory) examinations, which are widely used in the clinical settings for the assessment of RA activity and severity, were also performed by physicians. Interrelationships between QOL, patient subjective health status, and health and life satisfaction were analyzed with the following results: 1: The effect of QOL impairment by RA upon patients' subjective health rating and health satisfaction were not constant over the range of severity of disease status. Pain was found to lower overall subjective health and health satisfaction regardless of RA class. On the other hand, while the deterioration of mobility aspects of QOL had negative effects upon patients' subjective health status and satisfaction among less-disabled RA patients, any of physical aspects of QOL, including the degree of mobility impairment, showed no significant association with patients' subjective health status and satisfaction in the more disabled. 2: Psychological aspects of QOL (mood and tension) had significant associations with patients' subjective health status and satisfaction. In the less severe group, mood impairment had a significant effect on subjective health and satisfaction, while in the more severe group tension showed a significant association. It was indicated that management of psychological aspects of QOL is important in RA patients to improve and advance their subjective health status and satisfaction. 3: Although social aspects of QOL, i.e. social support, social life and job status, showed no significant relationship to subjective health rating and health satisfaction, those with less disease severity who lacked social support and who had a jobless state were likely to have lower disease acceptance and life satisfaction, while those with more severe disease who had less social interaction manifested lower life satisfaction. These results suggested that social aspects of QOL, while not directly associated with subjective health rating, could be important factors affecting disease acceptance and life satisfaction.

Long-term outcome of left ventricular dysfunction after surgery for severe aortic stenosis

Thirteen patients with severe aortic stenosis and left ventricular dysfunction (ejection fraction < 0.50, Group A) received echocardiographic evaluation before, and early and late after isolated aortic valve replacement. The results were compared with those of 11 aortic stenosis patients without left ventricular dysfunction (Group B). Using two-dimensional echocardiography, left ventricular diastolic internal diameter (LVIDd), left ventricular systolic internal diameter (LVIDs), left ventricular wall thickness (interventricular septum + posterior wall: LVWT), left ventricular fractional shortening (FS), left ventricular mass index (LVMI) and left ventricular end-systolic wall stress (ESWS) were assessed before (Pre), at one month (Early) and 4-7.6 (mean 5.5 +/- 1.0) years (Late) after operation. In the early postoperative period in Group A, significant decrease was observed in LVIDd (5.4 +/- 0.8 to 4.5 +/- 1.0 cm, p = 0.010), LVWT (3.3 +/- 0.7 to 2.9 +/- 0.7 cm, p = 0.027) and LVMI (336 +/- 149 to 222 +/- 112 g/M2, p = 0.013). From the early to late postoperative period FS showed significant improvement in both groups (0.23 +/- 0.12 to 0.32 +/- 0.12 in Group A, p = 0.025 and 0.27 +/- 0.07 to 0.36 +/- 0.07, p = 0.014). However, changes of other parameters were not significant and LVMI in Group A remained twice as high as the normal value. It is concluded from the above results, that LV contraction in aortic stenosis patients with preoperative left ventricular dysfunction improved during the late postoperative period. Although LVMI in the early postoperative period significantly decreased as compared with the preoperative value, it showed no further improvement and remained at an abnormally high level. Therefore, early surgical treatment of severe aortic stenosis before appearance of LV dysfunction should be recommended for postoperative recovery from LV hypertrophy.

[Detection and quantitation of cytomegalovirus DNA in plasma from patients with cytomegalovirus pneumonia]

Detection and semiquantitation of cytomegalovirus (CMV) DNA in plasma from 17 immunocompromised patients with CMV pneumonia diagnosed histopathologically, 15 CMV seropositive patients without CMV pneumonia and 24 CMV-seropositive healthy volunteers were evaluated, using the polymerase chain reaction (PCR). CMV DNA was detected in plasma from all of 17 patients with CMV pneumonia, from 1 of 15 patients without CMV disease, but from none of healthy volunteers. One patient without CMV disease exhibited positive CMV DNA by PCR 2 days before death. Plasma CMV DNA was negative at the time of admission in all patients, however, it became positive 1-28 days (mean, 14 days) before the onset of CMV pneumonia in 16 patients. The amount of viral DNA in plasma were 10(3) - 10(5) copies/ml (mean, 10 (4.0) copies/ml) when first detected by PCR. At the onset of CMV pneumonia, they were 10(4)-10(6)(mean, 10(5.3) copies/ml), and increased with disease progression and decreased with disease improvement because of treatment with antiviral agents. We succeeded in detection of CMV DNA in plasma before the development of CMV pneumonia, and showed the amount of viral DNA reflected the extent of active CMV pneumonia. Thus, PCR amplification of CMV DNA in plasma is a useful tool for early diagnosis and monitoring of immunocompromised patients.

Anatomical distribution and postnatal changes in endogenous free D-aspartate and D-serine in rat brain and periphery

We have investigated the anatomical distribution and postnatal development of D-aspartate and D-serine in the rat brain and periphery using HPLC techniques. D-Serine was confined predominantly to the brain throughout postnatal life. At birth, a substantial quantity of D-serine was observed throughout the brain areas. The cerebral D-serine content increased from birth to postnatal week (PW) 3 and remained constant thereafter, whereas the cerebellar D-serine content peaked at PW1. In contrast, the transient emergence of D-aspartate was found in almost all brain and peripheral organs. A substantial quantity of D-aspartate was also seen in all brain areas at birth, whereas the D-aspartate content in the cerebrum and cerebellum decreased dramatically by PW1 and 7 respectively. Further, the D-aspartate content and the ratio of D-aspartate to total aspartate were highest in the adrenal at PW3 (608 +/- 70 nmol/g, 45.9%) and in the testis at PW14 (221 +/- 7 nmol/g, 57.8%) respectively. Because D-serine potentiates N-methyl-D-aspartate receptor-mediated transmission through the strychnine-insensitive glycine site and because D-serine exhibits an N-methyl-D-aspartate receptor-related distribution and development, D-serine may be a tenable candidate for an intrinsic ligand for the glycine site. In contrast, because the periods of maximal emergence of D-aspartate in the brain and periphery occur during critical periods of morphological and functional maturation of organs, D-aspartate could participate in the regulation of these developmental processes of organs.

[Examination of cardiac myxomas complicated with embolism]

Cardiac myxomas complicated with embolism were examined. Of 51 patients who underwent surgical excision of myxomas during the last 19 years, 10 patients (6 patients originated from left atrium, 4 patients originated from right atrium) had complications by embolisms. The embolism occurred in cerebral arteries (5 cases), a coronary artery (1 case), a retinal artery (1 case), and pulmonary arteries (4 cases). Patients were divided into an embolism group and a non-embolism group to investigate risk factors of embolism. Arrhythmia, diameter, narrow peducle, and tumor friability were thought to be major risk factors. Gelatinous and rough surface type tumor tended to cause embolism. Hypervascular tumors did not cause embolism. Among 10 patients, 2 patients had already had new embolism and another 2 patients had aggravated their symptoms before making diagnosis of myxoma. Myxomas should always be considered as a source of embolization, which need meticulous investigation and prompt indication of surgical resection.

[Prediction of left ventricular functional recovery in patients with acute myocardial infarction using single photon emission computed tomography with thallium-201 and iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid]

The relationships between myocardial perfusion, fatty acid metabolism, and cardiac function were investigated using dual single photon emission computed tomography (SPECT) with thallium and iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid (123I-BMIPP) during the acute (10 +/- 1 days) and recovery (60 +/- 14 days) phases in 29 patients with acute myocardial infarction. There were 18 patients who underwent successful primary coronary angioplasty (PTCA group) and 11 patients who received conservative therapy (non PTCA group). Thallium and BMIPP uptakes were scored visually by a 4-point system and left ventricular ejection fraction (LVEF) was calculated by radionuclide ventriculography. Although significant positive correlations between thallium and 123I-BMIPP scores were observed during both phases, BMIPP scores were significantly lower than thallium scores in both acute and recovery phases in the PTCA group. No significant difference in thallium and 123I-BMIPP scores was observed at the recovery phase in the non PTCA group. LVEF significantly correlated with thallium and 123I-BMIPP scores in both phases in the PTCA group. Furthermore, the difference between thallium and 123I-BMIPP scores during the acute phase significantly correlated with the improvement of LVEF during the follow-up period in the PTCA group (y = 0.92x-0.77, r = 0.65, p < 0.005). These findings suggest that mismatch of perfusion and metabolism in infarcted myocardium assessed by thallium and 123I-BMIPP SPECT is increased by reperfusion therapy and persists at least until the recovery phase of myocardial infarction. The recovery of left ventricular function depends on the extent of the mismatched uptake, indicating a predictor for functional recovery following acute myocardial infarction.

[A successful repair of the aortic dissection (DeBakey type I) with ischemic complications of the kidney and lower extremities]

A 65-year-old male was referred to our institution under diagnosis of aortic dissection which passed 1 month after the onset. An aortography revealed DeBakey type I aortic dissection with the left renal artery involvement and the very narrow true lumen of the abdominal aorta compressed by the pseudolumen, especially at the orifice of the right renal artery. On the 3rd day of admission, the patient manifested SVC syndrome, oliglia and pulselessness of the femoral artery bilaterally, that indicated ischemia of the kidney and the lower extremities. An emergency operation was performed, and the ascending aorta was replaced using open distal anastomotic technique for the distal site of the aorta under deep hypothermia and retrograde cerebral perfusion method. The ischemic symptoms and SVC syndrome were disappeared promptly after operation. Postoperative CTscan showed the narrow true lumen of the abdominal aorta expanded remarkably. The postoperative course was uneventful and the patient discharged on the 54th postoperative day.

[Microbiological and clinical study of fungemia between 1981 and 1992]

Fungi were isolated from 113 (14.2%) of 789 patients with positive blood cultures at Oita Medical University Hospital between 1981 and 1992. The rates of fungemia increased in recent years, 13.9% (1981-1985), 12.1% (1986-1988) and 16.9% (1989-1992). The isolated fungi were Candida parapsilosis (25.7%), C. albicans (24.8%), C. tropicalis (14.2%), Trichosporon beigelii (10.6%), C. glabrata (8.0%) and so on. The major fungi were T. beigelii and C. glabrata in patients with hematologic malignancies, whereas they were C. albicans and C. parapsilosis in patients with non-hematologic diseases and C. glabrata increased in both groups. Prophylactic or emiric administration of antifungal agents probably influenced the difference of the causative organisms in the two groups.