[Pharmacological profiles of a novel tachykinin NK-2 receptor antagonist, TAC-363]

We examined the pharmacological profiles of a novel tachykinin NK-2 receptor antagonist, Na-(tert-butylcarbamoyl)-L-glutaminyl-L-tryptophyl-alpha-azap++ + henylalanine 2-benzyloxyethylamide (TAC-363). In vitro studies showed that TAC-363 caused a rightward shift of the contraction response curve with a slight inhibition of maximal response for the neurokinin A (NKA)-induced contraction of the hamster trachea and parallel rightward shift of the curve for the substance P (SP)-induced contraction of the guinea-pig ileum. The pA2 values were 9.82 and 8.42 on the contraction by NKA and SP, respectively. The selectivity of TAC-363 to NK-2 receptor was 25 times higher than that to NK-1 receptor. The compound did not affect the histamine and acetylcholine-induced bronchoconstriction in guinea-pig ileum. Intravenous administration (0.1-1 mg/kg) of the compound inhibited dose-dependently both NKA- and capsaicin-induced bronchoconstriction in guinea-pigs. The inhibitory effect of the compound lasted up to 60 min on NKA-induced bronchoconstriction in guinea-pigs. These results suggest that TAC-363 is a potent and selective NK-2 receptor antagonist, which is effective in vitro and in vivo. It may be useful in the treatment of NKA-dependent pathology, especially bronchial asthma.

The initial phase of gastrulation in sea urchins is accompanied by the formation of bottle cells

The morphogenetic processes responsible for the initial phase of gastrulation in sea urchins have yet to be satisfactorily defined. Using conventional and confocal microscopy we have analyzed the buckling of the vegetal plate to form the archenteron in embryos of Strongylocentrotus purpuratus. The cells of the vegetal plate elongate and a ring of 34 to 36 bottle cells forms within the vegetal plate during invagination. Rhodamine phalloidin staining reveals a reorganization of the actin cytoskeleton associated with these changes in cell shape. During buckling, the ring of bottle cells within the vegetal plate fluoresce intensely at their apical surface and in the narrow neck region. Ionophore A23187 induces precocious buckling and the formation of the ring of bottle cells. The calcium channel blocker verapamil and the calmodulin inhibitor trifluoperazine reversibly inhibit buckling and the formation of the ring of bottle cells. Treatment with antibodies to the apical lamina, which interferes with the initial stage of gastrulation, blocks the appearance of the vegetal plate phalloidin staining. Measurements of the dimensions of cells and an analysis of shape changes suggest that the formation of bottle cells reduces the surface area of the vegetal plate by more than 50%. We propose that actin-mediated changes in cell shape within the vegetal plate are responsible for producing forces which cause buckling of the vegetal plate during the initial phase of gastrulation.

TNF-mediated cytotoxicity and resistance in human prostate cancer cell lines

BACKGROUND

The contribution of TNF receptor (TNF-R) expression was investigated with respect to TNF sensitivity or insensitivity for androgen-dependent and androgen-independent human prostate cancer (PCA) cell lines, respectively.

METHODS

Flow cytometric analyses using monoclonal antibodies against the 55-kDa receptor (TNF-R1) and the 75-kDa receptor (TNF-R2) indicated that both receptors were expressed on all three cell lines.

RESULTS

Moreover, expression of TNF-R1 was greater than expression of TNF-R2 in these PCA cells. All three PCA cell lines produced IL-6. However, IL-6 production was enhanced when TNF-insensitive JCA-1 and PC-3 cells, but not TNF-sensitive LNCaP cells, were treated with rTNF (10(-9) M).

CONCLUSIONS

These data suggest that the lack of an antiproliferative effect of rTNF on the androgen-independent PCA cell lines PC-3 and JCA-1 is not due to the failure of these cells to express TNF-R, but may be related to the differences in TNF-mediated IL-6 expression by these PCA cell lines.

Significant influence of accompanying chronic hepatitis status on recurrence of hepatocellular carcinoma after hepatectomy. Result of multivariate analysis

OBJECTIVE

The aim of this study was to evaluate the correlation between the histologic status of accompanying chronic hepatitis and the recurrence rate of hepatocellular carcinoma (HCC) after hepatectomy by multivariate analysis.

SUMMARY BACKGROUND DATA

Recent studies have suggested that a considerable number of intrahepatic recurrence of HCC after hepatectomy might be the results of metachronous multicentric hepatocarcinogenesis. The authors hypothesized that the incidence of recurrence due to metachronous multicentric hepatocarcinogenesis would depend on the histologic status of accompanying chronic viral liver disease, which is a main promoter of HCC.

METHODS

One hundred ten patients with HCC who underwent curative resection were studied. Histologic status of accompanying chronic hepatitis was classified into the three categories: 1) normal liver or chronic persistent hepatitis (CPH, n = 13), 2) chronic aggressive hepatitis (CAH, n = 50), and 3) liver cirrhosis (LC, n = 47).

RESULTS

The Cox multivariate proportional hazard model showed that the accompanying chronic viral hepatitis status (p = 0.0133), extent of hepatectomy (p = 0.0078), and number of tumors (p = 0.0475) were significantly predictive variables for recurrence-free survival. By the log-rank test, recurrence-free survival rate in patients with CPH was significantly higher than those in patients with CAH (p = 0.0005) and LC (p = 0.0075). Patients with CAH had the lowest recurrence-free survival rate (vs. LC, p = 0.028).

CONCLUSIONS

The results of this study indicated the significant influence of histologic activity of hepatitis on recurrence of HCC. This might support the concept of significant contribution of multicentric hepatocarcinogenesis to recurrence of HCC after hepatectomy.

G protein specificity of the muscarine-induced increase in an inward rectifier potassium current in AtT-20 cells

Muscarine and somatostatin enhance an inward rectifier K+ conductance in the AtT-20 pituitary cell line. Both effects are abolished by pertussis toxin (PTX). To determine which PTX-sensitive G protein mediates these agonist effects, we made cDNAs encoding mutant PTX-insensitive Gi alpha subtypes, in which the cysteine residue fourth from the C terminus was replaced with serine. The mutated cDNA was transfected into AtT-20 cells, resulting in stable cell lines overexpressing a Gi alpha subtype. As controls, wild-type Gi alpha cDNA was transfected into AtT-20 cells. The agonist-induced increase of the inward rectifier K+ conductance in the transfectants was examined with the whole-cell clamp method. Only in the cell lines into which the mutated (PTX-insensitive) Gi2 alpha cDNA was transfected, did the muscarine response become PTX-insensitive, suggesting that Gi2 couples to the muscarinic receptor and enhances the activity of the inward rectifier K+ channel. However, PTX-insensitive somatostatin responses were not obtained in any of the cell lines transfected with a mutated Gi alpha cDNA, suggesting either that none of the Gi subtypes is a transducer for the somatostatin effect or that the mutation prevents the coupling of the Gi alpha to the somatostatin receptor.

Influence of associated viral hepatitis status on recurrence of hepatocellular carcinoma after hepatectomy

The purpose of this study was to investigate the relation between the recurrence of hepatocellular carcinoma (HCC) and the histologic status of underlying chronic liver disease from a viewpoint of multicentric hepatocarcinogenesis. Sixty-eight patients who underwent curative resection of HCC and have been followed for more than 2 years are reported. Based on the microscopic findings of the noncancerous part of the liver, the patients were divided into normal liver (N,n = 2), chronic persistent hepatitis (CPH,n = 6), chronic aggressive hepatitis (CAH,n = 31), and liver cirrhosis (LC,n = 29) according to a classification by the European Association for the Study of the Liver. Background data for the groups showed no significant differences. Recurrence was observed in none of the patients in the N and CPH groups, 26 (83.9%) of the patients in the CAH group, and 12 (41.4%) of the patients in the LC group. The cumulative disease-free survival rate of the CAH group was significantly lower than that of the CPH group (p < 0.05) and LC group (p < 0.01). This study revealed that the histologic status of the underlying chronic liver disease influenced the recurrence rate in patients with HCC. CAH was considered to be a risk factor for recurrence after resection of HCC.

A technique for culturing brain nuclei from postnatal rats

The technique for culturing brain nuclei from postnatal rats is described in detail. Key features of this simple method of culturing brain nuclei are: (a) to make brain slices of a particular brain region and to isolate the brain nucleus under direct visualization using a dissecting microscope; (b) to use papain for dissociation; (c) to grow neuron cultures over a glial feeder layer; and (d) to use rat serum (prepared in the laboratory) in the culture medium. We have developed neuronal cultures from several types of brain nuclei (such as the locus coeruleus) and identified the type of neurons immunocytochemically and histochemically. With this culture method, we can obtain high purity cultures of specific types of brain neurons. Our brain nucleus cultures are excellent materials for cellular and molecular physiological studies. Long-term changes of a single neuron belonging to a particular neuron type can be observed. Experiments using the patch clamp technique and intracellular injection of antibodies and antisense oligonucleotides are feasible.

Study of the changes of serum hyaluronic acid during porcine liver transplantation: influence of warm ischemia

Twelve porcine liver transplantations were performed to investigate whether serum hyaluronic acid (HA) serves as a marker of warm ischemic injury. Group 1 was a control without warm ischemia (n = 7), and pigs in Group 2 were sacrificed by intracardiac KCl injection 60 min before harvesting (n = 5). All pigs survived more than 4 days in Group 1. In Group 2, all died within 2 days due to graft failure. Arterial and hepatic venous glutamic-oxaloacetic transaminase (GOT) in Group 2 were higher after revascularization. However, there were no differences between the 2 groups in arterial and hepatic venous HA levels. HA clearance by the graft also showed no differences between the groups. Although GOT reflected the degree of warm ischemia, HA and its hepatic clearance were not influenced by warm ischemic damage. In conclusion, HA was not thought to serve as a marker of liver injury when the graft suffered from warm ischemia.

Identification of the cell type origin of odontoma-like cell masses in microphthalmic (mi/mi) mice by in situ hybridization

Tooth abnormalities occur in microphthalmic (mi/mi) mice. The elongated odontogenic epithelium is interrupted by unresorbed bone at the basal end of the mi/mi incisor, with the epithelium gathered into cell clusters. These clusters develop to odontoma-like masses. To identify the origin of the cell types of these odontoma-like masses, the localization of osteonectin (Osn), osteocalcin (Osc), osteopontin (Osp), matrix Gla protein (MGP) and amelogenin (Am) mRNA in the process of tooth development in mi/mi and +/+ mice was investigated by means of in situ hybridization. Decalcified mandibles of neonatal, 5-, 10-, 14-day-old mice were examined. Osn and Osc mRNA, which localized in osteoblasts and odontoblasts, were also detected in the cells of odontoma-like masses in mi/mi mice. The cells expressing these mRNA were short, columnar and odontoblast-like. Am mRNA was detected in ameloblasts. In mi/mi mice, Am mRNA was also detected in ameloblastic cell clusters, which were formed by the tall columnar cells in the odontoma-like masses. No apparent Osp mRNA expression was detected in the masses. These results indicated that even in odontogenic abnormal cells resulting from physical obstruction in mi/mi mice, the genes that are involved in normal tooth development were still expressed.

Properties of a slow nonselective cation conductance modulated by neurotensin and other neurotransmitters in midbrain dopaminergic neurons

1. A widespread mechanism of slow excitation throughout the nervous system involves overlapping changes in nonselective ion conductance and K+ conductance. We used whole cell patch-clamp recording to characterize such a nonselective conductance induced by neurotensin (NT) and other neurotransmitters in immunocytochemically identified dopaminergic neurons cultured from the rat ventral tegmental area (VTA). 2. The NT-induced inward current consisted of an initial peak and later "hump." The response was blocked reversibly by the nonpeptide NT-receptor antagonist SR48692, suggesting that it resulted from activation of NT receptors. 3. The channel was almost equally permeable to Na+ and K+, as determined from the reversal potential shift upon switching from Na+- to K(+)-containing external solution. The permeability of Cs+ was similar to that of Na+, as determined from the zero-current equation and average reversal potential in the 75 mM Na+ solution. Cl- was not significantly permeable. 4. In Ca(2+)-free external solution, the NT-induced current showed a fourfold increase in amplitude, and in high Mg2+ (20 mM) external solution, the NT-induced current showed an 80% decrease in amplitude, suggesting that external Ca2+ and Mg2+ could block the nonselective conductance. 5. The NT response was unaffected by loading the neurons with either the Ca2+ chelator 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid or with 1 mM ca2+. The nonselective conductance was therefore not Ca2+ activated. 6. Loading the neurons with cyclic GMP or cyclic AMP (each with the phosphodiesterase inhibitor isobutyl-methylxanthine) did not affect the NT response. The NT-induced nonselective conductance was therefore not cyclic nucleotide-activated. 7. The latency of the NT response was long (> or = 185 ms, average 406 ms, 30 degrees C), indicating that NT did not induce the conductance through ligand-gated channels. Thus, NT activated a slow nonselective cation conductance. 8. Neurokinin B, a metabotropic glutamate agonist, and muscarine elicited responses similar to the NT response. The NT response could be elicited after desensitizing the responses to these other neurotransmitters, indicating receptor specificity in the activation of the nonselective conductance.

Angiomyolipoma arising in the colon

Extrarenal angiomyolipomas are very rare. Here we report the first case of surgically resected angiomyolipoma of the descending colon that developed in a 50-yr-old man. The patient had no signs of or family history of tuberous sclerosis. He underwent a partial colectomy because the tumor obstructed the colon. Histologically, the tumor consisted of three components: mature fat cells, blood vessels, and smooth muscle cells, and was thereby diagnosed as an angiomyolipoma. Immunohistochemically, the proliferating smooth muscle cells were positive for vimentin, alpha-smooth muscle actin, and desmin. The tumor cells were negative for HMB-45, which is consistently expressed in renal angiomyolipomas.

[The effects of preoperative transcatheter arterial chemoembolization (TAE) for the recurrence of hepatocellular carcinoma (HCC) from the viewpoint of consecutive tumor necrosis effect]

From 1990 to 1994, seventy-seven patients with HCC below 10 cm in tumor diameter underwent hepatic resections after TAE. They were divided into two groups: group C, complete necrosis (over 90% histologically at the maximum cutting surface of the specimen): group I, incomplete necrosis (under 90%). There were no significant differences in clinical background of patients, histopathological features and total disease-free survival rate (DFR) between the two groups. Nevertheless, DFR of patients in group C was significantly better than that of patients in group I, limiting the patients for curative resection. It was suggested that the recurrence of HCC after resection might be inhibited by curative operation following preoperative TAE with complete necrosis of tumor.

[Ten-year follow-up of percutaneous transluminal coronary angioplasty]

The long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA) was evaluated in 124 patients who underwent PTCA between October 1982 and June 1985. Seventy-six patients had their proximal coronary arteries completely revascularized by PTCA (including repeat PTCA) and follow-up angiography showed the vessels were patent 3 to 6 months after the last intervention (group A). The other 48 patients showed incomplete revascularization (group B). The 10-year event-free survival rates from cardiac death and non-fatal myocardial infarction were 89.7% in group A and 93.5% in group B, respectively. Survival rates free from cardiac death, myocardial infarction, coronary bypass surgery, and repeat angioplasty for new lesions were 82.5% and 62.7%, respectively (p < 0.001). Ninety-nine percent of patients in group A and 79.5% of patients in group B were asymptomatic at the follow-up. Coronary angiography was performed in a total of 22 patients (19 patients in group A, 3 in group B). In group A, myocardial infarction occurred in one patient 8 years after PTCA. The infarct-related lesion seemed to be the same as the previous PTCA lesion. Although the other 20 PTCA lesions were all patent without progression, nine significant and new lesions were found on the coronary angiograms. Successfully revascularized vessels remained patent for over 10 years, but new lesions sometimes occur in segments other than the previously treated segment.

Effect of complement activation in human serum on isolated porcine islets

We investigated the effect of the activation of complement in human serum on isolated adult porcine islets using an in vitro model of pig-to-human islet transplantation. Pancreata were obtained from slaughterhouse pigs (6-8 mo old). Islets were prepared by intraductal collagenase digestion followed by purification on Ficoll gradients. The purified islets were incubated with xenogeneic human serum with or without heat inactivation for 45 min. As control, islets were incubated with autologous porcine serum. After the incubation, the islets' responsiveness to an acute glucose stimulus (5.5 mM, static incubation) was evaluated by measurement of the insulin content of the medium. Islets exposed to human serum showed significantly lower insulin secretory response than the control (1.76 +/- 1.17 microU/islet/120 min, without heat inactivation; 1.74 +/- 1.36 microU/islet/120 min, with heat inactivation; 3.39 +/- 0.92 microU/islet/120 min, control). No difference in insulin secretory response, however, was observed between islets exposed to human serum with heat inactivation and without. Furthermore, we evaluated the cytotoxic activity of human serum on porcine islets by a complement-dependent cytotoxicity using the MTT colorimetric assay, and found that the human serum had no complement-dependent cytotoxic activity against the islets. We concluded that the insulin secretion dysfunction of porcine islets exposed to human serum was not due to the activation of complement and there was no evidence of hyperacute rejection mediated by complement activation in the in vitro model of pig-to-human islet transplantation.

Ki-ras point mutations and proliferation activity in biliary tract carcinomas

The association between Ki-ras mutations and proliferation activity was investigated in a comprehensive series of biliary tract carcinomas (BTCs). We precisely microdissected samples of tissue from paraffin-embedded sections of 77 BTCs including 22 intrahepatic cholangiocarcinomas (ICCs), 36 extrahepatic cholangiocarcinomas (ECCs), and 19 gall bladder carcinomas (GBCs). Ki-ras mutations at exons 1 and 2 were determined by the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) method and confirmed by direct sequencing. Proliferation activity was immunohistochemically assessed to generate proliferating cell nuclear antigen labelling indices (PCNA LIs). Ki-ras mutations were detected in 10 of 22 ICCs (45%), 24 of 36 ECCs (67%), and in 16 of 19 GBCs (84%). The frequency of Ki-ras mutations in peripheral type ICCs was 33% (4 of 12) and that in the hilar type ICCs was 60% (6 of 10). In ECCs the highest value of 82% (9 of 11) was found for carcinomas located in the lower part of the biliary tree. Mean PCNA LI in mutation-positive BTCs was significantly elevated compared with the mutation-negative value. These results indicate frequent involvement of Ki-ras mutations in BTCs, especially in GBCs and in distal ECCs, and that carcinomas harbouring a mutation feature high cell proliferation activity.

[Role of reservoirs in intraarterial chemotherapy for recurrent hepatocellular carcinoma after hepatectomy]

We conducted a retrospective study on the role of reservoirs in intraarterial chemotherapy for recurrent hepatocellular carcinoma (HCC) after hepatectomy. Ninety-two out of 170 patients with HCC who underwent hepatectomy from 1987 to 1992 in our institute were enrolled in this study. HCC recurred in 55 patients. A rate of good patency of the catheter of the reservoir at the time of recurrence was found in 72.7% of the patients. Transcatheter arterial embolization (TAE) for recurrent tumor was not feasible in 3 patients, because of occlusion of the hepatic artery (3.3% of patients with reservoir, 5.5% of patients with recurrence). Eleven patients were treated by intraarterial chemotherapy using the reservoir and TAE or TAE and PEIT (group R), and 11 patients were treated only with TAE and/or PEIT (group NR). Although there were no significant differences between the two groups in the number of recurrent lesions and operative procedures, tumor-free interval was shorter in group R. Cumulative survival rates after recurrence were not significant. The frequency of TAEs was lower in group R, which shortened the hospitalization for postrecurrence therapy. Thus, intraarterial chemotherapy using reservoir contributed to improvement of the quality of life of patients with recurrent HCC.

Gq/11 and PLC-beta 1 mediate the substance P-induced inhibition of an inward rectifier K+ channel in brain neurons

1. Substance P (SP) induces a slow neuronal excitation in cholinergic neurons from the nucleus basalis by suppressing an inwardly rectifying K+ current (Kir). We have determined which G protein alpha-subunit mediates this SP effect. 2. After intracellularly injecting antibody against each alpha-subunit of G proteins (Gq alpha/11 alpha, G12 alpha, and G13 alpha) with an Eppendorf microinjector, we examined, by using the whole cell patch-clamp and the ON-cell mode of single-channel recording, the effect of SP on Kir in cultured neurons of the nucleus basalis. The effect of SP on Kir was substantially reduced in neurons injected with antibodies to Gq alpha/11 alpha but not with antibodies to G12 alpha or G13 alpha. 3. The effects of antibodies against three isozymes of phospholipase C (PLC-beta 1, PLC-beta 2, and PLC-beta 3) were tested. The SP-induced suppression of Kir was reduced by antibody against PLC-beta 1 but not by antibodies against PLC-beta 2 or PLC-beta 3. 4. We conclude that the SP-induced inhibition of Kir in nucleus basalis neurons is mediated by Gq/11 and PLC-beta 1.

Neural connection between the ventral portion of the lumbar intervertebral disc and the groin skin

This study was designed to investigate neural mechanisms of referred pain in lumbar intervertebral disc lesions. Patients with a degenerative disc in lower lumbar segments occasionally complain of groin pain, which cannot be explained anatomically as having a radicular origin. In rats pretreated with intravenous application of Evans blue dye, the dye extravasation appeared in the groin skin after application of capsaicin to the ventral portion of the L5-6 intervertebral disc. This response occurred even in rats with a sectioned L-5 spinal nerve and sympathetic trunks, but did not occur in rats with a sectioned genitofemoral nerve. Capsaicin topically applied to the sciatic nerve did not cause dye extravasation in the hindpaw. Therefore, groin dye extravasation was not due to a direct effect of capsaicin but, rather, presumably was caused by an "antidromic axon reflex" of dichotomizing C fibers or to a segmental sympathetic reflex causing vascular permeability. The present results indicate that the ventral portion of the lumbar discs is neurally connected to the groin skin via the upper (L-2) lumbar spinal nerves in rats. Groin pain coincident with low-back pain may be explained as referred pain, indicating that a lesion is present in the ventral portion of the lumbar intervertebral disc space.

[Growth of squamous cells lung cancer between alveolar basement membrane and alveolar epithelium]

We examined patterns of growth of cancer cells in specimens of alveoli taken from 41 patients with squamous cell carcinoma (36 men and 5 women, mean age 65 years). For comparison, 8 samples from patients with small cell carcinoma (6 men and 2 women, mean age 64) and 71 samples from patients with adenocarcinoma (48 men and 23 women, mean age 62) were also studied. The samples were fixed in formalin, embedded in paraffin, and then subjected to immunostaining. Glandular structures composed of non-atypical cuboidal cells with negative p53 staining and scanty positive PCNA staining were found in 90% of the samples of squamous cell carcinoma. In small cell carcinoma, 25% of the samples had small numbers of no-atypical glandular structures. In adenocarcinoma, no non-atypical glandular structures were seen. Glandular structures were observed in the periphery of the cancerous tissue. Some of these non-atypical cells were attached to the alveolar basement membranes. We conclude that squamous cell carcinoma grows between the basement membrane and the alveolar epithelium, and leaves noncancerous epithelium with glandular structure.

Enhancement of N-nitrosodiethylamine-initiated hepatocarcinogenesis caused by a colchicine-induced cell cycle disturbance in partially hepatectomized rats

The effects of a colchicine-induced M-phase block of regeneration after partial hepatectomy on early-stage liver carcinogenesis were studied in rats. When administered 1 or 3 days after N-diethylnitrosamine initiation and partial hepatectomy, colchicine increased the mitotic index of regenerating hepatocytes at days 4-6 without evidence of liver cell necrosis. When the protocol was combined with a selection procedure (E. Cayama et al., Nature (Lond.), 275: 60-62, 1978), a significant increase in the size but not number of gamma-glutamyltranspeptidase-positive foci at week 5 was observed in a colchicine dose-dependent manner. This was associated with an elevated incorporation of 5-bromo-2-deoxyuridine into the gamma-glutamyltranspeptidase-positive cells. In a longer-term experiment, the numbers, sizes, and 5-bromo-2-deoxyuridine labeling index of persistent nodules were increased significantly in colchicine-treated rats at week 9. This was associated with significant increases in the incidences and numbers of hepatocellular carcinomas at week 42. The above results raise the interesting possibility that a cell cycle disturbance in the early stage of liver carcinogenesis provides a persisting growth advantage for initiated cells, resulting in enhanced growth of foci and persistent nodules that evolve into hepatocellular carcinomas.

[Successful repair of right atrial rupture due to nonpenetrating trauma of the chest]

A 24-year-old male was brought to our hospital after being injured in a traffic accident. On arrival, his blood pressure was 70/44 mmHg and his pulse rate was 135/min and regular. Chest X-p revealed cardiomegaly but there was no pleural effusion or bone fracture. Echocardiogram revealed cardiac tamponade and he was diagnosed as cardiac rupture due to non penetrating trauma. Under midline sternotomy, right atrial rupture was repaired. The patient developed cardiac arrest lasting approximately 8 minutes during anesthetic induction, so he needed to be ventilated for 8 days. However his postoperative course was not so eventful and he was discharged 38 days after surgery without any neurophysiological disturbance.