[Operative results of acquired valvular disease with blood cardioplegia followed by terminal cardioplegia]

Cold blood cardioplegia followed by terminal cardioplegia was employed as a method of myocardial protection for acquired valvular disease. Postoperative clinical results of both cardiac iso-enzyme and cardiac function were discussed from the effect of the myocardial protection. In operative procedures of 62 cases, 30 cases underwent mitral valve replacement and other mitral repair, 17 cases aortic valve replacement, 10 cases double valve replacement and 5 cases modified Bentall operation. Iso-enzymes of Creatine-Kinase (CK) and Lactate-Dehydrogenase (LDH) were measured by the constant time-interval. Cardiac function was estimated in acute postoperative phase and late phase. Hospital mortality was 1.5%. The cause of death was thought to be postoperative Graft Versus Host Disease with skin rash and pancytopenia. Cardiac function during acute phase well recovered in 62 cases of which two cases were controlled with intra-aortic balloon pumping. The values of CK-MB were measured during aortic cross-clamp, 30 min, 3 hours, 6 hours and 24 hours after cross-clamp release. Peak CK-MB value was detected 3 hours or 6 hours in almost cases. In contrast, peak LDH-1 value was detected 24 hours after cross-clamp release. Perioperative myocardial infarction was occurred in one case with modified Bentall operation whose CK-MB value was elevated over 150 IU/L at 3rd hour and 24th hour. However, the cardiac radio-isotope data of this case revealed good cardiac function with left ventricular ejection fraction (LVEF) 76% by cardiac pool imaging in spite of small postero-lateral perfusion defect by Thallium 201 scintigram.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment of coronary aneurysm developed after PTCA

Two patients who developed coronary aneurysm at the site of Percutaneous Transluminal Coronary Angioplasty (PTCA) in proximal LAD accompanied by severe re-stenosis just proximal to the aneurysm are described. Both patients underwent Coronary Arterial Bypass Grafting (CABG) to distal LAD to stop anginal attacks refractory to any anti-anginal drugs and to prevent a rupture of a coronary aneurysm. After the operation the anginal attacks disappeared and no trace of coronary aneurysm was visible in the coronary angiogram.

A dissecting aneurysm involving a right-sided arch, right descending aorta and mitral regurgitation

A dissecting aortic aneurysm involving a right-sided aortic arch is quite rare. This report describes this unusual entity and emphasizes the requirement for precise anatomical definition by aortography to permit appropriate successful surgical therapy. Bilateral thoracotomy is essential for the surgical approach.

[A case of acute occlusion of the left common iliac artery due to blunt abdominal trauma]

A 56-year-old man was involved in an automobile accident and had abdominal blunt injury with the steering wheel. He developed slight abdominal distension and pulseless, cold sensation and peripheral cyanosis of the left lower extremity which suggested acute arterial occlusion. DSA revealed complete obstruction of the common iliac artery near its origin and the leakage of contrast medium at peripheral branch of the SMA. Four and a half hours after injury, surgical exploration was carried out. Laparotomy showed the laceration of the mesentery with accumulation of massive fresh and clotted blood in the abdominal cavity. Obstructed portion of the left common iliac artery was resected and arterial reconstruction was performed with prosthetic graft (8mm Gore-Tex for end to end left common-left external iliac bypass, 6mm Gore-Tex for side to end right common-left hypogastric bypass). A resected specimen demonstrated completely disrupted intima, resulting in the obstruction of the lumen associated with distal fresh thrombosis. The postoperative course was uneventful with successful patency of both grafts.

Intrabronchial leiomyoma treated by localized resection via bronchotomy and bronchoplasty

There have been no reports of intrabronchial leiomyomas treated by bronchotomy and bronchoplasty. Most intrabronchial leiomyomas have been treated by lobectomy or pneumonectomy because of their chronic infection or advanced parenchymal destruction. A leiomyoma of the left upper bronchus was diagnosed correctly by bronchoscopic biopsy, and successfully removed by localized resection via a bronchotomy and bronchoplasty. The site of excision was totally normal more than two years later. This conservative surgical procedure of an intrabronchial leiomyoma was useful for sparing lung parenchyma.

Xanthogranulomatous malignant fibrous histiocytoma arising from posterior mediastinum

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Effect of temperature on the arrested heart exposed to a 4-hour ischemia during blood potassium cardioplegia. An experimental study

This study was undertaken to evaluate the optimal myocardial temperature during a 4-hour ischemia induced by blood potassium cardioplegia (PC). Heart-lung preparations with work load circuit were used as experimental model. 24 mongrel dogs were divided into four groups and two myocardial temperatures (moderate hypothermia, deep hypothermia) and two perfusates (PC with blood, PC without blood) were tested. Parameters used to evaluate the myocardial protection include the coronary sinus blood pH of the initial reperfusion and left ventricular stroke work after resuscitation. In blood PC at moderate hypothermia, deleterious acid metabolites were minimally produced as evidenced by the coronary sinus blood pH (7.221 +/- 0.122) at initial reperfusion, and cardiac function was best recovered in this group. Blood PC at moderate hypothermia allows the heart to tolerate 4 h ischemia without an excessively elevated coronary perfusion pressure during cardioplegic infusion.

The cytoplasmic mucin in Paget cells of extramammary Paget's disease

The cytoplasmic mucin in the Paget cells of extramammary Paget's disease was examined with a battery of histochemical techniques. The staining methods used were alcian blue, azure A and periodic acid-Schiff. In a further attempt to identify various polyanions, staining was carried out with alcian blue containing various concentrations of electrolyte. Methylation, saponification, borohydride reduction, acid hydrolysis, and digestion with diastase, sialidase, chondroitinase ABC, or nucleases were also employed. The results obtained suggest that the cytoplasmic mucin in the Paget cells is sialomucin without side-chain substituent.