Sequential changes in laminin and type IV collagen in the infarct zone--immunohistochemical study in rat myocardial infarction

BACKGROUND

The healing process, which affects ventricular remodeling, is an important factor in the prognosis of myocardial infarction. We hypothesized that laminin and type IV collagen contribute to extracellular matrix assembly in healing after myocardial infarction. We examined sequential changes in these two components after experimental myocardial infarction in rats.

MATERIALS AND METHODS

Hearts were excised from 1 day to 10 weeks after permanent left coronary ligation in rats. Immunohistochemical staining with a polyclonal antibody to laminin and type IV collagen was performed by the avidin-biotin-peroxidase method.

RESULTS

Laminin: On day 3, laminin initially appeared in a wavy fashion in the granulation tissue of the infarct peripheral zone and was not restricted to the cell membrane; the staining distribution in the peripheral zone then gradually increased, reaching a maximum on days 7-11. The distribution progressed from the peripheral zone to the outer lesion of the central zone of the infarct for 1-2 days, and reached the center point after 2 weeks. The extent of the staining distribution gradually decreased after reaching this maximum, but the staining did not completely disappear. Type IV Collagen: Changes in type IV collagen were essentially the same as those in laminin. A wavy staining pattern of type IV collagen appeared in the infarct peripheral zone from day 3, reached its maximum extent on days 7-11, and decreased gradually thereafter. The distribution progressed from the peripheral zone to the outer lesion of the central zone for 1-2 days, reaching the center point after 2 weeks.

CONCLUSIONS

Laminin and type IV collagen contribute to extracellular matrix formation in the infarct zone relatively early after myocardial infarction.

[Correlation between pulmonary vascular changes and hemodynamic parameters during exercise before and after mitral valve surgery]

Sixteen cases with mitral valvular disease were studied with regard to the correlation between pathological changes in the pulmonary vasculature and pulmonary hemodynamics during exercise before and after surgery. In muscular pulmonary arteries obtained by open lung biopsy, medial wall thickness (MWT) was 13.8 +/- 3.2% and intimal thickness (IT) was 37.3 +/- 13.5%. MWT was correlated with IT (r = 0.60, p < 0.05). Wall thickness in pulmonary veins was 8.21 +/- 1.8%. Preoperative mean pulmonary arterial pressure (MPAP) during exercise was 45.9 +/- 9.4 mmHg, and decreased significantly to 38.1 +/- 11.3 mmHg postoperatively. However, in 4 patients, MPAP during exercise increased after surgery. Pulmonary vascular resistance (PVR) during exercise was unchanged before and after surgery (2.74 +/- 1.90 U.M2-->2.69 +/- 1.3 U.M2). MWT was significantly correlated with preoperative MPAP at rest only. In patients showing an increase of MPAP during exercise postoperatively, mean MWT was 16.2% and mean IT was 47.4%. In conclusion our data suggest that postoperative pulmonary hemodynamics does not improve in patients whose MWT exceeds 15% and IT exceeds 40% and that irreversibility may be due to pulmonary vascular lesions.

Reperfusion hastens appearance and extent of distribution of type I collagen in infarct zone: immunohistochemical study in rat experimental infarction

BACKGROUND

The effects of reperfusion on time-dependent alteration of type I collagen have not been examined.

OBJECTIVES

We compared the sequential changes in the appearance and distribution of type I collagen in reperfused infarct rat hearts to those in non-reperfused hearts.

METHODS

Using an experimental rat model of infarction, we performed immunohistochemical staining with a polyclonal antibody to type I collagen by the avidin-biotin-peroxidase method. Reperfusion was established after 2-h coronary ligation that produced complete necrosis of myocytes.

RESULTS

In reperfused hearts, type I collagen appeared in the peripheral zone of the infarct at day 2, which was 1 day earlier than in non-reperfused hearts. The extent of distribution of type I collagen in reperfused hearts was comparable to that observed approximately 1 day later in non-reperfused hearts.

CONCLUSION

Reperfusion can accelerate collagen matrix formation compared with that in non-reperfused hearts after acute myocardial infarction.

Growth regulation of endothelial cells by tissue fragments: analysis on mechanism of rapid endothelialization of tissue-seeded vascular prosthesis in a three-dimensional culture system

Rapid endothelialization of the inner surface was reported in an autologous tissue-seeded vascular prosthesis. We applied a three-dimensional in vitro culture system to elucidate the precise mechanism of rapid endothelial coverage of a tissue-seeded vascular prosthesis. Human venous, omental, adipose and striated muscle tissue fragments were harvested from surgical specimens. They were embedded in collagen gel, and 2.0 x 10(5) bovine aortic endothelial cells (BAECs) were seeded on the gel. The number of BAECs was counted on Days 2 and 7. Growth rate of BAECs was facilitated on the collagen gel with omental and striated muscle tissue fragments (p < 0.05). Factor VIII-negative spindle cells migrated around tissue fragments, especially around the omental and striated muscle tissue fragments. Rapid endothelialization of a tissue-seeded vascular prosthesis may result from facilitation of EC proliferation by viable tissue fragments and migrated cells. These results confirm tissue fragments regulate EC growth, and are useful as bioengineering tools.

Instrumentation and applications of an automated C-terminal fragment peptide fractionator for C-terminal sequence analysis of proteins

A novel automated C-terminal fragment peptide fractionator has been constructed. Digests with lysyl endopeptidase were covalently immobilized on p-phenylene diisothiocyanate polymer beads. Only the C-terminal fragment, which contains no lysyl residue, was liberated by cleavage at the first peptide bond of the immobilized fragment peptides with trifluoroacetic acid, and it was automatically collected. The whole procedure was automatically and precisely performed under microprocessor control in a nitrogen atmosphere. The resulting fragment was sequenced without further purification. Sequences of both N- and C-terminal regions can be routinely obtained for ca. 100 pmol samples by the use of a conventional automated Edman-type protein sequencer.

[A surgical case of infective endocarditis accompanied with immune complex glomerulonephritis]

Infective endocarditis (IE) is often accompanied with renal disease. Recently it is thought that immune complex is formed by infecting agent of IE deposit to glomerulus and this contributes to glomerulonephritis. The case was 59-year-old man. He admitted with symptoms of proteinuria, hematuria and fever and diagnosed aortic regurgitation with vegetative change of aortic valve with echocardiogram. After admission he had stroke. Renal function was poor and circulating immune complex (CIC) value was high. Str. viridans was defined by blood culture examination. Aortic valve replacement was done because of no normalization of infective response and of renal function. Bacteria was not detected from the vegetation of valve but detected in the vegetation of transitional zone to mitral valve. Postoperative course was uneventful and renal function became normal with normalization of infective response. Anti C3d antibody value became normal and he discharged 50th postoperative day. In case of ineffective medical treatment the early removal of infected valve will make a successful result.

Clinical significance of no-reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous transluminal coronary angioplasty

The clinical significance of the angiographic no-reflow phenomenon was evaluated in 93 patients with acute myocardial infarction treated by percutaneous transluminal coronary angioplasty (PTCA). On the basis of the post-PTCA angiograms, patients were divided into three groups: normal angiogram (group 1, n = 65), slight no-reflow (group 2, n = 13), and severe no-reflow (group 3, n = 15). Regional wall motion in the chronic phase was depressed in groups 2 and 3 compared with group 1. The proportion of the area of the transmural infarction to that of the total infarction determined by scintigraphy was higher in groups 2 and 3 than in group 1. A significantly higher incidence of myocardial rupture and of death resulting from cardiac causes was observed in group 3 compared with group 1. The severity of this phenomenon immediately after an emergency PTCA correlated well with the severity of myocardial damage, with patients having severe no-reflow showing the poorest prognosis.

Virological and serological characterization of asymptomatic blood donors positive for anti-hepatitis C virus antibody

To study the virological and serological characteristics of asymptomatic hepatitis C virus (HCV) carriers, 165 blood donors positive for antibody against HCV proteins by the second generation assay, were analyzed for their clinical backgrounds, serological reactivity against antigens derived from HCV by recombinant immunoblot assay, and the amount and genotype of HCV by the polymerase chain reaction. Compared with blood donors having abnormal levels of alanine aminotransferase (ALT), sera from the donors with normal levels of ALT reacted less frequently against NS4 antigens (anti-5-1-1: 34.4% vs. 54.5%, P = 0.0609; anti-c100-3: 34.4% vs. 56.1%, P < 0.05). Also the positivity for antibodies against these antigens were more frequent in sera from donors with genotype 1b HCV-RNA than other genotypes (anti-5-1-1: 61.0% vs. 23.5%, P < 0.01; anti-c 100-3: 61.0% vs. 26.5%, P < 0.01). The prevalence of each genotype in blood donors with normal ALT levels was different from that in patients with advanced liver disease (P < 0.05), genotype 1b being less and genotype 2a being more frequent. The number of HCV-RNA copies/0.5 ml in donors with normal ALT was 10(7.9 +/- 1.0) (n = 27) and that in patients with chronic liver disease was 10(7.4 +/- 0.8) (n = 116), the difference being statistically significant (P < 0.05). In conclusion, the results of this study suggest that asymptomatic blood donors carrying HCV have the serological and virological characteristics different from the patients with advanced liver disease.

Immunological and biochemical characterization of biglycan-like haemopoietic factor

Immunological and biochemical characteristics of a 100,000 MW biglycan-like haemopoietic factor, purified from thymic myoid cells 871207B, were studied to distinguish them from macrophage colony-stimulating factor (M-CSF), which they resemble in activity and biochemical properties. Rabbit antibody raised against a synthetic peptide fragment (J-1) designed from amino acid sequences specific to the 100,000 MW factor responded to 871207B cells, the conditioned medium of 871207B, and capillary-like structures in the thymus, but not to M-CSF producer L-929 cells or the conditioned medium of L-929 cells. In contrast, M-CSF epitope was detected in L-929 cells and the conditioned medium cells but not in 871207B cells or the conditioned medium, even after enzymatic digestion of glycosaminoglycan chains. Treatment of the 100,000 MW factor with chondroitinase ABC and AC produced a 50,000 MW component. Digestion of this product with N-glycanase resulted in a 40,000 MW protein component. These results suggest that the 100,000 MW factor is a proteoglycan consisting of a core protein with an apparent molecular mass of 40,000 MW, a 50,000 MW chondroitin sulphate chain and 10,000 MW N-linked oligosaccharide chains. A small amount of a 40,000 MW monocytic cell growth activity was also found in the 871207B cell-conditioned medium. An enzymatically obtained 40,000 MW factor, the conditioned medium 40,000 MW factor, and the 100,000 MW factor were specifically eluated from an anti-J-1 IgG-immobilized affinity column with monocytic cell growth activity, suggesting that the biological activity resides in the 40,000 MW core protein. The 100,000 MW factor induced the proliferation and differentiation of monocytic lineage cells from a variety of sources, such as bone marrow cells, peritoneal exudated cells and brain microglia cells.

Influence of a delay on latissimus dorsi muscle flap blood flow

The regional and total blood flow of canine latissimus dorsi muscle flaps (LDMFs) were examined to study the effect of a delay procedure, ligation of the perforators, before complete flap elevation. The regional blood flow of the middle and distal regions of the nondelayed LDMFs was poor and significantly lower than the proximal region at rest. The regional blood flow during the exercise test was improved and significantly higher in the middle (62% increase) and distal regions (187% increase) of the delayed LDMFs as compared with the nondelayed LDMFs. The mean total blood flow of the delayed LDMFs was 14 mL.min-1.100(-1) g at rest, increased to 30 mL.min-1.100(-1) g during exercise tests with intermittent burst electrical stimulation, and was maximal at 40 mL.min-1.100(-1) g immediately after the exercise. The phasic arterial blood flow of the delayed LDMFs was inhibited during contraction at 9 mL.min-1.100(-1) g, whereas it was 44 mL.min-1.100(-1) g during relaxation. In contrast, the phasic venous blood flow was accentuated during contraction to 32 mL.min-1.100(-1) g compared with 16 mL.min-1.100(-1) g during relaxation.

Effective production of the hepatitis C virus core antigen having high purity in Escherichia coli

The amino-terminal half of putative nucleocapsid (core) protein (amino acids 1-115) of hepatitis C virus (HCV) was directly overproduced in Escherichia coli under the control of the tac promoter. Overproduction of core antigen was achieved by inserting several target genes and by optimizing the culture conditions, whereas a large amount of directly expressed and purified core antigen has not yet been reported. Although the level of expression was comparable to that of the conventional E. coli fused expression system, our recombinant proteins contain only HCV amino acid sequence. Using recombinant E. coli, overproduced large-scale culture system was achieved in jar-fermenter. A highly purified sample of the expressed protein was obtained by ion-exchange and gel permeation column chromatography in the presence of 8 M urea. From a 3.5 l culture, approximately 440 mg of recombinant core protein was obtained after a two-step purification procedure. An enzyme-linked immunosorbent assay developed using the highly purified antigen satisfactorily diagnosed hepatitis C.

Sealing of a fabric vascular prosthesis with autologous adipose tissue: a preliminary report of its clinical application

A new method of sealing fabric vascular prostheses with autologous adipose tissue was clinically applied as an alternative to preclotting with fresh blood. Thirty-six patients with peripheral arterial occlusive disease were implanted with highly porous fabric prostheses. The prostheses were prepared by sealing the fabric pores with autologous adipose tissue that had been chopped up into small pieces and enmeshed in the fabric by forceful injection of the tissue suspension through a syringe. There was no complication related to the sealed graft such as graft bleeding after implantation. In-hospital mortality occurred in 4 patients: 1 case each of pneumonia, pulmonary infarction, sepsis, and acute myocardial infarction. During the period of 274 +/- 190 days, 3 prostheses were found to be occluded. All the other grafts were patent. The overall patency rate was 91.4%. Postoperative angiography revealed neither intimal thickening at the anastomotic sites nor irregularity of the prosthetic surface. The method proved safe and useful for implantation of smaller caliber artificial grafts.

[Usefulness of allopurinol for prevention of myocardial reperfusion injury in open heart surgery]

Xanthine oxidase has been demonstrated to be an important factor in postischemic reperfusion injury. Allopurinol is the inhibitor of xanthine oxidase. In this study, we evaluated usefulness of allopurinol for prevention of myocardial reperfusion injury in open heart surgery. Twenty adult patients were divided into two groups; Ap-group (n = 10) were administered allopurinol for seven days just before operation and control-group (n = 10) were administered nothing. The dose of allopurinol was ranged 100-300 mg/day. The dose was determined according to renal function of patients. Coronary sinus blood hypoxanthine, xanthine, uric acid, lactate, pyruvate, CK, and CK-MB levels were measured at before CPB, 5 and 15 min. after aortic declamping, 5 min. after CPB. Hypoxanthine and xanthine levels in Ap-group were significantly higher than those in control-group at 5 and 15 min. after aortic declamping, 5 min. after CPB. Uric acid levels in Ap-group were significantly lower than those in control-group at 5 and 15 min. after aortic declamping, 5 min. after CPB. Lactate, pyruvate, CK, and CK-MB levels were not different between Ap-group and control group. We considered that allopurinol suppressed the reaction rate of xanthine oxidase. Therefore, the levels of intermediates, hypoxanthine and xanthine, were high and, the level of final product, uric acid was low in Ap-group. However, allopurinol had no efficacy for the level of lactate, pyruvate, CK, and CK-MB, in this study.

[Reproductive and developmental toxicity studies of lactitol (NS-4) (2)--Teratogenicity study in rats by oral administration]

A teratogenicity study of lactitol, a hepatic encephalopathy drug, was conducted in Sprague-Dawley rats. Female rats were given lactitol orally at dose levels of 0 (control), 0.7, 2.65 and 10 g/kg from day 7 to day 17 of pregnancy. Twenty-two female rats per dose level were sacrificed on day 20 of pregnancy for examination of their fetuses, and thirteen pregnant rats per dose level were allowed to deliver naturally for postnatal examination of their offspring. The high dose of lactitol caused diarrhea or soft stool in pregnant rats. The food consumption of female rats decreased in the intermediate and high dose groups. The water consumption of female rats increased in the high dose group. The drug failed to alter the body weight of female rats. The weights of cecum of dams increased in the intermediate and high dose group. The high dose caused enlargement of cecum in dams. The drug failed to alter the numbers of corpora lutea and implantations, fetal mortality, the number of live fetuses, body weight of live fetus, sex ratio, and external, visceral and skeletal development of fetuses. Lactitol did not affect the delivery of dams, the number of live newborns, birth index, external development, body weight, viability index, weaning index, and sex ratio of weanlings. Nor did lactitol have any adverse effect on the postnatal development of the first (F1) generation offspring, such as differentiation, emotionality, motor ability, learning ability or reproductive performance. Nor did lactitol have any adverse effect on the second (F2) generation offspring. The results show that no-effect dose levels of lactitol are 0.7 g/kg for general toxicity in mother animals, 10 g/kg for reproductive function in mother animals and their offspring.

[Reproductive and developmental toxicity studies of lactitol (NS-4) (4)--Perinatal and postnatal study in rats by oral administration]

A perinatal and postnatal study of lactitol, a hepatic encephalopathy drug was conducted in Sprague-Dawley rats. Female rats were given lactitol orally at dose levels of 0 (control), 0.7, 2.65 and 10 g/kg from day 17 of pregnancy to day 21 after delivery. All pregnant rats per level were allowed to deliver naturally for postnatal examination of their offspring. The high dose caused diarrhea or soft stool in dams. The high dose suppressed the body weight of dams during the perinatal period. The food consumption of dams decreased in the intermediate and high dose groups. The water consumption of dams increased in the high dose group. The high dose caused enlargement of cecum and increase of weights of cecum in dams. The drug failed to affect the delivery of dams and gestation index. However, high dose caused prolongation of gestation period. Two dams in the high dose group failed to nurse their all newborns during early lactation. The drug did not affect the number of live newborns, birth index, external appearance, body weight, viability index, weaning index, and sex ratio of weanlings. Nor did lactitol have any adverse effect on the postnatal development of the first (F1) generation offspring, such as differentiation, emotionality, motor ability, learning ability or reproductive performance. Nor did lactitol have any adverse effect on the second (F2) generation offspring. The results show that the no-effect dose levels of lactitol are 0.7 g/kg for general toxicity in mother animals, 2.65 g/kg for reproductive function in mother animals, and 10 g/kg for their offspring.

[Reproductive and developmental toxicity studies of lactitol (NS-4) (1)--Fertility study in rats by oral administration]

A study of fertility and fetal development was conducted in Sprague-Dawley rats. Male rats were given lactitol, a hepatic encephalopathy drug, orally from 63 days before mating to the end of mating period. Female rats were given from 14 days before mating to day 7 of pregnancy. The dose levels for both males and females were 0 (control), 0.7, 2.65 and 10 g/kg. The females were sacrificed on day 20 of pregnancy for examination of their fetuses. The decrease in food consumption in either male or female was observed in the intermediate and high dose groups. The high dose caused soft stool, diarrhea and increase in water consumption in either male or female. Moreover, the high dose caused salivation and suppression of body weight gain in male. In the pathological examination, the enlargement of cecum were observed in male of the intermediate and high dose groups. The increase in cecum weight were observed in male in all lactitol groups, and in female of the high dose group. Lactitol did not affect on copulation and fertility indexes in either male or female rats. Lactitol failed to affect on estrous cycle in female rats, and number of corpora lutea, implantations and preimplantation egg losses. In the fetal examination, lactitol did not affect on the development of live fetuses. The results show that no-effect dose levels of lactitol are less than 0.7 g/kg in male rats and 0.7 g/kg in female rats for general toxicity, and 10 g/kg for reproductive function in parent animals and fetuses.

An isolated dissecting aneurysm of the superior mesenteric artery: report of a case

We report herein the case of a 56-year-old man found to have an isolated dissecting aneurysm of the superior mesenteric artery (SMA) after he presented with a 3-day history of postprandial epigastralgia of sudden onset. An echogram showed marked dilatation of the SMA and a high level of peripheral echoes in a linear fashion within its lumen. A thin-section contrast enhanced computed tomography revealed a thin flap, separating two distinct well-enhanced lumina. Angiography confirmed the presence of a localized dissecting aneurysm of the SMA. The patient was treated conservatively and has since been followed up as an outpatient. Following the presentation of this case, the problems regarding the diagnosis and management of this rare disease are discussed based on a review of the literature.

Structural elucidation of aibellin, a new peptide antibiotic with efficiency enhancing activity on rumen fermentation

A new peptide antibiotic, aibellin, that had the efficiency enhancing activity on rumen fermentation, was isolated from the culture broth of the fungus, Verticimonosporium ellipticum D1528, and its primary structure was elucidated from spectrometric analysis and chemical degradation. Aibellin is a 20-residue peptaibol, and it has a unique structural feature in the novel C-terminal amino alcohol. Moreover, aibellin is the first peptaibol that possesses two acidic amino acids in the C-terminal region and a Phe residue in the middle of the sequence.

[Re-coronary artery bypass grafting for anomalous origin of left coronary artery from pulmonary artery (Bland-White-Garland syndrome) after operation in infancy: a case of 18-year follow-up]

Anomalous origin of the left coronary artery from the pulmonary artery is a very rare congenital malformation. Re-coronary artery bypass grafting was performed in a 18-year-old man who had received coronary artery reconstruction with a homologous saphenous vein (from his mother) at 7-months old. After the first operation, clinical course was uneventful, but the patient became symptomatic because of effort angina at age 15. The electrocardiogram showed abnormal ST segments in Lead V2-5 and abnormal T waves in Lead V5-6. Coronary arteriography revealed that saphenous vein graft was occluded. The left internal thoracic artery (LITA) was anastomosed to the left anterior descending artery and a two coronary system was established. Postoperative angiography revealed that LITA was patent, and relief of angina was obtained.

[A case of aortic and mitral regurgitation with two aneurysms in the mitral valve]

A 59-year-old male was found to have two aneurysms in the mitral valve, mitral regurgitation, and aortic regurgitation by the echocardiographic examination. The patient had a previous history of infectious endocarditis by streptococcus at the age of 24. Under the diagnosis of mitral aneurysms developed after infectious endocarditis, surgery was undertaken. A 5 x 8 mm sized perforation in the right coronary cusp and two aneurysms in the anterior mitral leaflet, 22 mm and 17 mm in size, were found intraoperatively. Both the mitral and aortic valves were replaced. Patients with a history of infectious endocarditis have to be followed up for a long period of time. Transesophageal echocardiogram is useful in those patients. Considering high prevalence of aortic valvular diseases in those with a mitral aneurysm after infectious endocarditis, aortic valves should be carefully evaluated.

Banding a hemodialysis arteriovenous fistula to decrease blood flow and resolve high output cardiac failure: report of a case

We report herein the successful surgical treatment of a patient with high-output cardiac failure which developed from a high-flow hemodialysis arteriovenous fistula of the Brescia-Cimino type. Banding correction of the venous limb of the fistula with a woven Dacron prosthesis resulted in marked improvement of the cardiac failure. An ultrasonic study showed the fistula flow of 3.2 l/min to be as high as 40% of the resting cardiac output, or 8.0 l/min, before banding, while an intraoperative electromagnetic study was useful for controlling the degree of banding and showing the decrease of fistula flow from 3.7 l/min to 1.4 l/min.

Enantiospecific determination of ibuprofen in rat plasma using chiral fluorescence derivatization reagent, (-)-2-[4-(1-aminoethyl)phenyl]-6- methoxybenzoxazole

A highly sensitive and reversed-phase high-performance liquid chromatographic method for the determination of the enantiomeric composition of ibuprofen in rat plasma is described. The method is based on the resolution of the diastereomeric amides formed on reaction of the ibuprofen enantiomers with (-)-2-[4-(1-aminoethyl)phenyl]-6-methoxybenzoxazole ((-)-APMB) in the presence of 2,2'-dipyridyl disulphide (DPDS) and triphenylphosphine (TPP) in dichloromethane. The reaction mixture was allowed to stand at room temperature for 5 min, and the reaction was completed by evaporation with a stream of nitrogen at 40 degrees C. The minimum quantifiable concentrations were 0.2 microgram/mL and 0.4 microgram/mL for S-ibuprofen and R-ibuprofen, respectively, in a 10 microL injection volume. The method was applied to the determination of enantiomeric ibuprofen in plasma after oral administration to rats.

[Delayed sternal closure for life-threatening massive bleeding during re-open heart surgery]

Delayed sternal closure (DSC) was used for 4 patients undergoing various cardiac reoperations to control perioperative hemorrhage. DSC was performed 48-72 hours later. All patients left the hospital alive and in good condition. The only recognized complication was an abscess formation around the bleeding area, which was successfully treated with systemic antibiotics. The remaining 3 patients manifested no infections. In two of these patients, hemodynamic instability was continued because of right ventricular outflow tract obstruction by compression of the packs which were left over the bleeding area. The function of coagulation of the blood was recovered except prothrombin time (PT) at the time of definitive closure of the chest. Recovery of the function of coagulation was useful in deciding the timing of DSC than hemodynamic state.