Giant lymph node hyperplasia (Castleman's disease) in the chest

We have experienced 7 cases of giant lymph node hyperplasia in the chest from 1981 to 1992. The ages of the 1 male and 6 female patients ranged from 9.9 to 40.4 years (mean age, 29.2 +/- 10.4 years). In 4 patients, a mass was discovered in routine radiographs. Focal calcification suggesting continual enlargement over a long time was noted in 1 patient. The sites of lesions were unusual in 2 patients (intercostal space and intrapulmonary fissure). All patients underwent surgical removal of the mass. Five cases had typical features of the hyaline-vascular type, and 2 cases revealed a mixture of the hyaline-vascular type and the plasma-cell type. Follow-up was available in all patients (mean follow-up, 31.9 months). In 1 patient, recurrence was observed 9 years after surgical removal. In general, giant lymph node hyperplasia can occur anywhere in the chest, grow without symptoms, and recur in spite of complete resection. Surgical resection and close follow-up are advised.

Changes in the antioxidative defensive system during open heart operations in humans

It is known that reperfusion of the ischemic myocardium may intensify damage and increase the extent of myocardial necrosis. Oxygen free radicals and their metabolites have been implicated as possible elements in myocardial ischemia-reperfusion injury. In this study in cyanotic patients undergoing open heart operation for tetralogy of Fallot, the myocardial tissue activities of catalase, superoxide dismutase, glutathione peroxidase, and lactate dehydrogenase were determined together with the tissue contents of malondialdehyde, oxidized glutathione, and total glutathione using the spectrophotometric assay method. The tissue activities of catalase, superoxide dismutase, and glutathione peroxidase increased significantly after myocardial reperfusion (p < 0.05) when compared with the tissue activities of the control group (myocardial tissue taken immediately after aortic cross-clamping). The tissue content of malondialdehyde increased significantly after reperfusion (p < 0.05), but the tissue activity of lactate dehydrogenase and the ratio of oxidized glutathione to total glutathione showed an insignificant difference after reperfusion. These data suggest that peroxidation of the cardiac lipids was triggered by the reperfusion of the hypoxic heart, but the myocardial cellular damage was not significant enough to decrease the myocardial lactate dehydrogenase and total glutathione levels. These results also suggest that oxygen free radicals may play an important role in in-vivo myocardial reperfusion stress, but endogenous self-defensive enzyme systems to protect the cell against the cytotoxic oxygen metabolites also were triggered, and the resulting myocardial cellular damage was insignificant.

Lecompte procedure for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis

From December 1988 to February 1993, 19 patients were treated by the Lecompte procedure for complete transposition of the great arteries associated with a ventricular septal defect and pulmonary stenosis. The mean age at operation was 3.1 +/- 0.8 years (mean +/- standard error). This technique consisted of resecting the outlet septum, constructing a tunnel that connected the left ventricle to the aorta, closing the proximal pulmonary arterial stump, pulling the distal pulmonary artery down to the right ventriculotomy site directly, and covering anteriorly with the fixed autologous pericardium. Operative mortality was 5.3%. The mean follow-up was 24.2 +/- 3 months, with no late death. One reoperation was performed because of residual right ventricular outflow tract obstruction. All survivors were studied by echocardiography at intervals of 6 months to 1 year. In all survivors (except for 1 child who underwent reoperation), the estimated pressure gradient between the right ventricle and the pulmonary artery, the structure of the left ventricular outflow tract, left ventricular function, and right ventricular contractility were all satisfactory.

A moving-actuator type electromechanical total artificial heart--Part II: Circular type and animal experiment

A new type of electromechanical total artificial heart (TAH) based on circular rolling-cylinder mechanism was developed to overcome critical problems in motor-driven artificial hearts such as large size and difficulties in fitting the heart to atrial remnants and arterial vessels. Its performance and reliability were evaluated in mock circulation and in an animal implant experiment. The total weight and volume of the pump is 650 g and 600 mL, respectively. This new pump was implanted in a calf for total heart replacement and 96 h of survival was achieved. The whole system, including pump, controller, and control algorithm performed well enough to improve the prospect of eventual clinical application of our TAH system.

A tether-free, moving actuator total artificial heart

An electromechanical moving-actuator TAH was developed and implanted for 5 days in a calf experiment. The efficiency and durability were further improved using pendulous motion of the actuator. This new pendulum pump has a circular motion produced by gear mechanisms connected to the motor. It has a height (from valves to housing bottom) of 7 cm and centrally directed inlets and outlets for good fittability. Active filling (-10 mmHg) inside inner blood sacs was produced by the suction effects of the outer sacs attached to a moving actuator. Two acute animal experiments were performed using the pendulum pump with a Coridale sheep (50 kg weight), and a male calf (70 kg weight). A test was made of 30 minutes of tether-free operation of the implanted pendulum pump inside the small chest of the calf. The pump shows the engineering feasibility of the implantable electrical TAH inside a human chest cavity.