[Resuscitation using percutaneous cardiopulmonary support and beating heart surgery with balloon technique for a patient with penetrating cardiac injury].

We used percutaneous cardiopulmonary support (PCPS) and beating heart hemostasis with a balloon technique to resuscitate an 80-year-old woman who had been stabbed in the chest with pruning shears. She developed pulseless tamponade while waiting for surgery. Resuscitative thoracotomy was impossible in the emergency room due to the lack of appropriate equipment. We therefore decided to immediately resuscitate her using PCPS. Life-support circulation was established within 13 minutes and provided a stable period before surgery. The stab wound in the right ventricle was temporarily controlled with a urinary balloon catheter placed through the defect, and was repaired on the heart continued to beat She recovered from the fatal event without neurological impairment. PCPS is generally contraindicated for traumatic cases because of bleeding complications. However, it plays an important role as a life-saving procedure when emergency room thoracotomy is impossible.

NADPH-specific quinone reductase is induced by 2-methylene-4-butyrolactone in Escherichia coli.

2-Methylene-4-butyrolactone (MBL), an inducer of NAD(P)H:(quinone acceptor) oxidoreductase (EC 1.699.2) in animal cells, was found to induce NADPH-specific quinone reductase about 25-fold in Escherichia coli. MBL induced NADPH-quinone reductases with relative mobilities (Rm) of 0.70, 0.76 and 0.91 on polyacrylamide gel electrophoresis (PAGE). These three enzymes were found to be charge isomers with the same molecular size of 42 kDA. Two NADPH-quinone reductases (A and B) were purified to single proteins both with an apparent mass of 21 kDa on SDS-PAGE. Enzyme A corresponded to the activity of the band at Rm 0.76 with a minor active band at Rm 0.70, and enzyme B to the activity of band Rm 0.91. Both enzymes reacted exclusively with NADPH and were most active toward quinone derivatives and ferricyanide with the optimum pH at 7.0. The reaction followed a ping-pong mechanism with Km values for NADPH and menadione of 10.5 microM and 6 microM, respectively. The sequences of 20 amino acids at the N-terminal of enzymes A and B were identical, and furthermore coincided with that of the E. coli modulator of drug activity (mda66) submitted under the accession number U18656.

Involvement of phosphorylation in binding of nuclear scaffold proteins from rat liver to a highly repetitive DNA component.

The results of our previous work [Hibino et al., Biochim. Biophys. Acta 1174 (1993) 162-170] suggested that a highly repetitive DNA component facilitates bending of the helix axis to be recognized by the nuclear scaffold proteins from rat liver, P123 and P130. In the present experiment, it was shown that binding of these proteins to such a repetitive DNA component from rat liver nuclei (370-bp XmnI fragment) is based on a cooperative mode of interaction, although the binding activity of P130 is much higher than that of P123. The immunoblot analysis with anti-phosphoamino acid antibodies suggested that phosphorylation of serine and threonine residues occurs on P123 and P130, but also of tyrosine residue(s) on P130. The phosphatase assay showed that phosphoryl groups on these proteins may be involved in altering the DNA binding activities of the proteins. Thus, the results in the present study imply that phosphorylation of a nuclear scaffold protein in addition to the degree of bending of the DNA helix axis plays an important role in anchoring chromatin to the nuclear scaffold and in construction of a higher-order chromatin structure.

Successful removal of massive cardiac neurilemoma with cardiopulmonary bypass.

A 46-year-old woman was referred to our hospital because of cardiac enlargement seen on a chest radiograph. Imaging studies showed a massive intrapericardial tumor with a size of 12x8x7 cm. Tumor dissection included inspection of the inner aspect of the superior vena cava with use of cardiopulmonary bypass, because the mass was tightly adherent to both superior vena cava and right atrium. The pathologic diagnosis was neurilemoma.

Changes in graft flow pattern from the descending aorta due to intraaortic balloon pump.

During surgery for lung cancer in a patient who had undergone coronary artery bypass grafting through the descending aorta by left thoracotomy, we measured graft bypass blood flow from the descending aorta under intraaortic balloon pump (IABP) assistance. Under IABP assistance, the diastolic waveform changed to a spiky pattern with a sharp drop in blood flow of approximately 16% compared to that without IABP assistance. We report changes in graft flow pattern during IABP assistance when the graft is placed from the descending aorta.

Extracorporeal membrane oxygenation for severe heart failure after Fontan operation.

A 10-year-old boy with tricuspid atresia and Glenn anastomosis underwent a modified Fontan operation. After the operation, the pressure in the inferior vena cava increased, leading to oliguria and ascites. After the creation of continuity between the superior vena cava and the inferior vena cava to reduce the pressure gradient, there remained an elevated right atrial pressure. Six days of extracorporeal membrane oxygenation effectively stabilized his hemodynamics and organ function and allowed an excellent outcome.

Transapical aortic cannulation in pediatric patients.

We describe transapical aortic cannulation in pediatric patients. This technique may help to establish cardiopulmonary bypass in small children in whom aortic root cannulation is undesirable or not feasible.

Carney's complex in association with right atrial myxoma.

The association between myxomas, spotty pigmentation, and endocrine overactivity is referred to as Carney's complex. This report describes the case of a 24-year-old woman with right atrial myxoma who presented with this association. The patient had a previously excised myxoid tumor of the breast and uneven facial pigmentation was observed, but no evidence of endocrinopathy was detected. The myxoma originated from the right atrial wall adjacent to the junction of the inferior vena cava and right atrium, and was successfully excised. A brief review of Carney's complex is provided after discussion of this rare case.

Biocompatibility of a silicone-coated polypropylene hollow fiber oxygenator in an in vitro model.

BACKGROUND: A silicone-coated microporous hollow-fiber membrane oxygenator has been developed to prevent plasma leakage during long-term use. The objective of this study was to evaluate the biocompatibility of the oxygenator. METHODS: A silicone-coated oxygenator was compared with an uncoated oxygenator in an in vitro model of cardiopulmonary bypass. Simulated circulation was maintained for 6 h at 37 degrees C. RESULTS: Platelet counts decreased significantly (p < 0.05) and leukocyte counts tended to decline; however, the differences between groups were not significant. Concentrations of C3a increased significantly in both groups (p < 0.05), but levels were significantly less in the silicone-coated oxygenator (p = 0.008). In contrast, concentrations of C4a, beta-thromboglobulin, and granulocyte elastase increased significantly (p < 0.05), but the differences between groups were not significant. CONCLUSIONS: Silicone coating over a microporous hollow-fiber membrane may improve biocompatibility by reducing C3a activation.

Long term clinical results with 19 mm or 21 mm standard aortic St. Jude Medical prosthesis.

Comparison of long term clinical results after aortic valve replacement with 19 mm or 21 mm vs. 23 mm or larger bileaflet prostheses has not yet been reported. Between December 1979 and September 1993, 80 consecutive patients who underwent isolated aortic valve replacement at Niigata University using a standard St. Jude Medical valve were assigned to small size group (19 mm and 21 mm, n = 34) or to large size group (23 mm or larger, n = 46). In the small size group, patient's age was older, body surface area smaller, female patients and calcified aortic stenosis were dominant (all p < 0.01). The left ventricular systolic dimension was shorter (p < 0.001), while the cardiothoracic ratio was similar to that of the large size group. All patients received warfarin treatment, and target thrombotest level was 15 to 25% (equivalent to INR 1.6 to 2.1). Actuarial survival rates including hospital death in the small size group (94% at fifth postoperative year) were comparable to those in the large size group. Cerebrovascular event occurred in two patients with the small size prosthesis (1.3%/pty) and three with larger prosthesis (0.9%/pty). Major hemorrhagic complication was not observed in either group. No significant difference was noticed in the proportion free from valve-related morbidity. In the patients with aortic stenosis (n = 41), the left ventricular posterior wall thickness decreased from 15 mm preoperatively to 11 mm late post surgery in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of lymphatic drainage of the liver in gallbladder cancer: a case report.

We report a case of a patient with a unique lymph node relapse after right hepatectomy and aggressive lymph node dissection for gallbladder cancer. There was extensive involvement of the hepatic parenchyma from the primary tumor, but no extension to the lymph nodes or other adjacent organs. Seventeen months later, the patient underwent re-dissection of the retroperitoneal lymph nodes with right nephrectomy and partial resection of the vena cava because of lymph node recurrence at the hilum of the right kidney. This pattern of lymph node metastasis to the right side of the vena cava from gallbladder cancer invading the liver is probably due to the distinct lymphatic drainage of the liver.

Development of an endocardioscope for repair of an atrial septal defect in the beating heart.

The purpose of this study was to evaluate the possibility of surgical treatment of an atrial septal defect in the beating heart without cardiopulmonary bypass. The first step was to develop an endocardioscope that permitted observation of the inside of the beating heart. To visualize the inside of the beating heart, the tip of the endoscope was covered with a glass adapter. The endocardioscope was inserted through the right atrial appendage in eight beagles. The atrial septum, foramen ovale, coronary sinus, tricuspid valve, and chordae tendineae were identified without hemodynamic derangement. The second step was to attempt to close the foramen ovale with clips or staplers. We were able to close the foramen ovale with these devices, but a safer, easier device is needed. The endocardioscope we developed should prove to be a useful tool for minimally invasive surgical treatment of heart diseases, such as atrial septal defect.

Left atrial ball thrombi without mitral valve disease treated by surgical removal.

We describe two patients with free-floating left atrial ball thrombi with no evidence of cardiac disease except atrial fibrillation. One patient had experienced an embolic stroke, and the second patient had a history of stroke and peripheral thromboembolism. In each patient, the thrombi, which were not visible on transthoracic echocardiography, were detected by transesophageal echocardiography. Each patient underwent successful surgical removal using cardiopulmonary bypass.

Successful surgery for an acute type A aortic dissection following repair of a descending thoracic aortic aneurysm.

Acute type A aortic dissection in the presence of a previously repaired atherosclerotic descending thoracic aortic aneurysm is rarely reported. We experienced a patient who underwent an ascending aortic replacement with reconstruction of the aortic arch 16 months after repair of a descending thoracic aortic aneurysm. We succeeded in the redo operation with comprehensive techniques involving selective cerebral perfusion, deep hypothermia, early antegrade systemic circulation for cerebral protection, and femoro-femoral bypass with occlusion of the descending aorta for lower systemic perfusion as well as renal perfusion. The patient recovered and is doing well one year after the redo operation.

The effect of fibrin glue on inhibition of pericardial adhesions.

The effect of fibrin glue on inhibition of pericardial adhesions was tested using 26 beagle dogs. Dacron patches were sutured to the heart and tincture of iodine was applied to promote adhesions. Fibrin glue (3 ml) was sprayed over the patches in 15 dogs (test group), and was not separated in the remaining 11 dogs (control group). All animals in the test group had minimal adhesions between the pericardium and the epicardium or patched region, and an accumulation of gelatinous material was found in the subpericardial space. Marked fibrosis and a poor demarcation of the subpericardial space were found in the control group. The adhesion score and the visibility of coronary anatomy in the test group were significantly better than in the control group. The tension strength in the test group was significantly less than in the control group. We concluded, therefore, that fibrin glue may also be useful as an adhesion inhibitor.

[A successful biventricular assist for postoperative patient with severe heart failure and hepatorenal dysfunction after mitral and tricuspid valve surgery].

We report a case of successful biventricular assist for severe heart failure after open heart surgery. A 62-year-old man suffering from advanced valvular disease accompanied with hepatorenal dysfunction underwent mitral valve replacement and tricuspid annuloplasty on September 22, 1988. Because of inability of weaning from cardiopulmonary bypass, left heart assisted circulation using a roller pump with heparin-coated tubing system was inserted. Following the left heart assist, an right ventricular assist device (RVAD) was subsequently applied to intractable right ventricular failure. He was successfully weaned from an RVAD after 24 hours, and from left heart assisted circulation after 46 hours. At present, he is doing well without significant complications. Earlier application of biventricular assist might be effective for biventricular failure with hepatorenal dysfunction.

[Pulmonary annuloplasty in functional pulmonary regurgitation associated with mitral stenosis: a case report].

In order to prevent disadvantage of pulmonary regurgitation (PR) on cardiac function, pulmonary annuloplasty (PAP) was performed in a 58-year-old female. She suffered from severe mitral stenosis with right heart failure, and was in a state of cardiac cachexia. She was associated with PR due to pulmonary annular dilatation secondary to severe pulmonary hypertension. She underwent mitral valve replacement, tricuspid annuloplasty and PAP around the pulmonary annulus using a Teflon tape. No PR was observed by postoperative angiograms, and the operative method was proved to be effective on the treatment for PR. The PAP is recommended for patients with functional PR secondary to severe pulmonary hypertension.

[A case of surgical repair for combined septal perforation and cardiac rupture after myocardial infarction].

The successful surgical repair of the combination of septal perforation and cardiac rupture after myocardial infarction was underwent on a 73-year-old man. Complete correction could be performed under the fibrillated heart state employing cardiopulmonary bypass, resulted in the early postsurgical cardiac performance.

[Two case reports of recurrent mediastinitis with chronic mediastinal fistula successfully treated with muscle flap re-transposition].

We experienced two cases of recurrent poststernotomy mediastinitis with chronic mediastinal fistula. Both cases had already received muscle flaps for post operative mediastinitis. However, chronic mediastinal fistula appeared after nine months in the first case, and eleven months in the second case. We removed the infected tissue and the predgets, which were used on the ascending aorta. Then closed the wound by the muscle flap closure. The chronic fistula were closed, and the functional and cosmetic results were excellent.

[A concomitant operation of aorto-coronary bypass graft and lung cancer: report of a case].

A case of a 66-year-old man with ischemic heart disease and lung cancer is reported. Chest roentgenogram revealed an irregular 2.8 x 2.0 cm mass in the right upper lobe. Coronary angiography showed 75-90% stenosis of the left anterior descending artery, and these lesions was suspected to cause perioperative myocardial infarction. A concomitant operation of aorto-coronary bypass graft and right upper lobectomy was performed through median sternotomy. A concomitant operation must be considered to be definitive and ideally preferable in selected cases.