Double electron transitions [MN] or [MO] above 74W MIII edge in X-ray absorption spectra.

The x-ray absorption spectra in metallic W (Tungsten) have been measured above MIII edge using the third generation synchrotron radiation. ALS, Berkeley. Several features caused by multi-electron transitions were detected on MIII in solid phase. [3p4f], [3p5s], and [3p5p] double electron transitions were identified by the Z+1 approximation.

[Clinical evaluation of cardiac valve surgery combined with coronary artery bypass grafting].

Between 1991 and 1999, 23 cases underwent cardiac valve surgery concomitant with myocardial revascularization at our institution. Twelve cases (group I) had a primary valvular disease combined with coronary atherosclerosis, and other 11 cases (group II) were due to ischemic mitral insufficiency. There were 2 hospital deaths in group I (17%) and 4 in group II (36%). Three deaths in group II underwent left ventricular volume reduction surgery. On the basis of this observation, we concluded severe mitral regurgitation with ischemic cardiomyopathy was a particularly difficult management problem with disappointing clinical results. On the other hands, we considered concomitant revascularization should be done in the case of primary valvular disease when angiographically significant coronary artery stenosis was present.

[A case who needed additional Daggett's procedure for residual shunt after infarction exclusion technique for post-infarction ventricular septal perforation].

A 71-year-old woman had the surgical repair of post-infarction ventricular septal perforation with infarction exclusion technique. Three days after operation, residual shunt was observed by echocardiogram and she developed cardiac failure. Pulmonary to systemic flow ratio was 2.1, and pulmonary artery pressure was 42/23 (33) mmHg. Additional surgery for residual shunt was performed 22 days after the first operation. The part of Xenomedica patch was found loosely floating in the LV cavity. The infarcted myocardium was firm enough to closed directly, so a double Hemashield cardiovascular fabric was sutured on the left side of the perforated septum around VSP (Daggett's Procedure). The ventriculotomy was closed including the fabric with two felt strips. The postoperative course was uneventful. Though infarction exclusion technique has the advantage in many cases, much attention must be paid to prevent residual shunt.

[The management of mediastinitis after cardiac surgery].

Of 1067 consecutive patients who underwent cardiac surgery from 1985 to 1992, 19 (1.7%) patients experienced sternal wound complications. All patients required operative intervention with positive bacterial cultures. Before 1990, a group of 13 patients were treated by continuous closed irrigation with dilute povidone-iodine solution. Four patients died (30%). In another group of 6 patients who received omental or pectral muscle flap transfer after 1990, 2 patients died (33%). The mean duration of hospitalization for mediastinitis was 63 days in this group, which was significantly shorter than that of the former group (105 days). From these experiences, we conclude that omental or pectral muscle transfer is an excellent method of management for mediastinitis after cardiac surgery, and is better than continuous closed irrigation method.

[Operative technique of systemic to pulmonary artery shunt and aortoplasty utilizing in aberrant subclavian artery].

This paper presents a review of our experience of 3 cases of systemic to pulmonary artery shunt operation and 2 cases of subclavian flap aortoplasty using aberrant subclavian artery. The aberrant subclavian arteries were divided to release the vascular rings and were used as shunt grafts or reversed subclavian flaps. In case of shunt operation, this graft would be superior to the EPTFE graft of modified Blalock-Taussig shunt, from the point of view of the grafts' growth ability. In case of aortoplasty, if arch hypoplasia exists, this flap can repair it beyond the coarctation segment. When the aberrant subclavian artery is dissected, it should be avoided to use the contralateral subclavian artery, as it may cause cerebral damage because of the impairment of bilateral vertebral arterial circulation.