A novel approach to restore atrial function after the maze procedure in patients with an enlarged left atrium.

OBJECTIVE: Left atrial (LA) volume reduction surgery concomitant with the maze procedure has been reported to facilitate sinus rhythm recovery even in patients with refractory atrial fibrillation (AF) with an enlarged LA. However, it is unknown whether the procedures can also restore effective atrial function of the enlarged LA with over-stretched myocardium. METHODS: The maze procedures in association with mitral valve surgery were performed to 57 AF patients with an enlarged LA (LA diameter >or=60mm). Among them, 32 patients had concomitant LA volume reduction surgery (VR group). Another 25 patients did not have the volume reduction (control group). RESULTS: Three months postoperatively LA end-diastolic volume (LAEDV, ml) assessed by magnetic resonance (MR) imaging was larger in the VR group than that in the control group (291+/-117 vs 223+/-81 ml, p<0.05). Postoperatively, sinus rhythm recovery rate was better (84 vs 68%, p<0.05) and LAEDV was drastically smaller (118+/-48 vs 203+/-76 ml, p<0.001) in the VR group than those in the control group. Among the patients with sinus rhythm recovery in both groups, LA contraction ejection fraction (%) improved in the VR group but not in the control group (22.3+/-7.8 vs 10.3+/-4.7%, p<0.001). CONCLUSIONS: The LA volume reduction surgery concomitant with the maze procedure restored contraction of the enlarged LA; however, the maze procedure alone did not restore LA contraction in spite of successful sinus rhythm recovery. LA volume reduction surgery may be desirable to the patients with refractory AF with over-stretched LA.     

Dorsal wrist syndrome repair.

Dorsal wrist pain with or without a palpable dorsal wrist ganglion is a common complaint. Watson developed the concept of the dorsal wrist syndrome (DWS) which is an entity encompassing pre-dynamic rotary subluxation of the scaphoid and the overloaded wrist. We reviewed 20 cases of DWS treated surgically. There were nine males (11 wrists) and nine females (nine wrists). Post-operative follow-up ranged from five to 67 months (mean, 37 months). At operation, we observed SLL tears in eight wrists and dorsal ganglia in 12 cases. Following surgery, 12 cases reported being pain free, five had mild pain, two moderate pain and one case reported severe pain. Post-operative extension/flexion was 73/70 average. Post-operative grip strength was 28 kg average. We believe that excision of the posterior interosseous nerve and the dorsal capsule including the ganglion, if present, provides pain relief in DWS.     

The molecular structures of (RS)-1,2-diphenylethyl methacrylate and (RS)-α-tert-butylbenzyl methacrylate

The molecular structures of (RS)-1,2-diphenylethyl methacrylate (DPEMA) and (RS)-α-tert-butylbenzyl methacrylate (t-BBMA) were determined by means of X-ray diffraction. Crystals of (RS)-DPEMA are monoclinic, space group C2/c, a = 33,341(3), b = 5,916(1), c = 15,911(2) Å, β = 106,42(1)°, and Z = 8. Crystals of (RS)-t-BBMA are also monoclinic, space group P2₁/c, a = 6,028(1), b = 31,009(3), c = 15,207(1) Å, β = 96,780(8)°, and Z = 8. Both structures were solved by the direct method and refined by the block-diagonal least-squares procedure: DPEMA, R = 0,113 for 1 100 observed reflections and t-BBMA, R = 0,081 for 2206 non-zero reflections, respectively. The molecule of DPEMA has an antiperiplanar conformation as to the C?C and C?O double bonds about the C(1)? C(2) bond, a synperiplanar conformation as to the C?O and C? O bond about the C(1)? O(1) bond, and an anticlinal conformation about the O(1)? C(5) bond. One of the two t-BBMA molecules in an asymmetric unit has an antiperiplanar conformation as to the C?C and C?O double bonds about the C(1)? C(2) bond, whereas the other antiperiplanar molecule may contain some synperiplanar conformation. Both molecules have a synperiplanar conformation as to the C?O and C? O bonds about the C(1)? O(1) bond and an anticlinal conformation about the O(1)? C(5).     

A case of small-cell lung cancer effectively treated by bi-weekly administration of amrubicin

The patient was a 62-year-old man with small-cell lung cancer (limited disease). He was treated with cisplatin (CDDP) plus etoposide(ETP) and concurrent radiotherapy as first-line treatment. Although a complete response was achieved, his pro-GRP elevated 10 months later. He was treated with several anticancer agents including, CDDP plus irinotecan (CPT-11), CPT-11, paclitaxel and amrubicin (AMR). Although, as a monotherapy, the administration of AMR (30 mg/m(2)) for 3 consecutive days (3-day schedule) seemed to be most effective, severe myelosuppression was observed, and this treatment was discontinued. We changed the treatment schedule to biweekly administration of AMR (30 mg/m(2)). The level of pro-GRP decreased, and it was maintained at a similar level for 7 months. No severe toxicity was observed during this period. This case suggests that the bi-weekly administration of AMR may be a useful option for the treatment of small-cell lung cancer when a 3-day AMR schedule is highly myelosuppressive.     

A case of advanced hepatocellular carcinoma with lung metastases and cirrhosis that responded to combination chemotherapy with interferon-alpha and 5-fluorouracil

The prognosis for patients with hepatocellular carcinoma (HCC) with progressive liver cirrhosis or extrahepatic metastases remains dismal. We report a case of HCC with liver cirrhosis and lung metastases who had been treated successfully by combination chemotherapy of 5-fluorouracil (5-FU) and interferon-alpha (IFN-alpha). A 67-year-old male with a history of hepatitis C, liver cirrhosis and HCC was hospitalized because of cough and dyspnea. Computed tomography (CT) of chest revealed multiple lung metastases. Systemic combination chemotherapy with 5-FU and IFN-alpha was begun, and lung metastases disappeared after one course of treatment. He died of liver failure one year later, but no recurrence of lung metastases was seen. Although systemic combination chemotherapy of 5-FU and IFN-alpha induced the bone marrow suppression, it was effective for lung metastases and palliates symptoms and signs in our case of HCC.