The limitation of staged repair in the surgical management of congenital complex heart anomalies with aortic arch obstruction

OBJECTIVE: Severe aortic arch obstruction including an interrupted aortic arch in congenital complex heart anomalies remains a challenge in surgical management. METHODS: Treatment and outcomes in 75 consecutive patients who underwent an aortic arch repair as the first step of the staged repair protocol between 1975 and 2000 were reviewed. Their ages at repair ranged from 1 day to 8.5 months. RESULTS: Cross-sectional postoperative follow-up data were available in all the patients. The follow-up period ranged from 0 to 27.6 years (mean: 7.3 +/- 7.3 years). There were 20 postoperative hospital deaths (27%) and 7 late deaths. The Kaplan-Meier estimate of survival was 81.3% +/- 4.5% at 1 month, 68.0% +/- 5.4% at 1 year, 65.0% +/- 5.5% at 5 years, 63.1% +/- 5.7% at 10 years, 63.1% +/- 5.7% at 20 years. By Cox regression analysis, body weight of 2.5 kg or less is the only independent determinant of postoperative mortality (p = 0.04, multivariable odds ratio: 2.50, [95% confidence interval: 1.02-6.1]). The aortic arch morphology, the primary cardiac lesion, or date of operation did not reach a statistically significant level to show correlation with mortality. Reintervention to reconstruct the aortic arch was performed at 9 occasions in 8 of the 55 patients who survived the primary operation (14.5%). The Kaplan-Meier estimate of the reintervention-free rate was 91.3% +/- 4.2% at 5 years, 85.5% +/- 5.6% at 10 years, 75.6% +/- 8.2% at 20 years. Using multivariable Cox regression analysis, interrupted aortic arch (versus aortic coarctation) was the only independent predictor of a shorter time to reintervention (p = 0.001, multivariable odds ratio: 16.1, [95% confidence interval: 3.2-80.2]). CONCLUSIONS: The staged repair protocol was associated with significant limitations in patient survival and with the development of recurrent aortic arch obstruction. Thus, a primary repair protocol may serve as an alternate approach, especially in patients with low weight or with an interrupted aortic arch.     

Anomeric preference in uptake of D-glucose and of D-galactose by rat lenses

To determine the anomeric preference of uptake of D-glucose and of D-galactose by rat lenses, we crystallized alpha-, beta-D-[U-14C]glucose (720 microCi/mmol) and alpha-, beta-D-[U-14C]galactose (180 microCi/mmol) by our method and incubated them separately with rat lenses for 1 min, because of the short half-life of mutarotation of alpha-D-glucose (9.6 min) and of alpha-D-galactose (4.6 min) in HEPES medium at 30 degrees C. During aerobic incubation of rat lenses in HEPES medium containing radioactive alpha or beta anomer of D-glucose, there was no significant difference in the rate of uptake between alpha and beta anomers of D-glucose by rat lenses. However, 1.59 times greater incorporation of alpha-D-galactose was observed over that of beta-D-galactose under the same conditions.     

The effect of human SOD on the survival rate in rats with temporary splanchnic ischemia

The accumulation of oxygen free radicals is reported to occur in the organs subjected to temporary ischemia followed by reperfusion, resulting in the fatal outcome of the animals. The effects of human SOD, a representative scavenger of oxygen free radicals, on the survival rates were investigated in the rats with temporary splanchnic ischemia. The temporary ischemia was induced by the occlusion of anterior mesenteric and celiac arteries for 30min under anesthesia. Prior and after treatment with 2mg/100g of human SOD, iv or sc, produced significant improvements in survival rates. Human SOD, cloned from human placenta DNA and expressed in microorganisms, has extreme homogeneity. The results suggest the possible introduction of human SOD into clinical field as an effective scavenger of oxygen free radicals.(Ogawa R, Bitoh H, Ohi Y: The effect of human SOD on the survival rate in rats with temporary splanchnic ischemia. J Anesth 2: 41–45, 1988)     

Improvement in the Treatment of Childhood Cancer: Analysis of Survival Data from the National Children's Hospital (1965-1987)

Developments in the treatment of childhood cancer have beenevaluated in patients who had been treated in the National Children'sHospital from 1965 to 1987. The total number of patients was867, of which leukemia accounted for 376, malignant lymphoma61, neuroblastoma 174, Wilms' tumor 55, yolk sac tumor 29, rhabdomyosarcoma36 and hepatoblastoma 30. Patients were divided into three timeintervals: the 1960s, 1970s and 1980s. A marked improvementin five-year survival was recognized in Wilms' tumor and yolksac tumor, amounting to 80%, followed by rhabdomyosarcoma, acutelymphoblastic leukemia and malignant lymphoma. There was noimprovement in patients with acute non-lymphoblastic leukemia,neuroblastoma and hepatoblastoma. Prognostic factors for neuroblastomawere further analyzed, and the age of onset and stage of diseasewere found to have remained constant for 23 years. Factors relatingto the improvement of survival were discussed.     

Corroding characteristics of Eikenella corrodens.

Fourteen strains of Eikenella corrodens isolated from human oral cavity were studied to determine corroding characteristics. Nine out of the 14 strains produced corroding colonies under anaerobic culture condition. One of them produced corrosion even in an aerobic culture. No morphological differences in surface structures were observed between corroding and non-corroding strains of E. corrodens by transmission electron microscopy. The morphology of corroding colonies of E. corrodens was then examined by scanning electron microscopy. The surface of the corroding-colony center was smoothly convex. A boundary line was clear between the smooth center and the surrounding corrosion region. Double or triple frill-like structures surrounded the center portion with small convexities. Spreading bacterial masses were observed in the outer portion of the colony. Morphological observations of the corroding colony edge indicated that a surface translocation termed "twitching motility" or "gliding motility" occurs in the outer portion and plays a role in its colonization of periodontal regions.     

Neurolysis of celiac plexus and splanchnic nerve under ultrasonographic guidance

Key words  intractable pain - celiac plexus neurolysis - ultrasonography     

SOLITARY PLASMACYTOMA OF THE SUBMANDIBULAR LYMPH NODE WITH STROMAL AMYLOID DEPOSITS

This report concerns a case of solitary extramedullary plasmacytoma of the left submandibular lymph node in a 56-year-old man. The tumor showed monoclonal proliferation of abnormal plasma cells which revealed highly positive stainings of both methylgreen pyronin and kappa light chain using the immunoperoxidase technique in the cytoplasms, and further revealed massive'.amyloid'deposits in the stroma, which suggested the possibility of sequential amyloid formation upon the secretion of paraprotein by tumor cells.     

In vitro tuberculin reactivity of lymphocytes from patients with tuberculous pleurisy.

Mononuclear cells in pleural fluid from patients with tuberculous pleurisy were predominantly T cells. Responsiveness of pleural fluid T cells to purified protein derivative of tuberculin were studied by the assay of cell proliferation and production of lymphocyte mitogenic factor by the stimulation with purified protein derivative. Peripheral blood lymphocytes were also studied from patients and tuberculin-positive healthy controls. The order of responsiveness was as follows: pleural fluid lymphocytes greater than peripheral blood lymphocytes of patients without effusion = peripheral blood lymphocytes of healthy controls greater than peripheral blood lymphocytes of patients with effusion. The poor response of peripheral blood lymphocytes from pleurisy patients were recovered by the elimination of adherent cells in peripheral blood lymphocytes to the level of the response of peripheral blood lymphocytes from healthy controls. T cells purified from pleural fluid mononuclear cells responded more than those from peripheral blood. These results suggested that in the pleurisy patients purified protein derivative-reactive T cells in peripheral blood did not decrease in activity, but were depressed by suppressor cells, and further suggested that highly purified protein derivative-reactive T cells were accumulated in the pleural fluid.