Postoperative Size of the Right Ventricular Outflow Tract and Optimal Age in Complete Repair of Tetralogy of Fallot

One hundred forty-three patients underwent complete repair of tetralogy of Fallot with an overall mortality of 14.7%. The mortality rate correlated with the preoperative pulmonary artery to aorta (PA/Ao) diameter ratio but not with age. A retrospective study revealed that for success, the postoperative pulmonary annulus should be over 1.75 cm² per square meter of body surface area (BSA) in patients with a BSA of less than 0.6 m² at operation. The younger the patient, the lower was the ratio of right ventricular to aortic systolic pressure, even when the cross-sectional area index (CSAI) of the pulmonary annulus was the same. Even with application of an outflow patch, pulmonary regurgitation was negligible when the CSAI was less than 2.6 cm²/m². The pulmonary vascular response to increased blood flow was excellent in younger patients. Residual ventricular septal defect and recurrent pulmonary stenosis were unrelated to age.Thus, for symptomatic patients, even infants, we recommend that complete repair be attempted when the PA/Ao diameter ratio is over 0.3. For patients in whom this ratio is less than 0.3, operation should be undertaken when the average diameter index of the arterial pathway to the right upper lobe is above 4 mm/m². Should this index be less than 4 mm/m², a two-stage operation is recommended.     

Neuron-specific enolase and S-100 protein levels in cerebrospinal fluid of patients with various neurological diseases

Neuron-specific enolase (NSE) and S-100 protein (S-100) levels in cerebrospinal fluid (CSF) were determined in 129 patients with various neurological diseases. The chronological changes of these nervous system-specific proteins in CSF were also examined in 3 patients with acute disorders. NSE and S-100 levels were elevated in many cases with acute conditions. These specific proteins did not increase simultaneously but independently. These results suggested that NSE and S-100 in CSF would be useful markers for damage of the nervous system and that measurement of both NSE and S-100 might positively indicate whether the damage was neuronal, glial or mixed in origin. Moreover, from the serial determination of these substances, they would be better markers than cell counts and total protein in CSF for the active injury for the nervous tissues.     

Crystallization of glycine/β-benzyl-L-aspartate copolymer in the course of polymerization

In order to examine the structure and growth mechanism of copolymer crystals formed during polymerization, the heterogeneous copolymerization of glycine N-carboxy anhydride and β-benzyl-L-aspartate N-carboxy anhydride, initiated by butylamine, was studied in acetonitrile. In all the copolymerization systems, the crystal growth took place through formation of the cross-β structure, i.e., the introduction of glycine residues into the poly(β-benzyl-L-aspartate) chain during this particular copolymerization broke the α-helix of poly(β-benzyl-L-aspartate). The growth mechanism of the copolymer crystals was compared with that for poly(β-benzyl-L-aspartate) crystals reported previously.