Bone mineral density (BMD) at the distal one-third of the radius bone was measured by the dual energy X-ray absorptiometry (DEXA) method and cytoplasmic free calcium concentration ([Ca²⁺] _i) of urinary granulocytes was by flow cytometry. Enrolled in this investigation were healthy aged people (male: n=34, female: n=36, mean 74.4 yrs) in a rural area of southern Nagano prefecture. We used acetoxymethyl ester of fluo-3 (fluo-3AM) to measure [Ca²⁺]_i, in human urinary granulocytes. BMD of the male population (0.67g/cm²) was higher than that of the female population (0.47g/cm²).[Ca²⁺] _i, of urinary granulocytesin the female population (78.7nM) was higher than in the male population (48.2nM).[Ca²⁺] _i, in urinary granulocytes of the aged population was 63.5±51.2nM (mean±SD). These values were within the values of healthy adult peripheral blood cells, suggesting that these granulocytes were functional like blood cells. These data indicated that [Ca²⁺] i, of urinary granulocytes increased when BMD decreased, suggesting that the measurement of [Ca²⁺] _i, would give us a clue for the understanding of the pathophysiological mechanism of osteoporosis in the aged.

Lipoprotein(a) [Lp(a)] has been considered as an independent risk factor for arteriosclerotic diseases. With an anticipation that Lp(a) would also serve as a risk factor for abdominal aortic aneurysms (AAA), we analyzed serum and tissue Lp(a) levels of patients with AAA in relation to those in healthy individuals. Serum Lp(a) levels were significantly higher in the AAA group (53.2±60.8mg/dl) than in the healthy controls (14.6±13.6mg/d) (p<0.001). The Lp(a) level in the aneurysmal wall of patients with AAA was 49.8±38.2ng/mg. There was a significant correlation between serum and aneurysmal wall Lp(a) levels in AAA patients (r²=0.79, p<0.01). Immunohistochemical examination revealed Lp(a) in the extracellular matrix of the middle layer of the tunica intima, but not in the tunica media or externa.

Surgery for right atrial isomerism usually has a poor outcome because of complex congenital cardiac malformations. Here we rearn the outcomes of all 71 consecutive patients with right atrial isomerism whom we treated from their initial operation at Shizuoka Children's Hospital between January 1987 and October 2006. We categorized 34 patients treated between 1987 and 1996 as the ‘early’ group, and 37 patients between 1997 and 2006 as the ‘late’ group. The early group was more commonly associated with pulmonary stenosis (p=0.010), and the late group was more commonly associated with neonatal status (p=0.010), body weight less than 3.0kg (p=0.037), and pulmonary atresia (p=0.013). All 71 patients were scheduled for single ventricular repair. Survival in the early group was 52.9% at 1 year, and 32.4% at 5 years, and this poor outcome was related to 2 factors; cardiac dysfunction from volume loading and inappropriate lung perfusion area for Fontan completion. We therefore changed our surgical strategy in the late group as follows: earlier right heart bypass operation and aggressive atrioventricular valvoplasty to prevent volume overloading, and central pulmonary artery (PA) strategy (central PA plasty and blood flow source anastomosed to the central PA) and improvement of anastomosis of total anomalous pulmonary venous connection (TAPVC) to preserve appropriate lung perfusion area. If severe unbalanced pulmonary blood flow occurred, it was treated with a novel surgical approach consisting of ‘intrapulmonary-artery septation’. Survival in the late group was 66.8% at 1 year, and 53.1% at 5 years, which was better than the early group, but not with statistical significance (p=0.102). Univariate analysis identified significant risk factors for mortality as neonatal status (p=0.036), extracardiac TAPVC (p=0.049), and preoperative pulmonary vein obstruction (PVO) (p=0.001) in the early group, and mixed TAPVC (p=0.001) in the late group. Multivariate analysis identified preoperative PVO (p=0.038) in the early group, and mixed TAPVC (p=0.007) in the late group as significant risk factors for mortality. Outcome is improving with our current strategy of preventing volume overloading and preserving an appropriate lung perfusion area, even in the late group with more severe cases, and neonatal status, extracardiac TAPVC, and preoperative PVO are no longer risk factors for mortality, but mixed type TAPVC remains a serious problem and is associated with high mortality.