Nine patients underwent surgical repair of ventricular septal defect (VSP) following acute myocardial infarction in our hospital during the past 5 years. Sites of perforation were apex ventricular septum (A-VSP) in five, high anterior ventricular septum (H-VSP) in one and posterior ventricular septum (P-VSP) in three. A-VSPs were closed by single patch on the left ventricular side of the septum. H-VSP was closed by double patch and ventriculotomy was closed directly. For P-VSPs, three different operative procedures were performed. Patch closure of VSP and reconstruction of free ventricular wall was done in one, while in other two VSP was closed by single patch on the left or right side of the septum. There were two operative deaths, one A-VSP and one P-VSP. We think that patch closure through right ventriculotomy is useful in cases of small P-VSP.

A 3-month-old girl of univentricular heart of left ventricular type with atresia of left atrioventricular valve (LAVV) and coarctation of the aorta (Co/AO) is presented. UCG and angiography revealed concordant AV connection with straddling RAVV with transposed great arteries [SDDT]. The following pressures (in mmHg) were noted on catheterization: RA mean 1 (a=3, v=1), LA mean 12 (a=17, v=14), LV 84/0/8, Ao 81/41, and PA 74/39. Patent foramen ovale (PFO) was restrictive and balloon atrioseptostomy was not feasible. Blalock-Hanlon atrial septectomy (8×6mm), subclavian flap aortoplasy (SFA) and pulmonary arterial banding were performed simultaneously under bilateral thoracotomy. Acute renal failure occurred after surgery and the girl required peritoneal dialysis for 5 days. At 6 months after surgery, girl is doing well. There will be a predictable fall in pulmonary vascular resistance after atrial septectomy and SFA with a ligation of PDA may result transient increase in systemic resistance. Therefore, atrial septectomy and SFA in conjunction with pulmonary arterial banding should be done simultaneously.

Fourteen cases (ranged 4 days to 5 months old, mean=40 days old) of coarctation of thoracic aorta underwent subclavian flap aortoplasty were between Jan. 1986 and Dec. 1990. Early postoperative course in these patients was reviewed retrospectively. In 9 cases of these patients, complex intracardiac anormalies co-existed (VSD in 7, ECD in one, single ventricle with MA in one). Preoperative pressure gradients between upper and lower extremities were 40±7mmHg and the gradients were significantly reduced after the repair of coarctation (8±4mmHg). Serum creatinine phosphokinase (CPK) increased postoperatively reaching peak levels by day 3 (12, 315 ±8, 462IU/l) and then gradually decreased. Gultamic oxaloacetic transaminase (GOT), glutamicpyruvic transanmiase (GPT), serum urea nitrogen (BUN) and serum creatinine (S-Cr) also increased postoperatively. When patients were divided into two group following the maximum CPK levels (group A: >4, 000; group B: <4, 000IU/l), the duration of mechanical ventilation (A: 117±21; B: 20±9hr), max. S-Cr levels (A: 2.16±0.64; B: 0.47±0.13mg/dl) and max. GPT (A: 323±127; B: 58±24IU/l) were significantly increased in group A. There was no significant correlation between these factors and postsurgical residual pressure gradients. An increase in these factors did not depend on the operation time, age, body weight and additional surgical procedures such as pulmonary arterial banding. These data suggest that the transient unbalanced blood distribution might exist even under no pressure gradients between upper and lower extremities. This might be important in the management of postoperative patients after repair of coarctation.

Although the pelvic autonomic plexus may be considered a mixture of sympathetic and parasympathetic nerves, little information on its composite fibers is available. Using 10 donated elderly cadavers, we investigated in detail the topohistology of nerve fibers in the posterior part of the periprostatic region in males and the infero-anterior part of the paracolpium in females. Neuronal nitric oxide synthase (nNOS) and vasoactive intestinal polypeptide (VIP) were used as parasympathetic nerve markers, and tyrosine hydroxylase (TH) was used as a marker of sympathetic nerves. In the region examined, nNOS-positive nerves (containing nNOS-positive fibers) were consistently predominant numerically. All fibers positive for these markers appeared to be thin, unmyelinated fibers. Accordingly, the pelvic plexus branches were classified into 5 types: triple-positive mixed nerves (nNOS+, VIP+, TH+, thick myelinated fibers + or -); double-positive mixed nerves (nNOS+, VIP-, TH+, thick myelinated fibers + or -); nerves in arterial walls (nNOS-, VIP+, TH+, thick myelinated fibers-); non-parasympathetic nerves (nNOS-, VIP-, TH+, thick myelinated fibers + or -); (although rare) pure sensory nerve candidates (nNOS-, VIP-, TH-, thick myelinated fibers+). Triple-positive nerves were 5-6 times more numerous in the paracolpium than in the periprostatic region. Usually, the parasympathetic nerve fibers did not occupy a specific site in a nerve, and were intermingled with sympathetic fibers. This morphology might be the result of an "incidentally" adopted nerve fiber route, rather than a target-specific pathway.
Adrenergic Fibers ; Aged* ; Cadaver* ; Female ; Humans ; Hypogastric Plexus* ; Male ; Myelin Sheath ; Nerve Fibers* ; Nitric Oxide Synthase Type I ; Tyrosine 3-Monooxygenase ; Vasoactive Intestinal Peptide

Introduction
Essential hypertension is one of the leading causes of hypertension; responsible for more than 90% of such cases. Diet cure or drug treatment are usually prescribed for this disease. We drew notice to the antihypertensive effects of acupuncture.
Method
Subjects were healthy persons as well as patients complainig of simple essential hypertension. According to the WHO method, they were divided into three groups, e. g. normal, limitaneus, hypertensive. In situ needles were inserted in the antihypertensive points of both auricular sides for one week.
Effect
This treatment gave immediate results in 70% of the limitaneus and hypertensive groups. There was no observable effect for the balance. A number of these subjects were obese; a factor to be considered.
Evaluation
This method is very uncomplex and takes but minimal amount of time to treat patients.

A 70-year-old man was admitted to our institution due to aggravation of blood-sugar level control and because an abdominal CT showed dilatation of the main pancreatic duct. Upper gastrointestinal endoscopy revealed a flat elevated tumor with central ulceration in the second portion of the duodenum. Subsequent duodenoscopy for a more detailed examination showed that the tumor had originated in the minor duodenal papilla. A biopsy specimen showed moderately differentiated adenocarcinoma. Endoscopic retrograde pancreatography via the major duodenal papilla revealed a slightly dilated main pancreatic duct and obstruction of the accessory pancreatic duct. Endoscopic ultrasonography showed a hypoechoic mass in the minor duodenal papilla with retention of the muscularis propria of the duodenum. These findings suggest that the tumor existed only to a limited extent in the minor duodenal papilla, and that the tumor did not infiltrate into the pancreas. For treatment, pylorus-preserving pancreatoduodenectomy was performed, and histological findings revealed a well-differentiated adenocarcinoma that originated in the minor duodenal papilla. Primary adenocarcinoma of the minor duodenal papilla is extremely rare. Our case is the first report of primary adenocarcinoma of the minor duodenal papilla at an early stage with no infiltration into muscularis propria of the duodenum and pancreas.
Adenocarcinoma/*pathology/ultrasonography ; Aged ; Endosonography ; Humans ; Male ; Pancreatic Ducts/*pathology/ultrasonography ; Pancreatic Neoplasms/*pathology/ultrastructure