A 13-month-old girl (BW 4476g) with Taussig-Bing malformation was successfully treated by anterior intraventricular tunnel repair (Patrick-McGoon method). She had large subpulmonary malalignment ventricular septal defect with extreme inflow extension with anteroposterior relationship of the great arteries. Coronary arterial anatomy was a very rare type in that LAD branching from RCA originated from right facing sinus was running just anterior to the aorta and coronary relocation would result in straining and obstructing LAD. Intraventricular tunnel through the VSD to the aorta was tailored by use of a double velour Dacron conduit (14mm in diameter) and inflow extension of VSD was partly closed with a separate flat Dacron patch. LVOTO was not found on echocardiography and good clinical results were obtained at 11 months postoperatively.

From May 1975 to August 1991, 90 patients (56 males and 34 females) underwent Bentall's operations or its modified technique. In our modified technique the coronary ostium is cut out like a button and anastomosed to the aortic graft and aortic grafts are not wrapped by the aortic wall. Preoperative diagnoses were AAE (25 patients, 28%), Stanford type A dissection (19, 21%), Marfan's syndrome (16, 18%), aortitis syndrome (12, 13%), AR+ascending aortic aneurysm (6, 7%), syphilitic aortitis (5, 6%), AS+ascending aortic aneurysm (3, 3%), Valsalva's sinus aneurysm (2, 2%) and other diseases (2, 2%). The hospital mortality rate was 17% (15/90) for all cases. The hospital mortality for aortic dissection (37% (7/19)) and reoperation cases (75% (3/4)) were very high. There were 10 cases of late death and the 10 year actuarial survival rate was 66.3%. Among 11 cardiovascular events which occured in the late phase, 5 were dissection at other aortic sites in the type A dissection and Marfan syndrome cases, and 3 were pseudoaneurysm formation at the site of coronary or the aortic anastomosis in the aortitis syndrome cases, and a detachment of the composite graft in the Marfan's syndrome cases. The 10-year event-free rate was 92.0% for non-specific AAE, 68.8% for aortitis syndrome, 61.9% for Marfan's syndrome and 47.3% for Stanford type A dissection. Non-specific AAE had excellent long-term results, but Marfan's syndrome and dissection had poor results. The button technique for coronary reconstruction is effective for all cases and its long term results are good, but, even with this technique, coronary pseudo-aneurysm occured in cases of aortitis syndrome.

Hypercholesterolemia and hypertension are among the most important risk factors for cardiovascular (CV) disease. They are also important contributors to metabolic diseases including diabetes that further increase CV risk. Updated guidelines emphasize targeted reduction of overall CV risks but do not explicitly incorporate potential adverse metabolic outcomes that also influence CV health. Hypercholesterolemia and hypertension have synergistic deleterious effects on interrelated insulin resistance and endothelial dysfunction. Dysregulation of the renin-angiotensin system is an important pathophysiological mechanism linking insulin resistance and endothelial dysfunction to atherogenesis. Statins are the reference standard treatment to prevent CV disease in patients with hypercholesterolemia. Statins work best for secondary CV prevention. Unfortunately, most statin therapies dose-dependently cause insulin resistance, increase new onset diabetes risk and exacerbate existing type 2 diabetes mellitus. Pravastatin is often too weak to achieve target low-density lipoprotein cholesterol levels despite having beneficial metabolic actions. Renin-angiotensin system inhibitors improve both endothelial dysfunction and insulin resistance in addition to controlling blood pressure. In this regard, combined statin-based and renin-angiotensin system (RAS) inhibitor therapies demonstrate additive/synergistic beneficial effects on endothelial dysfunction, insulin resistance, and other metabolic parameters in addition to lowering both cholesterol levels and blood pressure. This combined therapy simultaneously reduces CV events when compared to either drug type used as monotherapy. This is mediated by both separate and interrelated mechanisms. Therefore, statin-based therapy combined with RAS inhibitors is important for developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity. This combined therapy can help prevent or treat CV disease while minimizing adverse metabolic consequences.
Atherosclerosis ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Diabetes Mellitus, Type 2 ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Hypercholesterolemia ; Hypertension ; Insulin Resistance ; Lipoproteins ; Metabolic Diseases ; Obesity ; Pravastatin ; Renin-Angiotensin System ; Risk Factors

We have used two methods for education of pathology at the Yokohama City University School of Medicine: 1) clinicopathological conferences on autopsy cases and 2) journal club using “Case Records of the Massachusetts General Hospital” published in the New England Journal of Medicine. Both methods are extremely effective for stimulating students' enthusiasm for learning, improving presentation skills, and consolidating the minds of students as future medical staff members. Furthermore, journal club enhances the affinity for reading medical English.

The new St. Jude Medical aortic valve graft prosthesis was evaluated for composite graft replacement of the aortic root in 32 patients at three institutions. This study was performed in conformity with the Japanese Drugs, Cosmetics and Medical Instruments Act. The grafts were preclotted with blood of serum albumin: coronary artery reconstruction was performed employing the classical Bentall procedure (4 cases), Cabrol's procedure (14 cases), the interposition graft technique (8 cases) or the button technique (6 cases); concomitantly the aortic arch was replaced in one patient, and the mitral valve was replaced in two patients. One early death (3%) occurred as the result of shock sustained prior to establishing cardiopulmonary bypass. Postoperative complications included perivalvular leakage (one case), perioperative myocardial infarction (two cases), hepatitis (one case). There were no late deaths and no complications related to the SJM valve graft prosthesis. The SJM valve graft prosthesis is a safe and reliable prosthesis for use as a composite graft replacement of the aortic root.

Introduction：Hyponatremia, which is frequently present in patients with end-stage cancer, causes delirium and disturbance of consciousness and is considered a poor prognostic factor. We report a case of hyponatremia with hypopituitarism in association with leptomeningeal metastasis, resulting in reversible disturbance of consciousness. Case report：A 77 year-old female received chemotherapy at our hospital for postoperative recurrence of lung cancer, and best supportive care due to a side effect. After transfer to another hospital, she experienced a sudden disturbance of consciousness and was returned to our hospital. A detailed examination resulted in a diagnosis of hyponatremia from hypopituitarism following leptomeningeal metastasis involving the cerebral ventricles. Hyponatremia was improved by NaCl supplement and hormone replacement, followed by recovery from disturbance of consciousness. Discussion：QOL of patients with end-stage cancer can be improved through the active treatment of reversible causes of disturbance of consciousness. Conclusion：When severe hyponatremia is detected in cancer patients, it is important to consider the possibility of hypopituitarism with brain metastasis or meninges dissemination in the differential diagnosis.