A 65-year-old woman presented with coughing and dyspnea. Giant left atrial myxoma was found by echocardiography. The tumor size was 7×5×4cm and its weight was 70g. The biatrial approach was chosen over left atriotomy or the transseptal approach. However, it may not be possible to decide on the correct incision line in cases of giant tumor. Intraoperative trans-esophageal echocardiogaphy was useful for evaluation of the mitral valve.

The patient was an 83-year-old man. He had pyloric stenosis due to Borrmann type III gastric cancer. He also had an abdominal aortic aneurysm 7cm in length. We performed gastrectomy and Y graft replacement simultaneously. His postoperative course was good. We discussed the operative indications and operative method, especially with regard to simultaneous operation.

Preoperative and postoperative evaluation was conducted on 25 patients (33 lesions) with arteriosclerosis obliterans (ASO) by three-dimensional CT angiography (3D-CTA) and intraarterial digital subtraction angiography (IA-DSA). The usefulness and problems of 3D-CTA for diagnosis of ASO were studied. Both methods had equal ability to detect lesions in the area of the iliac artery and the femoral artery. Totally occlusive lesions were accurately diagnosed by 3D-CTA, but diagnosis of stenotic lesions was much less accurate. To confirm blood flow following vascular reconstruction 3D-CTA was useful and IA-DSA was not required. 3D-CTA images can be obtained from desired directions and clearly detect calcification and blood clots with little health risk involved. They are useful for the diagnosis of ASO.

Conventional CT and three-dimensional CT angiography (3D-CTA) were conducted after peripheral arterial bypass surgery on 17 patients (26 grafts) from October, 1994 to April, 1996. Seventeen grafts were patent. The following objectives were satisfied in these cases: 1. Prosthetic graft or saphenous vein was depicted by 3D-CTA, 2. The distal portion of the native artery was depicted by 3D-CTA, and 3. Opacification of the graft interior was recognized by transverse section of CT. Nine grafts were occluded but prosthetic grafts were depicted in 5 cases, and prosthetic grafts and the distal portions of native arteries in 3 cases. Opacification of the graft interior was not seen in any case. Achievement of the above three objectives was considered necessary to determine graft patency.

A comparison was made of the three-dimensional CT angiography (3D-CTA) images of four grafts (IMPRA, Bionit, GELSOFT, and saphenous vein). All patent grafts were visualized by 3D-CTA, and opacification of the graft interior was noted in all cases on transverse sections of CT. Occluded GELSOFT and saphenous vein grafts could not be visualized by 3D-CTA. In spite of occlusion, IMPRA and Bionit were visualized by 3D-CTA. However, opacification of the graft interior could not be noted on transverse sections of CT. Confirmation should be made of the following: 1. distal portion of native artery shown on 3D-CTA, 2. recognition of opacification (high density) of graft interior on transverse sections of CT. When the CT threshold changed, occluded IMPRA and Bionit showed spotty images. This phenomenon should facilitate accurate diagnosis.

A 62-year-old man was diagnosed as having atrial septal defect (ASD) and atrial fibrillation (Af) upon admission to our hospital with acute myocardial infarction. He was placed on medication for 3 years but surgery was considered necessary because of the further complication of angina pectoris. Coronary arterial bypass grafting, ASD closure and right atrial separation procedure which was a modification of the right-sided maze operation, were performed simultaneously. Although chronic Af disappeared immediately after surgery, it reappeared on the 8th postoperative day, and medicinal and electrical defibrillation had no effect. We considered that the main cause of Af accompanied by ASD had existed in the right atrium before surgery. Also, as the right atrial separation procedure was less invasive than the Cox/maze procedure for such complications in patients with ischemic heart disease, we chose this method. In our patient, postoperative left ventricular loading was considered to have been the cause of Af recurrence. Therefore the indications for this procedure should be decided carefully in patients with preoperative left ventricular hypofunction or left atrial dilatation.

The patient was a 71-year-old man with intermittent claudication. Angiography indicated severe stenosis of the right common iliac artery. The right femoral artery was anastomosed to an artificial graft by conventional hand-sewn suturing and the left femoral artery by the Vascular Closure Staples (VCS). Postoperatively, the patient had an uneventful recovery and was discharged. This new procedure minimizes trauma to the vascular intima since the arcuate legged clip is non-penetrating. Suturing with VCS is more extensive than by the conventional method. VCS has been applied by the authors to treat arteriosclerosis obliterans lesions.

A survey was conducted on 117 agricultural cooperatives and 121 city, town and village offices in Nagano Prefecture to find out how they provide health care to the population. The following is a summary of the findigs of the questionnaire survey based on interviews.
1. Collaboration between agricultural co-ops and local public offices in health control activities has become closer. Nearly half of the agricultural co-ops plan and implement health screening programs jointly with city, town and village authorities. One of the favorable effects of the joint undertaking manifests itself in the form of improvement in the ratio of participants to the total populace. The average percentage of participation in the joint programs comes at 48.8% as against the prefectural average of some 22%. Moreover, the joint efforts bring about the desired effect on the implementation of after-screening guidance and other health promotion programs.
2. Of local health leaders, 87.2% said that they keep in contact with each other. Those who meet once in every one to three months account for 24.8% of the total. In the areas where health leaders have liaison meetings regularly, it is noted that there is close cooperation between medical insitutions and various health-related organizations, resulting in a marked improvement in the percentage of participation in health screenings. It is also noted that there is overall improvement in the attitude toward health control.
3. As regards the participation of inhabitants in health control activities, the women's, the young men's and the producers' associations have representatives to the health control promotion council of the agricultural cooperative in each region. Of the three associations, the women's association is the most enthusiastic with the participation ratio of 55.4%. Meanwhile, 67.8% of the agricultural co-ops send their representatives to the health promotion council of each municipal body. More representatives of agricultural co-ops and inhabitants should take part in the council in the interest of people's well-being.

Participants in our screening program for cerebrovascular disease are supposed to receive thyroid checkups at the time of ultrasound imaging of carotid arteries. Thus far, a total of 4,338 people have participated in this program. Of the total, 17 cases of papillary thyroid carcinoma were found (detection ratio: 0.39%). This study concerned with the 13 cases which underwent surgical treatment in our hospital. They all were diagnosed as early cancers--eight cases at stage N0 and five cases at stage N1--with an average tumor diameter of 11 mm. Besides, five cases of Basedow's disease (hyperthyroidism) and 15 cases of chronic thyroiditis were found (detection ratio: 0.35%). Of the 15 chronic thyroiditis cases, nine were found to have symptoms of hypothyroidism. We concluded that our screening program for cerebrovascular disease involving the ultrasonographic scans of the thyroid gland is very helpful not only in detecting malignancies at an early stage but also in screening for functional abnormalities of the thyroid.
Aspects of disease screening ; Ultrasonography ; Desiccated thyroid ; Thyroid Gland ; Diagnostic Neoplasm Staging

Between March 1985 and May 1988 we performed valve replacement to 86 cases using 92 Duromedics prosthetic valves in the atrioventricular position. Long term results were obtained, we examined the problem (especially thrombosed valve). The cumulative follow-up was 313.6 patients-year (p-y). The 6-year actuarial survival rate including early mortality was 83.4±4.1%. The valve-related complications were as follows; peripheral embolism 3 cases (1.0%/p-y), thrombosed valve 7 cases (2.2%/p-y), hemorrhage and paravalvular leakage each 1 case (0.3%/p-y). All valve-related complications were 12 cases (3.8%/p-y). Reoperation for valve-related complications were 5 cases (1.6%/p-y), it was all to thrombosed prosthetic valve. Thrombosed valve were seen 7 cases (4 cases in mitral, 3 cases in tricuspid position). The event free rate of thrombosed valve was 89.1±4.0%. It was high incidence in tricuspid position. We concluded that it was necessary to be done early reoperation the time of fixed with one leaflet alone.