We studied cardiac function and outcome long after aortic valve replacement using a 19mm bileaflet valve. The subjects consisted of 10 of 12 patients living 10 or more years after the operation and 7 of 8 living 5-9 years after the operation. We measured the left ventricular ejection fraction (LVEF), %fraction shortening (%FS), left ventricular diastolic dimension (LVDd), systolic dimension (LVDs), PWT, IVST, and LV-aortic pressure gradient (PG) of in 6 patients each in 10 more years after the operation (Group I) and 5-9 years after the operation (Group II) who underwent ultrasonography, and calculated the left ventricular mass index (LVMI). No statistically significant differences were seen in either parameter in either group. Prognosis was 1 cardiac 2 cancer deaths each in 10 or more years after the operation group. The cumulative survival rate was in 85.7% post operative 5-9 years and 72.7% in 10 years. Although cardiac function was maintained in both groups, more observation is needed from now on because the pressure difference or LVMI may increase.

Median sternotomy is commonly used for suture fixation of a myocardial lead. Instead of this conventional technique, we used the technique of resecting the 5th costal cartilage through a small horizontal skin incision at the left 5th sternocostal junction in 33 patients, between 1980 and 2001. Here we describe this procedure, as well as the outcome of patients who underwent this myocardial lead fixation procedure. A skin incision of about 6 to 8cm was made in the left 5th intercostal space. Approximately 5cm of the 5th costal cartilage was resected through the skin incision. Then, a myocardial lead was sutured on to the anterior wall of the right ventricle. The generator was generally placed in the upper subcutaneous space of abdomen. Additional costal cartilages were removed in 7 patients in whom a larger operating field could not be obtained initially. The electrode was sutured to the right ventricular wall in 28 patients, right atrial wall in 6 patients, and the left ventricular wall in 5 patients. The mean operation time was 150min and mean bleeding during operation was 82ml. Long-term results (258 months at the longest, at the time of writing) showed that all the patients did well, except for one adult who suffered cerebral infarction, and one child with pacing failure. Based on these findings, we believe that this procedure is minimally invasive method, and is good for fixation of a myocardial lead.

Surgery and cryoablation have been the preferred method for treating drug resistant ventricular tachycardia (VT). Cryoablation, the therapeutic usefulness of which has been documented in many reported studies, is nevertheless not free from technical difficulaties. The advent of Bard^® System 6000 Argon beam coagulator (ABC) as a new procedure alternative to cryoablation offered us a hope for solving problems with conventionally used techniques. Preliminary experiments with this device on dog myocardium permitted us to determine therapeutically adequate irradiation time and depth of cauterization and to locate an optimum area of myocardium to be coagulated. Based on these experiences, an attempt was made to use ABC as an adjunct to surgery in the surgical treatment of 4 patients with monofocal non-ischemic VT. In 1 of these 4 patients, VT disappeared postoperatively, making use of antiarrythmia drugs quite unnecessary, while in the remaining 3, a marked diminution of ventricular arrhythmia with a consequent reduction of drug dosage was achieved, use of the device thus being judged to be beneficial. These results led to the conclusion that ABC will provide a valuable adjunct to operation in selected cases of VT and, if the probe and other appliances are further refined, can reasonably be anticipated to be used as frequently as cryoablation.

We describe a 38-year-old, severely emaciated female with slowly progressive type 1 diabetes mellitus (SPIDDM), who had hypoglycemia due to fasting and an extremely low energy intake. After being diagnosed with diabetes mellitus (DM), she took in only 300-500 kcal per day and her weight had decreased to 30 kg, with a body mass index (BMI) of 11.4 kg/m². She was admitted with hypoglycemia, and SPIDDM was confirmed by nearly-completely ceased insulin secretion and seropositivity towards anti-GAD antibody. After appropriate dietary therapy and insulin administration, she recovered from a state of emaciation and her glucose metabolism was restored. With this patient it proved very effective for the general physician to coordinate treatment for both diabetes and an eating disorder.