We performed surgery for atrial fibrillation and mitral valve disease on 3 patients along with atrial mapping. Macroreentrant circuits were found in 2 patients and the other patient showed a preexcitation ectopic focus in the left atrium. Right atrial excitation was chaotic in all three patients. Of the two patients with reentry circuits, one patient underwent biatrial incisions and the other patient had only a left atrial incision. In the patient with a preexcitation ectopic focus, we performed cryoablation of that focus and made a left atrial incision in order to prevent the reoccurrence of atrial fibrillation after surgery. Following surgery, one patient experienced transient atrial fibrillation, however, continuous atrial fibrillation was resolved by this procedure and all patients returned to a normal sinus rhythm.

We evaluated the relation of changes in skin temperature, measured by thermography, to clinical symptoms and findings in patients who underwent coronary artery bypass surgery using the radial artery. All had a negative Allen test before operation. Ten consecutive patients who underwent surgery at least 3 months prior to the study were selected. Left radial artery grafts were harvested in all patients. Skin temperature was measured twice, before and after exercise. Two patients had a cold sensation at the arterial harvest site at rest. Three, including these two, complained of pain along the harvest site after exercise. No differences in temperature were observed before and after exercise in the ulnar aspects of the palm or forearm on either the left or right side. On the other hand, the increase in radial aspect temperature on the left side was smaller than that on the right. Skin temperature was clearly decreased after loaded exercise in 3 patients. We believe that the indications of grafting should be carefully considered because patients can show findings associated with circulatory disturbance at arterial harvest sites.

A hot water extract of Flammulina velutipes Sing.(FEH-1) showed a markedly high antitumor effect against sarcoma 180 in ICR mice. FEH-1 (10mg/kg) was administered intraperitoneally for consecutive 21 days before and after the subcutaneous inoculation of sarcoma 180 (4.1X10⁶ cells) to the mice. Animals were sacrificed on the 24th day after the inoculation of sarcoma 180 and tumor weight was determined. The highest tumor inhibition ratio was 98.5%, when FEH-1 was administered at the dose of 10mg/kg.
Cytotoxicity of FEH-1 was denied by the following two tests:(1) after mixed-culture of Vx2 tumor cells with FEH-1 for 7 days in vitro, number of Vx2 cells was counted by dye-exclusion technique, and (2) after contact of Vx2 cells with FEH-1 for 1 hour, the cell mixture was inoculated subcutaneously to the rabbits. It was suggested that antitumor effect of FEH-1 was host-mediated.

Aneurysm of peripheral pulmonary artery was rarely reported. A 51-year-old man who was pointed out a coin lesion at the right hilus region on the chest X-ray film complained back chest pain. Selective pulmonary arteriography revealed the peripheral pulmonary aneurysm of saccular dilatation running into the middle lobe. Aneurysmectomy was performed successfully and the patient returned to social work. Pathologic specimen revealed partly necrosis of medial cell. Eleven surgical cases including this case were reported in Japan. A brief review of the literature was made.

From March 1981 to March 1990, 61 patients with Stanford type B acute aortic dissection were initially treated by conservative therapy. Among these 61 patients, the dissected lumen became occluded due to thrombosis early after diagnosis in 25 patients (Group T) and remained patent in 36 patients (Group P). Twentythree patients in Group T (92%) and 22 patients in Group P (61%) were discharged without major complications related to acute aortic dissection. However, 2 patients in Group T (8%) and 14 patients in Group P (39%) required additional surgical therapy or died during hospitalization. The mean aortic diameter at the time of admission in Group T was smaller than that of Group P (38±3mm vs 43±7mm, p<0.05). During the observation period, there was a tendency for the diameter of the dissected aorta in Group T to decrease, but to increase in Group P. Long-term survival appeared to be better in Group T than in Group P, but there was no significant difference in the overall survival curve. Large aortic diameter at the time of admission and the presence of a true thoracic aortic aneurysm were major contributing factors influencing the prognosis. A long-term follow-up study showed that the dissected lumen reduced or disappeared in 14 of 23 patients in Group T (61%) but only 2 of 16 patients in Group P (12.5%). We concluded that the patients with small dissected aortas and thrombosed dissected lumens (Group T) can recuperate only with conservative therapy. However, patients with large dissected aortas and patent dissected lumen (Group P) may require surgical therapy even in Stanford type B aortic dissection.

A study was performed to clarify the relationships between oxygen uptake (VO₂) kinetics on recovery from incremental maximal exercise and blood lactate, glucose and alanine metabolism. Eight healthy males aged 21.6±3.3 years were studied. The incremental exercise test was performed using a modified version of Bruce's protocol until 30 min after exhaustion. The VO₂ responses on recovery were fitted by a two-component exponential model. Blood lactate concentration in the recovery phase was fitted by a bi-exponential time function to assess the velocity constant of the slowly decreasing component (γ2) expressing the rate of blood lactate removal. Both blood lactate and plasma alanine concentration were significantly increased from rest to maximal exercise, and were significantly decreased thereafter, but remained above resting values for 30 min after the maximal stage. Blood glucose concentration was significantly decreased following maximal exercise and returned to the pre-exercise value by 30 min after the maximal stage. Concentrations of plasma branched-chain amino acids (valine, leucine and isoleucine) were significantly decreased from the maximal stage until 30 min after exhaustion. The time constant of the slow component on recovery VO₂ [τVO₂ (s) ] was correlated with neither γ2 nor the degree of change in blood lactate from the maximal stage until 30 min after exhaustion (Δlactate) . However, τVO₂ (s) was significantly correlated with both Δ blood glucose and Δ alanine. In addition, Δ alanine was significantly correlated with Δ blood glucose. From these results, we conclude that oxygen uptake kinetics after exhaustive maximal exercise is related to glucose resynthesis through alanine metabolism, as compared with that from lactate metabolism.

A study was performed to clarify the effects of endurance training above the anaerobic threshold (AT) on the isocapnic buffering phase during incremental exercise in athletes. Eight middle-distance runners aged 19.6±1.2 years performed incremental exercise testing with a modified version of Bruce's protocol. After a 6-month high-intensity interval and paced running training at levels above AT, maximal oxygen uptake (VO₂max) (ml⋅ kg^-1⋅min^-1) was significantly increased from 60.1±5.7 to 64.7±5.5 (p<0.05) . AT (m⋅lkg^-1⋅min^-1) was slightly but significantly increased from 28.2±3.5 to 29.6±4.3 (p<0.05) . The respiratory compensation point (RC) (ml⋅ kg^-1⋅min^-1) was markedly increased from 53.0±8.3 to 57.7±8.2 (p<0.05) . Although neither the slope of the first regression line below AT (S1) nor that of the second line above AT (S2) calculated by V-slope analysis was altered, the range of isocapnic buffering (ml⋅kg^-1⋅min^-1) from AT to RC was significantly extended from 24.8±5.9 to 28.1±6.0 after the 6-months of training (p<0.05) . In addition, the amount of change in VO₂max after the 6-month of training period (ΔVO₂max) was correlated with Δisocapnic buffering (R=0.72, p<0.05) . We conclude that the degree of increased respiratory compensation point is larger than that of AT after high-intensity endurance training at levels above AT, and that the range of isocapnic buffering may be an important factor in relation to the increase in the maximal aerobic capacity of athletes.

A study was conducted to establish a method for quantitative evaluation of both the rate and degree of muscle oxygenation during ramp exercise using Near Infrared Spectroscopy (NIRS), and to determine the relationship of the indices to body composition and physical fitness. The subjects were 13 healthy men. After a warm-up period of 3 min at 20-W, the ramp exercise test was conducted. The exercise consisted of an increasing work rate at a slope of 20 W/min on a cycle ergometer performed until volitional fatigue. The NIRS probe used in the cycling exercise was placed on the vastus lateralis muscle. After 30 min of exercise, calibration was performed by cuff occlusion for 10 min with a pressure of 260 mmHg for quantitative determination of the NIRS curve. The oxygenation curve measured by NIRS during the exercise initially exhibited a linear decrease as the work rate increased. This rate of decrease in oxygenation was indicated by the NIRS slope (%/W) obtained from the calibration curve. In later stages of the exercise, the NIRS curve became flattened with increased work rate. The breaking point between the sloping phase and the flat phase was named the “NIRS Threshold 2, NT 2”. In addition, the rate of decrease in oxygenation at the end of exercise per maximal NIRS decrease obtained from the calibration curve was indicated as the %NIRS fall. The mean NIRS slope and %NIRS fall were 0.3±0.1%/W (range, 0.13 to 0.50%/W) and 29.9±11.8% (range, 12.0 to 50.0%), respectively. NT 2 was observed in 8 of the 13 subjects. The subjects were divided into two groups (NT 2 (+) and NT 2 (-) ) based on the appearance of NT 2. Both the NIRS slope and %NIRS fall in the NT 2 (+) group were significantly higher than those in the NT 2 (-) group. The NIRS slope was significantly correlated with VO₂/wt at VT (r=0.73, p<0.05) and wattage at VT (r=0.86, p<0.0001) . The %NIRS fall was significantly correlated with VO₂/wt at peak (r=0.80, P<0.001) . The NIRS slope and %NIRS fall were not significantly correlated with body mass index, %fat or thigh circumference.
These findings suggest that the NIRS slope indicates the efficiency of oxygen exchange in muscles activated during incremental exercise, and that the %NIRS fall indicates the ability to utilize Oxy-Hb+Mb against maximal oxygenation capacity in muscles. The NIRS slope and %NIRS fall can therefore be used as indices of muscular limitation during exercise, and as indices of muscular adaptation during exercise.

The purpose of this study was to confirm both the reproducibility of indices (NIRS slope, NT2, %NIRS fall) and the specificity obtained by analyzing the muscle oxygenation curve measured by near-infrared spectroscopy (NIRS) during ramp exercise. Ten healthy men participated in this study. The NIRS probe was placed on the vastus lateralis muscle. An increase in oxygenation was observed from rest to warm-up at 0 watts (Δ NIRS) . Oxygenation began to decrease lineally as the workload increased (NIRS slope) . In the latter phase of exercise, the oxygenation curve flattened out despite an increasing workload, and as a result, an inflection point was formed (NT2) . The minimum value of oxygenation during ramp exercise was indicated as“%NIRS fall.”
Protocol 1. After a warm-up period of 3 min at 0 watts, a ramp exercise (20 watt/min) test was performed until volitional fatigue. The test was performed for each subject twice (test-1, test-2) with a 1-week interval. Protocol 2. A test was performed with three consecutive ramp exercises (lOwatt/min·20watt/min·30watt/min) up to120watt each with sufficient rest between the exercises.
NT2 was observed in 7 of 10 subjects. Test-1 and test-2 mean values of ANIRS, NIRS slope, watts at NT2 (NT2) and %NIRS fall were not significantly different, and the correlations between test-1 and test-2 were highly significant (r=0.94, P<0.0001: ANIRS, r=0.99, P<0.0001: NIRS slope, r=0.91, P<0.002: NT2 and r=0.78, P<0.005 : %NIRS fall) . The regression lines obtained for correlations of results of test-1 and test-2 were y=-5.89+1.38X (Δ NIRS), y=0.02+ 1.03X (NIRS slope), y=31.52+0.83X (NT2), and y=19.91+0.61X (%NIRS fall) . No significant differences in both intercept and coefficient between the regression line and identity line were found in the NIRS slope and NT2. The rate of decrease in the oxygenation curve became steeper with an increase in work-load from 10 watts/min to 20 watts/min and to 30 watts/min. However, the mean values of the NIRS slope, modified by watts, were 0.29±0.06%/watt, 0.29±0.07%/watt and 0.29±0.07%/watt, respectively. There were no significant differences of the NIRS slopes among these exercises. The results indicate constancy of the rate of decrease in oxygenation per workload.
In conclusion, these findings demonstrate the reproducibility of the NIRS slope and the appearance of NT2 during ramp exercise, and the specific way in which the decrease in muscle oxygenation reflects workload. They suggest that analysis of the muscle oxygenation curve can be used to estimate muscular metabolism and indices of training effects.

Congenital heart disease of partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly was very rare. 21-year-old man, who was pointed out heart disease 6 months ago, was diagnosed as partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly by cardiac catheterization and angiography. The patient underwent surgery through the left forth intercostal incision without cardiopulmonary bypass. The end-to-side anastomosis was made between the vertical vein and the left atrial appendage following ligation of the vertical vein near the innominate vein. Surgical treatment was satisfactory in the postoperative angiography which was shown widely patent anastomosis. He was discharged with uneventful postoperative course and returned to full activity.