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.

Cabrol's technique was performed on a patient with corrected transposition of the great arteries (SLL), complicated by annuloaortic ectasia (AAE) and aortic regurgitation (AR). The patient, a 52-year-old male, complained mainly of dyspnea on physical exertion. In 1983, he underwent implantation of a pacemaker to treat advanced atrioventricular block. In 1994, his cardiac function deteriorated to NYHA III. Cardiac catheter examinations exhibited 2nd degree Seller's aortic valve insufficiency and 2nd degree insufficient closure of the left atrioventricular valve. The patient was Cardell classification B3, with a Shaher Type 4 coronary artery. A composite graft was made using a 27mm St. Jude Medical valve and a 30mm woven Dacron graft. The left atrioventricular valve had three leaflets, accessible from the right atrium using the septal approach. Kay's method was used to suture the posterior leaflet and reduce regurgitation. The patient has made favorable progress during the two-year follow-up period.

BACKGROUND : This survey examined how a physician's specialty may influence attitudes towards blood glucose control in diabetic patients.
METHODS : A questionnaire was mailed to all members of the Ishikawa Medical Association (n=1,610) as well as diabetic specialists (n=36) querying their specialties, confidence in offering diabetic treatment, and treatment goals/change levels of plasma glucose levels for 5 theoretical cases.
RESULTS : 301 physicians responded. The percentage answering treatment goal/change levels was 93% of internal medicine physicians (n=145), 72% of surgeons (n=29), 52% of pediatricians (n=23) and 20% in other specialties (n=99). The percentage answering “I am confident in offering diabetic treatment” was 57% of internal medicine physicians, 14% of surgeons, 13% of pediatricians and 3% in other specialties. There were significant differences among specialties in the fasting plasma glucose levels in the treatment goal, and the postprandial plasma glucose change levels. Internal medicine specialists tended to give higher glucose levels than other specialties.
CONCLUSIONS : The majority of physicians interested in diabetes care appear to be internal medicine specialists. Physician's specialty may influence their attitude toward glucose control in diabetic patients.

Cystic adventitial disease of the popliteal artery is an uncommon disorder. 58-year-old male complained of left intermittent calf claudication and couldn't sit straight. He preferred playing baseball and jogging. Digital subtraction angiograms revealed a smooth extrinsic compression on the proximal left popliteal artery. Surgical procedure was performed with posterior approach. The left popliteal artery was confirmed to be surrounded by two adventitial cysts at operation. After the evacuation and removal of these cystic wall, peripheral popliteal artery pulse was improved. Postoperative course was smooth and calf claudication was completely disappeared, post operative angiogram showed no stenosis. Histological examination of the resected specimen showed degenerated elastic fiber and inflammatory granulation. We have found 40 cases previously reported in Japan and the present case was 2nd one in our institute.