Eleven cases underwent tricuspid valve replacement with bioprosthetic heart valve between 1981 and 1990. Mean age was 51±12 years old and mean follow up period was 40±40 months. Mitral valve replacement in ten cases and aortic valve replacement in one underwent simultaneously. Warfarin and dipyridamole were prescribed for post-operative anti-coagulant therapy. Post-operative early death within 30 days was seen in two cases and late death was in two cases. Five years survival rate including early death was 70±14% and nine years survival rate was 54±18%. All seven cases excluding demised cases were III°or IV°in NYHA classification preoperatively but six were I°or II°at postoperative period. Preoperative functional status of all fatal cases were IV°. Cardio-thoracic ratio was 76.2±12.8% pre-operatively, 67.7±9.0 one year after operation, 66.3±7.8% three years after operation and 68.9±9.3 five years after operation. In conclusion post-operative cardiac function ameliorated, but could not return to fairly satisfactory state.

Fifty-two year-old woman was operated for type A acute dissection of the aorta superimposed on pre-existing post-stenotic dilatation dut to congenital aortic valve stenosis. The left main coronary artery was discontinued by dissection. Aortic valve replacement, replacement of ascending aorta by woven-Dacron graft and saphenous vein graft between the left anterior discending artery and the prosthetic graft. Compression gauze around the site of the anastomoses and the prosthetic graft was useful to control of intractable bleeding. The gauze could be extracted twenty-eight hours after the operation by platelet and plasma transfusion. She was well eleven months after the operation.

Injuries to the aorta complicating cardiovascular operations can be very challenging. This type of injury is usually related to manipulation of the aorta during surgical exposure or aortic cannulation. From March 1994 to October 1997, five patients with intraoperative injuries to the thoracic aorta occurred. Their ages ranged from 7 to 71 years old (mean, 43.5 years). Two were male and 3 female. Intraoperatively, trouble occurred suddenly due to acute aortic dissection related to aortic traumatic hemorrhagic disruption in three patients, and aortic cannulation in two patients. The confirmation of the diagnosis was prompted clinically, and all patients immediately underwent further surgical intervention. In terms of technique, we used a cardiopulmonary bypass (mean cardiopulmonary bypass time 239min, range 196 to 367min), and hypothermic circulatory arrest (mean arrest time 34min, range 20 to 44min, at deep hypothermia with 21.0°C urinary bladder temperature) during repair. Retrograde cerebral perfusion was utilized in two cases to assure protection for cerebral damage. Fortunately, there was no postoperative neurological complication and no hospital death in any of the cases. When such intraoperative injuries of the aorta once occur repair using aortic clamps often fail or is not feasible, and in such cases hypothermic circulatory arrest combined with retrograde cerebral perfusion should be applied to resolve this type of the serious troubles.

Since 1976, allergic contact dermatitis caused by Chrysanthemum morifolium Ramalk (commercial name: Kinriki) occured on the grower in Tokushima Prefecture. Consequently, a systematic study aimed at the isolation of the allergen of the chrysanthemum was udertaken.
The allergens were contained in the fresh juice of the leaves of chrysanthemum and they were of two types: one was water-soluble and the other was fat-soluble, judging from the results of application test of the skin reaction for sensitized guinea pigs.
The fresh juice of the chrysanthemums was fractionated with ammonioum sulfate saturation method and the active precipitates were chromatographed on Sephacryl S-300 and DEAE-cellulose column, successively. The most active fractions contained sugar and protein, suggesting that the water-soluble principles are high molecular glyco-protein. The other hand fat-soluble fraction was obtained from ethyl acetate extract of the supernatant of 65% ammonium sulfate saturation. The extract was chromatographed on silica gel column and on the thin layer to yield 5, 7-dihydroxychromone (I) and sesquiterpens (II-VI). Unfortunately, at that time the sensitization of ginea pigs was unsuccessfuly. Therefore their compounds could not be tested for the allergenic reaction.
When the precipitates of ammonium sulfate were extrcted with ethyl acetate, the allergenic activeity of the precipitates decreased. However, re-addition of the ethyl acetate extracts to the extracted precipitates recovered the activity. Cross reaction between the juice of leaves and sesquiterpene lactone, alantolactone, failed on skin reaction of sensitized ginea pigs.

A 52-years-old female farmer has suffered from bronchial asthma during the last 10 years during the lettuce growing season (NOV.-May). Laboratory test findings showed that her sumptoms were due to type I allergy. Namely, she showed eosinophilia, an increased level of Ig E and an immediate positive reaction to intracutaneous lettuce allergen. But, she gave negative reactions in RAST and immediate skin reaction test to 23 common allergens. By provocation tests she showed positive reactions to both the environment (FEV_1.0-26.8%) and allergen inhalation (FEV_1.0-30.0%), and had amoderate attack 15 minutes after inhalation of undiluted lettuce juice. The allergen was extracted from fresh lettuce juice by Coca's method. The protein concentration of the allergen was 8.74 mg/ml and its concentration in crude juice was 0.874 mg/ml.
Inhalation of lettuce juice during the harvest time was concluded to be the cause of this allergy.
A survey of farmers cultivating lettuce by a questionnaire and by mass physical examination revealed dermatitis as the most frequent complaint, with a similar incidence (7.1%) of respiratory symptoms including rhlnitis. However, further detailed questioning showed that the cause of most respiratory symptoms was not allergic, and the intracutaneous reaction of the farmers to the allergen was similar to that of control subjects who were not farm workers. The positive rate of the skin patch test was significantly higher in farmers growing lettuce than in control who were not farm workers.
Allergic disease caused by lettuce might be generated as allergic dermatitis of type IV. Type I allergy caused by lettuce is rare, but here we reported one case of this rare type.

Approximately 100 kinds of Foods for Specified Health Use (FOSHU) are used to “control postprandial elevated blood glucose level”. In this review, we describe their safety and effectiveness.

This study aimed to evaluate dynamic balance capability, bathyesthesia, and the composite compensation of bathyesthesia and visual sense for dynamic balance assessed by use of force plates and to examine their correlation to age in a cross-sectorial manner. Participants of this study were 147 healthy people (55 men, 92 women). To evaluate dynamic balance capability, we evaluated the index of postural stability (IPS), which is the logarithmic value of the ratio of the area of stability limits to the area of postural sway, with participants standing on a hard surface with eyes opened. To measure bathyesthesia, we evaluated the modified index of postural stability (MIPS), i.e., the IPS with participants standing on a soft surface with eyes closed. As for the composite compensation index of bathyesthesia and visual sense for dynamic balance, we calculated the rubber IPS Romberg ratio (MIPS/IPS). The correlation coefficients (Spearman’s rho) of IPS, MIPS and MIPS/IPS to age were −0.666 (p < 0.001), −0.697 (p < 0.001) and −0.600 (p < 0.001), respectively. These results suggest that dynamic balance capability and bathyesthesia decline with advancing age, and the composite compensation of bathyesthesia and visual sense for dynamic balance strengthens with advancing age.

Seventy patients with rheumatic valvular disease were evaluated with preoperative CT scanning. The correlation of the obtained CT images to the operative findings were examined. Left atrial thrombi were found in 24 cases at the operation. CT scan had detected thrombi in 19 cases (79.2%) and echocardiography in 15 (62.5%). CT failed to find them in 5 cases in which the left atrial thrombi were less than 3g. Echocardiogram, however, failed to detect thrombi in 9 cases, the largest being 14g. There were 15 cases with left atrial calcification, in which 10 cases had left atrial thrombi. Nine cases out of these 10 cases had rough left atrial surface after thrombectomy. Early postoperative CT of 10 with left atrial calcification showed recurrent left atrial thrombi in 4 (40%) cases. Mitral valve calcification was found in 42 cases during operation. CT scan was able to detect it in 40 (95.2%), while echocardiogram detected in 34 cases (81.0%) (p<0.05). All mitral valves with calcification required replacement. Out of 30 cases with non calcified mitral valves, 9 underwent OMC, and the other 21 underwent mitral valve replacement. Aortic valve calcification was found in 9 out of 11 cases with aortic stenosis. All has been diagnosed by CT scan. In conclusion, 1. In detecting the left atrial thrombi, CT scan was superior to echo-cardiography, and provided useful information for planning the operative procedure including atrial approach and valvular manipulation. 2. CT scan could detect calcification of left atrial wall which had high incidence of thrombus formation and rough left atrial surface. 3. CT scan could detect calcification of both mitral and aortic valve, and showed the severity of valvular structural changes.

To avoid homologous blood transfusion, the effectiveness of autologous blood predonation was evaluated in patients with elective abdominal aortic aneurysm (AAA) repair. From January 1993 to July 1996, 53 patients underwent Y graft replacement by using autologous rapid transfusion device AT1000^® (Electromedics. Inc, Englewood, CO). The patients were devided in to 3 groups. Thirty one patients had no blood donation (Group A). Twelve patients had 400ml blood donation with administration of an iron preparation (Group B). Ten patients donated the same amount of blood as those in Group B, with administration of both an iron preparation and recombinant human erythropoietin (rHuEPO) (Group C). There were no significant differences in terms of age, gender, operating time, intraoperative bleeding, and total amount of homologous and autologous blood transfusion in the 3 groups. In Group A, the mean volume of homologous blood transfusion was 250±370ml and in both Groups B and C, no homologous blood was required and 400ml autologous blood was used. Homologous blood transfusion was avoided in 58.9 (18/31) of patients in Group A and all of the patients in Groups B and C. Due to the blood predonation prior to surgery, a hemoglobin level decreased significantly at the time of operation in Group B (without rHuEPO), but in Group C (with rHuEPO) the hemoglobin level was kept constant. During the first postoperative week, the minimum hemoglobin level in Group C was significantly higher than in the other groups. In conclusion, by donating 400ml autologous blood before surgery and using an intraoperative autotransfusion system, homologous blood transfusion could be avoided in elective AAA repair. With rHuEPO, the hemoglobin level could be maintained, despite predonation and intraoperative blood loss.

Primary malignant cardiac tumors are extremely rare. Among these, leiomyosarcoma are particularly exceptional and only about 20 surgically treated cases have been extensively described. We describe a case of right atrial leiomyosarcoma which was accidentally found by computed tomography. The tumor was surgically resected under extracorporeal circulation. Two months later the patient had cerebral hemorrhage due to a brain metastasis, which almost completely disappeared after irradiation. There was no other evidence of recurrence for 12 months after operation.