We experienced three cases of triple shunts (VSD+ASD+PDA) for past ten years. All three cases admittied with cardiac failure and respiratory distress early in the infant period. Ligation of PDA, suture closure of ASD and patch closure of VSD were performed in the two cases. Another case was performed ligation of PDA because of low body weight (1, 700g). Triple shunts were correctly diagnosed in only one case. Another two cases were diagnosed VSD and PDA at operative period. The patient with low body weight was lost at 38 days after operation. Post operative course were uneventfull in the two cases of total repair. Triple shunts should be repaired in the same time. But two staged operations are consider to perform in the low body weight infant and patients with major general pediatric surgical disease.

A 75-year-old man who presented with fever and cough was given a diagnosis with active pulmonary valve endocarditis and transferred to our institution. Blood cultures were positive for Enterococcus faecalis, and transthoracic echocardiography showed a mobile vegetation attached to the pulmonary valve. Despite an 8-week treatment with antibiotics, a relapse of the infection required surgery. During the surgical procedure, we found that the vegetation had destroyed all of the pulmonary valve leaflets. After excising the pulmonary valve leaflets, we implanted a bioprosthetic valve and closed the pulmonary artery with autologous pericardium. The patient completed a 6-week course of intravenous antibiotics and was discharged on postoperative day 68. Postoperative transthoracic echocardiography demonstrated an adequate effective orifice area index. Our case report of isolated pulmonary valve endocarditis without predisposing factors is rare. The implantation of a bioprosthetic valve and enlargement with an autologous pericardial patch is an effective option for achieving a satisfactory hemodynamic profile.

We report a case of surgical treatment for pseudoaneurysm 4 years after Patch-and-Glue Repair of left ventricle free wall rupture (LVFWR) due to acute myocardial infarction (AMI) in 2004 in a 74-year-old woman, she had been followed in our hospital. And 2 years later, echocardiography and MRI showed a pseudoaneurysm at the repair spot which was growing very slowly. Since we found a thrombus in the pseudoaneurysm, a redo operation was performed in 2008. The pseudoaneurysm was successfully extirpated, under cardiopulmonary bypass. The infracted area had degenerated to scar tissue and we could suture tightly without worrying about a fissure in the wall. We can use Patch-and-Glue Repair to rescue the LVFWR patients due to AMI in the acute stage because it is possible to remove the pseudoaneurysm in the future, on pseudoaneurysm excision in a firmly infarcted area is possible in the chronic stage.

A case report of spontaneous dissection of the superior mesenteric artery (SMA) in a 53-year-old man who complained of sudden colic-midabdominal pain is presented. In this case, ultrasonography is very usefull for early diagnosis of dissection, and this is successfully treated by Ao-AMS bypass with excision of the proximal segment of SMA. Postoperatively the patient has no symptoms for 2 years.

The changes of hemodynamics during bathing in patients with heart diseases were studied by invasive methods using a Swan-Ganz catheter and UCG. As a population, we have used 37 peatients with heart disease, ages 20 to 76 (average age 52.9). There were 26 cases of myocardial infarction, 5 cases of valvular disease, 5 cases of cardiomyo pathy, and 1 case of VSD. Bathing was done with tap water in a Hubbard tank, for 10 minutes at 40°C and for 5 minutes at 43°C in a supine position. Arterial pressure, heart rate, pulmonary arterial pressure, pulmonary wedge pressure, right atrial pressure, cardiac output, stroke volume and stroke work index were increased during bathing and decreased after bathing. Systemic vascular resistance and pulmonary arteriolar resistance were decreased during bathing. Their changes were marked with a bath of 40 to 43°C. These findings suggest that preload may be increased during bathing, and preload and afterload reduced after bathing. Hydrostatic pressure, autonomic nervous reflexes or endocrine system were thought of as possible reasons for the increase in pulmonary arterial pressure. Because pulmonary arterial pressure, pulmonary wedge pressure and right atrial pressure increased during bathing even though systemic vascular resistance and pulmonary arteriolar resistance decreased, increase in venous return was thought of as the biggest possibility. And because the patients with low cardiac function could not control the extent of increase in venous return, pulmonary arterial pressure increased markedly in patients with low cardiac function. The patients with myocardial infarction were classifed into a group showing elevation of pulmonary arterial pressure (PAP) and a group showing no elevation of PAP. The group showing elevation of PAP, compared with that without PAP elevation, included many cases of severe myocardial infarction deter-mined by Forrester's classification, Killip's classification and Peel's prognostic index at admission to hospital. Among these patients showing PAP elevation, there were more cases having low physical work capacity and low ejection fraction at discharge from hospital than among the patients without PAP elevation.

Little is known about how isosorbide dinitrate (ISDN) contribute to bathing effects on patients with myocardial infarction. A study using an invasive method was made on 29 patients with myocardial infarction to clarify the hemodynamic changes occurring during bathing with and without sublingual ISDN, and to evaluate the overall effects of the ISDN. In bathing after discontinuing dosing of vasodilators (PRE-ISDN), patients were divided into the following two groups depending on the difference between the peak pulmonary capillary wedge pressure (PCWP) during bathing and PCWP before bathing: Increased PCWP group [(Group A): Δ PCWP≥10mmHg] and Unincreased PCWP group [(Group B): Δ PCWP <10mmHg].
Bathing was taken for 5 minutes at 42°C in a Hubbard tank, hemodynamics were observed during bathing and for 10 minutes after bathing, and after 30 minutes of sublingual administration of 5mg ISDN, bathing was taken in a similar manner. Group A patients showed a greater increase in heart rate, blood pressure, pulmonary arterial pressure (PAP), and right artial pressure than of Group B patients during bathing before being dosed with ISDN, and it seemed to be a considerable load on the heart. Although the remarkable increase of PAP and PCWP observed during the early stage of bathing before dosing with ISDN significantly decreased after sublingual dosing of ISDN (POST-ISDN) among Group A patients, these effects were not found in Group B patients. Group A showed more frequent reinfarction from a clinical viewpoint and triple vessel disease upon coronary arteriography, a lower ejection fraction upon left ventriculography, a higher left ventricular end-diastolic pressure, and lower left ventricular performance in most cases as compared to Group B. Although ISDN was found to be effective for severe cases in which the marked pre-load was observed by bathing, no beneficial effect on mild cases with well-maintained left ventricular performance was obtained.

Objective: The overproduction of reactive oxygen species leads to oxidative stress, which is related to lifestyle-related disease and cancer. Although antioxidants are considered as one of the countermeasures to oxidative stress, it is necessary to develop the assessment methodology for the antioxidant capacity which is closer to the inner body conditions. In this study, we examined antioxidant actions of plant extracts by using newly-developed neutrophil activity measurement system.
Method: Lemon verbena, Green tea, Camellia japonica and Antiallerge^® were used as plant extracts, and were diluted to medium in wide-range concentrations. Each solution was added on modified Mebiol Gel^® (hydrogel), and the mixture of blood and luminol were set onto the hydrogel in each tube. The amount of reactive oxygen species were measured by luminol-dependent chemiluminescence, whereas the cell count in the hydrogel was quantified as migratory activity of neutrophils.
Result: Lemon verbena and Green tea significantly inhibited reactive oxygen species in a concentration-dependent manner, whereas Camellia japonica and Antiallerge^® did not. The migratory activity of neutrophils was not affected by those plant extracts. Also, damaged cells were not detected.
Conclusion: It was suggested that Lemon verbena and Green tea scavenged reactive oxygen species without causing cell death of neutrophils. This new method for measuring neutrophil activities can be applied not only for assessing the status of inflammation and oxidative stress but also as the screening system for predicting the effectiveness of antioxidant and anti-inflammatory substances.

Hot water extract of adlay (Coix lachryma-jobi L. var. ma-yuen Stapf) seed, commonly called Yokuinin, has been used as herbal medicine for treating verruca vulgaris, et al. Although there have been a number of studies on the usefulness of Yokuinin, the pharmacological assessment of its husk, pellicle, and astringent skin remains unclear. In this line, we evaluated the effect of methanol extract from all parts of adlay grain (seed, husk, pellicle, astringent skin) on cancer cells and identified its useful chemical components. Results revealed that a fraction of the extract have weak growth-suppressing activity on human cervical cancer cell line (HeLa cell). In particular, 5,7-dihydroxychromone and coixol were isolated and identified from the active fraction. This indicates the possible cancer chemopreventive efficacy of methanol extract from adlay. Moreover, further tests are needed to determine the role of 5,7-dihydroxychromone.