A 55-year-old man presented with exertional dyspnea. He was found to have an incomplete atrioventricular septal defect (AVSD), mitral regurgitation, a patent foramen ovale (PFO), atrial fibrillation, and pectus excavatum. A one-stage operation including thoracoplasty in addition to the intracardiac repair was preferred in order to obtain a good view of the operative field and control the postoperative hemodynamics. Therefore, we performed autologous pericardial patch closure of the AVSD, mitral valve plasty with closure of the mitral cleft, direct closure of the PFO, and a modified maze procedure, followed by sternal elevation (modified Ravitch procedure) during chest closure. Postoperatively, his respiratory status on a respirator improved slowly and he was extubated on the 17th postoperative day. Dysphagia developed because of the prolonged intubation, but improved with deglutition rehabilitation. The subsequent postoperative course was uneventful and he was discharged on the 59th postoperative day. We performed a modified Ravitch procedure, instead of sternal turnover, because the latter requires exfoliating a broad area, which could increase the total blood loss and the risk of infection, and make it difficult to maintain the blood flow of the plastron. We obtained a good view of the operative field and stable hemodynamics postoperatively with sternal elevation in pectus excavatum accompanied by heart disease.

To examine the effects of pesticides on farmers working in vinyl-covered greenhouses, subacute toxicity tests were conducted on rabbits exposed in the greenhouse a period of three months to zinc ethylenebis-dithiocarbamate (ZED) and N-trichloromethylthio-tetrahydrophthalimide (NTT), which had been sprayed once or twice a week. As a result, the authors have arrived at the following conclusions:
1) Either ZED or NTT did not inhibit the growth of the rabbits during the period.
2) Any significant changes attributable to the spraying of both pesticides were not detected in blood, urine and biochemical examinations.
3) Pathohistological examination showed the infiltration of polymorphonuclear leukocytes and histocytes in the interalveolar tissue of the lungs of the NTT-exposed rabbits. However, in the case of the ZED-exposed group of rabbits, the infiltration was so slight that there was veritably no difference from the control group.
In the brain, heart, liver, kidney, spleen, suprarenal gland, stomach and intestines, there were no abnormalities worth mentioning.
4) In several cases of the NTT-exposed group, inflammation was observed in their eyes and skins, whereas nothing abnormal were observed in the ZED-exposed group.
5) The concentration of ZED in air within the vinyl greenhouse at a time of spraying was 0.35mg/m3 and NTT measured 0.20mg/m3. After a lapse of one hour, either pesticide was undetectable.

A 4-year-old boy was born with cyanosis and was given a diagnosis of tetralogy of Fallot and pulmonary atresia. Echocardiography showed membranous atresia of the pulmonary trunk that was connected to the left side of the ascending aorta via an aortopulmonary window 3 mm in diameter. Four major aortopulmonary collateral arteries (MAPCAs) were detected by cardiac catheterization and computed tomography angiography prior to undergoing surgery at 4 years of age. We performed one-stage complete unifocalization and definitive repair via a median sternotomy. The MAPCA supplying the left lower lobe was anastomosed to the true left pulmonary artery and the pulmonary artery trunk was augmented with an autologous pericardium patch. We then reconstructed the right ventricular outflow tract using a transannular patch and simultaneously patch-closed the VSD. The right/left ventricle pressure ratio after weaning from cardiopulmonary bypass was 0.8. The postoperative course was uneventful and the patient was discharged 26 days later. Seven months after the procedure, the right/left ventricle pressure ratio was decreased to 0.56 on cardiac catheterization.

A baby girl delivered at 41 weeks of gestation with persistent truncus arteriosus (PTA) and interrupted aortic arch (IAA) type A was referred to our institute for surgical intervention. Bilateral pulmonary artery banding (BPAB) proceeded through a median sternotomy at the age of 11 days to control excessive pulmonary blood flow. Thereafter, she gained weight under continuous prostaglandin E1 (PGE 1) infusion. Definitive repair proceeded at the age of 2 months. Cardiopulmonary bypass was established through a redo-median sternotomy, with two arterial cannulae (brachiocephalic artery and descending aorta). The aortic arch was reconstructed with direct anastomosis. The orifice of the pulmonary artery was removed from the arterial trunk and the defect in the aortic wall was directly closed. A ventricular septal defect was closed under cardioplegic arrest via a right ventriculotomy. The continuity from the right ventricle to the pulmonary artery was made using a hand-made, extended polytetrafluoroethylene (ePTFE) conduit with a bicusp. The sternum was left open at the end of the procedure and the chest was closed on post-operative day (POD) 3. She was weaned from mechanical ventilation on POD 4 and the postoperative course was uneventful. She was discharged on POD 49.

We report a rare case of double outlet right ventricle (DORV) with sub-pulmonary type ventricular septal defect (VSD). The great arteries were almost side-by-side, and the ascending aorta was located slightly posterior to the right of the pulmonary artery. We performed complete repair at the age of 25 days. Intra-cardiac rerouting (VSD closure) was carried out through the tricuspid valve. Arterial switch procedure was performed without the Lecompte maneuver. His postoperative course was uneventful and he was discharged 19 days after the operation without any complications.

We performed bilateral pulmonary artery banding (BPAB) through a median sternotomy on a four-day-old male infant with a double-outlet right ventricle (DORV) and interrupted aortic arch (IAA) who was delivered at 40 weeks of gestation. After urinary output improved, definitive repair was carried out 5 days later. Intra-ventricular rerouting was followed by arterial switch with the Lecompte maneuver. The aortic arch was reconstructed with direct anastomosis and the right ventricular outflow tract was augmented with a patch. The sternum was left open at the end of the procedure and the chest was closed on post-operative day (POD) 4. The patient was discharged from hospital on POD 78 after receiving treatment for pneumonia and chylothorax.

Objective: To inquire about how evaluation of physician supervisors is performed, and whether or not incentives to guide comprehensive community-based clinical clerkship for them are provided, in hospitals outside Sapporo Medical University.

Methods: We conducted field surveys using questionnaires distributed to physician supervisors and hospital directors, focusing on the evaluation of physician supervisors and whether they are provided with incentives. From the survey, we examined the attitude toward educational awareness of the physician supervisors.

Results: The number of hospitals where evaluations for physician supervisors were performed and incentives were provided was limited. In addition, 54.2% of the physician supervisors responded that incentives were unnecessary. Many of them considered that incentives for a hospital are more preferable than for individual supervisors.

Conclusion: These results suggest that with respect to community-based clinical clerkship outside the university, an appropriate method for providing incentives, including whether or not they are necessary, should be considered.

Each of the 1, 000-times dilute solution of both drugs, Salithion and Sumithion, were experimentally sprayed over rabbits in vinyl greenhouses at a rate of five hours a day for three consecutive days. Changes in the residual quantity of the drugs in the blood and also in the quantity of PNMC, a metabolite of Sumithion in urine, were measured with the passage of time after the spraying. At the same time, the liver functions of the rabbits were checked and they were also subjected to a urinalysis and a pathohistological examination. The conclusions drawn from these studies are as follows:
1) No abnormal findings were observed on the appearance of the rabbits exposed to Salithion and Sumithion. Nor were there any abnormalities in the ophthalmologic findings, especially, in the funduscopic findings, at 10 and 30 days after the spraying of these drugs.
2) The residual quantity of both drugs in all the experimented rabbit's blood was measured immediately after the spraying. However, these drugs later disappeared rapidly from the blood, and they could not be detected 10 days after the spraying.
3) There was a significant rise in the quantity of PNMC 24 hours after the spraying. Later, it decreased rapidly. Ten days after the spraying, its values returned to normal level before the spraying.
4) With respect to the serum ChE level, the changes in the groups exposed to Salithion and Sumithion were the same as those in the control groups. So, any influences were not observed on serum ChE by the spraying of these drugs.
5) In the liver function test, urinalysis and pathohistological examination, no abnomal findings attributable to the inhalation of both drugs were observed.
6) The drug concentration in the air in the vinyl greenhouses at the time of their spraying was 61.5μg/m³ for Salithion and 30.1μg/m³ for Sumithion.

In the previous report, we concluded that chances are very slim for Salithion and Sumithion to concentrate in rabbits as these organophosphorous compounds are excreted quickly. This conclusion was inferentially drawn from the results of measurements of concentration of Salithion and Sumithion residues in the blood after experimental exposures of rabbits to the pesticides.
In the present report, we will discuss the same toxicological problem based on our findings in a series of experiments using rabbits with hepatic disturbances induced by carbon tetrachloride (CCl₄).
Rabbits were divided into three groups. One consists of rabbits having light hepatic disorder. They were subcutaneously injected with 0.1ml/kg of 20% CCl4 olive oil for three days consecutively. Under the second group come rabbits with moderate liver disturbance caused by the injection of 0.3 ml/kg of 20% CCl₄ olive oil. The injection was also made for three days. The remaining group is the control group.
These rabbits were administered orally with 5mg/kg and 20mg/kg of Smithion for three days running.
The examination covered (1) Sumithion residue level in the blood, (2) PNMC level in urine, (3) hepatic function (ChE, GOT, GPT, BSP, Al-P, BUN), (4) urinalysis and (5) histopathological examination of the liver and the kidney. The results of these tests were studied in comparison with those of the control group.
The following is a summary of our conclusion:
1) In the control group, Sumithion residues in the blood disappeared quickly, and could not be detected 72 hours after administration.
2) As far as the disappearance of Sumithion and the excretion of PNMC are concerned, there was no significant difference between the control and the light and moderate liver disturbance groups of rabbits.
3) In the rabbits with CCl₄-induced liver disturbances, it was noted that the administration of Sumithion impeded serum and red-cell ChE activities to a remarkable extent, and delayed the recovery of the liver function.
4) However, the liver disturbance did not deteriorate. The histological observation of the liver and the kidney did not reveal any abnormality due to the administration of Sumithion, either.

BACKGROUND/AIMS: Several studies have shown the usefulness of endoscopic nasogallbladder drainage (ENGBD) in patients with acute cholecystitis. However, the procedure is difficult, and factors that affect technical success have not yet been clarified. We conducted a prospective study to evaluate the technical feasibility, efficacy, and predictive factors for the technical success of ENGBD in patients with acute cholecystitis. METHODS: All patients with moderate or severe acute cholecystitis who were enrolled underwent ENGBD between April 2009 and April 2011. Patients with surgically altered anatomy or pancreatobiliary malignancies were excluded. The primary outcomes included technical success, clinical success, and complications. Factors that could affect the technical success were also examined. RESULTS: Of the 27 patients who underwent ENGBD during the study period, technical success was achieved in 21 (78%) and clinical improvement was achieved in 20 (95%). Early complications were encountered in four patients (15%). Gallbladder wall thickness (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.08 to 2.47) and age (OR, 1.16; 95% CI, 1.00 to 1.35) were effective predictors of technical failure. CONCLUSIONS: ENGBD was effective in resolving acute cholecystitis; however, this modality was technically challenging and had a limited success rate. Because of technical difficulties, ENGBD should be reserved for limited indications.
Age Factors ; Aged ; Aged, 80 and over ; Cholecystitis, Acute/*surgery ; Drainage/*methods ; Endoscopy, Gastrointestinal/*methods ; Feasibility Studies ; Female ; Gallbladder/pathology/*surgery ; Humans ; Male ; Middle Aged ; Odds Ratio ; Postoperative Complications/epidemiology ; Prospective Studies ; Sphincterotomy, Endoscopic ; Treatment Outcome