To evaluate viability and severity of ischemically damaged myocardium, myocardial single emission tomography (SPECT) using 123I-BMIPP (BMIPP), a new tracer of myocardial metabolism of fatty acid, was performed before and after coronary artery bypass grafting (CABG). 201Tl myocardial SPECT (Tl) and left ventriculography (LVG) were also used. Thirty-three revascularized areas in eight patients were investigated. (1) Areas showing good redistribution on Tl and normal uptake on BMIPP indicated good viability and simple ischemic myocardium. Postoperative uptake of both tracers returned to normal levels. (2) Areas showing good redistribution on Tl and severely decreased uptake on BMIPP indicated jeopardized myocardium with severe ischemia. All such areas were seen in patients with unstable angina. Postoperative uptake of both tracers returned to normal levels. (3) Areas showing poor redistributionor severely decreased uptake on Tl and slight uptake on BMIPP indicating hibernating areas. Postoperative uptake became normal or better than preoperative uptake on Tl necrosis. However on BMIPP, the uptake was unchanged or recovered slightly. (4) Areas showing complete defect in Tl and BMIPP indicated necrosis and had no viability. Postoperatively the defect in both tracers were unchanged. Therefore, these areas required no revascularization. The ischemic state of myocardium could be assessed by evaluation of uptake patterns of BMIPP and Tl using myocardial SPECT. Therefore, using this new tracer of myocardial fatty acid metabolism “BMIPP”is useful for deciding culprit and viable lesions requiring coronary revascularization and evaluating therapeutical effects.

Periannular abscess and mycotic aneurysm due to infective endocarditis are very difficult conditions to treat surgically. Beginning in 1983, we introduced a translocation technique on 9 such cases. In particular, 7 patients who underwent a new sutureless translocation technique all showed an uneventful course and were discharged. There was no hospital death, but four patients died in the late period (2 heart failure, 1 ventricular tachycardia and 1 thrombotic valve). The sutureless translocation method consists of insertion of a composite valve into the ascending aorta (a ring was detached from an intraluminal ringed graft and a prosthetic valve was sutured to it at that point) and coronary artery bypass grafting to the right and left coronary arteries. Our new technique was simple, required only a short aortic clamping time (mean 173.9min) and there was no significant bleeding. This new translocation technique provides a solution for the treatment of periannular abscess and mycotic aneurysm due to infective endocarditis.

The purpose of this study was to clarify the relationship between the low back pain of college students and psychological factors by using a questionnaire for low back pains and five psychological tests. The tests consisted of the Hopkins Symptom Checklist (HSCL), State-Trait Anxiety Inventory (STAI), Purpose in Life (PIL) test, Hassles Scale for students and Type A test. The subjects were 337 college students (126 male, 211 female) ranging in age from 19 to 22 (mean ± SD: 20.2 ± 1.3) years. Seventy-four subjects whose lower back pain was thought to be caused by organic factors were excluded. The 263 subjects (102 males, 161 females, mean ± SD: 20.1 ± 1.1 years) were divided into three groups (NP: subjects with no pain, PND: subjects with pain but no difficulties in daily life, PD: subjects with pain and difficulties in daily life) by degrees of low back pain. The PD subjects showed a more negative attitude than those in the PND and/or NP groups for four tests, i.e., Hassles Scale and the psychosomatic component of the HSCL and State-Trait Anxiety Inventory tests. It was suggested that low back pain was related to psychological factors such as stress and anxiety.