We performed cardiac resynchronization therapy (CRT) in addition to aortic valve replacement (AVR) in a 74-year-old patient with poor cardiac function (New York Heart Association functional class III, ejection fraction 15%), complete right bundle branch block (CRBBB), left posterior hemiblock (LPH), and aortic valve insufficiency. Tissue Doppler echocardiography showed synchronicity of the septum and posterior segments in the left ventricle, and that contraction of the septum was in the systolic phase of the cardiac cycle after CRT. The New York Heart Association functional class improved from III to I after the operation. CRT of the dyssynchronized myocardium in a patient with CRBBB and LPH can improve regional cardiac function and synchronicity.

We performed cardiac resynchronization therapy (CRT) in addition to mitral valve replacement (MVR) in a 66-year-old patient with dilated cardiomyopathy (DCM) associated with complete left bundle branch block (CLBBB) and mitral valve insufficiency. Tissue Doppler echocardiography showed synchronicity of the septum and lateral wall in the left ventricle after CRT. New York Heart Association functional class improved from III to I after CRT and MVR. CRT of the dyssynchronic myocardium in a patient with DCM associated with CLBBB improves regional cardiac function and synchronicity.

To assess the changes in attitudes toward smoking after the smoking-prevention classes presented by Kumamoto Tobacco-Free Forum, this study administered a questionnaire survey to first-year junior high school students before and after a smoking-prevention class at a junior high school. The questionnaire that was used to pre and post comparison comprised thirteen items, ten from the Kano Test for Social Nicotine Dependence (KTSND-Youth) and three as follows: “I think I will be a smoker in the future,” “I think I will smoke about once,” and “What do you think of people around you who smoke tobacco?” The results of this pre- and post-class questionnaire indicate that attitudes toward seven items improved in a statistically significant way. These included four from KTSND-Youth: “Smokers cannot stop even if they want to,” “Smoking is adult-like and cool,” “Smoking is enjoys taste and a fragrance,” and “If it’s a place with an ashtray, it’s okay to smoke.” The smoking-prevention classes significantly decreased total KTSND-Youth scores. Furthermore, the analysis has clarified that the KTSND-Youth items: “Smoking is adult-like and cool” and “Doctor and school teachers say, ‘Tobacco is no good too much”, as well as the item “What do you think of people around you who smoke tobacco?” are significantly influencing factors for the item “I will be a smoker in the future.” These results indicate that the smoking-prevention classes presented by Kumamoto Tobacco-Free Forum were effective for decline in social nicotine dependence of the first-year students in junior high school.

An 82-year-old man was referred to our hospital for heart failure due to severe mitral regurgitation and severe tricuspid regurgitation. We performed mitral annuloplasty and tricuspid annuloplasty (TAP). Three weeks after surgery, he developed hemolytic anemia (HA). Transesophageal echocardiography revealed a defect in the left ventricular outflow tract that communicated directly with right atrium, and the jet was striking with the TAP prosthetic ring. HA was not controlled, so we performed re-operation. The defect was found in the atrioventricular membranous septum. The defect was closed and TAP was performed using an autologous pericardial roll again. We report a rare case of acquired left ventricular to right atrium communication after TAP.

A total of 82 cases of breast cancer detected by hand-scanning ultrasound massscreenig (hereafter referred to as US screening) over the past 15 years were divided into two groups--one aged under 50 and the other aged 50 or over at the time of examinaton. The accuracy and capacity of US screening and the rate of patients with subjective symptoms were studied for each group. As a result, we discovered that the groupaged under 50 was significantly higher in the rate of “further examination needed”, and the rate of “having subjective symptoms”, and was significantly lower in “positive predictivevalue” than the older age group. In the detection rate, sensitivity and specificity, there was no difference between the two groups. Thus, we concluded that US screening were beneficial to both groups.
Dividing the 15 years of US screening into three periods (each 5 years), we investigated the caliber of detected breast cancers, and found the tumor size became smaller year after year. As a result, the cases of non-palpable breast cancer came to form 26.6%, of which 72.3% was accounted for by invasive breast cancer. Further more, we found that in the group aged under 50, because of stiffness of their breast gland, the ratio of non-palpable breast cancer came to 30.2%, which was larger than in the older age group, and 69.2% cases out of them were invasive breast cancer. We are afraid that mass-screening by physical examination alone will overlook many cases of breast cancer, and we recommend that in view of the increasing mortality rate of breast cancer in women in their50s the safe and useful US screening program should be implemented without delay on the younger age group.

We report two cases of patch reconstruction for distal arch aneurysms. Supportive measures during operation included selective cerebral perfusion for brain protection and cardioplegic arrest for heart protection. During operation the whole body except for the heart was cooled down to 25°C, and only the heart was perfused at 36°C and kept beating. Both aneurysms were saccular, and after the resection of the aneurysm the defect of the aortic wall was reconstructed with woven double velour patches. The relationship between the pressure and the flow during coronary perfusion is not clear, but we thought the above measures should be taken when operating on distal arch aneurysm.

A 70-year-old man was found to have aortic regurgitation and underwent aortic valve replacement. About 10 minutes after disconnection from the cardiopulmonary bypass, cardiac arrest occurred suddenly and the bypass was immediately resumed. At this point, a Stanford type A aortic dissection was detected by transesophageal echocardiography, and the orifice of the left coronary artery was considered to be occluded by invasion of a hematoma. Although ascending aortic replacement with a prosthesis was performed under hypothermic circulatory arrest with selective cerebral perfusion, the heart did not resume vigorous beating. Therefore, saphenous vain graftings to the left anterior descending artery and the right coronary artery were performed. Finally, the patient could be weaned from the cardiopulmonary bypass. On postoperative digital subtraction angiography, neither occlusion nor stenosis in both coronary arteries was observed. We conclude that it would be considered to perform coronary artery bypass graftings in this particular condition.

A 61 y. o. male was admitted as a diagnosis of Stanford type A dissecting aortic aneurysm 6 day after the occurrence. An urgent operation was performed next day and the ascending aorta was replaced. Oral intake was initiated after uneventful postoperative 6 day-period. However, paralytic ileus became obvious associated with spiked fever over 38°C. Second trial after the suspension of oral intake also failed in the same result and turned out sepsis caused by Enterococcus faecium. The angiogram revealed the intact celiac axis and superior mesenteric artery (SMA), and the remarkably narrowed true lumen of the aorta. Although the clinical symptom was not typical, we thought that the ileus was induced by abdominal angina. At 78th postoperative day the fenestration of the abdominal aorta and the bypass grafting with saphenous vein between SMA and the abdominal aorta were performed. The symptom and sign of ileus subsided after the operation.

A 76-year-old man developed dysphagia and esophageal stenosis was diagnosed. A computed tomographic scan of the chest demonstrated a large aneurysm of the distal aortic arch. The patient had undergone left thoracoplasty 45 years previously for the treatment of lung tuberculosis, then the aortic arch with the aneurysm was displaced backward because of the narrowed upper thoracic cavity and the esophagus was sandwiched between the aortic arch and the spine. The patient was thought to be in danger of developing an aortoesophageal fistula, so an emergency operation was performed in spite of his age and general condition. He was successfully treated with graft replacement including reconstruction of three arch vessels and his severe dysphagia improved.