From 1982 to March 1999, 276 St. Jude Medical prostheses were implanted in aortic position. Of the 276 patients, 6 (2.2%) required redo aortic valve replacement due to aortic stenosis. The peak velocity measured by continuous-wave Doppler echocardiography ranged from 3.5 to 5.4m/sec with mean of 4.55m/sec. Aortic stenosis was attributable to pannus formation in 3 patients, valve thrombosis in 1 patient, and prosthesis-patient mismatch in 2 patients. The prostheses of patients with pannus formation were implanted in valve orientation parallel to the septum. It is therefore considered that the St. Jude Medical prosthesis should be implanted perpendicular to the septum in the aortic position and that careful follow-up observation of the patients should be made, particularly with echocardiography.

From 1983 to 1999, 12 St. Jude Medical prostheses were implanted in the tricuspid position. Mean patient age at the time of operation was 40±19 (6 to 62) years. Seven patients were female and five were male. There were no hospital deaths but three late deaths. The cumulative survival rate was 100% at 5 years, 80% at 10 years and 60% at 15 years. Four patients required redo tricuspid valve replacement because of a thrombosed valve. The reoperation-free rate was 100% at 5 years, 78% at 10 years and 29% at 15 years. The data illustrated that patients who underwent tricuspid valve replacement with the St. Jude Medical valve should receive strict anticoagulation therapy.

Papillary fibroelastoma is a relatively rare cardiac tumor. A report is presented on a 64-year-old man who was admitted to our institute with dyspnea. Distal arch aneurysm was detected by chest computed tomography and aortography. Preoperative transesophageal echocardiography revealed a tumor 9×5mm in size in the ventricular septum of the left ventricular outflow tract. Total arch replacement and tumor resection were performed. The pathohistological diagnosis of the tumor was papillary fibroelastoma. The postoperative course was uneventful and echocardiography conducted one year postoperatively revealed no recurrence.

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.

Between January 1991 and December 1998, we performed two successful procedures to repair abdominal aortic aneurysm with primary aortoenteric fistula. We had 197 surgical repair proceduers of aortic aneurysm during the same period. Incidence of primary aortoenteric fistula in abdominal aortic aneurysm was 1% in our institute. We performed primary closure of the fistula and removal of the possibily infected aneurysmal wall followed by anatomical grafting. We utilized omental wrapping for prophylaxis of potential graft infection. We achieved excellent surgical results in both patients by this approach.

A 67-year-old man with ascending aortic aneurysm was referred to our hospital. Transthoracic echocardiography showed severe aortic regurgitation with annuloaortic ectasia and transesophageal echocardiography revealed a quadricuspid aortic valve. This patient underwent aortic root replacement with a valve sparing technique. Under deep hypothermic circulatory arrest with retrograde cerebral perfusion, replacement of the ascending aorta was successfully performed. The postoperative course was uneventful. This patient is doing well 6 months after surgery without recurrence of aortic regurgitation.

A 74-year-old man was admitted to our hospital to undergo an operation for distal aortic arch aneurysm with chronic aortic dissection. The first operation was attempted through left lateral thoracotomy. Since the aorta had a severely calcified false lumen, conventional aortic replacement was considered to entail greater risk and graft replacement was given up. As an another option, endovascular stent grafting via the aortic arch through median sternotomy was selected as a second operation. Deep hypothermic circulatory arrest with selective cerebral perfusion was used during delivery and deployment of the stented graft through the aortotomy site. The distal stented graft was deployed into the true lumen at the ninth thoracic vertebral level. Neither endoleaks nor complications were observed. Postoperative computed tomography showed complete thrombosis of the distal aortic arch aneurysm and the false lumen. The postoperative course was uneventful. Transaortic endovascular stent grafting is an effective and less invasive treatment for aortic arch aneurysms with severely calcified aorta.

Anthropometry measurements, such as height and weight, have recently been used to predict poorer birth outcomes. However, the relationship between maternal height and birth outcomes remains unclear. We examined the effect of shorter maternal height on low birth weight (LBW) among 17,150 pairs of Japanese mothers and newborns. Data for this analysis were collected from newborns who were delivered at a large hospital in Japan. Maternal height was the exposure variable, and LBW and admission to the neonatal intensive care unit were the outcome variables. Logistic regression models were used to estimate the associations. The shortest maternal height quartile (131.0-151.9 cm) was related to LBW (OR 1.91 [95% CI 1.64, 2.22]). The groups with the second (152.0-157.9 cm) and the third shortest maternal height quartiles (158.0-160.9 cm) were also related to LBW. A P trend with one quartile change also showed a significant relationship. The relationship between maternal height and NICU admission disappeared when the statistical model was adjusted for LBW. A newborn's small size was one factor in the relationship between shorter maternal height and NICU admission. In developed countries, shorter mothers provide a useful prenatal target to anticipate and plan for LBW newborns and NICU admission.
Adult ; *Body Height ; Body Mass Index ; Female ; Hospitals ; Humans ; *Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; Japan ; Logistic Models ; Male ; Mothers/*statistics & numerical data ; Odds Ratio ; Risk Factors ; Weight Gain

With the progressive aging of the Japanese population, cardiac surgeons are increasingly faced with elderly patients. We have studied 29 consecutive patients, 80 years of age or older, who underwent aortic valve replacement at our institution between January 2000 and December 2003. Mortality, morbidity and late follow-up results were compared to those in 36 patients aged from 64 to 75 years old undergoing the same procedure over the same time period. The older patient group had a significantly higher incidence of calcified aortic stenosis and emergency operations and a higher score of NYHA functional class. Hospital mortality was 2 of 29 (6.9%) in the older patient group and 2 of 36 (5.6%) in the control group (ns). Postoperative renal failure and respiratory failure which needed prolonged ventilator support occured significantly more often in the older patient group. However, there was no significant difference between the 2 groups in terms of hospital stay. Almost all octogenarians showed improved NYHA functional class to class I or II after the operations. The actuarial survival rate was 89% in the older patient group and 78% in the control group at 3 years. The late survival rate and cardiac event-free rate were not significantly different between these 2 groups. Following aortic valve replacement, octogenarians, despite more compromised pre-operative status had good relief of symptoms, a favorable quality of life and a similar late survival to the younger patient groups. These findings support the recommendation that valve replacement should be performed in octogenarians with symptomatic aortic valvular disease.