Introduction : Right atrial (RA) and right ventricular (RV) dilatation that are associated with severe tricuspid regurgitation, and severe high RV pressure that is associated with pulmonary atresia and intact ventricular septum cause left ventricular (LV) dysfunction and hypoplastic lung. We have applied a modified RV obliteration technique that excludes non-functional enlarged RV for these diseases. Objectives : To evaluate the efficacy of our procedure. Methods and Results : Five patients (six operations) underwent the procedure without complications. Cardiothoracic ratio significantly decreased from 71±10% to 61±5% (p=0.017), and fractional shortening ended to increase from 27±17% to 37±5% (p=0.071). All of them achieved Fontan completion finally. One patient who underwent this procedure as a neonate experienced RV re-dilation 19 months later. He additionally received the same procedure in a Fontan operation, and then RV reduced again and good LV function was maintained. Conclusion : The application of modified RV obliteration technique is effective for Fontan candidates with nonfunctional RV.

Introduction : Although there are various diagnostic tools like computed tomography, magnetic resonance imaging, and positron emission tomography, it is sometimes difficult to precisely diagnose cardiac tumors. Early pathological diagnosis is crucial for possible chemotherapy and/or radiation therapy in cardiac malignant lymphoma. Objectives : To assess the diagnostic value of pericardial excisional biopsy and cytology of pericardial effusion for the pathological diagnosis of cardiac lymphoma. Methods : Five patients had a clinical diagnosis of cardiac tumor with no pathological diagnosis. The pericardial biopsy and pericardial effusion were obtained without sternotomy through the subxyphoid by a small incision under local anesthesia. Results : All procedures were completed without complications. In 3 cases, the cytology of pericardial effusion yielded a diagnosis of malignant lymphoma. One patient who had a negative cytology result in whom surgical resection was performed for definitive diagnosis and tumor volume reduction was found to have malignant lymphoma. The remaining patient underwent tumor biopsy via a cardiac catheter and benign lymphoma was diagnosed. There were no specific findings in the pericardial excisional biopsy in 3 cases. Conclusion : The analysis of cytology of pericardial effusion obtained through the subxyphoid may be useful for the diagnosis of cardiac malignant lymphoma. Pericardial excisional biopsy may not be necessary for the diagnosis of cardiac malignant lymphoma.

In Japan there are many people who are intolerant to alcohol. Known as flushers, they do not genetically have low Km acetaldehyde dehydrogenase (AlDH₂). Flushers are judged easily and accurately by the alcohol patch test. An ethanol patch test carried out on agricultural and fishing populations in Japan showed that approx. 40% were deficient in AlDH₂. A questionnaire survey of the drinking behavior of many people showed significant differences between the normal AlDH₂ and AlDH₂-deficient groups. The normal group drinks positively and actively, while the deficient group drinks negatively and passively. As a result, there were significant differences in subjective and objective symptoms that result from drinking between the two groups: More frequent hangovers, abnormal physical conditions and higher KAST scores were seen in the normal group, and health examination showed higher values in liver function tests, including γ-GTP, and higher levels of blood pressure, HDL-cholesterol (HDL-C), etc., in the normal AlDH₂group.
It may be very useful for prevention of alcohol-related health disorders to help Mongoloid peoples, such as the Japanese, recognize whether their AlDH₂ is normal or deficient, which is as determined by the ethanol patch test.

BACKGROUND AND PURPOSE: This study compared the muscle thickness (MT) and echo intensity (EI) of the abdominal, thigh, and lower leg muscles between the paretic and nonparetic sides in chronic stroke survivors. METHODS: Thirty-two stroke survivors living in the community participated in this study. The MT and EI, which are indicators of muscle mass and intramuscular fat or connective tissue, were assessed in the rectus abdominis, external oblique, internal oblique, transversus abdominis, rectus femoris, vastus intermedius, vastus lateralis, vastus medialis, tibialis anterior, gastrocnemius, and soleus via transverse ultrasound imaging. In addition, a possible indicator of physical activity—the frequency of going out per week—was evaluated. RESULTS: All quadriceps muscles and the tibialis anterior were significantly thinner and the EI values of the vastus intermedius, vastus lateralis, vastus medialis, and soleus were significantly higher in the paretic limb than the nonparetic limb. The MT and EI values of abdominal muscles did not differ significantly between the two sides. The MT values of the paretic rectus femoris, vastus lateralis, and vastus medialis were significantly associated with the frequency of going out after adjusting confounding factors. The MT of the nonparetic vastus lateralis was significantly associated with latency from stroke onset after adjusting confounding factors. CONCLUSIONS: Our results indicate that quantitative and qualitative changes on the paretic side in stroke survivors were the most robust in the thigh muscles, whereas such changes might not occur in the abdominal muscles.
Abdominal Muscles ; Connective Tissue ; Extremities ; Humans ; Leg ; Lower Extremity* ; Muscles* ; Quadriceps Muscle ; Rectus Abdominis ; Stroke* ; Survivors* ; Thigh ; Ultrasonography

Background: and Purpose The objective of this study was to identify 2-year longitudinal changes in the muscle thickness (MT) and echo intensity (EI) of the abdominal, thigh, and lower limb muscles in chronic stroke survivors. Methods: This study included 15 chronic stroke survivors aged 74.1±9.9 years. The MT, EI, and subcutaneous fat thickness values of the following muscles on the paretic and nonparetic sides were assessed on transverse ultrasound images: rectus abdominis, external oblique, internal oblique, transversus abdominis, rectus femoris (RF), vastus intermedius, vastus lateralis (VL), vastus medialis, tibialis anterior, gastrocnemius, and soleus. The ultrasound measurements were performed both at baseline and 2 years later. Results: After 2 years, the VL on the paretic side showed a significant decrease in MT (p= 0.031) and increase in EI (p=0.002), whereas the RF on the nonparetic side showed a significant decrease in EI (p=0.046). Correlation coefficient analyses showed that changes in MT (r= 0.668, p=0.012) and EI (r=0.597, p=0.018) of the VL on the paretic side were significantly associated with a change in the body mass index. Conclusions The findings of this longitudinal study suggest that the VL on the paretic side is subject to deteriorations in muscle quantity and quality, and conversely that the RF on the nonparetic side shows an improvement in muscle quality after 2 years in chronic stroke survivors

Surgical cases for pulmonary artery aneurysm after palliative operation for congenital heart disease are rare. A man in his 40s underwent Waterston operation (side-side anastomosis of the ascending aorta and right pulmonary artery) for pulmonary atresia and ventricular septal defect at the age of one. Medical follow-up was continued at a local clinic without definitive repair. He had complained of exertional dyspnea and cough for one month. CT scan on admission showed a large right pulmonary artery aneurysm and atelectasis of the right lung. An urgent operation was planned for the huge pulmonary artery aneurysm. Under cardiac arrest, the proximal end-to-side anastomosis to the aorta was conducted using a Y-shaped vascular prosthesis at the previous Waterston anastomosis. The peripheral pulmonary arteries were reconstructed by inclusion technique. Percutaneous cardiopulmonary support was necessary for one day after operation due to unstable hemodynamics. He was extubated on postoperative day (POD) 4 and transferred to our general ward on POD 5. He was discharged home on POD 38. He is now free from heart failure symptoms and recurrence of aneurysm one year after surgery. Careful follow-up is necessary for the dilatation of the pulmonary artery and aortic root. A definitive operation—Rastelli and closure of the ventricular septal defect—may be considered in the future if the pulmonary artery resistance is suitable for the repair.