Background: Myocardial ischemia causes accumulation of extracellular myocardial K⁺ ([K⁺]_e). However, the relation between [K⁺]_e, and local coronary venous K⁺, i.e., K⁺ in the great coronary vein ([K⁺]_gcv) has not been established. To determine the sensitivity of [K⁺]_gcv as a marker of myocardial ischemia, we continuously measured [K⁺]_e, using intramyocardial K⁺-selective plunge electrodes, and [K⁺]_gcv, using a catheter-tip K⁺ electrode inserted into the great cardiac vein, during two types of ischemia. Methods and Results: In in-situ pig hearts, ischemia was induced by implementing a progressive decrease in carotid-to-left anterior descending artery (LAD) shunt flow from 40 to 0 mL/min at constant heart rate (100-130/min) and a progressive increase in heart rate from 100 to 160 beats/min at the threshold flow. The progressive decrease in LAD flow to 5 mL/min caused parallel increases in [K⁺]_e (from 3.87 ± 0.37 to 8.65 ± 1.13 mM) and [K⁺]_gcv (from 3.87 ± 0.37 to 4.84 ± 0.43 mM). However, below 5 mL/min, [K⁺]_gcv failed to reflect the increase in [K⁺]_e and often decreased. The progressive increase in heart rate at the threshold flow caused parallel changes in [K⁺]_e (from 4.08 ± 0.36 to 4.87 ± 0.14 mM, n = 3) and [K⁺]_gcv (from 3.08 ± 0.42 to 4.18 ± 0.43 mM). The verapamil- and propranolol-induced changes in [K⁺]_e during low-flow ischemia were reflected by changes in [K⁺]_gcv. Conclusions: Change in [K⁺]_gcv is a sensitive marker of myocardial ischemia, except at very low coronary flow. Thus, [K⁺]_gcv can be used to detect early myocardial ischemia.

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Background: Complex electrocardiogram morphologies (atrial fibrillation [AF] nests) in sinus rhythm (SR) recorded by frequency domain techniques can serve as a pathologic substrate for atrial fibrillation (AF). We sought to characterize any direction-dependent and rate-dependent changes in dominant frequency (DF) and high DF sites in the left atrium (LA) in patients with AF. Methods: Eight patients with AF were included in the study. A basket catheter with 64 electrodes was placed in the LA. Forty-eight bipolar electrocardiograms were recorded during SR and during pacing from the high right atrium (HRA), proximal coronary sinus (CS), and distal CS at various pacing rates, ranging from 600 ms to 250 ms. The frequency domain measures of LA bipolar electrocardiograms were compared during SR and HRA, proximal CS, and distal CS. Results: The DF was found to be higher during proximal CS and distal CS pacing than during SR. The percentage of high DF (>70 Hz) sites was higher during distal CS pacing than during SR. The various pacing rates applied during HRA, proximal CS, and distal CS pacing did not affect the DF values. Conclusion: DF of atrial electrocardiograms obtained during SR was influenced by the direction of conduction but not by the pacing rate.

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当科における遅発型・超遅発型GBS 髄膜炎6 例について，臨床経過を後方視的に検討した．神経学的予後因子には，発症から治療開始までの期間，ショック，人工換気の使用，急性期の難治性けいれん，CRP 陰性化までの期間が考えられた．莢膜型と重症度に関連性は認めなかった．後遺症ありの2 例はABPC に軽度耐性があり，他系統抗菌薬の積極的使用が有効と考えられた．医療現場における現行の予防策の問題点も含めて考察した．

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成熟奇形腫の悪性転化を予測することは難しい．従来の報告では，悪性転化の予測因子として腫瘍径，腫瘍マーカー，年齢が挙げられている．今回我々は2003 年1 月から2015 年12 月までの13 年間に当院で治療した成熟奇形腫悪性転化の8 症例を検討した．8 症例で先の項目の中央値を検討したところ，従来の報告と一致していた．これらの項目と画像所見を合わせることで，成熟奇形腫の悪性転化を予測することができる可能性が示唆された．

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膵体部癌は腹腔動脈や総肝動脈などの重要な血管に近接しており，その直接浸潤で手術非適応とされることが多い．腹腔動脈浸潤症例については，術前に総肝動脈を塞栓し，側副血行路の発達により肝血流を維持して腹腔動脈幹合併切除を伴った尾側膵切除術を行うことで切除可能な症例がある．症例は68 歳，男性．膵体尾部癌の診断であった．術前化学療法を施行し，総肝動脈を塞栓し，膵切除を行った．術中に肝血流障害を認め，固有肝動脈-空腸動脈バイパスにより回避し得た症例である．このような症例は，われわれは経験がなく，文献的考察を加え報告する．

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集団食中毒で，急性脳症を合併した腸チフスの小児例を経験した．海外渡航歴はなく，発熱や消化器症状を主訴に入院．便・血液培養からSalmonella typhi が同定され，腸チフスと診断した．入院後みられた急性脳症は，後遺症なく治癒した．急性脳症発症時の髄液でIL-8，monocyte chemoattractant protein-1 が高値をとり，脳症発症にこれらのサイトカインの関与が示唆された．

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