We compared the efficacy of intravenous gamma globulin plus aspirin with that of aspirin alone in reducing the frequency of coronary-artery abnormalities in children with acute Kawasaki syndrome in a multicenter, randomized trial. Children randomly assigned to the gamma globulin group received intravenous gamma globulin, 400 mg per kilogram of body weight per day, for four consecutive days; both treatment groups received aspirin, 100 mg per kilogram per day, through the 14th day of illness, then 3 to 5 mg per kilogram per day. Two-dimensional echocardiograms were interpreted blindly and independently by two or more readers. Two weeks after enrollment, coronary-artery abnormalities were present in 18 of 78 children (23 percent) in the aspirin group, as compared with 6 of 75 (8 percent) in the gamma globulin group (P = 0.01). Seven weeks after enrollment, abnormalities were present in 14 of 79 children (18 percent) in the aspirin group and in 3 of 79 (4 percent) in the gamma globulin group (P = 0.005). No child had serious adverse effects from receiving gamma globulin. We conclude that high-dose intravenous gamma globulin is safe and effective in reducing the prevalence of coronary-artery abnormalities when administered early in the course of Kawasaki syndrome.

https://www.nejm.org/doi/pdf/10.1056/NEJM198608073150601?listPDF=true

The treatment of Kawasaki syndrome with intravenous gamma globulin.

Pulmonary surfactant is a complex and highly surface active material composed of lipids and proteins which is found in the fluid lining the alveolar surface of the lungs. Surfactant prevents alveolar collapse at low lung volume, and preserves bronchiolar patency during normal and forced respiration (biophysical functions). In addition, it is involved in the protection of the lungs from injuries and infections caused by inhaled particles and micro-organisms (immunological, non-biophysical functions). Pulmonary surfactant can only be harvested by lavage procedures, which may disrupt its pre-existing biophysical and biochemical micro-organization. These limitations must always be considered when interpreting ex vivo studies of pulmonary surfactant. A pathophysiological role for surfactant was first appreciated in premature infants with respiratory distress syndrome and hyaline membrane disease, a condition which is nowadays routinely treated with exogenous surfactant replacement. Biochemical surfactant abnormalities of varying degrees have been described in obstructive lung diseases (asthma, bronchiolitis, chronic obstructive pulmonary disease, and following lung transplantation), infectious and suppurative lung diseases (cystic fibrosis, pneumonia, and human immunodeficiency virus), adult respiratory distress syndrome, pulmonary oedema, other diseases specific to infants (chronic lung disease of prematurity, and surfactant protein-B deficiency), interstitial lung diseases (sarcoidosis, idiopathic pulmonary fibrosis, and hypersensitivity pneumonitis), pulmonary alveolar proteinosis, following cardiopulmonary bypass, and in smokers. For some pulmonary conditions surfactant replacement therapy is on the horizon, but for the majority much more needs to be learnt about the pathophysiological role the observed surfactant abnormalities may have.

https://erj.ersjournals.com/content/erj/13/6/1455.full.pdf

Pulmonary surfactant in health and human lung diseases: state of the art.

The first successful application of a transcatheter closure technique for patent ductus arteriosus (PDA) suitable for use in infants and children was performed by us in 1977. Since that time, there has been continued improvement and simplification of the equipment as well as in the implantation technique. Following a Food and Drug Administration protocol, a multicenter study was conducted to test the safety and effectiveness of this interventional method. The clinical results from three major regional test centers (Philadelphia, Houston, and New Haven) are presented. One hundred forty-six patients from a test population of 156 were treated for PDA with use of the Rashkind PDA Occluder Systems. Successful closure was accomplished in 94 (66%) of the total cases. Ten patients (7%) retained residual ductal murmurs despite correct placement of the occlusion devices; five additional patients (3%) were considered failures due to the presence of abnormal Doppler flow patterns after the procedure. Postrelease embolizations occurred in 19 (15%) instances. One patient required emergency surgical intervention after attempted retrieval of an embolized occluder. With the improvements in the manufacturing of the double-disk occluder systems as well as the perfection of the transvenous delivery technique, the incidences of closure failure and postrelease complications have decreased. Since January 1984, 78% of all transcatheter closure attempts were successful, with 10% embolization.

Nonsurgical closure of patent ductus arteriosus: clinical application of the Rashkind PDA Occluder System.

In this article, an overview of the hybrid welding process is given. After a short historic overview, a review of the fundamental phenomenon taking place when a laser (CO2 or Nd:YAG) interacts in the same molten pool as a more conventional source of energy, e.g. tungsten in-active gas, plasma, or metal inactive gas/metal active gas. This is followed by reports of how the many process parameters governing the hybrid welding process can be set and how the choice of secondary energy source, shielding gas, etc. can affect the overall welding process. An overview of the benefits and drawbacks of hybrid welding is presented, including reports on gap bridging ability, changes in welding speed and weld penetration, overall weld quality, and changes in heat input to the material being welded. This overview is followed by a few examples of industrial applications of hybrid welding. Finally, a section is devoted to explain about further work required in order to understand and tackle the hybrid welding process more efficiently in the future.In this article, an overview of the hybrid welding process is given. After a short historic overview, a review of the fundamental phenomenon taking place when a laser (CO2 or Nd:YAG) interacts in the same molten pool as a more conventional source of energy, e.g. tungsten in-active gas, plasma, or metal inactive gas/metal active gas. This is followed by reports of how the many process parameters governing the hybrid welding process can be set and how the choice of secondary energy source, shielding gas, etc. can affect the overall welding process. An overview of the benefits and drawbacks of hybrid welding is presented, including reports on gap bridging ability, changes in welding speed and weld penetration, overall weld quality, and changes in heat input to the material being welded. This overview is followed by a few examples of industrial applications of hybrid welding. Finally, a section is devoted to explain about further work required in order to understand and tackle the hybrid welding process more ...

Review of laser hybrid welding

Atrial appendages and venoatrial connections in hearts from patients with visceral heterotaxy

Left main coronary trunk compression by dilated main pulmonary artery in atrial septal defect. Report of three cases.

The criteria for reconstruction of right ventricular outflow tract in total correction of tetralogy of Fallot

Hybrid welding of stainless steels or aluminium alloys was performed with the heat sources of YAG laser and TIG, or YAG laser and MIG, respectively. The effects of welding conditions and melt flows on penetration depth, geometry and porosity formation were investigated with the X-ray transmission real-time observation method. Melt flows on penetration depth and geometry were consequently confirmed. Concerning porosity suppression, in TIG-YAG hybrid welding of stainless steel, no formation of bubbles was attributed to the absence of pores. On the other hand, disappearance of bubbles from the concave molten pool surface due to the arc pressure played an important role in reducing porosity in YAG-MIG hybrid welding of aluminium alloys at high arc currents.

https://ir.library.osaka-u.ac.jp/repo/ouka/all/12224/jwri35_01_13.pdf

Physical Phenomena and Porosity Prevention Mechanism in Laser-Arc Hybrid Welding

Six patients with coronary arterial lesions due to Kawasaki disease underwent aortocoronary by-pass grafting at our institute. Before surgery, all of them had been closely monitored for some years by means of selective coronary arteriography, thallium myocardial imaging, electrocardiography (treadmill and/or Holter), and two-dimensional echo cardiography. Based on this experience, we propose the following guidelines as an indication for aortocoronary by-pass in such patients. First, the following three conditions should be satisfied: 1) The progress of coronary arterial lesions has been documented by serial selective coronary arteriography; 2) redistribution to the perfusion defect has been detected on the delayed image in myocardial imaging; 3) no coronary arterial lesions distal to the graft site have been detected by coronary angiography. When these three conditions are satisfied, at least one of the following conditions must apply: 1) Localized stenosis in the left main trunk has progressed to critical stenosis; 2) there is occlusion of two or more vessels; 3) collateral vessels connecting to the peripheral portion of an occluded coronary artery arise from the peripheral part of a vessel with progressive localized stenosis; 4) progressive localized stenosis or critical stenosis has developed in the left anterior descending artery, in addition to significant stenosis in the right coronary artery.

Indication of aortocoronary by-pass for coronary arterial obstruction due to Kawasaki disease.

Welding with a yttrium–aluminum–garnet (YAG) laser only or with hybrid source combined with a YAG laser and a TIG arc was carried out on Type 304 stainless steel plate with low S content in the air or in the chamber with Ar gas including 0%–15% oxygen gas. It was confirmed in both laser and hybrid welding that the penetration and geometry of welds depended upon the volume of the oxygen in the ambient atmosphere, and that a pronounced “nail head” disappeared in a weld metal containing a higher content of oxygen. An x-ray transmission real-time imaging apparatus revealed that melt flows depended on the volume ratio of oxygen in the atmosphere and there was a strong melt flow from the keyhole inlet to the surrounding pool near the top surface in pure Ar atmosphere. It is therefore considered that the melt flows induced by surface tension produces the “nail head” in pure Ar shielding atmosphere and the resulting weld becomes a wine glass shape. During YAG laser and hybrid welding in the air or in the Ar gas with the oxygen gas increased, the downward melt flows along the keyhole wall was more dominant to produce slightly deeper welds with narrower surface bead widths due to the effect of the surface tension with the positive gradient. On the other hand, the formation of shallower YAG-TIG weld beads produced in air was attributed to the mechanism that the Marangoni convection and electromagnetic convection induced by TIG arc constriction in the central part of the molten pool prevented downward melt flows from a keyhole tip resulting in deeper penetration than the tip. It was moreover confirmed that the porosity reduction in hybrid welding at a high current was due to the reduced formation of bubbles.

Yasuaki Naito

Papers

Left main coronary trunk compression by dilated main pulmonary artery in atrial septal defect. Report of three cases.

The criteria for reconstruction of right ventricular outflow tract in total correction of tetralogy of Fallot

Physical Phenomena and Porosity Prevention Mechanism in Laser-Arc Hybrid Welding

Indication of aortocoronary by-pass for coronary arterial obstruction due to Kawasaki disease.

Effect of oxygen in ambient atmosphere on penetration characteristics in single yttrium aluminum garnet laser and hybrid welding