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A self-assembly of AgClO(4) with a Schiff-base ligand N,N'-bis(pyridin-2-ylmethylene)benzene-1,4-diamine (1) gave a 1D zigzag polymeric array [[Ag(2)(C(18)H(14)N(4))(2)](ClO(4))(2)(CH(3)CN)](n) (3), while the self-assembly of AgClO(4) with 3,3'-dimethyl-N,N'-bis(pyridin-2-ylmethylene)biphenyl-4,4'-diamine (2) afforded the molecular rectangle [[Ag(2)(C(26)H(22)N(4))(2)](ClO(4))(2)] (4). The structures of 3 and 4 were characterized by single-crystal X-ray diffraction analysis. Structural data for 3 indicate that the Ag(I) ion is coordinated by two ligands of 1 in a distorted tetrahedral fashion thereby leading to a 1D zigzag polymeric array. The zigzag chains are interdigitated with weak pi-pi stacking interactions. The structure of 4 consists of a discrete molecular rectangle where the silver atom has a distorted square-planar coordination with the pyridyl ligands and azomethine nitrogen atoms of 2. An intramolecular pi-pi interaction between the phenyl rings of adjacent Schiff-base 2 functions to stabilize the rectangular architecture. The Ag(I)-Schiff-base coordination polymer 3 is not stable in solution. The degradation and reorganization of 3 to form a [2 x 2] grid architecture [[Ag(4)(C(26)H(22)N(4))(4)](ClO(4))(4)] (3g) was supported in a FAB-MS study. The rectangular structure of 4 remains intact in solution at ambient temperature. The complexes 3g and 4 exhibit unusual luminescence behavior in solution at room temperature with significantly red-shifted emission in the visible region.

Three novel triosmium complexes with unusual coordination characteristics are reported. Treatment of the hydridotriosmium cluster (mu-H)2Os3(CO)10 with CNNPPh3 in CH2Cl2 gave complexes (mu-H)Os3(CO)(10)(mu2-eta2-C(H)NNPPh3) (1) and (mu-H)Os3(CO)10(mu2-eta1-CHPPh3) (2). Complex 1 represents the first example of the existence of a coordinated phosphinazine ligand. An in-situ 1H NMR study showed that the reaction of (mu-H)2Os3(CO)10 with CNNPPh3 produced complex 1 as the initial product in 100% conversion. The latter is not stable in solution and slowly eliminates nitrogen to form an unusual ylide complex 2 in quantitative yield. The thermolysis of 2 in refluxing toluene afforded (mu-H)3Os3(CO)9(mu3-eta1-CCO2CH2Ph) (3) as a colorless compound. Complexes 1-3 were characterized by spectroscopic methods and single-crystal X-ray diffraction analysis. The interesting feature of structure 3 is the presence of a mu3-alkylidyne ligand where the symmetrically triply bridged CCO2CH2Ph fragment lies perpendicular to and above the triosmium triangle.

Heteroleptic cyclometalated iridium(III) complexes featuring lepidine-based ligands and acetyl acetone auxiliary ligand are synthesized. Multiple lowest energy absorption bands are observed for these complexes indicating substantial mixing of the singlet and triplet levels. All the complexes emit orange or red color in dichloromethane solutions with lifetimes in the range 1.6-3.7 micros. The emission in the complexes probably originates from the (3)MLCT state. The complexes are applied as emitting guests in LED devices of the structure ITO/HTL(BPAPF or NPB)/6% Ir in CBP/BCP/Alq(3)/LiF/Al. They exhibit excellent device characteristics with an orange to red EL profile.

Background: Diagnostic algorithms for patients with blunt abdominal trauma have been in use since 1995. This study investigated the role of diagnostic algorithms in the management of adult patients with blunt splenic injury at our institution., Methods: A retrospective review of hospital records was performed to enroll patients with blunt injury of the spleen. Demographic data and information about injury severity, diagnostic methods, management and final outcomes were evaluated. Patients were separated into an early and late group according to the year that diagnostic algorithms were used (1990-1994 or 1995-1999)., Results: One hundred and twenty-one patients were enrolled. Initially, 71 patients had an operation (OP group), whereas 50 received non-operative management (NOM group). Patients in the OP versus NOM group had lower blood pressure and greater transfusion volumes in the emergency room, higher grade splenic injury, and a greater rate of intra-abdominal-related injury. NOM failed in 7 patients (14%). Early- versus late-group patients were less likely to have NOM and high grade splenic injury; however, the rate of NOM failure was not different between the early and late groups., Conclusion: Diagnostic algorithms using sonograms for screening provide an initial means of selecting patients for NOM. Patients with higher grades of splenic injury can then be managed non-operatively.

Background: Although whole-body hypothermia recently has been reported effective in improving the neurologic outcome after cardiac arrest, it is contraindicated in the management of trauma patients with hemorrhagic shock. To provide selective brain cooling in this situation, the authors speculated about the feasibility of hypothermic retrograde jugular vein flush (HRJVF). This preliminary study was conducted to test the effectiveness of brain cooling after HRJVF in rats without hemorrhagic shock., Methods: After jugular vein cannulation with cranial direction, Sprague-Dawley rats were randomized into a normal control group, a group that underwent flush with cold saline at 4 degrees C, or a group that underwent flush with saline at a room temperature of 24 degrees C. A Servo-controlled heat lamp was applied for all the rats to keep their rectal temperature at 37 +/- 0.5 degrees C. Their brain temperature and cerebral blood flow were checked., Results: Within the 10-minute period of cold saline flush (1.7 mL/100 g), brain temperature was immediately decreased, and this cooling effect could be maintained for at least 20 minutes. Cerebral blood flow was significantly increased after HRJVF, then returned gradually to the baseline as brain temperature elevated., Conclusions: This study successfully demonstrated a significant cooling effect in rat brain by HRJVF. For preservation of brain function, HRJVF may be useful in resuscitation for trauma patients with hemorrhagic shock after further studies on animals with shock.

An unusual mu4-bridging bonding mode of 2,2'-bipyrazine is observed for the first time in a luminescent coordination polymer [Ag2(bpyz)(NO3)2]n, which comprises of silver chains with alternating strong and weak Ag...Ag interactions.

The present report describes an unusual case of rectal perforation. An 81-year-old female was struck by a truck while walking in the street, and she was sent to a local hospital where fracture of the right subtrochanteric femur was diagnosed. She was admitted, in stable condition, for planned orthopedic operation. Consciousness change and respiratory distress developed 6 hours later. She was then transferred to a trauma center where extraperitoneal rectal perforation was diagnosed. Despite empirical antibiotics and surgical intervention, the patient unfortunately expired 3 days later. Unusual mechanism and incomplete physical examination were the major causes of delayed diagnosis. This case report also discusses the mechanism, classification and management of rectal perforation.

Background & Objective: This study was to identify the factors that affect the quality of life (QOL) and bring forward methods of improving the QOL of colostomy patients, so as to offer evidences for practical nurses., Methods: A descriptive, correlative design was employed in this study. From October, 2002 to February, 2004, 86 colostomy patients who discharged from Tumor Hospital of Sun Yat-sen University were recruited to complete a series of questionnaires, including EORTC QLQ-C30, Symptom Check List(SCL-90), Perceived Social Support Scale(PSSS). The SPSS11.0 was used for data analysis., Results: The QOL of colostomy patients was relatively low. The mean score of EORTC QLQ-C30 was 49.13+/-17.20. The score of QOL was negatively correlated with the score of SCL-90 and positively correlated with the score of social support. The score of SCL-90 was the most important factor that affected the QOL, followed by the income of the patients., Conclusion: The major factors affecting the QOL were mental health status, financial status and social support of the patients. The results point out practical nurses should keep an eye on these factors.

A convenient and efficient procedure was developed for preparing 3,4-diaryl-substituted maleimides through the improved synthesized diaryl-substituted fumaronitrile. The synthesis of diphenyl-substituted fumaronitrile derivatives from phenylacetonitrile compounds was analyzed and improved. We found the stoichiometry of the sodium methoxide and the concentration of the starting material, phenylacetonitrile derivatives, were crucial for the high yield and easy purification of the products. Particularly, bis(4-bromophenyl)fumaronitrile, bis(3-trifluoromethylphenyl)fumaronitrile, and bis(4-methoxyphenyl)fumaronitrile were isolated in good yields of 70-90% by simple suction filtration. In addition, (1)H NMR provided compelling evidence that the E-Z isomerization was involved in the formation reaction of the maleimide compounds from either fumaronitrile or maleonitrile derivatives. Single-crystal X-ray structures of these three fumaronitrile derivatives, the first three of the kind, were obtained, revealing the nonplanar molecular structure. We ascribe the strong solid-state fluorescence of these diphenylfumaronitrile derivatives to the nonplanar structure that inhibits the close packing of the molecule aggregation and thus the fluorescence quenching.

The title compound, C20H12N8, (I), has been prepared by the reaction of 1,4-dihydrazinophthalazine and pyridine-2-carboxaldehyde, followed by an oxidative cyclization by treatment with bromine. In the solid state, the molecules of (I) are discrete, comprising a fused and twisted four-ring system with an overall helical appearance. The distance between the two intramolecular pyridyl N atoms is 3.075 (2) A, this short contact distance suggesting a pi-pi interaction.

Objective: To determine the fundamental mechanism of brain protection by hypothermic retrograde jugular vein flush (HRJVF) in heatstroke rats., Design: Randomized, controlled, and prospective study., Setting: University physiology research laboratory., Subjects: Sprague-Dawley rats (270-320 g, males)., Interventions: Rats were randomized into four groups as follows: a) normothermic control (NC, n = 8); b) heatstroke rats without cold saline delivery (HS, n = 8); c) heatstroke rats treated with cold saline via femoral vein (HS+F, n = 8); and d) heatstroke rats treated with HRJVF (HS+J, n = 8). Right external jugular vein and right femoral vein were cannulated in each rat. The cannulation in the jugular vein was with cranial direction. To produce heatstroke, rats were placed in a chamber with an ambient temperature of 43 degrees C. The cold saline (4 degrees C, 1.7 mL/100 g) was delivered via the cannula in either the femoral vein or jugular vein immediately after the onset of heatstroke. Glutamate release in the brain, cerebral blood flow (CBF), and hematocrit of arterial blood were determined., Measurements and Main Results: After onset of heatstroke, HRJVF significantly decreased the glutamate release. In contrast, cold saline delivery via femoral vein could only delay the elevation of glutamate release in the brain. The CBF of HS and HS+F rats decreased rapidly after the onset of heatstroke, but the CBF of HS+J rats was initially elevated by HRJVF and was maintained at baseline 30 mins after onset of heatstroke. Hematocrit in all the rats did not change after testing., Conclusions: HRJVF protects the brain by maintaining cerebral blood flow in rats after heatstroke. To preserve brain function and prolong survival after severe heatstroke, maintenance of cerebral blood flow is important in the management of heatstroke.

A novel and convenient route for the synthesis of biologically potent and rare L-hexose derivatives from D-glucose is described. Conversion of diacetone-alpha-D-glucose (14) into 1,2:3,5-di-O-isopropylidene-beta-L-idofuranose (19) was efficiently carried out in two steps. Orthogonal isopropylidene rearrangement of compound 19 led to 1,2:5,6-di-O-isopropylidene-beta-L-idofuranose (27), which underwent regioselective epimerization at the C3 position to give the L-talo- and 3-functionalized L-idofuranosyl derivatives. Hydrolysis of compound 19 under acidic conditions furnished 1,6-anhydro-beta-L-idopyranose (35) in excellent yield, which was successfully transformed into the corresponding L-allo, L-altro, L-gulo, and L-ido derivatives via regioselective benzylation, benzoylation, triflation and nucleophilic substitution as the key steps. Applications of these 1,6-anhydro-beta-L-hexopyranoses as valuable building blocks to the syntheses of 4-methylcoumarin-7-yl-alpha-L-iduronic acid and the disaccharide moieties of bleomycin A(2) as well as heparan sulfate are highlighted.

An efficient preparation of rare 2-O-benzoyl-3-O-benzyl-1,6-anhydro-beta-l-idopyranose from commercially available diacetone alpha-d-glucose in five straightforward steps is described here. With this key building block in hand, the total syntheses of heparin oligosaccharides with three, five, seven, and nine sugar units are successfully carried out.

Objective: To determine whether direct retrograde ice saline infusion in the jugular vein without cardiopulmonary bypass protects rat brains after heatstroke., Design: Randomized, controlled, prospective study., Setting: University physiology research laboratory., Subjects: Sprague-Dawley rats (270-320 g, males)., Interventions: Rats were randomized into three groups and given a) no resuscitation after onset of heat stroke (HS, n = 8); b) ice saline infusion in the femoral vein after onset of heat stroke (HS + F, n = 8); or c) retrograde ice saline infusion in the external jugular vein after onset of heat stroke (HS + J, n = 8). Rats were exposed to an ambient temperature of 43 degrees C after vessel cannulation. Their mean arterial pressure, heart rate, colonic temperature, and brain temperature were continuously recorded. Survival time and brain pathology were checked., Measurements and Main Results: Although colonic temperature decreased 0.8-1.0 degrees C 15 mins after heatstroke in all groups, no treatment-related changes in colonic temperature were noted in any group. However, significant changes were observed in brain temperature. Fifteen minutes after heatstroke, brain temperature was 37.6 +/- 0.4 degrees C, 36.1 +/- 0.4 degrees C, and 33.6 +/- 0.8 degrees C in HS, HS + F, and HS + J, respectively. Survival time was 16.1 +/- 2.1, 33.0 +/- 3.8, and >120 mins in these groups, respectively. Neuron damage score was significantly lower in HS + J and without lateralization., Conclusions: We successfully demonstrated that direct retrograde hypothermic perfusion via the jugular vein without cardiopulmonary bypass protected the brain after heat stroke. This technique cooled the brain but did not significantly interfere with body temperature.

Introduction of a gamma-silyl group into nitro compounds of dihydrobenzofuran, dihydrobenzo[b]thiophene, and dihydrofuran allowed new transformations to take place in the presence of a Lewis acid to give the corresponding alpha,beta-unsaturated oximes or multisubstituted dihydrofurans, respectively, in good to excellent yields.[reaction: see text]

A series of robust, thermally stable open-framework cobalt nicotinate compounds, Co(2)(H(2)O)[C(6)H(4)O(2)N](4).0.5CH(3)CH(2)OH.0.5H(2)O (1), Co(2)(H(2)O)[C(6)H(4)O(2)N](4) (2), and Co(2)(H(2)O)[C(6)H(4)O(2)N](4).C(6)H(5)CH(2)OH (3), based on rigid dimetallic carboxylate clusters as the basic building unit have been prepared. Single-crystal X-ray crystallographic analyses of 1 and 3 reveal the host framework possessing an effective channel area with the dimensions of 10.8 x 4.5 A. These channels can accommodate guest molecules of various sizes and shapes such as ethanol, water, and benzyl alcohol. Thermogravimetric analysis shows a two-step weight loss corresponding to the loss of guest molecules followed by the loss of coordinated water. The host framework is thermally stable up to 295 degrees C. The cobalt nicotinate host remains intact, even upon the removal of the guest to form compound 2 as revealed by single-crystal X-ray diffraction analysis. Crystal data for 1: Co(2)(H(2)O)[C(6)H(4)O(2)N)](4).0.5CH(3)CH(2)OH.0.5H(2)O, fw = 656.33, triclinic, space group P(-)1, a = 10.5407(2) A, b = 11.8266(3) A, c = 14.1122(2) A, alpha = 106.878(4) degrees, beta = 102.411(2) degrees, gamma = 111.011(3) degrees, V = 1467.9(5) A(3), Z = 2. Crystal data for 2: Co(2)(H(2)O)[C(6)H(4)O(2)N](4), fw = 624.28, triclinic, space group P(-)1, a = 10.507(3) A, b = 11.824(2) A, c = 14.113(3) A, alpha = 107.06(2) degrees, beta = 102.39(2) degrees, gamma = 111.105(16) degrees, V = 1459.5(6) A(3), Z = 2. Crystal data for 3: Co(2)(H(2)O)[C(6)H(4)O(2)N](4).C(6)H(5)CH(2)OH, fw = 732.42, triclinic, space group P(-)1, a = 10.6671(6) A, b = 12.0063(7) A, c = 14.0658(8) A, alpha = 106.7180(10) degrees, beta = 102.2790(10) degrees, gamma = 111.1900(10) degrees, V = 1504.1(6) A(3), Z = 2. The magnetic exchange coupling between the dicobalt centers for compounds 1 and 3 are analyzed on the basis of both the Curie-Weiss expression and a binuclear magnetic model. The negative values of the magnetic exchange coupling constant indicate the antiferromagnetic nature within the cobalt dimer.

Objective: To investigate the variability in primary tumour volume in nasopharyngeal carcinoma and compare it with the tumour staging of the 1997 American Joint Committee on Cancer., Design: Prospective study., Setting: Tertiary care centre., Method: A series of 33 newly diagnosed patients who were treated with high-dose radiotherapy participated in the study., Main Outcome Measures: Using computed tomographic scans, primary tumour volumes were measured using the summation-of-areas technique, and the variability in tumour volume was determined. The Mann-Whitney test was used for statistical analysis., Results: A large variation in primary tumour volume was observed, especially in advanced-stage cases., Conclusions: Nasopharyngeal carcinoma shows considerable variability in primary tumour volume. Incorporation of primary tumour volume may lead to further refinement of the 1997 tumour staging system.

6-Chloropurine derivatives of gamma-(Z)-ethylidene-2,3-dimethoxybutenolide 3a, gamma-(Z)-ethylidene-2-methoxy-3-(4-nitro)benzyloxybutenolide 3b, gamma-(Z)-ethylidene-2-(4-nitro)benzyloxy-3-methoxybutenolide 3c, gamma-(Z)-ethylidene-2,3-di(4-nitro)benzyloxybutenolide 3d, and dimethylphosphono-gamma-(Z)-ethylidene-2,3-dimethoxybutenolide 11 as well as the adenine derivative of gamma-(Z)-ethylidene-2,3-dimethoxybutenolide 6 were synthesized. The key steps in the high-yield synthesis of 6 involved hydration/dehydration of the C(4)=C(5) in the precursor 3a. In the presence of NH4OH at elevated temperature, 3a underwent a reverse Michael-type addition with water to produce hydrate 5. At 37 degrees C, 6 was also hydrated in the presence of S-adenosyl-L-homocysteine hydrolase to afford 5. Butenolide 6 exhibited an inhibitory property toward the enzyme. Such type II (enzyme-mediated addition of water across C(4)=C(5)) mechanism is the first example of "enzyme-substrate intermediate" inactivation of S-adenosyl-L-homocysteine hydrolase. In contrast with type I mechanism-based inactivation, reduction of enzyme-bound NADP(+) to NADPH was not observed. Upon treatment with HCl, stereoselective dehydration of 5 occurred to give the target molecule 6. At ambident temperature, 3a was hydrated in the presence of NH4OH or pig liver esterase to produce 6-chloropurine derivative 4. An unambiguous proof of the structures of 3-5 was obtained by X-ray crystallographic analysis. For the synthesis of phosphonate derivative 11, the key step involved chlorination of phosphonate 9 by use of CF3SO2Cl and 1,8-diazabicyclo[5.4.0]undec-7-ene in CH2Cl2. 6-Chloropurine-containing butenolide 3d, 6-chloropurine derivative of 4-hydroxybutenolide 4, and adenine-containing 4-hydroxybutenolide 5 did not show anticancer and antiviral activities. 6-Chloropurine-containing ethylidene-2,3-dialkoxybutenolides 3a-c and phosphonate 11, however, exhibited inhibitory activity against murine leukemias (L1210 and P388), breast carcinoma (MCF7), and human T-lymphoblasts (Molt4/C8 and CEM/0) cell lines. They were also notably active toward thymidine kinase-deficient varicella-zoster virus (TK(-)VZV). Adenine-containing ethylidene-2,3-dimethoxybutenolide 6 exhibited marked selectivity in cytostatic activity against the murine leukemia (P388) cell line.

Purpose: Deep neck infections may be lethal if life-threatening complications occur, especially in immunocompromised hosts such as diabetic patients. This study was undertaken to better define the clinical features and prognosis of deep neck infections in the diabetic patients with special emphasis on the use of empirical antibiotics and the role and timing of surgical management., Patients and Methods: A retrospective analysis of 105 consecutive patients treated at a single institution during a 9-year period was conducted. Of these, 30 patients also presented with diabetes mellitus., Results: Compared with the nondiabetic patients, the unique features of deep neck infections in diabetic patients were as follows: (1) older age, (2) tendency of unclear infection source, (3) tendency to involve multiple spaces, (4) required more aggressive surgical intervention, (5) prolonged hospitalization, and (6) higher complication rate. The differences were statistically significant (P< .05). There were no significant differences in the complete blood count/ differential count positive findings and fever between the 2 groups (P> .05). Bacterial cultures showed that Klebsilla pneumoniae was the most common causative pathogen in diabetic patients., Conclusions: In deep neck infection patients with diabetes mellitus, the clinical course is more severe and there is a poorer prognosis. Thus, in treating them, we should keep close observation, appropriately control the diabetes, detect the life-threatening complications early, perform aggressive surgical treatment if fluctuation or complication occurs, and take into account the preponderance of K pneumoniae when administering the empirical antibiotics.

Objective: The purpose of this study was to determine if radiotherapy for nasopharyngeal carcinoma causes mucosal disease of the paranasal sinuses., Design: This study was a retrospective study., Setting: This study was conducted at a tertiary care centre., Method: A series of 69 newly diagnosed patients, without pre-existing sinus disease, who were treated with high-dose radiotherapy participated., Main Outcome Measures: The prevalence, severity, and time course of mucosal abnormalities were analyzed, as judged by consecutive computed tomographies (CTs)., Results: The CT study revealed that 58.8% of the postirradiation scans had mucosal disease of the sinuses. The maxillary sinus had the highest prevalence (42.3%) without statistical significance (p = .10). The difference by McNemar test for two follow-up scans was not significant (p = .48) and by Kappa test was significant (p = .04). The relationship between the prevalence and the time course post radiotherapy revealed that it remained a high prevalence until after the 4-year follow-up scans., Conclusions: The results of this study confirm that chronic sinus disease is a common late complication of radiotherapy and it persists for years. Thus, aggressive treatment is indicated.

A prospective study was performed to investigate the feasibility and benefit of evaluating blunt abdominal trauma (BAT) without diagnostic peritoneal lavage (DPL) or other invasive methods. Diagnostic algorithms were designed by using ultrasonography (US) as a screening method. For unstable patients, a free fluid >/= 2 mm thickness on US images over any one of the intraperitoneal spaces (bilateral subphrenic, Morrison, and Douglas pouch) was used as an indicator for laparotomy. For stable patients, any intraabdominal free fluid detected by US was used as an indicator for further investigations. Computed tomography served as a principal complementary method. To further clarify the clinical results, the rate of nontherapeutic laparotomy (NTL) was compared with that from a previous 5-year review done before this study. During studying period of 1 year, 170 patients were consecutively enrolled. There was no delayed diagnosis, and 66 patients were found to have BAT; 17 patients were initial unstable, among whom 15 had free fluid shown by US and 13 patients had confirmed BAT. Eight of the unstable patients with free fluid on US were saved from NTL, of whom six had retroperitoneal hematoma. There was no NTL in unstable patients. Twenty-two patients underwent laparotomy. Two laparotomies done for a suspicion of bowel injury turned out to be NTL. The rate of NTL in the present study was significant lower than that in a previous review (9.1% vs. 32.2%, p = 0.025). Hence following well designed algorithms, noninvasive evaluation of BAT can proceed with safety, and NTL is minimized.

Objective: In the era of antibiotics, most deep neck infections can be cured by conservative treatment, but some still result in life-threatening complications. In this study, we discuss whether or not there are predisposing factors of complicated deep neck infection., Design: A retrospective chart review of patients presenting between 1988 and 1996 was conducted., Method: Among 214 deep neck infection patients, 18 cases resulted in lethal complications. We used the "dummy" variable with logistic regression as the statistical analysis method., Results: Patients with an underlying disease, neck swelling, and delay time had a positive correlation that was statistically significance (p < .05). Patients who were older, male, with complete blood count/differential count-positive finding and fever had positive correlation, but this was not statistically significant (p > .05)., Conclusion: Although complicated deep neck infection is a rapidly progressive disease with a high mortality, we can not thoroughly predict the prognosis or avoid it happening completely. But, if we can detect and pay more attention to the high-risk group of patients with use of aggressive therapy, the incidence of complicated deep neck infection may be reduced.

Traumatic ventricular septal defect with valvular injury is an uncommon blunt trauma. It may develop either immediately or be delayed, but it should be corrected electively. With hemodynamic instability and cardiopulmonary deterioration, however, early repair is necessary as a lifesaving procedure. Two-dimensional echocardiography and Doppler color flow mapping are very important for rapid detection in patients who are critically injured. This is a case report of the successful repair of ventricular septal defect and posterior leaflet disruption of mitral valve right after blunt trauma.

A rapid Ca2+ release from Ca2+-loaded sarcoplasmic reticulum vesicles from fast skeletal muscle can be induced under conditions which permit the formation of a stable phosphorylated intermediate of the (Ca2+-Mg2+)-ATPase. Such a state can be achieved experimentally by phosphorylating the ATPase in the absence of Mg2+ ions, which otherwise would stimulate the dephosphorylation step(s). Also, quercetine stimulates the rapid release of Ca2+ if used in the concentration range which does not produce inhibition of phosphoenzyme formation, but which inhibits phosphoenzyme dephosphorylation. The rapid efflux of Ca2+ ions proceeds as long as the low affinity Ca2+-binding sites facing the lumen of the vesicles are saturated and as long as Ca2+ is removed from the catalytic sites facing the cytosol. A molecular mechanism of the phosphoenzyme-mediated Ca2+ release is proposed. This mechanism is based on a rapid shuttling of the ATPase molecules between an ADP-sensitive and an ADP-insensitive phosphorylated state.