given 30-45g of cocoa (copper content 1.14-1.71mg) per day for about 40 days. Among them, two patients could not condl with cocoa administration, anemia and neutropenia caused by copper deficiency showed a tendency to improve. After completing the study period, cocoa was reduced to 5g (copper content 0.19mg) per day in 23 patients. The mean serum copment for adults has been reported to be 1.28-2.5mg per day. We showed that 10g of cocoa (0.6mg total copper: 0.38mg in cocoa and 0.22mg in other nutrients) is sufficient to treat copper deficiency, and 5g of cocoa (0.37mg total copper: 0.19mg in cocoa and 0.18mg in other nutrients) is enough to maintain the normal level of serum copper in patients with long-term enteral nutrition.

A seventy-year-old man was admitted at our hospital because of dyspnea. Echocardiogram and left ventriculogram showed an aneurysm formation of the membranous ventricular septum and small left-to-right shunt through ventricular septum defect and also severe mitral and tricuspid insufficiency. Operation was performed after medical therapy for congestive heart failure. During operation, mitral leaflets showed no organic lesions nor prolapse, but the annulus was dilated. The cause of mitral insufficiency, we thought, might be congenital, and the annulus dilatation was caused of mitral insufficiency, we thought, might be congenital, and the annulus dilatation was caused to produce tricuspid insufficiency secondary. The ventricular septal communication became small (diameter; 5 mm) and was associated with aneurysm formation of the remaining portion of the membranous septum. And the aneurysm, protruding to the septal leaflet of tricuspid valves, enhanced tricuspid insufficiency. It was reported by many authors that the aneurysm formation was related to spontaneous closure of ventricular septal defect. Patients with small ventricular septal defect, without any symptoms, must be followed intensively, or they might get cardiac complications, such as arrhythmia, right ventricular outflow obstruction, tricuspid insufficiency, and so on.

We present the outcome of surgical management for thoracoabdominal aneurysms in 27 patients during the past 22 years. Ischemia of visceral organs was successfully prevented by axillofemoral temporary bypass using a 10mm PTFE graft with an 8mm branch for main visceral vessels and partial extracorporeal circulation perfusing visceral organs. No other significant

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