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We analyzed hemodynamic variables in patients with transposition of the great arteries with intact ventricular septum (simple transposition) after pulmonary artery banding and BlalockTaussig anastomosis to establish the criteria for two-staged arterial switch operation. The study included 35 patients who underwent the switch operation after banding and anastomosis; two died shortly after surgery, and one died of tachycardia 31 days after the operation. The left-to-right ventricular pressure ratio was above 0.83 in all surviving patients, 0.68 and 0.63 in the two operative deaths, and 0.84 in the other death. In the 32 surviving patients, angiographically determined left ventricular (LV) end-diastolic volume and ejection fraction averaged 147 ± 46(SD)% of normal and 0.64 ± 0.12, respectively. We also measured LV mass using angiographic LV semiaxes and end-diastolic LV posterior wall thickness obtained from an echocardiogram. These variables of the patients who died were not different from those of the surviving patients. The wall thickness was greater than 4 mm in the surviving patients, while it was 3.5 mm in the two patients who died early and 5 mm in the patient who died later. From the semiaxes, the wall thickness, and aortic diastolic pressure, all of which were obtained before the anatomic repair, we calculated the predictive LV wall stress. This wall stress would indicate the LV wall stress at the time of aortic valve opening immediately after the arterial switch operation. Predictive wall stress was less than 120 x 103 dynes/cm2 in all but one of the surviving patients, whereas it was 151, 153, and 186 x 103 dynes/cm2 in the three patients who died. From these data, we propose the following criteria for the safe two-staged arterial switch operation: left-to-right ventricular pressure ratio greater than 0.85; LV end-diastolic volume greater than 90% of normal; LV ejection fraction greater than 0.5, or it may be greater than 0.4; posterior wall thickness greater than 4 mm or very safely greater than 4.5 mm; and the predictive wall stress less than 120 x 103 dynes/cm2. (Circulation 1988;78:124-131) ith regard to postoperative physiology, it W is now increasingly accepted that the arterial switch operation is better than the atrial switch procedures in the surgical management of transposition of the great arteries (TGA). The basic concept is that the left ventricle (LV) supports the systemic circulation after the arterial switch operation; thus, systemic ventricular function should be normal in those patients, whereas the right (systemic) ventricular (RV) function is known From the

Although hypochlorhydria increases intraluminal nitrite and decreases intraluminal vitamin C, which increases the intraluminal formation of N-nitroso compounds, our results indicate that patients with gastric cancer may have additional factors that emphasize these changes.

H. pylori-induced gastritis increases serum NOx concentrations more prominently than those of pepsinogen. In H. pylori-negative subjects, serum correlates with serum pepsinogen II.