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Biomedical subjects

A Hashimoto

Publications and source records attributed to A Hashimoto.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Transcranial Doppler measurement of middle cerebral artery blood flow during continuous retrograde cerebral perfusion].

This is the first report of cerebral blood flow measurement with transcranial Doppler (TCD) during aortic arch reconstruction using continuous retrograde cerebral perfusion (CRCP) with deep hypothermia. Cerebral blood flow velocity was measured in 6 patients. CRCP was performed via the superior vena cava (SVC) at 30 cmH2O of internal juglar vein pressure and at 18 degrees C or lower of minimum bladder temperature. During the operation, the flow velocity of the middle cerebral artery (MCA) was continuously measured with TCD fixed on the temple. The cerebral blood flow during CRCP was different in each of the 6 patient. The retrograde MCA flow could be measured during CRCP in 3 patients, and the flow velocity was 11-60% of the MCA flow velocity before cardiopulmonary bypass. In the other 3 patients, retrograde MCA flow could not be detected during CRCP, but antegrade MCA flow could be found after antegrade perfusion was resumed. The antegrade flow velocity right after CRCP became more than the MCA flow before CRCP, which was regarded as a reaction due to cerebral ischemia. All the patients awoke within several (2-9) hours after operations and had no permanent neurological complications. But 2 patients developed drowsiness for several days after the operations; their CRCP times were 127 and 131 minutes. It is concluded that CRCP is a simple technique for brain protection, but the cerebral blood flow during CRCP is a simple technique for brain protection, but the cerebral blood flow during CRCP is different in each patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[A case of pulmonary tuberculosis developed immediately after a chest wall injury].

A 75-year-old female was admitted to our hospital for further examination of the cause of blood-stained sputum and abnormal shadow on chest radiogram which had developed immediately after an injury of right chest wall. The bacteriological examination of sputum on admission revealed negative Gaffky score, but positive PCR, and Mycobacterium tuberculosis was isolated by culture. Her symptoms and chest radiogram were improved by the administration of isoniazid, ethambutol and rifampicin. Although development of pulmonary tuberculosis induced by chest wall injury is rare, in case of the aged persons such possibility should be considered. PCR may be useful for rapid diagnosis of tuberculosis, even in such case.

Aged↗
PubMed1994

[Rapid identification of mycobacteria by combined method of polymerase chain reaction and the gen-probe DNA hybridization system].

We developed the rapid detection and identification method of mycobacteria, involving amplification of mycobacterial 16S rRNA gene by nested PCR and identification of M. tuberculosis complex or M. avium-intracellulare complex (MAC) by hybridization protection assay (HPA) using the acridinium-ester (AE) labeled DNA probe. The specificity of the nested PCR combined with DNA probe test was excellent in terms of detection of mycobacterial organisms and identification of M. tuberculosis or MAC. The detection limits of the present method were 10 fg DNA for M. tuberculosis, and 100 fg DNA for MAC, respectively. We further investigated on the optimum temperature for hybridization in HPA with AE labeled DNA probe because there was the difference in the mode of DNA-RNA hybridization from that of DNA-DNA hybridization. In our method, the optimum temperature of hybridization was estimated as 55 +/- 1 degrees C. In preliminary experiments on two clinical cases, we practically detected and identified M. tuberculosis and MAC in clinical specimens, such as sputa, by using this newly devised method. We concluded that this method is useful for rapid detection and identification of M. tuberculosis and MAC in clinical specimens.

Adult↗
PubMed1994

Effects of deep saturation diving on the lymphocyte subsets of healthy divers.

We examined the effect of deep saturation diving on the host defense mechanisms of five healthy volunteers using fluorescein-dye-conjugated monoclonal antibodies. Six divers engaged in a 440-m saturation diving simulation with total hyperbaric exposure of 30 days; five served as subjects. Change in the expression of surface molecules on the lymphocytes was analyzed during that period. Blood samples were serially taken on Days 4, 6, 8, 15, 22, 29, and after surfacing. The total number of lymphocytes showed no remarkable change. However, the fraction of T (CD3+) cells decreased from 68.0 +/- 3.3% to 55.8 +/- 5.8% (Day 8), and B cells increased reciprocally. In these T cells, the CD4:CD8 ratio (normally > 1.0) became less than 1.0 during compression and thereafter. In spite of the prophylactic use of anti-external otitis agents, one of the divers revealed a remarkable growth of Pseudomonas in the external auditory meatus, showing a high level of blood endotoxin (10.2 pg/ml). These results suggest that decrease in CD4+ fraction of T lymphocytes might explain in part the decreased resistance of divers to infective microorganisms in deep saturation diving.

Adult↗
PubMed1994

[Long-term results after cardiac valve replacement: 16 years follow-up of 190 patients].

According to STS/AATS guidelines 1988, we compared the long-term results after cardiac valve replacement (ReAVR 26, ReMVR 127, ReDVR 35, ReTVR 2, total 190 patients) with those after initial valve replacement (AVR 760, MVR 1, 001, DVR 431, TVR 22, total 2,214 patients). Actuarial survival (AS), reoperation free (RF) and freedom from all valve-related events (EF) at the 10th postoperative year were 74.6%, 100%, 70.1% after ReAVR, 84.2%. 97.8%, 75.8% after AVR, 82.9%, 91.4%, 75.8% after ReMVR, 86.5%, 91.7%, 70.7% after MVR. 78.4%, 92.9%, 63.2% after ReDVR, 82.8%, 95.6%, 73.8% after DVR, respectively. There was no significant difference of AS, RF and EF between ReVR and initial VR in any valve position. These results justify our current strategy of cardiac valve re-replacement.

Adolescent↗
PubMed1994

Tricuspid valve replacement with the bileaflet St. Jude Medical valve prosthesis.

Case histories of 39 patients who underwent tricuspid valve replacement with the St. Jude Medical prosthesis between June 1979 and August 1992 were reviewed in March 1993. The average patient age at the time of the operation was 46 +/- 11 years (range from 17 to 68 years). Concomitant mitral and/or aortic valve replacements were performed in 30 patients. All patients were given warfarin to maintain thrombotest between 10% to 25%. This number was between 2.8 to 1.6 times the control value in the International Normalized Ratio of prothrombin time. Three operative deaths occurred (7.7%). Among six late deaths, two patients died suddenly of unknown causes, and the remaining patient deaths were not valve-related. The actuarial survival rate at 14 years was 54.7%. Valve thrombosis occurred in one patient and was successfully treated with intravenous urokinase. This was the only valve-related complication (0.67%/patient-year). No reoperations were necessary in the tricuspid position. In conclusion, the St. Jude Medical valve is our choice of prosthesis for tricuspid valve replacement in adult patients who can receive proper anticoagulation therapy.

Adolescent↗
PubMed1994

[Relation between surgical outcome and preoperative end-systolic volume of the left ventricle in patients with regurgitant valvular heart disease].

The relation between the end-systolic volume index of the left ventricle (ESVI (ml/m2)) and the early and late results after valve replacement were reviewed in 249 patients with pure aortic regurgitation (AR) and 189 patients with pure mitral regurgitation (MR). The patients with AR were classified into 4 groups (A1-A4) and those with MR were classified into 3 groups (M1-M3) according to the ESVI. The ESVI, the number of patients (No of P), early mortality rate (EM) and the actuarial survival rate at 12 years after valve replacement (AS at 12 yr) in each group are shown in the following Table. [table: see text] The actuarial survival rate at 12 years after operation in A1 and A2 were significantly lower than that in A3 and A4. In 57% of the late deaths in A1 and A2 patients, the cause of the death was thought to be rhythm disturbance. In contrast, there were no differences in late survival among the three groups with MR (M1, M2 and M3). The minor axis of the left ventricle at end-diastole and at end-systole (Dd and Ds) and shortening fraction of the left minor axis (FS), evaluated by echocardiography, were normalized early after the operation in A1 patients only. The Dd, Ds and FS in A2 and A3 returned to normal late after the operation. However, in A4, these parameters still remained abnormal. Thus, patients with a deteriorated left ventricle can survive the operation. However, the long-term results in patients with AR with ESVI more than 150 ml/m2 were unsatisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Insufficiency↗
PubMed1994

Stereoselective antagonism by enantiomers of alanine and serine of phencyclidine-induced hyperactivity, stereotypy and ataxia in the rat.

Intracerebroventricular injection of the D-forms of alanine (Ala; 2-200 micrograms/rat) and serine (Ser; 20-2000 micrograms/rat) caused a dose-dependent inhibition of the ability of 10 mg/kg of phencyclidine (PCP; given i.p.) to increase automatically quantitated locomotor counts and cumulated scores of locomotion, stereotypy and ataxia for 90 min after PCP administration. D-Ala and D-Ser were found to be more potent than the corresponding L-isomers in attenuating the PCP-induction of these behavioral abnormalities. Although L-, but not D-Ser, at moderate doses (400 micrograms/rat) produced a slight decrease in cumulative ataxia scores after a 10-mg/kg PCP administration, D-, but not L-Ser, reduced the behavioral scores at large doses (more than 1000 micrograms/rat). Similarly, bilateral i.c.v. infusion of D-Ala (140 micrograms/rat) reduced the increasing effects of a lower dose of PCP (5 mg/kg i.p.) on locomotion, stereotypy and ataxia scores, whereas the L-form of Ala (140 micrograms/rat) lacked the inhibitory influence. The stereo-selectivity of the antagonism by Ala and Ser of PCP-induced abnormal behavior parallels that of the potencies of these amino acids as agonists for the strychnine-insensitive glycine site linked to the N-methyl-D-aspartate type excitatory amino acid receptor. Furthermore, the decreasing effects of D-Ala (200 micrograms/rat i.c.v.) and D-Ser (2000 micrograms/rat i.c.v.) on PCP-induced hyperactivity were antagonized by i.c.v. application of 5,7-dichlorokynurenate and 7-chlorokynurenate which are selective antagonists of the glycine modulatory site.(ABSTRACT TRUNCATED AT 250 WORDS)

Alanine↗
PubMed1994

[Pulmonary hypertension in aortic valve disease].

144 surgical patients with isolated aortic valve disease were reviewed to determine the incidence and the mechanism of pulmonary hypertension (PH). The hemodynamic data revealed PH (pulmonary artery systolic pressure of 40 mmHg or more) in 18 patients (12.6%). There was a positive correlation between left ventricular end-diastolic pressure (LVEDP) and pulmonary artery pressure. After operation the pulmonary artery pressure normalized in all cases but 2 patients in early post-operative period. In patients with aortic stenosis with PH, LVEDP/LVEDVI ratio was higher than that of patients without PH, which showed left ventricular diastolic dysfunction. In patients with aortic regurgitation with PH, the cause of elevated LVEDP was not only severe long-standing regurgitation with ventricular dysfunction, but also the imbalancement of compensation by dilated ventricle with preserved left ventricular function.

Adult↗
PubMed1994

[Clinical effect of the combined therapy of arbekacin and imipenem/cilastatin against methicillin-resistant Staphylococcus aureus].

We evaluated the efficacy of combined therapy of arbekacin (ABK) and imipenem/cilastatin (IPM/CS) against infections by methicillin-resistant Staphylococcus aureus (MRSA). The MICs of ampicillin, cefmetazole, cefotiam, cefuzonam, flomoxef, fosfomycin, ofloxacin, minocycline, ABK and IPM/CS against clinically isolated strains of MRSA were examined. Almost all strains of MRSA were resistant to these antibiotics except ABK. Furthermore, combination of ABK and IPM/CS showed smaller MICs than that of ABK or IPM/CS alone. All fractional inhibitory concentration indices (FIC indices) of ABK plus IPM/CS were lower than 0.75. The efficacy rate of combined therapy of ABK and IPM/CS in 22 patients with MRSA infections (15 patients with pneumonia, 3 patients with chronic bronchitis, 2 patients with sepsis, a patient with subcutaneous abscess and a patient with DPB) was 68%. And no patients had adverse reactions. Six (27%) of 22 strains of MRSA were eradicated. Significant correlations were found between bacteriological effect and severity of disease, and between serum albumin level and clinical effect.

Aged↗
PubMed1994

[Surgical treatment of infective endocarditis in patients with congenital heart disease].

From 1981 to March 1993, 21 patients underwent surgical treatment for infective endocarditis (IE) associated with congenital heart disease (CHD). We evaluated the surgical results with regard to various factors, including microorganisms, pre- and postoperative complications, the correlation between CHD and the infective focus in the valve, the operative methods and surgical results. Underlying CHD included ventricular septal defect (VSD) in 15 (71.5%), persistent ductus arteriosus (PDA) in 2 (9.5%), tetralogy of Fallot (TF) in 2 (9.5%) and incomplete endocardial cushion defect (IECD) in 2 patients (9.5%). Microorganisms were detected in 71.4% of the patients, including streptococcus in 11 patients (52.4%), staphylococcus in 2 (9.5%) and gram-negative bacillin in 2 (9.5%). Embolism or infarction was noted preoperatively in 5 patients (23.8%) and was located in the kidney in 4 patients, the leg in 2, and in the liver and lung in 1 patient each. Among 15 patients with VSD, the lesion of IE was seen on the left side of the heart in 11 patients, on the right side in 3 and on both sides in 1. The PDA and IECD were seen on the left side in 2 patients each, but the IE focus of the 2 patients with TF was on the left side in one and on both sides in the other patient. Aortic valve replacement was performed in 17 patients, mitral valve replacement in 3, tricuspid valve plasty in 2, tricuspid annuloplasty in 1 and pulmonary valve resection in 2 patients. The operative mortality was 4.8% and there were no reoperations or late deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Surgical treatment of ischemic mitral regurgitation].

Mitral regurgitation secondary to ischemic heart disease carries a significant mortality even after emergent open heart surgery. We report on 16 patients with mitral regurgitation associated with ischemic heart disease. The pathological findings were chorda elongation and papillary muscle dysfunction (PMD group) in 12 patients, and papillary muscle rupture (PR group in 4 patients. Preoperative characteristics were severe left ventricular failure in PMD group and high incidence of renal failure, in associated with high age in PR group. In PMD group, mitral plasty was performed in 10 patients out of 12 patients. In PR group all patients underwent mitral valve replacement. Thirteen patients underwent mitral surgery combined with coronary artery bypass grafting. No operative death was seen, one hospital death and 3 late deaths occurred. Three late deaths were seen in PMD group due to sudden death in 2 cases and arrhythmia in 1 case. One hospital death in PR group was due to multi-organ failure. We suggested incorporating these therapeutic concepts may introduce satisfactory results in surgical treatment for ischemic mitral regurgitation.

Aged↗
PubMed1994

[A case of endometrial tuberculosis diagnosed by polymerase chain reaction].

A 30-year-old female was admitted to our hospital for further investigation of infertility. The menstrual culture and polymerase chain reaction (PCR) of the endometrial tissue for detection of Mycobacterium tuberculosis were both positive. The pelvic CT scan and hysterosalpingography showed a slightly expanded uterus and irregularity of the endometrium. Barium enema and pyelography showed no abnormality. Since these data established a diagnosis of early primary endometrial tuberculosis, the combined therapy of three antituberculous agents was commenced. Menstrual smear, culture and PCR for M. tuberculosis were examined monthly throughout the therapy. The mycobacterial culture became negative soon after the start of therapy, followed by a negative PCR result 3 months later. We conclude that PCR is useful for the rapid detection of M. tuberculosis not only in pulmonary but also in endometrial tuberculosis.

Adult↗
PubMed1994

[Evaluation of (1-3)-beta-D-glucan in aspergillosis and cryptococcosis].

(1-3)-beta-D-Glucan (beta-glucan) is a major structural component of fungi. The G test is a direct method to detect beta-glucan using fractionated (1-3)-beta-D-glucan-sensitive component, factor G, eluted from the limulus lysate. Previously, we reported that the G test is a more sensitive method than the mannan detection assay for the serological diagnosis of Candida infection. In this study, we discuss beta-glucanemia in patients with pulmonary aspergillosis and cryptococcosis. The concentration of beta-glucan was less than 10 pg/ml in 9 of 10 cases of pulmonary cryptococcosis, except for one case receiving hemodialysis (16.5 pg/ml). beta-Glucan increased in 3 cases of invasive pulmonary aspergillosis (27-937 pg/ml). Galactomannan antigen was positive in all of those cases. In 8 cases of aspergilloma, which showed fungus ball on roentgenogram, the mean concentration of beta-glucan was 67.1 +/- 92.7 pg/ml. Two of 8 cases were positive for galactomannan antigen. One of three cases of PAIC (productive aspergilloma on the inner wall of a cavity) and one case of chronic necrotizing pulmonary aspergillosis showed slightly increased levels of beta-glucan and positive results of galactomannan antigen test.

Adult↗
PubMed1994

[Directions for reoperation of patients with Björk-Shiley convexo-concave valve prosthesis, based on long-term experience].

Although a high incidence of strut fracture of the Björk-Shiley convexo-concave (C-C) valve prosthesis has been reported, it is still controversial whether the prosthesis functioning normally should be replaced electively. To clarify our policy for this issue, we reviewed 28 patients who had undergone mitral valve replacement with a C-C valve prosthesis, and evaluated long-term results according to STS guidelines. The incidence of valve-related complications expressed as % patient-year were; structural deterioration 0.30, nonstructural dysfunction 0.30, thromboembolism 1.20. There were no thrombosed valves, anticoagulant-related hemorrhage or prosthetic valve endocarditis. The actuarial free rate after valve replacement with the C-C at 10 years, constructed by the Kaplan-Meier method, were compared with those with St. Jude Medical (SJM) valve prosthesis. (1) Actuarial survival: 77.9 vs 87.3 (NS), (2) Reoperation-free: 91.6 vs 98.0 (p < 0.05), (3) thromboembolism-free: 83.7 vs 83.9 (NS), (4) Event-free (hospital death+reoperation+valve-related complications: 71.2 vs 77.7 (NS). The long-term results with the C-C were compatible to those with a SJM valve prosthesis. However, if a strut fracture occurs, it is very difficult to save the patient's life. The hospital mortality of re-replacement of valve prosthesis during the last 10 years, at our institute, was 2.6%, which is almost equal to the cumulative risk of strut fracture of the C-C valve after 10 years (3.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Exercise-induced STV1 elevation: a sign of right ventricular dysfunction in recent inferior myocardial infarction.

BACKGROUND: Little is known about exercise-induced electrocardiographic ST segment shift in right-sided precordial leads, especially elevated ST in patients with subacute inferior myocardial infarction. OBJECTIVE: To test the clinical significance of exercise-induced STV1 deviation with special regard to right ventricular function and right ventricular involvement. DESIGN: Sixty-eight patients with recent inferior myocardial infarction (without having a left descending arterial lesion) aged 30 to 73 years (mean +/- SD, 59.1 +/- 10.0) were investigated with respect to biventricular function observed in radionuclide ventriculography and treadmill stress electrocardiographic findings. RESULT: STV1 shift during exercise (delta STV1) had a negative linear logarithmic relationship only with the right ventricular ejection fraction (RVEF) and no correlation with the left ventricular ejection fraction (delta STV1 = 6.7604-1.7528xlnRVEF, r = 0.709, P = 0.0001). Significant STV1 elevation (delta STV1 of 0.5 mm or more) predicted right ventricular dysfunction (RVEF of 40% or less) and right ventricular infarction with sensitivities of 76% and 77%, specificities of 88% and 92%, and accuracies of 84% and 77%, respectively. Twenty patients with STV1 elevation (0.5 mm or more) showed nearly identical rest and exercise electrocardiographic findings, exercise capacities and similar stenotic lesions on coronary angiography, to 43 patients without significant STV1 elevation. Elective balloon angioplasty reduced the delta STV1 during exercise in only three of six patients (50%) with right ventricular infarction. CONCLUSION: Exercise-induced STV1 elevation may be a useful indicator of global right ventricular dysfunction and/or right ventricular infarction in the subacute phase of myocardial inferior infarction.

Adult↗
PubMed1993

Widespread distribution of free D-aspartate in rat periphery.

We have identified and quantified free D-aspartate in adult rat peripheral organs using gas chromatographic-mass spectrometric and high-performance liquid chromatographic techniques. The level of free D-aspartate was highest in the adrenal, testis, spleen and pituitary, followed by the thymus, lung, ovary, placenta, pancreas and heart, and below the detection limit in the kidney, liver, brain, muscle and serum. These data provide the first evidence that a high level of free D-aspartate widely occurs in the adult rat periphery and suggest that the D-amino acid may be an endogenous substrate for D-aspartate oxidase.

Animals↗