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Biomedical subjects

A Hashimoto

Publications and source records attributed to A Hashimoto.

At least 163 records · Page 9Linked to original sources
PubMed1996

[Long-term results and special issues of operation for infective endocarditis].

Between 1977 and June 1996, 183 patients underwent operation for infective endocarditis (IE) at our institution. Long-term mortality and morbidity were analyzed according to the STS/AATS guidelines (1988). Operative mortality including hospital deaths was 4.9% in all patients. Actuarial survival (including all deaths) at 10 postoperative years was 79.6% after AVR (n = 91), 87.9% after MVR (n = 40) and 90.0% after DVR (n = 46). There was no significant difference among 3 groups. Reoperation free and freedom from all valve-related mortality and morbidity at 10 years were 94.0% and 70.4% after AVR, 90.9% and 83.7% after MVR and 93.4% and 79.7% after DVR, respectively. And the differences among 3 groups were not significant in both freedom proportions. Overall results in this series of patients were acceptable. However, several patients with active IE and extensive perivalvular abscess were not saved even if translocation method and/or other advanced surgical procedures were applied. Introduction of aortic valve homografts might be a key factor for successful treatment for patients with extensive IE lesion.

Adolescent↗
PubMed1996

A new supportive method of aortic aneurysm surgery: centrifugal left heart bypass combined with an oxygenator and a heat exchanger.

A new supportive method of centrifugal left heart bypass with oxygenation was performed in 25 patients and compared with standard left heart bypass in 45 patients. Femoro-femoral bypass was selected in another 6 patients because of the presence of a left atrial adhesion. Intraoperative complications related to standard left heart bypass, hypoxia, hypothermia, and ventricular fibrillation, were eliminated by using this method. This supportive method maintained good hemodynamics and improved the surgical result of extended thoracoabdominal aortic replacement. Hospital deaths decreased from 6.7% to 3.2%.

Adult↗
PubMed1996

Biventricular bypass with oxygenation for postcardiotomy ventricular failure.

Between January 1984 and March 1995, biventricular bypass (BVB) with oxygenation was used in 17 patients for postcardiotomy ventricular failure at the Heart Institute of Japan, Tokyo Women's Medical College. Of the 17 patients, 12 (70.6%) were weaned from the circulatory support, and 8 (47.1%) were discharged from the hospital. The time interval from the endo of cardiopulmonary bypass to the start of BVB was significantly shorter in weaned patients than in unweaned patients. The duration on support also has been shortened significantly in the last 6 years, compared with the earlier 6 years. Causes of death were severe heart failure or ventricular arrhythmia in 6 patients and multiple organ failure in 3 patients. These results suggest that early application and timely weaning from biventricular bypass with oxygenation might be the effective circulatory support of choice for treatment of postcardiotomy ventricular failure.

Adult↗
PubMed1996

[A case of extra anatomical bypass grafting for coarctation of aorta associated with Turner's syndrome].

A 24-year-old woman with manifestations of Turner's syndrome was referred for detail examinations and treatment of right subclavian tumor on chest X-ray. She was short and obese (147 cm tall and weigh 65 kg). And she had hypertension at upper extremities (160/100 mmHg). Chest enhanced CT revealed right subclavian arterial aneurysm and coarctation of aorta. Aortography showed interrupted descending thoracic aorta with short atretic segment followed by distal descending aorta, aneurysmal collateral artery from right subclavian artery to abdominal aorta and other small collateral arteries. Left lateral thoracotomy was thought to have a high risk for bleeding in the short and obese patient with ample collateral arteries. Therefore, extra anatomical bypass grafting from ascending aorta to abdominal aorta was performed through median sternotomy and laparotomy. After operation recovery was uneventful without residual hypertension. In this report, we discuss about the operation of adult coarctation of aorta and usefulness of extraanatomical bypass grafting.

Adult↗
PubMed1996

[A case report of a successful Redo Bentall operation].

An initial Bentall operation was performed on a patient aged 38 years with annuloaortic ectasia and aortic regurgitation. An echocardiogram and RI angiogram revealed a perigraft aortic aneurysm on the same patient aged 45 years. The aneurysm gradually developed and the maximum diameter reached 90 mm in size. The Redo-Bentall operation (Piehler modification) was successfully done once again on the same patient aged 56 years. The anastmosis between the right coronary orifice and the graft was detached on all sides. The anastmosis between the left coronary orifice and the graft was detached two thirds of all sides.

Aneurysm, False↗
PubMed1996

[Cardiac surgery in patients on chronic hemodialysis].

From March 1993 to February 1993, 36 patients with chronic renal failure underwent cardiac surgery with intraoperative hemodialysis (HD). We examined and compared the medium term results of those patients cased upon the time periods of operation and types of heart disease. With respect to the time periods of operation, the 1st term (n = 12) was between March 1985 and February 1989, and the 2nd term (n = 24) was between March 1989 and February 1993. Concerning types of disease, Group A was comprised of 24 patients with ischemic heart disease, and Group B was comprised of 12 patients with valvular or congenital heart disease. Only one early death was observed in the 1st term (8.3%: LOS). As for late death, 5 cases were observed in the 1st term (45.3%), and 2 cases were observed in the 2nd term (8.3%). The actuarial survival rate (post 3 years) was 72.7% in the 1st term and 91.3% in the 2nd term. In each case, the survival rate of the 2nd term was significantly better than the that of the 1st term (p < 0.025). When compared cased upon the types of disease, the actuarial survival rate (post 6 years) was 84.6% in Group A, and 45.5% in Group B, respectively. This difference was statistically significant (p < 0.05). Causes of late death were cerebral hemorrhage in 5 cases, sudden and unknown in one and DIC in the remaining one patient. There were many postoperative complications in this series in addition to the above stated fatal ones. The majority of them, however, were successfully treated, if early diagnosis of them was obtained. During the perioperative period through the long-term period, incidents of fatal hemorrhage among patients on chronic dialysis were reduced by 1) strict management of hypertension; 2) HD without use of Heparin; and 3) with respect to patients who required Warfarin after valve replacement, through the careful anti-coagulant therapy which maintained the thrombo-test (TT) value at precise levels.

Adult↗
PubMed1996

[A surgical case report of an atrial septal defect combined with stenosis of the left main coronary artery caused by a dilated pulmonary artery in adult].

We encountered a 40-year-old male patient diagnosed to have an atrial septal defect combined with pulmonary hypertension and left main coronary artery stenosis of 50% caused by a dilated pulmonary artery. Preoperative Trazoline tolerance test revealed an increase in pulmonary artery pressure from 77/22(40) to 85/24(42), and a decrease in pulmonary vascular resistance from 4.2 U.m2 to 3.6 U.m2. Moreover, his treadmill exercise test was positive. We performed only a patch closure of the atrial septal defect. The postoperative catheterization examination showed normal pulmonary artery pressure, mild mitral valve regurgitation, and improvement of the left main coronary artery stenosis from 50% to 41%. After 6 months, his treadmill exercise test was negative. We believe that it is important to estimate preoperatively for the possible reversibility of pulmonary hypertension in a patient with an atrial septal defect combined with a left main coronary artery stenosis caused by a dilated pulmonary artery.

Adult↗
PubMed1996

[Endobronchial actinomycosis].

A 63-year-old man was admitted to our hospital with obstructive pneumonia. The chest X-ray film and computed tomogram showed an infiltrative shadow in the right lower lung field. Examination with a fiberoptic bronchoscope showed a mass in the right basal bronchus. These findings suggested the diagnosis of lung cancer with obstructive pneumonia. Histopathological examination of a specimen obtained by transbronchial biopsy revealed sulfur granules with infiltration of neutrophils, which led to the diagnosis of endobronchial actinomycosis. After three months of treatment with penicillin, the mass disappeared. Comparison of bronchoscopic findings before and after penicillin treatment clearly showed the efficacy of therapy.

Actinomycosis↗
PubMed1996

Aortic valve replacement in small aortic annulus with or without annular enlargement.

BACKGROUND AND AIMS OF THE STUDY: Surgical treatments for aortic valve disease in the presence of a small aortic annulus need appropriate indications for operative procedures and precise selection of valve prostheses. The objective of this study was to compare long term results after aortic annular enlargement with those after operation using a small valve prosthesis. MATERIALS AND METHODS: Since 1980, 45 patients with small aortic annulus underwent operation at our institution. There were six men and 39 women, and their ages ranged from 16 to 69 with a mean of 45.6 years. Of these patients, 28 underwent aortic annular enlargements (Nicks' procedure in 13, Manouguian's in 12 and apico-aortic bypass in three patients) and 17 patients received standard aortic valve replacement with a small valve prosthesis (19 mm Standard St. Jude Medical). Mean follow up was 8.6 years in the enlargement group and 4.9 years in the standard group. RESULTS: Early mortality was 3.6% (1/28) in the enlargement group and 5.9% (1/17) in the standard group (NS). The 10-year actuarial survival including all deaths was 85.7% in the enlargement group and 62.7% in the standard group (p < 0.10). The rate of freedom from reoperation at 10 years was 90.7% in the enlargement group and 93.8% in the standard group (NS). The 10-year freedom from all valve-related events was 81.0% in the enlargement group and 58.8% in the standard group (p < 0.05). CONCLUSIONS: The above results suggest that long term mortality and morbidity after aortic annular enlargement might be superior to those after standard AVR with a small valve prosthesis.

Adolescent↗
PubMed1996

[Long-term results of cardiac valve replacement with a Delrin-disk model of the Björk-Shiley valve prosthesis--comparative analysis with the Spherical-disk model].

Records from 99 patients who received the Delrin-disk model (Group D) of the Björk-Shiley (BS) prosthesis between December, 1971 and November, 1974 were reviewed and compared to those from 248 patients who received the Spherical-disk model BS between January, 1975 and June, 1981 (Group S). Complete follow-up was obtained in 98.8% of the patients. The follow-up was over 1302.3 patient-years (mean 13.2 years per patient) in Group D and 2967.5 patient-years (mean 12.0 years per patient) in Group S. Early mortality was not significantly different (Group D: 18.2%, Group S: 10.5%). Of 15 late deaths in Group D, 12 (60%) were valve related and of 58 late deaths in Group S, 34 (58.6%) were valve related. The survival proportion based on Kaplan-Meier analysis, and which included early deaths, was equivalent in both groups (Group D: 65.7% at 21 years, Group S: 64.8% at 18 years). The freedom from reoperation was 74.3% at 21 years for Group D and 95% at 18 years for Group S (p < 0.005). The incidence of prosthetic valve dysfunction in Group D was significantly higher than that in Group S during 15 years after insertion of the valve. The freedoms from thromboembolism and valve-related events were not significant in both groups. Gross examination of the explanted Delrin disk found wear indentations and excessive clearance between the disk and the prosthetic ring. Therefore, disk wear was the primary cause of prosthetic valve dysfunction for the Delrin model. These results suggest that patients with the Delrin-disk model of the Björk-Shiley prosthesis should receive close follow-up for structural integrity of the valve. Further, reoperation might be needed due to significant valve dysfunction in this group of patients.

Adolescent↗
PubMed1996

[A case report of papillary fibroelastoma of the aortic valve].

A 69-year-old woman was referred to our hospital with an aortic valve tumor. She had shown signs of chronic heart failure due to atrial fibrillation and hypertension for 4 years. There was no history of thromboembolism such as stroke and myocardial infarction, unaccountable fever, weight loss, and systemic symptoms. With two-dimensional echocardiography, a cardiac valve tumor was detected during a routine examination for heart failure. Echocardiographic findings showed a homogeneous mass with a diameter of approximately 1.5 cm, fixed directly to the noncoronary aortic valve cusp. During the operation, a papillary neoplasm, 1.5 by 1 cm, was observed at the midportion of the left ventricular side of noncoronary cusp without a peduncle. The tumor was excised together with all cusps. A 21-mm SJM aortic valve was implanted in position, and thereafter she remained free from symptoms. Histopathological examination of the tumor revealed benign papillary fibroelastoma. Two-dimensional echocardiography was utilized for a diagnosis of the aortic papillary fibroelastoma.

Aged↗
PubMed1996

[Cerebral oxygen desaturation during rewarming in retrograde cerebral perfusion with total circulatory arrest].

To evaluate cerebral oxygen desaturation during retrograde cerebral perfusion with total circulatory arrest (RCP), we measured cerebral oxygen extraction (O2 Ext), and arterio-venous oxygen differences (AV DO2) during and after RCP and compared the results with usual cardiopulmonary bypass (CPB) using continuous jugular blood saturation (SjO2) monitoring. In the RCP group, 7 patients underwent aortic arch replacement with RCP and in the CPB group, 4 patients underwent valvular surgery with CPB. A 5.5 Fr oximetric catheter was placed in the jugular bulb and cerebral venous and radial arterial blood were sampled. Oxygen partial pressure and saturation were measured at six intervals from cerebral venous and radial arterial blood. Measurements were taken at the following phases: phase I: before ECC was established, phase II: immediately after ECC started; phase III: at hypothermia (18 degrees C in the RCP group and 28 degrees C in the CPB group), phase IV: during rewarming (30 degrees C), phase V: after rewarming (36 degrees C), phase IV: immediately after weaning from ECC. All 11 patients survived without neurological complications. The minimum SjO2 of continuous monitoring during rewarming in the RCP group was significantly lower than in the CPB group. AVDO2 in the RCP group was also significantly higher than in the CPB group during rewarming. O2 Ext in the RCP group was significantly higher than in the CPB group during and after rewarming. Differences in glucose utilization during and after rewarming were also detected. Moreover, to determine factors that influence SjO2 during and after rewarming, we evaluated correlations with arterial PaCO2, arterial pH, and rewarming duration. There were significant (p < 0.05) correlations between SjO2 and PaCO2 in phase IV and phase V, between SjO2 and pH, and between SjO2 and rewarming duration. In conclusion, continuous SjO2 measurements reflected cerebral oxygen desaturation during and after rewarming in RCP. In RCP, significantly greater desaturation during and after rewarming was detected than in CPB. Therefore we suggest that relatively slow rewarming, higher PaCO2, and more acidic pH strategies were advantageous for preventing desaturation during and after rewarming in RCP.

Adult↗
PubMed1996

[A case report on graft replacement of ruptured aneurysm of the arch and the descending thoracic aorta associated with dense pulmonary adhesion].

A 73-year-old patient had been followed for aortic arch aneurysm of 54 mm in diameter. He was hospitalized complaining of chest and back pain. A chest CT scan showed ruptured aortic arch aneurysm extending to mid-descending thoracic aorta, and an emergent operation was decided. The trachea was intubated with a univent tube providing a movable blocker (System Corporation) which was directed to the left bronchus for differential lung ventilation. The descending thoracic aorta was exposed through the left 4th intercostal thoracotomy just at the site intending to anastomose a prosthetic graft because of dense pulmonary adhesion. The ascending and arch aorta was approached via median sternotomy. Under deep hypothermia and retrograde cerebral perfusion, total arch and descending aortic replacement was performed using an arch graft providing four branch grafts for neck vessels reconstruction and pump perfusion. The patient showed moderate pulmonary bleeding during and after cardiopulmonary bypass, but improved gradually. He was weaned from the respirator on the 13th post-operative day. During extensive thoracic aortic surgery using left thoracotomy combined with median sternotomy, left lung deflation using a univent tracheal tube with a blocker, and circulatory arrest during distal aortic anastomosis, are useful in preventing lethal pulmonary bleeding caused by lung injury under the fully heparinized condition. However, in cases associated with dense pulmonary adhesion, it is important to dissect carefully just a small area necessary to anastomose a graft, and to take elaborate assistant measures.

Aged↗
PubMed1996

[Clinical evaluation of sulbactam/cefoperazone for lower respiratory tract infections. Correlation between the efficacy of sulbactam/cefoperazone and beta-lactamase].

The efficacy and safety of sulbactam/cefoperazone (SBT/CPZ) were evaluated in 42 patients with respiratory tract infections, including pneumonia (29 patients) and lower respiratory tract infections (5 patients). Overall clinical efficacy rates (excellent + good) were 79% in pneumonia and 80% in respiratory tract infections in 34 patients evaluated for clinical efficacy. It was excellent that the clinical efficacy rate was 92% in mild and moderate pneumonia. Pathogens isolated from sputa were 31 strains, including 8 strains of Pseudomonas aeruginosa, 7 of Streptococcus pneumoniae, 3 of Staphylococcus aureus and 3 of Haemophilus influenzae. Since the isolates were eradicated in 18 strains, replaced in 3, unchanged in 2 and unknown in 8, the overall eradication rate was 91%. The eradication rates were 89% in beta-lactamase producing strains and 100% in beta-lactamase positive sputum, and excellent or good in 19 (83%) of 23 patients with beta-lactamase negative sputum. The eradication rate was 88% in 5 patients with beta-lactamase positive sputum. One patient experienced a moderate rash. Abnormal laboratory test values were observed in 10 patients (26.3%), but these abnormalities were mild and transient. These results suggested that SBT/CPZ was effective and safe for the treatment of respiratory tract infections caused by beta-lactamase producing as well as beta-lactamase non-producing bacteria.

Aged↗
PubMed1996

Augmentation of parasympathetic nerve function in patients with extrinsic bronchial asthma--evaluation by coefficiency of variance of R-R interval with modified long-term ECG monitoring system.

Patients with bronchial asthma (BA) have evidence of increased vagal cholinergic tone. Although the cardiovascular-respiratory tests used in the past might have been biased by concomitant chest disease, coefficiencies of variance of the R wave to R wave (RR) interval (CVR-R) on electrocardiogram (ECG) have been applied to many diseases as a method of functional evaluation of the parasympathetic nerve system. In 24 hour recordings of ECG (Holter ECG), continuous values of CVR-R have been determined for each one-minute period with a recently developed long-term ECG monitoring system. To examine functional augmentation of parasympathetic nerve in patients with BA, we applied this system in the present study to determine the alteration of parasympathetic nerve function during an inhaled methacholine provocation test in 14 patients and 7 healthy subjects. CVR-R values were calculated from the collection of a 24-hour electrocardiogram. Bronchial response, which was measured by methacholine inhalation, was evaluated with the baseline value of respiratory resistance (Rrs-cont), the cumulative dose producing a 35% decrease in respiratory conductance (PD35Grs) and the minimum cumulative dose required to start to decrease respiratory conductance from baseline (Dmin). The serum concentrations of epinephrine and norepinephrine were measured at the basal and double-increased levels of respiratory resistance during the inhalation test. The increased values of CV(R-R) in asthmatic patients were intimately associated with augmented respiratory resistance. The disparity of CV(R-R) values (delta CV) during the resistance levels from basal to double in the asthmatic group was significantly greater than that in the control group. The absolute change of CV(R-R) values in the asthmatic group was significantly larger than that in the control group. There was a significant correlation between delta CV and Dmin (r = 0.536, p < 0.05), and between delta CV and PD35Grs (r = 0.552, p < 0.05). The serum concentrations of epinephrine and norepinephrine were not significantly different during the methacholine inhalation provocation test. We conclude that alteration of the values of CV(R-R), which were calculated with a modified long-term ECG recording system, may reflect the change of parasympathetic nerve function and the severity of bronchial hyperreactivity, and this system can be a useful non-invasive method for evaluation of increased vagal tone in patients with bronchial asthma.

Adult↗