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Biomedical subjects

A Ohtaki

Publications and source records attributed to A Ohtaki.

At least 37 records · Page 2Linked to original sources
PubMed1999

Impaired lung oxygenation in acute aortic dissection.

BACKGROUND: In the early phase after the onset of acute aortic dissection, oxygenation impairment often occurs. However, the etiology and clinical course of this phenomenon have not been established. We examined the serial changes of oxygenation, inflammatory reaction and laboratory data in patients with acute aortic dissection. METHODS: Nine patients (DeBakey type I; 4, type II; 3 and type IIIb; 2), aged 46 to 82 years were included in this study. All patients were managed in the intensive care unit, and systolic arterial pressure was maintained at around 110 to 120 mm Hg. Oxygenation was impaired in all patients, three (33%) of whom required mechanical ventilatory support. RESULTS: Pleural effusion was observed in eight (89%) of nine patients. Respiratory index was 0.98+/-0.19 (mean +/-SEM) at the time of admission, and elevated to 1.59+/-0.35, 1.58+/-0.21, 1.60+/-0.28 respectively, at day 1, 2 and 3. Oxygenation index was 318+/-34 at the time of admission, and decreased to 271+/-34, 255+/-19, 263+/-26, respectively, at day 1, 2 and 3. These values recovered to normal after day 4. The increase of white blood cells and high fever (>38 degrees C) continued until day 3. Platelet counts recovered after day 4. The serum bilirubin level was highest (2.0+/-0.5 mg/dl) at day 3, and decreased gradually after day 4. In two recent patients whose serum interleukin-8 (IL-8) was measured, IL-8 levels increased according to the impaired oxygenation or aneurysmal enlargement. Impaired oxygenation, inflammatory changes, platelet consumption and bilirubin elevation continued until day 3 and resumed normal levels after day 4. CONCLUSIONS: These changes may be due to hemolysis, consumption coagulopathy or inflammation associated with acute aortic dissection. IL-8 elevation may be associated with aneurysmal enlargement and these phenomena.

Aged↗
PubMed1999

Hemodynamic effects of alpha-human atrial natriuretic polypeptide on patients undergoing open-heart surgery.

BACKGROUND: A cardiac hormone, alpha-human atrial natriuretic polypeptide (alpha-hANP), acts as a vasodilator and a diuretic by activating cyclic GMP formation. We studied the hemodynamic effects of continuous intravenous infusion of alpha-hANP on patients undergoing open-heart surgery. METHODS: A total of 15 patients, including 7 with CABG, 4 with AVR, 2 with CABG plus AVR, and 2 with AVR plus MVR were involved in the study. They underwent open-heart surgery in our institute between July 1996 and April 1997. The mean age of patients was 68 years, ranging from 63 to 77. A dosage of 0.05 microg/kg/min of alpha-hANP was administered to all patients on postoperative day 1. Hemodynamics and blood and urine samples were measured at the following times: 2 hours before continuous intravenous infusion of alpha-hANP, 0, 1, 2, 3, 6, 12 and 24 hours after continuous intravenous infusion. We concomitantly measured urine volume and the plasma concentration of alpha-hANP. RESULTS: The plasma concentration of alpha-hANP increased sufficiently after the beginning of continuous intravenous infusion without any side effects, and the urine volume increased too. The administration of alpha-hANP induced a decrease in central venous pressure, pulmonary capillary wedged pressure and the pulmonary vascular resistance index. Systemic vascular resistance index and cardiac output remained unchanged. CONCLUSIONS: It is useful for the management of patients with associated volume overload following open-heart surgery because the administration of alpha-hANP decreases preload and facilitates satisfactory urination.

Aged↗
PubMed1998

[Ventricular septal defect associated with pulmonary hypertension in monozygotic twins--a case report with surgical repair].

This is a report of two-year-old female monozygotic twins, both having a ventricular septal defect (VSD, Kirklin type II) and accompanying moderate pulmonary hypertension (PH). The two patients underwent a patch closure procedure to repair the VSD at the same time, and their postoperative courses were uneventful. Rubenstein and Weaver have reported the only case of surgical treatment for monozygotic twins having both VSD and PH. Our patients are the second such case of surgical treatment of VSD and PH in monozygotic twins.

Cardiac Surgical Procedures↗
PubMed1998

Management of postoperative fever in cardiovascular surgery.

BACKGROUND: The causes and management of postoperative fever were studied. MATERIALS AND METHODS: During a four-year-period beginning in January of 1991, high fever over 38.5 degrees C max occurred in twenty-five (6%) out of 395 patients who underwent cardiovascular surgery. RESULTS: Nine of the patients (28%) evidenced bacteriological infections as follows; 3 cases of mediastinitis, 2 cases of respiratory tract infection, 1 case of MRSA colitis and a wound infection in one case. The three patients with mediastinitis died and the two cases of MRSA were detected from the culture of pacemaker leads. Bacteriological infection was not detected in other 18 (72%) patients with fever. However, we speculated that the clinical causes of fever in 9 out of 18 patients were as follows; catheter fever in 3 patients, acalculous cholecystitis in 2, fungus infection in 2, aseptic meningitis in one and viral myelitis in one patient. Two patients with acalculous cholecystitis recovered after percutaneous transhepatic gallbladder drainage. The causes of fever were not apparent in nine patients, however the source might be related to artificial prostheses used intraoperatively in five patients. C-reactive protein (CRP) was elevated beyond 10 mg/dl in 13 (52%) of the 25 patients. CRP increased in all seven bacteriologically positive patients and in six (32%) of the bacteriologically negative patients. CONCLUSIONS: Precise and prompt bacterial examinations are necessary in patients with CRP elevation because the origins of fever were bacteriological in only 28% of the patients with a high fever. Good prognoses may be obtained by suitable management in bacteriologically negative patients.

Adult↗
PubMed1998

A comparison of the University of Wisconsin solution and the modified Kawakami solution for initial flush and coronary perfusion in long-term canine heart preservation.

BACKGROUND: We compared two different solutions, the University of Wisconsin (UW) solution (intracellular-like) and the modified Kawakami (mK) solution (extracellular-like), for initial flush of coronary vascular beds before simple storage and following coronary perfusion. METHODS: After a right thoracotomy in the 4th intercostal space, the donor heart was isolated by ligating the azygos vein and venae cavae, and cross-clamping the aorta. Cardiac arrest was then obtained with a cold GIK solution. Following initial flush of coronary vascular beds, the donor heart was resected, stored utilizing a combination of simple immersion and coronary perfusion, and then transplanted. A total of 48 mongrel dogs was divided into three groups each using different solutions for the initial flush of coronary vascular beds and for coronary perfusion. In group I (n=10) the UW solution was used for both initial flush and coronary perfusion. In group II (n=7) the mK solution was used for both initial flush and coronary perfusion, and in group III (n=7) the UW solution was used for initial flush and the mK solution for coronary perfusion. Intracellular high-energy phosphate was surveyed by 31P-nuclear magnetic resonance spectroscopy. RESULTS: After 12-hour simple immersion and 1-hour coronary perfusion, phosphocreatine and adenosine triphosphate were significantly (p<0.05) higher in group III than in groups I and II. The high-energy phosphate levels of the graft tissue were better in groups I and III than in group II. Orthotopic transplantation was then performed using 10 preserved grafts in group I and seven preserved grafts of group III. After transplantation, left ventricular (LV) pressure of group I animals recovered to 82.3% and group III recovered to 95.8% of the control values. LV dp/dt of group I and III animals recovered to 76.5% and 96.7% of the control values, respectively. CONCLUSIONS: The UW solution, which is acceptable for both initial flush and simple storage, is not suitable for continuous coronary perfusion even for a short period due to its high viscosity. A combination of the UW solution both for initial flush and the following cold simple immersion and the mK solution for continuous coronary perfusion is appropriate for long-term preservation of the canine heart.

Adenosine↗
PubMed1997

Benign tumors of the lung: a 20-year surgical experience.

In the following report, we describe our investigation of the diagnosis and operative methods for benign tumors of the lung, in which the surgical treatment was selected due to suspicious malignancy. This study included 22 patients with benign tumors. The patients' mean age was 55 years old. The histological diagnosis was made postoperatively prior to 1985 and intraoperatively after 1986. Hamartoma was the most common of the benign tumors. In benign tumors, the preoperative diagnosis was almost the same as the postoperative one. Of the patients with benign tumors, 78% underwent lobectomy or segmentectomy prior to 1985, and none have undergone any invasive procedures since 1986. Malignant tumors are sometimes difficult to distinguish from benign tumors preoperatively. Therefore, intraoperative histological examinations are necessary in cases in which malignancy is suspected. In such cases, a smaller invasive procedure should be selected due to the possibility of the tumor being benign.

Adult↗
PubMed1997

Left ventricular fibroma in an aged patient: report of a case.

We report herein the case of a 77-year-old man with a left ventricular tumor originating from the papillary muscle of the left ventricular wall, in whom a successful tumor resection with mitral valve replacement was performed. The pathological diagnosis of the tumor was confirmed as cardiac fibroma. His postoperative course was uneventful and he is currently well with no signs of recurrence 2 years after surgery.

Aged↗
PubMed1997

Arterial embolization as preoperative treatment for pulmonary aspergillosis with hemoptysis.

Pulmonary aspergillosis associated with old tuberculosis is generally resistant to treatment. Thus, if patients are treated only with conservative therapy, their condition continues to deteriorate due to repetitive hemoptysis, and may even become critical. Surgical treatment is required for these patients; however, it is extremely difficult to resect the lesion due to severe adhesions to the chest wall and vascular proliferation surrounding the lesion. We performed preoperative arterial embolization, achieving good results in three patients with hemoptysis caused by pulmonary aspergillosis. The feeding arteries were embolized using microcoils and/or gelatin sponges, and a lobectomy was safely carried out in all patients. We concluded that preoperative arterial embolization is a safe and effective technique to prevent massive hemorrhage occurring at the time of surgery.

Aged↗
PubMed1997

Thoracoscopic closure of a congenital partial pericardial defect.

We describe our technique for performing direct thoracoscopic closure of a congenital partial pericardial defect, which was successfully employed in a 15-year-old boy. This is the first such report of a procedure that is noninvasive and may therefore become the treatment of choice for patients with a small congenital pericardial defect.

Adolescent↗
PubMed1997

Malfunctioning Starr-Edwards mitral valve 21 years after installation.

Two cases of malfunctioning Starr-Edwards cloth-covered mitral valve prostheses requiring reoperation are presented. Both cases underwent successful surgical repair 21 years after the valve replacement. The causes were a disturbance of the poppet during the opening movement due to excessive tissue ingrowth and a paravalvular leak associated with a tear of the valve seat. Replacement of the Starr-Edwards valve prosthesis more than 20 years after the initial installation has not been reported.

Female↗
PubMed1997

[Application of alpha-hANP for the management following open-heart surgery: report of two cases].

Alpha-human atrial natriuretic peptide (alpha-hANP) has a vasodilating and diuretic action. Intravenous continuous administration of alpha hANP (0.05 microgram/kg/min) was attempted for two patients with low urine output despite good hemodynamics following open-heart surgery. Following the administration of alpha-hANP, urine volume increased markedly, and central venous and pulmonary capillary wedge pressures immediately decreased. Intravenous continuous administration of alpha-hANP is useful for the management of patients associated with the volume overload following open-heart surgery.

Aged↗
PubMed1997

[Mitral valve prolapse associated with severe pulmonary hypertension: a case report].

Severe (110/50 mmHg) pulmonary hypertension (PH) secondary to mitral valve prolapse is rare. We reported herein severe PH secondary to mitral valve prolapse in a 65-year-old female. The patient underwent mitral valve replacement and tricuspid annuloplasty. The pulmonary artery pressure after the operation decreased to 69/20 mmHg. Prostagrandin E1 was effective for residual PH compared with nicardipine hydrochloride.

Aged↗
PubMed1997

Percutaneous transhepatic gallbladder drainage for acute acalculous cholecystitis following cardiovascular surgery.

Four (1.2%) out of 321 patients required percutaneous transhepatic gallbladder drainage (PTGBD) following cardiovascular surgery. Cholecystitis was initially suspected based upon the occurrence of postoperative fever and the results of abdominal X-ray films. The main physical finding was tenderness of the right upper quadrant abdomen in all patients. Spontaneous pain and Blumberg's sign were not apparent. Distension of the gallbladder and sludge in the gall-bladder were detected in all four patients by ultrasonography, but calculi were not observed. Thickening and edema of the gallbladder wall, generally suggestive of cholecystitis, were observed in only one patient. PTGBD was performed from 5 to 43 (mean 16) days after surgery. The drained fluid was concentrated bile and not purulent. High fever dropped and serum transaminase and C-reactive protein levels decreased within three days after PTGBD. Bacteriologic examinations of the bile and arterial blood were negative in all cases. No complications as a result of PTGBD introduction occurred. PTGBD is a safe and effective procedure, and therefore should be actively performed even in the early phase of acute cholecystitis.

Acute Disease↗
PubMed1997

Availability of nasal mask BiPAP systems for the treatment of respiratory failure after cardiovascular surgery.

BACKGROUND: The availability of nasal mask bi-level positive airway pressure (BiPAP) support in managing respiratory failure following cardiovascular surgery was studied. MATERIALS AND METHODS: BiPAP support was used for eight patients requiring postoperative prolonged respiratory support of 72 hours or longer. Their mean age was 65 years of age and the mean periods of postoperative endotracheal intubation was 12+/-5 days. BiPAP support was removed within 48 hours in six out of eight patients. Reintubation of an endotracheal tube was not necessary in all eight patients after the BiPAP treatment. RESULTS: The respiratory rates during the BiPAP management remained unchanged. The values of the respiratory index significantly (p<0.01) improved after BiPAP management (1.5+/-0.2 --> 0.9+/-0.2). A-aDO2 and Qs/Qt decreased (p<0.1) after the BiPAP management. There were no significant differences in central venous pressure and circulatory states during BiPAP support. CONCLUSIONS: In conclusions, BiPAP support is a noninvasive management technique for postoperative respiratory failure and may also prevent prolonged endotracheal intubation.

Aged↗
PubMed1996

Use of ultrasound-guided percutaneous needle biopsy in the diagnosis of mediastinal tumors.

We herein report the usefulness of ultrasound-guided percutaneous needle biopsy for histological diagnosis in 18 patients with mediastinal tumors. Computed tomography revealed these tumors to be in contact with the chest wall. The preoperative diagnosis was thymoma in 7 patients, germinoma in 5, neurogenic tumor in 3, and "other" in 3. The most commonly encountered indication for an ultrasound-guided percutaneous needle biopsy was an anterior mediastinal lesion (78%; 14 of 18 patients). In 16 (89%) of the 18 patients, the biopsy diagnosis corresponded to the postoperative diagnosis. No complications were encountered in any of the patients. This new technique of ultrasound-guided percutaneous needle biopsy is both relatively simple and highly accurate and may thus be useful for outpatients. Preoperative ultrasound-guided percutaneous needle biopsy is thus considered to be a safe and reliable method for the histological diagnosis of mediastinal tumors, and a good alternative to traditional biopsy techniques such as mediastinoscopy or thoracotomy.

Adolescent↗
PubMed1996

Secundum atrial septal defect associated with mitral valve cleft: report of a case with chromosomal syndrome of trisomy 3p.

A 4-year-old boy was diagnosed as having a chromosomal abnormality with trisomy 3p associated with a secundum atrial septal defect and a cleft of the anterior mitral leaflet. His craniofacial features showed microcephaly, micrognathia, ocular hypertelorism associated with epicanthus, and low-set ears. Moderate mental retardation and hypoplasia of the penis were also noted. A left ventriculogram demonstrated grade 2 mitral regurgitation according to the Sellers' classification with a prolapsing of the mitral leaflets. A cleft of the anterior mitral leaflet was detected at the time of operation. The secundum atrial septal defect was directly closed and the mitral cleft was repaired. This is the first report of trisomy 3p associated with an atrial septal defect and a mitral valve cleft.

Child, Preschool↗