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Biomedical subjects

F Oguma

Publications and source records attributed to F Oguma.

At least 19 recordsLinked to original sources
PubMed1995

[Syphilitic thoracic aortic aneurysm with destruction of vertebral body, producing numbness of lower extremities and paraplegia].

Numbness and paraplegia are uncommon complaints in patient with thoracic aortic aneurysm (TAA). The patient was a 64-year-old man. He suffered numbness and gait disturbance (paraplegia). The blood examination showed no positive findings except a Wassermann was positive. Roentgen examination of the chest showed two abnormal shadows like tumors. The CT and MRI revealed destruction of the vertebral bodies and TAAs adjacent to the spinal cord. After the graft replacement was performed, numbness and paraplegia disappeared. This suggests that in our patient the TAAs destruct the vertebral body and produce pressure on the spinal cord, causing numbness and paraplegia. We experienced a rare case of the syphilitic TAA producing bone destruction, numbness and paraplegia.

Aortic Aneurysm, Thoracic↗
PubMed1994

Combined warfarin and antiplatelet therapy after St. Jude Medical valve replacement for mitral valve disease.

OBJECTIVES: The clinical effect of combined warfarin and antiplatelet therapy on the incidence of stroke and postoperative complications after mitral (plus aortic) valve replacement was studied and compared with that observed with warfarin therapy alone. BACKGROUND: It has been reported that combined warfarin and antiplatelet therapy may be effective but may be associated with an increased hemorrhagic risk. Therefore, definite benefits of the treatment in patients with an implanted prosthetic valve have not been clearly documented. METHODS: Between January 1980 and December 1992, 195 patients with a St. Jude Medical valve at the mitral (plus aortic) position were assigned to receive treatment with either warfarin alone (125 patients) or warfarin plus antiplatelet agents (70 patients), such as dipyridamole (150 or 300 mg daily, 14 patients) or ticlopidine (200 or 400 mg daily, 56 patients). A minimal dose of aspirin (10 to 40 mg) was added (29 patients) if the maximal platelet aggregation rate by collagen was not reduced. The target thrombotest level was 10% to 20%. RESULTS: The two treatment groups were similar with regard to gender and age distribution. The number of patients with atrial fibrillation, left atrial thrombus, history of previous stroke, simultaneous aortic valve operation and previously performed valve procedures were comparable in the two groups. Actuarial survival rate at 10 years was 98.3 +/- 1.7% (mean +/- SD) in the warfarin plus antiplatelet group and 90.3 +/- 3.2% in the warfarin group (p < 0.05 at 1 and 9 to 12 years). The actuarial stroke-free rate at 10 years was 95.3 +/- 3.4% and 84.3 +/- 3.8%, respectively (p < 0.05 by the generalized Wilcoxon test). The actuarial complication-free rate at 10 years was 89.4 +/- 4.3% and 67.9 +/- 4.8%, respectively (p < 0.05 by the generalized Wilcoxon test). No hemorrhagic complications were seen in the warfarin plus antiplatelet group. CONCLUSIONS: The results strongly indicate the effectiveness and safety of combined warfarin plus antiplatelet treatment after St. Jude Medical valve replacement for mitral (plus aortic) valve disease.

Actuarial Analysis↗
PubMed1994

Surgical excision of a broad-based left atrial myxoma: report of a case.

We report herein the case of a 72-year-old woman who underwent successful resection of an unusual type of broad-based left atrial myxoma. The tumor, which was attached to the fossa ovalis and anterior wall of the left atrium posterior to the aorta, was resected en bloc with the interatrial septum and the affected free wall of the left atrium. The defect in the left atrium and atrial septum was then reconstructed with an equine pericardial patch. To our knowledge, this type of cardiac myxoma, with a base extending from the septum to the atrial wall, has not been previously reported.

Aged↗
PubMed1993

Direct thrombolytic revascularization of the occluded basilar artery.

Successful direct revascularization in a 54-year-old man with embolism of the basilar artery following St Jude Medical valve replacement for mitral regurgitation 6 years earlier is reported. He arrived at the hospital in a deep coma. Computed tomography showed no new lesions, but subsequent angiography revealed occlusion of the basilar tip, bilateral posterior cerebral arteries and right superior cerebellar artery. Direct thrombolytic therapy was performed using 420,000 units urokinase through an infusion catheter placed in the basilar artery. The patient immediately regained consciousness, with only slight diplopia. Direct thrombolytic therapy is considered to be an effective treatment for thromboembolism following prosthetic valve replacement in certain selected cases.

Basilar Artery↗
PubMed1993

[A case report of pulmonary metastasis of malignant fibrous histiocytoma (MFH) accompanied by mediastinal lymph node metastasis].

Mediastinal lymph node metastasis associated with pulmonary metastasis is rarely seen in soft tissue sarcoma. A case is presented in which investigation of primary lung cancer (cT2N2M0) in a 78-year-old woman with a history of MFH of the left thigh revealed pulmonary metastasis of MFH accompanied by paratracheal (#2) and anterior mediastinal (#3a) lymph node metastases.

Aged↗
PubMed1993

[Flow characteristics and responses to vasoactive drugs in canine gastroepiploic artery].

We studied flow characteristics and response to norepinephrine, Chlorpromazine and gastrin in 22 canine gastroepiploic artery (GEA) recirculation model. The GEA flow was obtained by a drip for a minute, opening the end of pedicle GEA. Furthermore, aortic flow and celiac arterial flow were measured by magnetic flow probe. The administration of chlorpromazine, vagostigumine, and gastrin induced a increase in both celiac arterial flow and pedicle GEA graft flow. Especially, the administration of gastrin induced significant increase in GEA flow and celiac arterial flow. Furthermore, adding norepinephrine step-wisely, the GEA flow increased remarkably, in spite of decrease of celiac arterial flow. This response was caused from difference in vascular resistance among celiac arterial branches. Therefore, the pedicle GEA graft has homogenous response as same as intact GEA that perfuses stomach, because its flow was affected by adrenergic and parasympathetic agent, alpha-blocker and gastric hormone.

Animals↗
PubMed1992

[Late postoperative outcome of plastic operation versus valve replacement for mitral regurgitation].

Between January 1980 and August 1991, 99 patients underwent operation for mitral valve regurgitation (MR). The ages of the patients ranged from 12 to 67 years, (49.4 +/- 11.9 years), and there were 39 males and 60 females. Pathological cause of regurgitation, which was determined by intraoperative inspection and histological findings of excised leaflets, was rheumatic in 46, degenerative in 38, infective endocarditis in 9, ischemic in 4 and unknown in 2 patients. Cardiac rhythm was atrial fibrillation in 73, normal sinus rhythm in 24 and junctional rhythm in 2 patients. Our principles for valve repair were (1) excision of responsible segment and repair for prolapsed leaflet due to torn chordae, (2) shortening of elongated chordae, (3) annuloplasty, and (4) repair of perforated leaflet. Finally, 19 patients endured plastic operation, and 80 patients underwent prosthetic valve replacement. The rate of plastic procedure was 62.5% (10/16) in degenerative MR with mural chordal lesions, 42.9% (3/7) in rheumatic MR without stenosis, 22.2% (2/9) in infective endocarditis and 100% (2/2) in MR with unknown etiology. Mitral valve repair was failed both in rheumatic MR associated with stenosis (39 patients) and in ischemic MR (4 patients). A ten-year survival rate after operation was 92.2 +/- 3.1% in patients with valve replacement and 83.6 +/- 10.0% with valve repair (N.S.), and a proportion of event-free survival in patients with valve replacement was similar to valve. Late postoperative cardiac catheterization revealed decreased left ventricular volume indices and increased left ventricular end-systolic stress/volume ratio in both groups compared to preoperative values, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Surgical therapy of HCG-producing mediastinal tumor accompanied with intrapulmonary metastasis].

The patient is a 31-year-old man who was suffering from hyperthyroidism and left hemothorax. His serum HCG level was extremely elevated and chest X-ray showed a mass shadow of anterior mediastinum and bilateral multiple intrapulmonary metastasis. Our clinical diagnosis was primary HCG-producing germ cell carcinoma of mediastinum and immediately administered CDDP and VP-16. Chemotherapy was effective and tumor extirpation was carried out for mediastinum and lungs by median sternotomy. All of the resected specimen showed no cancer cells and 4 years have passed with no evidence of recurrence. Aggressive surgical approach is indicated for mediastinal germ cell carcinoma accompanied with intrapulmonary metastasis when chemotherapy is effective.

Adult↗
PubMed1991

[Surgical treatment of ascending aortic lesions associated with aortic insufficiency].

Twenty four patients underwent surgical treatment for ascending aortic lesions with aortic insufficiency at our institution. There were 16 male and 8 female patients from 12 to 67 years. Of 24 patients, 11 patients had Marfan's syndrome, and were younger at the time of operation. Three types of operative procedure were performed, that is, aortic valve replacement (AVR) and supracoronary graft replacement in 4 patients, AVR and covering the aneurysm of ascending aorta in 9, and composite graft replacement of the aortic valve and ascending aorta in 11. One patient died of perioperative myocardial infarction within 30 days after operation (early mortality rate, 4.2%). Another 5 patients died during the initial hospitalization, but no deaths were related to operative procedures. There was a total of 5 (27.8%) late deaths among the 18 patients follow-up with 5 and 10 years survival rate, 60.8%, 52.1%, respectively. Four of five patients was the cases with Marfan's syndrome. There were no statistically significant differences among three different procedures, but all patients who underwent composite graft replacement and left the hospital alive are doing well.

Adolescent↗
PubMed1990

[Long-term results of valve replacement in the right side of the heart in congenital heart disease--comparative study of bioprosthetic valve and mechanical valve].

Valve replacements in the right side of the heart (TVR and PVR) were done on 16 patients with congenital heart disease, mainly tetralogy of Fallot and Ebstein anomaly. Including reoperations, 19 operations were performed on them and 20 artificial valves were inserted. Ten mechanical valves (7 St. Jude Medical valves, 3 Starr-Edwards valves) and 10 bioprosthetic valves (7 Carpentier-Edwards valves, 3 Ionescu-Shiley valves) were used. Age at valve replacement ranged from 9 to 52 years (mean 23.0 years), and the follow-up period was 1.28-19.8 years (mean 5.7 years). Including 2 sudden deaths, late death occurred in 4 patients, on all of whom mechanical valve replacements were done at the primary operation. Five-year survival rate of all patients was 76.4 +/- 12.1%, and 10-year survival rate was 63.6 +/- 15.4%. All the patients who received bioprosthesis at the primary operation survived at the time of this follow-up study. On the contrary, long-term results of mechanical valve was unsatisfactory with the 5-year survival of 62.5 +/- 17.1%. In spite of anti-coagulation therapy with warfarin, three patients with mechanical valve complicated thrombotic valves, which necessitated re-operations. Calcified bioprosthetic valve occurred in one patient with I-S valve 8.5 years after the implantation. Five-year complication-free rate was 87.5 +/- 11.7% for bioprosthesis, whereas it was 50.0 +/- 15.8% for mechanical valve (p less than 0.056). It is concluded that the bioprosthesis is the first choice for the valve replacement in the right side of the heart in congenital heart disease.

Adolescent↗
PubMed1990

[Successful repair of an acute type A dissection during pregnancy].

We report a successful repair of an acute type-A aortic dissection during pregnancy. A 29-year-old pregnant woman in the 32 weeks of gestation with Marfan Syndrome was admitted to our hospital for the treatment of anterior chest and back pains. An urgent aortogram through pulmonary artery revealed an aortic dissection beginning from the ascending aorta to the aortic bifurcation. On the following day, an emergent Cesarean section was performed and a baby weighing 1944 g was delivered. Thereafter, cardiopulmonary bypass was instituted and the ascending aorta was opened. An intimal tear was found 2 cm above the aortic valve. The dissected space was closed with reinforcement of Teflon felt strip. A Dacron gusset was sutured to restore aortic continuity. During the weaning from the CPB, a retrograde aortic dissection developed and the heart became arrested. Therefore we immediately converted the aortic perfusion cannula from the right external iliac artery to graft of the ascending aorta, and the operation was completed successfully with a good recovery of the heart. The mother and her child have been alive and well for 3 years and 5 months after the operation.

Adult↗
PubMed1990

[Delayed sternal closure following open-heart surgery in infants and children].

Between January, 1982, and December, 1987, 14 patients failed to approximate sternum after open-heart surgery in infants and children. The indications for keeping sternum open were enlarged heart, myocardial edema, severe depression of myocardial contractility and reduced lung compliance due to pulmonary edema. Of the 14 patients, 9 underwent delayed sternal closure between 2nd and 13th postoperative day, and 4 were long-term survivals. All the rest of five patients who were left their sternum open, died of intractable cardiac failure within 16th postoperative day. During the sternum open, three patients suffered from complications-myocardial bleeding in one, and mediastinitis in two. But none of them directly related to the death, and one patient with mediastinitis successfully healed with closed mediastinal irrigation. Although the employment of the delayed sternal closure is rare and limited to the patient with severe heart failure, its judicious use adds advantages in the management of low cardiac output state in infants and children immediately postoperative period.

Cardiac Surgical Procedures↗
PubMed1989

[Results of pulmonary resection for metastatic lung tumors].

The results of pulmonary resection for metastatic pulmonary lesions in our institution are reviewed. Over the period of ten years 43 patients underwent 46 thoracotomies with a 5 years survival rate of 40.8%. The most significant predictors of survival were type of primary tumor, number of lesions removed and disease-free interval, while there were no statistically significant difference in survival rates between partial resection and lobectomy. Recurrence in the early postoperative period was often observed in the patients with bilateral pulmonary metastases and their 5 years survival rate was as low as 21.9%. Though multiple lung metastases is not contraindication for pulmonary resection, we should be prudent to operate for those patients with multiple lung metastases. Our results suggest that the patient with solitary lesion, long disease-free interval and no metastases to mediastinal lymph nodes is the best candidate for resection of the metastatic pulmonary lesions.

Adolescent↗
PubMed1989

[Intermediate-term results after Fontan type operation for single ventricle].

From 1983 to 1985, Fontan type operation were successfully performed on five patients with single ventricle. Marked cyanosis disappeared soon after the surgery, and normal exercise tolerance was obtained in all cases but one in the late postoperative period. Compared to marked improvement in the exercise tolerance test, cardiac output remained subnormal both at rest and during exercise even in the late postoperative period. Several types of asymptomatic arrhythmias were observed during the acute postoperative days, but they were not recognized in the intermediate-term postoperative period. Routine blood chemistry studies showed that hepatic function was within normal limits, but hepatic dysfunction was suggested by Indocyanine Green clearance test. Renal function was well preserved after Fontan type procedure. Though cardiac output is subnormal, Fontan type procedure is a safe and effective operation, and intermediate-term state is satisfactory without any signs of heart failure.

Adolescent↗
PubMed1989

Malignant spindle cell tumor of the pericardium. Evidence of sarcomatous mesothelioma with aberrant antigen expression.

A case of malignant spindle cell tumor occurring in the pericardium is presented. The tumor arose from the pericardium of a 51-year-old Japanese woman with no history of exposure to asbestos. The tumor extended into the pericardial and left pleural cavities. The primary and metastatic tumors consisted of fusiform cells with frequent mitoses. Ultrastructurally, the tumor cells possessed a discontinuous external lamina, cytoplasmic processes, microfilaments and desmosomal intercellular junctions. Immunohistochemical examination showed that most tumor cells were positive for Leu 7, and several for S-100 and glial fibrillary acidic protein. Unexpectedly, most of the tumor cells also expressed keratin. These findings favor a diagnosis of sarcomatous mesothelioma with aberrant antigenic expression or heterogeneous differentiation of neoplastic cells.

Female↗
PubMed1986

Role played by oxygen in myocardial protection with crystalloid cardioplegic solution.

To evaluate the importance of the oxygen dissolved in crystalloid cardioplegic solution, the protective effects of oxygenated glucose-insulin-potassium cardioplegic solution (O2-GIK) (oxygen tension greater than 600 mm Hg) on the isolated working guinea pig heart were compared with those of deoxygenated (N2-GIK) (oxygen tension less than 10 mm Hg) and aerated GIK solution (GIK) (oxygen tension = 140 to 160 mm Hg). Hearts were subjected to 180 minutes of ischemia with intermittent infusions (every 30 minutes) of cold cardioplegic solution, followed by 30 minutes of normothermic reperfusion. The O2-GIK solution tended to maintain high-energy phosphates at higher levels during ischemia, and resulted in the best recovery of cardiac function. Though not as effective as O2-GIK, GIK solution produced protective effects; N2-GIK solution failed to exert such effects. These results strongly suggest that the protective effects of crystalloid cardioplegic solution are due primarily to the oxygen dissolved in it; anaerobic metabolism or washout of the metabolites plays a minor part.

Animals↗