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Biomedical subjects

H Kitazume

Publications and source records attributed to H Kitazume.

At least 37 records · Page 2Linked to original sources
PubMed1990

Restenosis after percutaneous transluminal coronary angioplasty--a histopathological study using autopsied hearts.

Restenosis was studied histopathologically by serial step sectioning of 22 coronary arteries from 21 patients in whom percutaneous transluminal coronary angioplasty (PTCA) had been performed (9 arteries from patients who had died shortly after PTCA and 13 from those who had died considerably later). Nine of the 13 arteries from the patients who had died long after PTCA were immunohistochemically stained using anti-actin antibody for examination of spindle-shaped cells proliferating in the intima. In the patients who had died shortly after PTCA, all 9 arteries showed fresh thrombus formation. In the patients who had died considerably later after PTCA, however, there was fragmentation of the internal elastic lamina (IEL) in 9 arteries. In each of these 9 arteries, a remarkable proliferation of intimal cells was observed on the intimal side, mainly at the site of the IEL fragmentation. These spindle-shaped cells were identified as smooth muscle cells (SMC) because they stained reddish-brown with Masson's trichrome, and because immunohistochemical staining with anti-actin antibody was also positive. In 2 arteries, proliferation of SMC and elastic fibers was observed on the luminal side of the intima, despite absence of fragmentation in the IEL. Proliferation of SMC in false lumens was identified in 2 patients with medial dissection. From the above findings, the following 4 forms of restenosis after PTCA have been identified: 1. thrombus formation; 2. proliferation of SMC on the intimal side, mainly around fragmentation in the IEL; 3. proliferation of SMC on the luminal side of the intima where there was no fragmentation of the IEL; and 4. proliferation of SMC in dissected false lumen. The proliferation of SMC on the intimal side of the disrupted IEL was thought to have been a result of migration of SMC from the media to the intima, because SMC proliferation was seen around the disrupted region.

Adult↗
PubMed1989

[Undesirable outcome of percutaneous transluminal coronary angioplasty including irreversible damage and re-stenosis of dilated lesions].

To clarify the prognostic implications due to the limitations of coronary angioplasty, 564 newly-dilated lesions were analyzed for the prevalence of irreversible damage (sudden deaths, myocardial infarction, re-stenotic lesions and occlusion unsuitable for or unsuccessful following repeated angioplasty) and re-stenosis after re-dilatation. Re-stenosis occurred in 170 of the 564 newly-dilated lesions, and in 36 of the 135 re-dilated lesions. After repeated angioplasty, up to three times, 449 lesions (89.9%) were eventually patent angiographically, while irreversible damage was observed in 21 lesions. Re-stenosis after re-dilatation was observed more often in variant angina and in lesions exceeding 15 mm in length. Irreversible damage occurred more often in elderly patients and in patients with lesions of the right coronary artery.

Adult↗
PubMed1989

[Digital subtraction angiography and Fourier analysis of the left ventriculography: new methods of analyzing left ventricular function].

To evaluate two new methods of analyzing left ventricular function, digital subtraction left ventriculography (DSLV) and Fourier analysis of left ventriculography (FALV) were performed after conventional left ventriculography (LV) in 17 consecutive catheterized cases. Ejection fraction of FALV and LV corresponded closely with the correlation coefficient of 0.906, while segmental wall motion corresponded less with the range of correlation coefficients from 0.56 for the apical segment to 0.94 for the anterior wall. In 10 cases with asynergic segments of the left ventricle, Fourier analysis showed less hypokinesis in four (all had hypokinesis at the septal segment), the same degree in five and more in one case, suggesting the possibility of FALV to evaluate three-dimensional left ventricular function in a single projection.

Angiography, Digital Subtraction↗
PubMed1988

Percutaneous transluminal coronary angioplasty for elderly patients.

To examine the clinical efficacy of percutaneous transluminal coronary angioplasty in elderly patients, 350 consecutive procedures of coronary angioplasty were reviewed by dividing the patients into two groups: 142 cases of elderly patients whose ages were 65 years or older and 208 cases of younger patients. The primary success rate was satisfactory in both groups (86.6% in the elderly patients and 88.5% in the younger patients) and frequency of complication was acceptable (3.1% vs 2.9%) in both groups. Although restenosis tended to occur more frequently in the elderly patients (36.8% vs 27.1%), most of the lesions were re-dilated. These indicate that coronary angioplasty can be extended to elderly patients. The primary success rate started to decrease with circumflex arteries at age 70 years, and a similar trend was seen with right coronary arteries at age 65 years. Careful selection of the patients for coronary angioplasty as well as detailed analysis of the coronary anatomy and aorta are required to obtain clinical success and to prevent complications.

Aged↗
PubMed1988

[Emergency percutaneous transluminal coronary angioplasty for acute myocardial infarction].

Coronary angioplasty combined with thrombolytic therapy using urokinase (UK-PTCA) was attempted for acute myocardial infarction from September 1983 to December 1985, and without thrombolytic therapy (direct PTCA), thereafter. For UK-PTCA, the lesion was severely stenosed in 13, subtotally occluded in two and totally occluded in 21, and 29 lesions (81%) were successfully dilated. For direct PTCA, the lesion was stenosed in five, subtotally occluded in two and totally occluded in 14, and 19 lesions (90%) were dilated. Only one lesion in UK-PTCA had restenosis during hospitalization, but it was successfully redilated. Follow-up angiography was performed for 26 among 29 UK-PTCA cases and showed patency (diameter stenosis less than 50%) in 13, restenosis (less than 50%) in 12 and occlusion in one. Ten among 12 restenosed lesions were redilated and they were all patent at subsequent angiography. In 15 of 19 dilated lesions with direct PTCA, the lesion was patent in 10, and restenosed in five. Four of them were redilated and remained patent at subsequent angiography. Major complications occurred only in the UK-PTCA group before the judicious use of intra-aortic balloon pumping for hemodynamic instability. These included two deaths due to cardiogenic shock, one coronary dissection, and one sudden reocclusion, possibly due to thrombus formation. PTCA is applicable with or without thrombolytic therapy for acute myocardial infarction with high primary success rate and maintain coronary flow thereafter.

Adult↗
PubMed1987

Mechanism of luminal enlargement in PTCA and restenosis: a histopathological study of necropsied coronary arteries collected from various centers in Japan.

Necropsy studies of coronary arteries were made in 14 patients who died after percutaneous transluminal coronary angioplasty (PTCA). Eight patients died shortly after PTCA, while the other six patients died some considerable time later. A total of 9,920 serial step sections of necropsied coronary arteries at the site of PTCA were prepared and examined histopathologically by light microscope to determine the mechanism of luminal enlargement in PTCA, as well as the occurrence of restenosis. Of the eight patients who died shortly after PTCA, two had disruption of the intima and the media in the arterial wall located opposite the site that had atheroma, in spite of the fact that the former wall is more normal than the latter. Dissection of the media was camed out in four patients and intimal desquamation performed in six. All the patients revealed fresh thrombus formation. Of the six patients who survived for a long time after PTCA was performed, two had disruption of the intima and the media located opposite the site with atheroma. In one, the media was dissected and in another, intimal desquamation was camed out. In one patient, release of atheroma into the lumen was suspected. Proliferation of intimal cells was revealed in three patients indicating that restenosis had occurred. No compression of the atheroma was observed in any of the 14 patients. The above findings led to the conclusion that the mechanisms of luminal enlargement in PTCA are: 1) intimal and medial disruption in the arterial wall located opposite the atheroma; 2) medial dissection; 3) intimal desquamation; 4) release of atheroma into the lumen; and 5) any combination of 1) -4).

Adult↗
PubMed1986

Combined thrombolytic therapy and coronary angioplasty for acute myocardial infarction.

From September, 1983, to August, 1984, combined thrombolytic therapy and percutaneous transluminal coronary angioplasty was used to treat 22 cases of acute myocardial infarction. Initial coronary angiograms showed total obstruction in 13 and severe stenosis in 9. Intracoronary infusion of urokinase reopened 7 of 13 totally occluded lesions but left a residual severe stenosis. Coronary angioplasty opened all of the remaining totally obstructed lesions and decreased the stenosis in 14 of 16 stenosed lesions. These procedures were performed 0.5 to 24 hours after the onset of chest pain. Lesions were not successfully dilated in two patients, because of arterial dissection in one and rethrombus formation in the other. One patient died from progressive hypotension beginning during the procedure, despite technically successful coronary angioplasty. Eighteen of the 20 successfully dilated lesions were patent at repeat angiography performed 1 to 3 weeks later. One successfully dilated lesion occluded 8 days after the procedure and was redilated by a larger sized balloon.

Adult↗
PubMed1982

Idiopathic hypertrophic subaortic stenosis and coronary atherosclerosis. Results of coronary artery bypass alone and myectomy combined with coronary artery bypass.

Twenty-one patients with combined coronary artery disease and idiopathic hypertrophic subaortic stenosis (IHSS) have had coronary artery bypass grafting alone (Group I, n = 7) or in combination with left ventricular septal myectomy (Group II, n = 14). Patients ranged in age from 46 to 73 years (mean 59 years). There were no operative deaths, but one Group I patient died 16 months after operation. Patients in Group I have had continuing symptoms after the operation, whereas Group II patients have had consistent relief of symptoms. Patients with documented IHSS and coronary atherosclerosis should undergo combined coronary bypass and septal myectomy if symptoms recur with medical management.

Aged↗