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Biomedical subjects

H Nikaidoh

Publications and source records attributed to H Nikaidoh.

At least 19 recordsLinked to original sources
PubMed2000

Preoperative and postoperative endotoxemia in children with congenital heart disease.

STUDY OBJECTIVES: Recent data indicate that increases in inflammatory cytokines are seen in patients with diverse cardiac diseases. However, the primary stimulus for cytokine secretion during cardiac illness remains unknown. Since bacterial endotoxin is a potent inducer of cytokines, we determined the incidence, magnitude, and clinical relevance of endotoxemia in children with congenital heart disease before and after surgical repair. DESIGN: A prospective, observational study. SETTING: A large, urban, university-affiliated, tertiary-care children's hospital. PATIENTS: Thirty children with a variety of congenital heart defects (median age, 59 days; median weight, 4.0 kg) were sequentially enrolled. INTERVENTIONS: Blood was sampled prior to surgery, and at 1, 8, 24, 48, and 72 h following cardiopulmonary bypass. Assays included plasma endotoxin, lipopolysaccharide-binding protein (LBP), and interleukin-6 (IL-6). MEASUREMENTS AND RESULTS: Twenty-nine of 30 patients (96%) had evidence of endotoxemia during the study period. Twelve of the 30 patients (40%) were significantly endotoxemic prior to surgery. LBP, a plasma marker that responds to bacteria and endotoxin, rose significantly following cardiopulmonary bypass, as did the plasma levels of IL-6. Fifteen of 30 patients met prospectively defined criteria for experiencing a severe hemodynamic disturbance in their postoperative course. These patients had significantly higher preoperative plasma LBP (p < 0.02) and plasma endotoxin levels (p < 0.05), compared to patients with less-severely disturbed hemodynamics. Mortality was 25% in patients with preoperative endotoxemia, compared with no mortality in patients who were not endotoxemic before surgery (p = 0.05). CONCLUSIONS: These data demonstrate that endotoxemia in children with congenital heart disease is more common than previously suspected, and is associated with clinical outcomes. We conclude that clinical trials targeting endotoxin will be necessary to determine if endotoxin is a causal, etiologic agent in the disease process.

Acute-Phase Proteins↗
PubMed1996

Major intrahepatic venovenous fistulas after a modified Fontan operation.

After the Fontan operation, systemic venous hypertension drives transpulmonary blood flow. Owing to this physiology, there is a significant incidence of effusions, splanchnic congestion, and generalized edema. To attentuate the effusive problems, partial exclusion of the hepatic veins has been recently practiced by Jacobs and Norwood. This report concerns a patient we recently treated for profound progressive cyanosis due to an acquired intrahepatic venovenous shunt after a Fontan operation with partial hepatic vein exclusion.

Child, Preschool↗
PubMed1996

Calcifying fibrous pseudotumor of the chest wall.

This report concerns the finding of a clinically benign 4-cm mass in the anterior thorax of a 12-year-old girl. The tumor was inseparable from the chest wall. A wide excision was performed. Microscopic examination proved it to be a rare but distinctive lesion recently entitled "calcifying fibrous pseudotumor" primarily involving the chest wall. Wide excision is thought necessary to preclude local recurrence.

Calcinosis↗
PubMed1994

Two-dimensional and Doppler echocardiography alone can adequately define preoperative anatomy and hemodynamic status before repair of complete atrioventricular septal defect in infants < 1 year old.

OBJECTIVES: We sought to assess the ability of two-dimensional and Doppler echocardiography alone, without cardiac catheterization, to evaluate infants < 1 year of age for complete open heart repair of complete balanced atrioventricular (AV) septal defect. BACKGROUND: Two-dimensional echocardiographic-Doppler examinations provide accurate anatomic detail in patients with AV septal defect. Lung biopsy data have shown that patients rarely develop significant inoperable pulmonary vascular disease before 7 months of age. Although calculated pulmonary arteriolar resistance is often elevated in young infants with this heart defect, this elevation rarely reflects significant pulmonary vascular changes in infants < 7 to 12 months of age. METHODS: We performed a retrospective review of 34 patients who underwent complete repair of AV septal defect at our institution between January 1, 1988 and September 1, 1992. Some patients had both catheterization and echocardiographic-Doppler studies (group I, n = 16); others had only echocardiographic-Doppler studies (group II, n = 18). RESULTS: The groups were comparable with regard to age at echocardiography and operation, days in the hospital, days with ventilatory and inotropic support and occurrence of postoperative pulmonary hypertension. One child (2.9%) died during the early postoperative period, and one child in each group (5.8%) died within the 1st year of life. Preoperative echocardiography allowed better detailing of anatomy, valve commitment and regurgitation than was possible with catheterization alone. Knowledge of preoperative pulmonary resistance did not alter the surgical decision or predict postoperative pulmonary hypertension. There was no apparent difference in mortality between the two groups (0 vs. 5.5%), but the small number of patients in each group provides for a very low power (beta = 0.04) calculation. This mortality rate is not different from that reported in recent studies. CONCLUSIONS: Patients with AV septal defect can safely undergo surgical correction of this defect on the basis of echocardiographic-Doppler data alone.

Echocardiography, Doppler↗
PubMed1987

Surgical management of subaortic stenosis in patients with single ventricle and transposition of the great vessels.

Subaortic stenosis can develop in patients with single ventricle and transposition of the great vessels. Its presence increases the risk of septation or Fontan repair, and reports of surgical management have indicated high mortality. This report describes the results of an approach that includes direct resection of the stenosis via an aortotomy, and delay of the Fontan repair to a later date. Nine children with single ventricle underwent surgery for subaortic stenosis from 1968 to 1984. Three deaths occurred postoperatively from ventricular dysfunction in patients who underwent either conduit bypass (one patient) or repair via ventriculotomy (two patients). Of the six long-term survivors, one infant underwent ventriculotomy and subaortic resection, and the last five patients had subaortic resection via an aortotomy without any other simultaneous procedure. Avoidance of ventriculotomy and decreased cardiopulmonary bypass time lowers the risk of stenosis repair in the presence of a hypertrophied ventricle. Fontan repair after some regression of the ventricular hypertrophy is recommended, and has been accomplished in one patient to date. All patients repaired via aortotomy are alive and well 1 to 6 years postoperatively.

Aortic Valve Stenosis↗
PubMed1985

Influence of hypothermia and circulatory arrest on cerebral temperature distributions.

A finite element model of the bioheat transfer equation has been developed to simulate the temperature distribution in the head of a subhuman primate. Simulations were made of the induction of deep hypothermia and of subsequent hypothermic circulatory arrest (HCA). Simulations of the circulatory arrest phase were performed with different values of surface heat transfer coefficient and tissue metabolic heat generation. Numerical results were compared with experimental data for the same procedure. The simulations indicate the brain cools rapidly to a near isothermal condition in response to an infusion of cold arterial blood. However, extracerebral structures cool much more slowly. The bulk of heat gain by the brain during HCA is due to heat transfer from these warmer extra-cerebral tissues. These results suggest extended cooling by cardiopulmonary bypass (CPB) combined with surface cooling pads should reduce or even prevent the rise of brain temperatures during HCA.

Animals↗
PubMed1984

Aortic translocation and biventricular outflow tract reconstruction. A new surgical repair for transposition of the great arteries associated with ventricular septal defect and pulmonary stenosis.

Transposition of the great arteries associated with ventricular septal defect and left ventricular outflow tract obstruction remains a serious surgical challenge. A new surgical technique that utilized aortic root mobilization and transfer combined with reconstruction of the right and left ventricular outflow tracts was applied successfully in two children. This technique provides an additional type of arterial switch operation for complex transposition and is an alternative to (1) the conventional combination of Mustard (Senning) procedure with closure of the ventricular septal defect and relief of left ventricular outflow tract obstruction and (2) the Rastelli operation.

Aorta↗
PubMed1981

Inflammatory esophagogastric junction polyp.

A nine-year old boy with Addison's disease had a long history of epigastric pain. When a large polyp was found in the distal esophagus, it was surgically removed. To our knowledge, this is the youngest patient to undergo surgery for esophagogastric junction polyp. The literature on the subject is reviewed.

Child↗
PubMed1979

Tuberculous aneurysms of the descending thoracic aorta: report of a case with fatal rupture.

Tuberculous aortic aneurysm is a rare disease entity. The majority of affected patients succumb to perforation and exsanguination. The only chance for survival and cure is by resection and prolonged antituberculosis chemotherapy. Our case illustrates the high risk of rupture of tuberculous aortic aneurysms. Post-mortem examination revealed that the mechanism of aneurysm formation was by direct caseous involvement of the descending thoracic aorta from a juxtaposed left upper lobe parenchymal tuberculous process. Our findings also favor the concept that miliary dissemination (in the presence of tuberculous aortic aneurysm) is the result rather than the cause of the tuberculous aortic process.

Aorta, Thoracic↗
PubMed1977

Pulmonary vascular disease in complete atrioventricular canal defect.

The incidence and time of occurrence of pulmonary vascular disease were studied in 67 children with the complete form of atrioventricular (A-V) canal defect. Advanced pulmonary vascular disease begins to develop during the first year of life, with intimal fibrosis (grade 3 cahnges) noted between age 6 months to 1 year. Vascular dilatation with plexiform lesions (grade 4 changes) can be found by age 1 year. These changes can be found in some patients in spite of hemodynamic findings usually considered to indicate lesser degrees of vascular disease. After age 2 years advanced pulmonary vascular disease is commonly found and may persist after surgical correction of the defects. A similar rapid progression of pulmonary vascular disease was noted in 40 children who had a large ventricular septal defect without A-V canal in whom systemic pressure was transmitted directly to the pulmonary vascular bed. Thirty-six of the 67 children had trisomy-21. No difference was noted in the speed of progression of pulmonary vascular disease between these children and those without trisomy 21. Palliative or corrective surgery should be performed in these patients by age 1 year to prevent development of advanced pulmonary vascular disease.

Age Factors↗
PubMed1976

Ascending aorta-right pulmonary artery shunt.

Seventy-seven patients with ascending aorta-right pulmonary artery shunt were reviewed; 48 had tetralogy of Fallot, 9 had pulmonary atresia, 11 had transposition of the great vessels with pulmonary stenosis, 4 had tricuspid atresia, and 5 had miscellaneous complex lesions. Their ages ranged from one day to 13 years. The over-all mortality rate was 17.8 per cent. Ten patients underwent total repair and takedown of the shunt with no deaths. The problems of increased pulmonary flow, pulmonary hypertension, preferential flow to one lung, kinking and distortion of the pulmonary artery, and the technical difficulties at the time of takedown were reviewed and discussed.

Aorta↗
PubMed1975

Surgical management of anomalous left pulmonary artery causing tracheobronchial obstruction. Pulmonary artery sling.

An anomalous left pulmonary artery causing tracheobronchial obstruction is a rare malformation seen in infancy. Sixty-four cases have been described in the literature, with 17 survivors with or without surgical therapy. We reviewed the literature and the 5 cases seen at The Children's Memorial Hospital during the past 20 years. Three of these patients survived, 2 of whom have not been previously reported. The main clinical features are progressive respiratory distress, cyanosis, and apneic episodes resulting from obstruction of the lower trachea and bronchi by an anomalous left pulmonary artery. Obstructive emphysema with or without atelectasis is very common in this condition and should suggest to the clinician the possiblity of this anomaly. The important diagnostic clues are an anterior indentation of the esophagus on esophagography, narrowing of the lower end of the trachea and right bronchus on bronchography, and anomalous origin of the left pulmonary artery from the right on angiography. We prefer to approach this anomaly by a left anterolateral thoracotomy with transection and end-to-end anastomosis of the anomalous left pulmonary artery in front of the trachea. Respiratory complications due to residual tracheomalacia are common after the operation.

Bronchial Diseases↗