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Biomedical subjects

J Kamata

Publications and source records attributed to J Kamata.

36 records · Page 2Linked to original sources
PubMed1998

[Supervised cardiac rehabilitation for the patients with the disturbance of the motor function after cardiac surgery: the significance of physical therapists' participation].

There are sporadic instances of patients with the motor function disturbance of non-cardiac origin after cardiac surgery, and these patients may need prolonged post-operative cardiac rehabilitation. We established our cardiac rehabilitation program for post-operative patients and a total of 124 patients underwent the post-operative cardiac rehabilitation program (male 73, female 51, average age 60). Among them, 12 patients (9.7%) received the physical therapy for the disturbance of motor function post-operatively. These 12 patients were retrospectively studied. Physical therapies performed were the exercise therapy to improve the range of motion to prevent contracture in 3 patients with peroneal nerve palsy and drop foot, the exercise therapy for pre-operative or post-operative hemiplegia in 6 patients, the instruction of exercise for lumbago in 1 patient with spinal cord disease, respiratory physical therapy in 1 patient, and myotherapy for arthritis in 1 patient. Treatment with physical therapy was very useful in rehabilitating these patients. Active participation of physical therapists in cardiac rehabilitation for patients with the disturbance of motor function after cardiac surgery is possible. It is expected that their participation may improve the quality of life in this subset of patients.

Adult↗
PubMed1997

Predictors of sinus rhythm restoration after Cox maze procedure concomitant with other cardiac operations.

BACKGROUND: There have been sporadic cases of persistent atrial fibrillation and sick sinus syndrome after the maze procedure. The purpose of this study was to identify the predictors of sinus rhythm restoration after operation. METHODS: Between March 1993 and June 1995, we evaluated retrospectively 96 consecutive patients who underwent the maze procedure (maze III) in combination with another type of cardiac operation. Four patients who died and 6 patients who required permanent pacemaker implantation because of sick sinus syndrome were excluded. Ambulatory electrocardiographic monitoring was evaluated 1 year after operation. Multiple logistic regression analysis was applied to identify the predictors of sinus rhythm restoration. RESULTS: The final population comprised 86 patients (mean age, 59.8 years; 67 patients with mitral valve disease). Overall, sinus rhythm was restored in 68 of 86 patients (79.1%). The magnitude of the atrial fibrillatory wave positively predicted postoperative sinus rhythm restoration. Conversely, left atrial diameter was inversely related to postoperative sinus rhythm restoration. The odds ratio of having both a fine atrial fibrillatory wave (< 1.0 mm) and enlarged left atrial diameter (> or = 65 mm) for patients with sinus rhythm restoration was 0.04 (95% confidence interval, 0.01 to 0.28). CONCLUSIONS: Atrial fibrillatory wave and left atrial diameter were independent predictors of sinus rhythm restoration after the maze procedure in patients with chronic atrial fibrillation and organic heart disease.

Adult↗
PubMed1997

Electrocardiographic nature of restored sinus rhythm after Cox maze procedure in patients with chronic atrial fibrillation who also had other cardiac surgery.

OBJECTIVE: To characterise heart rate variability and high frequency components of restored sinus rhythm after the maze procedure. The maze procedure for chronic atrial fibrillation may prevent thrombotic events and improve the quality of life. However, the electrocardiographic nature of restored sinus rhythm after the maze procedure has not been fully elucidated. PATIENTS AND METHODS: Between March 1993 and August 1995, 104 consecutive patients undergoing the maze procedure in combination with other cardiac surgery were studied. There were 100 long-term survivors (78 with mitral valve disease, 9 with aortic valve disease, 8 with congenital heart disease, and 5 others). Twenty age-matched patients with mitral valve disease who were in normal sinus rhythm preoperatively were enrolled as a control group. 30 days after surgery, the presence of arrhythmias and the circadian changes of heart rate variability were estimated by ambulatory electrocardiographic monitoring and the filtered P duration was evaluated by signal-averaged electrocardiogram. RESULTS: Restoration of sinus rhythm was observed in 73 of 100 cases. Subjects were classified into three groups according to their postoperative ambulatory electro-cardiographic monitoring findings: patients in group 1 (n = 73) (1a: 58 regular sinus rhythm; 1b: 15 sinus rhythm with frequent premature atrial contractions (> 1000/day); patients in group 2 (n = 21) still had persistent atrial fibrillation; and patients in group 3 (n = 6) required permanent pacemaker implantation because of sick sinus syndrome. The success rate of restoration of sinus rhythm was 88.3% if left atrial diameter was small (< 65 mm). Circadian changes in the low frequency to high frequency power ratio in group 1a were significantly diminished compared with control group (P < 0.01). Furthermore, the filtered P duration in group 1a (150 (20) ms) and group 1b (158 (23) ms) were longer than in the control group (122 (11) ms) (P < 0.01). CONCLUSIONS: The maze procedure may result in a decreased sinus response and non-uniform transmission of impulses in the atrium.

Adult↗
PubMed1997

Can the maze procedure be combined safely with mitral valve repair?

BACKGROUND AND AIMS OF THE STUDY: The safety of combining mitral valve repair with the maze procedure for chronic atrial fibrillation in the surgical management of patients with mitral valve disease is not well elucidated. We present our operative results regarding mortality and morbidity after such combined surgery. As a comparison, our operative results after mitral valve repair in patients without chronic atrial fibrillation are presented. METHODS: Between April 1993 and December 1994, 39 patients with chronic atrial fibrillation underwent mitral valve repair and concomitant maze procedure (group 1) at the Iwate Medical University. During the same period, 36 patients with sinus rhythm and one patient with DDD pacemaker underwent mitral valve repair (group 2). In order to evaluate the operative risk, morbidity, and mortality of adding the maze procedure to mitral valve repair, total cardiopulmonary bypass time, aortic cross-clamp time, intraoperative blood loss, intubation period, and duration of ICU stay were compared between the groups. RESULTS: Total cardiopulmonary bypass time and aortic cross-clamp time in group 1 were longer than in group 2 (174.0 +/- 38.8 min versus 150.1 +/- 54.4 min; p = 0.032, 122.5 +/- 30.7 min versus 95.8 +/- 38.2 min; p = 0.0012). However, the duration of ICU stay, intubation period, and intraoperative blood loss were not different between the groups. There were no hospital deaths in either group. Four patients in group 1, and two patients in group 2 required re-exploration for bleeding (p = NS). Two patients in group 1, and none in group 2 required pacemaker implantation postoperatively (p = NS). Two patients in group 2, and none in group 2 had minor cerebral infarction (p = NS). At hospital discharge, 28 patients in group 1 (72%) and 35 patients (97%) in group 2 were in sinus rhythm. CONCLUSIONS: The maze procedure can be combined with mitral valve repair without adding undue operative risk to patients. Those patients with chronic atrial fibrillation undergoing mitral valve repair may be advised for the possibility of concomitant maze procedure.

Aged↗
PubMed1997

Clinical usefulness of the effective regurgitant orifice area determined by transesophageal echocardiography in patients with eccentric aortic regurgitation.

BACKGROUND AND AIMS OF THE STUDY: The aortic regurgitant jet is frequently eccentric, and Doppler color flow mapping techniques of the distal jet is influenced by this eccentricity. The aim of the present study was to determine whether the effective regurgitant orifice area (EROA), determined by the proximal isovelocity surface area (PISA) method using multiplane transesophageal echocardiography (m-TEE), could be used to evaluate the severity of aortic regurgitation (AR) in patients with an eccentric jet. METHODS: Forty-eight patients with eccentric AR were studied. Values of EROA determined by the PISA method were compared with results from cross-sectional area (CSA), vena contracta (VC) width, aortic angiography, and regurgitant fraction. RESULTS: Values of EROA correlated well with results from CSA (r = 0.73, p < 0.001), VC (r = 0.74, p < 0.001), angiographic grade (rs = 0.90 p < 0.001), and regurgitant fraction (r = 0.84, p < 0.001) in patients with eccentric aortic regurgitation. Values of EROA > 0.27 cm2 were always associated with a regurgitant fraction > 0.4, while EROA values < 0.27 cm2 were always associated with a regurgitant fraction < 0.4. CONCLUSIONS: We conclude that, in patients with an eccentric jet, measurement of EROA values by the PISA method using m-TEE is a reliable method of assessing the severity of AR.

Aorta, Thoracic↗
PubMed1996

Successful utilization of the median sternotomy approach in the management of descending necrotizing mediastinitis: report of a case.

We describe herein the case of a patient in whom a median sternotomy was successfully employed for mediastinal drainage in the treatment of descending necrotizing mediastinitis (DNM). Although most reports describe cervical or thoracotomy approaches, our experience strongly suggests that median sternotomy is a satisfactory alternative approach for treatment of this disease.

Adult↗
PubMed1995

Myxoma of the mitral valve detected by echocardiography and magnetic resonance imaging.

Myxomas of the mitral valve diagnosed during life are exceedingly rare. We employed transthoracic and transoesophageal echocardiography and magnetic resonance imaging enhanced by gadolinium-diethylene-triamine-pentaacetic acid in a patient with palpitations. After these examinations clearly demonstrated a myxoma on the atrial side of the posterior mitral valve leaflet, urgent surgery was performed. When a small tumour of the mitral valve exists, these examinations are useful not only for detecting and characterizing the tumour, but also for deciding the optimal surgical management.

Adult↗
PubMed1995

Transient cortical blindness following bypass graft angiography. A case report.

Transient cortical blindness, an uncommonly recognized complication of cerebral angiography, is an exceedingly rare event after cardiac catheterization and angiography. This report describes a sixty-two-year-old patient who had transient cortical blindness following bypass graft angiography. In this case, the authors showed that cortical blindness was associated with the breakage of the blood-brain barrier (BBB) and an increase in vascular permeability rather than with primary cerebral circulatory insufficiency. When the possibility exists that an excess volume of contrast medium may enter the cerebral circulation as in this case, that is, following a coronary artery bypass graft (CABG) using the internal mammary artery (IMA), precautionary measures may be necessary such as changing the type of contrast medium to be used or decreasing the volume injected. When cortical blindness occurs, it is a serious clinical problem whether transient or permanent. Therefore, the circumstances leading to this complication should be understood to determine suitable treatment and management.

Blindness↗
PubMed1995

Concentration of soluble vascular cell adhesion molecule-1 (VCAM-1) correlated with expression of VCAM-1 mRNA in the human atherosclerotic aorta.

BACKGROUND: Adherence of circulating monocytes and lymphocytes to arterial endothelium is detectable early in experimental and human atherosclerotic plaque formation. The purpose of the present study was to assess vascular cell adhesion molecule-1 (VCAM-1) mRNA expression and the properties of soluble VCAM-1 in patients with atherosclerotic aortic disease. METHODS: Thirteen patients with aortic disease (mean age 64 years) and 40 healthy volunteers (mean age 32 years) were included in the study. We investigated the expression of VCAM-1 mRNA in eight human aortic specimens obtained during surgery. Of these, two showed no evidence of atherosclerotic plaque formation [aortic dissection (n = 1) and annuloaortic ectasia (n = 1)], whereas six had demonstrable complex atherosclerotic formation [abdominal aneurysm (n = 5) and aortic dissection (n = 1)]. The RNase protection assay was performed using an alpha 32P-labeled 121 base pair VCAM-1 cRNA probe. We also measured concentrations of the soluble VCAM-1 using two-site enzyme immunoassays in 40 healthy volunteers and in 13 patients with abdominal and thoracic aortic aneurysms. RESULTS: In human samples, VCAM-1 mRNA expression was found to be higher in the six patients with complex atherosclerotic formation [optical density (OD), 0.71 +/- 0.14] than in the two patients with no evidence of atherosclerotic plaque formation (OD, 0.53 and 0.49). The concentration of serum soluble VCAM-1 was higher (850 +/- 298 ng/ml) in patients with aortic or thoracic disease than in the healthy volunteers (494 +/- 94 ng/ml). In addition, there was a relationship between VCAM-1 mRNA expression and the concentration of soluble VCAM-1 (y = 2088x-554, r2 = 0.73). CONCLUSION: VCAM-1 expression is higher in the human aorta in patients with atheromatous changes. Furthermore, concentrations of soluble VCAM-1 may provide important information about endothelial activation or in-vivo damage.

Adult↗
PubMed1995

ST-segment/heart rate loop analysis on treadmill exercise testing can provide diagnostic and prognostic information in patients with stable effort angina.

BACKGROUND: In the assessment of myocardial ischemia and its severity using treadmill exercise testing (TMET), the magnitude of ST-segment depression is conventionally used. It is often difficult to distinguish false-positive from true ST-segment depression and to assess the severity of coronary artery disease (CAD). The purpose of the present study was to assess the ability of ST-segment/heart rate loop (ST/HR loop) analysis to provide diagnostic and prognostic information in patients with stable effort angina. METHODS: ST/HR loop analysis was studied in 118 patients with stable effort angina without previous myocardial infarction who were taking medication. ST/HR loop patterns were classified into four types: type A (n = 38), simple clockwise rotation; type B (n = 34), clockwise rotation with quick ST recovery in the first half; type C (n = 21), ST-segment depression that recovered at a constant rate; and type D (n = 25), simple counter-clockwise rotation. The control group consisted of 40 patients who had no ST-segment depression but were proved to have significant stenosis on coronary angiography. The ST/HR loop types were compared with (1) the conventional TMET parameters, (2) findings of coronary angiography, (3) severity of ischemia evaluated by exercise thallium-201 myocardial single-photon emission computed tomography (exercise TI-201 myocardial SPECT), and (4) short-term prognosis by follow-up study. RESULTS: The value of the simple heart-rate-adjusted ST-segment depression index (delta ST/HR index) in the type A group (6.1 +/- 5.8 microV/bpm) was higher (P < 0.05) than in the type C and D groups (2.7 +/- 2.0 microV/bpm and 1.7 +/- 1.2 microV/bpm, respectively). In the type A group, 68% of the patients had multiple diseased coronary arteries. In the type D group, 88% of the patients had either no significant coronary artery stenosis or significant stenosis in a single coronary artery. The ischemic size calculated by exercise TI-201 myocardial SPECT was higher (P < 0.05) in the type A group (47.6 +/- 24.6%) than in the type B, C, and D groups (21.4 +/- 16.6%, 14.9 +/- 15.8% and 7.8 +/- 7.4%, respectively). During the follow-up study nine cardiac events occurred in the type A group, three in the type B group, and one in the type C group. The prognosis of the type A patients was significantly worse than that of the type D and control patients (P < 0.01). CONCLUSION: We conclude that the ST/HR loop analysis is a simple and useful parameter for providing diagnostic and prognostic information for patients with stable effort angina.

Aged↗
PubMed1995

[Is intraoperative monitoring of transesophageal echocardiography necessary for mitral valve repair?].

To clarify the clinical significance of the intraoperative monitoring for mitral valve repair by transesophageal echocardiography (TEE), we evaluated the correlation of color Doppler flow area of residual mitral regurgitation (residual MR area) between intraoperative and postoperative TEE. Subjects were 12 patients (average age was 54.7 years) underwent recently intraoperative TEE. These 12 patients were divided into two groups: Group A (MR area < 2.0 cm2; n = 8) and Group B (MR area > 2.0 cm2; n = 4). None of the 12 patients required second pump run. In all cases, residual MR area, as determined using intraoperative TEE, was less than 3.2 cm2. One month after surgery, the MR area did not showed an increase in Group A, while in Group B it decreased slightly in 2 cases, remained unchanged in 1 case and increased slightly in 1. Our findings do not support the usefulness of intraoperative monitoring with TEE. It seems difficult to predict the outcome of residual MR on the basis of the MR area alone. At present, we thought that, possibly, intraoperative monitoring with TEE is indispensable for mitral valve repair. A longer follow-up will be necessary to draw firm conclusions.

Echocardiography, Transesophageal↗
PubMed1994

3 beta-Hydroxysteroid dehydrogenase activity and gestagen concentrations in bovine cotyledons and caruncles during gestation and parturition.

3 beta-Hydroxysteroid dehydrogenase (3 beta-HSD) activity in bovine cotyledons was much higher than in caruncles throughout the gestation period. The activity of this enzyme in cotyledons increased greatly to 150.6 +/- 5.8 pmol min-1 mg-1 protein during the seventh month of gestation, reached a peak of 221.0 +/- 34.9 pmol min-1 mg-1 protein during the eighth month, and decreased at parturition. Progesterone and 20 alpha-hydroxyprogesterone concentrations in cotyledons also increased sharply to 2.69 +/- 0.30 and 2.15 +/- 0.42 ng mg-1 protein, respectively, during the seventh month of gestation, reaching peaks of 2.86 +/- 0.47 and 2.51 +/- 0.36 ng mg-1 protein, respectively, during the eighth month and decreasing at parturition, in a manner similar to the activity of 3 beta-hydroxysteroid dehydrogenase. The fluctuation of 17 alpha-hydroxyprogesterone concentration in cotyledons was different from that of progesterone and 20 alpha-hydroxyprogesterone. These findings indicate that the activity of 3 beta-hydroxysteroid dehydrogenase in the placenta is enhanced during the third trimester, and progesterone synthesized in the cotyledons is converted concurrently to 20 alpha-hydroxyprogesterone before progesterone is transferred to the fetal blood.

17-alpha-Hydroxyprogesterone↗
PubMed1993

Aromatase activity and oestrogen concentrations in bovine cotyledons and caruncles during gestation and parturition.

Two peaks of aromatase activities were detected in bovine cotyledons, 2.76 +/- 0.96 pmol min-1 mg-1 protein at month five of gestation and 3.62 +/- 0.78 pmol min-1 mg-1 protein immediately after parturition, but aromatase activity in caruncles was very low throughout gestation. Oestrone concentrations in the cotyledons and caruncles were 0.93 +/- 0.50 and 1.51 +/- 0.69 ng mg-1 protein at month five of gestation, but 4.31 +/- 1.66 and 3.36 +/- 0.98 ng mg-1 protein immediately after parturition, indicating a biphasic pattern. Our findings suggest that oestrogen synthesis in the bovine placenta increased to a maximum at least twice during the period from gestation to parturition; at month five of gestation and at parturition the changes in aromatase activity may only be partially explained by changes in oestrogen production.

Animals↗
PubMed1993

[Detection of myocardial ischemia by 99mTc-Teboroxime myocardial SPECT: a comparison with 201Tl myocardial SPECT].

Exercise myocardial SPECT using 99mTc-Teboroxime was performed and the regions of ischemic area were compared with 201Tl myocardial SPECT in 8 patients with coronary artery disease. All patients had no evidence of previous myocardial infarction, and underwent bicycle ergometer exercise according to a standardized multistage exercise protocol. At peak exercise, 555 MBq 99mTc-Teboroxime or 75 MBq 201Tl was injected intravenously. After termination of exercise, images were obtained with a gamma camera rotating through a 180 degrees arc from 45 degrees right anterior oblique to 45 degrees left posterior oblique. The concordance of 99mTc-Teboroxime SPECT and 201Tl SPECT was 63% in ischemic region and 83% in normal region. Furthermore, one patient underwent dipyridamole infusion and 99mTc-Teboroxime SPECT was carried out. The images obtained by dipyridamole 99mTc-Teboroxime SPECT were equivalent to the images of exercise 201Tl SPECT. 99mTc-Teboroxime SPECT seems useful for the detection of the coronary artery disease. It was suggested that evaluation of the myocardial viability in acute phase of myocardial infarction can be possible by using 99mTc-Teboroxime SPECT.

Aged↗
PubMed1992

[Increased serum levels of human cardiac myosin light chain 1 in patients with renal failure].

In this study, we measured cMLC1 concentration in serum and urine from patients with acute myocardial infarction (AMI), chronic renal failure (CRF), and various grades of renal dysfunction (RD) in comparison with normal controls, by using enzyme immunoassay (EIA) with monoclonal antibody, and attempted to elucidate the mechanism of increased serum level of cMLC1 in patients with renal failure. The serum level of cMLC1 of CRF patients under maintenance hemodialysis (HD) was 20.3 +/- 19.6 ng/ml, markedly higher than normal controls (0.54 +/- 0.55 ng/ml). The patients with RD and CRF under conservative therapy had higher serum cMLC1 level than normal controls especially in advanced CRF, while each value not correlating with their creatine clearance (Ccr). cMLC1 in urine was detectable in only two cases with AMI accompanied with CRF or RD. In addition, immunohistological studies of renal biopsy specimens from RD patients did not show cMLC1 deposits in glomerulus. These results suggest that cMLC1 is assumably filtered through the glomerulus, and then absorbed in the renal tubule.

Humans↗
PubMed1991

[Problems of Mason-Likar lead system in treadmill exercise electrocardiography].

A Mason-Likar (M-L) leads system has been widely used in the exercise electrocardiography (ECG) using treadmill for the detection of myocardial ischemia. In routine treadmill exercise ECG using M-L lead, we often observe different patterns of ST-T forms those of II, III and aVF on bipolar leads. In this study, on 213 patients, conventional 12 lead ECG and the M-L lead placement ECG were recorded both at supine and standing positions. A careful analysis was made on all the records of patterns, durations, and amplitudes of QRS and T waves. We also evaluated the ST trendgram of patients with no ischemic changes proven exercise TI-201 myocardial single photon emission tomography (SPECT). Quantitative examination showed no significant differences between those in precordial leads of the standard and the M-L lead system in any subjects. The augmented amplitude of QRS and T waves, the disappearance of abnormal Q-waves in II, III, aVF lead, the negative inversion in QRS phase in lead aVL an left axis deviation were often recognized with M-L lead placement. In treadmill exercise ECG, ST depression more than 1 mm in II, III, aVF lead was noted 14 out of 17 patients with no ischemic changes. The all ST-T changes showed "not-decrescendo" type in ST trendgram. We concluded that rigorous evaluation for electrical axis, the configuration of ST-T waves and the existence of myocardial ischemia in leads II, III, aVF was necessary on treadmill exercise ECG using M-L lead replacement.

Coronary Disease↗