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Biomedical subjects

K Daitoku

Publications and source records attributed to K Daitoku.

At least 19 recordsLinked to original sources
PubMed2006

[Emergency small-sized stent placement following aortic true lumen obliteration of Stanford type B acute aortic dissection].

Acute aortic obstruction induced by acute aortic dissection frequently causes life-threatening organ ischemia. Although early reperfusion of lower extremities, renal and mesenteric artery is necessary, surgical treatment such as graft replacement is invasive and may result in myonephropathic-metabolic syndrome (MNMS), which leads to loss of limb and life. We herein report a case of stent placement as a less invasive treatment for true lumen obliteration associated with Stanford type B aortic dissection in a patient with chronic renal failure on hemodialysis. Ten mm metallic stents were placed in the obliterated true lumen of the descending aorta in order to perfuse peripheral organs within 5 hours after occurrence. It relieved symptoms of visceral organ and leg ischemia. On the postoperative day 14, abdominal discomfort after meal, hypertension in the upper extremity and headache appeared. Chest and abdominal computed tomography (CT) revealed stenosis of the true lumen proximal to the stents. On the other hand, the diameter of the true lumen was inversely dilated distal to the stents. Bilateral axillo-femoral artery bypass was performed with relief of upper extremity hypertension and visceral organ ischemia. The patient otherwise had an uneventful course and was discharged on the postoperative day 37. Our experience suggests that emergency stent placement can provide an option that is less invasive, more effective and prompt treatment for patients with visceral organ and leg ischemia resulting from acute aortic dissection.

Aortic Dissection↗
PubMed2004

[Ruptured thoracic aortic aneurysm presenting as massive epistaxis; report of a case].

An 80-year-old woman was transported to the emergency room at our hospital by the ambulance, suffering from massive epistaxis. As the patient was hemodynamically stable, otolaryngologist attempted to perform tamponade using nasal packing. However, the patient's condition deteriorated, with the development of dyspnea and a reduction in oxygen saturation to 90%. A chest X-ray performed at this point revealed left lung consolidation and pleural effusion while chest computed tomography (CT) demonstrated that rupture of a descending aortic aneurysm with periaortic hematoma and extension of hemorrhage into the left lower lobe of the lung. Emergency surgery was performed under partial extracorporeal circulation, established by cannulation of the right femoral artery and vein. In addition to the replacement of the descending aorta with a prosthetic conduit, left lower lobectomy was necessary because of severe adhesion to the descending aorta. The postoperative course was largely uncomplicated apart from development of chylothorax, which resolved with a short period of total parenteral nutrition and she was discharged 50 days after surgery.

Aged↗
PubMed2003

[Effectiveness and advisability of using a graft in off-pump coronary artery bypass grafting].

In off-pump coronary artery bypass grafting (off-pump CABG: OPCAB) procedures involving multiple vessels, the Aorta No-Touch technique is increasingly being adopted to avoid cerebral infarction, while gastro-epiploic artery (GEA)-left anterior descending coronary artery branch (LAD) anastomosis or composite T-grafting is performed to supply blood to multiple coronary arteries through the left internal thoracic artery (LITA) as an inflow conduit. The objective of the present study is to investigate the effectiveness and advisability of grafting in patients who undergo OPCAB involving multiple vessels, including those who undergo standard CABG. CONCLUSIONS 1: Composite T-grafts of the LITA in OPCAB involving multiple vessels can present certain problems with patency, patient survival, and need for subsequent revision procedures. In the event of a graft failure, serious symptoms resembling left main coronary trunk (LMT) may develop. 2: The incidence of cardiac events with GEA-LAD is high, and patency in the distal phase is poor. 3: Ideally, LITA-LAD should be performed alone. 4: Among patients who have been screened before the procedure, satisfactory results are obtained for OPCAB in which the ascending aorta serves as an inflow conduit; this procedure should be considered as a viable option.

Aged↗
PubMed2002

Myocardial protection of the pressure overload hypertrophied heart in human cardiac surgery by acceleration of anaerobic glycolysis.

BACKGROUND: Because of the decreased tolerance to ischemia and increased reperfusion injury in hypertrophied myocardium, myocardial hypertrophy is a well known risk factor for cardiac surgery. We have previously demonstrated in a left ventricular hypertrophy (LVH) model that a highly buffered cardioplegic solution (HBS) that provided glucose as a substrate and promoted anaerobic glycolysis during ischemia afforded superior myocardial protection when compared to standard formulations. And we reported the superiority of this cardioplegia in human cardiac surgery. METHODS: In this study, 16 patients with aortic stenosis (AS) and LVH receiving HBS were reviewed and compared to another patient group with AS and LVH who received either cold blood cardioplegia (CBC; n=5) or glucose insulin potassium (GIK; n=6). RESULTS: Postoperative cardiac index was better in the HBS group than the other two groups with similar or lower catecholamine. CK-MB was lower in HBS group than GIK group, but this was not significant. Only one DC cardioversion was required in the HBS group, whereas 2 DC in the CBC group and total 7 DC in the GIK group. CONCLUSIONS: We found that histidine buffered cardioplegic solution provided comparable or better pump performance after surgery with relatively lower inotropic requirement, less DC cardioversion and homologous blood requirements for left ventricular hypertrophied heart associated with aortic stenosis.

Aged↗
PubMed2002

[An adult case of Bochdalek hernia without an obvious cause; report of a case].

A 72-year-old female was transported by ambulance to our department to undergo transthoracic surgery. She had previously undergone transabdominal surgery under a diagnosis of adult Bochdalek hernia, but the restoration was believed to have been incomplete. During the transthoracic procedure, a dorsolateral defect of the diaphragm was detected and reinforcement with a Gore-Tex patch was performed. The patient's postoperative course was uneventful. Adult Bochdalek hernia is rare, but it requires immediate surgical intervention. Although transabdominal surgery is generally considered the first line treatment approach to restore Bochdalek hernia, restoration of the diaphragm is occasionally difficult. On the other hand, a transthoracic approach is thought to be effective as it allows for observation of the lung and diaphragm, and easy closure of the diaphragmatic defect. As complete restoration through early surgical intervention is important, a transthoracic approach in conjunction with transabdominal surgery should be considered whenever necessary.

Aged↗
PubMed2002

[A report of three surgical cases in a family of Marfan syndrome].

A family of 3 patients with Marfan syndrome was reported. All of them had surgical interventions in cardiovascular disorders such as DeBakey type I, III aortic dissection and thoracoabdominal aortic aneurysm. In 2 patients, multiple surgical treatments were performed for aneurysmal dilatation of the distal false lumen or another lesions of the treated aorta. Since cardiovascular lesions of Marfan syndrome are systemic and progressive, the postoperative long term follow-up, including systemic evaluation of the arterial system, is essential to detect the latent cardiovascular complications. Careful examining the family with Marfan syndrome is necessary to discover any cardiovascular abnormalities in these people early.

Adult↗
PubMed2002

[Modified bentall operation using composite graft without resection of aortic valve].

A 27-year-old male whose diagnoses were aortic dissection (Stanford A), aortic regurgitation, annulo-aortic ectasia, and Marfan syndrome underwent modified Bentall operation using composite graft and total arch replacement. Modification of proximal suture without resection of aortic valve like intravalvular implantation might have resulted in good recovery without blood transfusion. Another 63-year-old male who suffered from spontaneous aortic rupture with aortic regurgitation also underwent modified Bentall operation in the similar manner as the first case with good result. Spontaneous aortic rupture reported here is a rare case, and operation is thought to be prerequisite for the patient who suffers from this disease to survive.

Adult↗
PubMed2000

NO is involved in MCh-induced accentuated antagonism via type II PDE in the canine blood-perfused SA node.

The possible role of type II (cGMP-stimulated cAMP hydrolysis) phosphodiesterase (PDE) in the accentuated antagonism of muscarinic effects on heart rate during beta-stimulation via endogenous nitric oxide (NO) was evaluated. The canine isolated sinoatrial node preparation was cross circulated with arterial blood of a support dog. The sinoatrial rate of the preparation was 96 +/- 5 beats/min (n = 16) at control. Methacholine (MCh; 0.01-1 microg) injected into the right coronary artery in a bolus fashion caused dose-dependent decreases in sinoatrial rate. Under an intra-arterial infusion of isoproterenol (1 microM), resulting in approximately 50% increase in sinoatrial rate, MCh-induced decreases were markedly augmented from -18 +/- 3% to -44 +/- 4% at 0.3 mg of MCh. When N(G)-nitro-L-arginine methyl ester (100 microM) or N(G)-monomethyl-L-arginine (100 microM) were continuously infused, the augmented MCh-induced decreases in sinoatrial rate were significantly suppressed (-29 +/- 3% or -25 +/- 3%, respectively, P < 0.01). Pretreatment with either 3-isobutyl-1-methylxanthine (IBMX; 20 microM), a non-selective PDE inhibitor, or amrinone (20 microM), a selective type III (cGMP inhibited cAMP hydrolysis) PDE inhibitor, doubled the isoproterenol-induced increase in the sinoatrial rate. However, the augmented MCh-induced decreases in sinoatrial rate were significantly depressed by IBMX (from -23 +/- 5% to -14 +/- 1%, P < 0.01) but not by amrinone (to -20 +/- 3%). These results suggest that MCh-induced accentuated antagonism in the sinoatrial node pacemaker activity can be modulated by endogenous NO via an activation of the type II cyclic GMP-stimulated cAMP PDE.

Acetylcholine↗
PubMed2000

Electrogram characteristics indicative of a recurrent conduction site after ablation of the inferior vena cava-tricuspid annulus isthmus: a study in the canine blood-perfused atrioventricular preparation.

Analysis of the electrograms recorded along the ablation line can identify a recurrent conduction site after ablation of the isthmus between the inferior vena cava (IVC) and tricuspid annulus (TA) for atrial flutter. The present study examined the relationship between the activation sequence and electrogram characteristics using a model of recurrent conduction in the isthmus. The canine heart was isolated (n=8) and cross-circulated with the arterial blood of a support dog. A plaque electrode was placed at the isthmus, and 42 bipolar electrograms (filtered and unfiltered) were recorded during pacing at 120beats/min from the lateral right atrium before and after creating a narrow gap by 2 discontinuous incisions from the TA to the IVC. All bipolar electrodes, with the cathode in the TA side and the anode in the IVC side, were placed perpendicular to the TA. Before creating the incisions, the wavefront (WF) from the pacing impulse traveled uniformly in the isthmus and almost in parallel to the TA, and the filtered electrogram at each site showed a single potential. After creating the incisions, the WF propagated through the gap and spread radially to the area distal to the incisions. In close proximity to the incision lines opposite to the pacing site, the WF advanced from the gap towards the TA and IVC perpendicularly to the TA. Filtered electrograms on the incision lines showed double or split potentials, whereas those on the gap showed a single or fractionated potential. In unfiltered electrograms recorded from the TA to the IVC in close proximity to the incision lines opposite the pacing site, reversal of electrogram polarity was noted at the gap. A single or fractionated potential between double potentials indicates a gap between lines of conduction block. Electrogram polarity reversal along the ablation line indicates the presence of 2 opposing WF arising from the gap.

Animals↗
PubMed1999

Norepinephrine measurement in the isolated, blood-perfused papillary muscle of the dog by using ex vivo microdialysis.

Subendocardial interstitial norepinephrine (NE) was measured in the isolated, blood-perfused papillary muscle (PM) preparation of the dog by using ex vivo microdialysis. A microdialysis fiber was inserted into the base of the PM and perfused with Ringer's solution at a rate of 1 microl/min. Dialyzed NE concentrations were measured by high-performance liquid chromatography with an electrical detector. The basal dialyzed NE concentration from the subendocardial interstitium was 1.74+/-0.24 nM (n = 12, mean +/- SE). When the anterior septal artery was occluded for 5 min, the dialyzed NE concentration from the subendocardial interstitium 0-5 min after occlusion increased to 2.90 +/-0.61 nM (n = 12, p<0.05 versus before occlusion). When desmethylimipramine, a neuronal uptake 1 inhibitor, was administered into the anterior septal artery at a rate of 100 nmol/ml for 30 min, dialyzed NE concentration substantially increased from 1.55+/-0.33 to 2.63+/-0.34 nM (n = 3, p<0.05). Likewise, the occlusion-induced increase in dialyzed NE was augmented to 3.75+/-0.90 nM by desmethylimipramine infusion into the anterior septal artery. These observations suggested that the ex vivo microdialysis of the isolated, blood-perfused PM preparation of the dog is a sensitive method for measuring the subendocardial interstitial NE and that coronary artery occlusion increases the subendocardial interstitial NE as early as within 5 min.

Animals↗
PubMed1992

Rapid growth and difficulty of early detection of scirrhous carcinoma of the stomach.

We report six cases of scirrhous carcinoma of the stomach in which we were able to observe the natural history of serial radiographs. All the patients developed scirrhous carcinoma of the stomach in an observation periods ranging from 2 to 15 months (mean: 5.8 months). No abnormalities or obvious findings indicative of a carcinoma were detectable, on the prior radiographs, even when they were reviewed. Endoscopy was also performed in two patients during the observation period, and no lesions were detected. At the time of diagnosis, two patients were inoperable because of metastases and died of the disease 2 and 5 months later. Three patients died of the disease 5, 8, and 26 months after gastrectomy, respectively. Only one patient is free of disease 16 months after gastrectomy. Our findings suggest that the difficulty of detection and the rapid growth of this tumor may explain why it is seldom detected at an early stage and has a very poor prognosis.

Adenocarcinoma, Scirrhous↗
PubMed1991

Preventive effect of cimetidine on chronic erosive gastritis induced by taurocholate in rats.

We studied the preventive effect of cimetidine at the microscopic level on chronic erosive gastritis induced experimentally by 6-months of administration of drinking water containing 5 mmol/l of the sodium salt of taurocholic acid (TCA) in rats. The chronic erosive gastritis was characterized by mucosal erosions, reduction of mucosal thickness and reduction in the number of parietal cells per unit area, infiltration of inflammatory cells which were mainly lymphocytes and plasmocytes, and proliferation of collagenous fibers in the gastric mucosa. A standard meal including cimetidine 0.4 and 0.8%, which was administered ad libitum with TCA, reduced the total length of erosions, normalized the mucosal thickness and the number of parietal cells, and reduced inflammatory cell infiltration in the gastric mucosa. However, cimetidine did not show any effect on the proliferation of collagenous fibers in the interstitial space of the mucosa. The doses administered were 400 mg/kg/day and 800 mg/kg/day for 6 months. Cimetidine, thus, had a preventive effect on experimental chronic erosive gastritis in rats.

Animals↗
PubMed1986

[Therapeutic effect of ceftizoxime on infections in aged patients].

Ceftizoxime (CZX) were administered and tested for the efficacy and safety in 80 elderly patients who were older than 65 years of age with infections. The sensitivity of bacteria found in these infections to CZX was examined before the administration of the drug. Serum concentrations and the rate of urinary output of the drug were examined in 3 cases. The clinical effect of CZX was as follows: 29 cases (36.3%) of excellent effectiveness and 31 cases (38.8%) showed moderate effectiveness. The patients were divided into 2 groups depending on the presence or the absence of other diseases in their backgrounds. Effectiveness of CZX for patients with and without other diseases were 74.0% and 85.7%, respectively. The effectiveness of CZX in patients with other diseases in their background was lower than the group without other diseases. Other antibiotics were used in 16 cases before the use of CZX. The effectiveness of CZX for these patients was 62.5%. Infecting bacteria were detected in a total of 46 cases (19 cases of respiratory infections and 27 cases of urinary tract infections). Among the respiratory cases, 8 were due to Gram-positive bacteria and 11 were due to Gram-negative bacteria. No Gram-positive organisms were detected from urinary tract infections, which were all due to Gram-negative bacteria. Sensitivities of isolates of these infecting bacteria to CZX were very sensitive 3 isolates, sensitive (++) 8 and slightly sensitive (+) 1 isolate. It was found that CZX was effective against 39 of 46 cases from which causative organisms were identified. The effectiveness ratio was 84.8%. Serum concentration of CZX was determined after a drip injection of 1 g CZX for 1 hour. The half-lives of CZX in plasma in healthy subjects and aged patients were 1.33 hours and 2.15 hours, respectively. The rate of urinary output of CZX during 6 hours after the injection was 76.4% in healthy subjects. Delayed urinary output which was 58.2% during 7 hours after injection was observed in aged patients. Fever in 1 patient and eosinophilia in 3 cases were observed after administration of CZX.

Age Factors↗
PubMed1985

Chlorpromazine-induced cardiomyopathy in rats.

We studied the chronic effects of chlorpromazine (CPZ) on the myocardium of rats using light and electron microscopy. Wistar strain rats were divided into two groups and given either normal saline or CPZ intraperitoneally at a dose of 5 mg/kg body weight/day for 30 consecutive days. Myocardial degeneration, atrophic muscle fiber, and myocardial fibrosis were observed by light microscopy in all CPZ-treated rats. Ultrastructural alterations of the myocardium were also found in all CPZ-treated rats. They consisted of contracted myofibers, mitochondriosis, degenerated mitochondria, dilated sarcoplasmic reticulum, and increased collagen fibers. However, no abnormal histologic or ultrastructural changes were observed in the normal saline-treated rats. We therefore conclude that a chronic administration of a sedative dose of CPZ causes myocardial damage in rats.

Animals↗