Biomedical subjects

K Hisano

Publications and source records attributed to K Hisano.

At least 19 recordsLinked to original sources

PubMed2003

Changes in cerebral oxygenation in children undergoing surgical repair of ventricular septal defects.

There have been few published studies on changes in cerebral oxygenation during paediatric cardiac surgery as measured by conventional near-infrared spectroscopy. We studied changes in cerebral oxygenation in 16 children undergoing surgical repair of ventricular septal defects. Fifteen of the patients showed similar patterns of changes: brain tissue concentrations of oxyhaemoglobin decreased significantly during cardiopulmonary bypass, whereas there was no significant change in brain tissue concentrations of deoxyhaemoglobin. In the remaining patient, who suffered decreased blood flow to the lower body during surgery, the pattern of changes was different to that of the other subjects. This patient suffered postoperative respiratory and renal failure. This study suggests that conventional near-infrared spectroscopy may be useful for clinical monitoring during ventricular septal defect repair.

Analysis of Variance↗

PubMed2002

Effects of mild and moderate hypothermia on apoptosis in neuronal PC12 cells.

BACKGROUND: There is still a possibility that mild hypothermic therapy may be useful as a neuroprotective tool during the intraoperative period, although the mechanism of cerebral protection by mild hypothermia is not well understood. We hypothesized that mild hypothermia may be protective against cerebral ischaemia by inhibiting post-ischaemia apoptosis. In this study, we used serum-deprived PC12 cells as the neuronal apoptotic model and examined the direct effects of mild and moderate hypothermia. METHODS: Apoptosis was induced by depriving the cell culture medium of serum, which is one of the most representative methods to induce apoptosis, but not necrosis, in PC12 cells. Effects of mild (35 and 33 degrees C) and moderate (31 and 29 degrees C) hypothermia on apoptosis were evaluated. Cytotoxicity (lactate dehydrogenase leakage) and the percentage of apoptotic cells (calculated by flow cytometry with propidium iodide) were evaluated 4 days after induction of apoptosis. As a control, cells without induction of apoptosis were incubated under the same conditions as the apoptosis group. RESULTS: Without induction at 37 degrees C, cytotoxicity and the percentage of apoptotic cells were over 60 and 90%, respectively. At each temperature examined below 35 degrees C, significant decreases in cytotoxicity and the percentage of apoptotic cells were observed. Mean cytotoxicity at 31 and 29 degrees C was 50.2 (SD 4.2)% and 47.9 (4.4)%, respectively. The percentage of apoptotic cells at 31 and 29 degrees C was 42.5 (7.4)% and 36.5 (7.3)%, respectively. In the control group, cytotoxicity and the percentage of apoptotic cells were significantly higher at 29 degrees C than at 37 degrees C. CONCLUSIONS: Mild and moderate hypothermia (29-35 degrees C) inhibited apoptosis, although hypothermia below 30 degrees C may induce apoptosis in intact cells.

Animals↗

PubMed2000

Management of cholelithiasis in combination with cardiovascular surgery.

A retrospective review of the perioperative management of patients with cardiovascular surgical disorders and cholelithiasis was conducted, and the surgical strategies employed are discussed. Between 1988 and 1998, 18 patients having cardiovascular surgical disorders underwent cholecystectomy. These patients were divided into three groups: group I, given a one-stage operation (n = 9); group II, given a two-stage operation (n = 3); and group III, given cholecystectomy during follow-up after cardiovascular surgery (n = 6). In group I, a median laparotomy was adopted for patients with an abdominal aortic aneurysm (AAA) to allow both disorders to be treated through the same incision, whereas a right subcostal approach was employed to separate the incisions for patients who underwent cardiac operations. In group II, one patient underwent cholecystectomy before cardiac surgery, and two patients underwent cholecystectomy for postoperative cholecystitis after cardiovascular operations. One patient from group II and all from group III were on preoperative anticoagulant therapy, two of whom underwent laparoscopic cholecystectomy. No fatal complications such as prosthetic infection, intraperitoneal hemorrhage, or cerebral attack were encountered. In conclusion, we consider that performing cholecystectomy during AAA repair may be safe and prevents the risk of postoperative cholecystitis; it is preferable to treat cholelithiasis coexisting with cardiac disorders concomitantly with or before cardiac operations; and laparoscopic cholecystectomy can be safely performed under anticoagulant therapy.

Adult↗

PubMed2000

Posterior sagittal anorectoplasty for failed imperforate anus surgery: lessons learned from secondary repairs.

PURPOSE: The aim of this study was to evaluate secondary operations using a posterior sagittal approach in patients with fecal incontinence and impaction after primary repair of anorectal malformations. METHODS: Twenty patients (14 boys, 6 girls) who had previous failed surgery for imperforate anus underwent secondary operations. The indications for surgery included fecal incontinence (n = 16) and fecal impaction (n = 4). Patients ranged in age from 2 to 30 years (mean, 11 years), with 4 over the age of 20 years. The primary procedures included abdominosacroperineal (n = 7), sacroperineal (n = 10), and perineal (n = 3) pull-throughs. At surgery, none of the patients underwent a diverting colostomy. The rectum was mobilized from the surrounding structures through a posterior sagittal approach. The surgical findings included anteriorly displaced anus (n = 17), laterally displaced anus (n = 3), mesenteric fat surrounding the rectum (n = 4), mega-rectosigmoid (n = 2), and others (n = 3). The rectum underwent reconstruction, which involved relocation of the rectum and anus to surround them with the muscle complex. RESULTS: Patients underwent follow-up for periods ranging from 8 months to 6 years after surgery (mean, 3 years). To evaluate the functional results, fecal continence scores (Templeton and Ditesheim) were calculated for incontinent patients. Of the 16 incontinent patients, 12 achieved continence and 4 some improvement. Of the 4 patients with fecal impaction, 2 achieved daily voluntary bowel movement, whereas the other 2 have mild constipation and need occasional enemas. CONCLUSIONS: Our study suggests that (1) a secondary operation through a posterior sagittal approach can restore fecal continence and is efficacious even in adolescents and adults and (2) a posterior sagittal procedure can be safely performed without a diverting colostomy.

Adolescent↗

PubMed1999

Combined resection of the thoracic esophagus and thoracic descending aorta.

We conducted combined resection of the thoracic esophagus and thoracic descending aorta in 2 patients, one with advanced esophageal cancer with aortic invasion and the other aortoesophageal fistula caused by a false aortic aneurysm. Combined resection of esophageal tumor and adjacent involved organs was conducted in 14 patients with A3:T4 esophageal cancer but none survived 3 years and resecting tumor-invaded organs did not improve patient survival. One major problem of combined resection of the esophagus and aorta is contamination of the posterior mediastinum. In 1 patient, 2-stage surgery for the esophagus and in situ aortic replacement was conducted to reduce operative risk and avoiding infection of the prosthetic vascular graft. With thoracic descending aortic aneurysm adjacent to the esophagus on the increase, cardiovascular surgeons should prepared to undertake combined resection of both the aorta and esophagus.

Aged↗

PubMed1998

Antibodies against Helicobacter pylori were detected in the cerebrospinal fluid obtained from patients with Guillain-Barré syndrome.

We examined the antibodies against Helicobacter pylori proteins in the cerebrospinal fluid (CSF) of 7 patients with Guillain-Barré syndrome (GBS). Crude H. pylori antigens, fractionated heat shock protein (HSP), and urease B (UB) from H. pylori antigens were separated by SDS-PAGE. With Western blot analysis, four of seven CSF samples had several IgG antibodies against H. pylori proteins, including HSP and UB. No cross reactivity against Campylobacter jejuni was observed. These antibodies may be involved in the immune responses of patients with GBS.

Adult↗

PubMed1998

Ligation of medically refracted patent ductus arteriosus (PDA) in an extremely low body weight premature infant.

Medically refracted patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) preterm (gestation 24 weeks 2 days) infant was successfully ligated under general anesthesia in the neonatal intensive care unit (NICU). Pharmacological agents are more effective to close PDA in preterm infants than in full-term infants, although within 48 h three doses of indomethacin were not sufficient to close PDA in this case. At the age of 69 h the infant developed severe symptoms including bradycardia, systemic hypotension, pulmonary hypertension, diastolic steal (reverse distal aorta flow velocity), and anuria. A PDA ligation was thus performed surgically at 72 h of age. General anesthesia and surgical stress were tolerated by this 531 g infant. Postoperatively all symptoms improved dramatically and the general conditions were stable. On the 38th day the endotracheal tube was extubated and on the 50th day nasogastric milk feeding was started. The oxygen supply was weaned on the 78th day. Growth and development until 6 months were within the normal range of very low birth weight infants. A surgical ligation as early as possible in medically refracted PDA in an ELBW infant is thus considered to be a safe and effective treatment. It prevents the development of further complications of cardiopulmonary vascular problems. Color Doppler echocardiography can reliably measure the PDA size, flow velocity, and hemodynamic changes of persistent PDA, even in tiny infants.

Ductus Arteriosus, Patent↗

PubMed1998

Laparoscopic orchiopexy of intraabdominal undescended testis associated with congenital diaphragmatic hernia.

Laparoscopy is an advantageous method for the repair of intraabdominal undescended testis since both an abdominal exploration and vascular elongation can be effectively performed by laparoscopic assistance. A 3-year-old boy and a 1-year-old boy complaining of unilateral nonpalpable left testes were observed following previous congenital diaphragmatic hernia repairs on the day of birth. In these operations, a laparoscopic working sheath was inserted through a small supraumbilical incision. On each boy, a laparoscopically intraabdominal testis was found close to the left internal inguinal ring. In addition, a 10-mm trocar port was placed in the right lower abdominal quadrant and a 5-mm port was placed in the left lower quadrant. For the purpose of orchiopexy, the left testicular vessels were isolated over their full length. The left side of the testis was pulled through the inguinal ring to an inguinal canal divided by the abdominal wall, and then was retracted into the scrotum. The internal ring was thereafter closed externally by the fascia transversalis. Both patients are doing well, with no testicular atrophy or inguinal hernia for 1 and 2 years, respectively, after the above operations.

Child, Preschool↗

PubMed1998

Arterio-venous extracorporeal membrane oxygenation of fetal goat incubated in artificial amniotic fluid (artificial placenta): influence on lung growth and maturation.

PURPOSE: The authors attempted to achieve extrauterine support of goat fetuses using arteriovenous extracorporeal membrane oxygenation (A-V ECMO) via umbilical vessels, incubated in a warm bath. They hypothesized that this extrauterine support system affected both the lung growth and maturation of goat fetuses. METHODS: Four goat fetuses at about 125 days' gestation (term, 150 days) were placed in this fetal ECMO system. Their four twin fetuses with similar body weights were harvested and examined for baseline data before ECMO (pre-ECMO data). The mean duration of A-V ECMO was 138.8+/-66.9 hours (range, 87 to 237 hours). Tracheal ligation was performed on all four fetuses to prevent the efflux of fetal tracheal fluid and to collect a sample of tracheal fluid daily. The surfactant and electrolytes of the tracheal fluid were analyzed in pre-ECMO (twin fetuses) and during ECMO. The surfactant of lung tissue, and lung weight were analyzed in pre-ECMO (twin fetuses) and after ECMO. Plasma cortisol and T3 levels were also assayed as hormonal factors that affected lung maturation in pre-ECMO and during ECMO. RESULTS: The phospholipid, phosphatidylcholine, and lecithin-sphingomyelin ratio of the tracheal fluid on day 5 during ECMO (15.0+/-7.1 mg/dL, 53.4+/-26.5%, and 6.2+/-7.1) were elevated above pre-ECMO (10.0+/-4.6 mg/dL, 43.0+/-0.6%, and 4.0+/-2.9), but there were no significant differences. The phosphatidylcholine and disaturated phosphatidylcholine of the lung tissue after ECMO were 72.3+/-15.4 mg/g and 19.2+/-8.2 mg/g, which were significantly higher than pre-ECMO (53.7+/-13.9 mg/g and 11.6+/-4.1 mg/g). The Cl- and K+ of the tracheal fluid were 123.5+/-6.2 mEq/L and 3.7+/-0.7 mEq/L on day 1 during ECMO, which were significantly lower than pre-ECMO (141.8+/-2.9 mEq/L and 6.8+/-1.1 mEq/L), but they then recovered to pre-ECMO levels. The wet and dry lung weights after ECMO were 87.8+/-18.0 g and 6.3+/-1.9 g, which were significantly higher than pre-ECMO (49.3+/-5.9 g and 4.2+/-1.3 g). Plasma cortisol levels and T3 levels during ECMO were significantly higher than pre-ECMO. Electron microscopy demonstrated a higher increase of mature type 11 cells in the lungs after ECMO than pre-ECMO. CONCLUSION: This fetal A-V ECMO system in the bath showed a production of surfactant, the maintenance of ion transport by the pulmonary epithelium, an increase in lung weight, and an increase in mature type II cells, resulting in lung growth and maturation.

Amniotic Fluid↗

PubMed1998

A new artificial placenta with a centrifugal pump: long-term total extrauterine support of goat fetuses.

PURPOSE: We tried long-term total extrauterine support of goat fetuses at high pump flow, which was pulsatile and synchronized with the cardiac cycle and at low oxygen tension in the umbilical artery and vein by use of the new artificial placenta. METHOD: This system consisted of an arteriovenous extracorporeal membrane oxygenation using umbilical artery and vein and a thermoregulated water bath. Five goat fetuses (125 +/- 0.7 days of gestation, 2.0 +/- 0.9 kg) were incubated in lactated Ringer's solution. Mean pump flow rate ranged from 113 +/- 16 to 193 +/- 13 ml/min/kg, and umbilical arterial oxygen tension was maintained at 20 +/- 3 to 23 +/- 5 mm Hg for five fetuses. RESULT: Blood gas analysis echocardiogram showed that fetal circulation and sufficient oxygen consumption could be maintained, and fetal extrauterine support conditions were made as similar as possible to physiologic circulatory conditions. We achieved long-term extrauterine support of goat fetuses up to 237 hours (mean 137 +/- 58 hours). CONCLUSION: We believe that this system can be used for experimental models of the fetus and will come into clinical application for fetal extrauterine support systems and backup systems for fetal operations.

Animals↗

PubMed1997

[Development of extracorporeal membrane oxygenation for neonates with severe respiratory failure].

Extracorporeal membrane oxygenation (ECMO) is one of the most highly developed artificial organ treatment of the last decade. Especially for severe neonatal respiratory failure, ECMO has become standard treatment in Japan following the same pattern as in the USA. In the USA, more than 12,000 infants have been registered for ECMO treatment by the Extracorporeal Life Support Organization (ELSO), and their total survival rate is above 80%. Recently, to avoid ligating the carotid artery, most neonates who required ECMO have been supported by a veno-venous (V-V) bypass using a double-lumen catheter via the right internal jugular vein into the right atrium. To prevent bleeding complications, the introduction of Nafamostat Mesilate and the development of a heparin-coated system would be advantageous. Progresses in these instruments and perfusing techniques might enlarge the indications of ECMO. We performed an experiment on fetus ECMO as artificial placenta. The fetuses were incubated for 10-237 hours by A-V ECMO using a centrifugal pump successfully and maturation of the lung was revealed. In the future the fetus ECMO could be introduced clinically as a back-up system for fetal surgeries and incubation for extra-premature infants.

Cystic Adenomatoid Malformation of Lung, Congenita↗

PubMed1996

Quantitative detection of secretory immunoglobulin A to Helicobacter pylori in gastric juice: antibody capture enzyme-linked immunosorbent assay.

Helicobacter pylori is a major etiologic agent in gastroduodenal disorders. In this study, immunoglobulin A (IgA) antibodies to H. pylori were estimated in serum and gastric juice specimens from patients with gastritis and peptic ulcers using antibody capture enzyme-linked immunosorbent assays (ACELISAs). The antibody titers of the ACELISAs are independent of the antibody concentration and reflect the ratio of H. pylori-specific IgA to total IgA. The ratio is stable, although the antibody concentration fluctuates in gastric juice. Using the ACELISAs it was possible to evaluate quantitatively not only serum IgA (SR-IgA) antibodies but also secretory IgA (SC-IgA) antibodies in gastric juice. There were significant differences between the patients and control group in the SR-IgA and SC-IgA ACELISAs. Furthermore, the ACELISAs made it possible to compare between SR-IgA antibodies in serum and SC-IgA antibodies in gastric juice. In all patients, the ratios of H. pylori-specific IgA were higher in gastric juice than in serum. These results suggest that H. pylori SC-IgA antibodies are mainly produced by the local immune response in the gastric mucosa. Our studies indicate that ACELISA is well suited for the analysis of local immune response in mucosa.

Adult↗

PubMed1996

[Operative corrections of funnel chest depend on age group].

The methods of correcting funnel chest are various and many. It's necessary to select the proper method depending on the age group. For children, sternal elevation by Ravitch's procedure produces to better results without prosthesis. For adolescent patients, the elevated sternum can be maintained by Kirschner's wires. Furthermore, adult patients have severe chest wall deformities with calcificated costal cartilage. The methods sternal elevation methods cause an unsatisfactory by postoperative appearance for adult patients with funnel chest. Two adult patients, 20 and 48-year-old men, underwent the sternal turnover methods with complete sternal blood supplies. The procedures of the new method turn over the sternal body crossing bilateral internal thoracic vessels and abdominal rectal muscles. No chest wall deformities were seen and the patency of internal thoracic arteries and superior epigastric arteries was revealed by postoperative arteriography.

Adolescent↗

PubMed1996

[A case of intrathoracic goiter].

Intrathoracic goiter is an uncommon conditional lesion. A case of intrathoracic goiter in a 66-year-old woman is herein described. Her chief complaint was anterior chest opplession. A computed tomographic scan and magnetic resonance imaging (MRI) revealed intrathoracic goiter pressed the trachea to the right side. The tumor was safety and completely took by collar incision without thoracotomy. Histologically, the mass was diagnosed the adenomatous goiter. In this case, MRI was very useful to be determined the surgical approach.

Aged↗

PubMed1995

Lansoprazole versus lansoprazole plus amoxicillin treatment for eradication of Helicobacter pylori in patients with gastric ulcer.

Helicobacter pylori is a major cause of gastritis and an important factor in duodenal ulcer relapse. Eradication of H. pylori has usually been achieved by triple therapy, a combination of bismuth salts and two antibiotics. The disadvantage of these regimens is the large number of tablets and the high incidence of side effects. A new H+,K(+)-ATPase inhibitor, lansoprazole (LPZ), has a strong acid inhibitory effect and an anti-H. pylori effect in vitro. These dual effects have an advantage for the eradication of H. pylori by LPZ alone or by a combination of LPZ and antibiotics. In this study, we investigated an anti-H. pylori effect of LPZ alone and LPZ plus low-dose amoxicillin and the relation between the status of H. pylori colonization and the endoscopic healing stage. LPZ monotherapy suppressed H. pylori but did not eradicate it. LPZ plus low-dose amoxicillin dual therapy eradicated H. pylori in 45.5% of patients with gastric ulcer disease. However, this rate is not satisfactory for eradication therapy. The optimal dosage and duration of treatment need to be specified. A high rate of healing to the endoscopic S2 stage was achieved by eradication of H. pylori and the recurrence of gastric ulcer was suppressed in patients in whom H. pylori was eradicated. The eradication of H. pylori may change the natural course of gastric ulcer disease as it does in duodenal ulcer disease.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed1995

Detection and identification of cagA of Helicobacter pylori by polymerase chain reaction.

AIM: To investigate cagA, which is linked to vacuolating cytotoxin activity of Helicobacter pylori, using molecular techniques. MATERIALS AND METHODS: A polymerase chain reaction method was used to detect cagA from clinical isolates of H. pylori. H. pylori strain diversity was examined by DNA restriction fragment length polymorphism (RFLP) patterns with cagA as a probe. RESULTS: The detection rate of the cagA products was significantly higher in strains from gastric ulcer patients than in those of chronic gastritis patients (78.9 versus 56.0%; P < 0.05), and RFLP patterns were different between gastric ulcer and gastric cancer strains. CONCLUSIONS: A polymerase chain reaction method established for the detection of cagA proved to be rapid and useful. Analysis of cagA may therefore be a useful genetic technique for the study of strain diversity.

Antigens, Bacterial↗

PubMed1994

Adrenogenital syndrome caused by an androgen-producing adrenocortical tumor.

We describe here a typical case of virilizing adrenocortical tumor. A 23-year-old Japanese woman had her male-like musculature, hirsutism, the absence of breast development and marked clitoromegaly. Adrenal androgens were remarkably elevated, with plasma dehydroepiandrosterone sulfate 2,752 micrograms/dl, plasma testosterone 250 ng/dl and urinary 17-ketosteroids 203.4 mg/day. A well-encapsulated tumor approximately 7 cm in diameter was detected in the left adrenal gland by computed tomography, magnetic resonance imaging and arteriography. The tumor was surgically resected and histologically diagnosed as a benign adrenocortical adenoma. The elevated adrenal androgens returned to normal postoperatively with amelioration of her masculinized clinical features.

Adenoma↗

PubMed1994

The effect of the immune response to Helicobacter pylori in the development of intestinal metaplasia.

AIM: To determine whether cytotoxic Helicobacter pylori antibodies occur in gastric mucosa, and whether these antibodies contribute to the development of intestinal metaplasia. MATERIALS AND METHODS: The number of mononuclear inflammatory cells, which specifically produce immunoglobulin (Ig)G and IgA antibodies, was investigated by using an enzyme-linked immunospot assay and the fraction of mononuclear inflammatory cells determined in gastric biopsy specimens from 34 subjects with H. pylori infection. Assays for the cytotoxicity of H. pylori antibodies were performed on cultured Japanese green monkey kidney (Vero) cells and by in vitro tests. RESULTS: The number of IgG and IgA antibody-producing cells was positively correlated with the degree of inflammation of the gastric mucosa. However, the number of IgG antibody-producing cells was lower in subjects with intestinal metaplasia than in those without. This was not the case for IgA. Significant cytotoxic damage was observed in Vero cells in vitro when incubated in a solution containing the H. pylori IgG antibody, antigen and polymorphonuclear leukocytes. No cytotoxicity was seen with the IgA antibody or with the antigen or polymorphonuclear leukocytes alone. CONCLUSIONS: H. pylori infection is associated with the appearance of immunocompetent mononuclear cells in gastric mucosa. These cells produce H. pylori antibodies of the IgG class which are capable of causing cytotoxic damage in the epithelial cells, obviously through activation of polymorphonuclear leukocytes by antibody-antigen complexes. The occurrence of these cells is inversely related to intestinal metaplasia, suggesting that they may be involved in the processes of epithelial damage leading to the appearance of intestinal metaplasia.

Adult↗