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Biomedical subjects

K Minami

Publications and source records attributed to K Minami.

At least 37 records · Page 2Linked to original sources
PubMed2003

Recovery of organ dysfunction during bridging to heart transplantation in children and adolescents.

The beneficial effects of ventricular assist devices on organ dysfunction during bridging to heart transplantation have been widely reported in the adult population. In contrast, the use of ventricular assist devices used as bridge-to-transplant in children is limited. To evaluate organ recovery during ventricular support in pediatric transplant candidate, respiratory, renal and hepatic function were reviewed retrospectively. The Thoratec device (stroke volume 65 ml) and the HIA-Medos-system (stroke volume 25/10 ml) were used as bridge-to transplant in 11 children and adolescents who were in low-output-syndrome despite maximal pharmacological support. Prior to implantation five patients were mechanically ventilated, six patients underwent cardiopulmonary resuscitation, eight patients had anuria (one treated by hemofiltration), three patients had liver dysfunction and four patients had signs of severe infection. At the time of implantation one patient was supported by the intraaortic balloon pump and one by the femorofemoral bypass for rapid hemodynamic stabilization. Eight patients were treated using the Thoratec device (one of these by Nova cor on the left side), three by the HIA-Medos system. The support time ranged between seven and 140 days. Seven patients could be extubated within three days. Renal function recovered in all pts. Liver enzymes decreased in all pts without reaching normal values. Bilirubin values also decreased in survivors but increased to 9.3 mg/dL in non-survivors. At least seven patients underwent successful heart transplantation, three patients died because of multiorgan failure after extended transfusion and one patient because of technical failure. In our experience the hemodynamic situation was sufficient in all bridging to transplant candidates. In all patients who underwent successful transplantation, transplantability was associated with rapid organ recovery within seven days after initiating mechanical assistance. Extended blood tranfusions, combined failure of three organs and increasing bilirubin values during support seem to be predictors of poor outcome.

Adolescent↗
PubMed2003

[Lateral tunnel versus extracardiac cavopulmonary connections].

To examine the mid term outcome of the lateral tunnel Fontan and the result is to be compared to extracardiac Fontan operation. Between March 1991 and May 2002, 72 lateral tunnel (LT) and 28 extracardiac conduit (EC) total cavopulmonary connection (TCPC) were performed. Right atrium was incised parallel to the sulcus terminalis and LT was created by using autologous right atrial wall. Lateral tunnel size was determined 1-2 mm larger than normal half pulmonary artery (PA) size according to the body weight. There were 1 early and 1 late death, both initial LT group. Supraventricular tachycardia was found in 1 patient with EC group and 4 in LT group (all heterotaxy syndrome). There were no differences in mortality and mobidity between LT and EC TCPC. Lateral tunnel TCPC is useful especially to small infants and children.

Adolescent↗
PubMed2003

[A device to prevent an air-leakage after a thoracoscopic surgery for spontaneous pneumothorax].

PURPOSE: In a thoracoscopic surgery for the patient with spontaneous pneumothorax, an air-leakage from the staple-line is one of the most troublesome complications. Recently we have been using a polyglycolic acid (PGA) sleeve for staple-line reinforcement. The purpose of this study was to investigate an efficacy of staple-line reinforcement in the patients who underwent thoracoscopic lung resection using an automatic stapler. OBJECTS: Last 4 years, 55 patients with primary spontaneous pneumothorax underwent thoracoscopic surgery using an automatic stapler. PGA sleeve was used in 19 patients as PGA group, fibrin glue was applied to the staple-line in 6 patients as fibrin group and no staple-line reinforcement was applied in 30 patients as no-reinforce group. We investigated the efficacy of staple-line reinforcement according to the results after surgery in these 3 groups. RESULTS: Average drainage time in PGA group, fibrin group and no-reinforce group were 2.1, 2.2 and 2.8 days, respectively. In PGA group, the drainage time after surgery tended to be short term. The relapse of pneumothorax after surgery developed in 2 patients in PGA group (10.5%) and 8 patients in non-reinforce group (26.7%). In PGA group, the relapse after surgery tended to be low rate. CONCLUSIONS: Bioabsorbable PGA sleeve could be an useful device for a staple-line reinforcement in the patients who underwent lung resection using automatic stapler.

Adolescent↗
PubMed2002

Importance of sympathetic activation for the expression of Na+-Ca2+ exchanger in end-stage failing human myocardium.

AIMS: In end-stage heart failure, an alteration in the expression of the Na+-Ca2+ exchanger has been reported. Regulation of its expression is largely unknown. We sought to find out whether Na+-Ca2+ exchanger in human heart failure is regulated by sympathetic activation. In addition, since Na+-Ca2+-exchange is electrogenic, we conjectured whether increased expression of Na+-Ca2+ exchanger is associated with an increased incidence of cardiac arrhythmias. METHODS AND RESULTS: Twenty-three patients suffering from end-stage cardiac failure were examined in the hours preceding cardiac transplantation. Plasma levels of norepinephrine, epinephrine, atrial natriuretic peptide, renin activity, aldosterone, tumour necrosis factor (TNF)-alpha, and TNF-receptors were measured. All parameters were elevated relative to 21 healthy control subjects. As determined by immunoblots, protein levels of the Na+-Ca2+ exchanger were increased by 56% and protein levels of sarcoplasmic reticulum (SR) Ca2+-ATPase were decreased by 20% in left ventricles of the explanted failing hearts. A significant correlation between protein and neurohumoral levels was exclusively found for the Na+-Ca2+ exchanger with norepinephrine (r=0.64; P=0.01). Recent Holter ECGs revealed that patients with sustained or non-sustained ventricular tachycardia (more than three consecutive beats) had significantly higher Na+-Ca2+ exchanger protein and plasma norepinephrine levels than patients with a maximum of two consecutive beats (Na+-Ca2+ exchanger: 109+/-10 vs 83+/-7, n=11 each, P<0.05; norepinephrine: 1359+/-159 vs 656+/-88 pg. ml(-1), n=9 each, P<0.001). CONCLUSIONS: Sympathetic activation may enhance the expression of Na+-Ca2+ exchanger in end-stage heart failure. The data support the hypothesis that increased Na+-Ca2+-exchange could favour malignant ventricular arrhythmias.

Biological Transport↗
PubMed2002

Coronary vein leads for cardiac pacing in patients with tricuspid valve replacement.

BACKGROUND: Because after tricuspid valve replacement (TVR) the transvenous implantation of endocardial leads is contraindicated, myocardial screw-in leads were used to ventricular pacing. Recently available coronary vein (CV) leads are stimulating the left ventricle epicardially and can be implanted transvenously, too. METHOD AND RESULTS: We implanted these leads in patients (pts) with TVR (n = 7) or after valve repair (n = 1) without complications. In 7 pts we used bended CV leads with a microporous tip and only in one pt a CV lead with a stimulation via metal ring. The stimulation thresholds (ST) were stable in all pts. CONCLUSIONS: The use of CV leads offers a minimal invasive approach for permanent cardiac stimulation after TVR. Low chronic ST are resulting in an energy saving pacemaker mode. CV leads can be used after previous heart surgery as well as for difficult anatomical situations.

Cardiac Pacing, Artificial↗
PubMed2002

[Reoperation for metachronous pulmonary or tracheal lesions after pneumonectomy].

Although aggressive reoperation for metachronous multiple primary lung cancer or intrathoracic recurrence without distant metastases have been recommended to the patients of primary lung cancer and metastatic lung tumor, surgical indication after a previous pneumonectomy is restricted because of residual pulmonary function. We report about 3 reoperated cases for metachronous pulmonary or tracheal lesions after left pneumonectomy. Case 1: A 61-year old male who underwent left pneumonectomy for primary lung cancer was reoperated for tracheal cancer 41 months after the pneumonectomy. Case 2: A 61-year old male who underwent left pneumonectomy for primary lung cancer was reoperated for metachronous multiple primary lung cancer 59 months after the pneumonectomy. Case 3: A 59-year old male who underwent left pneumonectomy for metastatic lung tumor from rectal cancer was re-operated for intrathoracic recurrence 28 months after the pneumonectomy. All cases are alive without recurrence.

Humans↗
PubMed2001

The analysis of heparin-protein interactions using evanescent wave biosensor with regioselectively desulfated heparins as the ligands.

Evanescent wave biosensor has been recently employed as a powerful tool for analyses of macromolecular interactions. In the present study, evanescent wave biosensor analysis was developed to analyze the heparin-protein interaction using as ligands a series of heparin derivatives regioselectively desulfated by chemical methods, particularly to evaluate the effect of each sulfate group of heparin. The method for immobilizing heparin on the cuvette of the evanescent wave biosensor equipment was optimized to obtain the high response required for accurate measurement. The best result was achieved when the amino group introduced at the reducing end of heparin was coupled with carboxymethyl dextran on the surface of the cuvette using glycolchitosan as a multivalent linker. The established system appeared to describe well the interactions of heparin with such proteins as acidic and basic fibroblast growth factors and tissue factor pathway inhibitor.

Biosensing Techniques↗
PubMed2001

Successful use of cardiac allograft from serotonin antagonist intoxication.

BACKGROUND: Compromised organ donors are generally not accepted for heart transplantation (HT) despite the increasing number of critically ill patients on the waiting lists. By extending the donor criteria to include certain cases of intoxication, the organ shortage may be reduced. METHODS: The case of a successful orthotopic HT with an allograft from a donor poisoned by antidepressant overdose is presented. RESULTS: Early graft function was satisfactory with anteroseptal dyskinesis and an ejection fraction of 75% on echocardiography. The cardiac allograft recipient suffered some postoperative complications including gastrointestinal problems. The following period was up to now uneventful. Discharge from the intensive care unit was after 4 days. In-hospital stay was prolonged at 26 days. CONCLUSIONS: Because of limited myocardial toxicity, donor hearts from certain victims of antidepressant intoxication may be safely used for HT. Existing cardiac organ donor criteria must be reevaluated to maximise the available organ pool.

Adult↗
PubMed2001

Role of Thr(11) in the binding of omega-conotoxin MVIIC to N-type Ca2+ channels.

As replacement of Thr(11) of omega-conotoxin MVIIC with Ala significantly reduced the affinity for both N- and P/Q-type calcium channels, we examined the effect of substitution at this position with other residues. Binding assays using rat cerebellar P2 membranes showed that the affinity is in the order of Leu>Val, aminobutyric acid, Thr>Asn&z.Gt;Ser, Ala, Asp, Phe, Tyr for N-type channels and Thr>Leu, Val, aminobutyric acid, Asn, Ser>Ala&z.Gt;Asp, Phe, Tyr for P/Q-type channels, suggesting that aliphatic amino acids with longer side chains are favorable for block of N-type channels. The effects of substitution were examined electrophysiologically in BHK cells expressing N-type Ca2+ channels. Inhibition of Ba2+ current by the analogs did not completely correlate with binding affinity, although binding to BHK cells was comparable to rat cerebellar membranes.

Alanine↗
PubMed2001

Gene expression analysis in colorectal cancer using practical DNA array filter.

PURPOSE: We examined the usability of a newly developed, compact-sized DNA array filter for studying the gene expression pattern of individual colorectal cancer. METHODS: Complementary DNA probes were prepared from mRNA extracted from colonic cancer specimens and adjacent normal mucosa and then were labeled with chemiluminescence. These labeled probes were allowed to bind to the gene fragments on the filter. A specialized scanning charge-coupled device camera measured the intensity of each chemiluminescent spot, which is an indicator of the degree to which a specific gene is expressed. Gene expression image was quantified into intensity of signals by using computer software. RESULTS: Characteristic gene expression patterns were obtained from the colonic cancer cell line, RPMI4788, and the leukemia cell line, HL60, by using this compact-sized DNA array filter in the preliminary experiment. Up-regulation of nm23, TIMP1, VEGF, and cyclin E and down-regulation of some tumor suppressor genes (p53, TOSO, and SIVA), beta-catenin, and metallothionein were observed in colonic cancer specimen when compared with those of normal mucosa. CONCLUSIONS: We have obtained unique gene expression patterns from colorectal cancer and normal tissue by using a newly developed compact-sized DNA array filter system. Collecting, storing, and analyzing of gene expression data from many samples of colorectal cancer will enable us to identify distinct subsets of patients based on molecular characteristics in the near future.

Cell Line↗
PubMed2001

Transdermal ketoprofen mitigates the severity of postoperative sore throat : [Le kétoprofène transdermique réduit le mal de gorge postopératoire].

PURPOSE: To evaluate prospectively the incidence and severity of postoperative sore throat in 63 orotracheally intubated patients undergoing general anesthesia for various surgical procedures and to determine whether postoperative sore throat could be attenuated by treatment with the transdermal nonsteroidal anti-inflammatory drug ketoprofen applied on the anterior skin of the neck during operation. METHOD: Patients were randomly assigned to have treatment with ketoprofen (ketoprofen group) or to have placebo tape treatment (control group). Postoperative analgesia was obtained by continuous epidural infusion of local anesthetics, and no narcotics were administered intraoperatively or postoperatively. All patients were interviewed postoperatively after 12-20 hr using a scoring scale questionnaire. Sore throat was scored as 0=no sore throat, 1=minimal, 2=mild, 3=moderate, 4=severe. RESULTS: In the control group, 16 of 32 patients had a sore throat. In the ketoprofen group, less patients (ten of 31 patients) had a sore throat (not significant). The severity of sore throat was alleviated significantly in the ketoprofen group (P <0.05). CONCLUSION: This study suggests the pain caused by tracheal intubation is relieved by intraoperative topical use of transdermal ketoprofen.

Administration, Cutaneous↗
PubMed2001

The potential clinical value of GML and the p53 gene as a predictor of chemosensitivity for colorectal cancer.

BACKGROUND: Adjuvant chemotherapy with 5-fluorouracil (5-FU) and mitomycin C (MMC) has commonly been used after resection of colorectal cancer. The aim of this study was to determine the predictive value of p53 mutation or the expression of GML, a target of p53, for sensitivity to 5-FU and MMC. METHODS: We analyzed p53 mutations and the expression of GML in six colorectal cancer cell lines (SW837, DLD-1, RPMI4788, WiDr, HT-29, and HCT116), and examined the correlation between genetic changes and in-vitro chemosensitivity to MMC and 5-FU by measuring the colony-forming ability in these cell lines. We also introduced GML cDNA into a cell line that lacked endogenous GML expression to investigate changes in sensitivity to MMC and 5-FU. RESULTS: The sensitivity to MMC was highest in HCT116, which had no p53 gene abnormalities and expressed endogenous GML, and lowest in RPMI4788 cells, which had neither p53 gene abnormalities nor expression of endogenous GML. For 5-FU treatment with 24-h exposure, HCT116 showed the highest sensitivity, and SW837, which had p53 mutations without expression of GML, showed the lowest sensitivity. The introduction of GML cDNA to RPMI4788 (RPMI4788-GML) showed that the sensitivity of RPMI4788-GML to MMC was enhanced almost to the level of HCT116 cells. However, when RPMI4788-GML were exposed to 5-FU for 24 h, the sensitivity of RPMI4788-GML was slightly increased compared with that of the parental cells, but was slightly lower than that of HCT116. CONCLUSION: GML expression and p53 mutation in colorectal cancer may be useful predictive genetic markers for sensitivity to MMC and 5-FU, respectively.

Antibiotics, Antineoplastic↗
PubMed2001

Differential indication for mechanical circulatory support following heart transplantation.

PURPOSE: We describe our experience with ventricular assist devices (VAD) in patients with cardiogenic shock refractory to pharmacological therapy and support using intraaortic balloon pump after cardiac transplantation. PATIENTS: Between July 1987 and August 1997, 848 patients underwent cardiac transplantation in our hospital. INTERVENTIONS: Fifteen patients (1.8%) needed mechanical circulatory support for refractory cardiac failure due to right heart failure (six patients), primary graft failure (three patients), and acute rejection (six patients). Three pump systems were used: Biomedicus Centrifugal Pump, Abiomed BVS 500, and Thoratec VAD. The choice of system depended on the indication and quality of each device. Seven patients (47%) could be weaned from the mechanical circulatory support (MCS) system and three patients (20%) are long-term survivors. RESULTS: All 15 patients developed at least one serious complication, such as multiorgan failure (MOF), liver failure, acute renal failure or sepsis. Twenty-five per cent had severe bleeding and 13% had neurological complication. Mortality was due mostly to MOF, MOF and sepsis or sepsis. The survivors had a CI greater than 2.2 l.min.m2, total bilirubin less than 1.0 U/1, and did not undergo resuscitation. CONCLUSIONS: Heart failure after cardiac transplantation severe enough to require MCS is currently associated with several major complications and high mortality (80%).

Adult↗
PubMed2001

Influence of cytoimmunological state on the development of tuberculosis in heart transplant recipients.

We examined the relationship between the development of tuberculosis and the cytoimmunological state of orthotopic heart transplant (HTx) recipients, which is affected by immunosuppressive therapy. Tuberculosis developed in 7 (1%) of 716 HTx recipients (four men and three women, aged 33-71 years) during a 7-year period, the standardized annualizing rate being about 1370/100000 per year, which is greater than the 17.5/100000 per year in the general population of Germany. Tuberculosis developed in the early posttransplant period in four patients when they were experiencing episodes of ongoing rejection, after 2.5, 3.5, 4.0, and 9.0 months, respectively, the standardized annualizing rate being 780/100000 per year. In three of those four patients, cytoimmunological monitoring was carried out until the development of tuberculosis. The repeated administration of pulsed corticosteroid therapy followed by oral steroids reduced T-cell and CD4+ T-cell counts, which could have increased the risk of tuberculosis developing if they were exposed. The cytoimmunological state of the remaining three patients in whom tuberculosis developed late after HTx, when episodes of ongoing rejection did not exist, was similar to the preoperative state, the standardized annualizing rate being 590/100000 per year. These findings indicate that the relatively high incidence of tuberculosis in post-HTx patients could be attributable to the immunosuppressive therapy given, including steroids.

Adult↗
PubMed2001

Pseudoaneurysm after heart transplantation with history of LVAD driveline infection.

An infective complication of the aorta is a potential cause of early and late mortality after heart transplantation. We report the case of a 21-year-old male cardiac transplant patient in whom a pseudoaneurysm of the recipient site of ascending aorta coincided with the site of the outflow prosthesis of a preexisting left ventricular assist device; this condition developed 9 months after transplantation.

Adult↗