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Biomedical subjects

K Shiroma

Publications and source records attributed to K Shiroma.

At least 19 recordsLinked to original sources
PubMed2000

Telomerase activity in giant condyloma acuminatum.

A 46-year-old male came to our hospital 1 month after noticing a 2-cm penile tumor. Since malignant findings such as atypical cells and mitosis were not observed in the frozen sections obtained at operation, the pathological diagnosis of this tumor was giant condyloma acuminatum. This tumor was analyzed by a telomeric repeat amplification protocol method, and telomerase activity was revealed. For comparison, a case of squamous cell carcinoma and a case of condyloma acuminatum were examined. Telomerase activity was observed in our case and in the case of squamous cell carcinoma. To our knowledge, this is the first case of telomerase activity in giant condyloma acuminatum ever reported. In addition to the histological examination, measurement of telomerase activity may provide valuable objective diagnostic information on evaluating the degree of malignancy of giant condyloma acuminatum and in obtaining a differential diagnosis between the benign and malignant.

Biomarkers, Tumor↗
PubMed2000

[Ventricular septal defect with pulmonary hypertension and concomitant left atrial myxoma in elder patient: a successful surgical case report].

A 70-year-old man was admitted with syncope attack on exertion. Ventricular septal defect with pulmonary hypertension and left atrial myxoma were confirmed by ultrasonography and cardiac catheterization. Preoperative Pp/Ps was 0.95 and pulmonary vascular resistance was 16 units. Pulmonary vascular resistance decreased to 9.6 units by the administration of Isoproterenol and decreased to 8.5 units with PGE1. Patch closure of VSD and excision of left atrial myxoma were performed simultaneously. The patient recovered completely, although he suffered from pneumonia and jaundice due to liver congestion postoperatively. Cardiac catheterization before discharge revealed Pp/Ps 0.38 and PVR 10.1 units.

Aged↗
PubMed1999

Safety and efficacy of autologous platelet transfusion in cardiac surgery: comparison of cryopreservation, blood collection on the day before surgery, and blood collection during surgery.

In a group of 39 patients with ischemic heart and valvular disease (January 1997 to May 1998), three platelet collection methods were compared in terms of safety and effectiveness. The methods were: (i) collection of autologous platelets over several weeks and freezing them for storage until surgery (frozen group, 12 patients); (ii) collection of autologous platelets on the day before surgery and preserving them without freezing (fresh group, 8 patients); and (iii) collection of autologous platelets intraoperatively (intraoperative group, 9 patients). Ten patients served as controls (control group). Blood pressure was not significantly affected by platelet collection in the frozen and fresh groups, but both systolic (P < 0.01) and diastolic blood pressure (P < 0.05) decreased significantly after collecting platelets in the intraoperative group. Similarly, heart rate was unaffected by platelet collection in the frozen and fresh groups, while it increased significantly in the intraoperative group (P < 0.05). Blood loss after 24 h was significantly smaller in the fresh group than in the frozen group (P < 0.05). Total blood transfusion volume was significantly smaller in the frozen and fresh groups than in the intraoperative and control groups (P < 0.05). Bleeding time 2 h postoperatively, when administration of autologous platelets had been completed, was reduced compared with immediately postoperative values in all three groups receiving autologous platelets (P < 0.05). However, only the frozen and fresh groups showed a significantly shorter bleeding time than the control group (P < 0.05). In all three groups receiving autologous platelets, the platelet count was significantly increased after administration of autologous platelets, but only the fresh group had a platelet count that was significantly greater than the control group (P < 0.05). From these results we conclude that the frozen and fresh groups received safer treatment than the intraoperative group. Although hemostasis improved after all three regimes of autologous platelet transfusion, only the frozen and fresh groups had a reduced need for allogeneic blood transfusion compared with the control group. For this reason we conclude that the frozen and fresh groups were also superior to the intraoperative group in terms of effectiveness. However, the recovery of platelets after frozen storage was low, and to obtain a good effect with the freezing method it is necessary to collect and store large volumes of platelets. In terms of simplicity, safety, and efficacy, the fresh method seems to be the preferred technique.

Aged↗
PubMed1999

Effects of experimental chemoendocrine therapy with a combination of a pure antiestrogen and 5-fluorouracil on human breast cancer cells implanted in nude mice.

The antitumor effects of an experimental chemoendocrine therapy combining a new pure antiestrogen ICI 182780 and 5-fluorouracil (5-FU) were studied on MCF-7 human breast cancer cells implanted in nude mice. ICI 182780 had a dose-dependent antitumor activity, which was potentiated by the concomitant use of 5-FU. When compared with the control group, the estrogen receptor (ER) level in the ICI 182780 group was lower and that in the combination group was markedly lower. Cell cycle analysis by flow cytometry (FCM) resulted in a lower percentage of S-phase cells (%S) in the treated mice. No significant difference was observed in the 5-FU concentrations in tumor cells, while the 5-FU content in RNA was significantly higher in the combination group. The changes in free thymidylate synthetase (TS) concentration indicated TS synthesis after the administration of 5-FU to be more greatly suppressed in the combination group than in the 5-FU group. These results suggest that ICI 182780 and 5-FU exert their combination effect mainly on ER-positive cells, and that the suppression of TS synthesis in tumor cells and the potentiation of the 5-FU-induced metabolic dysfunction of RNA are thus involved in the mode of action of this combination therapy.

Animals↗
PubMed1999

[Prophylaxis of recurrence in superficial bladder carcinoma by intravesical chemotherapy--comparative study between instillation of combined double anticancer agents and single anticancer agent].

We performed a study to compare the usefulness of double or single anticancer agents in the prophylactic treatment after the transurethral resection (TUR) of superficial bladder cancer. We experienced 127 superficial bladder cancer cases. Of these cases, 42 were treated with intravesical adriamycin (ADR) and peplomycin (PEP), 56 with ADR, PEP, epirubicin (epi-ADR) or pirarubicin (THP) only, and the remaining 29 with TUR only. Nonrecurrence rates were significantly higher in the intravesical treated cases than in the cases with TUR only, and also significantly higher in the cases treated with ADR and PEP than the other treated cases. We concluded that intravesical chemotherapy with combined agents was more effective than with a single agent.

Administration, Intravesical↗
PubMed1999

[Treatment of stress incontinence by percutaneous bladder neck stabilization (Vesica)].

We experienced 9 cases of percutaneous bladder neck stabilization (Vesica) for patients with urinary incontinence who were diagnosed with stress incontinence from December 1995 to June 1998. None of the patients were able to control continence with any drugs. Chain cystography was performed on all of the patients before and after surgery. The posterior urethro-vesical angle before surgery was over 130 degrees in all of the patients, and it improved after the operation. Moreover, the mean volume of the pad test greatly decreased from 47 g to 1 g. All of the patients were treated with epidural anesthesia. The operation time was less than 60 minutes. The subjective and objective findings were satisfactory. We conclude that percutaneous bladder neck stabilization is a very useful surgical treatment for stress incontinence.

Aged↗
PubMed1998

[Aortic and mitral valve aneurysms complicated with infective endocarditis: a case report].

A rare case of aortic and mitral valve aneurysms complicated with infective endocarditis was accurately diagnosed by transesophageal echocardiography. A 57-year-old man with severe aortic regurgitation due to infective endocarditis was admitted to our hospital. Transthoracic echocardiography showed an aortic valve aneurysm on the right coronary cusp and perforations on the other cusps. Transesophageal echocardiography demonstrated a small aneurysm on the anterior leaflet of the mitral valve which was not clearly visualized by transthoracic echocardiography. Color Doppler echocardiography revealed severe aortic regurgitation and mild mitral regurgitation without perforation of the mitral valve aneurysm. Aortic valve replacement and mitral valvuloplasty of the anterior mitral leaflet were performed. The right coronary cusp of the aortic valve showed marked thinning with infiltration of inflammatory cells. The postoperative clinical course was uneventful.

Aortic Valve↗
PubMed1997

[Severe aortic regurgitation with marked thickening of the aortic annulus: a case report].

A 74-year-old woman with severe aortic regurgitation and marked thickening of the aortic annulus received aortic valve replacement. Transesophageal echocardiography demonstrated marked thickening of the aortic annulus. The maximum thickness of the aortic annulus was about 11 mm at the side of the right coronary cusp. Histological examination revealed non-specific inflammation of the aortic annulus and aortic valve chiefly composed of lymphocytes and plasma cells. Thickening of the aortic annulus associated with inflammatory aortitis was the cause of aortic regurgitation in this patient.

Aged↗
PubMed1997

A case of Turner's syndrome associated with partial anomalous pulmonary venous return complicated by dissecting aortic aneurysm and aortic regurgitation.

We report a successful surgical case with Turner's syndrome associated with partial anomalous pulmonary venous return (PAPVR) complicated by aortic dissection and aortic regurgitation without coarctation of the aorta. The patient, a 30-year-old woman, is of a short stature who was diagnosed with Turner's syndrome at the age of 12. She has suffered from dyspnea and edema of the legs since a year ago and was admitted to our hospital in June 1994 as echocardiography revealed rapid dilatation of ascending aorta and aortic regurgitation. A chest X-ray showed cardiothoracic ratio of 63% and transesophageal echocardiogram revealed that ascending aortic diameter was extended up to 60 mm at its maximum and that it was possible to distinguish true lumen from false lumen. The aortic arch was found to be normal. Also revealed by cardiac catheterization was drainage of the left upper pulmonary vein to the innominate vein. The L-R shunt ratio was 2.2. The surgery was performed by the Bentall method. The composite graft with a 21 mm St. Jude Medical prosthetic heart valve placed on the annulus of aortic valve. The ostiums of the coronary arteries were directly anastomosed to the composite graft with Carrel patch. After declamp of the aorta, the left pulmonary vein was directly anastomosed to the left atrial appendage without causing stenosis. The postoperative course was uneventful, and the cineangiogram after surgery demonstrated successful repair. Reports of cases of Turner's syndrome like this are sparse.

Abnormalities, Multiple↗
PubMed1997

[Surgical results of emergency coronary artery bypass grafting: effect of left main trunk lesion].

Emergency coronary artery bypass grafting has higher risk than elective surgery. Furthermore, if a lesion is located at left main coronary artery, the frequency of cardiogenic shock or high risk patient would be greater, and operative results would be worse. Between January, 1989 and December, 1995, 45 patients who underwent emergency CABG were included. Age ranged 44 to 80 years (mean 67 +/- 7.6 years; 31 men, 14 women). Of 45 cases, 12 cases were patients with LMT lesion. Results were analysed by univariate analysis and multivariate logistic analysis. Of 45 emergency cases, 5 were operative death and 3 were hospital death. Mortality rate was 17.8%, which was significantly higher than the mortality of elective CABG (2.8%) during the same period (p < 0.001). A factor that influenced the mortality was acute myocardial infarction (AMI), which was confirmed by both univariate and multivariate logistic analyses. Odds ratio (relative risk) was 12.4 for AMI. Only one patient died in 12 cases with LMT (8.3%). This case was due to complication after catheter intervention possibly caused by MOF. Thus, the relative risk of LMT was not so high (p = n.s). Other factors showed no significant correlation. Although the emergency case of LMT lesion was generally severe, we could have the same result as other emergency surgeries when patients were revascularized as soon as possible.

Adult↗
PubMed1996

[Emergency coronary artery bypass grafting (CABG) in a case of coronary occlusion secondary to long segmental dissection of left anterior descending artery after percutaneous transluminal coronary angioplasty (PTCA)].

A 60-year-old man with unstable angina underwent PTCA at left anterior descending artery (LAD) #6, which had stenosis of 90%. Subsequently, a long segmental dissection formed from #6 to #7 and the patients was scheduled for CABG. On the day before the expected date of CABG, he had an angina attack and a 12 lead electrocardiogram (ECG) showed ST segment and T wave elevation in V1-3. Coronary angiograms revealed 99% stenosis in LAD #6 and immediately rePTCA was performed at the site. RePTCA improved the stenosis to 50%, but ECG showed an inverted T wave in V3,4 and emergency CABG was performed, with the saphenous vein at LAD #8 and high lateral artery. Some authors have stated that CABG is not useful for long segmental coronary dissection, but we conclude that CABG should be definitely considered in such a case, because this procedure resolves pressure gradients at before-and-after entry and the bypass grafts will be never occluded whenever anastomosis (intima-adventitia-graft) is performed.

Angioplasty, Balloon, Coronary↗
PubMed1994

[Diagnosis of perioperative myocardial infarction by cardiac troponin T following coronary artery bypass grafting].

The determinations of cardiac troponin T provide the highest diagnostic efficiency for the detection of myocardial cell necrosis. To assess perioperative myocardial infarction, serum levels of cardiac troponin T were determined in 14 patients undergoing coronary artery bypass grafting (CABG). The patients were divided into two groups: group I (n = 9), those whose troponin T was less than 1.00 ng/ml on the first postoperative day; group II (n = 5), those whose troponin T was more than 1.00 ng/ml on the first postoperative day. Troponin T levels in group II patients were significantly higher than in group I from the second to the seventh postoperative day. Two patients in group II had specific changes on the electrocardiogram detecting perioperative myocardial infarction as a new Q wave and R wave reduction. These results suggest that troponin T is a valuable marker of perioperative myocardial infarction following CABG.

Adult↗
PubMed1994

[Coronary artery bypass surgery in a patient with Basedow's disease controlled in hypothyroid state].

Coronary artery bypass surgery was performed in 55-year-old male with angina pectoris and Basedow's disease. His thyroid function was controlled in hypothyroid state, in order to avoid thyroid crisis perioperatively. At the start of the extra-corporeal circulation (ECC), values of T4, free-T4, T3 and free-T3 decreased progressively below the lower limits and remained depressed during ECC. The values returned almost to the pre-ECC levels at 2 hours after ECC. However, thereafter a gradual fall was seen up to 3 days after ECC. On the other hand, postoperative concentration of reverse-T3 progressively increased. Perioperative course was uneventful. The patient remains free of angina pectoris with optimal anti-thyroid drug therapy.

Angina Pectoris↗
PubMed1993

[A case of right ventricular outflow reconstruction surgery using an autologous pericardial non-valved conduit to treat pulmonary atresia with uncommon systemic-pulmonary collateral artery].

A 11-year-old girl diagnosed as having pulmonary atresia with uncommon systemic-pulmonary artery underwent on March 6, 1991. The collateral artery was derived from the left subclavian artery and divided from the descending aorta. Right ventricular outflow reconstruction was performed using a non-valved conduit of the autologous pericardium, and anastomosis of the conduit and pulmonary artery was successfully performed prior to extracorporeal circulation, because of the conduit's flexibility. Thus, we could reduce extracorporeal circulation time. Postoperative course was excellent, and patient is free from the morbidity associated with prosthetic valve. It is considered that a non-valved conduit of the autologous pericardium may be effective, but will require a long term follow-up.

Blood Vessel Prosthesis↗
PubMed1993

[Pulmonary artery reconstruction for extreme tetralogy of Fallot and similar complex heart diseases before cardiopulmonary bypass].

It is sometimes difficult to repair the pulmonary artery in extreme tetralogy of Fallot and other similar complex heart diseases, such as pulmonary atresia with major aorto-pulmonary collateral arteries, because of their complexity. Therefore, cardiopulmonary bypass takes longer in these patients than in those with usual tetralogy of Fallot. We undertook reconstruction of the pulmonary artery in 4 cases of extreme tetralogy of Fallot and other similar complex heart diseases before cardiopulmonary bypass. We investigated the cardiopulmonary bypass time in these patients and compared it with that in patients with usual tetralogy of Fallot. There was no significant difference in cardiopulmonary bypass time between the two groups. In the 4 extreme cases, the postoperative course was uneventful. We conclude that this attempt reduced the cardiopulmonary bypass time and facilitated the surgical correction.

Adolescent↗
PubMed1992

[Mitral valve surgery using combined superior-transseptal approach to the left atrium].

Although various approaches to the mitral valve surgery have been tried in the past, it still may be difficult to obtain a good surgical field, particularly in cases of small left atrium or reoperation. We performed mitral valve surgery in 6 patients using the combined superior-transseptal approach to the left atrium proposed by Berreklouw. Exposure of the mitral valve was excellent and the operative procedure was simple in all cases. There were no differences in bleeding volume, length of operation or complication of arrhythmia between patients treated with this new approach and a group treated with conventional approach in our institute.

Adult↗
PubMed1991

[Case report of right ventricular myxoma].

A 14-year-old woman was admitted to our hospital due to heart murmur. Loud systolic murmur at the forth intercostal space was altered its intensity by patient's posture. The chest roentgenogram showed normal cardiovascular silhouette. The electrocardiogram revealed normal sinus rhythm without right bundle branch block. The echocardiography and cineangio-cardiography proved a tumor in the right ventricle. Right heart catheterization showed pressure gradient for 35 mmHg between the right ventricle and the pulmonary artery. At surgery, the tumor was excised with the full thickness of the anterior right ventricular wall. The tumor was cardiac myxoma with 15 g of weight. The patient's postoperative course was uneventful.

Adolescent↗