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Biomedical subjects

M Kitamura

Publications and source records attributed to M Kitamura.

At least 271 records · Page 15Linked to original sources
PubMed1996

Biventricular bypass with oxygenation for postcardiotomy ventricular failure.

Between January 1984 and March 1995, biventricular bypass (BVB) with oxygenation was used in 17 patients for postcardiotomy ventricular failure at the Heart Institute of Japan, Tokyo Women's Medical College. Of the 17 patients, 12 (70.6%) were weaned from the circulatory support, and 8 (47.1%) were discharged from the hospital. The time interval from the endo of cardiopulmonary bypass to the start of BVB was significantly shorter in weaned patients than in unweaned patients. The duration on support also has been shortened significantly in the last 6 years, compared with the earlier 6 years. Causes of death were severe heart failure or ventricular arrhythmia in 6 patients and multiple organ failure in 3 patients. These results suggest that early application and timely weaning from biventricular bypass with oxygenation might be the effective circulatory support of choice for treatment of postcardiotomy ventricular failure.

Adult↗
PubMed1996

[Emergency coronary artery bypass in an 84-year-old patient with severe left main disease and cardiogenic shock].

An 84-year-old male was admitted to pur hospital because of unstable angina. The patient presented in cardiogenic shock with a cardiac index of 1.3 l/min/m2 associated with hypotension (systolic blood pressure < 80 mmHg) and oliguria, and in ventricular fibrillation after an acute broad anterolateral infarction due to severe left main coronary disease. The patient received an intra-aortic balloon pumping (IABP) and underwent emergency CABG. After completion of CABG, left ventricular contractility was markedly diminished to maintain systemic circulation. Because the patient could not be weaned from cardio-pulmonary bypass (CPB) in spite of IABP and high-dose of catecholamines, we decided to continue CPB. It was continued for 163 minutes and the patient was successfully weaned from CPB. In spite of the high risk of operative mortality with CABG for left main shock syndrome in elderly patients, CABG could be performed safely. The patient ran an uneventful postoperative course and is now doing well.

Aged↗
PubMed1996

[Arterial infusion chemotherapy for advanced gastric cancer by sequential MTX/5-FU].

Intra-aortic infusion chemotherapy by low-dose sequential MTX/5-FU was performed in 46 advanced or recurrent gastric cancer patients. Partial response was found in 13 cases (28%). The major lesion of 13 responders was inoperable Borrmann Type 4 gastric cancer in 4 cases, peritoneal recurrence with an abdominal wall in 6 cases, recurrence in the abdominal mass in 2 cases and Douglas pouch in one. The mean duration of effectiveness in the responders was 6.7 months and the median survival time was 19 months after the treatment. The side effects were mainly related to the digestive organs, but the symptoms were mild. Leucopenia of grade 3 and 4 was found in 6 (13%) and thrombocytopenia of grade 2 in one patient. Arterial infusion chemotherapy by sequential MTX/5-FU proved to be effective in poorly differentiated and signet ring cell carcinoma, such as Borrmann type 4 gastric cancer.

Adenocarcinoma↗
PubMed1996

[Transition of renal function after repeated intraperitoneal CDDP administration].

The purpose of this study was to clarify the development of renal dysfunction in 20 patients intraperitoneally administered CDDP after gastrectomy and to determine whether this treatment is tolerable for outpatients. The initial dose of CDDP was 100 mg/body and the successive dose was 40-50 mg/body. Subjects received 96 intraperitoneal CDDP administrations in all, and their total doses ranged 90-400 mg (median: 249 mg). As a result, renal dysfunction up to grade 2 developed in 7 patients (35%) with high frequency, while the rate to all administrations was 12% (12/96). Although the creatinine clearance decreased with the increase of cumulative dose, serum creatinine or BUN did not relate to this change. Therefore, we concluded that this treatment for outpatients could not be recommended because there was nothing to indicate renal function easily or sensitively at the present time.

Adult↗
PubMed1996

[Induced hypertensive chemotherapy with angiotensin-II for liver metastases from gastric cancer].

The theoretical purpose of induced hypertensive chemotherapy used together with injection of Angiotensin-II is to increase the delivery of anticancer drug to the target tumor tissue by increasing blood flow in the tumor. Angiotensin-II (0.1 mg) was dissolved in 50 ml of normal saline, and given through a peripheral vein by a microinfusion pump. When systolic pressure rose to about 140 to 150 mmHg, Mitomycin C (10 to 20 mg/body) was given for 10 minutes via implanted port, whose tip was located in hepatic artery, followed by continuous infusion of 5-FU at 250 mg/day for 5 days. Response could be measured in 4 of all cases (66.7%). CR was found in 2 and PR in 2. Bone metastases or systemic lymph node metastases occurred after a few months in one CR case and one NC case. We concluded that this mode of chemotherapy was a useful measure for the treatment of liver metastases from gastric cancer.

Aged↗
PubMed1996

Infrared thermometry for rapid, noninvasive detection of reflux of spermatic vein in varicocele.

PURPOSE: We evaluated infrared thermometry for measurement of reflux of blood via the internal spermatic vein. MATERIALS AND METHODS: The change in scrotal temperature in patients with varicoceles and controls with different positions was measured with an infrared thermometer. RESULTS: Scrotal neck temperature in the patients increased during Valsalva's maneuver with upright position (mean plus or minus standard deviation 34.62 +/- 1.20 to 36.05 +/- 1.42C), while no statistically significant increase occurred in the controls (32.91 +/- 0.92 to 33.42 +/- 1.15C). Two weeks after high ligation of the internal spermatic vein the scrotal temperature in the patients decreased to the same level (0.59 +/- 0.84C) as in the controls. Using this method 2 subclinical varicoceles were also found on the right side in patients with a left varicocele. CONCLUSIONS: Infrared thermometry is noninvasive, rapid and simple for documenting varicoceles, including subclinical disease.

Adult↗
PubMed1996

[Cardiac surgery in patients on chronic hemodialysis].

From March 1993 to February 1993, 36 patients with chronic renal failure underwent cardiac surgery with intraoperative hemodialysis (HD). We examined and compared the medium term results of those patients cased upon the time periods of operation and types of heart disease. With respect to the time periods of operation, the 1st term (n = 12) was between March 1985 and February 1989, and the 2nd term (n = 24) was between March 1989 and February 1993. Concerning types of disease, Group A was comprised of 24 patients with ischemic heart disease, and Group B was comprised of 12 patients with valvular or congenital heart disease. Only one early death was observed in the 1st term (8.3%: LOS). As for late death, 5 cases were observed in the 1st term (45.3%), and 2 cases were observed in the 2nd term (8.3%). The actuarial survival rate (post 3 years) was 72.7% in the 1st term and 91.3% in the 2nd term. In each case, the survival rate of the 2nd term was significantly better than the that of the 1st term (p < 0.025). When compared cased upon the types of disease, the actuarial survival rate (post 6 years) was 84.6% in Group A, and 45.5% in Group B, respectively. This difference was statistically significant (p < 0.05). Causes of late death were cerebral hemorrhage in 5 cases, sudden and unknown in one and DIC in the remaining one patient. There were many postoperative complications in this series in addition to the above stated fatal ones. The majority of them, however, were successfully treated, if early diagnosis of them was obtained. During the perioperative period through the long-term period, incidents of fatal hemorrhage among patients on chronic dialysis were reduced by 1) strict management of hypertension; 2) HD without use of Heparin; and 3) with respect to patients who required Warfarin after valve replacement, through the careful anti-coagulant therapy which maintained the thrombo-test (TT) value at precise levels.

Adult↗
PubMed1996

Aortic valve replacement in small aortic annulus with or without annular enlargement.

BACKGROUND AND AIMS OF THE STUDY: Surgical treatments for aortic valve disease in the presence of a small aortic annulus need appropriate indications for operative procedures and precise selection of valve prostheses. The objective of this study was to compare long term results after aortic annular enlargement with those after operation using a small valve prosthesis. MATERIALS AND METHODS: Since 1980, 45 patients with small aortic annulus underwent operation at our institution. There were six men and 39 women, and their ages ranged from 16 to 69 with a mean of 45.6 years. Of these patients, 28 underwent aortic annular enlargements (Nicks' procedure in 13, Manouguian's in 12 and apico-aortic bypass in three patients) and 17 patients received standard aortic valve replacement with a small valve prosthesis (19 mm Standard St. Jude Medical). Mean follow up was 8.6 years in the enlargement group and 4.9 years in the standard group. RESULTS: Early mortality was 3.6% (1/28) in the enlargement group and 5.9% (1/17) in the standard group (NS). The 10-year actuarial survival including all deaths was 85.7% in the enlargement group and 62.7% in the standard group (p < 0.10). The rate of freedom from reoperation at 10 years was 90.7% in the enlargement group and 93.8% in the standard group (NS). The 10-year freedom from all valve-related events was 81.0% in the enlargement group and 58.8% in the standard group (p < 0.05). CONCLUSIONS: The above results suggest that long term mortality and morbidity after aortic annular enlargement might be superior to those after standard AVR with a small valve prosthesis.

Adolescent↗
PubMed1996

[Long-term results of cardiac valve replacement with a Delrin-disk model of the Björk-Shiley valve prosthesis--comparative analysis with the Spherical-disk model].

Records from 99 patients who received the Delrin-disk model (Group D) of the Björk-Shiley (BS) prosthesis between December, 1971 and November, 1974 were reviewed and compared to those from 248 patients who received the Spherical-disk model BS between January, 1975 and June, 1981 (Group S). Complete follow-up was obtained in 98.8% of the patients. The follow-up was over 1302.3 patient-years (mean 13.2 years per patient) in Group D and 2967.5 patient-years (mean 12.0 years per patient) in Group S. Early mortality was not significantly different (Group D: 18.2%, Group S: 10.5%). Of 15 late deaths in Group D, 12 (60%) were valve related and of 58 late deaths in Group S, 34 (58.6%) were valve related. The survival proportion based on Kaplan-Meier analysis, and which included early deaths, was equivalent in both groups (Group D: 65.7% at 21 years, Group S: 64.8% at 18 years). The freedom from reoperation was 74.3% at 21 years for Group D and 95% at 18 years for Group S (p < 0.005). The incidence of prosthetic valve dysfunction in Group D was significantly higher than that in Group S during 15 years after insertion of the valve. The freedoms from thromboembolism and valve-related events were not significant in both groups. Gross examination of the explanted Delrin disk found wear indentations and excessive clearance between the disk and the prosthetic ring. Therefore, disk wear was the primary cause of prosthetic valve dysfunction for the Delrin model. These results suggest that patients with the Delrin-disk model of the Björk-Shiley prosthesis should receive close follow-up for structural integrity of the valve. Further, reoperation might be needed due to significant valve dysfunction in this group of patients.

Adolescent↗
PubMed1996

Concentrations of vascular endothelial growth factor in the sera of normal controls and cancer patients.

Vascular endothelial growth factor (VEGF) is known to play crucial roles in tumor angiogenesis. We have investigated the circulating level of VEGF in sera from cancer patients as well as from healthy normal controls using a sensitive enzymatic immunoassay. Immunoreactive VEGF proteins were detectable in normal sera, and the cutoff level was determined to be 180 pg/ml. In examined patients with all types of cancer, including breast, gastrointestinal, hepatobiliary, and lung cancer, an aberrant increase in the circulating level of VEGF was detected. For example, in 137 primary breast cancer patients, 12 (8.8%) showed an aberrant increase in VEGF levels. This aberrant expression of VEGF in sera was significantly associated with the progression of the disease, and with VEGF protein expression in tumor tissues. In addition, a Western blot analysis confirmed the presence of the VEGF165 form in sera from a patient with recurrent breast cancer. It was concluded that VEGF was detectable in normal sera, and its level was increased in some populations of cancer patients. A positive angiogenesis regulator, VEGF might function as an endocrine growth factor, particularly for solid tumors.

Adult↗
PubMed1995

Dissimilarities between cholinergic and dopaminergic turning elicited by nucleus accumbens stimulation in freely moving rats.

Contralateral turning was produced by unilateral injection of carbachol (0.5, 2.5, 5 micrograms) into the nucleus accumbens, but not into the dorsal or ventral striatum. This behaviour was inhibited by muscarinic M1 acetylcholine receptor blockade in the nucleus accumbens, and less effectively by blockade of muscarinic M2 and nicotinic acetylcholine receptors. Unilateral injection of a mixture of the dopamine D1 receptor agonist 1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine-7,8-diol (SKF 38393, 5 micrograms) and the dopamine D2 receptor agonist quinpirole (10 micrograms) also produced contralateral turning. The stepping pattern, however, completely differed from that induced by carbachol. The number of carbachol-induced turnings was reduced by dopamine D1 or D2 receptor blockade (8-chloro-2,3,4,5-tetrahydro-3-methyl-5-phenyl-1H-3-benzazepine-7-ol (SCH 23390) and l-sulpiride, respectively) in the nucleus accumbens. However, the reduction was due to a change in the turning pattern. Blockade of muscarinic acetylcholine receptors in the nucleus accumbens did not change the contralateral turning induced by unilateral injection of dopamine receptor agonists into the nucleus accumbens. The results demonstrate that there is no functional interaction between the cholinergic and dopaminergic substrates involved, although blockade of the dopamine receptors elicited behavioural deficits that competed with the turning elicited by carbachol. The contralateral turning elicited by carbachol injection into the nucleus accumbens requires an intact dopamine activity at the level of dopamine D1 and D2 receptors in the ipsilateral, but not contralateral, ventrolateral striatum.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1995

Lesser sac herniation through the greater omentum and gastro-pancreatic ligament: report of a case.

We report herein the case of a woman who developed a lesser sac hernia which was especially unusual in that the small bowel prolapsed through a defect in the greater omentum and was thereafter strangulated by a hole in the gastro-pancreatic ligament. The gastro-pancreatic ligament has never before been documented as causing an internal hernia. In our patient, a plain abdominal X-ray demonstrated as soft-tissue mass displacing the stomach to the left while abdominal computed tomography and ultrasonography showed a sac-like encapsulation of the small bowel loops between the liver and stomach. Careful evaluation of these radiographic findings allowed for the preoperative diagnosis of a lesser sac hernia to be made.

Adult↗
PubMed1995

Detection of aberrations in androgen receptor gene by analysis of single-stranded conformation polymorphisms in polymerase chain reaction products.

Analysis of single-stranded conformation polymorphisms in polymerase chain reaction (PCR) products (PCR-SSCP) is a sensitive method for detecting point mutations in genomic DNA. To investigate its utility in examining the androgen receptor gene, we analyzed data on a patient with the testicular feminization syndrome (TFS) with a known point mutation in exon C. We detected mobility shifts of fragments of the corresponding region. Since examination of the subject's brother (legally sister), who also has TFS, revealed an identical shift pattern, we sequenced the exon C of the sibling and detected a mutation identical to that in the former. We conclude that PCR-SSCP is available for screening mutations of the androgen receptor gene.

Adult↗
PubMed1995

Long-term results of aortic valve translocation for mycotic periannular abscess: comparative study of Danielson's original method and our threadless method.

Between June, 1983, and October, 1992, we performed Danielson's original translocation method in four patients (group I) and our translocation method in seven patients (group II), for the treatment of active periannular abscess. There were no perioperative or hospital deaths in either group. The long-term results of these two groups are compared in this report. There were four late deaths (mortality rate 100%) in group I, and three late deaths (mortality rate 43%) in group II. The causes of death were cardiac in six patients and noncardiac in one patient. Vein graft failure occurred in one group I patient (25%) and in two group II patients (28%). Rupture or aortic pseudoaneurysm formation occurred in three group I patients (75%). These findings suggest that our threadless method may be superior to Danielson's original translocation method. Therefore, with close observation, especially of saphenons vein great (SVG) failure, arterial graft use could be acceptable for translocation.

Abscess↗
PubMed1995

Operation for type A aortic dissection: introduction of retrograde cerebral perfusion.

Circulatory support during operation for type A aortic dissection is controversial among many medical centers. In the last 21 years, 100 patients with type A aortic dissection underwent 102 operations including 2 reoperations, and 29 patients showed Marfan's syndrome. During operation, no cerebral perfusion technique was used through February 1985 (period I), antegrade cerebral perfusion was applied since March 1985 (period II), and retrograde cerebral perfusion was introduced in November 1990 (period III). Surgical results were compared among these subgroups. Operative mortality was 12.1% in 33 chronic and 57.1% in 7 acute patients in period I, 11.1% in 27 chronic and 54.5% in 11 acute patients in period II, and 6.7% in 15 chronic and 0% in 9 acute patients in period III (period II versus III; p = 0.04). Retrograde cerebral perfusion decreased permanent brain complications. The 5-year actuarial survival was 59.7% in period I and 63.2% in period II (not significant), and the 3-year survival of period III was 91.7%. Actuarial survival of period III was significantly higher than those of periods I and II (p < 0.05). Surgical repair of aortic arch with cerebral perfusion techniques reduced the residual aneurysms. These results show that surgical results of type A aortic dissection in this series improved with the introduction of retrograde cerebral perfusion and extended surgical procedures.

Adult↗
PubMed1995

Operation for type B aortic dissection: introduction of left heart bypass.

Various support techniques for surgical treatment of type B aortic dissection have been used and recommended in many medical centers. In the last 21 years, 55 patients with type B aortic dissection underwent 65 operations including 10 reoperations, and 10 cases showed Marfan's syndrome. As circulatory support during operation, venoarterial bypass mainly was used until March 1987 (period I) and low-dose heparinized left heart bypass was applied since April 1987 (period II). Surgical results were compared among subgroups by the Kaplan-Meier actuarial method and Cox-Mantel statistical analysis. After the operation, early mortality was 27.3% in 33 patients in period I and 9.4% in 32 patients in period II (p = 0.06). The incidence of fatal hemorrhagic complications was decreased significantly by using the left heart bypass technique (p < 0.02). The 5-year actuarial survival of type B dissection was 60.6% in period I and 79.2% in period II (p = 0.07). These results suggest that surgical results of type B aortic dissection in this series might be improved with the introduction of left heart bypass and extended surgical procedures.

Adult↗