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Biomedical subjects

M Shinonaga

Publications and source records attributed to M Shinonaga.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Coagulation disorders as early predictor of brain injury].

To identify early prognostic value of brain injury, a comparison was made between computerized tomography (CT) findings, coagulation abnormalities, and clinical features in 51 patients with closed head injury. The patients were divided into three groups according to their plasma level of fibrin-fibrinogen degradation product (FDP): normal group (FDP 10 micrograms/ml or less) in 20 patients; moderately abnormal group (FDP 10-40 micrograms/ml) in 15 patients; and highly abnormal group (FDP 40 micrograms/ ml or more) in 16 patients. Cases with a fatal clinical course were mostly associated with very high FDP level. Mortality rate in the highly abnormal group was 44% and 7% in the moderately abnormal group were dead cases, while no cases in the normal group turned out poor outcome. Injury severity, as assessed by Glasgow Coma Scale (GCS) score, correlated with the increase of plasma FDP level. Although severe head injury (GCS 8 or less) was found in 44% of the highly abnormal group and 13% of the moderately abnormal group, normal group only had one case (5%). Very high FDP concentrations were found to be associated with combined hemorrhagic lesions and mass effect on CT scan, but not with a specific localization of brain damage. In summary, the evaluation of coagulation and fibrinolytic function in patients following closed head injury might have both diagnostic and prognostic value.

Adolescent↗
PubMed1995

Congenital coronary artery fistula--surgical results and late changes in coronary artery aneurysm.

Four pediatric cases of congenital coronary artery fistula were surgically treated and followed for 8 years. In the 3 cases of right coronary artery to right ventricle fistula, regression of coronary artery dilatation was observed postoperatively. In the 1 case of circumflex artery to right atrium fistula, aneurysmal dilatation of the abnormal vessel persisted for 8 years. A reduction in vessel size is expected if the fistula-related coronary artery has a normal course and normal branchings. When the aneurysmal vessel takes an abnormal course without branches, it should be removed surgically along with fistula closure.

Child↗
PubMed1995

[Changes in hematological indices, iron levels and marrow erythroids through autologous blood donation before cardiac surgery--predonation with versus without recombinant human erythropoietin].

Preoperative autologous blood donation is widely used in cardiac surgery. However, some patients are unable to store adequate amounts of blood before surgery, and some develop anemia after the operation. We attempted to clarify the limitations of blood donation alone and its influence on erythropoiesis in comparison with those associated with adding recombinant human erythropoietin (rEPO). Subjects were twenty-five patients who were scheduled to undergo elective cardiac surgery. A unit of autologous blood (200 ml) was to be donated every 3 or 4 days for 2 weeks. 200mg of ferrous sulfate was given orally every day in 10 patients (the simple donation group), while 200 U/kg of rEPO was given intravenously 3 times a week in combination with oral ferrous sulfate supplementation in 15 patients (the rEPO-treatment group). After donation, reticulocyte counts increased significantly in both groups. In the simple donation group, hematocrit levels decreased significantly (p < 0.02), while serum iron levels did not change significantly. In the rEPO-treatment group, hematocrit levels remained unchanged and serum ferritin levels decreased significantly (p < 0.02) after the donation; in addition, serum iron levels in the rEPO-treatment group decreased significantly (p < 0.05) than those in the simple donation group during donation. The erythroid/nucleated cell ratio remained almost normal in the simple donation group. This ratio was significantly higher in the rEPO-treatment group than in the simple donation group (36.4 +/- 8.3% versus 26.2 +/- 6.8%, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Venovenous extracorporeal membrane oxygenation in an elderly patient with severe respiratory failure--report of a case].

A 69-year-old woman, who developed acute respiratory distress syndrome (ARDS) after coronary artery bypass grafting, underwent venovenous extracorporeal membrane oxygenation (V-V ECMO) because conventional ventilatory support was ineffective. We used a covalently bonded heparin surface ECMO system, including an artificial lung, a centrifugal pump, cannulas, tubing and connectors, that was maintained with low-dose systemic heparinization, the patient was weaned from ECMO after 186 hours. During ECMO, her platelet count was about half of the initial level and markedly elevated thrombin-antithrombin complex (TAT), plasmin-alpha 2 plasmin inhibitor complex (PIC) and D-dimer were decreased by the use of heparin and protease inhibitors. V-V ECMO seems to be useful even in patients with severe adult respiratory failure and can be performed safely if a heparin covalent circuit is applied.

Aged↗
PubMed1994

[A new operative technique for pulmonary artery banding: adjustment of pulmonary artery bands by mitral valve flow velocity].

We developed a new technique to adjust the pulmonary artery band at surgery by monitoring the mitral valve flow velocity, which is indirectly indicative of the pulmonary flow. We employed this technique for 10 consecutive patients aged from 5 days to 5 months (mean, 1 months) weighing from 2.7 to 4.4 kg (mean, 3.3 kg). Underlying disease was aortic coarctation or interrupted+ventricular septal defect in 7 patients, single ventricule in 1 patients and miscellaneous defects in 2 patients. The pulmonary artery was exposed through a left lateral thoracotomy and a 3 mm wide Teflon tape was placed around the main pulmonary artery. The transducer of the Doppler echocardiography was placed along the left sternal border. The band was tightened gradually until the maximum velocity of the mitral valve flow decreased to around 70% of the previous level. During banding procedure, arterial oxygen saturation, heart rate and left ventricular contractility were monitored continuously. If bradycardia, unacceptable hypoxemia or ventricular dysfunction occurred, the band was released. The mitral valve flow velocity decreased rapidly by just a little additional tightness of the band between the range of 50% to 80% of the previous level. This technique enabled a very fine adjustment (less than 0.5 mm plication) and postoperative management has become very easy. Although there is a limitation of this technique that monitoring of the mitral valve flow velocity cannot be applied to the patients with significant interatrial shunt or mitral regurgitation, we conclude that this technique is simple and useful to obtain the optimum constriction of the pulmonary artery with excessive pulmonary blood flow.

Aortic Coarctation↗
PubMed1994

[Tetralogy of Fallot with a restrictive ventricular septal defect caused by a membranous flap].

A 5-year-old boy who had typical tetralogy of Fallot (TOF) with mild cyanosis was referred to us. Preoperative echocardiogram revealed that in addition to the TOF morphology, an abnormal piece of tissue attached to the right side of the ventricular septum was floating and obstructing flow through the ventricular septal defect (VSD) in systole. Preoperative cardiac catheterization showed suprasystemic right ventricular pressure with a gradient of 60 mmHg between the right ventricle and the aorta, and a right ventriculogram demonstrated a narrow radiolucent structure beneath the aortic valve in the right ventricle. During surgery a fibrous membranous tissue, with no relation to the tricuspid valve, was found to extend from the edge of the VSD to the aortic valve and to partially occlude the defect. This tissue was used as a suture anchorage for patch closure of the defect. Preoperative echocardiography is useful to detect such flaps and early surgical correction should be done to prevent right ventricular failure resulting from right ventricular pressure overload.

Child, Preschool↗
PubMed1994

[Successful primary correction for tetralogy of Fallot associated with total anomalous pulmonary venous drainage (type Ia)].

The surgical correction was performed successfully in a 3-year-old girl with tetralogy of Fallot associated with total anomalous pulmonary venous drainage (type Ia). The preoperative cardiac catheterization and angiography showed high systolic pulmonary artery pressure (58 mmHg) and small left ventricular volume (54% of normal). The early postoperative course was stormy because of the unstable circulatory state. During the early postoperative period, we estimated the volume of left ventricle by 2 D echocardiography. A significant increase of the volume was observed on the 8th postoperative day, when her circulatory state became stable. The cardiac catheterization before discharge revealed Pp/Ps of 0.38 and normal LV volume. We conclude that primary repair should be done for this combined cardiac anomaly, even if small left ventricle and pulmonary hypertension is present.

Female↗
PubMed1994

Total circular annuloplasty with absorbable suture for the repair of left atrioventricular valve regurgitation in atrioventricular septal defect.

To obtain a better control of left atrioventricular valve regurgitation, we applied total circular annuloplasty with the use of absorbable sutures to 14 children with atrioventricular septal defect (six complete forms and eight incomplete forms). In the intraoperative period, a good coaptation of the leaflets was achieved and the regurgitation was minimized or disappeared. Follow-up studies with echocardiography for 13 survivors showed a gradual increase of annular size during the postoperative period. Ten patients of the survivor group (77%) maintained good valvular competency in a long-term period. Total circular annuloplasty is a simple and effective procedure to reduce the regurgitation and prevent the annular dilatation during the immediate postoperative period.

Cardiac Surgical Procedures↗
PubMed1993

Thoracoscopic stapled bullectomy supported by suturing.

In 1985, a thoracoscopic technique for closing bullae with hemostatic clips was developed. However, the method was limited, and therefore clinical application was small. A linear endoscopic stapler (Endo-GIA) was developed in 1990. The advent of the Endo-GIA nearly made thoracoscopic treatment of spontaneous pneumothorax practicable, and ended the use of clipping. In addition, a new operative technique was developed, the 3-cm minithoracotomy bullectomy for the treatment of spontaneous pneumothorax. This technique has now become obsolete. The current method is that of a thoracoscopic stapled bullectomy using the Endo-GIA, supported by suturing. The recurrence rate was 2.7% (1/37) using this method. The one recurrence occurred in a case where no bullae were observed during the operation. Our findings suggest that thoracoscopic stapled bullectomy supported by suturing is a practicable treatment of spontaneous pneumothorax. An economical use of the endoscopic stapler and complementary suturing may be less expensive than using a laser. Pleurodesis should be performed in the patients in whom no distinct bullae are discovered thoracoscopically.

Humans↗
PubMed1993

Does recombinant human erythropoietin accelerate erythropoiesis for predonation before cardiac surgery?

This study was performed to determine the effect of recombinant human erythropoietin (rEPO) on preoperative autologous blood donation in patients undergoing elective coronary bypass or valvular operations. Nineteen patients received 200 u/kg of rEPO intravenously 3 times a week, and 210 mg/day of iron sulfate orally, for 2 weeks before surgery (EPO group). Seven matched patients only took the same dose of iron sulfate (control group). Bone marrow was aspirated from the sternum during surgery, and the Myeloids/Erythroids ratio was calculated in 13 patients of the EPO group. The total donated blood mass was 853 +/- 231 g in the EPO group, and 657 +/- 140 g in the control group (p < 0.05). The average increase in hemoglobin (Hb) mass from admission to the day before surgery was 87 +/- 33 g in the EPO group, and 24 +/- 13 g in the control group (p < 0.001). Furthermore, the logarithm of the ratio of "increased Hb mass/Hb mass at admission" was significantly correlated to the Myeloids/Erythroids ratio (r = -0.9130, p < 0.01). These results strongly indicate that rEPO is a very useful agent for predonation of autologous blood for cardiac operations.

Adult↗
PubMed1993

[A successful insertion of the prosthetic valve in supraannular position concomitant with pericardial enlargement of the aortic root in a child: a case report].

A 4-year-old boy admitted to our hospital due to congestive heart failure one year after the intracardiac repair of tetralogy of Fallot. Echocardiography and cineangiography revealed severe aortic regurgitation. The aortic valve replacement was performed with a prosthesis larger than the aortic annulus. Operative findings showed that the cause of aortic regurgitation was infective endocarditis. The aortic root was enlarged with pericardial patch and a 21 mm St. Jude Medical valve prosthesis was inserted in supraannular position. This technique was very useful for insertion of a prosthetic valve one or two sizes larger than the aortic annulus without risk of distorting the mitral valve or left ventricular function.

Aortic Valve↗
PubMed1993

[A case of carcinoid tumor of the right truncus intermedius resected by the bronchoplasty without lobectomy].

A case report of endobronchial carcinoid was presented. A 20-year-old male complaining of hemoptosis was bronchoscopically proved to have a carcinoid tumor located in the membraneous portion of the right truncus intermedius. Right thoracotomy was done on February 26, 1990, and bronchoplasty was performed without losing lung parenchyma. We cut right upper bronchus, truncus intermedius, and main bronchus, and performed double-barreled anastomosis between a double end of right upper bronchus and truncus intermedius and right main bronchus. Histological diagnosis was typical carcinoid. Postoperative course was uneventful, and one year after the operation anastomosis line was proved clear with no evidence of carcinoid recurrence of granular stenosis.

Adult↗
PubMed1993

[An operative case of aortic valve regurgitation due to blunt trauma to the chest].

While a 70-year-old man was riding a motorcycle, he was hit by car on his chest on October 19, 1990. Medical check-up at the emergency room of another hospital was negative. However, he fell in to dyspnea on the night of next day which progressed to develop signs of orthopnea. He revisited the hospital where he was found to have aortic regurgitation and subsequent congestive heart failure after medical examination including echocardiography and was referred to our hospital 7 days after the accident. He was operated upon the following day. On opening the pericardium, about 100 ml of reddish black fluid was accumulated. The appearance of the heart was normal except for black discoloration of the epicardial fat pad at the base of the aorta. Opening the ascending aorta transversely, the right coronary cusp was found to be perforated. The aortic valve was considered preferable to replace than to repair. The aortic valve was replaced with a St. Jude Medical valve. His recovery was uneventful and he has been well thereafter.

Accidents, Traffic↗
PubMed1993

[Excellent late results of total circulatory annuloplasty with absorbable suture for the repair of mitral regurgitation of atrioventricular septal defects in children].

We treated 15 children with atrioventricular septal defects (6 complete type and 9 incomplete type) using total circulatory annuloplasty for mitral regurgitation. In 14 patients, total circulatory annuloplasty was performed with absorbable suture and in one patient with polypropylene suture. Operative death was one patient associated with tetralogy of Fallot and another 14 patients survived. Preoperative mitral regurgitation was grade 1 in one patient, grade 2 in 6 patients and grade 3 in 7 patients. After operation mitral regurgitation reduced to grade 1 in 13 patients and grade 2 in one patient. In the late results, only one patient underwent reoperation for exacerbation of mitral regurgitation. The present data suggested that total circulatory annuloplasty with absorbable suture was very useful technique for the repair of mitral regurgitation of atrioventricular septal defects in children.

Child↗
PubMed1992

[Surgery of vascular rings associated with complex intracardiac anomaly].

Two rare cases with surgically treated vascular ring associated with complex congenital cardiac anomaly are reported. Each case showed vascular ring due to right aortic arch, right descending aorta, aberrant left subclavian artery and left ductus arteriosus. Case 1 was a 2-year-old boy associated with ligamentum arteriosum and total anomalous pulmonary venous connection (TAPVC), and presented dyspnea and dysphagia. Case 2 was a 3-year-old girl associated with patent ductus arteriosus (PDA) and tetralogy of Fallot (TOF). In case 1, the two-staged operation was performed because of the necessity of mechanical ventilation and of recurrent respiratory infection. Division of the ligamentum, dissection of bronchus and esophagus was performed at the first operation through left thoracotomy, and the intracardiac repair of TAPVC was done three months later. In case 2, PDA division and the intracardiac repair of TOF was done simultaneously through median sternotomy because of the mild symptom of vascular ring and technical feasibility. Each case was successfully treated and became completely asymptomatic.

Abnormalities, Multiple↗
PubMed1991

[Surgical management of valve replacement in children].

From 1965 to 1990, 49 valve replacements were performed on 43 patients under the age of 15. Mitral valve replacements were performed on 21 patients, and re-replacements were done on 4 of them afterwards. In the first 9 mitral valve replacements before 1974, Starr-Edwards (S-E) ball valves were used. Five of these patients died in the hospital (early mortality rate was 56%). Since 1975, bioprosthetic valves were used in three cases, but all of these valves ceased to function due to primary tissue failure (PTF) within 3 years. Consequently, SJM valves are now used as a first choice. Ten aortic valve replacements were performed on 9 patients with the results of one early death, two late deaths, and one late re-operation. Tricuspid valve replacements were performed on 11 patients, 5 of whom utilized S-E ball valves. Three of the five patients died in the hospital. One patient was re-operated on, swapping the S-E ball valve for the SJM valve. SJM valves were used primarily in 2 patients, and bioprosthetic valves in 4. Two patients died, one with a SJM valve, and the other with a bioprosthetic valve. Two pulmonary valve replacements were performed, one employing a SJM valve, the other a bioprosthetic valve. Two adult patients with SJM valve in the right side of the heart had thrombotic complications, though the patients with bioprosthetic valves had none. Atrioventricular valve replacements were performed on 5 patients under the age of 3, but all of them died.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Surgical management of congenital aortic valve stenosis in neonates and infants].

From 1985 to 1989, 4 neonates or infants (3 males and 1 female) underwent open valvotomy for severe aortic valve stenosis. In all patients, preoperative echocardiograms showed abnormal findings of endocardial fibroelastosis and/or poor performance of left ventricle. All patients underwent valvotomy using cardiopulmonary bypass. There was one early death from left ventricular failure. All other patients survived and the pressure gradient through aortic valve was reduced from 50-100 mmHg to 25-50 mmHg postoperatively. We conclude that infants with severe aortic valve stenosis should undergo open valvotomy before the manifestation of endocardial fibroelastosis and/or left ventricular muscle damage, and that open aortic valvotomy using cardiopulmonary bypass is most suitable method for severe aortic valve stenosis in infants.

Aortic Valve↗