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Biomedical subjects

S Ohtake

Publications and source records attributed to S Ohtake.

At least 73 records · Page 4Linked to original sources
PubMed1999

Real time assessment of myocardial revascularization during coronary artery bypass surgery by means of ultrasonic integrated backscatter.

OBJECTIVE: The recovery of cyclic variation (CV) of ultrasonic integrated backscatter (IB) may provide a more sensitive predictor of the success of myocardial revascularization. This study was designed to elucidate the possibility of real time assessment of coronary artery bypass grafting (CABG) using CV of IB. METHODS: We studied 10 patients (61 +/- 4 years old) with the perfused areas by stenosed or occluded LAD without myocardial infarction. There were six ischemic dysfunctional areas, and four ischemic but non-dysfunctional areas. The CV of IB was measured before and just after extracorporeal circulation (ECC). Wall motion was analyzed by segmental wall thickening during systole at the same time of the IB analysis during CABG and at 3 weeks after CABG. Those 10 areas were completely revascularized. RESULTS: In the non-dysfunctional areas, wall thickening did not change and remained at normal values before and after ECC, and 3 weeks after CABG (31 +/- 3% 29 +/- 3% and 29 +/- 5%, respectively). The magnitude of CV of IB did not also change before and after ECC (8.0 +/- 1.6 dB and 7.8 +/- 1.3 dB). However, in the ischemic dysfunctional areas, while wall thickening did not change before and after ECC (21 +/- 5% and 20 +/- 5%), it increased and reached similar values as the non-dysfunctional regions at 3 weeks after CABG (26 +/- 7%, P < 0.01 vs. before and after ECC values). The magnitude of CV of IB increased even after ECC (3.71 +/- 0.4 dB vs. 7.4 +/- 3.5 dB, P < 0.05), and reached the same level as those in the non-dysfunctional areas. There was a significant relationship between wall thickening at 3 weeks after bypass grafting and magnitude of CV of IB after ECC (r = 0.67, P < 0.05). CONCLUSIONS: Improvement in wall motion was gradually attained after bypass grafting. On the contrary, an increase in the magnitude of CV of IB was obtained immediately after myocardial revascularization. Our data suggest that CV of ultrasonic IB method can provide close real time information regarding the effectiveness of bypass surgery.

Coronary Artery Bypass↗
PubMed1999

No beneficial effect from addition of etoposide to daunorubicin, cytarabine, and 6-mercaptopurine in individualized induction therapy of adult acute myeloid leukemia: the JALSG-AML92 study. Japan Adult Leukemia Study Group.

To assess the efficacy of etoposide added to the standard remission induction therapy for acute myeloid leukemia (AML), newly diagnosed adult AML patients were randomized to receive either daunorubicin (40 mg/m2/day x 4 or more), behenoyl cytarabine (200 mg/m2/day x 10 or more), and 6-mercaptopurine (70 mg/m2/day x 10 or more) (BHAC-DM), or the same three drugs plus etoposide (100 mg/m2/day x 5) (BHAC-EDM) for response-oriented individualized induction therapy. The patients achieving complete remission (CR) received the same 3 courses of consolidation therapy followed by 6 courses of maintenance/intensification therapy. M3 patients were excluded because all-trans retinoic acid was used. Of 667 patients registered, 655 were evaluable. The median age was 49 (range 15 to 85). CR rates were 77% in the BHAC-DM group and 75% in the BHAC-EDM group. In 173 M4 patients, CR rates were 86% and 69% (P = 0.009), and in 32 M5 patients, 80% and 77% (P = 0.810) in the BHAC-DM and the BHAC-EDM groups, respectively. The predicted 6-year overall survival rates were 30% and 38% (P = 0.925) for the BHAC-DM and BHAC-EDM groups, and the disease-free survival rates of CR patients were 25% and 35% (P = 0.352), respectively. Nonhematological toxicities after the first course of induction therapy were almost equal among the two groups, with the exception of a greater loss of hair (P = 0.024) and more frequent diarrhea (P = 0.013) in the BHAC-EDM group. We concluded that in the present study, the addition of etoposide to the standard individualized induction therapy showed no advantage in adult AML, even among M4 and M5 patients.

Acute Disease↗
PubMed1998

[Evaluation of cerebral circulation during cardiopulmonary bypass using near-infrared spectroscopy].

Cerebral oxygenation level during cardiopulmonary bypass (CPB) was measured using near-infrared spectroscopy as a monitor of cerebral circulation in 30 patients. Six adult cases with thoracic aortic aneurysm were operated on using selective cerebral perfusion (SCP). CPB was established under moderate hypothermic temperature in 9 adult cases (hypothermic group, lowest blood temperature during CPB; 25 degrees C) and under normothermic temperature in 9 adult cases (normothermic group, lowest blood temperature during CPB; 34 degrees C). In congenital cases (n = 6), CPB was established under moderate hypothermic temperature (congenital group, lowest blood temperature; 25 degrees C). The oxyhemoglobin (HbO2) level showed a significant positive correlation with cerebral blood flow during SCP (r = 0.715). There was no significant correlation between SjO2 and HbO2 in the SCP group. The HbO2 levels in the hypothermic group after 30 and 60 min, from the initiation of CPB and 30 min. before the weaning of CPB were significant lower than the control level (p < 0.05). HbO2 levels in the congenital group after 0, 30 and 60 min. from the initiation of CPB and 30 min. before the weaning of CPB were significantly lower than the control level (p < 0.01). The deoxyhemoglobin (HbR) level in the hypothermic group after 30 and 60 from the initiation of CPB and 30 min. before the wearing of CPB were significantly higher than the pre level (p < 0.05). The mixed venous saturation (SvO2) in the normothermic group showed significant lower levels than those in the hypothermic group (p < 0.01). However, there was no significant difference in HbO2 levels between the two groups. In conclusion, these results suggest that near-infrared spectroscopy may be a noninvasive and useful technique for the cerebral circulation monitoring during CPB.

Adolescent↗
PubMed1998

[Painless aortic dissection late after aortic valve replacement, presenting as superior vena cava syndrome].

A 68-year-old man, who had underwent aortic valve replacement (AVR) with Björk-Shiley disc valve for aortic regurgitation 17 years ago, was transferred to our hospital complaining of facial redness and swelling, without chest or back pain. Preoperative examination revealed DeBakey type II aortic dissection, which caused superior vena cava syndrome (SVC syndrome). Emergent ascending aortic replacement was performed, postoperatively central venous pressure (CVP) decreased from 33 to 9 mmHg, and SVC syndrome was relieved. Painless aortic dissection after AVR, presenting as SVC syndrome, is a rare case, and close follow-up should be performed under consideration of painless aortic dissection late after AVR.

Aged↗
PubMed1998

Simultaneous operation for minimally invasive direct coronary artery bypass and abdominal aortic aneurysm repair.

Simultaneous minimally invasive direct coronary artery bypass and abdominal aortic aneurysm repair were conducted in a 66-year-old man uneventful, requiring no transfusion. Surgery required 9 hours and 2 minutes. The tracheal tube was extubated in the operating room. Postoperative bleeding was 215 ml. The postoperative course was very smooth, with the patient able to walk on postoperative day 1. Postoperative coronary arteriogram and aortogram showed favorable results and the patient was discharged on day 23 after surgery.

Aged↗
PubMed1998

Off-pump coronary bypass using interposed radial artery graft.

We describe a patient with severely diseased ascending aorta and small internal mammary arteries, who underwent off-pump coronary artery bypass to the left anterior descending coronary artery and right coronary artery using composite arterial grafts consisting of the pedicled proximal internal mammary artery and interposed radial artery graft. The interposed radial artery graft provides advantages, such as making coronary anastomosis on the beating heart easier and to increasing the flow potentiality of the internal mammary artery.

Aged↗
PubMed1998

A long term follow-up of a randomized trial comparing interferon-alpha with busulfan for chronic myelogenous leukemia. The Kouseisho Leukemia Study Group.

To evaluate the long-term effectiveness of interferon-alpha (IFN-alpha) therapy in patients with chronic myelogenous leukemia (CML) in chronic phase, we examined the updated outcomes of 159 patients who had been enrolled between 1988 and 1991 into a randomized trial comparing IFN-alpha with busulfan. At a median follow-up of 73 months, the median survival was 71 months in the IFN-alpha group and 55 months in the busulfan group (P=0.0563), and the median time of remaining in chronic phase was 58 months in the IFN-alpha group and 39 months in the busulfan group (P=0.4676). Landmark analysis showed a significant advantage in survival (P=0.009) and duration of chronic phase (P=0.0001) in patients with any cytogenetic response among the IFN-alpha group. About half patients were discontinued IFN-alpha administration in spite of cytogenetic response in this study. It appears that continuation of IFN-alpha might possibly confer a survival advantage. Pretreatment factors associated with cytogenetic response included high hemoglobin level, low percentage of peripheral basophils and low leukocyte counts. Multivariate analysis identified lower percentage of bone marrow basophilia (P=0.007) for survival advantage. If a group with a very good prognosis is predicted by a new prognostic model, it might be an option to wait for bone marrow transplantation.

Adult↗
PubMed1998

A novel technique for cardiopulmonary bypass using vacuum system for venous drainage with pressure relief valve: an experimental study.

To decrease the circuit priming volume, develop safety, and simplify the equipment, a cardiopulmonary bypass (CPB) circuit using a vacuum suction venous drainage system with a pressure relief valve was developed. The efficacy of this vacuum system was compared to that of a conventional siphon system. The system contains a powerful vacuum generator and a pressure relief valve to keep the negative pressure constant when blood suction is used. Using 8 mongrel dogs, the feasibility and the efficacy of this CPB system was tested. The changes in the negative pressure in the reservoir were within 5 mm Hg whether the suction lines were switched on or off. In all animals the amount of blood in the venous reservoir was stable throughout bypass. The decrease of priming volume was from 725 ml (siphon system) to 250 ml (vacuum system). At the end of CPB, the levels of hemoglobin in the vacuum system were significantly higher than those in the siphon system. These results demonstrated that this vacuum drainage system can provide simplification and a miniaturization of the cardiopulmonary bypass circuit resulting in low hemodilution during CPB.

Animals↗
PubMed1998

Minimally invasive cardiac surgery: current status and perspective.

Recently, the minimally invasive approach has become a growing aspect in the field of cardiac surgery with the goal of eliminating cardiopulmonary bypass (CPB) and/or median sternotomy. In coronary bypass surgery, the application of this approach is direct anastomosis, primarily of the left internal thoracic artery to the left descending coronary artery under a beating condition without the use of CPB through a small left thoracotomy minimally invasive direct coronary artery bypass (MIDCAB). In the repair of intracardiac lesions, CPB cannot be excluded, but a small right parasternal incision or small partial sternotomy (ministernotomy) has been applied for congenital defects and mitral and aortic valve lesions. With technological advances in CPB, these approaches may become more popular in the near future.

Anastomosis, Surgical↗
PubMed1998

Analysis of prognostic factors in newly diagnosed acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Japan Adult Leukemia Study Group.

PURPOSE: We conducted a multicenter study of differentiation therapy with all-trans retinoic acid (ATRA) followed by intensive chemotherapy in patients with newly diagnosed acute promyelocytic leukemia (APL) and analyzed the prognostic factors for predicting complete remission (CR), event-free survival (EFS), and disease-free survival (DFS). PATIENTS AND METHODS: All patients received ATRA until CR. If patients had an initial leukocyte count greater than 3.0 x 10(9)/L, they received daunorubicin (DNR) and behenoyl cytarabine (BHAC). During therapy, if patients showed blast and promyelocyte counts greater than 1.0 x 10(9)/L, they received additional DNR and BHAC. After achieving CR, patients received three courses of consolidation and six courses of maintenance/intensification chemotherapy. RESULTS: Of 198 registered, 196 were assessable (age range, 15 to 86 years; median, 46) and 173 (88%) achieved CR. Multivariate analysis showed that no or minor purpura at diagnosis (P = .0046) and age less than 30 years (P = .0076) were favorable factors for achievement of CR. Predicted 4-year overall survival and EFS rates were 74% and 54%, respectively, and the 4-year predicted DFS rate for 173 CR patients was 62%. Multivariate analysis showed that age less than 30 years (P = .0003) and initial leukocyte count less than 10 x 10(9)/L (P = .0296) were prognostic factors for longer EFS, and initial leukocyte count less than 10.0 x 10(9)/L was a sole significant prognostic factor for longer DFS (P = .0001). CONCLUSION: Our results show that age, hemorrhagic diathesis, and initial leukocyte count are prognostic factors for APL treated with ATRA followed by intensive chemotherapy.

Adolescent↗