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Biomedical subjects

S Shindo

Publications and source records attributed to S Shindo.

At least 19 recordsLinked to original sources
PubMed1992

Surgical treatment of Takayasu arteritis.

From 1959 to 1991, 93 patients underwent vascular reconstruction for Takayasu arteritis at our institution. The details of the cases were as follows: 16 were of type I (brachiocephalic ischemia), 48 type II (hypertension), 13 type III (extensive lesions with cerebral ischemia and hypertension), and 16 type IV (aneurysms). Carotid reconstruction, repair of atypical aortic coarctation, renovascular reconstruction, and aneurysm repair were performed independently or in combination. Nine operative deaths occurred, 8 cases of which were operated before 1970. The most serious of the delayed complications was suture line aneurysm formation, which was encountered in ten cases. The aneurysms were often found long after the operation, some of them developing even after more than 20 years. Takayasu arteritis is characterized by extensive inflammation and destruction of the medial elastic fibers and long term postoperative observation is mandatory to improve the late survival rate.

Aortic Aneurysm↗
PubMed1992

[Operative strategy for thoracoabdominal aortic aneurysm with concomitant reconstruction of four main abdominal branches].

A thoracoabdominal aortic aneurysm (TAAA) involving major abdominal branches remains still difficult to be managed. From 1983 to 1990, we successfully operated five such cases. Our operative strategy for TAAA which necessitates concomitant reconstruction of four major abdominal branches is i) to utilize temporary bypass to maintain distal perfusion during aortic cross-clamping, ii) to reconstruct bilateral renal arteries prior to aortic clamping in order to shorten renal ischemic time as much as possible, iii) to reconstruct celiac and superior mesenteric arteries by Crawford's method, iv) to reconstruct two pairs of intercostal arteries by using diagonal anastomosis in the proximal site, and v) to divide the left renal vein temporarily for easy manipulation of renal arteries. All five cases were recovered uneventfully. This procedure, in which the renal ischemic time is saved as short as possible, is considered a safe and reasonable one for thoracoabdominal aortic aneurysms.

Adult↗
PubMed1992

[Long-term patency of aorto-coronary saphenous vein grafts].

One hundred eighty-two cases with 814 aorto-coronary saphenous vein grafts were studied according to coronary risk factors (smoking, hypertension, hyperlipidemia, diabetes mellitus, obesity and family history). The patency rates of all cases were as follows, early-term (within one year after operation): 92.3%, mid-term (within 5 years after operation) 80.7%, long-term (more than 5 years after operation): 66.0%. Coronary risk factors have great influence upon the mid- and long-term patency, especially upon the latter. The long-term patency rate of the grafts complicated with hyperlipidemia was 57.4% and that without hyperlipidemia was 81.8% (p less than 0.01). Hyperlipidemia, complicating 55.5% of all cases, was one of the most influential factors on the patency and also the most difficult one to be controlled. In the United States and Europe, many cases were complicated with hyperlipidemia, and it was considered that the poor patency of the saphenous vein grafts in those countries was due to this fact. Pathological studies revealed that hyperplasia of intima and media, characteristics of venosclerosis, appeared frequently in the saphenous vein grafts having more than three risk factors, and that the factors had effect not only upon arteries but also upon veins. So we conclude that saphenous vein grafts are the materials of good long-term patency, and that the control of the risk factors, particularly hyperlipidemia, is the key to improve the patency.

Adolescent↗
PubMed1992

[Right-sided patent ductus arteriosus with a right aortic arch and right descending aorta].

We experienced an extremely rare anomaly, i.e. right-sided persistent ductus arteriosus with a right aortic arch and right descending aorta. Reviewing the literature, we found only two cases clinically reported in Japan as far as we know. The diagnosis was established by angiography and MRI. We treated the patient successfully through right thoracotomy.

Aorta, Thoracic↗
PubMed1991

[A successful report of emergency CABG for severe calcified thoracic aorta--the porcelain aorta].

The best management for patients requiring CABG with severe calcification of the thoracic aorta has not be established. To clamp ascending aorta in such cases produce cerebral embolization, aortic dissection or mural laceration. We reported a 60-year-old male for unstable angina with LMT lesion. Emergency CABG using IABP was performed with femoral cannulation, moderate hypothermia and induced ventricular fibrillation. His postoperative course was uneventful and coronary arteriography revealed a satisfactory patent graft of the RITA to the LAD system.

Aorta, Thoracic↗
PubMed1991

[Successful report of total aortic root replacement by a new technique].

We employed a new procedure of the total aortic replacement in 2 cases which is made of composite graft and reimplantation of the coronary arteries by direct suture technique. These patients took good clinical course and were discharged after operation. We believe that this procedure is a very useful for annuloaortic ectasia or dissecting aortic aneurysm involved coronary artery with aortic regurgitation.

Aged↗
PubMed1990

Haptoglobin subtyping with anti-haptoglobin alpha chain antibodies.

Specific antibodies against the human haptoglobin (HP) alpha chain were raised and used for immunoblotting after isoelectric focusing to determine Hp alpha subtypes in a reproducible and simplified manner. By eliminating the staining of the HP beta chain, HP alpha subtypes were visualized more precisely and simply than by previously reported methods. Subtypes of a total of 1211 sera, obtained from two different populations in Japan, were examined by the new method. Four HP alpha subtypes (HP 1S-1S,2FS-1S, 2FS-2FS and 2FS-2SS) and five subtypes combined with a new variant (HP 2FS-1V1, 2V1-1S, 2FS-2V1, 2FS-2V2 and 2FS-2V3) were observed. HP 1V1 belonged to HP alpha 1, and HP 2V1, 2V2 and 2V3 belonged to HP alpha 2, and their alleles were designated HP A*1V1, HP A*2V1, HP A*2V2 and HP A*2V3, respectively. The allele frequencies were calculated to be as follows: HP A*1S, 0.2597; HP A*1V1, 0.0004; HP A*2FS, 0.7333; HP A*2SS, 0.0008; HP A*2V1, 0.0045; HP A*2V2, 0.0008; and HP A*2V3, 0.0004. The allele frequency of HP A*2SS, which is common in the European population, is less frequent than HP A*2V1 in the Japanese population.

Alleles↗
PubMed1990

Long-term follow-up of 2529 patients reveals gastric ulcers rarely become malignant.

To examine the relationship between peptic ulcer and gastric cancer, we investigated 2529 patients with peptic ulcer diagnosed from 1963 to 1975. During the follow-up period of 9-23 years, we found 38 in whom gastric cancer developed or who died of gastric cancer. Included were nine in whom gastric cancer was detected at the same site as the gastric ulcer initially diagnosed, and 22 in whom the gastric cancer was detected at another site. In the remaining seven, gastric cancer was given on the death certificate, but the details were unknown. When the data on gastric ulcer initially diagnosed were reevaluated, gastric cancer was suspected or could not be completely ruled out in seven of the nine in whom gastric cancer was detected at the same site. In the remaining two, a diagnosis of benign ulcer was made even when the initial data were reviewed. In these two, however, there was the possibility that the initially diagnosed gastric ulcer represents a phase of the "malignant cycle." The number of deaths from gastric cancer in patients with gastric ulcer was significantly low, compared with that expected and computed by the age- and sex-matched general population. These results suggest that gastric ulcers rarely become malignant.

Adolescent↗
PubMed1990

Congenital arteriovenous fistula in the gluteal region--a report of five cases.

Five cases of congenital arteriovenous fistula in the gluteal region have been encountered in our department in the past 20 years. In all cases, the fistulous masses were in the connective tissue between the gluteal muscles and well-localized. Preoperative angiography showed the feeding arteries to be the superior gluteal, the inferior gluteal, and/or the lateral femoral circumflex arteries, and all the arteriovenous fistulae were excised almost completely with success. In this report, we emphasize the importance of precise estimation of the feeding arteries on preoperative angiography and ligating them before excising the fistulous masses, to ensure safe surgical treatment.

Adolescent↗
PubMed1990

Renal function and growth after antireflux surgery in children.

The outcome of antireflux surgery for vesico-ureteral reflux (VUR) was studied in 39 children (65 renal units). The T max of the renogram improved significantly after operations in 51 (78.5%) of the 65 renal units due to a reduction of the back pressure. Improvements in scarring were observed in only 3 (7.3%) of 41 scarred kidneys. The growth of 38 kidneys was examined using the renal ratio, more than 2 years (mean, 3 years and 1 month) after the operation. The normal renal ratio was restored in 1 of 12 small kidneys with a preoperative size of less than the mean -2SD. The other 11 kidneys remained small, but 6 of these grew with a normal growth curve. The growth of the remaining 5 kidneys was unremarkable. Of the 26 kidneys with a normal renal ratio, 4 became small after the operation, but all the others had growth within the normal range.

Child↗
PubMed1990

Risk of gastric cancer in patients with non-surgically treated peptic ulcer.

We followed up 2072 patients with unoperated gastric and duodenal ulcer, diagnosed from 1963 to 1975, and evaluated the risk of development of gastric cancer. During the follow-up period of 9-23 years 38 patients had a gastric cancer or died of gastric cancer. The number of gastric cancers in patients with duodenal ulcer (observed/expected = 3:12) was statistically low (p less than 0.01) compared with the number expected from the sex- and age-matched general population. On the other hand, the number of patients with gastric ulcer and the number of those with both gastric and duodenal ulcers was 29 and 6, neither of which differed significantly from the expected occurrence. These results suggest that in peptic ulcer patients the risk of developing gastric cancer is equal to or low compared with that of the general population.

Adolescent↗
PubMed1990

[Effectiveness and limitations of IABP or LVAD in right ventricular dysfunction].

IABP and well functioning left ventricular assist device for a failing left ventricle have potential for altering the loading condition of the right heart. Depending on the extent of myocardial damage and the pulmonary vascular resistance, IABP and LVAD can have different degree of hemodynamic effect on the right ventricle. We examined 20 clinical cases who required IABP support to wean from cardiopulmonary bypass. In 10 cases (group I), CVP rose up above 20 cmH2O within 12 hrs of post operative period. In another 10 cases (group II), CVP rose less than 20 cm H2O. Then we compared hemodynamic change (m-PAP, PVR, CVP, PAWP, CI and RVSWI) between two groups until 72 hrs of post operative period. No significant differences were noted in PVR and CI between two groups, but CVP, m-PAP, PAWP and RVSWI were markedly higher in I group. Reduction of RV afterload produced with an IABP may probably be due to degree of recovery of failing left ventricular function. It is though that IABP has less favorable effect on right ventricular in the cases whose CVP elevate above 20 mmH2O within 12 hrs after operation than in those with CVP below 20 cmH2O. Clinical studies were made on 4 cases with biventricular failure in our experiences of 8 LVAD cases (LV aneurysmectomy + VSP closure, MVR + AVR + CABG + LV aneurysmectomy, CABG + LV aneurysmectomy and MVR + CABG). LVAD seems to have more beneficial effect on RV afterload, than IABP right ventricular dysfunction, however, is likely to continue in the cases whose CVP elevates above 30 mmH2O even if LVAD is used.

Adult↗
PubMed1989

[Surgical treatment of the prosthetic valves in reoperation].

Surgical treatment and problems in patients required reoperation for malfunctioning prosthetic valves are reviewed in our institute. The cinefluoroscopy and pulse doppler echocardiography were helpful for diagnosis of artificial valve dysfunction. In recent two decades valve replacement were performed in 382 cases and number of re-implanted valve were 469. Among them the cases of reoperation were 21 and reimplanted valves were 25 (5.6%); 4.7% in aortic, 5.0% in mitral, 6.7% in tricuspid position. Three cases of those patients had three operations. Main causes of reoperation were primary tissue failure in Carpentier-Edwards porcine xenograft (6 cases, 23%) and cloth wear in Starr-Edwards ball valve (9 cases, 38%) and thrombosis in St. Jude Medical bi-leaflet valve (3 cases, 15%). In most cases St. Jude Medical valve were chosen for the alternative prosthetic valve in reoperation. We applied IABP support to seven patients for severe low cardiac output syndrome after the operation and overall mortality was 24% in reoperation. It concluded that St. Jude Medical valve may be most reliable because of low incidence of postoperative complication in our institute.

Adult↗
PubMed1989

[A small-caliber synthetic vascular prosthesis prelined with autogenous canine endothelial cells].

Endothelial cells (ECs) were harvested enzymatically from external jugular veins of twelve dogs, and were cultured to confluency. A 4mm-Dacron graft coated with collagen was seeded with these ECs in vitro by rotation method to create a prelined graft. After 72-hour incubation, each graft was implanted to the femoral artery of the dog whose veins were removed already, with non-seeded control graft contralaterally. Eight prelined grafts were patent at four weeks (66.7%), while one control graft was patent (8.3%, p less than 0.05). The monolayer lining of the ECs was manifested microscopically in the midportion of the explanted prelined graft, but the patent control graft had only fibrin network in the luminal midportion. From this improved patency rate and the earlier endothelialization, the prelined graft with autogenous ECs has been expected to play an important role in development of a small-caliber vascular prosthesis.

Animals↗
PubMed1989

[The results of surgical treatment of post-infarction left ventricular aneurysms].

The surgical results of post-infarction left ventricular aneurysmectomy have been evaluated in 24 patients approximately 1 year after operation. In 20 patients coronary artery bypass grafting (CABG) was also carried out. In 8 patients mechanical circulatory assist such as intra-aortic balloon pump (IABP) or left ventricular assist device (LVAD) was undertaken for the purpose of weaning from cardiopulmonary bypass. Postoperative left ventricular function, such as ejection fraction and cardiac index, and classification of the New York Heart Association were improved significantly after aneurysmectomy. However, postoperative improvement of these parameters was not remarkable in cases of poor preoperative left ventricular function. Preoperative left ventricular function revealed to be poor in multiple vessel disease, and concomitant coronary artery bypass grafting with aneurysmectomy can be performed with good long-term results and significant improvements of postoperative cardiac function. In patients that had showed the end-diastolic perimeter more than 40% and the shortening rate of transverse axis at the left ventricular base less than 20%, postoperative improvement of cardiac function revealed unsatisfactory. Mechanical circulatory assist showed lifesaving effect, but in cases that required IABP or LVAD postoperative cardiac function has not improved significantly.

Adult↗
PubMed1989

Species variation and the success of endothelial cell seeding.

In vivo seeding of vascular grafts in dogs has resulted in the formation of a confluent luminal monolayer and increased patency. Results of similar trials in humans have been mixed. Interspecies variation of the harvest, attachment, and growth of vascular endothelium might explain these apparent differences. Endothelial cells were harvested by standard enzymatic techniques from bovine aorta (n = 7), canine external jugular vein (n = 9), and human saphenous vein (n = 8). Growth curves were generated by means of a replicate microwell technique and then compared with the following observations: Harvest of endothelium from human saphenous vein provides a lower yield of viable endothelial cells. When compared to bovine or canine cells, the lag phase of the growth curve of human cells is prolonged and the doubling time in the growth phase is increased. These results suggest that in humans there are fewer available cells, and conditions for endothelial cell growth may be more stringent than for other species. It may be necessary to develop alternative methods of seeding before success in humans can be achieved.

Animals↗
PubMed1988

Glomerular basement membrane thickness in recurrent and persistent hematuria and nephrotic syndrome: correlation with sex and age.

The glomerular basement membranes (GBM) were measured in 264 patients with recurrent and persistent hematuria (152 males, 112 females), 47 patients with minimal change nephrotic syndrome (26 males, 21 females), and 91 patients with focal segmental glomerular sclerosis and nephrotic syndrome (55 males, 36 females). The average number of glomeruli measured was 2.5 per case. Analysis of the data showed GBM thickness to be significantly greater in males (n = 233) than in females (n = 169) (Student's t-test, P less than 0.01). There was no difference in GBM thickness between the two groups of nephrotics; the data were subsequently combined and the group referred to as idiopathic nephrotic syndrome. There was also no difference in GBM thickness among the immunofluorescence-defined subcategories of recurrent hematuria, and these groups were combined. GBM thickness was significantly greater in the idiopathic nephrotic syndrome than in recurrent hematuria (Kruskal-Wallis H test, Po = less than 0.001). Analysis of the data showed, in both conditions, a gradual increase with age throughout the span of the study (1-69 years). Regression analysis of GBM thickness and age in recurrent hematuria showed Ro = 0.43 and Po = less than 0.001, in idiopathic nephrotic syndrome Ro = 0.61 and Po = less than 0.001. The differences between nephrotic syndrome and recurrent hematuria may be based on the inclusion in the recurrent hematuria group of patients with genetically thin GBM; they may also be based on the inclusion in the idiopathic nephrotic syndrome group of patients with subendothelial thickening, a relatively frequent occurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗