Biomedical subjects

S Takamoto

Publications and source records attributed to S Takamoto.

At least 19 recordsLinked to original sources

PubMed2003

Ex vivo gene transfer of basic fibroblast growth factor improves cardiac function and blood flow in a swine chronic myocardial ischemia model.

We previously reported adenovirus-mediated ex vivo gene transfer of basic fibroblast growth factor (bFGF) as a new treatment for leg ischemia. This time, we tested this method on a swine myocardial ischemia model, seeking the possibility of its application for ischemic heart disease. An ameroid constrictor was placed around the proximal left circumflex branch of pigs to induce myocardial ischemia. Simultaneously, a skin section was harvested and fibroblasts were cultured. Fibroblasts were then infected with adenovirus vector containing a bFGF cDNA with a secretory signal sequence (bFGF group, n=8) or a LacZ cDNA (control group, n=8). At 28 days after constrictor implantation, 2.5 x 10(6) fibroblasts were administered into each of the right and left coronary arteries. The injected fibroblasts accumulated in the myocardium without causing myocardial ischemia. Echocardiography, electromechanical mapping and coronary arteriography were conducted just before and 28 days after fibroblast injection, and regional left ventricular myocardial blood flow was measured 28 days after fibroblast injection. These evaluations revealed that the bFGF group exhibited significant development of collateral vessels and improvement of myocardial contraction in the ischemic area compared with the control group. We believe that this method is a promising treatment strategy for ischemic heart disease.

Adenoviridae↗

PubMed2003

[Semi-automatic suturing device for minimally invasive cardiac surgery].

Semi-automatic suturing device for minimally invasive cardiac surgery (MICS) was developed. Exchange of the needle is attained by an automatic grasping action and the needle shift parallel to the long axis of the device. This device (5 mm in diameter) can be inserted through a 5 mm trocar. This new device facilitates not only operative procedure such as mitral valve replacement and patch closure during MICS but conventional cardiac surgery.

Cardiac Surgical Procedures↗

PubMed2003

[Aortic valve replacement in a renal transplant recipient].

A 65-year-old male was admitted to our hospital for surgical treatment of congestive heart failure with aortic regurgitation. He had received renal transplantation 15 years before in the United States, and had been under immunosuppressive regimen with ciclosporin and mycophenolate mofetil. Although the renal allograft function had been gradually deteriorating, and preoperative serum creatinine level was 1.8 mg/dl, and it decreased to 1.5 mg/dl after aortic valve replacement. Cryopreserved aortic allograft was needed for the aortic valve replacement. The reasons are; the patient may need hemodialysis (HD) or retransplantation of the kidney in the future, and the immunosuppressive therapy for kidney will provide good immunologic environment for second allograft, i.e.--aortic valve. He tolerated the operation well and the immunosuppressive agents were continued in the perioperative period. He is now in New York Heart Association (NYHA) class I.

Aged↗

PubMed2002

Hepatic vein-to-azygos vein connection in a patient with interrupted inferior vena cava.

Massive systemic-to-hepatic venous collaterals developed in a 8-year-old boy with left isomerism and azygos connection of the inferior vena cava who had undergone total cavopulmonary shunt leaving the hepatic vein connected to the common atrium 5 years previously. A hepatic vein-to-azygos vein connection via an autologous pericardial roll successfully ameliorated cyanosis and physical activity. Hepatic vein-to-azygos vein connection is technically easy and is favorable in providing balanced distribution of hepatic venous blood to both lungs. We recommend this technique as an effective alternative to hepatic vein-to-pulmonary artery connection in patients developing collateral vessels after total cavopulmonary shunt.

Azygos Vein↗

PubMed2002

Mediastinitis after percutaneous dilatational tracheostomy.

In our experience, PDT after total arch replacement, especially after dissection of neck vessels, should be approached with caution. A long skin incision that allows discharge to drain from the wound and a sufficiently long postoperative tracheostomy period to allow tissue healing in the neck are necessary for prevention of mediastinitis.

Aged↗

PubMed2002

[Metastatic sternal tumor from thyroid papillary carcinoma; report of a case].

A 68-year-old male was referred to our department for treatment of a metastatic sternal tumor in the manubrium sterni. Primary lesion was papillary carcinoma of the left lobe of the thyroid gland. Total thyroidectomy, cervical lymph node dissection, resection of manubrium sterni with concomitant resection of bilateral clavicles, 1st ribs and 2nd ribs, and chest wall reconstruction using Marlex Mesh were performed on January 29, 2001. Considering relatively good prognosis and good response to multimodality therapy, surgical resection of sternal metastatic lesion from differentiated thyroid cancer seems to be a choice of therapy as a part of multimodality approach, including surgery, radioiodine and external radiation therapy, to thyroid cancer with systemic spread.

Adenocarcinoma, Papillary↗

PubMed2001

Hemodynamic responses to intrapleural insufflation with hemipulmonary collapse.

BACKGROUND: The hemodynamic effects of carbon dioxide (CO2) insufflation with hemipulmonary collapse were studied in consecutive thoracoscopic harvests of the left or right internal mammary artery (IMA), which were used for video-assisted coronary artery bypass grafting. METHODS: Thirty-eight patients (30 male, eight female) with a mean age of 69.5 +/- 11.5 years were selected, and 33 left and five right IMA were harvested thoracoscopically. After hemipulmonary collapse was established by single-lung ventilation, low-flow (2-3 L/min) CO2 was delivered at a constant intrapleural pressure of 8-10 mmHg. Using electrocardiography, a radial arterial catheter, a Swan-Ganz catheter, and transesophageal echocardiography, we obtained values for seven hemodynamic variables. Baseline data were collected during bilateral lung ventilation. Each variable was then measured during hemipulmonary collapse and insufflation. The significance of any changes was established with Student's t-test after correcting for baseline differences. RESULTS: Insufflation facilitated IMA harvest by expanding the pleural space between the anterior chest wall and heart. Mean insufflation times were 40.8 +/- 12.2 min on the left and 33.5 +/- 8.5 min on the right. Significant increases from the baseline values were observed in the mean central venous pressure (L:4.7-9.0 mmHg, R: 5.1-14.0 mmHg, p < 0.05), the pulmonary arterial pressure (L: 11.3-17.3 mmHg, R: 12.1-19.9 mmHg, p < 0.05), and the pulmonary capillary wedge pressure (L: 7.2-10.5 mmHg, R: 6.5-10.0 mmHg, p < 0.05). On the right, but not on the left, slight decreases were noted in the mean arterial pressure and cardiac index (71.3-62.6 mmHg, 2.01-1.76 L min-1 m-2, p < 0.05). CONCLUSIONS: The hemodynamic effect resulting from one-lung collapse plus low-flow CO2 insufflation at 8-10 mmHg for 30-40 min is mild in both hemithoraces, although the impact is greater on the right.

Aged↗

PubMed2001

Determination of acrolein by headspace solid-phase microextraction gas chromatography and mass spectrometry.

We developed a headspace solid-phase microextraction (headspace SPME) method to measure acrolein in human urine. This new technique resolves some problems with the headspace gas chromatography and mass spectrometry (GC-MS) method which we developed previously. With the original method, a column and a filament were damaged by the injection of air. A 0.5-ml urine (or phosphate-buffered saline) sample in a glass vial containing propionaldehyde as an internal standard was heated for 5 min. The SPME fiber (65 microm carbonwax-divinylbenzene fiber) was exposed to the headspace and then inserted into a GC-MS instrument in which a DB-WAX capillary column (30 m x 0.32 mm, film thickness 0.5 degrees m) was installed. The total analysis time was 15 min. The inter-assay and intra-assay coefficients of variation were 10.07 and 5.79%, respectively. The calibration curve demonstrated good linearity throughout concentrations ranging from 1 to 10,000 nM. The headspace SPME method exhibits high sensitivity and requires a short analysis time as well as the previous method. We conclude that this method is useful to measure urinary acrolein.

Acrolein↗

PubMed2001

Thoracoscopic surgery and conventional open thoracotomy in metastatic lung cancer.

BACKGROUND: We performed a retrospective comparison of the oncological outcome of thoracoscopic surgery for pulmonary metastasis with that of conventional open thoracotomy. METHODS: The patient population for our retrospective comparison was comprised of 45 patients undergoing pulmonary resections via video-assisted thoracoscopy (thoracoscopy group) and 55 undergoing similar resections by open thoracotomy (open group) for pulmonary metastases between 1994 and 1999. RESULTS: Solitary metastasis was resected more frequently with thoracoscopy than open thoracotomy. There were no significant intergroup differences in rates of local recurrence from the initial pulmonary resection site. The actuarial 1-year, 2-year, and 3-year survival rates were, respectively, 82.8%, 70.0%, and 62.3% in the thoracoscopy group and 93.6%, 64.6%, and 52.7% in the open group. The rates of pulmonary recurrence and survival also did not differ significantly between the two groups with solitary metastases. CONCLUSION: Thoracoscopic surgery for metastatic lung disease appears to be feasible as long as the preoperative metastatic tumor evaluation using chest computed tomography (CT) is accurate.

Actuarial Analysis↗

PubMed2001

Eight novel mutations of the FBN1 gene found in Japanese patients with Marfan syndrome.

Marfan syndrome (MFS), an autosomal dominant connective tissue disorder, is caused by mutations in the gene encoding fibrillin 1 (FBN1). The clinical spectrum and severity of MFS disorder varies greatly both between and within families. Since there have been only a few reports on the relationship between FBN1 genotypes and clinical phenotypes in Japanese patients, the FBN1 gene was analyzed in 27 Japanese patients diagnosed with MFS. The nucleotide sequence of the 65 exons of the FBN1 gene was analyzed by PCR and direct sequencing. We have identified six polymorphisms and nine mutations including: four missense mutations (C1652Y, Q2054P, D2127Y, C2221R) in six patients, three nonsense mutations (R215X, S813X, R2220X) in three patients, and two frameshift mutations (2567insT, 7790insT) in three patients. Six of these nine mutations were in the calcium-binding epidermal growth factor-like domains all causative mutations detected except for C2221R were novel. It has been reported that the severe phenotypes of infantile MFS correlate with mutations in the mid region of FBN1, however, mutations were not detected in this region in the population analyzed in this study. Our results suggest that the location of the mutation is not the sole determinant of phenotypic severity; rather there is some difference in the genetic basis of MFS between Japanese and Caucasian populations.

Adolescent↗

PubMed2001

Effects of lung metastasectomy on respiratory function.

OBJECTIVE: The effects of lung metastasectomy on respiration were evaluated. SUBJECTS: From 1961 to 1999, 203 patients underwent lung metastasectomy. Of these, 102 patients who had undergone only partial lung resection, had undergone sufficient respiratory function testing, and had not suffered from other lung disease were included. RESULTS: Unilateral thoracoscopic surgery caused less decrease in percent vital capacity than surgery through a posterolateral thoracotomy, in both the early (rate of decrease: 16.2 +/- 9.1 vs. 33.0 +/- 12.0%, p < 0.01), and the late postoperative period (2.0 +/- 4.5 vs. 17.8 +/- 6.0%, p < 0.0001). Two thoracoscopic operations caused less decrease in percent vital capacity than 2 operations through a posterolateral thoracotomy (21.3 +/- 13.8 vs. 61.1 +/- 8.1%, p = 0.02). Bilateral metastasectomy through a median sternotomy caused less decrease in percent vital capacity than that through posterolateral thoracotomies (45.5 +/- 13.7 vs. 60.8 +/- 8.8%, p < 0.05). Four (36%) of 11 patients who had undergone 3 or more metastasectomies exhibited dyspnea of degree 3 or higher on the Hugh-Jones classification. CONCLUSIONS: Thoracoscopic metastasectomy and metastasectomy through a median sternotomy caused less restrictive respiratory dysfunction than metastasectomy through a posterolateral thoracotomy. Since metastatic lung disease often necessitates repeated metastasectomy, and repeated metastasectomy often causes severe restrictive respiratory dysfunction, metastasectomy should be performed with a less invasive procedure.

Adult↗

PubMed2001

Tonsillar metastasis from large cell carcinoma of the lung.

A 52-year-old female was referred to our department for treatment of a left lung tumor, 80 mm in diameter, arising in the left S1 + 2. The patient's chief complaint was persistent dry cough and spiking fever. Left upper lobectomy with hilar and mediastinal lymph node dissection (ND2a) was performed, and the pathological diagnosis was primary large cell carcinoma of the lung, p-T3N0M0. At one week after being discharged, the patient visited our outpatient clinic complaining of a sore throat. A tumor in the right tonsil was discovered, and excisional biopsy revealed it to be metastasis from the large cell carcinoma of the lung. Right cervical lymph node metastasis was also detected, and the patient was treated by combined chemo-radiotherapy, resulting in a complete remission.

Carcinoma, Large Cell↗

PubMed2001

Indication and perioperative management for cardiac surgery in patients with liver cirrhosis. Our experience with 3 patients.

Three patients with noncardiac Child A cirrhosis underwent cardiac surgery. All survived surgery, but 2 died during follow-up periods. A 61-year-old woman who underwent successful double valve replacement died of diabetic coma and severe acidosis due to intestinal necrosis 18 months later. A 57-year-old woman who underwent successful mitral valve replacement died of liver failure induced by heart failure 9 years later. A 45-year-old man who underwent coronary artery bypass grafting is doing well 18 months after discharge. Proper perioperative management, including high-flow cardiopulmonary bypass, pharmacological and mechanical circulatory support, and mechanical respiratory support prevented further, potentially lethal, hepatic dysfunction, leading to good early surgical results. We concluded that patients with Child A cirrhosis could tolerate cardiac surgery. Subsequent surgical results, however, were unsatisfactory, and more careful follow-up is necessary to obtain better late results.

Cardiac Surgical Procedures↗

PubMed2001

Midterm results after aortic valve-sparing operation.

OBJECTIVES: We have conducted aortic valve-sparing operation for patients having aortic root dilatation and almost normal aortic valve leaflets since August 1998, and here report midterm results. METHODS: Patients with dilated aortic annulus or Marfan's syndrome were treated with reimplantation, and the remaining patients with remodeling. Either 24 or 26 mm graft was selected based on aortic annular diameter and leaflet size. Aortic valve competence was assessed regularly with echocardiography. RESULTS: Five patients (age: 29 +/- 13 yr), including 4 with Marfan's syndrome, had undergone reimplantation, and 3 (age: 46 +/- 18 yr) remodeling by December 2000. Mean follow-up was 18 (range: 10-32) months, and no postoperative death has occurred and no reintervention has been required thus far. All the patients in the remodeling group showed only a small pressure gradient through the aortic valve and decreased left ventricular diameter. Two in the reimplantation group showed a pressure gradient exceeding 20 mmHg. Two Marfan's syndrome patients in the reimplantation group showed slightly increased diastolic left ventricular diameter and 3 slightly increased systolic left ventricular diameter. Although aortic regurgitation had diminished in all patients by discharge, moderate aortic regurgitation recurred in 1 non-Marfan's syndrome patient in the reimplantation group because of degenerated aortic valve. CONCLUSION: Although postoperative aortic valve function was not perfect in all patients undergoing reimplantation, midterm results after aortic valve-sparing operation were generally satisfactory. Proper selection of patients, procedures, and graft size was thought to be important to ensure a favorable surgical outcome.

Adolescent↗

PubMed2001

Malignant fibrous histiocytoma in the anterior mediastinum.

The origin of a malignant fibrous histiocytoma in the anterior mediastinum is rare. A 71-year-old man was referred to our department for treatment of a tumor 15 cm in diameter originating in the anterior mediastinum. Malignant fibrous histiocytoma was suspected after a percutaneous needle biopsy. Systemic screening showed no other organ involvement, and the tumor was considered to be a primary mediastinal tumor. The tumor, resected through a median sternotomy, was well encapsulated and resection was complete. The pathological diagnosis was malignant fibrous histiocytoma originating in the anterior mediastinum.

Aged↗

PubMed2001

Hemolysis after mitral valve replacement with mechanical valve prostheses.

OBJECTIVE: We evaluated effects of type, size, and orientation of mechanical mitral valve prostheses on hemolysis. METHODS: Subjects were 84 patients who had undergone mitral valve replacement. Lactate dehydrogenase was mainly used as a marker of hemolysis and was measured before surgery, 1 month after surgery, and in the late postoperative period. RESULTS: Valves used included 16 Medtronic-Hall, 32 St. Jude Medical, and 36 CarboMedics valves. Medtronic-Hall valves caused less hemolysis than St. Jude Medical or CarboMedics valves in the late postoperative period. This resulted because hemolysis due to Medtronic-Hall valves was more severe 1 month after surgery than in the late postoperative period and because hemolysis due to St. Jude Medical or CarboMedics valves was more severe in the late postoperative period than 1 month after surgery. One reason for this finding is that cardiac output was greater in the late postoperative period than 1 month after surgery, making regurgitation through the pivots of bileaflet valves more severe. The orifice area and the orientation of prostheses did not affect hemolysis. CONCLUSION: St. Jude Medical or CarboMedics valves caused more severe hemolysis than Medtronic-Hall valves in the late postoperative period.

Aged↗

PubMed2001

Primary low-grade B-cell lymphoma in mucosa-associated lymphoid tissue of the lung.

A 67-year-old asymptomatic woman was referred to our department for treatment for a left lung tumor. The tumor was 40 mm in diameter and was present in the left lower lobe. A primary low-grade B-cell lymphoma in the mucosa-associated lymphoid tissue of the lung was suspected after a trans-bronchial lung tissue biopsy. Systemic screening revealed no other organ involvement, and the tumor was considered to be a primary lung tumor. A left lower lobectomy with hilar and mediastinal lymph node sampling was performed. Pathological examination revealed centrocyte-like cells that expressed CD20. These cells had invaded the bronchiolar epithelium to form lymphoepithelial lesions. The pathological diagnosis was confirmed to be primary low-grade B-cell lymphoma in the mucosa-associated lymphoid tissue of the lung. The origin of this tumor type in the lung is relatively rare.

Aged↗

PubMed2001

Extended repair of thoracic aorta through left thoracotomy after aortic root replacement.

A patent distal false lumen after repair of type A aortic dissection often poses serious late complications. We present a successful repair of dissecting aortic aneurysm through left thoracotomy, extending from the ascending to descending thoracic aorta after composite graft replacement of the aortic root. Although staged operations, including the elephant trunk procedure, are usually chosen for remaining extensive aortic disease after replacement of the aortic root or the ascending aorta, a single-stage repair from the ascending to the descending thoracic aortas through left thoracotomy can be a favorable option to treat a patient with this type of aortic disease.

Adult↗