PubMed Health⌕ Search

Biomedical subjects

T Asada

Publications and source records attributed to T Asada.

At least 91 records · Page 5Linked to original sources
PubMed1994

Surgical treatment of ventricular septal defect and its sequelae in adults.

We operated on 20 adult patients with ventricular septal defect (VSD). In 7 of these cases (aged 36 to 51 years, average 42.6 years), VSD was accompanied by sequelae other than pulmonary hypertension. Concomitant procedures in type-I VSD included a suspension of the prolapsed aortic cusp in 2 patients, a repair of the ruptured sinus of Valsalva in 2, and a new procedure for active infective endocarditis, described below, in 2. In this latter procedure, the aortic valve and infected Valsalva sinus were excised, and the pulmonary valve and the right ventricular wall to which the infection had extended were thoroughly debrided. The resulting defect was closed with a single patch, and a prosthetic valve was inserted in the position of the original aortic valve using this patch as part of the annulus. Another patient with the type-II VSD underwent concomitant tricuspid valve replacement for infective endocarditis. In the mean follow-up period of 77.1 months, 6 patients have been doing well in New York Heart Association class I, and the remaining patient with Valsalva repair remained in class II due to dilated cardiomyopathy.

Adult↗
PubMed1994

[Predictive factors of falls among urban community-dwelling elderly].

One hundred and three ambulatory and healthy elderly (age; 73.8 +/- 7.3 years) took part in a one year prospective study of falling. All the subjects underwent a baseline examination consisting of an interview, physical and mental examination, laboratory tests and identification of all drugs being taken. Additionally, spontaneous postural sway while standing still was measured using a computerized posturography system. Thereafter, we carried out bimonthly check-ups to obtain information about falls. During the study period, the subjects sustained 54 falls and 14 subjects fell twice or more. Multiple logistic regression analysis of selected medical and demographic variables indicated that the most influential variables regarding those who fell twice or more were a history of falling, not living alone and poor tandem gait. Although a history of falling contributed to the value of spontaneous sway while standing still, the value did not attain a statistical significance for predicting falling.

Accidental Falls↗
PubMed1994

Surgical treatment of ventricular septal defect and ruptured sinus of Valsalva associated with infective endocarditis.

Two patients with ventricular septal defect of Kirklin type I and ruptured right coronary sinus of Valsalva associated with infective endocarditis were operated on. Both had bacillus vegetation clinging to the aortic and pulmonary valves and the right ventricular intimal wall around the septal defect. Aortic and pulmonary regurgitation were also found. The surgical approach included vertical incision of the right ventricular outflow tract and pulmonary trunk and transverse aortotomy. The right coronary sinus of Valsalva showed distinct aneurysmal change in one patient. The aortic valve and infected Valsalva sinus were excised in both cases, and the pulmonary valve and right ventricular wall where infection extended thoroughly débrided. The resulting defect, including the ventricular septal defect and excised right Valsalva sinus and aortic annulus, was closed with one patch, and the prosthetic valve inserted in the position of the original aortic valve using this patch as part of the annulus. Both patients had a good postoperative course and are doing well, although slight pulmonary regurgitation persists.

Adult↗
PubMed1994

[Mitral valve replacement and right ventricular outflow repair for hypertrophic obstructive cardiomyopathy].

A 44-year-old male with hypertrophic obstructive cardiomyopathy (HOCM) was operated on. He was in NYHA class III with a chief complaint of exertional dyspnea refractory to medical treatment. Echocardiography showed asymmetric septal hypertrophy and systolic anterior movement of the mitral valve, which caused obstruction of the left ventricular outflow tract. It also showed obstruction of the right ventricular outflow tract due to septal hypertrophy. Cardiac catheterization showed a systolic pressure gradient of 70 mmHg at the LV outflow tract and that of 30 mmHg at the RV outflow tract. He underwent mitral valve replacement and patch enlargement of the RV outflow tract. Postoperative course was uneventful. Postoperative catheterization showed a remarkable decrease of pressure gradient to 10 mmHg at the both outflow tracts.

Adult↗
PubMed1994

[Development of a troublesome behavior scale (TBS) for elderly patients with dementia].

A rating scale for assessing troublesome behavior associated with dementia illnesses was developed. This instrument, named the troublesome behavior scale (TBS), is designed to be completed by family and professional caregivers. It is comprised of 14 questions assessing a variety of types of disruptive or burdensome behavior. Two of the 14 questions differ in their assessment for outpatients and that for inpatients. Each of the 14 items is rated with 5 possible responses corresponding to the frequency of the behavior in the preceding month (from 0 = never, to 4 = once every day or more). Thus, higher scores indicate more disturbance. The TBS was administered to 146 outpatients and 167 inpatients with dementia based on the DSM III-R criteria in order to test its reliability and validity. The data were analyzed separately for outpatients and inpatients. The reliability of the scale, based on calculation of perfect agreement rates and kappa values, indicated high test-retest and inter-rater reliability for both samples. Validity, by confirmatory factor analysis of the data from the outpatients, revealed three main factors, namely, "behavior toward caregivers", "self-absorbed behavior" and "elaborate behavior". The same analysis of data from inpatients resulted in a different set of three factors: "behavior interfering with care work", "behavior necessitating watchful protection" and "behavior resulting in missing articles". From these findings TBS appears to be a reliable and valid instrument for assessing troublesome behavior of patients with dementia.

Aged↗
PubMed1994

[Change of mitral regurgitation before and after myocardial revascularization--is mitral repair required for ischemic mitral regurgitation?].

In twenty seven patients, intraoperative change of ischemic mitral regurgitation before and after coronary artery bypass grafting (CABG) was assessed using transesophageal echocardiography. The size of mitral regurgitation (MR) was determined by the area of MR color flow on the doppler echocardiogram. After CABG, MR area decreased in 20 patients (average: 3.7 cm2-->1.5 cm2), unchanged in one patient and increased in 6 patients (average: 17 cm2-->2.9 cm2). The change of MR area corresponded with the change of mitral annular diameter in 23 patients but uncorresponded in 2 patients. MR areas correlated exponentially with mitral annular diameters and the fair linear relation was observed between the postoperative to preoperative ratio of MR area and the postoperative increase in mitral annular diameter with the correlation of r = 0.81. When the larger MR area or mitral annular diameter before CABG was observed, the larger MR area after CABG remained, but annular diameter before CABG had more effect on postoperative MR area. No significant correlation was found between MR area and infarcted region, revascularized region, segmental wall motion etc. In conclusion, when the moderate or marked mitral annular dilatation was found in association with prominent ischemic mitral regurgitation, mitral annuloplasty with CABG should be considered.

Adult↗
PubMed1994

[Surgical treatment of incomplete endocardial cushion defect in elderly patients].

We experienced 5 surgical cases of incomplete endocardial cushion defect who were 50 years old or older. Preoperatively, 3 cases were in New York Heart Association (NYHA) class II and 2 in class III. Catheterization study showed that systolic pulmonary arterial pressure was 24 to 48 (average; 38) mmHg and pulmonary-to-systemic flow ratio was 3.4 to 8.1 (average; 5.2). Left ventriculography showed mitral valve regurgitation (grade I-1 cases, grade II-3, grade III-1) with cleft and goose neck sign in all cases. Single atrium and patent foramen ovalis were associated in each one case. At operation, suture of mitral cleft and patch closure of ostium primum defect from mitral valve side were performed. Postoperatively, NYHA class, cardiomegaly, pulmonary arterial pressure and mitral regurgitation improved remarkably in all patients. During the follow-up period from 18 to 126 months (average; 57), right bundle branch block and supraventricular arrhythmia in electrocardiogram disappeared in 3 of 4 and 4 of 5 cases, respectively. Surgical treatment and postoperative course of incomplete ECD were reviewed in over-50-year-old patients, in reference to 17 surgical cases in Japan.

Electrocardiography↗
PubMed1994

[Development of an assessment of basic care for the demented (ABCD)].

A rating scale measuring care status related to assistance with basic ADL for demented patients was developed. This instrument, named the ABCD, is designed to be completed by family and professional caregivers, and consists of two subscales assessing the level of difficulty of help with the ADL (difficulty scale) and the reasons why assistance is needed (reason category). In the difficulty scale, each of 6 items is rated with 4 possible responses corresponding to the degree of physical assistance from the caregiver and of the patient's cooperation with the assistance. In the reason category, for 5 activities excluding voiding, the reason is assessed with the following three possible responses: A; physical disability, B; disability in motivation and/or so-called apraxia, C; a combination of A and B. The ABCD was administered to 124 outpatients and 203 inpatients with dementia based on the DSM III-R criteria in order to test its reliability and validity. The data from the out- and inpatient samples were analyzed separately. The reliability study of the two subscales based on calculation of perfect agreement rates and kappa values indicated high test-retest and inter-rater reliability for both samples. The Cronbach alpha values of the difficulty scale were also high. As to the validity of the difficulty scale, there was a significantly high correlation between the score obtained with this scale and the results of two established assessment instruments. For the outpatients, logistic regression analysis revealed that the score obtained with this scale was the only predictor of institutionalization and mortality within 1 year after the baseline examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1994

Root surface caries of denture wearers in middle-aged and elderly people.

With an increasing number of elderly people retaining natural dentition, the number of exposed root surfaces and root surface caries is increasing. A total of 100 people, aged from 38 to 86, were examined for exposed root surfaces and root surface caries. Denture wearers and non-denture wearers were examined. The following results were obtained; 1. The percentages of exposed root surfaces were significantly higher (P < 0.05) in the 60's and 70's age groups. Root surface caries showed a tendency to increase until people were in their 60's. 2. Denture wearers had more exposed root surfaces (P < 0.05) and were more likely to have root surface caries than non-denture wearers. Denture wearers showed a tendency to have more severe grades of root surface caries than non-denture wearers. 3. Concerning denture wearers, there were not significant differences in the percentages of exposed root surfaces of buccal and proximal surfaces facing edentulous space. However, proximal surfaces facing edentulous space were more prone to root surface caries than buccal surfaces (P < 0.05).

Adult↗
PubMed1993

Automatic precursor-ion switching in a four-sector tandem mass spectrometer and its application to acquisition of the MS/MS product ions derived from a partially (18)O-labeled peptide for their facile assignments.

We developed an acquisition processor unit to control MS1 and MS2 in a four-sector tandem mass spectrometer simultaneously. The magnetic field strength of MS1 corresponding to the precise centers of the precursor ions, whose masses are determined by MS1 in advance, is recalibrated using an appropriate standard just before an MS/MS experiment, which allows consecutive acquisition of the MS/MS spectra from multiprecursor ions by B2/E2-linked scanning of MS2 synchronized with automatic B1 switching to the centers of each precursor ion on MS1. The accuracy of the automatic precursor-ion switching and the efficiency of consecutive B2/E2-linked scannings were demonstrated by measurement of a peptide mixture. The new MS/MS control system was further applied to rapid acquisition of the MS/MS spectra of isotopic ions of MH+ and (M + 3)+ with normal oxygen and (18)O at the alpha-carboxyl group of a partly (18)O-labeled peptide, which can be easily prepared by enzymatic hydrolysis of a protein in buffer containing 40 atom % H2(18)O. MS/MS analysis of an (18)O-labeled peptide by the present system allowed facile and reliable assignment of MS/MS product ions to a peptide sequence. The usefulness of the method was also demonstrated by measurement of some peptides that give MS/MS product ions incidentally observed at the same mass or assignable to some incorrect sequence.

Amino Acid Sequence↗
PubMed1993

An autopsy case of coexisting portal systemic encephalopathy and senile dementia of the Alzheimer type.

An autopsy case of portal systemic encephalopathy and senile dementia of the Alzheimer type coexisting in a 77-year-old man is described. The patient had suffered recurrent episodes of delirium after a subtotal gastrectomy for gastric carcinoma. He died of DIC 45 months after the gastrectomy. A pathological examination revealed a vascular plexus around the liver which might have served as collateral circulation. Neuropathologically, spongy necrosis and Alzheimer type II changes of astrocytes were found in the basal ganglia and fronto-occipital cortices. In the same anatomical regions, only immunohistological staining using antibody against amyloid beta-protein and the periodic-acid methenamine silver method revealed abundant neuriticplaques, cerebral amyloid angiopathy and diffuse plaques. We discussed the clinicopathological findings in this case.

Aged↗
PubMed1993

Intracaval and intracardiac extension of malignant thymoma.

A case of malignant thymoma presenting as the superior vena cava syndrome is reported. A 56-year old male was admitted with superior vena cava syndrome. CT and NMR-CT scan showed a solid homogenous superior mediastinal mass; which filled the lumen of the superior vena cava and the right atrium. A biopsy of the right atrial mass showed myxoma, and operation was performed. Histopathologically the tumor was diagnosed as thymoma. Intracaval and intracardiac extension of a thymoma is very rare.

Diagnosis, Differential↗
PubMed1993

Surgical treatment of cardiac myxoma and its complications.

A total of 20 patients (15 women, five men) were operated on for cardiac myxoma. Their ages ranged from 17 to 74 (mean 56) years. Myxoma was located in the left atrium in 18 patients and in the right in two. Systemic embolism occurred in eight patients, causing cerebral infarction in three, ischaemia of the extremities in two, occlusion of the external carotid artery with cerebral infarction in one, myocardial infarction in one and pulmonary infarction in one. Five patients with severe congestive heart failure required emergency surgery. All myxomas were removed using cardiopulmonary bypass with excision of the attachment walls. Details are given of additional surgery performed on some of the patients. Two patients died, one from pulmonary insufficiency after emergency surgery and the other from an unrelated problem. The remaining 18 patients showed a good recovery and are doing well with no intracardiac recurrence, although one with cerebral infarction underwent clipping of an aneurysm, which was detected later in the infarcted area.

Adolescent↗
PubMed1993

[Aortic arch reconstruction without aortic cross-clamping using separate extracorporeal circulation].

Between March 1991 and October 1992, 21 consecutive patients underwent aortic arch reconstruction without aortic cross-clamping using separate extracorporeal circulation in combination with retrograde blood cardioplegia (Non-clamping selective cerebral perfusion). Twelve patients had true arch aneurysm, 3 had acute aortic dissection and 6 had chronic aortic dissection including 2 redo cases. Cardiopulmonary bypass (CPB) was instituted with an arterial cannula in the femoral artery and 2 cannulae in both vena cavae. When tympanum temperature was lowered to 20 degrees C by central cooling, CBP was stopped temporarily. As soon as the aortic arch was incised longitudinally together with aneurysm, flexible 12 Fr. balloon cannulae were inserted into the three arch arteries via their orifices and selective cerebral perfusion was started. The perfusion flow was kept between 0.3 L/m2/min and 0.35 L/m2/min with the pressure of catheter tip from 30 to 60 mmHg to keep tympanum temperature 18 degrees C. Heart was protected by retrograde continuous cold blood cardioplegia. During arch correction, the descending aorta was occluded by a balloon then abdominal viscera were perfused via a femoral return cannula and rewarming to 25 degrees C was started to prevent visceral organ failure and coagulopathy. The time of separate perfusion ranged 20 to 161 minutes with a mean of 99.9 minutes. Except one patient who died of pneumonia, 20 patient (95.2%) were discharged and doing well. No cerebral complication, myocardial infarction, lung bleeding and coagulopathy occurred. In order to prevent the infarction by debris and to protect vital organs, this method is reliable for aortic arch reconstruction.

Aged↗
PubMed1993

[Surgical treatment of coronary artery-pulmonary artery fistula].

We experienced 4 cases of left coronary artery-pulmonary artery fistula. Two cases had small fistulas associated with atherosclerotic coronary lesions, and the other 2 had large fistulas with aneurysmal enlargement. In the former 2 cases, ligation of the fistulas and closure of the opening of fistula into the pulmonary artery through pulmonary arteriotomy were performed together with coronary artery bypass grafting and left ventricular aneurysmectomy. In one of the latter 2 cases, the fistula arising from the anterior descending branch was ligated and the opening of fistula draining into the pulmonary artery was closed through pulmonary arteriotomy. In another case, both openings of the fistula into the anterior descending branch and the pulmonary artery were closed from inside through incision of the dilated fistula. In all 4 cases, operations were performed using cardiopulmonary bypass and retrograde coronary perfusion, which could afford good heart protection even in cases with coronary lesions and coronary steal phenomenon. All cases went an uneventful postoperative course. Postoperative angiograms showed disappearance of the fistulas in 3 cases. In one case, however, residual fistula was found because a fine fistula might be overlooked. In such a case with complicated fistulas with aneurysmal enlargement, fistulas should be examined carefully through incision of the enlarged anomalous vessels. In this paper, diagnosis, operative indication and treatment for coronary artery-pulmonary artery fistula were discussed.

Adult↗