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Biomedical subjects

T Asada

Publications and source records attributed to T Asada.

At least 127 records · Page 7Linked to original sources
PubMed1992

[Clinical appraisal of myocardial protection for coronary artery bypass grafting--efficacy of retrograde continuous cold blood cardioplegia].

Myocardial protection is one of the most important problems during coronary artery bypass grafting in patients with severe coronary artery disease. In this communication we have demonstrated retrograde continuous cold blood cardioplegia (RC-CBCP) in such cases with preferable results. In this study myocardial protection for CABG surgery was evaluated from the points of the myocardial distribution of cardioplegic solution, the changes of the value of myocardial enzyme, the recovery of cardiac function after unclamping of the aorta, and the results of operation [mortality and incidence of perioperative infarction (PMI)]. The effects of myocardial protections were compared among the following 4 groups: group-A (n = 38) where antegrade cardioplegia with 10 ml/min of CBCP was used; group-R (n = 52), retrograde cardioplegia with 10 ml/min of CBCP; group-Rm (n = 59), retrograde cardioplegia with 7-8 ml/100 g LVMW (left ventricular mass weight)/min of CBCP; group-Rmt (n = 65), RC-CBCP with terminal warm blood cardioplegia (TWB). Judging from myocardial temperature measured at the end of initial cardioplegic infusion, the myocardial distribution of cardioplegic solution in group-R was significantly favorable even in the distal area of severe coronary artery stenotic lesions exceeding 90% compared with group-A. The recovery of cardiac function assessed from the incidence of occurrence of spontaneous beating and the dose of cathecholamine at the weaning of cardiopulmonary bypass were most excellent in group-Rmt among the 4 groups. There was no significant difference in postoperative peak CK-MB and LDH-1 isoenzyme levels among the 4 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Two cases of hypertrophic obstructive cardiomyopathy (HOCM) treated with mitral valve replacement].

The first patient was a 60-year-old female who had suffered from several episodes of cardiac failure due to severe mitral regurgitation and HOCM. The patient underwent urgent MVR because she had cardiac tamponade due to left ventricular perforation during cardiac catheterization. The second patient was a 64-year-old female with a history of several cardiac failures. The patient had an operation because she had been symptomatic under medical treatments. She underwent MVR instead of myectomy due to relatively thin ventricular septum. Both of them are doing well after the operations in NYHA class I. Although myotomy and myectomy are preferable procedure for HOCM as a first choice, MVR should be considered for the patients who have severe mitral valve regurgitation or the thin interventricular septum.

Cardiomyopathy, Hypertrophic↗
PubMed1992

[Retro-TH catheter for retrograde coronary sinus perfusion].

Retrograde coronary perfusion via the coronary sinus for myocardial protection can be performed more safely and exactly with Retro-TH catheter (3 way balloon catheter) which was originally designed. In addition, this catheter can be useful for selective cerebral perfusion in patients with aortic aneurysm involving aortic arch and for selective visceral and renal perfusion in patients with thoracoabdominal aneurysm. From January 1987 to March 1992, we performed 735 open-heart surgery, 12 surgery for aortic arch aneurysm and 6 surgery for thoracoabdominal aneurysm with the aid of this catheter and obtained satisfactory results.

Catheterization↗
PubMed1992

[A case of subglottic tracheal stenosis following tracheostomy successfully treated with laryngo-tracheal anastomosis].

A 77-year-old male patient underwent laryngo-tracheal anastomosis for subglottic tracheal stenosis. He developed exertional dyspnea 10 month after tracheostomy. Anterior and lateral wall of the cricoid cartilage and the first two tracheal cartilages were resected, preserving the recurrent laryngeal nerves. The distal trachea was anastomosed to the thyroid cartilage primarily and tracheostomy was made at 6th tracheal ring. Postoperatively, anterior flexion of the neck was maintained for a week. Oral intake was started on the 2nd postoperative day. The patient showed smooth recovery. The important points of this operation are: 1) preoperative evaluation of the residual subglottic space, 2) intraoperative care for preservation of the recurrent nerves, especially at the lateral sides of the crycoid cartilage, and 3) postoperative maintenance of the cervical anterior flexion.

Aged↗
PubMed1992

[Surgical treatment of active infective endocarditis and prosthetic valve endocarditis].

Fifteen patients with active native valve endocarditis (NVE) and 5 with prosthetic valve endocarditis (PVE) were subjected to this study. Among the patients with NVE, one of 10 with simple destruction of leaflets and 2 of 5 with annular infection died postoperatively of cerebral bleeding and persistent infection. Five patients with annular infection, whose microorganisms were Streptococcus faecalis, Staphylococcus epidermidis and gram-negative coccus, had a shorter duration from onset to operation (mean 38 days) compared with the others (mean 85 days). A patient with NVE requires an urgent operation, especially when these microorganisms are identified. Among those with PVE, 3 underwent operation at the active phase and one at the chronic phase. Two patients with mechanical valve endocarditis by Staphylococcus and Candida died, but the other 2 with bioprosthetic valve endocarditis by alpha-Streptococcus survived, because infection was localized in the leaflets. Another patient with mechanical valve endocarditis by alpha-Streptococcus survived with conservative management. While a patient with bioprosthetic valve endocarditis requires an early operation as well as NVE, a patient with mechanical valve endocarditis requires selected management considering the microorganism and general condition.

Adult↗
PubMed1991

The effects of TFC-612, a 7-thia prostaglandin E1 derivative, on platelet function.

The anti-platelet activities of TFC-612, methyl 6-(((1R, 2S, 3R)-3-hydroxy-2-((1E, 3S, 5R)-3-hydroxy-5-methyl-1-nonenyl)-5- oxocyclopentyl) thio)hexanoate, were compared to prostaglandin E1 (PGE1). TFC-612 inhibited human, guinea-pig and rabbit platelet aggregation induced by ADP, collagen or epinephrine with potency 1-8 times that of PGE1. TFC-612 also inhibited thrombin induced (14C) serotonin release in rabbit platelets. Platelet aggregation was dose dependently inhibited 1 hr after oral administration of TFC-612 (0.32-1.0 mg/kg) and the inhibition lasted up to 6 and 24 hours at 0.32 and 1.0 mg/kg, respectively, in guinea-pigs. In contrast, PGE1 had no effect with oral administration at a dose of 3.2 mg/kg. TFC-612 (0.32-3.2 micrograms/kg, i.v.) induced platelet disaggregation of thrombi on Achilles tendon in the extracorporeal shunt model in cats. In addition, TFC-612 (1 mg/kg, po) inhibited the adhesiveness of guinea-pig platelets to a glass bead column ex vivo. TFC-612 increased cyclic AMP (cAMP) levels in rabbit platelets. Thus, the anti-platelet action of TFC-612 may be due to an increase in cAMP levels. These results indicate that TFC-612 might be an orally active anti-thrombotic drug.

Alprostadil↗
PubMed1991

The effects of TFC-612, a 7-THIA prostaglandin E1 derivative, on platelet function.

The anti-platelet activities of TFC-612, methyl 6-(( 1R,2S,3R)-3-hydroxy-2-((1E,3S,5R)-3-hydroxy-5-methyl-1-nonenyl)-5- oxocyclopentyl) thio)hexanoate, were compared to prostaglandin E1 (PGE1). TFC-612 inhibited human, guinea-pig and rabbit platelet aggregation induced by ADP, collagen or epinephrine with potency 1-8 times that of PGE1. TFC-612 also inhibited thrombin induced (14C) serotonin release in rabbit platelets. Platelet aggregation was dose dependently inhibited 1 hr after oral administration of TFC-612 (0.32-1.0 mg/kg) and the inhibition lasted up to 6 and 24 hours at 0.32 and 1.0 mg/kg, respectively, in guinea-pigs. In contrast, PGE1 had no effect with oral administration at a dose of 3.2 mg/kg. TFC-612 (0.32-3.2 micrograms/kg, iv) induced platelet disaggregation of thrombi on Achilles tendon in the extracorporeal shunt model in cats. In addition, TFC-612 (1 mg/kg, po) inhibited the adhesiveness of guinea-pig platelets to a glass bead column ex vivo. TFC-612 increased cyclic AMP (cAMP) levels in rabbit platelets. Thus, the anti-platelet action of TFC-612 may be due to an increase in cAMP levels. These results indicate that TFC-612 might be an orally active anti-thrombotic drug.

Administration, Oral↗
PubMed1991

[Analysis of breakdown in family care for patients with dementia].

Although it has been stressed that patients with dementia should be cared for at home, family care seems to break down sooner or later. On the other hand, the number of demented patients is now increasing at a far greater rate than can be handled by institutions for the elderly. For these reasons, the appropriate use of social resources is now being emphasized. As early as 1960, Macmillan pointed out that the emotional relationship between an elderly patient and the relative responsible for him determines whether family care will breakdown, and stressed the importance of troublesome behavior in this relationship. Since then, researchers have studied the problem of troublesome behavior in demented patients and the burden that this creates for relatives nursing them. Such studies have stressed that the support of caring relatives is indispensable for the community care of demented patients. In the present study an attempt was made to analyze in detail the breakdown of family care for demented patients. To facilitate systematic study, we complied a pair of check lists containing criteria of troublesome behavior and care burden, adapted from the Disability and Handicap criteria of the WHO. For the purpose of the study, we regarded troublesome behavior as Disability, and care burden as Handicap. The subjects were 40 demented patients and their respective main carers, who had requested institutional care. Before the breakdown, the author had been in charge of all of the patients. The mean period of patient observation was 12 months. At the point when the decision of institutionalization was made by family members, visits were made to each patient-carer pair, and the check lists were used to assess troublesome behavior and care burden. In order to clarify the features of the subject group, the author also visited and examined another 30 patient-carer pairs, who still lived in their home communities, between June and September, 1990. The mean period of observation for these patients was 18 months. There were no significant differences in sex, diagnosis, duration of illness, cognitive function, or number of physical complications between the two groups. No significant difference was found in the total score for the behavior check list between the two groups. In contrast, however, there was a significantly higher score for the burden check list representing those caring for the patients in the study group. Furthermore, it was revealed that social activity, individual free time and familial interaction, as well as many emotional and physical aspects, were more severely affected in the subject carers. This result appeared to confirm that the care burden itself, rather than troublesome behavior is responsible for breakdown. In all of the 70 pairs analyzed, a significant correlation was found between the total score for the behavior check list and that for the burden check list. The result of this study highlighted several new emerging problems. One serious problem is that of patients driving by themselves. In addition, many of carers reported recurrent falls by the patients. As to the problems faced by carers themselves, an appreciable number had been forced to give up their jobs to devote themselves to patient care. In general, female carers with husbands younger than 65 years reported economic distress. Additionally, unlike the situation in most western reports, as many as 43% of the main carers in this study were daughters in law. These problems faced by carers seem to be common in Japan, and are perhaps characteristic of Japanese society.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1991

[Pressure monitoring of the coronary sinus during retrograde cardioplegia].

Though the retrograde perfusion via the coronary sinus is a useful way of myocardial protection for more complicated cardiac surgery, coronary venous injury and inadequate preservation of the right ventricle were considered to be disadvantageous. In order to deal effectively with these problems we made a 3-way balloon catheter (Retro-Higami type 12 Fr) and evaluated the importance of monitoring the perfusion pressure in the coronary sinus in 214 patients. The mean perfusion pressure during retrograde cardioplegia infused by a pump was 29.4 +/- 9.1 mmHg, and had significant relation to the left ventricular mass weight (LVMW) which was calculated by UCG method. High perfusion pressure above 40 mmHg, which could have induced coronary venous injury, was noticed in 24 patients, but proper countermeasures could avoid venous injury completely. In 16 of those the high perfusion pressure was due to inadequate position of a tip of the catheter, and in other 8 it was due to relatively high flow rate of cardioplegic solution to LVMW. Twenty-eight patients showed low perfusion pressures below 20 mmHg, due mainly to the leakage from the orifice of the coronary sinus. The coronary sinus pressure during continuous gravity retroperfusion which was 9.2 +/- 2.6 mmHg seemed to bring optimal delivery of cardioplegic solution to the myocardium. On the basis of the results obtained from this clinical study we conclude that the monitoring of coronary sinus pressure during retroperfusion is useful not only to avoid coronary venous injury but to maintain adequate perfusion.

Adult↗
PubMed1991

[Emergent coronary artery bypass grafting (CABG) for over-80-year-old patients].

We experienced 2 emergent CABG for over-80-year-old patients. First patient, an 81-year-old male, showed total occlusion of left main truncus (LMT) and 90% stenosis of right coronary artery (RCA), and fell in shock. He underwent PTCA for LMT under intraaortic balloon pumping (IABP) and recovered from shock. But 3 days later, pulmonary congestion and heart failure developed along with mitral regurgitation. Emergent CABG to left anterior descending branch (LAD) and RCA was performed using saphenous vein grafts in combination with mitral annuloplasty by Kay's method. Second patient, an 82-year-old male, showed 50% stenosis of LMT, 99% stenosis of LAD and total occlusion of RCA, and fell in shock. Emergent CABG to LAD and RCA was performed using saphenous vein grafts under IABP. In spite of some perioperative serious complications, both patients survived and have been doing well. Some problems of CABG for elderly patients were discussed.

Aged↗
PubMed1991

[Analysis of problems in patients over 70 years of age undergoing open-heart surgery for ischemic heart disease].

The operative results of ischemic heart disease in 102 patients over 70 years of age were compared with the results in 296 patients under 70 years, operated on between January 1985 and February 1991. The incidence of emergent or urgent operations increased significantly with the increase of age (under 64 yrs; 29% of 217 patients, 65 to 69 yrs; 46% of 79, 70 to 74 yrs; 49% of 70, over 75 yrs; 75% of 32) and the mortality rates increased accordingly (5.9%, 11.3%, 15.7%, 37.5% respectively). The mortality rate of isolated coronary artery bypass grafting over 70 years was significantly higher than under 70 years. The mortality rate of mechanical complication after myocardial infarction increased in the patients over 70 years. The incidence of postoperative complication in the patients over 70 years was higher and infectious (11%), pulmonary (10%) and embolic (9%) complications were prominent among others. The tendency of increase in the in-hospital expenses was seen with the increase of age. Although elderly patients have increased morbidity and mortality, particularly when operated on emergency or urgently, survivors quality of life are excellent and justify continued performance of open-heart surgery in the patient over 70 year of age.

Age Factors↗
PubMed1991

[A case of bilateral multiple pulmonary arteriovenous fistula treated by the right fistula plication and resection of the left lingual lobe with use of microwave tissue coagulator (MTC)].

A 53-year-old man with the history of brain abscess and multiple cerebral arterio-venous malformations underwent the staged operation for bilateral multiple pulmonary arterio-venous fistulas (PAVF). Right fistula plication and the resection of the left lingular lobe using MTC were performed through posterolateral thoracotomy. Postoperatively, the patient showed the right residual fistula, but, he has been doing well without PAVF complications such as polycythemia and hypoxemia. In conclusion, 1) PAVF with central nervous system complications should be treated aggressively either by surgery or by embolization. 2) MTC was useful for the resection of the lung because of no air leak and bleeding coming from the resected section.

Arteriovenous Fistula↗
PubMed1991

[Aorto-caval fistula due to rupture of abdominal aorto-iliac aneurysm--a case report of successful repair].

A 62-year-old man who had complained of swelling of bilateral lower extremities, exertional dyspnea and jaundice for 3 months was referred to our hospital with a diagnosis of large abdominal aneurysm and congestive heart failure. His aortography and Doppler echocardiography revealed that he had the aorto-caval fistula due to rupture of abdominal aorto-iliac aneurysm. He underwent a reconstruction of abdominal aorta with woven Dacron bifurcation graft together with a closure of fistula with 3 mattress sutures. The postoperative course was uneventful and he is free from any symptoms. Problems of diagnosis, operative management and results are discussed, reviewing the previously reported cases in Japan.

Aorta, Abdominal↗
PubMed1991

[Continuous hemofiltration vs hemodialysis for the acute renal failure after cardiovascular surgery].

Recently we have performed continuous hemofiltration (CHF) for the patients of acute renal failure after cardiovascular surgery. In this article, we discuss the effectiveness of CHF in the acute phase of renal failure after cardiovascular surgery compared with hemodialysis (HD). CHF group included 12 cases, and HD group included 19 cases. Two cases (16.7%) of CHF group and two cases (10.5%) of HD group were survived and discharged from hospital. Filtration volume of CHF (93.8 +/- 81.0 l) was significantly higher than that of HD (27.1 +/- 22.9 l), but filtration rate of CHF (410 +/- 87.4 ml/H) was significantly lower than that of HD (572 +/- 167 ml/H). Thus CHF removed excess water more gently and effectively than HD. Because the influence to the hemodynamics of CHF was much less than that of HD, we were able to start CHF (4.3 +/- 4.6 days after operation, BUN: 55.3 +/- 19.5 mg/dl), Cr: 3.95 +/- 0.63 mg/dl) significantly earlier than HD (7.8 +/- 4.1 days after operation, BUN: 113.1 +/- 29.4 mg/dl, Cr: 6.10 +/- 1.04 mg/dl). We needed high dose catecholamine or blood transfusion for the 11 cases (57.3%) of HD group during HD, but we needed them for only 1 case (8.3%) of CHF group. We concluded that CHF was safer and more useful than HD in the treatment of acute renal failure after cardiovascular surgery.

Acute Kidney Injury↗
PubMed1991

[Aortitis syndrome with aortic regurgitation and bilateral coronary ostial stenosis].

A 17-old-male was admitted to our hospital with the chief complaints of anterior chest oppression and syncope. His aortography showed severe aortic regurgitation with annular dilatation, and his coronary angiography revealed 90% stenosis of the left coronary ostium and total occlusion of the right coronary ostium. Because his symptoms increased in spite of steroid therapy during 2 weeks, aortic valve replacement with 25 mm SJM prosthetic valve and coronary artery bypass grafting using internal thoracic artery (IHA) and gastroepiploic artery (GEA) were performed at acute stage. Postoperative course was almost uneventful. Postoperative angiography showed graft patency and no evidence of perivalvular leakage. This is, to the best of our knowledge, the first report of coronary reconstruction using IHA and GEA for coronary disease associated with aortitis syndrome.

Adolescent↗
PubMed1991

[A case report of pulmonary sequestration (Pryce I) associated with infective endocarditis].

We experienced a case of pulmonary sequestration of Pryce type I associated with infective endocarditis (IE). A 19-old-man had prolonged high fever of 39 degrees C against antibiotic therapy. He was referred to our hospital because of the positive blood culture and abnormal echocardiographic findings, which were severe aortic regurgitation with vegetations clinging the aortic cusps. In addition, his chest X-ray film showed mass lesion behind the cardiac shadow, and continuous murmur was auscultated on this portion. The left pulmonary arteriography revealed no arterial distribution to the left lower lobe, while aortography showed an aberrant artery arising from the descending aorta entering into this lobe. One month after aortic valve replacement for IE, left lower lobectomy and amputation of the aberrant artery were performed successfully. Pathologically, inflammatory changes of the aortic valve and proliferations of intimal and medial wall of the aberrant artery were shown. However, alveo-bronchial structure of the resected lobe was normal. Diagnosis, complications and surgical management of pulmonary sequestration were discussed.

Adult↗