Biomedical subjects
Publications and source records attributed to T Ida.
A simple technique for minimally invasive valve operations is described. With a 10-cm midline skin incision, excellent exposure of both the mitral and aortic valves is achieved through a right-sided partial sternotomy, which enables us to perform easy repair or replacement of these valves.
We started to perform MIDCAB for the cases of markedly low cardiac function from June, 1996 and obtained satisfactory results. So we expanded the indications to include only left anterior descending artery (LAD) lesion from June, 1997 and have since performed this operation on 14 cases. The 14 cases of MIDCAB were divided into two groups, Group L consisting of 6 low risk cases: 1 lesion alone without any complications involving other organ before operation and Group H made up of 8 high risk cases: multi branch lesion but rated as high risk because of the extracorporeal circulation being used. Both Group L and Group H were free of operation death and hospital death. In Group L, all the cases underwent operation without blood transfusion, the period of postoperative stay in ICU was not longer than 1 day, on catecholamine was required after operation and complications were not found either. The patency of the graft was 100 percent. The patients were discharged 13.7 days after operation. In Group H, 2 cases required blood transfusion and 3 cases required catecholamine after operation. Complication arising from operative wound were noted in 3 cases. One GEA graft to the right coronary artery and one LITA to the LAD buried in the muscle were occluded. After operation, hospital stay for 23.9 days was required. In Group L, the postoperative course was excellent, so MIDCAB was considered indicated well for this group. In Group H too, the selection of MIDCAB was considered adequate that the risk of conventional CABG is considered much higher.
UNLABELLED: We experienced 8 cases in which Coronary Artery Bypass Grafting (CABG) was performed by the arterial graft alone with radial artery (RA) and inferior epigastric artery (IEA) used in addition to internal thoracic artery (ITA) and right gastroepiploic artery (RGEA). All the patients were male ranging in age from 50 to 66 years (mean 57.5 year). The number of anastomosis was 3 to 5 branches (mean 3.6 branches). IEA was anastomosed with LITA and used as a composite graft in all cases. As for the proximal anastomosis of RA it was anastomosesd with ascending aorta. On postoperative radiography of graft, LITA, RITA, IEA and RA were all patent and RGEA was occluded only in one anastomosis where it was sequentially used (96.6%). All the patients followed a satisfactory postoperative course, and no case developed any major complications. CONCLUSION: The use of IEA and RA made it possible to perform CABG using only the artery with excellent postoperative results and early patency rate of the graft.
Coronary artery perforation is a relatively rare complication in coronary angioplasty. We report the case of a 71-year-old male, who was salvaged by emergency surgery, for cardiogenic shock due to subepicardial hematoma associated with balloon angioplasty. Such a case has not yet previously been reported.
The main purpose of the present study was to determine whether any abnormalities in the response of fibrinolytic activity to venous occlusion could be observed in patients undergoing chronic hemodialysis (HD patients). A 10-min venous occlusion test was performed in 13 HD patients and in 9 healthy subjects. The arm opposite to the arteriovenous fistula was occluded in HD patients. The following factors were measured: tissue plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), plasmin-alpha2-plasmin inhibitor complex (PIC), stabilized fibrin degradation product (D-dimer), and von Willebrand factor antigen determined by enzyme immunoassay, and endothelin 1 by radioimmunoassay with two antibodies. Preocclusion levels of PIC, D-dimer, von Willebrand factor, and endothelin 1 were significantly higher and those of t-PA significantly lower in HD patients than in controls. During the occlusion, there was a positive correlation between the percent changes in t-PA and von Willebrand factor and between those in von Willebrand factor and PIC. There was no correlation between percent and absolute changes during the occlusion in endothelin 1 and those in t-PA, PAI-1, PIC, D-dimer, or von Willebrand factor. There was no significant difference between HD patients and controls as to the percent changes in hematocrit, t-PA, PIC, D-dimer and von Willebrand factor. HD patients demonstrated a significantly greater percent change in PAI-1 than controls. The mechanism by which endothelin 1 is released in response to the occlusion appears to differ from that for t-PA, PAI-1, and von Willebrand factor. PAI-1 may be readily released in response to stimuli to blood vessels in HD patients.
Hemolytic anemia is a well-recognized complication of mechanical heart valve prosthesis but, as yet, has not been reported after mitral valve repair with chordal replacement. We report a case of severe hemolytic anemia after mitral valve repair with chordal replacement and Carpentier-Edwards annuloplasty ring insertion. Progressive prolapse of the anterior leaflet due to the artificial chordae being too long caused recurrent regurgitation which was responsible for the hemolysis. The patient also had idiopathic thrombocytopenic purpura, but successful second mitral valve repair was performed after high-dose gamma-globulin therapy.
The histological characteristics were comparatively analyzed among biopsy specimens, surgically removed prostates and metastatic lymph nodes obtained from 60 patients with prostatic adenocarcinoma treated by radical prostatectomy. According to the WHO-Mostifi's classification, the proportion of the 6 histologic components, large and/or small simple glands (LSG), micro-glands (MIC), cribriorm (CRB), fused glands (FUS), medullary/solid (MED) and columns-cords/trabecular (C-C), was determined semiquantitatively. LSG, MIC, and CRB are androgen-sensitive components, while FUS, MED and C-C are androgen-refractory components. The proportions of 5 histologic components excluding MIC were similar in the biopsy and prostate specimens. In 78.3% of the patients, the presence (or absence) of androgen-refactory components in the biopsy specimens coincided with that in the prostate specimens. However, the histologic except for the C-C component. Metastatic lymph nodes contained androgen-refactory components in all cases and tended to have more CRB and FUS and fewer LSG. The histology of the needle biopsy specimens may reflect that of the prostate glands, and may serve as a valuable parameter for determining therapeutic modalities. In addition, androgen-refactory components are frequently present in lymph node metastasis.
Early postoperative results were studied in 50 cases of coronary artery bypass graft (CABG) using a radial artery (RA). The patients ranged in age from 37 to 81 years, with the mean age of 61 years. Of them, 49 were male. An average of RA was 17.6 cm at completion of detachment and 15.6 cm when the graft was cut for use. The internal diameter before anastomosis an average of 3.7 mm on the proximal side and an average of 2.8 mm on the distal side. RA was anastomosed with ascending aorta in 47 cases, with the left internal thoracic artery in 2 cases and with the right internal thoracic artery in one case on the proximal side. RA was anastomosed with the left anterior descending branch area in 6 cases, with the left circumflex branch area in 40 cases and with the right coronary artery area in 4 cases on the distal side. There was no case of operative death, but one patient died while in hospital. The cumulative patency rate of the RA grafts was 95% (n = 40). Early postoperative results of the RA graft were satisfactory, therefore the RA graft were satisfactory, therefore the RA graft was an excellent alternative conduit for myocardial revascularization.
BACKGROUND AND AIMS OF THE STUDY: The Carpentier-Edwards (CE) ring was developed to restore the normal 3:4 ratio between the anteroposterior and transverse diameters of the mitral valve orifice during systole. It is difficult to use in patients in whom the ratio is more than 3:4. To overcome this problem, we developed an adjustable obturator, the ratio of which may be changed by sliding apart its two components. METHODS: Remodeling annuloplasty was performed using part of a flexible Duran ring or autologous pericardium and the adjustable obturator in 17 patients with severe MR, including two with high anterior leaflet. RESULTS: Physiologic remodeling annuloplasty was easily accomplished in all cases. Intraoperative echocardiography was performed in 14 patients, and it showed no regurgitant jet in 11 cases and only trivial jet in three. CONCLUSION: Physiologic remodeling annuloplasty to retain the natural shape of the anterior leaflet by using an adjustable obturator is a very useful technique that enables annuloplasty to be performed in all cases, irrespective of the shape of the anterior leaflet.
Mortality rates associated with cardiovascular disease (CVD) are high in long-term dialysis patients. Increased levels of plasma fibrinogen (FBG), coagulation factor VII (FVII), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) as well as hyperlipidemia are regarded as important risk factors for CVD. To investigate whether there are differences in the risk of CVD between chronic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, serum lipid levels and plasma FBG, FVII, t-PA, and PAI-1 levels were measured in 17 patients on HD and 17 patients on CAPD. FBG was measured by the thrombin time method, FVII activity (FVIIc) by the chromogenic prothrombin time method, and t-PA and PAI-1 activity by the chromogenic substrate assay. No difference was found in body mass index (BMI) between HD and CAPD patients. Total cholesterol (TC), TC/high-density lipoprotein (HDL)-C ratio, low-density lipoprotein (LDL)-C, and triglycerides (TG) were significantly increased, and HDL-C was significantly decreased in CAPD patients compared with HD patients. FBG and FVIIc were significantly elevated in CAPD patients compared with controls or HD patients. T-PA activities were significantly higher in HD and CAPD patients than in controls. CAPD patients showed significantly higher PAI-1 activities than controls or HD patients. Significant positive correlations were found between FBG or FVIIc and TC, between FBG and LDL-C or TG, and between FVIIc and LDL-C in these patients. T-PA showed significant negative correlations with FBG, PAI-1, TC, LDL-C, and TG. There was a significant positive correlation between PAI-1 and TG and a significant negative correlation between PAI-1 and HDL-C. We conclude that CAPD patients may have a greater risk of CVD than do HD patients, and that coagulation and fibrinolytic activity are correlated with lipid disorders in these patients.
To clarify the role of thromboxane A2 (TxA2), endothelin-1 (ET-1) and endothelin-3 (ET-3) in the progression of glomerular injury in accelerated nephrotoxic serum nephritis (NTN) in the rat, we studied the expression of ET-1 and ET-3 at the kidney by immunohistochemical method and examined the effect of a novel TxA2 receptor antagonist, S-1452. The S-1452-treated group showed significantly lowered 24-hr proteinuria and milder glomerular cell proliferation and lobulation than the non-treated group (NT group) on experimental day 10. There was no significant difference in the glomerular polymorphonuclear cell (PMN) exudation between the 2 groups. Immunofluorescent findings revealed that ET-1 and ET-3 were seen along the glomerular capillary wall and partly in the mesangial area in all rats of the NTN group. The degree and positive rate of ET-1 and ET-3 staining were significantly higher in the NTN group than in the S-1452 group. These findings suggest that TxA2 may be an important mediator in the development of NTN, and that TxA2 receptor antagonist may be useful for the reduction of glomerular injury in this type of nephritis. In addition, local production of ET may contribute to the development of this nephritis.
This study describes the use of the polymerase chain reaction (PCR) to detect the tet(K) and tet(M) tetracycline resistance genes in Staphylococcus aureus. Primers based on the DNA sequence of the tet(K) and tet(M) genes from S. aureus were used as primers in the PCR assay to detect the presence of genes for resistance to tetracycline and minocycline. Two-hundred and fifteen isolates of S. aureus from Asian countries as Japan, Indonesia, China, Korea and Thailand were examined, and the results confirm that tet(K) specifies resistance to tetracycline but not to minocycline and tet(M) specifies resistance to both tetracycline and minocycline. We observed two different types of clinical isolates of S. aureus strains resistant to minocycline and tetracycline: the first carried only the tet(M) gene, while the second carried both the tet(M) and the tet(K) genes. Almost all of the clinical isolates of S. aureus resistant to minocycline and tetracycline from Indonesia, China and Thailand carried both tet(M) and tet(K) genes, while most of clinical isolates of S. aureuss from Japan and Korea carried only tet(M) gene.
To circumvent the problems associated with a dilated aortic annulus we first reduced the diameter of the annulus with a short section of Dacron graft and then implanted a smaller size homograft within the graft. This procedure was successfully performed for complete homograft aortic root replacement in a 25-year-old man with severe aortic insufficiency due to a dilated aortic annulus. The indication for homograft replacement can thus be widened, even to patients with a dilated aortic annulus.
The success rate of surgical treatment for blowout type free wall rupture of the left ventricle following myocardial infarction has been reported as 4 to 24%. A 64-year-old woman was admitted to our hospital for inferior acute myocardial infarction with cardiogenic shock. In the catheter laboratory, her hemodynamics disclosed electro-mechanical dissociation, and we had to perform an emergent operation there. In order to preserve left ventricular volume and reduce the risk of bleeding, we adopted a modified method using both patch and felt strip sandwich methods which obtained favorable result. The patient was sent to a rehabilitation hospital on the 43rd post operative day because of a mild cerebral complication and she is now doing well with only a slight speaking disturbance at a follow-up period of 10 months.
To shed light on the role of thromboxane A2 (TXA2) in renal injury, we evaluated the effects of S-1452, a TXA2 receptor antagonist, on rats with streptozotocin (STZ)-induced diabetic nephropathy and murine lupus nephritis. In STZ diabetes rats (n = 6), urinary protein excretion significantly increased from 8 weeks and was about 5 times as much as that in normal rats at 10 weeks after induction of diabetes. In S-1452-treated rats (n = 6), increase in urinary protein was rarely observed and was significantly inhibited at 8 and 10 weeks after induction of diabetes. In (NZB x NZW)F1 mice, no proteinuria was detected in vehicle controls (n = 20) and S-1452-treated mice (n = 20) from 0 to 8 weeks after initiation of S-1452 treatment. Proteinuria was observed in 3, 7 and 8 mice in the control group, and 0, 2 and 5 mice in the S-1452 group at 12, 16 and 20 weeks after initiation of S-1452 treatment, respectively. Proteinuria developed more slowly in S-1452-treated mice than in vehicle controls. In conclusion, TXA2 receptor antagonist, S-1452, suppresses the progression of renal injury.
Partial amino acid sequences of a soluble protoporphyrinogen-oxidizing enzyme (PPO) purified from tobacco cultured cells were identified. The sequences of two regions of the soluble PPO corresponded to the acid/base catalysis and heme binding regions of plant peroxidases. Anti-soluble PPO IgG cross-reacted with these plant peroxidases. Thus, the soluble PPO seems to be a kind of peroxidase.
Between July 1991 and January 1995, 74 patients with pure mitral valve regurgitation (MR) underwent mitral valve plasty (MVP) at out institute. Our procedure includes chordal replacement of the anterior leaflet with PTFE sutures (42 patients). There were one hospital death (1.4%) and two late deaths (2.7%) in this series. Only 2 patients (2.7%) needed valve replacement after unsatisfactory repair during the same operation. Late postoperative doppler echocardiographic study (mean follow-up, 12.0 months) showed less than mild regurgitation in 66 patients (95.7%) of 69 patients who are alive. In April 1993 we decided to complete the repair with no or only trivial regurgitant flow by intraoperative transesophageal echodoppler study (TEE). The results have remarkably improved. Late postoperative echodoppler study revealed less than mild reguritant flow in all 49 patients having undergone mitral valve repair with no or trivial regurgitation by intraoperative TEE. It is clear than the TEE study has contributed to the better quality of mitral valve plasty, and we believe that it is important for better long term results to complete mitral valve plasty with no or only trivial regurgitant flow.
Aortic valve replacement combined with enlargement of the valvar ring by the Nicks method and coronary artery bypass grafting via the left internal thoracic artery were performed for an 11-year-old girl with occlusion of the left coronary ostium. The left coronary sinus was covered with membranous tissue, so the left coronary ostium was not found. Aortic valve replacement with 21 mm prosthetic valve was possible by enlarging the valvar ring. The internal thoracic artery which is expected to grow with development of the body was used as the graft.