[Surgical treatment following administration of prostaglandin E in a ductus-dependent neonate with cyanotic congenital heart disease].
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Biomedical subjects
Publications and source records attributed to T Yanai.
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Effects of hyperbaric oxygen (HBO) on acute cerebral ischemia were studied in spontaneously hypertensive rats, which had the carotid artery bilaterally ligated. The animals were exposed to HBO (100% 02 at 2 ATA) for 30 min at 1 or 3 h after carotid ligation (treated group). Survival time and brain tissue metabolites were measured after HBO in these animals and compared with ischemic animals without HBO exposure (nontreated group). The animals treated at 3 h after ligation survived longer (6.5 +/- 0.7 h) than did nontreated ones (4.3 +/- 0.2 h) (P less than 0.05). The cerebral lactate increased much less in these treated animals (24.60 +/- 1.67 mM/kg) than in nontreated ones (31.78 +/- 1.68 mM/kg) (P less than 0.05). Cerebral ATP levels tended to decrease less in the former (0.66 +/- 0.17 mM/kg) than in the latter (0.59 +/- 0.07 mM/kg). When HBO started at 1 h after carotid ligation, however, there were no significant differences of survival time or brain metabolites between treated and nontreated groups of animals. The present results indicate that HBO administered at 3 h after brain ischemia prevents further increase in cerebral lactate and produces a slight but significant increase in survival time.
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A case of intracranial malignant teratoma found in a 27-year-old man was reported. This unique tumor was found in the right frontal lobe separated from the pineal region and revealed various tissue components such as stratified squamous epithelium, glandular tissues, neuron, glia, ependyma, fibromuscular tissue, cartilage, bone, hemangiomatous lesion, melanin-laden cells, and some germ cell components. An immunohistochemical study demonstrated the presence of S-100 protein, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), and Factor VIII in some tumourous components. In particular, the distribution of S-100 protein in some germ cells suggested the possibility of the neuroectodermal origin of the germ cells or, alternatively, differentiation to the neuroectoderm.
A case of glioblastoma arising in the pons of a 14-year-old boy in whom transsynaptic degeneration was found in the inferior olivary nucleus is reported. The tumor occupied most of the pons including the tegmental tract and invaded into the midbrain, medulla oblongata, cerebellar peduncles, thalamus, basal ganglia, and meninges. The right inferior olivary nucleus was devoid of the tumorous lesion, but many neurons were severely vacuolated. An immunohistochemical study using glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), and S-100 protein was performed. GFAP and S-100 protein were positive in the reactive glia of the nucleus and NSE gave a faint reaction in some degenerated neurons. These degenerative changes found in neurons of the inferior olivary nucleus were considered to be transsynaptic degeneration due to the destruction of the tegmental tract at the pons and of cerebellar peduncles by invasive pontine glioblastoma.
Blood pressures (BPs) were measured with standardized sphygmomanometers in 434 Japanese boys and girls living in the town of Hisayama. Simultaneously, data on pulse rate, weight and height were obtained. Out of the original 434 subjects, data were obtained repeatedly for 5 years in 280 subjects. BP levels were significantly correlated with weight in those aged 14-15 and also 19-20 years, but correlation coefficients were small. During the 5-year period, the mean systolic and diastolic blood pressure (SBP & DBP) increased significantly in both sexes, but the increments were greater in boys. Both SBP and DBP at 14-15 years of age were significantly correlated with data taken 5 years later for both sexes, and subjects with a higher initial BP (more than 90th percentile of the distribution) tended to have a higher BP after 5 years. SBPs after 5 years were independently correlated with initial SBP levels and changes in QI (D-QI) in both sexes. On the other hand, DBPs after 5 years were independently correlated with initial DBP levels and height for boys, and initial DBP levels and D-QI for girls.
Two patients with disruption of Carpentier-Edwards porcine mitral bioprosthesis presenting with a musical systolic murmur were reported. The two patients noted sudden development of a loud musical murmur 4 (Case 1) and 6.5 (Case 2) years after surgery. Case 1 had associated heart failure. Phonocardiogram disclosed a loud musical systolic murmur with regular vibrations at 230-240 Hz in Case 1, and 250-260 Hz in Case 2. In Case 1, echocardiography demonstrated fine fluttering of the porcine mitral valve at the same frequency as the murmur. Doppler echocardiography revealed characteristic Doppler signals from the porcine valves at a frequency of 250-300 Hz with several harmonics above and below the baseline. In addition, in Case 2, similar Doppler signals were obtained from the aortic walls, ventricular septum and posterior wall of the left ventricle. In both cases, left ventriculograms demonstrated grade 3 mitral regurgitation without paravalvular leakage, and at surgery, the porcine bioprosthesis showed a tear in one of markedly thinned cusps, without evidence of calcification. It was considered that a torn cusp was the source of the murmur, and this, in association with the resonance of the entire heart, produced the loud musical murmur. Thus, a musical systolic murmur is suggested to be one of important signs of dysfunction of porcine bioprosthesis.
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Long-term prognosis of borderline hypertensives was studied in a prospective population survey carried on since 1961 in the town of Hisayama, Japan. Five consecutive BP recordings on 1621 subjects aged 40 and over were obtained at entry, and the variability in BP between the first and fifth readings was taken into account when classifying the subject into categorical groups. Even with an estimated variability in BP in several measurements on one occasion, a large fluctuation in BP was observed in both the borderline hypertensives and the normotensives. Borderline hypertensives with a transient elevation in BP more frequently died from cardiovascular disease than did those without BP elevation, as estimated by the long-term cumulative mortality. However, there was no difference in the frequency of hypertension-related organ damage between these two groups at entry.
We have studied the long-term results of valve replacement operations in 591 patients, one year or more after surgery, and also analyzed rates of social return in 523 patients (response rate, 86.1 per cent) by questionnaire. Of the 591 patients, 81 patients suffered early death (mortality rate, 13.7 per cent) and 41 patients late death (mortality rate, 6.9 per cent). The causes of the latter were left atrial thrombus (18 cases), heart failure (10 cases), artificial valve failure (five cases), renal failure (two cases) and hepatic insufficiency, infection and accident (one case each). Second replacement was performed in 18 patients (3.0 per cent), 49 months on average from the first operation. The survival rate at the 12th postoperative year was 68.7 per cent. The overall rate of social return after valve replacement was 64.8 per cent, including 74.8 per cent for mitral valve replacement, 54.3 per cent for aortic and 51.5 for multivalvular. The rate of social return has been improved to 76.4 per cent in the last five years.
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