Biomedical subjects
Publications and source records attributed to A Fukui.
We report 2 cases of lattice corneal dystrophy type III and gelatinous drop-like corneal dystrophy predominantly manifested in one eye. These 2 corneal dystrophies are found frequently in Japan. The case of lattice corneal dystrophy type III is the second, and the case of gelatinous drop-like corneal dystrophy is the first report at this time.
Lactated Ringer's solution was prepared, in which concentration of potassium was either 10 or 20 mEq.l-1, and that of glucose was 1.4%. Each preparation was infused into 10 patients who underwent surgical operations under general anesthesia. Effects of this fluid therapy on changes in serum potassium and blood sugar were studied comparing with infusion of lactated Ringer's solution in which concentration of potassium was 10 mEq.l-1, and glucose was 0.7%. Both serum potassium and blood sugar levels were maintained within normal ranges with the lactated Ringer's solution containing 20 mEq.l-1 of potassium and 1.4% of glucose. On the other hand, the former tended to decrease and the latter tended to increase with the lactated Ringer's solution containing potassium 10 mEq.l-1 and glucose 1.4%. We consider that the homeostatic effect with the lactated Ringer's solution containing 20 mEq.l-1 of potassium and 1.4% of glucose would be to lower blood glucose level by concomitant intracellular influx of potassium and glucose. Therefore these high potassium lactated Ringer's solutions balanced adequately with glucose are useful for fluid therapy during surgical procedure under general anesthesia.
We analyzed left ventricular (LV) pulsus alternans in 49 patients with hypertrophic cardiomyopathy during cardiac catheterization. LV pulsus alternans was noted in 6 of 17 patients with hypertrophic obstructive cardiomyopathy, 5 of whom already showed intraventricular pressure gradient at rest. No patient with hypertrophic non-obstructive cardiomyopathy had LV pulsus alternans. Pulsus alternans was neither observed in the right ventricle nor in the pulmonary artery. There was little, if any, pulsus alternans in a low pressure LV chamber (subaortic portion) and peripheral artery during LV pulsus alternans in a high pressure chamber. LV end-diastolic pressure also remained unchanged during LV pulsus alternans, except in one case. It is suggested that LV pulsus alternans in hypertrophic obstructive cardiomyopathy may imply LV dysfunction associated with increased afterload.
To assess left ventricular (LV) diastolic function in patients with LV dysfunction, LV pressures (manometer tip) and biplane angiograms were analyzed for 27 patients with LV systolic dysfunction (EF < or = 0.45) (dilated cardiomyopathy or coronary artery disease) and 18 normal controls. LV volumes were obtained from frame-by-frame analyses of angiograms. LV relaxation was assessed by the time constant (T) of LV pressure decay. LV relaxation was impaired in patients with LV dysfunction, however, early diastolic filling assessed by the peak filling rate (PFR) and mean filling rate (MFR) during the rapid filling phase was maintained. Compared to the control group, early diastolic filling was significantly decreased in patients with LV dysfunction without mitral regurgitation (MR), but not in those with LV dysfunction with MR. In conclusion, although diastolic filling may be modified by MR, LV relaxation and early diastolic filling are essentially impaired in patients with LV dysfunction.
Lactated Ringer's solutions, whose concentration of potassium was 10 or 20 mEq.l-1, were infused into 10 and 9 patients undergoing surgical operations under general anesthesia, respectively. Effects of these fluid therapies on serum potassium and blood sugar were studied comparing with the effect of infusion of regular lactated Ringer's solution. A decrease in serum potassium concentration seen with the regular lactated Ringer's solution during the surgery was minimized with the lactated Ringer's solutions of 10 or 20 mEq.l-1 of potassium. With the lactated Ringer's solutions of higher concentrations of potassium, an increase in blood sugar level, which was noted with the regular lactated Ringer's solution, was not observed although all the lactated Ringer's solutions contained 0.7% of glucose. Furthermore, base excess remained at a normal level in patients of high potassium groups, but it decreased in patients of the regular potassium group. Lactated Ringer's solutions of high potassium levels are useful to maintain serum potassium and glucose levels at more normal levels during surgical procedures under general anesthesia.
We described the anesthetic management of a 24-year-old woman with Sjögren's syndrome, complicated by systemic lupus erythematosus, rheumatoid arthritis and renal tubular acidosis. She not only had hepatorenal dysfunction associated with this condition, but also had allergic reactions to various antiphlogistics and sedatives. In selecting anesthesia for the present case, care was taken to choose anesthesia that would cause no aggravation of the injured hepatorenal function. Application of nitrous oxide and isoflurane for the induction and maintenance of anesthesia enabled us to a control the patient without special problems. Artificial nose and belladonna were also used for the treatment of dryness of the respiratory and digestive systems and other mucosae. With regard to the patient's allergic predisposition, simple medications were used with sufficient care.
Synovial osteochondromatosis of the hand is uncommon, except for tenosynovial chondromatosis of the digits. It is even more rare in the wrist joint. A patient with synovial osteochondromatosis of the distal radioulnar joint that involved the triangular fibrocartilage complex is described. At operation, synovectomy, excision of osteochondral bodies, and removal of the entire triangular fibrocartilage complex was done. The triangular fibrocartilage complex was reconstructed using part of the extensor carpi ulnaris tendon. One year after operation, the patient had regained almost full range of motion and is without pain.
From May 1958 to May 1987, 331 digits were replanted successfully with an overall survival rate of 86.2%. Complete success in replantation of amputated fingers requires an accurate anastomoses of both arteries and veins. However, anastomosis between arteries may not be possible in some patients. Since reports that a thumb amputated at the interphalangeal joint area could be successfully replanted by an arteriovenous shunt on the palmar side, we did arteriovenous shunts in four such cases. Two replantations were successful; necrosis developed in the other two patients.
Explore the source record for details and available documents.
In previous studies using rabbit ears, total venous perfusion flaps (TVPF) were used that did not contain in the experimental model any chosen arteries truly representative of clinical venous flaps. We discovered that the TVPF could survive even under conditions of poor blood circulation. In the present study, conditions of the recipient veins were investigated using flow-through veins in TVPFs of rabbit ears and human dorsal digital veins. The research suggested that conditions for TVPF survival are a high density of the venous network in the flap and the presence of venous oscillation, high oxygen tension, and effective blood flow in the recipient vein.
In free tissue transfer, the recipient arteries and veins are often damaged by injury, and their lumens are often narrowed due to thickening of the intima. These factors are considered paramount in the poor success rate of free tissue transfers. In the reported study, the authors examined the effects of continuous intraarterial infusion with heparin and urokinase in experimental epigastric flap transfer. By intraarterial infusion, the drug concentration at the target site could be significantly increased. The viability of an epigastric flap transferred to a recipient site with thickened arterial intima was significantly improved in a rabbit model by a seven-day continuous local intraarterial infusion of heparin at 10 U/kg/hr and urokinase at 100 IU/kg/hr, compared with control or intravenous infusion. Use of an anticoagulant with a fibrinolytic enzyme is considered to be the best choice for a successful outcome in flap transfer.
To assess left ventricular (LV) diastolic function in idiopathic restrictive cardiomyopathy (IRCM) and amyloid restrictive cardiomyopathy (ARCM), we analyzed LV cineangiograms and pressures (tip manometer) in two patients, one with IRCM and the other with ARCM. LV volume and instantaneous rate of change of volume were derived from frame-by-frame analyses of angiograms. LV relaxation was assessed by the time constant of isovolumic pressure decay. LV compliance was evaluated by the pressure-volume relationship. From these analyses, we conclude as follows: (1) In restrictive cardiomyopathy (RCM), LV diastolic dysfunction may be characterized by impaired relaxation and decreased compliance; (2) LV diastolic filling was minimally impaired or normal in both conditions; (3) The ventricular diastolic pressure wave form of "dip and plateau" seemed not to be a characteristic sign in RCM.
We examined silent myocardial ischemia in diabetics by treadmill exercise testing. There were 28 diabetic men and 64 diabetic woman without angina, with a mean age of 59 +/- 11 years. Symptom-limited treadmill exercise testing was performed, and we used the electrocardiogram during exercise and immediately after exercise for judgement. ST segment depression was defined as positive if there was at least 0.1 mV of ST depression 80 ms from the J point. It was defined as negative if max heart rate (HR) was more than 80% of target HR and there was no significant ST depression. It was defined as equivocal if there was no significant ST depression but max HR was less than 80% of target HR. In 92 diabetics, 21 patients (23%) showed positive ST depression, 35 (38%) showed negative ST depression, 36 (39%) showed equivocal ST depression. In 56 diabetics exclusive of treadmill equivocal patients, 38% of patients showed positive ST depression. Treadmill positive diabetics had a significantly higher rate of smokers, patients with hypertension, and a higher triglyceride level as compared with treadmill negative diabetics. Coronary arteriography, which was performed in six treadmill positive diabetics, revealed coronary stenosis of more than 75% in four patients.
Coronary artery fistula and coronary artery-cardiac chamber shunts were observed in 16 cases out of 462 consecutive cases in which coronary angiography was performed. 9 of these cases had coronary artery fistula, 5 of the cases had coronary artery-cardiac chamber shunts. 2 cases had both of these conditions. Coronary artery fistula has a draining vein originating from the coronary artery and an entering vein terminating in the cardiac chamber or the pulmonary artery. Coronary artery-cardiac chamber shunts have no such veins, and contrast material used in the injection phase of coronary angiography escapes directly into the cardiac chamber. 2 cases of coronary artery fistula, 2 cases of coronary artery-cardiac chamber shunts, and 1 case involving the both of these conditions showed positive results in submaximal exercise tolerance tests, and no significant arteriosclerotic changes in the coronary artery. These factors lead us to suggest that coronary artery-cardiac chamber shunts cause cardiac ischemia for the same reason that coronary artery fistula does.
A large neurofasciocutaneous flap that consisted of a peroneal flap and a segment of sural nerve was used in the simultaneous reconstruction of a large soft tissue and nerve defect caused by a crushing injury of the distal forearm. A 10 x 15 cm peroneal flap, including a 10 cm segment of sural nerve, was successfully transferred to an 8 x 12 cm skin defect, reconstructing a 5 cm defect of the median nerve. Two years after repair, the opponens pollicis muscle showed good contraction, although palmar abduction of the thumb remained poor. Static two-point discrimination was 20 mm on the pulp surface of both thumb and index finger and 15 mm on the middle finger.
Venous drainage of musculocutaneous grafts prepared on the backs of rats survived successfully by preserving the draining vein. Even in musculocutaneous flaps, venous drainage at the distal part of the flap plays an important role in a successful take. An experiment was prepared in a rat model in which the iliolumbar veins were utilized as the draining veins, and musculocutaneous flaps, 4 x 10 cm in size, were created. In this experiment, it was shown that even in random pattern musculocutaneous flaps, necrosis can be prevented by preserving the draining vein.
From May 1958 to May 1987, 428 upper extremities were replanted, with an overall survival rate of 87.4 percent. With the aim of increasing the survival rate a new method was tried. Unlike conventional continuous intravenous infusion, a Teflon catheter (28 gauge) was inserted into the proximal main artery of the anastomosed artery, and a daily dose of 80 ml comprising 240,000 U of urokinase, 40 micrograms of prostaglandin E1, 10,000 U (maximum) of heparin, and low molecular weight dextran was administered by means of continuous infusion for the 10 consecutive days, during which arterial thrombosis is likely to occur. Thirteen cases (replantations and damaged digital arteries) survived without any re-operation for arterial thrombus. There were statistically significant differences (p less than 0.025) in platelet count, fibrinogen, and AT III preoperatively and three days postoperatively. There were also statistically significant differences (p less than 0.05) in prothrombin time, partial thromboplastin time, and clotting time between pre-operative measurements and those taken four and 15 hr postoperative, but those data remained within normal range. No abnormalities were present in the arteries through which the catheter was inserted, as validated by postoperative digital subtraction angiography.
Recently, the pedicled venous flap and "flow-through" venous flap have been the focus of increasing attention for skin defects of the fingers and hands. For successful venous flap use, the following approaches have been suggested: (1) a pedicled venous flap with preservation of the draining veins alone; (2) a "flow-through" flap with preservation of a flow-through vein in the flap; and (3) an arterialized "flow-through" venous flap which ensures arterial blood flow into the flap. Based on findings that venous blood is helpful in flap survival, the authors made use of the first two flap types, the pedicled venous flap and the "flow-through" venous flap and attempted to establish and clarify reasonable conditions for flap survival. Venous pressure of the finger and elbow was measured and venographies of the finger and hand were also carried out. The following conditions are regarded as essential in successful venous flap procedures: (a) use of a venous flap with a rich venous network; (b) preservation of many "flow-through" veins; (c) harvesting a pedicled venous flap where the veins have afferent (reversed) venous pressure; and (d) anastomosing veins of the "flow-through" flap with recipient veins where high efferent venous pressure exists and differential pressure is observed. Clinical cases are presented and the authors attempt to explain flap failure from previously unknown causes. Conditions for flap harvesting are also discussed.