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Biomedical subjects

A Furuse

Publications and source records attributed to A Furuse.

At least 37 records · Page 2Linked to original sources
PubMed1999

Estimation of functional liver reserve in patients before cardiac surgery using antipyrine plasma clearance test.

BACKGROUND: Hyperbilirubinemia is not uncommon and is sometimes fatal after valvular surgery. One important cause of it is a poor functional liver reserve, however, conventional tests reflect hepatic blood flow and do not offer precise evaluation of the pure functional liver reserve. Antipyrine has particular pharmacological properties, and its plasma clearance represents quantitatively the functional capacity of the liver. In this study, we measured antipyrine plasma clearance in cardiac surgical patients and evaluated the feasibility of using this parameter as a predictor of the risk of postoperative hyperbilirubinemia. METHODS: The plasma clearance of antipyrine was measured preoperatively in 40 cardiac patients undergoing mitral and/or tricuspid valvular surgery and its relations with hemodynamics or postoperative course were studied. RESULTS: Antipyrine clearance in preoperative patients was 0.365+/-0.175 (mean +/- SD) ml/min/kg, lower than the normal range (0.405+/-0.04 ml/min/kg), and showed no correlation with cardiac index, while the plasma disappearance rate of indocyanine green depended on the cardiac index. The maximum postoperative total bilirubin level showed significant correlation with antipyrine clearance (r=-0.699); this correlation coefficient was greater than that with indocyanine green (-0.477). The correlation was more prominent in patients with cardiac dysfunction. Furthermore, antipyrine clearance showed significant predictability of the duration of ICU stay. CONCLUSIONS: Antipyrine clearance provides a precise estimate of functional liver reserve which is independent of hemodynamics and predicts the risk of postoperative hyperbilirubinemia in preoperative cardiac patients.

Adult↗
PubMed1998

Developmental changes in carbonic anhydrase II in the rat kidney.

We examined the distribution and maturational changes of carbonic anhydrase I (CAI) and carbonic anhydrase II (CAII) in microdissected nephron segments of Sprague-Dawley rats. CAI and CAII proteins were measured by enzyme-linked immunosorbent assay. CAI was not detected in any nephron segment in 7-week-old rats. CAII was present in the collecting ducts, proximal tubules, and thick ascending limbs of loop of Henle in 7-week-old rats. CAII contents were significantly higher in the early proximal tubules (S1) than in second (S2) and late (S3) portions of the proximal tubules, while the contents in S1 were less than in cortical collecting ducts (CCD), outer stripe and inner stripes of the outer medullary collecting ducts (OMCDo and OMCDi). CAII content in each of S1, CCD, and OMCD of 1-week-old rats was only 14% or less of that of adults, but increased steeply during the 2nd and 3rd weeks of life, reaching almost 40% at 3 weeks of age and 97% at 7 weeks. Our results indicate that CAII is present throughout the entire nephron of the rat, and that CAII content in S1, CCD, and OMCD increases exponentially during the first 7 weeks of life. Our data suggest that the immature low levels of CAII may explain, at least in part, the limited capacity of urinary acidification during neonatal life. Further studies are necessary to establish the role of such changes in CAII content in acid-base homeostasis during neonatal life.

Animals↗
PubMed1998

Repair of ruptured anastomotic aneurysm: elephant trunk technique after endovascular covered stents.

Endovascular covered stents were successfully applied to temporarily halt hemoptysis and postpone surgical intervention in a 69-year-old man with a ruptured anastomotic false aneurysm of the distal aortic arch. Surgical graft implantation was performed successfully by the elephant trunk technique 14 days after the endovascular stent-grafting, at which time aspiration pneumonia had subsided.

Aged↗
PubMed1998

Atrial ablation with an IRK-151 infrared coagulator.

BACKGROUND: The purpose of this study was to develop a method of atrial ablation. In the IRK-151 infrared coagulator, light from a tungsten-halogen lamp is focused into a quartz rod. The distal exit plane is connected to a tip made of sapphire to allow linear ablation. METHODS: Thirty-six lesions were created in 9 mongrel dogs. The beating ventricular myocardium was ablated from the epicardium. In each dog, 4 lesions were created by using the following durations of application: 3, 9, 15, and 21 seconds. After the ablation, the myocardium was fixed and stained. A linear lesion on the beating right atrial free wall was created. Before and after the ablation, epicardial plaque-electrode mapping was performed. Three months after ablation, remapping was performed. RESULTS: The ablated myocardium had well-demarcated necrosis without carbonization or vaporization. The maximum depth was 10.3 +/- 0.8 mm. The conducting pathway was blocked. The block, once made, continued for 3 months. CONCLUSIONS: The IRK-151 produces well-demarcated lesions that were deep enough for atrial ablation to block the conducting pathway.

Aluminum Silicates↗
PubMed1998

Coronary artery bypass grafting by median sternotomy in patients with a tracheostoma.

The approach to the heart for open heart surgery in patients with a tracheostoma requires careful consideration. The presence of a tracheostoma interferes with the standard sternotomy and increases the risk of mediastinitis. We have successfully performed coronary artery bypass grafting in two patients with a tracheostoma using the limited median sternotomy and describe the surgical procedure used in these patients.

Coronary Artery Bypass↗
PubMed1998

Persistent hemolysis after coil occlusion of a patent ductus arteriosus in a patient with aortic regurgitation.

We report a rare case of hemolysis after coil occlusion of a patent ductus arteriosus (PDA), which was treated by surgical removal of the coil and closure of PDA. A 65-year-old woman was admitted to our hospital with congestive heart failure due to severe aortic regurgitation associated with PDA. Before undergoing open heart surgery she underwent closure of the PDA using a Jackson coil as an adjunct of treatment to improve her hemodynamic state. However, a small residual shunt resulted in severe hemolysis. Two weeks after the intervention she underwent aortic valve replacement and PDA closure after removal of the coil through the main pulmonary artery under moderate hypothermia and temporary circulatory arrest. Hemolysis is always secondary to a residual leak and several methods have been reported to manage this complication. Our report suggests that early surgical retrieval of the coil before the organized thrombus is formed, can be safely performed even in an elderly patient whose ductus is usually fragile.

Aged↗
PubMed1998

Oxygen utilization and hemodynamic response during exercise in children after Fontan procedure.

Eight patients, 9.1 to 16.5 years of age, were studied 2.8 to 8.5 years after Fontan operation. Oxygen utilization was determined during upright bicycle exercise. The cardiac index and stroke index were measured by echocardiography and the anaerobic threshold was determined. The results were compared with 10 patients after surgical closure of the atrial septal defect. Anaerobic threshold (AT) in Fontan patients was lower than in the control subjects. Oxygen consumption at each stage of exercise was significantly lower in the Fontan group compared with the control subjects. From the beginning of exercise until AT, the increase in stroke index was lower in the Fontan patients than in the control subjects. After that point, the stroke index decreased significantly in the Fontan patients while it remained almost at the same level in the control subjects. Significant correlations were observed between the oxygen pulses and the stroke index at AT both in the control and Fontan groups. These results suggest that impaired exercise capacity in Fontan patients is mainly due to a subnormal response of the stroke index at AT and to the decreased response of the stroke index and the heart rate at the maximal workload.

Adolescent↗
PubMed1998

[Cardiac surgery in Jehovah's Witness].

Clinical experiences of 35 cardiothoracic operations in Jehovah's Witness patients were presented with special reference to a method of taking informed consent for surgery. At first the surgeon explained the details of the proposed surgery including its risks and benefits. He should also express his confidence in accomplishing the operation without blood transfusion. Otherwise he should not dare to perform the operation. The surgeon asked the patient to talk about his or her religious belief in transfusion denial. Then the surgeon was allowed to talk about his professional duty and ethical belief in saving the patient at all costs. Finally, both the patient and the surgeon would sign the document of informed consent without fully determining whether or not the patient would undergo transfusion at an unexpected situation since the possibility of such unexpected necessity of blood transfusion was believed extremely low by both the surgeon and the patient. The trust of the patient in the technique of the surgeon was the key to this agreement.

Blood Transfusion↗
PubMed1998

[Open heart surgery in patients with a tracheostoma].

From April 1992 to May 1997 six patients underwent open heart surgery, who had tracheostoma at the time of operation. The sternum was divided completely in three patients whose tracheostoma lay highly on the neck, and it was cut transversely on the manubrium at the level of the first intercostal space, below which it was split longitudinally in two patients (partial median sternotomy). In one patient right anterolateral thoracotomy was used. There were no operative death and no complication related to infection. A left internal thoracic artery (LITA) was used successfully for a bypass conduit in two patients who underwent partial median sternotomy. Dissection of the proximal portion of the LITA through the second intercostal space prior to the sternotomy made the graft procurement feasible in this particular situation. In conclusion, full-length sternotomy is performable safely when the tracheostoma lies highly on the neck, and the partial sternotomy up to the midmanubrium is applicable, including LITA harvesting, even if it is just at the sternal angle.

Adolescent↗
PubMed1998

[Atrial septal defect and severe pulmonary hypertension in an adult who needed nitric oxide inhalation after repair].

A 51-year-old male was diagnosed as having an ostium secundum atrial septal defect with severe pulmonary hypertension. Although pulmonary artery pressure was as high as 96/32 and pulmonary vascular resistance was 14.2 U.m2, he underwent corrective surgery, because pulmonary to systemic blood flow ratio was 2.0. After he regained consciousness in ICU, pulmonary hypertensive crises recurrently occurred and the hemodynamics became quite unstable. Administration of conventional drugs proved to be ineffective. Since inhalation of low dose (3-4 ppm) nitric oxide was started, however, his condition was markedly improved and he recovered uneventfully thereafter. Two years later, pulmonary artery pressure was reduced to 52/28 and pulmonary vascular resistance was 9.9 U.m2. Although good outcome can not be expected in all surgically treated cases, we should refrain from deciding easily that surgery is contraindicated, because no criteria of surgical indication for atrial septal defect with pulmonary hypertension appears to be perfect.

Administration, Inhalation↗
PubMed1998

[Thoracoscopic decortication for chronic empyema thoracis: report of a case].

Thoracoscopic surgery for empyema thoracis treatment is still uncommon in Japan. We report a case of chronic empyema thoracis which was successfully treated with decortication through thoracoscopy. A 63-year-old man presented with respiratory distress, appetite loss and hoarseness. He had been suffering from diabetes mellitus for 13 months. His chest X-ray film revealed that he had suffered from the left chronic empyema. As the decortication procedure was feasible at the preliminary exploration, it was then performed through the thoracoscopy. The lung re-expanded well after the pleural peel was removed. His chest drainage tube was drawn out on 19th postoperative day.

Chronic Disease↗
PubMed1998

[Superimposed infective endocarditis at anterior mitral leaflet in a patient with prolapsed posterior leaflet: report of a case treated with valvuloplasty].

A 64-year-old male patient was referred to our hospital for massive mitral regurgitation after infective endocarditis. Echocardiography revealed vegetation on the atrial surface of the midst of the anterior mitral leaflet. At operation it was found that the anterior leaflet was perforated due to infection, and the posterior leaflet was prolapsed resulting from elongated chordae. Anterior leaflet was patched with autologous pericardium, and posterior leaflet was repaired with rectangler resection. An autologous pericardial strip was sutured to posterior mitral annulus. The patient survived the operation without complication.

Cardiac Surgical Procedures↗
PubMed1997

The stiffness of lymph nodes containing lung carcinoma metastases: a new diagnostic parameter measured by a tactile sensor.

BACKGROUND: It is believed that the stiffness or hardness of a lymph node containing a metastasis differs from that of lymph node without a metastasis because of the difference in tissue density, which is derived from the lymph node's histopathologic features. Prior to this study, however, there had been no attempts to quantify the hardness or stiffness of lymph nodes. The authors developed a new tactile sensor and system for measuring the stiffness (g/cm) of lymph nodes accurately, and they studied its utility as a tool for diagnosing lymph node metastases. METHODS: Clinical specimens were obtained from 14 patients who underwent lobectomy or pneumonectomy with hilar and mediastinal lymph node dissection for nonsmall cell lung carcinoma at the University of Tokyo between January and July 1996. With the tactile sensor developed by the authors, 212 resected lymph nodes were measured for their stiffness. RESULTS: Among these 212 resected lymph nodes, 57 were diagnosed as containing metastases (38 from adenocarcinomas and 19 from squamous cell carcinomas). The mean stiffness of the lymph nodes that contained metastases was 3.35 +/- 1.57 g/cm, and that of lymph nodes without metastases was 1.23 +/- 0.50 g/cm (P < 0.001). Receiver operating characteristic analysis revealed that the area under the curve was 0.93, indicating excellent accuracy of the method. When the cutoff was 1.5 g/cm, the sensitivity was 91.2% and the specificity was 78.1% for detection of lymph node metastases. CONCLUSIONS: Measurement of the stiffness of resected lymph nodes was confirmed as an accurate approach to diagnosing lymph node metastases without knowledge of other factors, such as lymph node size or color.

Aged↗
PubMed1997

Hemoptysis from an emphysematous bulla developing after open-heart surgery: report of a case.

We present herein the case of a 62-year-old woman with an emphysematous bulla who developed intractable hemoptysis 16 days after undergoing mitral and aortic valve replacement with tricuspid annuloplasty. A bronchoscopic examination with balloon occlusion of the bronchial lumen revealed that the blood source was the right middle lobe bronchus. A computed tomographic (CT) scan of the chest subsequently demonstrated a blood-filled emphysematous bulla in the right middle lobe. A right middle lobectomy was performed and the bulla was observed to be swollen with clotted blood. The respiratory tract bleeding stopped immediately after the lobectomy. Pathohistological examinations suggested that disruption of the pulmonary vessels in the wall of the bulla had caused the respiratory tract bleeding.

Aortic Valve Insufficiency↗