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Biomedical subjects

A Hashimoto

Publications and source records attributed to A Hashimoto.

At least 343 records · Page 19Linked to original sources
PubMed1989

[Two cases reports of neurologic complications after aortic aneurysm operation].

Two cases with dissecting aortic aneurysm of DeBakey type IIIb were treated by graft replacement of the descending thoracic aorta under temporary bypass (Heparinized Hydrophilic Polymer shunt tube) with concurrent somatosensory evoked potential (SEP) monitoring. The SEP was unchanged during operation in both cases, and three sets of intercostal or lumbar arteries were reattached in case 2. In case 1 anterior spinal artery syndrome occurred below the fourth thoracic level (T-4) and right side hemiplegia immediately after the operation. Case 2 had normal neurological function initially after recovering from anesthesia but showed Brown-Séquard syndrome below the first lumbar level (L-1) two days later. In both cases, neurologic disturbance gradually recovered, 19 months postoperatively, case 1 can walk with assistance, and case 2 is able to resume his former activity. The probability of the prevention of neurologic deficits is discussed.

Aortic Dissection↗
PubMed1989

[A patient with olivopontocerebellar atrophy combined with sleep apnea syndrome].

A 52-year-old man with olivopontocerebellar atrophy was admitted to Ehime University Hospital for examination of sleep apnea. Overnight polysomnographic study revealed that his sleep apnea was predominantly the central type. With progress of the disease, the dominance of apnea pattern changed from the central type to the obstructive type. After tracheostomy, the apnea index decreased from 15 per hour to 12.4 per hour. However, the apnea index of the central type increased from 1.5 per hour to 12.4 per hour. These findings suggest that the effect of tracheostomy is not always beneficial in sleep apnea, and that the frequency and the pattern of apnea are not always indicators of tracheostomy.

Humans↗
PubMed1989

[Cardiac surgery in chronic dialysis patients: usefulness of continuous ambulatory peritoneal dialysis (CAPD)].

Eleven chronic dialysis patients underwent cardiac surgery in the past six years. Six of these cases had coronary artery disease, three had valvular heart disease and the other two had congenital heart disease. Of those 11 patients, 5 cases were successfully maintained on CAPD in the pre- and post-operative period. The remaining 6 patients were treated with hemodialysis before the operation and received intermittent peritoneal dialysis or hemodialysis following cardiac surgery. Intraoperative hemodialysis was carried out in 9 cases under cardiopulmonary bypass. There was one early death of low cardiac output syndrome, and two patients died of brain hemorrhage in the late post-operative period. Both of the latter two had hypertension and were maintained on hemodialysis under anticoagulant therapy. The other 8 are doing well and 5 of them are on CAPD. These results suggest that the procedure without anti-coagulation and/or CAPD should be chosen for the cardiac operation of chronic dialysis patients with hypertension.

Adult↗
PubMed1989

[A review of surgical treatment of aneurysms of the aorta].

During 23 years, from 1965 to August 1988, 264 patients with thoracic and thoracoabdominal aortic aneurysms including dissecting aneurysms were operated upon, and the overall operative mortality was 19.1%. Before the midst of 1972, the surgical mortality was 55%, but after the midst of 1972 it was 13.1%, and for the most recent 5 years it was only 7.8%. Experiences of the surgical treatment of true aneurysms of the each segments of the aorta, ie, ascending, transverse arch, descending thoracic, and thoracoabdominal, as well as the surgical treatment of the dissecting aneurysms, were reviewed. Factors contributing to the progress in the surgical treatment of the aortic aneurysms were 1) graft inclusion technique in which Bentall's procedure was included, 2) improved cardioplegic technique, 3) temporary long external bypass, 4) left heart bypass with a Biopump without total body heparinization, 5) deep hypothermia, and 6) open distal anastomosis for the transverse arch replacement. At the present time, there are several problems to be solved, that are further improvement of surgical treatment of the dissecting aneurysms of the aorta, prevention of the postoperative hemiplegia, and further improvement of the long term results after surgical treatment of aneurysms of the aorta.

Aortic Dissection↗
PubMed1989

[Mitral insufficiency due to ruptured chordae tendineae--clinical features, early and late results of valve replacement and repair].

To evaluate the early and late results of mitral valve replacement and reconstruction for mitral insufficiency due to ruptured chordae tendineae respectively, 74 consecutive cases were analyzed. Fifty-five (74.3%) of the patients were men, and the mean age was 48 +/- 12 years old (range 16 to 76). The causes of the mitral disease were idiopathic in 50 (67.6%), rheumatic in 7 (9.4%) and infective endocarditis in 11 (14.9%) patients. In idiopathic 50 cases, 24 had mitral valve prolapse and 16 had both mitral valve prolapse and hypertension. Forty-one (55.4%) of the patients were in NYHA functional class III or IV preoperatively. Thirty (40.5%) cases underwent surgery within one year after their initial symptoms of heart failure onsets including six emergency operation cases due to uncontrollable acute lung edema. Chordae to anterior mitral leaflet were ruptured in 31 (a5, m16, p10)[41%] patients, to the posterior mitral leaflet in 45 (a4, m23, p18)[59%], and to both leaflets in one patient. Mitral valve replacement was performed in 68 patients (91.9%) and 6 patients (8.1%) underwent mitral valve repairs. Twenty cases underwent associated procedures that included tricuspid valve annuloplasty in 8, aortic valve replacement in 5 and myocardial revascularization in 4 cases. There were two operative deaths (2.4%); both occurred after replacement, left ventricular rupture in one and DIC in one. Mean follow-up period was 4.5 years (range 1 to 17) in 67 cases. There were four late deaths; all occurred after replacement. However five patients sustained mild mitral insufficiency after mitral valve repair including one that became worse of regurgitation three years after isolated Kay's annuloplasty, there were no cases that had needed reoperation and no late death after reconstruction. Left ventricular function and pulmonary arterial pressure were almost normalized in more than 90% cases postoperatively. Our data indicated that mitral valve reconstruction (McGoon's plus Kay's method as standardized maneuver) was the procedure of choice for selected patients with mitral insufficiency owing to ruptured chordae tendineae to the posterior mitral leaflet, including more limited patients with ruptured chordae to the anterior mitral leaflet.

Adolescent↗
PubMed1989

[Clinical study on the effects of assist bypass on left ventricular contractility].

This study was undertaken to evaluate the effects of circulatory support on cardiac function in 7 patients. They were 2 men and 5 women with of age 34-54 years; Six patients underwent mitral valve replacement and one had mitral valve plasty. End-systolic pressure/volume (ESP/ESV) representing left ventricular contractility was measured just before ECC starting and after cardiac beating began in the process of rewarming. Measurements were repeated at every, interval of 10 minutes up to 60 minutes. ESP/ESV (mmHg/ml) [% of that before ECC] were as following; before ECC: 1.69 +/- 0.68 (mean +/- SD) [100], after 10 minutes; 0.40 +/- 0.24 [25.1 +/- 13.8], after 20 minutes; 0.52 +/- 0.26 [31.5 +/- 12.9], after 30 minutes; 0.77 +/- 0.28 [47.6 +/- 10.5], after 40 minutes; 0.97 +/- 0.26 [60.5 +/- 11.3], after 50 minutes; 1.18 +/- 0.46 [70.6]8.0], after 60 minutes; 1.36 +/- 0.56[80.4 +/- 12.7]. It took 39.6 minutes to recover up to 69% of that before ECC. These data suggested that the myocardial ischemia associated with aortic cross clamping continued for at least 60 minutes after cardiac beating resumed. We concluded that assist bypass should be applied to those who could not be weaned from ECC despite adequate use of catecholamine and volume loading.

Adult↗
PubMed1989

[A case of WPW syndrome with slow Kent documented by ATP injection].

A 46-year-old woman with chest tightness and palpitation at exercise was admitted to Sapporo Medical College Hospital for the evaluation of the ST-T changes on stress electrocardiogram. In this patient, PQ time was 0.14 second and pre-exitation was not clearly documented on electrocardiogram at rest. Bolus injection of 10 mg of adenosine-5'-triphosphate (ATP) demonstrated deltawave through the elongation of antegrade conduction of atrio-ventricular (AV) node. Electrophysiological study also showed left lateral accessory pathway with slow antegrade conduction, slow Kent. Stress 201-T1 myocardial scintigraphy using bicycle ergometer did not show the existence of ischemic region in spite of the ST-T changes on electrocardiogram. In this case, it seemed that a false positive ST-T changes might be caused by ventricular pre-exitation through slow Kent fiber. From these findings, it was suggested that the transient interruption on conduction through AV node by ATP bolus injection may be a useful diagnostic method in borderline pre-exitation syndrome.

Adenosine Triphosphate↗
PubMed1989

[A case of intra-ventricular dissociation with dual ventricular tachycardia].

A 63 year old woman with chronic heart failure was admitted to our hospital for palpitation attack on 26th Apr 1988. The patient was died by cardiogenic shock and recurrent ventricular fibrillation 12-hours after admission. The autopsy revealed diffuse myocardial fibrosis and disarray which was compatible with dilated cardiomyopathy. The electrocardiogram on admission showed a peculiar wide QRS tachycardia with atrioventricular dissociation. After intravenous injection of 400 mg of procainamide, the QRS was separated into two types. The one type was left bundle branch block (LBBB) type with right axis deviation (type A), which was similar as that documented on Jan 1985, and the other was LBBB with normal axis (type B). Each wide QRS tachycardias were sustained independently and simultaneously either with RR 440 msec. or with RR 600 msec as if they were dissociated intraventricularly. The different wide QRS tachycardia documented on Feb 1986 was suspected as the fusion beats with type A and the QRS resembling type B. Although ventricular tachycardia with beat-to-beat changes of QRS morphology was generally regarded as bidirectional tachycardia, double foci were considered as origins of the two types of wide QRS tachycardia simultaneously observed in this patient.

Cardiomyopathy, Dilated↗
PubMed1989

[Malfunction of the Björk-Shiley valve prosthesis due to disc defacement--report of two cases of successful reoperation].

Derlin-disc model Björk-Shiley valve prosthesis was reoperated due to the disc defacement. One had admitted cerebral embolism which was suggested due to the prosthetic valve malfunction of aortic position and the other had congestive heart failure due to the malfunction of mitral position. These patients had implanted Derlin-disc model Björk-Shiley valve prosthesis in the aortic and mitral position 10 and 11 years ago. One's cineangiocardiography showed mild aortic regurgitation and the other showed mitral regurgitation due to the malfunction of the prosthesis. The episode of cerebral embolism in one patient was suggested due to the malfunction of aortic prosthetic valve, and congestive heart failure in the other patient was due to the malfunction of mitral prosthetic valve. These prostheses which removed at the reoperation were observed with strat shape indentation and distinct of the disc which resulted the malfunction of the prostheses. In patient who replaced with Derlin-disc model Björk-Shiley valve prosthesis should be carefully followed up.

Aortic Valve↗
PubMed1989

[Selection of candidates for a ventricular assist device as a bridge to heart transplantation].

This study was undertaken to see how many people could receive the ventricular assist device (VAD) as a bridge to heart transplantation and to get selection criteria of the recipient. From January 1984 to December 1987, 9916 patients were admitted to our institute and 399 cases of them were dead. All dead cases were examined in terms of age, heart disease, other organ function, infection, and so on. There were 42 possible candidates for VAD, 31 men and 11 women. The average age was 50 years with a range from 22 to 63 years. Ten cases (23.8%) of them had the indication for VAD bridge to transplantation. The criteria for transplantable patients included the following three categories: I) Cardiogenic shock: Irreversible left or double ventricular failure with or without life-threatening dysrhythmia during IABP therapy--4 cases. II) End-stage valvular heart disease; Operation under VAD stand-by--2 cases. III) Postoperative refractory ventricular pump failure: Failure to wean from assist circulation after IABP trial or sustained ventricular failure under IABP support--4 cases. It was indicated that continuous precise evaluation of the deteriorating hemodynamics and the intensive care for major organ functions (renal, pulmonary, neurologic, hepatic, coagulation, etc.) were important to select the candidate for VAD bridge to heart transplantation.

Adult↗
PubMed1989

[Ten-year experience with the St. Jude Medical valve replacement: comparison with the Björk-Shiley valve].

St. Jude Medical (SJM) valve replacement in 995 patients with a cumurative follow-up period of 2,730 patient-years was compared with the Björk-Shiley (BS) valve replacement in 406 patients, who had followed up for 3,779 patient-years (pt-yr). The overall survival rates of aortic, mitral, and double valve replacement with SJM (and BS) at 10 years were 60.6% (80.0%), 89.6% (81.9%), 90.3% (73.9%), respectively. The linealized incidences of thromboembolism, valve thrombosis, prosthetic valve endocarditis, anticoagulation-related hemorrhage, significant hemolysis, and structural failure in SJM (and BS) were as follows: 1.32%/pt-yr (0.82%/pt-yr), 0.11%/pt-yr (0.21%/pt-yr), 0.18%/pt-yr (0.08%/pt-yr), 0.04%/pt-yr (0.24%/pt-yr), 0.18%/pt-yr (0.13%/pt-yr), and 0%/pt-yr (0.05%/pt-yr), respectively. Reoperation (explant and re-replacement or suture repair) was required in 10 SJM patients (0.37%/pt-yr) and in 14 BS cases (0.37%/pt-yr). Actuarially over 97% of patients were free of valve-related mortality at 10 years in both groups. From these results we conclude that both SJM and BS valves are equally excellent cardiac valve prosthesis. Considering the better hemodynamic characteristics and technical feasibility, we have thus far adopted SJM, rather than BS, as a first prosthesis of choice.

Adult↗
PubMed1988

Effect of the dietary alpha-linolenate/linoleate balance on leukotriene production and histamine release in rats.

Rats were fed semi-purified diets supplemented either with safflower seed oil rich in linoleate (18:2n-6) or with perilla seed oil rich in alpha-linolenate (18:3n-3) through two generations. In the major phospholipids of polymorphonuclear leukocytes (PMNs), the proportions of n-6 polyunsaturated fatty acids (18:2, 20:4, 22:4 and 22:5) were higher but those of n-3 acids (20:5, 22:5 and 22:6) were lower in the safflower group than in the perilla group. When stimulated with a calcium ionophore, the PMNs from the safflower group produced 27% more leukotriene (LT)B4 than those from the perilla group. The formation of LTB5 which has biological activities less than 1/10 those of LTB4, was negligible in the safflower group but was 40 ng/10(7) PMN cells in the perilla group. The amount of the total LTB formed in the perilla group tended to be more than in the safflower group. The formation of SRS-A (slow-reacting substances of anaphylaxis) by PMNs was determined by measuring the spasmogenic activities of LTs on guinea pig ileum. SRS-A activity was 59% higher in the safflower group than in the perilla group. In contrast, histamine release from rat peritoneal mast cells was not significantly different between the two groups. Thus, the increasing the alpha-linolenate/linoleate ratio of diets results in the decreased formation of LTs derived from 20:4n-6 in PMNs. This may be beneficial in lowering the severity of allergic and inflammatory responses caused by LTs, and thereby shifting the pathological symptoms to normal self-defense mechanism.

Animals↗
PubMed1988

Stent creep of porcine bioprosthesis in the mitral position.

Stent creep, often associated with valve malfunction, is said to play an important role in the long-term performance of a porcine bioprosthesis. We have measured the angle of the stent post showing maximal inward bending (IBA) on 44 mitral porcine bioprostheses. All of them were explanted 1 to 12 years (mean explant time, 7.8 years) postoperatively at reoperation. Patients included 19 men and 25 women, ranging in age from 24 to 66 years (mean age, 47.2 years). Mean IBA was 12.7 +/- 4.2 [SD] degrees in 14 valves implanted for 7 years or less and 16.4 +/- 5.8 degrees in 30 valves implanted 8 years or longer (p less than 0.05). There was no significant difference in IBA among valves based on type (25 Hancock valves, 15.0 +/- 4.7 degrees; 10 Angell-Shiley valves, 16.2 +/- 8.6 degrees; and 9 Carpentier-Edwards valves, 14.4 +/- 3.7 degrees). There was a significant difference in IBA based on valve size (37 valves measuring 25-29 mm in diameter, 16.3 +/- 5.1 degrees; and 7 valves measuring 31 mm in diameter, 9.9 +/- 5.1 degrees; p less than 0.05). IBA showed a tendency to have a large value in a heart with a small left ventricular end-systolic volume. We conclude that (1) stent creep is not related to the materials or designs of the stent post, but tends to increase with passage of time in place; and (2) compression of the left ventricular wall is one of the main causes of stent-post bending.

Adult↗
PubMed1988

T-cell depletion by monoclonal antibodies does not prevent granuloma formation in mice.

Effects of T-cell depletion on the formation of organized granulomas in mouse skin were investigated. Monoclonal antibodies (MoAbs) to L3T4 and Lyt-2.2 were injected into euthymic BALB/c mice in order to deplete both T-helper and T-suppressor cell populations. Four days after injection, hepatic schistosome egg granulomas were transplanted into the skin. Injection of MoAbs to L3T4 and Lyt-2.2 was repeated in the recipient mice 6 days later. At the time of transplantation, flow cytometric analysis showed that the number of T cells which were positively stained with surface markers decreased on average by 68% in both regional lymph nodes and spleen. The mitogen response of spleen cells was also markedly reduced. Despite their immunosuppressed condition, development of organized granulomas was observed in the skin of recipient mice by light and electron microscopy 3 weeks after transplantation. The findings indicate that T-cell function may not be essential for initiation of organized granuloma formation.

Animals↗