[Study of aortic surgery with temporary bypass using H-PSD tube (Anthron)].
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Biomedical subjects
Publications and source records attributed to A Hashimoto.
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Stent creep is often associated with malfunction of bioprosthesis. We measured the inward bending angle of the stent-post showing maximum bending (IBA) on 42 mitral porcine xenografts retrieved 1 to 12 yrs (mean 7.7 yrs) postoperatively at reoperation. Patients were 12 men and 28 women, ranging in age from 26 to 58 yrs. Mean +/- S.D. for IBA was 12.7 +/- 4.2 degrees(ds) in 14 valves being implanted for less than 7 yrs and 16.9 +/- 5.5 ds in 28 valves longer than 8 yrs (p less than 0.05). There was a significant difference in IBA between 36 valves of 25-29 mm size (16.3 +/- 5.1 ds) and 6 valves of 31 mm (10.3 +/- 5.5 ds) (p less than 0.05), but no significant difference between 23 Hancock valves (15.5 +/- 4.4 ds), 10 Angell-Shiley valves (16.2 +/- 8.6 ds) and 9 Carpentier-Edwards valves (14.4 +/- 3.7 ds). IBA showed a tendency to have large valve in the heart with small left ventricular end-systolic volume. The results showed that stent creeping phenomenon was not related to the material or design of stent-post, but tended to increase with passage of time in place. Furthermore, it was suggested that stent creep was induced by the mechanism of compression of the stent by the left ventricular wall.
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This study of the rostral part of medial agranular cortex (AGm) was undertaken with two principal aims in mind. First, to delineate the efferent connections of AGm and compare these with the pattern of afferents defined by us in a previous study. Second, to provide a firmer basis for anatomical and functional comparisons with cortical regions in monkeys. Autoradiographic, horseradish peroxidase, and fiber degeneration techniques were used. Rostral AGm has a variety of corticocortical connections--with lateral agranular motor cortex (AGl); visual, auditory, and somatic sensory regions; and limbic/paralimbic areas including orbital, insular, perirhinal, entorhinal, retrosplenial and presubicular fields. The projections to orbital, perirhinal and entorhinal cortices are bilateral. Thalamic projections of rostral AGm are concentrated in the ventral lateral, central lateral, paracentral, mediodorsal and ventromedial nuclei. Moderate terminal fields are consistently seen in the reticular, anteromedial, central medial, gelatinosus, parafascicular, and posterior nuclei. More caudal projections reach the central gray, superior colliculus and pontine gray. The efferents of the adjacent AGl were also examined. Although many of these overlapped those of rostral AGm, there were no efferents to visual or auditory cortex and limbic/paralimbic projections were reduced. Thalamic projections were more focused in the ventral lateral and posterior nuclei and there were no terminal fields in the central gray or superior colliculus. Based on its afferent and efferent connections, role in contralateral neglect, and the results of microstimulation studies, rostral AGm can be viewed as a multimodal association area with strong ties to the motor system. On these structural and functional grounds, rostral AGm bears certain striking resemblances to the frontal eye field, supplementary motor, and arcuate premotor areas of monkey cortex.
From July 1978 to June 1984, 540 St. Jude Medical valve prostheses were implanted in 462 adult patients. Overall operative mortality was 4.8% (22/462): 5.7% after aortic valve replacement (AVR) (8/140); 3.3% after mitral valve replacement (MVR) (8/244); and 7.7% after aortic and mitral valve replacement (DVR) (6/78). There were 16 late deaths among 440 operative survivors; six (38%) were valve related. The actuarial survival rate at six years was 94.5% in AVR and 93.5% in MVR. At five years it was 91.6% in DVR. The freedom from valve-related death at six years after AVR, MVR and at five years after DVR was 97.8%, 98.6% and 95.8%, respectively. The incidence of valve-related complications (expressed as %/patient-year (number of events] was as follows: thrombo-embolism (AVR 0.7 (2), MVR 2.0 (13), DVR 2.8 (5], valve thrombosis (AVR 0.3 (1), MVR 0.2 (1), DVR 0 (0], prosthetic valve endocarditis (AVR 0.3 (1), MVR or DVR 0 (0]. There were no cases of primary structural failure, serious anticoagulant-related hemorrhage or clinical event of hemolysis. The incidence of all valve-related complications in AVR, MVR and DVR was 1.3, 2.2 and 2.8%/pt-yr, respectively. The freedom from thrombo-embolism at six years after AVR and MVR and at five years after DVR were 91.4%, 92.4% and 88.7%, respectively. Re-operation was performed in only one patient with MVR because of valve thrombosis (0.2%/pt-yr after MVR, overall 0.1%/pt-yr). These results indicate that St. Jude Medical prosthesis has provided a satisfactory performance with acceptable risks of late complications in patients who were properly anticoagulated during six-year follow-up period.
A 26-year-old woman with partial anomalous pulmonary venous drainage into the right atrium (Scimitar syndrome) was successfully operated upon by incorporating an intra-atrial conduit. The single right pulmonary vein present was connected to the right atrial inferior vena cava junction. The atrial septum was extremely deviated to the left, and the left atrium was located entirely on the left of the spine. A small patent foramen ovale was found. The distance between the orifice of the right pulmonary vein and the enlarged atrial septal defect was too great to use an intracardiac patch, so a 14 mm woven Dacron graft, 6 cm long, was interposed between them. The patient is doing well 21 months following the operation.
Angiotensin converting enzyme (ACE) activities of bronchoalveolar lavage fluid (BALF) and serum in patients with sarcoidosis and with silicosis were measured. Serum ACE was measured by enzymic assay and radioimmunoassay. There was a close relationship between ACE activity and content (r = 0.78). Serum ACE activities in patients with active sarcoidosis (37.5 +/- 11.1 nmol/min/ml, mean +/- SD) and with silicosis (25.5 +/- 9.3) were significantly elevated from the control (18.6 +/- 6.0). BALF ACE activities in the control, patients with active sarcoidosis and with silicosis were 0.23 +/- 0.19 nmol/min/ml, 0.94 +/- 0.97 and 0.38 +/- 0.05, respectively. BALF ACE in patients with active sarcoidosis and with silicosis were significantly different from the control. When BALF ACE was corrected by the cell count of alveolar macrophage (per 10(6) cells), activity was significantly different from control only in the patients with sarcoidosis. Moreover, only the alveolar macrophages in sarcoidosis were stained by immunofluorescence and immunocytochemistry using rabbit antihuman ACE antibody. Induction of ACE in alveolar macrophage might have an important role for the activity or progression of sarcoidosis.
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Autoantibodies for anterior pituitary cell surface membrane (PitCSA) were assayed by immunofluorescence method using GH3 cells (rat GH and prolactin secreting cell) and AtT-20 cells (mouse adrenocorticotropic hormone secreting cell) as antigens. Out of 18 insulin dependent diabetic patients who were positive for antibodies to islet cell surface membrane (ICSA), 3 cases (16.7%) were positive for antibodies to GH3 cells and 12 cases (66.7%) were positive for antibodies to AtT-20 cells. Moreover, out of 18 insulin dependent diabetic patients who were negative for ICSA, 2 (11.1%) and 6 cases (33.3%) were positive for antibodies to GH3 cells and AtT-20 cells, respectively. Among 5 adrenocorticotropic hormone (ACTH) deficient patients, all of the sera were positive for antibodies to AtT-20 cells. These results suggested that PitCSA and ICSA have independent features, though both are closely related, and that PitCSA was one of the significant immunological markers often observed in the sera of the patients with insulin dependent diabetes mellitus (IDDM) and ACTH deficiency.
Immune complex solubilizing capacity (ICSC) of sera obtained from patients with insulin-dependent diabetes mellitus (IDDM) was assayed by the spectrophotometric method. In 17/32 IDDM sera, ICSC was significantly low. The value of ICSC was only weakly correlated with serum CH50 (r = 0.42). Six sera out of 28 showed a high serum immune complex level and low ICSC. The results with these 6 cases suggest the possibility that circulating antigen-antibody complex might be insoluble in vivo. The precise characterization of these 6 patients' autoantibodies was obtained with immunofluorescence tests. Interestingly, 2 of these sera were positive for islet cell surface antibodies (ICSA) and AtT-20 cell (ACTH secreting cell) surface antibodies.
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