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Biomedical subjects

A Nogami

Publications and source records attributed to A Nogami.

At least 91 records · Page 5Linked to original sources
PubMed1991

[A case report on the perforation of a gastric tube ulcer after esophageal reconstruction for cancer].

The development of peptic ulcers in gastric tubes used for esophageal reconstruction for cancer are rare. However, they can potentially cause serious complications, including perforation and hemorrhaging. We experienced a case in which an ulcer of large size developed in the gastric tube, and it was very difficult to treat. The patient was a 72-year-old man, who had undergone an esophagotomy of the thoracic portion, an gastroesophagoplasty through the anterior portion of the sternum, and postoperative radiotherapy 2 years ago. Eight days after his admission, the ulcer began excessive bleeding, and we performed an emergency operation. The ulcer perforated into the mediastinum, and developed an abscess involving the intrathoracic artery. After hemostasis and debridement, we resected the upper half of the gastric tube, closed the oral side of the remaining portion, and converted the cervical esophageal stump into an external fistula. The wound was covered with a flap. A histological examination showed an ulcer with no evidence of malignancy, and without any signs of healing. Five months were required for the wound to heal completely. After that, we succeeded in reconstruction through jejunal free-transfer, using the microvascular surgery technique. Some pathogenesis is suggested for gastric ulcers after gastroesophagoplasty. Despite performing a vagotomy, the secretion of acid from the gastric mucosa is common. Both this condition, and the deterioration of the mucosal barrier caused by surgery, can play significant roles in the development of the ulcer. The histological influence of postoperative radiotherapy is also important, as this treatment aggravates the circulatory disturbance, and disturbs the histological reaction necessary for healing.

Aged↗
PubMed1991

[Coronary artery bypass surgery in dialysis patient].

In patients with chronic renal failure undergoing hemodialysis for a long period, arteriosclerosis progresses rapidly, and the incidence of ischemic heart diseases is high. We performed coronary artery revascularization in a patient with chronic renal failure complicated by angina pectoris in whom discontinuation of dialysis was sometimes needed for hypotension during dialysis. Her postoperative course was uneventful. Problems in intra and postoperative management of dialysis patients are reported.

Angina Pectoris↗
PubMed1990

Prognostic significance of sustained monomorphic ventricular tachycardia induced by programmed ventricular stimulation using up to triple extrastimuli in survivors of acute myocardial infarction.

The prognostic significance of sustained monomorphic ventricular tachycardia (VT) induced by programmed ventricular stimulation using up to 3 extrastimuli was evaluated in 133 consecutive survivors of acute myocardial infarction (AMI) at a mean interval of 1.8 +/- 1.1 months after onset. This was compared with hemodynamic and angiographic abnormalities shown by cardiac catheterization and ventricular ectopic activity detected by Holter monitoring. Sustained monomorphic VT was induced in 25 (19%) patients, sustained polymorphic VT in 11 (8%) patients, nonsustained monomorphic VT (greater than or equal to 10 beats) in 12 patients (9%) and nonsustained polymorphic VT in 9 patients (7%). Multivariate logistic regression analysis of clinical, angiographic, hemodynamic and electrocardiographic variables showed that the presence of a left ventricular aneurysm (p = 0.005) and Lown grade 4B ventricular ectopic activity (p less than 0.001) were independent predictors of inducibility of sustained monomorphic VT. During a mean follow-up of 21 +/- 13 months, there were 8 (6%) sudden cardiac deaths and 3 (2.3%) spontaneous occurrences of life-threatening sustained VT. The 2-year probability of freedom from sudden cardiac death or sustained ventricular tachyarrhythmias was 53 +/- 13% for patients with inducible sustained monomorphic VT, 70 +/- 10% for those with a left ventricular ejection fraction less than 40% and 58 +/- 13% for those with Lown grade 4B ventricular ectopic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Arrhythmogenic right ventricular dysplasia with sick sinus syndrome and atrioventricular conduction disturbance.

Although arrhythmogenic right ventricular dysplasia (ARVD) is believed to involve primarily the right ventricle, left ventricular abnormalities have also been described. We report a case of ARVD with abnormalities of the sinus node, right atrium and atrioventricular node. The biopsies taken from the right atrium and the right ventricle showed replacement of myocardium by fibrous tissue. The pathologic changes of this disease process may extend into the atrium and atrioventricular node.

Atrioventricular Node↗
PubMed1990

[A case of intrapulmonary schwannoma that should be distinguished from lung cancer].

A 32-year-old woman was referred to our division because of abnormal shadow on a chest X-ray film taken at an annual health survey. Chest X-ray films and chest CT scanning revealed a smooth-surface mass at the left hilus. A bronchoscopic examination revealed severe extraluminal compression in the left basal bronchus but no visible tumors. Surgical treatment was performed on the suspicion of lung cancer. Since the intraoperative frozen section examination revealed a benign tumor, the tumor mass was resected. Based on intraoperative and pathological findings, benign intrapulmonary schwannoma associated with the left basal bronchus was diagnosed. Only 15 cases of intrapulmonary schwannoma have been reported in Japan.

Adult↗
PubMed1990

Usefulness of electrophysiologic study and endomyocardial biopsy in differentiating arrhythmogenic right ventricular dysplasia from idiopathic right ventricular tachycardia.

Fifteen patients with right ventricular tachycardia without evidence of coronary artery disease or dilated or hypertrophic cardiomyopathy were evaluated, by means of electrophysiologic study and right ventricular endomyocardial biopsy. Six cases were diagnosed as definite arrhythmogenic right ventricular dysplasia (ARVD), while 2 cases without characteristic findings of ARVD by noninvasive studies and angiography were diagnosed as probable ARVD on the basis of their electrophysiologic and histopathologic data. In conclusion, ARVD is relatively common as an etiology of right ventricular tachycardia, and detailed electrophysiologic study and endomyocardial biopsy appear to be useful for diagnosis of ARVD.

Adolescent↗
PubMed1990

[A case of massive hemoptysis occurring after lung injury due to a torn segment of pleural calcification].

A 64-year-old man was referred to our hospital because of little improvement of hemoptysis lasting three days after drug therapy. A chest roentgenogram and fiberoptic bronchoscopic examination performed on the second hospital day when the patient experienced a massive hemoptysis of about 2,000 ml revealed arterial bleeding from the left upper lobe. Even after extensive embolizations of the left upper bronchial, the first, second, third and 4th intercostal arteries, the patient's hemoptysis did not improve. On the 73rd hospital day the patient underwent left upper lobectomy. Macroscopic and microscopic examinations in the resected specimen revealed lung injury due to a torn segment of pleural calcification after tuberculous pleuritis, resulting in the massive hemoptysis. Although physicians encounter many patients complaining of hemoptysis and/or hemosputum, this case is considered to be very rare.

Calcinosis↗
PubMed1989

Coronary flow velocity waveforms in aortic stenosis and the effects of valve replacement.

In 6 patients with pure aortic stenosis, the flow velocity waveforms in the left anterior descending coronary artery were studied using an 80-channel 20-MHz pulsed Doppler velocimeter before and immediately after aortic valve replacement. All patients showed normal coronary arteriograms. The left anterior descending coronary artery flow velocity waveform in aortic stenosis was characterized by a reverse flow in the first half of systole and a slowly increasing diastolic inflow. After aortic valve replacement, the reverse flow in the first half of systole disappeared in all patients, but an end-systolic reverse flow was discerned in 5 of 6 patients. The increasing rate of the diastolic inflow was augmented in all patients. After aortic valve replacement, the time from onset of diastole to the diastolic peak velocity was shortened from 176.8 +/- 28.8 to 90.5 +/- 18.8 ms (p less than 0.01), and the diastolic peak velocity increased from 90.5 +/- 28.0 to 122.5 +/- 17.2 cm/s (p less than 0.05). Blood pressure and heart rate, however, did not change significantly before and after valve replacement. These changes in the left coronary artery velocity waveforms after valve replacement suggest the beneficial effects of removal of aortic stenosis on human coronary artery inflow.

Aortic Valve↗
PubMed1989

Rapid assessment of rate and antiarrhythmic drug effect on the myocardium using asymmetric biphasic pulse stimulation.

An asymmetric biphasic pulse which stimulates the heart and neutralizes the poststimulation polarization at the electrode-myocardial interface permitting the recording of the evoked endocardial response (EER) up to approximately 1 ms poststimulation with the same electrode used for stimulation is described. Using this mode of cardiac stimulation in 20 dogs the effects on the EER of increasing heart rate and antiarrhythmic drugs, procainamide (PA) and N-acetylprocainamide (NAPA), were studied. EERs were recorded during bipolar and unipolar pacing rates of 120, 150, and 200/min before and during a five step PA or NAPA infusion which resulted in progressively increasing PA and NAPA plasma concentrations (Cps), 1.7-32.5 mg/l for PA and 8.1-116.1 mg/l for NAPA. The effects of progressively increasing heart rates were: The T wave amplitude and QS area increased with increases in rate; during pacing at 120, 150, and 200/min, the T wave amplitudes were 7.6 +/- 2.3, 8.2 +/- 2.1, and 9.8 +/- 2.5 mV and the QS areas were 905 +/- 204, 995 +/- 199, and 1101 +/- 231 mVms. The QT interval and QST area decreased with increases in rate; during pacing at 120, 150, and 200/min, the QT intervals were 265 +/- 61, 249 +/- 57, and 226 +/- 52 ms and the QST areas were 288 +/- 198, 221 +/- 154, and 154 +/- 52 mVms. The effects of the antiarrhythmic drugs, PA and NAPA, on the EER were: PA prolonged both the QS duration and QT interval at low Cp (type Ia antiarrhythmic drug property); at a therapeutic PA Cp of 15.0 +/- 0.2 mg/l and a heart rate of 120/min the percent increase of the QS duration was 12 +/- 4% (P = 0.001) and that of the QT interval was 20 +/- 6% (P less than 0.001). The prolongation of the QS duration by PA was rate dependent, the faster the rate the greater the prolongation. NAPA prolonged the QT interval at low Cp, while the QS duration was not significantly effected at low or therapeutic Cps (type III antiarrhythmic drug property); at a therapeutic NAPA Cp of 15.9 +/- 1.6 mg/l and a heart rate of 120/min the percent increase of the QS duration was 1 +/- 1% (NS) and that of the QT interval was 13 +/- 9% (P = 0.018). Our results show that the use of an asymmetric biphasic pulse allows for pacing and recording of an EER, QS and T waves, with a single electrode.(ABSTRACT TRUNCATED AT 400 WORDS)

Acecainide↗
PubMed1989

Time-dependent risk of and predictors for cardiac arrest recurrence in survivors of out-of-hospital cardiac arrest with chronic coronary artery disease.

One hundred one consecutive patients with chronic coronary artery disease who had survived out-of-hospital cardiac arrest in the absence of acute myocardial infarction underwent electrophysiologic evaluation and were followed prospectively. Ventricular tachyarrhythmias were inducible in 76 patients (75%) in the control state and were suppressed by antiarrhythmic drugs or surgery in 32 of the 76 patients (42%). During a mean follow-up of 27 months, cardiac arrest recurred in 21 patients: in two of the 25 patients in whom ventricular tachyarrhythmias were not inducible in the control state, three of the 32 in whom inducible ventricular tachyarrhythmias were suppressed after treatment, and 16 of the 44 in whom inducible ventricular tachyarrhythmias could not be suppressed after treatment. Actuarial rate of cardiac arrest recurrence was 11.2% during the first 6 months of follow-up ("high-risk early phase") and then decreased to less than 4% in each subsequent 6-month period. Multivariate Cox proportional hazards analysis identified an ejection fraction less than 35% (p = 0.0013) and persistent inducibility of ventricular tachyarrhythmias (p = 0.0025) as independent predictors of cardiac arrest recurrence for the entire follow-up period. Separate analysis of variables within and after the first 6 months showed that an ejection fraction less than 35% was the strongest predictor for early phase recurrence (p = 0.0078) but had only marginally significant predictive value for late phase recurrence (p = 0.0516). Persistent inducibility of ventricular tachyarrhythmias had no significant predictive value for early phase recurrence (p = 0.1382) but was the strongest predictor for late phase recurrence (p = 0.0061). These data suggest that, in patients with chronic coronary artery disease who survive out-of-hospital cardiac arrest, poor ejection fraction and persistent inducibility of ventricular tachyarrhythmias have a different predictive influence on early and late phase recurrence. Time-dependent risk factor analysis may have great clinical relevance in assessing an individual's changing risk over time.

Aged↗
PubMed1989

Triphasic time dependence of prognostic markers in patients with sustained ventricular tachyarrhythmias and coronary artery disease.

To characterize the time dependence of prognostic markers for arrhythmia recurrence and arrhythmic death, 81 consecutive patients with documented sustained ventricular tachycardia (VT) or fibrillation (VF) and coronary artery disease (CAD) were analyzed. During follow-up, 28 patients had arrhythmia recurrence and 15 patients had sudden or arrhythmic death. Three different hazard phases were identified by fitting piece-wise exponential function curves to the distribution of both arrhythmia recurrence and sudden/arrhythmic death. An initial phase (0 to 6 months) had an arrhythmia recurrence rate of 2.1% per month; a second low-risk phase (6 to 38 months) had a rate of 0.88%; and a late high-risk phase (greater than 38 months) had a rate of 2.2%. Sudden/arrhythmic death rates in each phase were 1.1%, 0.41%, and 1.7% per month, respectively. Separate Cox regression analyses within each phase identified the following independent predictors of arrhythmia recurrence: in the early phase, ejection fraction (EF) (p = 0.033) and VT inducibility rank (p = 0.048); and in the late phase, VT inducibility rank only (p = 0.003). Likewise, independent predictors of sudden/arrhythmic death were: in the early phase, EF (p = 0.049); and in the late phase, VT inducibility rank (p = 0.008) and previous history of congestive heart failure (p = 0.032). In CAD patients with documented sustained VT/VF, the probabilities of arrhythmia recurrence and sudden/arrhythmic death each followed a similar triphasic hazard function. Highest risk occurred in the late phase and the VT inducibility rank was predictive of late phase events, while EF was a predictor of early phase events.

Adult↗
PubMed1989

[Effects of nitroglycerin on the graft flow during aortocoronary bypass surgery].

The effects of an intravenous infusion of nitroglycerin on the hemodynamics and bypass graft flow to left coronary artery were studied in sixteen patients during coronary artery surgery. Systolic blood pressure, cardiac output and left ventricular minute work were not affected by 0.2 microgram/kg/min of nitroglycerin but graft flow volume especially diastolic graft flow increased significantly and the characteristics of flow velocity waveform in the graft became more diastolic predominant. By 1 microgram/kg/min of nitroglycerin a significant decrease in systolic blood pressure, cardiac output and graft flow were recognized, however diastolic graft flow was preserved despite of a decrease in left ventricular minute work. These findings demonstrate that nitroglycerin can be safely administered intravenously during aortocoronary bypass surgery, and suggest that nitroglycerin improves the balance of myocardial oxygen demand and supply, and relieves myocardial ischemia.

Animals↗
PubMed1989

[Two cases of miliary tuberculosis following prosthetic valve replacement].

Pyrexia which occurs at late stage after prosthetic heart valve replacement must be suspected to be caused by prosthetic valve endocarditis (PVE). However, since confirmatory diagnosis is difficult, we are concerned about the treatment for so many cases. We encountered two cases who were suspected PVE at late stage after prosthetic aortic valve replacement and diagnosed miliary tuberculosis at autopsy. Here, we present a report of the two cases.

Aged↗
PubMed1988

Coronary flow characteristics of left coronary artery in aortic regurgitation before and after aortic valve replacement.

In 6 patients with pure aortic regurgitation, the velocity waveform in the left anterior descending coronary artery (LAD) was measured using an 80-channel 20-MHz-pulse Doppler velocimeter before and immediately after aortic valve replacement. All patients showed normal coronary angiograms. Flow velocity was analyzed by both zero-cross and fast Fourier transform methods in real time. The LAD flow in severe aortic regurgitation was characterized by an increase in the systolic flow component, a small and rapidly decreased diastolic flow, an irregular velocity profile across the vessel, and a wider velocity spectrum. After aortic valve replacement, systolic flow decreased by 36.3 +/- 21.7% (p less than 0.01), whereas diastolic flow increased by 81.4 +/- 51.8% (p less than 0.05). The ratio of diastolic flow to total LAD flow increased from 63 +/- 13% to 82 +/- 7% (p less than 0.05). The velocity profile became more parabolic and had a narrow spectrum. These results suggest that operation for aortic regurgitation induces beneficial effects on the myocardial inflow immediately after valve replacement.

Adult↗
PubMed1988

Serial analysis of spontaneous and induced ventricular arrhythmias in a canine model of myocardial infarction.

To study the time course of spontaneous and induced ventricular arrhythmias after myocardial infarction (MI), 20 dogs underwent ligation of the left anterior descending coronary artery and temporary occlusion and reperfusion of the obtuse marginal branch. There were 5 early deaths (less than 24 hours) due to spontaneous ventricular fibrillation (VF). All 15 survivors exhibited spontaneous ventricular tachycardia (VT) up to day 3 with the shortest cycle length occurring at 17 hours after MI (232 +/- 11 msec: mean +/- SEM). The grade of arrhythmia complexity was decreased after day 4 compared to day 1 (p = 0.049), and the number of ventricular premature complexes was reduced after day 6 (1700 +/- 1390/hour) compared to day 1 (9500 +/- 640/hour, p = 0.042). Serial electrophysiologic studies were carried out on days 8, 15, 22, and 29 via an implanted antitachycardia pacemaker using 1 to 3 extrastimuli and rapid ventricular pacing (RVP). On day 8, VT was inducible in 7 dogs (46%), VF in 4 (27%), and 4 dogs (27%) exhibited a negative response. On day 15, 3 more dogs became negative, and all previously negative dogs displayed negative responses. From day 15, the inducibility of VT/VF remained "constant" using RVP. However, inducibility by triple extrastimuli declined week by week until day 29. Stepwise logistic regression analysis of 20 variables selected the mass of the MI as the only independent predictor of inducible VT/VF by multiple extrastimuli and RVP after day 15 (p = 0.049). Thus significant time- and mode-dependent changes in inducibility of VT/VF occur during the early phase after MI.

Animals↗