Biomedical subjects
Publications and source records attributed to A Seki.
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Pulmonary metastatic tumors in two patients with locally well controlled uterine cancer were treated with bronchial arterial infusion chemotherapy. The first patient underwent a radical hysterectomy and pelvic lymphadenectomy for stage IIb cervical cancer. Fifteen months after the operation, pulmonary metastasis was identified. Clinical evidence of tumor was negative after bronchial arterial infusion chemotherapy, systemic chemotherapy and radiotherapy. The patient continues to be healthy without recurrent signs six years after bronchial arterial infusion chemotherapy. The second patient underwent a radical hysterectomy and pelvic lymphadenectomy for stage II endometrial cancer. Fifteen months after the operation, pulmonary metastasis was identified. After bronchial arterial infusion chemotherapy and systemic chemotherapy, regression of the tumors was observed. This patient has also survived for two years since the lung metastases. These results indicate that bronchial arterial infusion chemotherapy is a potent treatment for pulmonary metastases of uterine cancer.
We experienced a successful surgical case, who was a 16-year-old boy suffered from atrial septal defect with congenital factor XI deficiency. This disorder is an inherited disorder of blood coagulation characterized by a defect of the intrinsic pathway of thrombin formation and a mild to moderate bleeding tendency, but it can result in severe bleeding in surgical procedures. Open heart surgery in this disorders is rare. Preoperatively we prepared 4000 cc of fresh frozen plasma, but operated without using it. It would appear that the possibility of open heart surgery with congenital factor XI deficiency suggest in this case.
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Aneurysms involving either the aortic arch or the proximal descending thoracic aorta in five patients were resected with the aid of profound hypothermic total body retrograde perfusion. Traditional surgical management of the aortic arch and the descending thoracic aorta necessitates clamping of the aorta. However, this technique may be associated with rupture or atheroembolism. Rupture occurring at the clamping site may be difficult to repair. Atheroembolism to the brain compromises the neurologic system, and multiple organ embolism is associated with disseminated intravascular coagulopathy. Atheroembolism in cardiovascular surgery has become increasingly prevalent. It is necessary to prevent clamp injuries and to preserve the function of the vital organs, such as the brain, heart, and liver, during aortic reconstruction. We applied a total body retrograde perfusion technique to operations for aortic aneurysms. Total body retrograde perfusion consists of cerebral protection by continuous perfusion through the superior vena cava, intermittent retrograde coronary perfusion through the coronary sinus, and continuous abdominal visceral perfusion through the inferior vena cava. It can yield a relatively bloodless operating field without the need for aortic clamping. We believe this new adjunct offers excellent results in the surgical treatment of aneurysms of the aortic arch or adjacent structures.
PURPOSE: To determine the immunopathologic role of the lymphocytes and lymphokines in aqueous humor (AH) of patients with Vogt-Koyanagi-Harada disease (VKH). METHODS: The distribution of leukocyte subsets in the peripheral blood and AH was examined using fluorescein isothiocyanate-conjugated monoclonal antibodies. The levels of lymphokines, such as interleukin-2 (IL-2) and interleukin-6 (IL-6), in the sera, AH, and cerebrospinal fluid from the patients with VKH were determined using an enzyme-linked immunosorbent assay. RESULTS: T cells constituted the majority of lymphocytes within AH. The value for CD4+ cells (helper/inducer T lymphocytes) in AH was 51.7% +/- 14.9% (mean +/- SD) and that for CD8+ cells (cytotoxic/suppressor T lymphocytes) was 31.1% +/- 13.0%. The percentage of HLA-DR+ cells (B lymphocytes, monocytes, macrophages, and activated T lymphocytes) in AH (50.8% +/- 24.9%) significantly exceeded (P < 0.001) that in blood (13.1% +/- 4.2%). The percentage of CD8+ cells in AH from three patients with the delayed type of VKH rose during their clinical course. The level of IL-6 was significantly elevated in AH from the patients with VKH. The level of IL-6 in AH correlated with the number of lymphocytes in AH, and it reflected the severity of the inflammatory response in AH of patients with VKH. The level of IL-2 in the sera, AH, and cerebrospinal fluid was in the normal range. CONCLUSIONS: Aqueous humor lymphocytes from the patients with VKH were more activated than were peripheral blood lymphocytes. IL-6 may play an important role as an inflammatory mediator in VKH. It may be useful to analyze the lymphocyte subsets and the levels of lymphokines, especially of IL-6, at the site of inflammation in uvea to improve the criteria for assessing the prognosis of VKH.
Excellent quality of MR cisternography was acquired using "long echo train length fast spin echo sequence" (TR/TE = 2666/200, ETL = 24, 6 or 8 NEX, 3 mm thickness, 0 mm interslice gap, 19 cm FOV, 512 * 384, 2 DFT method). The inner ear anatomy such as canaliculus cochleae or lamina spiralis ossea were well visualized. The VII, VIII th nerve bundles within the internal auditory canal were detectable as 1 to 4 bundles. The vessels in the cerebellopontine angle or the internal auditory canal were also demarcated from the VII, VIII th nerve bundles because of their flow void. Signal to noise ratio seemed to be better than 3 DFT method, however limited spatial resolution in the cranio-caudal direction might require additional sagittal or coronal scan.
Hypothermic retrograde cerebral perfusion is a new technique for protecting the brain. Satisfactory cerebral protection should be possible even for periods of retrograde perfusion greater than 60 minutes. However, there are some concerns that functioning venous valves at the jugular-subclavian junction may impede retrograde flow to the brain and consequently cerebral protection may not be adequate. To overcome this obstacle, we have developed an easy and safe technique of selective jugular cannulation through the right atrium using a central venous catheter and a guidewire. We have employed this technique successfully in 15 patients who underwent operation on the aortic arch.
Hypothermic circulatory arrest and selective cerebral perfusion for aortic arch surgery have been reported, but these procedures are of limited duration, require hazardous and complicated techniques and can cause clamp injury. Continuous retrograde cerebral perfusion (CRCP) is a new and simple technique for the protection of the brain during hypothermic circulatory arrest. We applied CRCP in 26 patients who underwent aortic arch surgery. Continuous retrograde cerebral perfusion was performed with a mean blood flow of 383 +/- 176, range 120-800, ml/min. The mean duration of CRCP was 63 +/- 15, range 32-92, min with the superior vena cava pressure at 15-42 mm Hg. No neurologic deficit was observed in 20 patients (90%) and only minor deficits in 2 out of the 22 cases without severe postoperative complications, allowing evaluation of the effectiveness of CRCP. Four patients had other severe complications, and the effectiveness of the method could not be evaluated. Continuous retrograde cerebral perfusion can be an excellent and safe technique which avoids clamp injury during aortic arch surgery.
During the long-term follow-up of patients with hypertrophic cardiomyopathy (HCM), some patients develop left ventricular (LV) wall motion abnormalities in the absence of fixed coronary artery disease. The purpose of this study is to clarify which clinical features in patients with HCM seem to influence gradual development of LV wall motion abnormalities over an extended period of time. The study investigates the incidence, mechanism and predictors of these abnormalities. In this retrospective study of 162 patients with HCM, followed-up for an average of 13.3 years, we focused our attention on 16 patients who gradually developed two different forms of LV wall motion abnormality. In 11 of these 16 patients, apical segmental dysfunction with midzone obstruction was recognized; the remaining five patients showed generalized hypokinesis, as seen in dilated cardiomyopathy. The 11 patients with apical segmental dysfunction presented with extensive apical hypertrophy reaching the midventricular level at first examination. The five patients with generalized hypokinesis showed a slight decrease in LV contractility and reduced localized antero-apical wall motion even at initial examination. None of the patients in either group developed the other group's features during their clinical course. These two groups had different initial manifestations and pursued different clinical courses, suggesting that the underlying mechanisms causing wall motion abnormalities are different.
Two-dimensional echocardiography, cardiac catheterization, electrophysiologic studies, and biopsies of cardiac and skeletal muscle were performed in a patient with complete atrioventricular block as the initial manifestation of restrictive cardiomyopathy. The patient also showed distal myopathy with rimmed vacuoles. Weakness of the distal leg muscles occurred several years after the initial cardiac manifestations and the patient developed congestive heart failure 1 year before the second admission. Endomyocardial biopsy showed patchy myocardial fibrosis without endomyocardial fibrosis or any other specific findings of myocardial disease. Histochemical examination of skeletal muscle showed the typical features of distal myopathy with rimmed vacuoles. In some patients with atrioventricular block as the initial manifestation of restrictive cardiomyopathy, the cardiomyopathy may be just 1 manifestation of a more generalized disorder affecting both cardiac and skeletal muscle.
We performed a retrospective analysis of the fate of 990 medically treated Japanese patients with coronary artery disease. Patients were enrolled in this study between September 1973 and February 1984. They were confirmed to have significant coronary artery disease by coronary angiography. There were 924 males and 66 females with a mean age of 54.4 years. The mean duration of follow-up was 9.4 years with a range of 6.5 to 17.0 years. The 5-year and 10-year survival rates for the entire population were 92.1% and 84.4%. The 5-year and 10-year survival rates in patients with single- (SVD), double- (DVD), and triple-vessel disease (TVD) and left main trunk (LMT) disease were as follows: 96.0% and 91.9% for SVD, 93.8% and 87.5% for DVD, 83.2% and 68.3% for TVD, and 89.3% and 84.6% for LMT disease. This was the first large follow-up study of coronary artery disease in Japan. Its results suggest that the prognosis of Japanese patients with coronary artery disease is more favorable than that of patients in Western countries. In addition, the findings should provide a control data base for future studies in Japan and the West.
Early hepatic lesions in rats fed ethionine plus a choline deficient (ECD) diet were examined histopathologically. The purpose of this experiment was to examine preventive and suppressive effects of drugs on fatty or cirrhotic liver induced by ECD, but contrary to our expectations, all groups except the normal diet group showed neoplastic lesions in the liver. Macroscopically, milky-white nodules were seen in most all the rats except for a few dead ones. Microscopically, the characteristic lesions consisted of neoplastic nodules, glandular structures and oval cell hyperplasia. The glandular structures were already present in a rat that died on day 34 of administration and showed neoplastic developmental structures morphologically similar to cholangiofibroma. The neoplastic nodules appeared later than the glandules and were observed in rats that died after day 42. To the best of our knowledge, this is the first report of hepatic lesions consisting of mainly glandular structures induced by an ECD diet.
Between 1981 and 1991, 17 consecutive patients underwent surgical repair of postinfarction ventricular septal rupture (VSR). 15 patients were operated upon during acute phase after the onset of VSR. Two patients were operated upon six weeks or more after the onset. Overall hospital mortality was 43% in the reviewed group. Our experience suggested that the number of the patients over 70 years of age increased and prevalence in VSR associated with the multivessel coronary artery disease was recognized. Despite improved surgical techniques and enhanced myocardial protection, our experience with surgical treatment of VSR was not as successful as we had hoped. Delay of operation is likely to produce hemodynamic instability and may increase operative mortality. In conclusion, the preoperative mechanical and pharmacological support should be performed, even if the patient is not so critically ill, and the earlier operation might lead to more favourable results in the surgery of the postmyocardial infarction ventricular septal rupture. In addition, preoperative coronary angiography for the precise evaluation of the coronary artery lesions might contribute to better results in the late phase of postoperative period.
In recent 3 years, six cases of diaphragmatic hernia caused by blunt trauma were treated surgically. Traumatic mechanics, appearance of rupture, associated injury, diagnostic procedure and surgical treatment are reviewed. All of them were survived with immediate surgical repair. Thoracoscopy is so useful to diagnose the right sided diaphragmatic hernia.
We present a case of an emergency operation on acute MR and cardiac rupture due to a blunt thoracic trauma. This 27-year-old male suffered a severe blow to the chest when his motorcycle crashed to a tree. He was brought to this hospital by ambulance. On admission, the patient was in shock due to hypotension. Echocardiogram revealed cardiac tamponade and MR of grade 3/4. Pericardial drainage was performed immediately and his condition improved. Systolic pressure of the pulmonary artery was high at 70 mmHg which measured by Swan Ganz catheter. Isolated cardiac injury was diagnosed based on the results of various tests. A sign of acute pulmonary edema progressively deteriolated, therefore, emergent operation was performed on the same day. As cardiac fissure lesions were confirmed under cardiopulmonary bypass, we repaired the inferior side of the left ventricle and then closely examined the mitral valve. Both anterior and posterior papillary muscles were completely torn, so we immediately commenced with procedures to, replace a prosthetic valve. No complication were encountered, and the postoperative course was good. Complete ruptures of the papillary muscles due to trauma is rarely reported. We believe this case is exceptionally uncommon and worthy of reporting.
46 patients underwent surgery for the ascending aorta and the aortic arch using continuous hypothermic retrograde systemic venous perfusion (RSVP). Good cerebral protection has been obtained by this method in most patients including four in whom periods of retrograde perfusion exceeded 90 minutes (the longest 140 min). In first 19 patients retrograde perfusion was performed through conventional caval cannulae, but one of them sustained serious neurological damage despite a relatively short duration of retrograde perfusion probably due to impediment of retrograde flow to the brain with venous valves at the jugular-subclavian junction. Then we have developed a new technique that employs a cavoatrial cannula inserted selectively into the internal jugular vein beyond the valve at the venous angle and have applied this technique in last 27 patients.
Diabetes mellitus is a well-known risk factor in the patients undergoing coronary artery bypass grafting (CABG) and with increasing frequency diabetic patients are referred for CABG. From the fact that the arteriosclerosis is more diffuse and advanced in patients with diabetes, the presence of the diabetic state might be expected to be at risk for CABG. We retrospectively evaluated the surgical results in 91 patients with diabetes mellitus operated on from January, 1985, to June, 1991, compared with a control group of 339 patients during the same period. Compared with nondiabetic patients, diabetic patients had more extensive coronary artery disease and, therefore, received the more number of grafts per patient. However, no difference was noted in the incidence of operative mortality, morbidity and postoperative complication. The incidence of postoperative sternotomy infection was slightly higher, if not statistically significant, in the diabetic patients. Our study demonstrates that patients with diabetes mellitus can be operated on relatively safely.