Adult coronary artery disease secondary to Kawasaki disease in childhood.
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Adolescent↗
Biomedical subjects
A Seki
Publications and source records attributed to A Seki.
Long-term prognosis of patients with achalasia treated by cardial dilatation therapy.
The long-term prognosis of expanding bag dilatation therapy using a Matsuo pneumatic bag dilator was evaluated in 163 cases of esophageal achalasia treated by this method over the 26-year period from 1964 to 1989. In all these cases, one year or more had passed since therapy. Practically no correlation was found between the efficacy of the therapy and the grade of esophageal dilation prior to therapy, the previous history of symptomatic distress or the number of dilatations performed. The efficacy of expanding bag cardial dilatation was most obvious in the increase of body weight, 59 cases (36.2%) showing an increase of 1-5 kg and 48 cases (29.4%) showing an increase of 6-10 kg. The therapy was rated "highly effective" in 61 cases (37.4%) and "effective" in 60 cases (36.8%), i.e. it was effective in a total of 121 cases (74.2%). It was rated as being "ineffective" in 16 cases (9.8%) including 4.3% of cases in which an operation had been performed. This indicated that surgical operation of esophageal achalasia should be performed in those cases in which good long-term results were not obtained even after expanding bag dilatation therapy had been carried out several times.
Adolescent↗
Successful resection of a distal aortic arch aneurysm in a patient with Behçet's disease using an "aortic no-touch" technique and hypothermic total-body retrograde perfusion.
Resection of a false aneurysm of the aortic arch in a patient with Behçet's disease was safely performed using an "aortic no-touch" technique. This consisted of: (1) femoral artery and bicaval cannulation, (2) profound hypothermia (below 20 degrees C) by core cooling, (3) retrograde cardioplegia through the coronary sinus, and (4) total body retrograde perfusion via both venae cavae without aortic cross-clamping. The patient showed no evidence of neurological damage and the postoperative course was uneventful.
Adult↗
Hypocholesterolemic effect of ursodeoxycholylcysteic acid in hamsters fed a high cholesterol diet.
We studied the effect of feeding ursodeoxycholylcysteic acid, the cysteic acid conjugated analog of ursodeoxycholyltaurine, on serum and liver cholesterol levels and on intestinal absorption of cholesterol and bile salts in hamsters. Addition of ursodeoxycholylcysteic acid to the cholesterol-enriched diet reduced the elevation of serum and liver cholesterol levels caused by feeding cholesterol. However, supplementation with ursodeoxycholylcysteic acid to the standard diet did not show any significant change in serum and liver cholesterol levels. Administration of ursodeoxycholylcysteic acid caused a decrease in dietary cholesterol absorption but did not interfere with the ileal transport of endogenous bile salts. Hence the hypocholesterolemic activity of dietary ursodeoxycholylcysteic acid is thought to be the effect on intestinal absorption of cholesterol but not to be the interruption of the enterohepatic circulation of bile salts.
Animals↗
[Problems and prevention in using arterial grafts for coronary artery bypass grafting].
The arterial graft has proved to be superior to the saphenous vein graft for coronary bypass grafting (CABG), because of its excellent long-term patency. However, there mains controversial on the choice of the arterial grafts. Six hundreds and twenty seven patients who had CABG using both arterial grafts and saphenous vein grafts, operated upon over 11-years period between 1980 and 1991, have been analysed. Some disadvantages and complications associated with the use of arterial grafts were demonstrated in our series. We discussed, the flow capacity, myocardial protection and postoperative complications in using arterial grafts for CABG.
Aged↗
[Coronary artery bypass surgery in the elderly].
In recent years it has become apparent that the number of persons 70 years of age or older is increasing. Between June, 1980, and December, 1990, 75 patients 70 years of age and older (range, 70-79 years; mean 73.1) underwent isolated coronary artery bypass grafting (CABG). During this same interval, 507 patients less than 70 years old underwent isolated CABG. Preoperative status in the elderly showed a significantly greater prevalence of women, urgent or emergent operation, triple vessel disease and diabetes. Operative mortality was higher among the elderly compared with the younger patients (p < 0.05). The increased frequency of urgent or emergent operation in the elderly was associated with postoperative complications. Major complications related CABG in the elderly were serious cerebrovascular accidents and low cardiac output syndrome. In order to improve the results of CABG in the elderly, it is essential to perform the elective operation following careful evaluation of both cardiac function and central nervous system.
Aged↗
[Selective jugular cannulation for hypothermic retrograde cerebral perfusion in thoracic aortic operations (reverse over the wire-catheter method)].
We have employed hypothermic retrograde total body perfusion via the caval cannulae as a supportive measures to protect the brain and other systemic organs in operations for aortic arch aneurysms or acute aortic dissection. But occasionally unsatisfactory results ensued, because competent valves located in the internal jugular vein near the jugulo-subclavian junction may block retrograde blood flow to the brain from the caval cannula. To cope with this problem, we designed an easy and safe method to cannulate the internal jugular vein transatrially utilizing guidewire and central venous catheter, and thereafter we have used this technique clinically and obtained good results.
Aorta, Thoracic↗
[Alcohol and hypertension].
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Alcohol Drinking↗
Amplification immunoassay for the determination of hepatitis B surface antigen.
A sensitive sandwich immunoassay for the determination of Hepatitis B surface antigen (HBs) was developed, using a cascade system of Limulus amebocyte lysate as a signal amplification system. Lipopolysaccharide (LPS) was conjugated to anti-HBs antibody. Anti-HBs antibody was adsorbed to polystyrene beads. First, HBs were reacted to solid phase anti-HBs antibody (a-HBs). After the reaction, the beads were rinsed, and were then reacted with a-HBs-LPS. Then, LPS activity specifically bound to the beads was measured. HBs could be measured in the range of 10(-10)-10(-12) g/mL.
Hepatitis B Antibodies↗
A new surgical approach to tricuspid annuloplasty: possibility of an extracardial suture technique "AV-gathering".
A new extracardiac method of annuloplasty for tricuspid insufficiency was performed on cadavers and in dogs. This procedure effectively produced valvular ring cerclage without causing any decrease in right coronary arterial blood flow. In the animal model, using this approach experimental tricuspid stenosis was successfully attempted. The details of the procedure are reported in this article.
Animals↗
Stunned myocardium and sympathetic denervation--clinical assessment using MIBG scintigraphy.
To evaluate the clinical relationship between stunned myocardium and the sympathetic nervous system, 6 patients who had stunned myocardium accompanied by T wave inversion underwent simultaneous 123I-metaiodobenzyl guanidine (MIBG) scintigraphy and thallium scintigraphy. All patients showed abnormal filling defects on the MIBG scintigrams in the areas with stunned myocardium but the thallium scintigrams were almost normal. The extent of the defects in these 6 patients was determined on the MIBG scintigrams using a Bull's eye display. The defects were found to be larger than those in 4 patients with angina pectoris, and those in 4 patients who had previously shown T wave inversion but had a normal electrocardiogram at the time of examination. Thus, it is suggested that sympathetic denervation is one of the mechanisms causing stunned myocardium.
3-Iodobenzylguanidine↗
[Treatment of cardiomyopathies with beta blockers].
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Adrenergic beta-Antagonists↗
Two cases of bi-ventricular dysplasia associated with ventricular tachycardia and familial occurrence of sudden death.
Two strikingly similar patients with arrhythmogenic right ventricular dysplasia which severely impaired not only the right ventricle but also the left ventricle are described in association with familial occurrence of sudden death. A 49-year-old man experienced syncope which was due to ventricular tachycardia. Electrocardiography revealed a first degree atrioventricular block, incomplete right bundle-branch block, T wave inversions in leads II, III, a VF and V1 to V5, and multiformal ventricular extrasystoles. Echocardiography and ventricular cineangiography showed not only the right ventricular dilatation with an aneurysm in the right ventricular apex, inflow and outflow tracts, but also mild dilatation of the left ventricle with left ventricular apical and posterior aneurysms. Radionuclide angiography also disclosed dysfunction of both ventricles, especially during exercise. His family history revealed that 3 members of his family died of sudden deaths. A 56-year-old woman experienced syncope secondary to ventricular tachycardia, with left bundle-branch block. Electrocardiography showed complete right bundle-branch block, left axis deviation, and T wave inversions in leads V1 to V4. Echocardiography and ventricular cineangiography revealed not only marked right ventricular dilatation with the "triangle of dysplasia", but also a left ventricular aneurysm in the apex and posterior portion. Her elder brother died of a sudden death, and electrocardiograms of 2 members of her family showed ventricular extrasystoles and T wave inversions. These 2 cases may well be termed "familial bi-ventricular dysplasia".
Cardiac Complexes, Premature↗
[Natural history of 82 patients with hypertrophic cardiomyopathy: follow-up for over ten years].
The natural courses of 82 patients with hypertrophic cardiomyopathy (HCM) were investigated in follow-up periods of over 10 years (mean follow-up: 11.7 yrs.). Twelve patients had obstructive, 30 non-obstructive and 40 apical HCM. There were 76 males and 6 females. The mean age at the initial diagnosis was 48 years. All patients underwent cardiac catheterization and left ventriculography, and two-dimensional echocardiography was conducted in some patients. To determine the clinical features influencing the prognosis, their serial laboratory and clinical data were reviewed and analyzed. Five patients died of non-cardiac causes. Only one died suddenly. Congestive heart failure developed in 3 patients, 2 with obstructive and one with non-obstructive HCM. Two patients had cavity dilatation and deteriorated ventricular function, and finally exhibited dilated cardiomyopathy-like features. Characteristically, in this deteriorating group, a decrease in the QRS voltage and an abnormal Q wave gradually developed without clinical evidence of myocardial infarction. Two patients with apical HCM in this group had decreases in their QRS voltages and in the depths of their giant negative T waves. They developed apical left ventricular asynergy without myocardial infarction or congestive heart failure. There were no specific clinical or laboratory parameters predictive of sudden death. Atrial fibrillation occurred in 9 patients, resulting in 3 cases of cerebral infarction, one myocardial infarction, and one congestive heart failure. One patient received pacemaker implantation because of the sick sinus syndrome. Three had acute myocardial infarction. Aortocoronary bypass grafting was performed in 3 patients. These results indicate that the good long-term life prognosis of HCM can be expected in all types of HCM. Among the 82 patients, only one died suddenly. However, since the natural history of HCM can take a variety of courses, careful observation is necessary.
Atrial Fibrillation↗
[Blood flow analysis of aorto-coronary bypass graft using a Doppler catheter--with special reference to comparison of SVG with IMAG].
Since June to December, 1988, 46 patients had aorto-coronary bypass grafting (CABG) to the left anterior descending artery. Fifteen patients among them were subjected to this study. In 8 cases the internal mammary artery (IMAG group) was used and in 7 cases the saphenous vein graft was chosen as a bypass material (SVG group). Mean periphery anastomotic portion was 2.3 +/- 0.5 places for each group. Within two months after operation, intra-graft flow velocity was measured using a Doppler catheter. Mean cross sectional areas of the graft were 13.3 +/- 8.4 mm2 in the SVG group and 6.0 +/- 1.2 mm2 in the IMAG group. Peak flow velocity in diastole in SVG group and IMAG group were 9.9 +/- 2.7 cm/sec and 15.9 +/- 8.9 cm/sec, respectively (p less than 0.05). Also flow velocity in SVG (6.7 +/- 1.8 cm/sec) was significantly (p less than 0.05) lower than that in IMAG (12.1 +/- 6.4 cm/sec) in systole. There were no significant differences in peak, mean and integrated D/S ratio between SVG and IMAG as follows, peak D/S ratio: 1.6 +/- 0.3 in SVG, 1.4 +/- 0.4 in IMAG, mean D/S ratio: 1.5 +/- 0.3 in SVG, 1.4 +/- 0.4 in IMAG, integrated D/S ratio: 2.0 +/- 0.4 in SVG, 2.7 +/- 0.9 in IMAG. It is concluded that no significant differences were demonstrated between SVG and IMAG as to the intra-graft flow velocity profile at least in 2 months after operation.
Aged↗
[A treatment of intractable sternal osteomyelitis--significant use of pedicle muscular flaps].
In recent years, the greater omentum of pedicle muscular flap has been used to treat chest wall infection and Sternal Osteomyelitis following cardiac or respiratory surgery. In Japan, however, there has been an increasing number of cases in which neither the greater omentum Nor the rectus muscle can be used due to the comparatively young age of the patient. There are also many cases undergoing abdominal surgery for malignant tumor and bypass surgery of the coronary artery in which the internal thoracic artery (ITA) and gastroepiploic artery (GEA) are used. We studied three such cases; a case of coronary aortic bypass graft (CABG) where ITA from both the right and left sides were used following stomach resection; a case in which CABG and gallbladder resection were carried out simultaneously; and a case of sternal osteomyelitis is years following surgery for ventricular septal defect. All three cases had undergone reconstructive surgery using the pectoralis major muscle or a pedicle muscular flap from the latissimus dorsi muscle. It is estimated that cases of CABG using both the right and left sides of ITA and GEA, cases of the elderly as well as cases of children will continue to increase. Consequently, cases of sternal osteomyelitis in which neither the omentum nor rectus muscle can be used will also increase. Therefore, it is considered that treatment using pedicle muscular flaps from the breast or dorsal area may be very effective. Herein, we report on the choice of treatment and its results.
Aged↗
[The significance of internal thoracic artery-left anterior descending coronary artery bypass grafting in postoperative angiographic studies--with reference to indication of ITA and factors of string sign].
Internal thoracic artery (ITA) graft for myocardial revascularization has shown superior long-term patency. However, several reports pointed out that the flow capacity of ITA was questionable and the string sign of ITA graft was sometimes observed in the findings of postoperative angiography when the stenosis of the coronary artery was of a lesser degree. We studied pre- and postoperative angiographic findings of 101 patients who underwent ITA grafting to the left anterior descending coronary artery. Postoperative angiography showed that the blood flow from the ITA graft ran through the site of anastomosis only towards the distal end when preoperative stenosis of the native left anterior descending coronary was less than 75%. ITA flow ran bidirectionally (retrogradely and antegradely) when stenosis was within 75 to 90%. Many cases with stenosis of greater than 90% showed the progression of the native lesion, that is, total obstruction of the left anterior descending coronary artery. It becomes clear by statistical study that the postoperative progression of native proximal lesion of the left anterior descending coronary artery correlates neither with the morphological state of the coronary artery nor sites of lesions, but the severity of stenosis. A conclusion has been drawn from angiographic study, that the blood flow from the ITA graft run into two directions; towards the distal and the lesion of the left anterior descending coronary artery, if the free flow through ITA was about 60 ml/min and at the same time, preoperative stenosis of coronary artery was 75% or more.
Adult↗
[Myocardial revascularization using bilateral internal mammary arteries for total occlusion of LMCA in an adult case: sequelae of Kawasaki's disease in childhood].
A 43-year-old female patient suffering from effort angina underwent coronary artery bypass grafting. Coronary arteriogram demonstrated complete occlusion of the left main, proximal circumflex (Cx), and proximal left anterior descending coronary arteries (LAD) and a nonocclusive fusiform calcified aneurysm of the proximal right coronary artery (RCA). The left coronary artery system opacified via collateral vessels from the RCA. No other abnormalities were found in the entire aorta and its major branches. Myocardial revascularization was performed using the right IMA to bypass to the Cx and the left IMA to bypass to the LAD successfully. Prior to the operation, she had neither coronary risk factors nor inflammatory signs, though she had experienced fever of unknown origin lasting about a week when she was 11 years old. Accordingly we supposed that such coronary arterial lesions might have arisen from Kawasaki's disease in her childhood.
Adult↗