Biomedical subjects
Publications and source records attributed to A Taira.
A 47-year-old female who had removal of pericardial cyst is reported. Preoperative examination including echocardiography, computed tomography and magnetic resonance imaging (MRI) demonstrated the cystic nature of the mass attaching to the right pericardial surface. MRI clearly revealed that the cyst was bilocular. MRI brings a more detailed information of pericardial cyst for surgery.
A proper dosage of warfarin after artificial cardiac valve replacements has been determined as an indication of coagulation activity. In some cases, the coagulation activity cannot be maintained within the therapeutic range because Prothrombin time (PT) values deviated from Thrombotest (TT) values. Here we studied each relationship between warfarin concentrations in blood, coagulation activity, vitamin Ks and other coagulation-related agents which were measured in patients administered warfarin after artificial cardiac valve replacements and whose coagulation activity was maintained within a therapeutic range, and in patients whose PT values deviated from TT values. The obtained results were interpreted as follows. 1) There was a high correlation between values from Thromborel S (a clot method) and values from Chromoquick (a method using a synthesized substrate). Since TT values had little variations compared to PT values, the former was an excellent indication of coagulation activity. 2) There was no correlation between warfarin concentrations in blood and coagulation activity in the group in which warfarin concentrations in blood vary within a day (Group B); but there was highly reverse correlation in the group in which warfarin concentrations in blood vary with days (Group A). 3) There was good correlation between warfarin concentrations and PIVKA-II concentrations in blood in Group A. Further, the concentration of Gla-Protein C was one microgram/ml or less on the fourth day from the initiation of warfarin administration. 4) For example, a patient whose PT value of 67% deviated from TT value of 19% on the eleventh day from the initiation of warfarin administration had vitamin K1-epoxide concentration of 2.68 ng/ml and MK-7 concentration of 1.26 ng/ml on the same day, respectively, which were higher levels than those in Group A.
Multi-visceral allografts including the liver, pancreas and gastrointestinal tract were transplanted in 10 pigs. Eight of them survived for 7 to 21 days. Histopathological changes were studied in the liver, pancreas and gastrointestinal tract. An en bloc transplantation revealed no particular course after transplantation than those individual organ transplantation. The status of rejection was assessed by our histological criteria, which are divided into 5 grades about the liver and 4 grades about other organs according to the severity of the acute rejection. A higher grade of rejection was apparently in the small and large intestine especially after the 10th post-transplanted day (Grade II to III in the small and large intestine v. Grade 0 to II in the liver, stomach and pancreas). The study suggests the existence of organ specific susceptibility to rejection in multi-visceral organ transplantation.
In an attempt to define the preoperative risk factors that predictably influence mortality after aneurysmectomy, this study reviews the surgical management of abdominal aortic aneurysms in a series of 110 consecutive patients who underwent elective resection. The preoperative risks to be added to the present study included pulmonary insufficiency, renal dysfunction, advanced age of over 80 years, ischemic heart disease, and associated other diseases such as thoracic aneurysms, atherosclerosis of the limbs and malignant tumors. Forty-six patients had one of these risk factors (one-risk group), 17 had two (two-risk group), and 9 had three (three-risk group). The operative mortality rates were 4.2 per cent for the high-risk patients and 0 per cent for the patients at no risk. As the number of risk factors increased, aneurysm repair was associated with an increased operative mortality; being 2.2 per cent in the one-risk group, 5.9 per cent in the two-risk group and 11.1 per cent in the three-risk group. The common risk factor in patients who died after aneurysmectomy was pulmonary insufficiency which induced prolonged periods of assisted ventilation. Thus, the optimal management of high-risk patients, particularly those with pulmonary insufficiency, may reduce the mortality after aneurysmectomy.
As an experimental model of human tonsillitis, Arthus tonsillitis of the rabbit was produced. In a previous paper, we demonstrated that an increased fibrinolytic activity in the circulating blood and increased proteolytic activity of the local tissue with Arthus tonsillitis were observed. In the present study, the mechanism of the increased proteolytic activity at the local site (tonsil with Arthus-type tonsillitis) was examined using cell cultures of lymphocytes originating from the tonsil with Arthus-type inflammation. That is, lymphocytes isolated from tonsil tissue of the rabbit were cultured in a culture medium for the short term. After culture, the used medium was collected and the presence of plasminogen activator in the culture medium and lymphocytes was investigated. It was clarified that plasminogen activator did exist in the culture medium of lymphocytes originating from the tonsil of rabbits with Arthus tonsillitis. Furthermore, addition of T cell growth factor to the culture medium of lymphocytes derived from non-treated tonsil induced the development of plasminogen activator in that culture medium. However, addition of B cell growth factor did not lead to the development of plasminogen activator activity in the culture medium. These results suggest that plasminogen activator originating from lymphocytes of the tonsil may play an important role in the increased proteolytic activity observed at the local site of Arthus tonsillitis.
Fifty-two cases of abdominal aortic aneurysms including common iliac aneurysms operated on during July, 1981 and December, 1989 have been studied. They were divided into the following three of elective operation (n = 34), impending rupture (n = 5), and ruptured (n = 13) groups. Cases with abdominal operations without aneurysms were randomly selected as the control group (n = 12). Overall operative mortality was 9.6%, consisted of 30.8% of the ruptured, 20.0% of the impending rupture and 0% of the elective operation groups. Respiratory functions including FEV1.0%, V75, V50, V25 and V25/Ht were significantly lowered in the ruptured group. PaO2 of the ruptured group was also significantly lowered in comparison with both the control and the elective operation groups. Leukocytic granular elastase, playing a role of destruction of the elastin component in the pulmonary alveoli and the aortic media, was increased in the patients with ruptured aortic aneurysms, though the difference was not significant. The data suggested the possibility of aneurysm rupture in case with elevated leukocytic granular elastase. Surgery for abdominal aortic aneurysm, even in cases with decreased pulmonary function, should be considered aggressively to elimination of ominous result of aneurysm rupture.
The North Kyushu Co-operative Study Group for Cancer Chemotherapy (21 participating facilities) carried out a comparative study of post-operative adjuvant chemotherapy in the treatment of 243 patients after surgery of gastric cancer in stages II, III and IV over 27 months period starting from October 1983. The patients were divided randomly into group A (treated with 20 mg of MMC on the day of the surgery and 10 mg of MMC on the following day, and with a daily dose 600 mg of orally administered tegafur starting from two weeks after the surgery. In addition to the above treatments, patients with Stage IV were treated with 10 mg of MMC every three months starting from four weeks after the surgery) and group B (treated with MMC in a similar manner to group A, and with 600m g of UFT instead of the tegafur). Thirty-three patients (13.6%) were excluded or dropped out, and the remaining 210 cases were analyzed. No severe side effects appeared in either of the groups, and a long-term administration was safe. The five-year survival rate among the radical surgery patient was significantly higher in the UFT group compared with the tegafur group (p less than 0.05). Significantly higher survival rate in the UFT group was observed (p less than 0.05) for the cases of poorly-differentiated adenocarcinoma. From the above results it appears that an addition of UFT to the treatment with MMC is useful in post-operative adjuvant chemotherapy for gastric cancer.
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To determine the optimal use of Verapamil as a myocardial protective agent during open heart surgery, patients were divided into 3 groups of 15 patients each of the same severity and operative difficulty. In group I, Verapamil was added to the blood cardioplegia in a concentration of 1 mg/L. In group II, 0.2 mg/kg of verapamil was added in the pump prime and in group III, in addition to the same amount of pump prime, an additional 0.1 mg/kg of Verapamil was added to the bypass circuit at 60 minutes after the start of bypass and continuous drip of 0.5 micrograms/kg/min for 24 hours after surgery. Only group III continued to maintain an effective concentration of verapamil, that was said in a range between 15 and 100 ng/ml in the serum during and after surgery. It is suggested from the present study that recommendable verapamil administration is as in group III with no severe arrhythmias, significantly less usage of catecholamines without mortality.
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The best means of managing tricuspid regurgitation associated with acquired valvular disease is still controversial. During the period from 1978 to 1988, 111 patients who had tricuspid regurgitation along with associated valvular dysfunction were treated in Kagoshima University Hospital. Patients with moderate to severe regurgitation underwent annuloplasty in 61 (Carpentier's in 39, DeVega's in 20, and Kay's method in 2) and valve replacement in 8. Forty-two patients were treated conservatively on the tricuspid valve because of mild regurgitation. We found the results to be less satisfactory with a high incidence of postoperative deaths and residual tricuspid regurgatation in the group treated by annuloplasty with a Carpentier ring than in the other two groups of annuloplasty or in the group of valve replacement. We conclude the modified DeVega's method is the first choice for annuloplasty in patients with mild to moderate regurgitation, and we believe it appropriate to replace the valve in an increasing number of subjects which have severe regurgitation.
Embolized catheter fragments in the heart and great vessels were successfully removed in seven patients by nonsurgical techniques. All procedures for the retrieval were completed without complications or difficulty using instruments such as multipurpose grasping forceps, stone basket, loopsnare and myocardial biopsy catheters. Embolized catheter fragments should be removed promptly before fatal complications develop, and can be taken off safely and simply by nonsurgical technique.
Nine-year-old girl who had Seckel's syndrome (bird-headed dwarfism), one of low birth weight dwarfisms, was successfully operated upon for the associated atrial septal defect. To our knowledge, 17 cases with this syndrome have been reported in Japan. Only three cases including our patient had congenital heart disease.
Klippel-Feil syndrome is characterized by congenital fusion of the cervical vertebrae. Anomalies in other organs sometimes combine. Many kinds of congenital cardiac anomalies, most frequently ventricular septal defect, considerably associate with this syndrome. Few cases of surgical corrections of cardiac anomalies with Klippel-Feil syndrome have been reported up to today. Therefore surgical problems with this syndrome have not been solved yet, completely. We have experienced a very rare case of a 18-year-old female of total anomalous pulmonary venous connection (Darling Ia type) associated with Klippel-Feil syndrome, that was repaired successfully. No difficulty in the surgical and anesthesiological management referring to the fusion of cervical vertebrae was encountered. The result of surgical correction of congenital cardiac anomalies in Klippel-Feil syndrome mainly depends on the severity of the heart disease and not on Klippel-Feil syndrome itself, as literature and the present case suggest.
A 65-year-old man with discrete subaortic stenosis complicated by ventricular septal defect and aortic stenotic insufficiency was successfully operated on. To our knowledge, the present case was the oldest patient who underwent open-heart surgery for discrete subaortic stenosis.
The purpose of this study was to determine the criteria of valve selection from the long-term results of Hancock, Carpentier-Edwards, St Jude Medical and Bjork-Shiley prostheses, taking into special account the frequency of reoperation. Reoperations on the Hancock bioprosthesis were performed on six patients for tissue leaflet disruption with an incidence of 2.2 per cent/patient-year. Reoperations on the Carpentier-Edwards bioprosthesis were performed on 24 patients for tissue leaflet disruption in 23 patients and prosthetic valve endocarditis (PVE) in one, with an incidence of 3.8 per cent/patient-year. Reoperations on the Bjork-Shiley prosthesis were performed in two patients for severe hemolysis, with an incidence of 0.32 per cent/patient-year. Reoperations on the St Jude Medical prosthesis were performed on 3 patients, for valve thrombosis in one patient, PVE in one, and hemolysis in one, with an incidence of 0.23 per cent/patient-year. The overall mortality rate was 20 per cent, or 7 patients, and the indications for reoperation affected this. Patients with primary tissue failure had a mortality rate of 10.3 per cent; those with a thrombosed valve, 0 per cent; those with hemolysis, 66.7 per cent; and those with valve infection, 100 per cent. A good chance of survival may be achieved in patients facing prosthetic valve complications by performing reoperation as soon as possible after early detection, since mortality is high following emergency reoperation and in patients with severe symptoms. Currently, we recommend mechanical prostheses for valve replacement except in patients over 70 years old and in younger patients with absolute contraindications to anticoagulative therapy.
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