Biomedical subjects
Publications and source records attributed to A Taira.
A case of symptomatic accessory lobe of the liver occurred in a 15-year-old Japanese girl with hyperthyroidism. The patient presented with acute abdominal distress; at operation, a twisted necrotic mass of the accessory lobe of the liver was found. A review of the literature failed to show a previously reported instance in a child.
Ninety-one patients with true and dissecting aortic aneurysm were reviewed. They ranged in age from 65 to 87 years (mean 71 years). Forty-eight patients were diagnosed with abdominal aortic aneurysm, 21 patients with thoracic aortic aneurysm and 22 patients with dissecting aortic aneurysm. They were divided into 2 categories, surgical group and non-surgical, and the prognoses of the 2 groups were compared. The average age of surgically treated cases was significantly younger than that of non-surgical cases. This study suggests that elective operation should be considered for abdominal aortic aneurysms because of the high risk of late rupture. In older patients with thoracic aortic aneurysm, the prognosis was better in surgically treated patients than in those not treated. However, the surgical mortality rate of elective operation was high. The surgical mortality rate of older patients with dissecting aortic aneurysm was not satisfactory, and medical treatment which decreases blood pressure should be considered first. All patients classified as Stanford type A should be operated on if possible.
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Fatal hemolysis after mitral valve replacement with the St. Jude bileaflet tilting prosthesis is reported in two patients. Although one underwent re-replacement of the valve, both died from multiple organ failure and acute renal failure, respectively. Scanning electron microscopy revealed microthrombi adherent to a leaflet in one and irregular leaflet surfaces in the other. Such defects are rare but are possible causes of hemolysis in patients with the St. Jude mitral valve prosthesis.
To assess the feasibility and function of small donor hearts for large recipients, small donor hearts were orthotopically transplanted into large recipients. Thirty adult mongrel dogs were used to form donor-recipient (D-R) combinations with the D-R heart weight ratio ranging from 0.47 to 1.78. In the D-R heart weight ratio of 0.8 or above (mean 1.11, Group I), the successful transplantation rate was 57 per cent, while it was 81 per cent in cases of less than 0.8 (mean 0.67, Group II) (no statistical difference). In 10 dogs (5 with D/R heart weight ratio greater than or equal to 0.8, 5 with less than 0.8) a recovery rate in cardiac function of the transplanted small heart was studied 2 hours following transplantation. There was no significant difference, hemodynamically in the normal range of left atrial pressure (LAP) between the two groups. The close relationship between cardiac output (CO) and volume load in the range of 10 to 15 mmHg of LAP was transformed to a linear function in the over 0.8 group. It was technically and hemodynamically possible to transplant small dog hearts to larger recipients up to the D-R heart weight ratio of 0.47. The importance of an adequate heart rate for the increase of CO in transplanted smaller donor hearts was emphasized.
Three cases with typical cooing murmurs in degenerated porcine valves at mitral positions were studied. An echophonocardiogram disclosed that the origin of cooing murmur was due to cusp vibration with fixed cycle in frequency. Three failed xenografts were replaced with mechanical valves and the removed prostheses were examined. The first valve had a torn cusp, the second had a perforated cusp and the third had both a torn and perforated cusps. The failed leaflets were all pliable and not thickened in properties. These common findings are suspected to relate closely to the occurrence of a musical cooing murmur. Since all cases with cooing murmurs suddenly developed severe or progressive heart failure, we recommend prompt evaluation and reoperation when a cooing murmur appears in the patients with xenografts.
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Of fifty-eight consecutive patients surgically treated for aneurysm of the abdominal aorta, twenty were emergency cases following the rupture. Associated diseases were found in 85 per cent of patients; hypertension being the most common. Fifty per cent of patients were in shock on admission. The duration between rupture and operation was three hrs to two weeks with the average of 115.5 hrs. In six patients, the diagnosis of abdominal aortic aneurysm was known for over six months. The operative mortality rate in case of ruptured abdominal aortic aneurysm was 45 per cent. The most important determinants of survival were the incidence of shock on admission, the incidence of associated disease, the known duration of the aneurysm, and the time interval from rupture to admission. The intraoperative factors most influencing survival were the type of rupture, intraoperative hypotension, and total blood loss. Comparison of the mortality rate in elective surgery of abdominal aortic aneurysms (5.3 per cent) with that in ruptured aneurysms (45.0 per cent) suggests the necessity for early elective operations whenever abdominal aortic aneurysms are diagnosed.
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