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Biomedical subjects

A Usui

Publications and source records attributed to A Usui.

At least 109 records · Page 6Linked to original sources
PubMed1992

[Operative management of Stanford type A aortic dissection using selective cerebral perfusion].

Ten patients underwent surgical treatment for type A aortic dissection from October 1986 to April 1989 using hypothermic cardiopulmonary bypass (CPB) with selective cerebral perfusion (SCP). CPB was begun with femoral artery cannulation. The right axillary artery (RAA) and the left common carotid artery (LCCA) were separately cannulated and perfused with CPB blood by individual pump heads. The average flow to the RAA was 5.4 +/- 1.2 ml/min/kg body weight (mean +/- SD) and 5.6 +/- 2.6 ml/min/kg body weight to the LCCA. The average blood pressure of the superficial temporal artery was 53.1 +/- 15.1 mmHg in the right side and 52.5 +/- 24.7 mmHg in the left. The nasopharyngeal temperature during SCP was maintained at 19.3-24.7 degrees C (mean, 21.1 degrees C). The SCP time ranged from 112 to 197 minutes (mean, 168 +/- 20.8 minutes). There was one operative death. She died of myocardial infarction 3 days after operation. There were two late deaths. One patient died of infection 3 months after operation and another died of cholecystitis 4 months after operation. Cerebral infarction developed in the last patient. Among the 10 patients it was only one neurological sequela, which was surmised to be caused by technical problem in carotid artery cannulation. The good cerebral protection was obtained in our experience by SCP as mentioned above.

Aged↗
PubMed1991

Prenatal diagnosis of Duchenne muscular dystrophy by restriction fragment length polymorphism analysis with pERT 87 intragenomic deoxyribonucleic acid probes.

Prenatal diagnosis of DMD was performed with three intragenic genomic probes and chorionic villus sampling. A total of 8 unrelated families with at least one DMD were analysed. DNA was extracted from peripheral white blood cells for carrier testings (50 individuals). For prenatal detection, it was extracted from chorionic villi obtained by chorionic villus sampling at 9 menstrual weeks. DNA was digested with an appropriate restriction enzyme followed by overnight electrophoresis in 1% agarose gels. DNA was transferred from the gel to nylon membrane according to the protocol of an alkaline transfer method. The pERT 87 probes were labeled by nick translation. The membranes were hybridized overnight after prehybridization. After washing, the membranes were exposed to X-ray films to make autoradiograms for restriction fragment length polymorphism analysis. Fetal sex was determined by a rapid screening test with a Y chromosome-specific repeat sequence. Out of 8 fetuses, 4 were males and 4 were females. All of 4 male fetuses were determined to be unaffected. Out of 4 female fetuses, 3 were diagnosed as non-carriers, and the carrier status of the remaining one was not able to be determined because her mother was not informative for all testings.

Chorionic Villi Sampling↗
PubMed1991

[YAG laser contact therapy of ovarian endometriosis under laparoscopy].

Thirty-six patients with ovarian endometriosis were treated with Nd:YAG laser contact irradiation under laparoscopic control. Indications for laparoscopy were infertility (n = 20) and dysmenorrhea (n = 16). The laparoscopic procedures so far undertaken in our clinic include: Aspiration of chocolate cyst, removal of ovarian endometriosis, adhesion-lysis, uterine nerve ablation, coagulation of peritoneal endometriosis and irrigation. No complications were seen. After undergoing this procedure, eight of 20 patients achieved pregnancy and 15 of 16 patients obtained pain relief. Serum CA125 levels were significantly decreased postoperatively. We confirmed that contact irradiation with a cone-shaped sapphire probe provides adequate incision and lysis at lower power levels, and that this method is an effective treatment for ovarian endometriosis.

Adult↗
PubMed1991

Concentration of Mn-superoxide dismutase in serum in acute myocardial infarction.

Serum concentrations of manganese-containing superoxide dismutase (Mn-SOD; EC 1.15.1.1), a mitochondrial enzyme present in high concentrations in the heart, were measured successively by enzyme immunoassay in 18 patients with acute myocardial infarction (AMI) and in eight with angina pectoris. Results were compared with creatine kinase (EC 2.7.3.2) isoenzyme MB (CK-MB) concentrations in the same specimens. The mean (and SD) serum Mn-SOD concentration in 120 healthy adults was 77.5 (18) micrograms/L. Mn-SOD concentrations exceeding 150 micrograms/L (greater than mean + 4 SD) were considered above-normal. In patients with AMI, the Mn-SOD concentration was 80 (16.8) micrograms/L on admission and increased gradually after the first hospital day. The peak, 260 (109) microgram/L, occurred on the fourth hospital day, at which time the Mn-SOD concentrations in all AMI patients were above normal. Thereafter the Mn-SOD concentration decreased slowly, but still was above normal in 14 of 18 patients on the seventh hospital day. On the other hand, in patients with angina pectoris, the Mn-SOD concentration was 78 (11) micrograms/L on admission and did not increase significantly [peak value 97.5 (42) micrograms/L on the fourth hospital day]. The serum concentration of Mn-SOD is a potentially useful marker for estimating cardiac mitochondrial damage and for diagnosing AMI, especially in the late phase.

Adult↗
PubMed1990

[Study on adoptive immunotherapy on patients with renal cell carcinoma. I. Functional characteristics of peripheral blood mononuclear cells and serum immunosuppressive factors in patients with renal cell carcinoma].

The immune responses in patients with renal cell carcinoma were evaluated from the production of interleukin-2 (IL-2), the expression of IL-2 receptors and the activity of lymphokine activated killer (LAK) cells. In addition, the effect of the patient's serum on the expression of IL-2 receptors and LAK activity were investigated. The production of IL-2 by peripheral blood mononuclear cells (PBM) from patients with renal cell carcinoma was not suppressed, when compared with that in controls. However, the expression of IL-2 receptors tended to decrease with the progression of clinical stage. The LAK cells generated by PBM of patients with renal cell carcinoma had significant cytotoxic activity against Daudi cells, ACHN cells and autologous tumor cells, while autologous serum suppressed the expression of IL-2 receptors and the induction of LAK cells in patients with renal cell carcinoma. Furthermore, serum from patients with renal cell carcinoma suppressed the cytotoxic activity of LAK cells generated by PBM from a normal volunteer. These results indicated the presence of immunosuppressive factors in the serum of patients with renal cell carcinoma which impaired the clinical effect of treatment using IL-2 or LAK cells.

Aged↗
PubMed1990

[Study on adoptive immunotherapy in patients with renal cell carcinoma. II. Plasmapheresis with adoptive immunotherapy using LAK cells and IL-2].

The existence of immunosuppressive factors which impair the clinical effect of treatment using IL-2 or lymphokine activated killer (LAK) cells has been reported in the serum of patients with renal cell carcinoma. For the purpose of eliminating these immunosuppressive factors, plasmapheresis combined with adoptive immunotherapy using LAK cells was performed in ten patients with stage IV renal cell carcinoma. Immunological examinations revealed that the number of peripheral blood lymphocytes, NK activity and the ratio of Leu 11 positive cells were increased during the treatment. Of the 9 evaluable patients, one has a partial response, 5 showed no change and 3 had progressive disease. In addition to the one partial response, the size of some metastatic lesions in the lungs decreased in 2 patients during the treatment. As serious side effects, brain edema progressed in 2 patients with brain metastases and acute hepatitis due to plasmapheresis was noted in one patient. Moreover, transient and reversible renal dysfunction developed in most patients. These results indicated that plasmapheresis combined with adoptive immunotherapy using LAK cells is a useful therapy for patients with advanced renal cell carcinoma.

Adult↗
PubMed1990

Transatrial balloon technique for activation mapping during operations for recurrent ventricular tachycardia.

Results of operations for recurrent ventricular tachycardia have improved since methods of mapping that allow a directed approach to the problem have been developed. With standard operative techniques (ventriculotomy and introduction of a hand-held probe or multiple electrode array), it has not always been possible to obtain satisfactory endocardial activation maps during the tachycardia. We have recently developed a new transatrial balloon approach that has greatly facilitated intraoperative mapping. This paper describes our total experience with the new approach and draws attention to details of the cardiopulmonary bypass technique and the surgical approach needed for safe balloon insertion across the mitral valve. We describe how correlation between position of target electrodes on the balloon and the internal geometry of the heart is achieved and discuss the choice and application of appropriate ablation techniques. In our series of 37 consecutive patients, 35% had a grade IV ventricle (ejection fraction less than 20%), 32% had a previous posterior infarct, 51% did not have a resectable aneurysm, and 54% had been receiving amiodarone within 1 month of the operation. These factors have been associated with poor operative results in other series. With the transatrial balloon technique, we were able to induce and map ventricular tachycardia in 100% of patients (average 2.6 +/- 1.3 morphologies per patient). Using a variety of ablation techniques (endocardial excision, cryoablation, or balloon electric shock ablation), we have achieved surgical control of the arrhythmias in 84% of patients with an operative mortality rate of 14%. We recommend transatrial balloon mapping as the procedure of choice for intraoperative identification of arrhythmogenic foci in patients with recurrent ventricular tachycardia.

Catheterization↗
PubMed1990

S-100ao protein in serum during acute myocardial infarction.

Concentrations in serum of S100ao protein (alpha alpha form of S-100 protein, which is present at high concentrations in heart muscle) were successively measured by enzyme immunoassay in 21 patients with acute myocardial infarction (AMI) and six with angina pectoris (ANP). Results were compared with measurements of creatine kinase isoenzyme MB (CK-MB) concentrations in the same specimens. Mean S100ao concentrations in sera from 100 healthy adults were 0.12 (SD 0.08) microgram/L. In patients with AMI, S100ao concentrations were 4.74 +/- 5.27 micrograms/L at admission, peaked 8 h after admission (23.5 +/- 27.7 micrograms/L), then decreased gradually. Among nine AMI patients who were admitted within an hour after their attack, eight showed abnormally high concentrations of S100ao in serum (greater than 0.5 microgram/L), whereas only four showed abnormally high CK-MB concentrations (greater than 5 micrograms/L) in sera at the time of admission. Serum S100ao concentrations remained within the normal range in all six patients with ANP; however, serum CK-MB concentrations were increased in two of them. Therefore, serum S100ao is useful not only for detection of AMI but also for differentiating AMI from ANP.

Acute Disease↗
PubMed1989

Beta-enolase in blood plasma during open heart surgery.

The enolase isoenzyme composed of the beta subunit (alpha beta or beta beta enolase) is distributed predominantly in the heart and skeletal muscles. To see whether it may be a useful indicator of myocardial damage, concentrations of beta-enolase (the beta subunit of enolase) were determined in serial blood samples taken from 18 patients who underwent mitral valve replacement, using a highly sensitive enzyme immunoassay method. They were compared with those of creatine kinase MB isoenzyme (CK-MB) in the same samples. The mean arterial beta-enolase concentration was 6.60 (SD 3.84) ng.ml-1 at the beginning of anaesthesia. It increased rapidly after reperfusion and rose to greater than 100 ng.ml-1 at 2 h post-reperfusion. It remained high until 12 h post-reperfusion, and then decreased slowly. The plasma beta-enolase concentrations were significantly higher in coronary sinus samples than in arterial samples in the early phase after reperfusion. Since plasma carbonic anhydrase III, which is known to be localised only in the skeletal muscle, did not increase during the surgery, we suggest that the major portion of the elevated plasma beta-enolase was derived from heart muscle. Plasma concentrations of beta-enolase increased as quickly as those of CK-MB after reperfusion. The CK-MB concentrations had returned to normal at 2 d but the beta-enolase concentrations remained elevated up to 7 d. These results show that the determination of beta-enolase in plasma may be useful for estimating myocardial damage during open heart surgery.

Adult↗
PubMed1989

A simplified concept for a bileaflet atrioventricular valve that maintains annular-papillary muscle continuity.

We have developed a simplified concept for a bileaflet atrioventricular prosthesis that can be constructed from a simple sheet of glutaraldehyde preserved pericardium. The valve has no rigid ring or stent and no cloth sewing ring. Insertion of the valve reestablishes normal continuity between the annulus and the papillary muscles. We have replaced the mitral valve in nine dogs using this prosthesis. All valves have been competent with excellent valve opening areas as confirmed by echo-Doppler assessment. Studies up to 4 1/2 months have confirmed excellent hemodynamics and there has been no evidence of early tissue failure. Possible advantages of this simple valve design are improved hemodynamics, ease of construction and insertion, and low cost.

Animals↗
PubMed1989

Creatine kinase BB isozyme in the blood during open heart surgery--comparison with creatine kinase MB and MM isozymes.

By using a recently developed highly sensitive enzyme immunoassay method, concentrations of the 3 forms of cytoplasmic creatine kinases (CK-BB, CK-MB and CK-MM) were determined in blood samples serially taken from 18 patients who received mitral valve replacement. Blood CK-BB levels, 0.64 +/- 0.32 ng/ml at the beginning of anesthesia, rose sharply after reperfusion reaching the peak level (23.3 +/- 7.56 ng/ml) 2 hours after reperfusion, and then fell rapidly. The response of CK-BB in blood was rapider and more sensitive than that of CK-MB or CK-MM. The CK-BB concentrations were significantly higher in coronary sinus samples than in arterial samples. These results suggest that the major portion of elevated blood CK-BB level in the early phase after reperfusion are derived from the heart muscle.

Cardiopulmonary Bypass↗
PubMed1989

[Transvenous permanent pacemaker implantation for Fabry's disease. 3 cases report].

Three men with Fabry's disease (angiokeratoma corporis diffusum universal ) are described. In the first patient, atrial fibrillation appeared, and a permanent cardiac pacemaker (VVI) was implanted. Sick sinus syndrome with complete atrioventricular block was occurred on the second patient. Transvenous pacemaker (DDD) implantation was performed for him. The last patient was younger brother of the second patient. He demonstrated complete atrio-ventricular block, so cardiac pace maker (VAT) was implanted. They showed a low value of granulocyte's alpha-galactosidase activity. During 1 to 4 year follow up period, they showed no trouble about pacemaking. Fabry's disease is an disorder of glycosphingolipid metabolism. This disorder is characterized by the accumulation of trihexosyl ceramide in many sites. Cardiac involvement and abnormal electrocardiographic manifestations are common in this disorder. Permanent cardiac pacemaker is necessary for severe bradycardia caused by this disorder.

Adult↗
PubMed1989

[A study of the controlled ovarian hyperstimulation using GnRH agonist and pure FSH in in vitro fertilization-embryo transfer and gamete intrafallopian transfer program].

The present study was undertaken to examine controlled ovarian hyperstimulation (COH) during an IVF-ET/GIFT program with GnRH agonist (GnRH-a) and pure FSH and with the conventional method. Pituitary desensitization was induced with a subcutaneous injection of GnRH agonist (leuprolide acetate) in 20 patients undergoing COH for oocyte recovery. These 20 patients had previously dropped out of our IVF-ET/GIFT program because of a low estradiol response or premature LH surge. Comparisons were made among the menstrual cycles of 20 drop-out patients, the same patients' cycles after GnRH-a and pure FSH administration (GnRH-a group), and the cycles of 20 non-drop-out patients (control group). After treatment with GnRH-a and pure FSH, Estradiol levels were increased (GnRH-a cycles:previous cycles, 1,520 +/- 416 pg/ml:416 +/- 209.1 pg/ml), while the premature LH surge was decreased (GnRH-a cycles:previous cycles, 2:12). Moreover, the number of follicles at the day of hCG injection was increased (GnRH-a group: control group, 4.6 +/- 1.3:3.4 +/- 1.5). However, the fertilization rates for the GnRH-a group and the control group did not differ markedly, though the pregnancy rate was increased slightly in the former (GnRH-a group:control group, 25%:15%). In conclusion, it was seen that COH using GnRH-a and pure FSH contributed to a better ovarian response and suppression of LH surge in patients who had previously dropped out of the IVF-ET/GIFT program using conventional ovarian stimulation.

Adult↗
PubMed1989

[Beta-enolase in blood plasma during open heart surgery--comparing with CK-MB and CA-III in blood plasma].

Enolase isozyme composed of the beta subunit (alpha beta or beta beta enolase) is distributed predominantly in the heart and skeletal muscles. Concentrations of beta-enolase (beta subunit of enolase) in blood plasma samples serially taken from 18 patients, who received mitral valve replacement, were estimated by using a highly sensitive enzyme immunoassay method and compared with those of CK-MB in the same samples. Plasma beta-enolase levels, that were 6.60 +/- 3.84 ng/ml at the beginning of anesthesia, increased rapidly after reperfusion reaching the plateau more than 100 ng/ml between 2 to 12 hours, showing two peak (116 +/- 45.7 ng/ml at 4 hours and 112 +/- 48.1 ng/ml at 12 hours after reperfusion), and then decreased slowly remaining high levels even when plasma CK-MB levels became normal. The beta-enolase concentrations were significantly higher in coronary sinus samples than in arterial samples early after reperfusion. Since plasma carbonic anhydrase III, which is known to be localized only in the skeletal muscle, did not increase during the surgery, it is suggested that the major portion of elevated plasma beta-enolase levels were derived from the heart muscle. Plasma levels of beta-enolase increased as quickly as those of CK-MB after reperfusion and kept high levels longer than those of CK-MB. These results indicate that the determination of beta-enolase in plasma may be useful for estimating the myocardial damage during open heart surgery.

Carbonic Anhydrases↗
PubMed1989

S-100ao protein in blood and urine during open-heart surgery.

Concentrations of S100a0 protein and CK-MB were measured by enzyme immunoassay in serial samples of arterial and coronary-sinus blood and urine taken from 26 patients who were undergoing mitral valve surgery. The mean concentration of arterial S100a0 in plasma was 0.32 (SD 0.28) ng/mL at the beginning of anesthesia, increased sharply after reperfusion, peaking [14.4 (SD 6.63) ng/mL] after 45 min of reperfusion, then decreased rapidly. The concentration of creatine kinase (CK) isoenzyme MB in arterial blood plasma was greatest 3 h after reperfusion [107 (SD 54.5) ng/mL]. S100a0 concentrations in urine increased dramatically after reperfusion [16,300 (SD 12,000) ng/h vs 44 (SD 32) ng/h], while CK-MB increased slightly [135 (SD 75) ng/h vs 19 (SD 12) ng/h]. These results suggest that S100a0 in cardiac muscle is released into the bloodstream during open-heart surgery and is discharged into the urine more rapidly than is CK-MB. Determination of S100a0 in plasma or urine thus may be useful for estimating damage to heart muscle during open-heart surgery.

Biomarkers↗
PubMed1989

[The change of creatine kinase bb isozyme in patients undergoing mitral value replacement--comparison with creatine kinase MB and MM isozymes].

By using highly sensitive enzyme immunoassay method recently developed, concentrations of the three forms of cytoplasmic creatine kinases (CK-BB, CK-MB and CK-MM) were determined in blood plasma samples serially taken from 18 patients, who received mitral valve replacement. Plasma CK-BB levels, that were 0.64 +/- 0.32 ng/ml at the beginning of anesthesia, increased sharply after reperfusion reaching peak levels (23.3 +/- 7.56 ng/ml) at 2 hours after reperfusion, and then decreased rapidly. The response of CK-BB in plasma was more rapid and sensitive than that of CK-BB or CK-MM. The CK-BB concentrations were significantly higher in coronary sinus samples than in arterial samples. These results suggest that the major portion of elevated plasma CK-BB levels at early phase after reperfusion were considered to be derived from the heart muscle.

Creatine Kinase↗