Biomedical subjects
Publications and source records attributed to E Takeuchi.
Our cadaver dissection demonstrated that the lateral calcaneal artery is large enough for microsurgical anastomosis. Based on the finding, the lateral calcaneal flap was first successfully applied as a free flap that included the lesser saphenous vein and the sural nerve in the pedicle. This thin sensory flap, dispensing with main arterial damage, is indicated for the lesion of the posterior heel, plantar, and hand.
We previously reported that circulating natural thymocytotoxic autoantibody (NTA) and IgG-anti-DNA antibodies were the major serological characteristics of a substrain of SAM, SAM-P/1. We present here a study of ageing in which we further measured and compared various kinds of circulating IgG antibodies including anti-collagen type II, rheumatoid factor (RF), and anti-2,4,-dinitrophenol (DNP), between SAM-P/1 and control SAM-R/1 mice. The results showed that age-associated increases in anti-collagen type II antibodies in SAM-P/1 were distinctively higher than those in SAM-R/1 when the mice were over 4 months of age, and the increases were significantly correlated with increases in NTA, anti-DNA antibodies, RF activities and anti-DNP antibodies. Anti-collagen type II antibody activity was not significantly inhibited by preincubating the antibodies with DNA, IgG-Fc and DNP-BSA samples. These findings suggest that antibodies specifically directed against collagen type II can be produced in a background of polyclonal B cell activation, and that these antibodies in association with NTA and anti-DNA antibodies may play a pathogenic role in the development of accelerated senescence in SAM-P/1 mice.
Retrograde cerebral perfusion through a superior vena cava (SVC) cannula is a new technique used to protect the brain during circulatory arrest. Cerebral blood flow, oxygen consumption, blood sugar consumption and auditory brain stem responses were measured at various rates (100, 200 and 300 ml min-1) of retrograde cerebral perfusion in normothermic mongrel dogs (n = 12, body-weight 13-15 kg). During perfusion about 20% of the perfusate from the SVC was returned via the aorta, while the rest drained into the inferior vena cava. External jugular venous pressure increased as the perfusion rate increased (mean(s.d.) 26.0(6.4) mmHg at a rate of perfusion of 300 ml min-1). Oxygen and blood sugar consumption also increased as the rate of perfusion increased. Retrograde cerebral perfusion at 300 ml min-1 provided half of the cerebral blood flow (mean(s.d.) 14.7(6.4) versus 34.3(7.8)ml min-1) of antegrade cardiopulmonary bypass (CPB). Analysis of the blood returned through the aorta during perfusion at a rate of 300 ml min-1 showed that mean(s.d.) oxygen consumption was about one-third (4.4(2.1) versus 12.3(7.1) ml min-1) and blood sugar consumption about 15% (17(22) versus 114(54)mg min-1) of that seen in blood returned through the SVC during CPB. Auditory brain stem responses disappeared immediately when perfusion was started but recovered completely as soon as CPB was resumed. Although the oxygen provided by perfusion was not sufficient to maintain cerebral function, it should help protect the brain during circulatory arrest.
From 1984 to 1992 in Japan, 37 cases, including 2 cases of our own, have been reported to involve the percutaneous removal of foreign bodies from the cardiovascular system by catheter. We reviewed the cases of these foreign bodies and the locations, approaches and types of catheters used for removal. The reported foreign bodies were usually iatrogenic in origin and were approximately two times larger than those found in patients who had self-dislodged catheters. The most common catheter approaches were from either the right femoral or saphenous veins.
Hypothermic circulatory arrest for aortic arch surgery can be tolerated for a limited period of time. To avoid this disadvantage, we used hypothermic cardiopulmonary bypass (CPB) with selective cerebral perfusion (SCP), in which the femoral artery, right axillary artery (RAA) and left common carotid artery (LCCA) were separately cannulated and perfused by individual pump heads. The pressures of bilateral superficial temporal arteries were monitored to maintain the cerebral perfusion pressure at 50 mmHg. The flow of RAA and LCCA was maintained at 5 ml/min/body weight kg, the pressure of each superficial temporal artery at 50 mmHg and the nasopharyngeal temperature at 20 degrees C. To perform the "open distal repair", the CPB was stopped while cerebral perfusion was maintained. Between 1986 and 1991, 20 patients were operated on with this method. Mean duration of SCP was 169 minutes (73 to 210), and mean duration of CPB was 290 minutes (136 to 472). There was no intraoperative death. Operative mortality rate within 30 days after surgery was 10% (2/20). Neurological sequelae occurred in one patient with emergency operation for acute aortic dissection, into LCC of whom we had trouble in inserting a cannula. It was considered that SCP could be performed for at least 2 hours with the results of good cerebral protection.
Partial anomalous pulmonary venous connection (PAPVC) is often associated with other congenital heart diseases. Atrial septal defect, particularly, appears in about ninety percent of patients with PAPVC. Successful repairs were made in two patients of total left PAPVC with intact atrial septum. In one patient, left thoracotomy was made, and the vertical vein was anastomosed to the left atrial appendage. Cardiopulmonary bypass was not used in this case. In the other patient, median sternotomy was made, and the vertical vein was anastomosed to the posterior wall of the left atrium under cardiopulmonary bypass. Although postoperative prognosis are excellent sofar in both cases. We consider that the latter operative procedures are preferable for PAPVC not associated with atrial septal defect. In the present paper, the detailed operative procedures and approaches for these two cases are reported, and the concerning literatures are discussed.
Cerebral tissue blood flow (CBF), renal tissue blood flow (RBF), hepatic tissue blood flow (HBF), and oxygen metabolism have been measured in 8 mongrel dogs which underwent hypothermic (20 degrees C) retrograde perfusion via the inferior vena cava (IVC). IVC perfusion was performed with aortic drainage and cross-clamping of superior vena cava (SVC) at IVC pressures of 20 or 30 mmHg. CBF, RBF, and HBF at 30 mmHg of IVC pressure were 10.4 +/- 6.8, 11.4 +/- 5.5, and 19.2 +/- 11.3 mL/min/100 g. These values were 33%, 47%, and 64% of those observed with a cardiopulmonary bypass and flow rate of 1000 mL/min, and 77%, 112%, and 168% of those observed with retrograde cerebral perfusion via the both internal maxillary veins at 25 mmHg of SVC pressure. Oxygen consumption at this time was 3.78 +/- 1.77 mL/min. CBF, RBF, HBF, and oxygen consumption at 20 mmHg of IVC pressure were 7.7 +/- 4.8, 7.5 +/- 4.7, and 9.9 +/- 4.7 mL/min/100 g and 2.02 +/- 0.72 mL/min, respectively. As IVC pressure increased, CBF, RBF, HBF, and oxygen consumption increased. However, high IVC pressure by the retrograde perfusion was associated with high portal venous pressure, which would cause ascites. IVC perfusion can supply some amount of blood flow to the liver and kidney. It may therefore be advantageous to maintain proper IVC pressure to protect the abdominal organs during systemic arterial circulatory arrest under deep hypothermia.
The expression and localization of epidermal growth factor (EGF) receptor were investigated immunohistochemically using anti-EGF receptor antibody in the normal rat liver and 3'-methyl-4-dimethylaminoazobenzen (3'-Me-DAB) induced tumors in rats. In 8 weeks after 3'-Me-DAB treatment, multiple nodules of cholangiocarcinoma were found in the rat liver, and atypical nodules of hepatocytes were also found 14 weeks later. Immunoreactive products against EGF receptor were only slightly positive in the normal liver, the nodule of cholangiocarcinoma, and atypical nodule of hepatocytes. It was noted that EGF receptor immunoreactivity was more intense in non-cancerous tissue adjacent to tumorous nodules than in the cancerous tissue. The present finding suggests that the expression of EGF receptor may be associated with regenerating as well as carcinogenetic processes in the rat liver.
Retrograde cerebral perfusion through a superior vena caval cannula is a new technique for protecting the brain during aortic arch operations. In mongrel dogs (n = 10; 13 to 15 kg) we have performed retrograde cerebral perfusion (300 mL/min) by infusing blood through a superior vena caval cannula with aortic and inferior vena caval drainage. We have measured the cerebral tissue blood flow, oxygen consumption, and carbon dioxide exudation during retrograde cerebral perfusion at normothermia (NT, 37 degrees C) and hypothermia (HT, 20 degrees C) and have compared these values with values obtained in dogs during cardiopulmonary bypass (1,200 mL/min). Cerebral tissue blood flow was measured by the hydrogen clearance method. During retrograde cerebral perfusion about 20% of the superior vena caval perfusate was returned through the aorta and the rest drained from the inferior vena cava. Cerebral vascular resistance during retrograde cerebral perfusion was lower than that during cardiopulmonary bypass (NT, 63.8 +/- 52.5 versus 126.9 +/- 58.4; HT, 28.4 +/- 32.8 versus 69.5 +/- 28.7 x 10(3) dynes.s.cm(-5). Retrograde cerebral perfusion provided half the cerebral tissue blood flow of cardiopulmonary bypass (NT, 14.7 +/- 6.4 versus 34.3 +/- 7.8; HT, 17.6 +/- 5.6 versus 37.2 +/- 10.6 mL/min). Retrograde cerebral perfusion also provided a third of the oxygen (NT, 4.4 +/- 2.1 versus 12.3 +/- 7.1; HT, 1.4 +/- 0.8 versus 4.2 +/- 1.3 mL/min) and discharged 20% of the carbon dioxide (NT, 0.24 +/- 0.08 versus 1.19 +/- 0.58; HT, 0.15 +/- 0.06 versus 0.51 +/- 0.17 mmol/min) when compared with cardiopulmonary bypass. Retrograde cerebral perfusion may reduce ischemic damage during interruption of cerebral blood flow.
A case in which a patient with stenoses of the right and left coronary ostia and heavy calcification of the aorta caused by Takayasu's disease was successfully treated by coronary artery bypass grafting is presented. The aortic ends of the two grafts were attached to a xenopericardial patch, which was sutured into the ascending aorta. This technique can be done without fine sutures, which are required for proximal anastomosis of a vein graft, and may reduce the risk of ostial stenosis.
Concentrations of Manganese-containing superoxide dismutase (Mn-SOD) were measured perioperatively by enzyme immunoassay in serial samples of arterial and coronary sinus blood and urine taken from 18 patients undergoing mitral valve surgery. The mean Mn-SOD concentration in the arterial blood samples was 66.2 (SD 16.1 ng/ml) at induction of anesthesia, increased gradually after reperfusion and peaked on the 2nd post-operative day [150 (SD 58.3) ng/ml]. The mean concentration of Mn-SOD in the coronary sinus blood samples was significantly higher than in the arterial samples only at the 6th hour after reperfusion [97 (SD 21.8) ng/ml vs 90.3 (SD 20.9) ng/ml, p < 0.05]. Although concentrations of Mn-SOD in blood did not increase in 8 patients who underwent midline sternotomy for a mediastinal tumor, they increased dramatically in 3 patients who sustained a perioperative myocardial infarction. During open heart surgery the peak values of plasma Mn-SOD concentrations were correlated to that of plasma creatine kinase-MB concentrations (r = 0.5532, n = 18, p < 05) and cardiac ischemic period (r = 0.5186, n = 18, p < 05). Although the meaning of an increase in plasma Mn-SOD concentrations during open heart surgery is not clarified, it may be released from the heart and anywhere also in the body damaged during cardiopulmonary bypass.
A case is described in which a new treatment was taken to eradicate an aortic root abscess in a 56-year-old man with aortic prosthetic valve endocarditis. Debridement of all apparently infected tissue created left ventricular-aortic discontinuity, involving the orifice of the right coronary artery. A conduit of a diameter of 23 mm was made by hand with a glutaraldehyde preserved xenopericardial graft. A 21 mm St. Jude Medical prosthetic valve was sewn in it at 2 cm to its edge. The hand-made valved conduit was used to reconstruct the left ventricular outflow tract and aortic root. A saphenous vein graft was anastomosed end-to-side to the right coronary arterial system and to the conduit distal to the prosthetic valve. The aortography revealed no aortic regurgitation nor abnormalities of the conduit, such as aneurysm formation, and the coronary arteriography showed a functioning graft 5 months after surgery.
Leftward shift of the infundibular septum (IS) in interrupted aortic arch (IAA) with ventricular septal defect (VSD) often develops significant left ventricular outflow obstruction (LVOTO). Seven-day-old boy with 2.6 kg body weight underwent the two-stage operation for this anomaly. The aortic arch was interrupted between the left common carotid and the left subclavian artery. At the first stage, a 5 mm GORE-TEX graft was used to connect the interrupted arch, and pulmonary artery banding was performed. In closure of VSD at the second stage, IS was penetrated by stitches for the VSD patch to left ventricular outflow tract. IS with leftward shift could be pulled toward right ventricular side with patch fixation and LVOTO was prevented by this method.
There is no definitive surgical procedure for acquired lesions of the tricuspid valve (TV). From Feb, 1978, through March, 1990, the surgical treatment for the organic lesions of TV was performed in 10 patients, repair in 6 and TV replacement in 4. TV was repaired by commissurotomy, annuloplasty or valvuloplasty, or combination of them. When residual significant tricuspid regurgitation (TR) and/or stenosis (TS) was detected by intraoperative pulsed Doppler echocardiography after reparative procedures, TV was replaced. Follow-up periods ranged from 1 to 12 years (mean, 45.3 months). There was no early death, and late death was noted in one patient 32 months after operation. Preoperatively, 7 patients were in NYHA class IV and 3 in class III. Out of survivors, 7 are in class I and 2 in class II because of progression of mitral stenosis or coronary artery disease. Following surgery, the patients exhibited significant decrease in the cardiothoracic ratio (69.3 +/- 7.2 to 56.9 +/- 6.4%; p less than 0.01) and in the mean right atrial pressure (11.4 +/- 3.6 to 8.6 +/- 3.1 mmHg; p less than 0.05). The postoperative right ventriculography showed mild to moderate TR in 3 of 6 patients who underwent TV repair. In conclusion, TV repair could be a reasonable procedure for the organic TV lesions, although careful follow-up is recommended for residual TR.
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.
A modification of De Leval technique for closure of ventricular septal defect (VSD) in atrioventricular discordance (AVD) with double outlet right ventricle (DORV) was reported. A 2-year-and-8-month-old boy underwent total repair for this anomaly. The first two stitches for closure of VSD were placed on the lower margin of the defect in which conducting tissues were not situated. Next remained stitches for closure of the defect could be continued toward upper margin of VSD in the morphologically right ventricular side of VSD while pulling the just previous stitches with good exposure and ease. We concluded that this modification was useful for making safe De Leval technique for closure of VSD in AVD.
A case of primary paraganglioma of the lung in a 48-year-old woman is presented. She was found to have a coin lesion in lower lobe on routine radiography. Results of bronchoscopic examination were negative, and exploratory right thoracotomy was performed. At operation, non-invasive encapsulated tumor found in posterior basal segment of the right lower lobe was enucleated. Histological analysis of the resected tumor proved to be compatible with pulmonary paraganglioma. Pulmonary paraganglioma is said extreme rare, and so only 21 cases were previously reported in the literature including this case.
A 66-year-old-man with carotid stenosis complicated by coronary disease is reported. He suffered from mild motor weakness on the right side and speech disturbance. Radiological examination revealed 90% stenosis at the cervical portion of the left internal carotid artery, and two-vessel coronary disease. In order to prevent intraoperative cardiac stroke, initial percutaneous coronary angioplasty (PTCA), was performed and the subsequent carotid endarterectomy (CEA) was performed successfully. Preoperative symptoms gradually improved and he was discharged as ambulatory. Because atherosclerosis is always systemic, patients with carotid artery disease should be examined for coronary disease. We recommend greater use of coronary angiography and, when a lesion is found, the use of PTCA, which is a safer method in terms of preventing intraoperative cardiac stroke of CEA than any other method.