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Biomedical subjects

F Oguma

Publications and source records attributed to F Oguma.

36 records · Page 2Linked to original sources
PubMed1992

[Late postoperative outcome of plastic operation versus valve replacement for mitral regurgitation].

Between January 1980 and August 1991, 99 patients underwent operation for mitral valve regurgitation (MR). The ages of the patients ranged from 12 to 67 years, (49.4 +/- 11.9 years), and there were 39 males and 60 females. Pathological cause of regurgitation, which was determined by intraoperative inspection and histological findings of excised leaflets, was rheumatic in 46, degenerative in 38, infective endocarditis in 9, ischemic in 4 and unknown in 2 patients. Cardiac rhythm was atrial fibrillation in 73, normal sinus rhythm in 24 and junctional rhythm in 2 patients. Our principles for valve repair were (1) excision of responsible segment and repair for prolapsed leaflet due to torn chordae, (2) shortening of elongated chordae, (3) annuloplasty, and (4) repair of perforated leaflet. Finally, 19 patients endured plastic operation, and 80 patients underwent prosthetic valve replacement. The rate of plastic procedure was 62.5% (10/16) in degenerative MR with mural chordal lesions, 42.9% (3/7) in rheumatic MR without stenosis, 22.2% (2/9) in infective endocarditis and 100% (2/2) in MR with unknown etiology. Mitral valve repair was failed both in rheumatic MR associated with stenosis (39 patients) and in ischemic MR (4 patients). A ten-year survival rate after operation was 92.2 +/- 3.1% in patients with valve replacement and 83.6 +/- 10.0% with valve repair (N.S.), and a proportion of event-free survival in patients with valve replacement was similar to valve. Late postoperative cardiac catheterization revealed decreased left ventricular volume indices and increased left ventricular end-systolic stress/volume ratio in both groups compared to preoperative values, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Surgical therapy of HCG-producing mediastinal tumor accompanied with intrapulmonary metastasis].

The patient is a 31-year-old man who was suffering from hyperthyroidism and left hemothorax. His serum HCG level was extremely elevated and chest X-ray showed a mass shadow of anterior mediastinum and bilateral multiple intrapulmonary metastasis. Our clinical diagnosis was primary HCG-producing germ cell carcinoma of mediastinum and immediately administered CDDP and VP-16. Chemotherapy was effective and tumor extirpation was carried out for mediastinum and lungs by median sternotomy. All of the resected specimen showed no cancer cells and 4 years have passed with no evidence of recurrence. Aggressive surgical approach is indicated for mediastinal germ cell carcinoma accompanied with intrapulmonary metastasis when chemotherapy is effective.

Adult↗
PubMed1991

[Surgical treatment of ascending aortic lesions associated with aortic insufficiency].

Twenty four patients underwent surgical treatment for ascending aortic lesions with aortic insufficiency at our institution. There were 16 male and 8 female patients from 12 to 67 years. Of 24 patients, 11 patients had Marfan's syndrome, and were younger at the time of operation. Three types of operative procedure were performed, that is, aortic valve replacement (AVR) and supracoronary graft replacement in 4 patients, AVR and covering the aneurysm of ascending aorta in 9, and composite graft replacement of the aortic valve and ascending aorta in 11. One patient died of perioperative myocardial infarction within 30 days after operation (early mortality rate, 4.2%). Another 5 patients died during the initial hospitalization, but no deaths were related to operative procedures. There was a total of 5 (27.8%) late deaths among the 18 patients follow-up with 5 and 10 years survival rate, 60.8%, 52.1%, respectively. Four of five patients was the cases with Marfan's syndrome. There were no statistically significant differences among three different procedures, but all patients who underwent composite graft replacement and left the hospital alive are doing well.

Adolescent↗
PubMed1990

[Long-term results of valve replacement in the right side of the heart in congenital heart disease--comparative study of bioprosthetic valve and mechanical valve].

Valve replacements in the right side of the heart (TVR and PVR) were done on 16 patients with congenital heart disease, mainly tetralogy of Fallot and Ebstein anomaly. Including reoperations, 19 operations were performed on them and 20 artificial valves were inserted. Ten mechanical valves (7 St. Jude Medical valves, 3 Starr-Edwards valves) and 10 bioprosthetic valves (7 Carpentier-Edwards valves, 3 Ionescu-Shiley valves) were used. Age at valve replacement ranged from 9 to 52 years (mean 23.0 years), and the follow-up period was 1.28-19.8 years (mean 5.7 years). Including 2 sudden deaths, late death occurred in 4 patients, on all of whom mechanical valve replacements were done at the primary operation. Five-year survival rate of all patients was 76.4 +/- 12.1%, and 10-year survival rate was 63.6 +/- 15.4%. All the patients who received bioprosthesis at the primary operation survived at the time of this follow-up study. On the contrary, long-term results of mechanical valve was unsatisfactory with the 5-year survival of 62.5 +/- 17.1%. In spite of anti-coagulation therapy with warfarin, three patients with mechanical valve complicated thrombotic valves, which necessitated re-operations. Calcified bioprosthetic valve occurred in one patient with I-S valve 8.5 years after the implantation. Five-year complication-free rate was 87.5 +/- 11.7% for bioprosthesis, whereas it was 50.0 +/- 15.8% for mechanical valve (p less than 0.056). It is concluded that the bioprosthesis is the first choice for the valve replacement in the right side of the heart in congenital heart disease.

Adolescent↗
PubMed1990

[Successful repair of an acute type A dissection during pregnancy].

We report a successful repair of an acute type-A aortic dissection during pregnancy. A 29-year-old pregnant woman in the 32 weeks of gestation with Marfan Syndrome was admitted to our hospital for the treatment of anterior chest and back pains. An urgent aortogram through pulmonary artery revealed an aortic dissection beginning from the ascending aorta to the aortic bifurcation. On the following day, an emergent Cesarean section was performed and a baby weighing 1944 g was delivered. Thereafter, cardiopulmonary bypass was instituted and the ascending aorta was opened. An intimal tear was found 2 cm above the aortic valve. The dissected space was closed with reinforcement of Teflon felt strip. A Dacron gusset was sutured to restore aortic continuity. During the weaning from the CPB, a retrograde aortic dissection developed and the heart became arrested. Therefore we immediately converted the aortic perfusion cannula from the right external iliac artery to graft of the ascending aorta, and the operation was completed successfully with a good recovery of the heart. The mother and her child have been alive and well for 3 years and 5 months after the operation.

Adult↗
PubMed1990

[Delayed sternal closure following open-heart surgery in infants and children].

Between January, 1982, and December, 1987, 14 patients failed to approximate sternum after open-heart surgery in infants and children. The indications for keeping sternum open were enlarged heart, myocardial edema, severe depression of myocardial contractility and reduced lung compliance due to pulmonary edema. Of the 14 patients, 9 underwent delayed sternal closure between 2nd and 13th postoperative day, and 4 were long-term survivals. All the rest of five patients who were left their sternum open, died of intractable cardiac failure within 16th postoperative day. During the sternum open, three patients suffered from complications-myocardial bleeding in one, and mediastinitis in two. But none of them directly related to the death, and one patient with mediastinitis successfully healed with closed mediastinal irrigation. Although the employment of the delayed sternal closure is rare and limited to the patient with severe heart failure, its judicious use adds advantages in the management of low cardiac output state in infants and children immediately postoperative period.

Cardiac Surgical Procedures↗
PubMed1989

[Results of pulmonary resection for metastatic lung tumors].

The results of pulmonary resection for metastatic pulmonary lesions in our institution are reviewed. Over the period of ten years 43 patients underwent 46 thoracotomies with a 5 years survival rate of 40.8%. The most significant predictors of survival were type of primary tumor, number of lesions removed and disease-free interval, while there were no statistically significant difference in survival rates between partial resection and lobectomy. Recurrence in the early postoperative period was often observed in the patients with bilateral pulmonary metastases and their 5 years survival rate was as low as 21.9%. Though multiple lung metastases is not contraindication for pulmonary resection, we should be prudent to operate for those patients with multiple lung metastases. Our results suggest that the patient with solitary lesion, long disease-free interval and no metastases to mediastinal lymph nodes is the best candidate for resection of the metastatic pulmonary lesions.

Adolescent↗
PubMed1989

[Intermediate-term results after Fontan type operation for single ventricle].

From 1983 to 1985, Fontan type operation were successfully performed on five patients with single ventricle. Marked cyanosis disappeared soon after the surgery, and normal exercise tolerance was obtained in all cases but one in the late postoperative period. Compared to marked improvement in the exercise tolerance test, cardiac output remained subnormal both at rest and during exercise even in the late postoperative period. Several types of asymptomatic arrhythmias were observed during the acute postoperative days, but they were not recognized in the intermediate-term postoperative period. Routine blood chemistry studies showed that hepatic function was within normal limits, but hepatic dysfunction was suggested by Indocyanine Green clearance test. Renal function was well preserved after Fontan type procedure. Though cardiac output is subnormal, Fontan type procedure is a safe and effective operation, and intermediate-term state is satisfactory without any signs of heart failure.

Adolescent↗
PubMed1989

Malignant spindle cell tumor of the pericardium. Evidence of sarcomatous mesothelioma with aberrant antigen expression.

A case of malignant spindle cell tumor occurring in the pericardium is presented. The tumor arose from the pericardium of a 51-year-old Japanese woman with no history of exposure to asbestos. The tumor extended into the pericardial and left pleural cavities. The primary and metastatic tumors consisted of fusiform cells with frequent mitoses. Ultrastructurally, the tumor cells possessed a discontinuous external lamina, cytoplasmic processes, microfilaments and desmosomal intercellular junctions. Immunohistochemical examination showed that most tumor cells were positive for Leu 7, and several for S-100 and glial fibrillary acidic protein. Unexpectedly, most of the tumor cells also expressed keratin. These findings favor a diagnosis of sarcomatous mesothelioma with aberrant antigenic expression or heterogeneous differentiation of neoplastic cells.

Female↗
PubMed1986

Role played by oxygen in myocardial protection with crystalloid cardioplegic solution.

To evaluate the importance of the oxygen dissolved in crystalloid cardioplegic solution, the protective effects of oxygenated glucose-insulin-potassium cardioplegic solution (O2-GIK) (oxygen tension greater than 600 mm Hg) on the isolated working guinea pig heart were compared with those of deoxygenated (N2-GIK) (oxygen tension less than 10 mm Hg) and aerated GIK solution (GIK) (oxygen tension = 140 to 160 mm Hg). Hearts were subjected to 180 minutes of ischemia with intermittent infusions (every 30 minutes) of cold cardioplegic solution, followed by 30 minutes of normothermic reperfusion. The O2-GIK solution tended to maintain high-energy phosphates at higher levels during ischemia, and resulted in the best recovery of cardiac function. Though not as effective as O2-GIK, GIK solution produced protective effects; N2-GIK solution failed to exert such effects. These results strongly suggest that the protective effects of crystalloid cardioplegic solution are due primarily to the oxygen dissolved in it; anaerobic metabolism or washout of the metabolites plays a minor part.

Animals↗