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Biomedical subjects

H Hirose

Publications and source records attributed to H Hirose.

At least 433 records · Page 24Linked to original sources
PubMed1985

Ninety consecutive corrective operations for tetralogy of Fallot with or without minimal right ventriculotomy.

Eighty-eight patients with tetralogy of Fallot and two patients with ventricular septal defect and pulmonary atresia underwent repair without right ventriculotomy (n = 43) or with a minimal right ventriculotomy (n = 47) of 10 to 15 mm. The ventricular septal defect was closed through the tricuspid valve in 75 patients. The pulmonary valve was either preserved or reconstructed to maintain its competence. The age at operation was 1 or 2 years in 51 patients. There was one operative death and there were no late deaths. The results of postoperative cardiac catheterization in the present series of patients (n = 34) were compared with those of control patients (n = 21) who had repairs with a conventional right ventriculotomy in the preceding period. There was no significant difference in right ventricular/left ventricular systolic pressure ratio or in cardiac index either at rest or during isoproterenol infusion between the two groups. The incidence of significant pulmonary regurgitation (Grade greater than or equal to 2/4) was less (p less than 0.05) in the present patients (47%, n = 34) than in the control patients (81%, n = 21). The right ventricular end-diastolic volume index (ml/m2) was smaller in the present patients than in the control patients both at rest (91 +/- 37 versus 142 +/- 28, p less than 0.01) and during isoproterenol infusion (81 +/- 21 versus 109 +/- 30, p less than 0.01). The right ventricular ejection fraction was higher in the present patients than in the control patients during isoproterenol infusion (57% +/- 4% versus 49% +/- 6%, p less than 0.01). The incidence of ventricular arrhythmias (Lown's grade greater than or equal to 2) was less in the present patients (6/35) than in the control patients (36/65) (p less than 0.005). This method of repair for tetralogy of Fallot carries no more risk than the conventional method, and the results are better with respect to postoperative right ventricular function and ventricular arrhythmia.

Adolescent↗
PubMed1985

[Clinical examination of torsion of the spermatic cord--review of 177 cases reported in the recent Japanese literature including our present 7 cases].

Between January 1974 and December 1984, 16 patients underwent surgical exploration at our Hospital. Seven of these patients proved to have torsion of the spermatic cord and nine were strongly suspected to have this lesion in spite of lack of torsion during operation and the remaining 3 patients suffered from epididymitis. The 7 patients with torsion ranged in age from 14 to 22 years old. The left side was involved in 4 patients, and the right side in 3 patients. Six patients had internal rotation and 1 had external rotation. In all of them, intravaginal torsion was noticed at various degrees of twist (270 degrees-540 degrees). Orchidopexy was performed in 5 cases in which the operation could be done within 15 hours after onset of the symptom but in 2 cases in which 50, and 56 hours had elapsed orchidectomy was unavoidable. The 177 cases reported in the Japanese literature since Kumon's report including our present 7 cases were reviewed statistically in detail. Case reports of this lesion, especially in newborns, is increasing every year. The age distribution showed two peaks, one at the time of puberty (10-19 years old) and the other shortly after birth. There was a predominance for the left side, internal rotation and twisted degrees of 180 degrees to 360 degrees in this series. In the cases in which over 24 hours has elapsed before surgery, orchidectomy was performed frequently.

Adolescent↗
PubMed1985

[A case of multiple cerebral aneurysms caused by cardiac myxoma].

A case of neoplastic aneurysm caused by left atrial myxoma is reported. The patient was a 50-year-old woman who has been suffered from occasional vertigo and syncopal attack. She was admitted with a sudden loss of consciousness and cerebellar ataxia on December 1, 1983. Cerebral angiogram revealed multiple aneurysms in the periphery of both middle cerebral arteries and obstruction of the right superior cerebellar artery. Echocardiography displayed a cardiac myxoma in the left atrium. She suddenly died from recurrent cerebral embolism on January 7, 1984. The diagnosis was confirmed by the autopsy. The histopathological examination revealed that the wall of cerebral arteries were destroyed by the tumor cells of myxoma, and it caused cerebral aneurysms. We presented the detail of this case, and discussed about a mechanism and a treatment of neoplastic aneurysms.

Female↗
PubMed1984

Ambulatory electrocardiographic study of the frequency and cause of ventricular arrhythmia after correction of tetralogy of Fallot.

Ambulatory 24-hour electrocardiographic monitoring with a Holter recording system was performed in 100 patients after repair of tetralogy of Fallot. The incidence and severity of ventricular arrhythmia (VA) were studied relative to operative age, follow-up period after corrective surgery, hemodynamic data, ventricular function and operative method. Significant VA (Lown grade 2 to 4) was detected in 41 patients. Patients with significant VA (group I) were older (11.7 +/- 10.0 years old) at operation than those without VA (group II) (5.5 +/- 5.8 years, p less than 0.001). The follow-up period after operation in group I (9.5 +/- 4.8 years) was significantly (p less than 0.001) longer than that in group II (5.5 +/- 4.3 years). The incidence of elevated right ventricular (RV) systolic pressure was significantly (p less than 0.005) higher in group I (43%) than in group II (7%). RV ejection fraction in group I (48 +/- 6%) was significantly (p less than 0.001) lower than that in group II (56 +/- 5%). The new operative method for tetralogy of Fallot without or with minimal right ventriculotomy was more frequently performed in group II (49%) than in group I (15%, p less than 0.005). Pulmonary regurgitation, RV and left ventricular size, and left ventricular ejection fraction were not related to severity of VA. Thus, serious VA was related to higher age at operation, longer interval after surgery, elevated RV systolic pressure, depressed RV ejection fraction and RV scar.

Adolescent↗
PubMed1984

Long-term results of open mitral commissurotomy for mitral stenosis with severe subvalvular changes: a ten-year evaluation.

Out of 212 patients undergoing open mitral commissurotomy for mitral stenosis from January, 1972, to December, 1981, 53 patients had extremely severe subvalvular changes. In this study, we evaluated postoperative results in these 53 patients. There were 2 operative deaths (3.8%) and 1 late death (1.9%). Of the 50 surviving patients, 34 (68%) were in New York Heart Association Class I and 13 patients (26%) were in Class II, postoperatively. Three patients (6%) required reoperations an average of 5 years 5 months because of the progression of residual mitral regurgitation. The actuarial rate of freedom from mortality and reoperation was 78.6% at 10 years after operation. When anticoagulant therapy was not given, no patient had thromboembolic complications. Postoperative hemodynamic studies demonstrated that mean diastolic gradients across the mitral valve were 5.30 +/- 1.25 mm Hg (standard deviation) at rest and 9.50 +/- 5.13 mm Hg during exercise. Calculated mitral valve areas were 1.86 +/- 0.48 cm2 at rest and 1.88 +/- 0.51 cm2 during exercise. There was no evidence of any adverse effects of mild to moderate valve calcification. It is concluded that for a follow-up period as long as 10 years, the stenosed mitral valve with greatly advanced subvalvular deformities can be salvaged with low mortality, low incidence of reoperation, and acceptable valve function even when such deformities are associated with mild to moderate calcification.

Blood Pressure↗
PubMed1984

An effective adjunct to tricuspid annuloplasty.

A simple and effective adjunct to annuloplasty is presented for use in patients in whom dilatation of the annulus may not be sufficient to convert the tricuspid valve into a bicuspid valve. Several interrupted sutures are placed on the leaflets adjacent to the commissural zone between the anterior and posterior leaflets prior to exclusion of the posterior leaflet.

Humans↗
PubMed1984

Influence of varied [Ca2+]0 and [Na+]0 on slow responses of newborn and adult rat hearts.

The electrophysiological properties of slow responses of rat hearts were investigated in newborn (two-day-old) and adult (few-month-old) rats under conditions of high [K+]0 (25 mM) with isoproterenol (1 X 10(-7)M) using the standard techniques of intracellular microelectrode recording. The potentials of slow responses were measured in varied [Ca2+]0: in adults the peak potential varied linearly with a slope of about 31 mV for a 10-fold change in [Ca2+]0, while in newborns it varied, but not linearly, and showed a positive peak potential in low [Ca2+]0 (0.5 mM). In a low [Na+]0 solution (55% [Na+]0), with constant [Ca2+]0 (2 mM), the peak potential was reduced in newborn hearts, while it was little affected in adult hearts. These results suggest that the peak potential of the slow response depends mainly on [Ca2+]0 in adult rat hearts, while it depends on both [Ca2+]0 and [Na+]0 in newborns.

Action Potentials↗
PubMed1984

Deposition of hepatitis B e antigen in membranous glomerulonephritis: identification by F(ab')2 fragments of monoclonal antibody.

The pathogenic ability of hepatitis B e antigen (HBeAg) to induce membranous glomerulonephritis was evaluated by the most specific method presently available. Monoclonal antibody was raised against HBeAg, and F(ab')2 fragments were obtained and labeled with fluorescence. By this reagent, 10 out of 16 patients with membranous glomerulonephritis with hepatitis B surface antigen in the serum revealed granular deposition of HBeAg along glomerular capillary walls. Among the cases with glomerular HBeAg deposits, nine had detectable HBeAg in the serum and one had antibody to HBeAg (anti-HBe). The specificity of HBeAg staining was ascertained by blocking and inhibition tests, and the fluoresceinated anti-HBe F(ab')2 reagent did not stain the glomerular immune deposits in the patients with membranous glomerulonephritis who did not carry hepatitis B virus (HBV). None of the studied patients showed deposition of hepatitis B surface or core antigens in the glomerulus. On the basis of these results, immune complexes involving HBeAg may induce membranous glomerulonephritis in persons who carry HBV.

Adolescent↗
PubMed1984

Effects of sofalcone on necrotizing agents-induced gastric lesions and on endogenous prostaglandins in rats stomachs.

Attempts were made to investigate the effect of 2'-carboxymethoxy-4,4'-bis(3-methyl-2-butenyloxy) chalcone (sofalcone) on necrotizing agents-induced gastric lesions and on prostaglandin E2 (PGE2)-like activity of the gastric tissue in rats. Sofalcone, 100 mg/kg i.p. and 300 mg/kg p.o., markedly suppressed 0.6 N HCl- or 100% EtOH-induced gastric lesions. Sofalcone, 100 mg/kg i.p., also significantly suppressed 0.2N NaOH-induced gastric lesions. Sofalcone suppressed 0.6 N HCl-induced gastric lesions with both oral and intraperitoneal routes, and the effect was particularly marked at 60 min. A dose of 100 mg/kg i.p. showed suppression lasting for up to 300 min. 0.6 N HCl-induced gastric lesions were significantly aggravated by indomethacin treatment (10 mg/kg s.c.). Oral sofalcone (300 mg/kg) significantly suppressed the aggravation of gastric lesions by indomethacin given before and after sofalcone, but the i.p. (100 mg/kg) did not show significant suppression in the case of pretreatment with indomethacin. PGs-like activity in the gastric tissue was increased in both of the fundus and the antrum by the administration of sofalcone without any dose-dependency. The increase was continuous and lasted for 6 h in the fundus of the stomach.

Animals↗
PubMed1984

Postoperative changes of pulmonary vascular resistance in patients with complete atrioventricular canal defect. Relation to the age at primary repair.

The postoperative changes of pulmonary vascular resistance (PVR) of two age groups of children with complete atrioventricular canal (CAVC) were compared. Patients were divided by age at the time of primary repair; Group-1 (G-1, n = 4) with age below 2 years (average 13.8 mo.) and Group-2 (G-2, n = 5) with age over 2 years (average 44.0 mo.). All except one were Down's syndrome. Preoperatively, pulmonary to systemic resistance ratio (Rp/Rs) were 0.87 +/- 0.50 in G-1 and 0.41 +/- 0.13 in G-2 (n.s.), and postoperative study (average 6.5 mo.) showed no significant falls in Rp/Rs in both groups. However, G-2 showed significantly lower Rp/Rs postoperatively (0.79 +/- 0.19 in G-1 vs 0.27 +/- 0.12 in G-2, p less than 0.05). Mean pulmonary artery pressure (mPA) showed significant fall after surgery in only G-2 (66.8 +/- 6.6 to 31.8 +/- 11.6 mmHg, p less than 0.005). Anatomically, type-A showed better postoperative change in mPA compared to type-C. This study summarized the early progression of pulmonary vascular obstructive disease with poor postoperative improvement even the primary repair was done before 2 years of age. The less advanced pulmonary vascular disease in G-2 might have some relations to the natural selection of the disease.

Age Factors↗
PubMed1984

Re-evaluation of the indications for cardiac valve replacement.

We re-evaluated the indications for mitral valve replacement and reconstruction, and attempted to determine the optimal time for aortic valve replacement. (1) The actuarial event-free survival rate in patients undergoing open mitral commissurotomy for mitral stenosis with far-advanced subvalvular deformities was 78 per cent at 11 years after surgery and similar in patients undergoing mitral valve replacement for mitral stenosis. Postoperative clinical improvements compared favorably with those in patients undergoing mitral valve replacement. If quality of postoperative life in patients not requiring anticoagulants is borne in mind, open mitral commissurotomy should be given strong consideration as the procedure of choice for the majority of patients with mitral stenosis. (2) The long-term results of reconstructive procedures for mitral regurgitation largely depend upon the pathological anatomies contributing to the development of mitral regurgitation. The results were less satisfactory in patients with fibrotic changes of valvular and subvalvular tissue than in patients undergoing mitral valve replacement for mitral regurgitation. (3) In aortic valve replacement, the postoperative prognosis was poor in patients with a preoperative left ventricular end-systolic volume index exceeding 200 ml/m2 and left ventricular ejection fraction less than 0.35. Operative management of patients with aortic valve disease should be considered, before severe left ventricular systolic dysfunction is evident.

Aortic Valve↗
PubMed1984

Mechanical control of circulation: clinical results with intra-aortic balloon pumping and veno-arterial bypass in left and/or right cardiac failure.

Eighty-seven cases were studied in which IABP was used with open heart surgery, and 19 in which V-A bypass was employed. IABP was used in 31 patients with ischemic heart disease, which had the best survival rate (52%). Recent experience shows that the effects of IABP increase the operability of certain high-risk patients with severely impaired left ventricular function. In valvular heart disease, IABP was used with a survival rate of 34%. In congenital heart disease, the IABP survival rate was the worst among the groups studied because, in addition to left heart failure, many other factors also as cause the low cardiac output syndrome during corrective surgery for complicated cardiac anomalies. In total right heart bypass, or Fontan's procedure, three out of five cases were weaned from IABP; one of them is still alive. IABP was used with success in one case of valvular heart disease with almost no contraction of the right ventricle after repair. Therefore, IABP could be expected to improve the condition of severe postoperative right heart failure, or the equivalent condition, when there is subnormal left ventricular function in the postoperative period and pulmonary vascular resistance is normal. There has been only one successful V-A bypass lasting 11 hours, in valvular heart disease, and another case, in congenital heart disease, where the patient was weaned after V-A bypass lasting four days.

Aged↗