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Biomedical subjects

H Hirose

Publications and source records attributed to H Hirose.

At least 649 records · Page 36Linked to original sources
PubMedDate not supplied

Enhancement of cardiac prostacyclin release during reperfusion after diltiazem supplemented potassium cardioplegia.

The effect of diltiazem as an adjunct to cardioplegia was examined for cardiac eicosanoid release in 12 patients who received aorto-coronary bypass. The patients were divided into two groups: diltiazem group (No. = 6) (10 mg/L of diltiazem in crystalloid potassium cardioplegia) and control group (No. = 6) (same cardioplegia without diltiazem). The plasma levels of thromboxane B2 and 6 keto PGF1 alpha (metabolites of thromboxane A2 and prostacyclin) in systemic artery and coronary sinus blood were measured during early reperfusion. A significantly larger arterio-venous difference in 6 keto PGF1 alpha concentration was found immediately after aortic clamp release in the diltiazem group (124 +/- 77 vs 12 +/- 47 pg/ml, p less than 0.05). The plasma thromboxane B2/6 keto PGF1 alpha ratio in coronary sinus blood was lower in the diltiazem group immediately after aortic clamp release (0.47 +/- 0.16 vs 0.74 +/- 0.18, p less than 0.05). There was no significant difference in arterio-venous TxB2 concentration between the two groups. In terms of myocardial protective effect evaluated by CPK-MB release, there was no significant difference between the two groups. The results indicated that diltiazem used as an adjunct to cardioplegia enhanced the production of endogenous PGI2 during early reperfusion, although its beneficial effect on myocardial protection was not shown in terms of enzyme leakage.

6-Ketoprostaglandin F1 alpha↗
PubMedDate not supplied

Reoperation-free survival after closed mitral commissurotomy. A 28-year follow-up study in 469 patients.

We evaluated the long-term results in 469 patients who underwent closed mitral commissurotomy (CMC) between 1952 and 1972, and analyzed actuarial and reoperation-free survival rates together with the recurrence of symptoms necessitating reoperation after CMC. There were 36 operative deaths (7.6%) and 167 late deaths (36.8%) including 40 deaths following reoperation. One hundred and twenty patients (26%) required reoperation a mean of 13.8 years after CMC, with a range of one to 27 years. The actuarial survival rates were 75%, 58% and 38% at 10, 20 and 28 years after surgery, respectively. The reoperation-free survival rates were 70%, 42% and 15% at 10, 20 and 28 years, respectively. Untreated subvalvular changes and inadequate commissurotomy were definite factors adversely influencing the long-term results.

Actuarial Analysis↗
PubMedDate not supplied

Budd-Chiari syndrome treated by Senning's procedure.

Two patients with Budd-Chiari syndrome who underwent a new surgical procedure developed by Senning are reported. A 33-year-old man was diagnosed as having Budd-Chiari syndrome with a membranous obstruction of the inferior vena cava (IVC) and right hepatic vein and short segmental obstruction of the left hepatic vein. Removal of the obstruction by dorsocranial resection of the liver and reconstruction of the veins by hepatoatrial anastomosis was carried out. In a 53-year-old female, the same procedure was carried out for a short segmental obstruction of the IVC and left hepatic vein. In both patients, postoperative examination revealed good patency of the IVC and the hepatic veins and increased portal venous flow as measured by Doppler-echography. This procedure is considered the method of choice for Budd-Chiari syndrome with membranous and/or short segmental obstruction of the IVC and hepatic veins.

Adult↗
PubMedDate not supplied

Myocardial energy metabolism in preserved heart: comparison of simple storage and hypothermic perfusion.

Isolated canine hearts were preserved for 24 hours by either simple hypothermic storage in Collins' M solution (group 1, n = 7) or hypothermic perfusion with oxygenated modified Krebs solution (group 2, n = 7), followed in both cases by reperfusion with cross circulation. Myocardial biopsies taken consecutively during preservation and after reperfusion were analyzed for high energy phosphates (adenosine triphosphate [ATP], adenosine diphosphate [ADP], adenosine monophosphate [AMP], and creatine phosphate), their catabolites (inosine), and lactate. In group 1, ATP decreased from 23.7 +/- 2.8 mumol/gm dry weight (mean +/- standard deviation) at 0 hours to 5.6 +/- 2.8 mumol/gm dry weight at the end of preservation. Creatine phosphate decreased and lactate increased significantly during 24 hours of preservation. The consumption rate of ATP appeared to have decreased after 18 hours of preservation. In group 2, ATP, creatine phosphate, and lactate remained at control levels during preservation. Coronary vascular resistance, however, increased significantly. After reperfusion functional measurements of the hearts in both groups did not vary significantly, despite the difference in myocardial ATP content (11.2 +/- 4.9 mumol/gm dry weight in group 1 and 17.9 +/- 3.9 mumol/gm dry weight in group 2; p less than 0.05). Simple hypothermic storage manifested a limitation in terms of energy store compared with hypothermic perfusion, whereas the latter appeared to have a risk of possible myocardial damage caused by the perfusion itself.

Animals↗
PubMedDate not supplied

Strut fracture of a Björk-Shiley mitral valve prosthesis with successful reoperation.

Component failure of a mechanical valve is an extremely serious complication. We experienced strut fracture and disc embolization of a 27 mm Björk-Shiley convexo-concave mitral valve prosthesis implanted one year and 9 months previously. The emergency operation was successful. In the follow-up of patients with Björk-Shiley convexo-concave models manufactured before March 1982, the possibility of strut fracture should be kept in mind.

Adult↗
PubMedDate not supplied

Noninvasive assessment of myocardial viability by measuring adenosine triphosphate degradation product in coronary sinus effluent of preserved dog heart.

Isolated dog hearts (n = 19) were preserved in cold Collins solution at 4 degrees C for 1 to 26 hours. At the end of preservation the coronary system was flushed out by cold cardioplegic solution, and the hearts were reperfused with supporting dogs. Myocardial biopsies at the end of preservation and coronary sinus effluents at the time of flush-out were analyzed for adenosine 5'-triphosphate and inosine. Both the degree of depletion in adenosine triphosphate content and the accumulation of inosine in the myocardium during preservation correlated significantly to the preservation time (correlation coefficient = -0.85 and 0.86, respectively). There was a significant correlation between the myocardial inosine level and total amount of inosine released into coronary sinus effluent (correlation coefficient = 0.91, p less than 0.001). Also, a significant correlation between the total amount of inosine in coronary sinus effluent and cellular level of adenosine triphosphate was found (correlation coefficient = -0.86, p less than 0.001). Five hearts that failed to resume beating showed significantly higher amounts of released inosine than the other hearts (3.3 +/- 0.9 versus 1.5 +/- 0.5 mumol, p less than 0.005). These results indicate that the inosine level in the coronary sinus effluent reflects the myocardial energy state, and it is suggested that the measurement of inosine level in the effluent may be applicable as a noninvasive method for assessment of myocardial viability in heart preservation.

Adenosine Triphosphate↗
PubMedDate not supplied

Results of open heart surgery in patients with impaired renal function as creatinine clearance below 30 ml/min. The effects of pulsatile perfusion.

Twelve patients (pts) with coronary and/or valvular heart disease and preoperative creatinine clearance (Ccr) below 30 ml/min underwent cardiac surgery using cardiopulmonary bypass (CPB) with pulsatile (P:n = 7) and nonpulsatile (NP:n = 5) perfusion. Preoperative Ccr was 15.8 +/- 4.4 ml/min in the P group and 26.5 +/- 4.7 ml/min in the NP group. After surgery, the NP group showed significant increases in BUN and serum creatinine within a week, but the P group showed significant increase in BUN only. The NP group had a significant decrease in Ccr on the 7th postoperative day, but there was no significant change in the P group. Three patients, 2 from the NP group and one from the P group, died from complications (operative mortality: 14 vs 40%). These data suggested that P-CPB appeared to be advantageous in patients with preoperatively impaired renal function with low Ccr although many other factors might influence the outcome.

Acute Kidney Injury↗
PubMedDate not supplied

Reconstruction of portal vein with an autograft of splenic vein.

To re-establish the portal circulation following extensive resection of the portal vein, we interposed an autograft of the splenic vein between the portal and superior mesenteric veins during total pancreatectomy in three patients with cancer of the pancreas. The postoperative course in two patients was uneventful, and patency of the graft was demonstrated angiographically on the 41st and 78th postoperative days, respectively. In the remaining patient an episode of postoperative peritonitis occurred with leakage of the gastrointestinal anastomosis. The patient died on the 78th postoperative day from a massive metastasis to the liver. Autopsy revealed a narrowing of the graft due to technical failure and inflammatory changes, but there was no evidence of cancer invasion. Thus, the autograft of the splenic vein proved useful to bridge the portal vein system.

Female↗
PubMedDate not supplied

Evaluation of hypothermic heart preservation with University of Wisconsin solution in heterotopically and orthotopically transplanted canine hearts.

In simple cold storage of the heart, 4 hours has been proved to be a clinically safe ischemic time. The University of Wisconsin solution has been reported to extend cold ischemic time in preservation of the liver, kidney, and pancreas. The purpose of this study is to clarify the safe cold ischemic time in heart preservation with University of Wisconsin solution experimentally in heterotopically and orthotopically transplanted canine hearts. In heterotopic heart transplantation, 120 minutes after reperfusion, maximum slope of the left ventricular end-systolic pressure-volume relationship was recovered to 94% +/- 13% in the 4-hour simple cold preservation group with GIK solution and 104% +/- 11% in the 8-hour simple cold preservation group with University of Wisconsin solution but was not recovered in the 8-hour simple cold preservation with GIK solution and 16-hour simple cold preservation with University of Wisconsin solution groups. One hundred twenty minutes after reperfusion, myocardial tissue blood flow measured by laser Doppler flowmeter was recovered to 90% +/- 19% after 4 hours with simple cold preservation with GIK solution and 98% +/- 9% after 8 hours with simple cold preservation with University of Wisconsin solution but was not recovered after 8 hours with simple cold preservation with GIK solution and 16 hours with simple cold preservation with University of Wisconsin solution.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMedDate not supplied

Clinical study on hepatocellular carcinoma with extrahepatic malignancies.

In a consecutive series of 146 patients with hepatocellular carcinoma (HCC), 10 patients (6.8%) were found to have one or two extrahepatic malignancies (EHM). Of these, eight had double cancers and two, triple cancers. The associated malignancies included eight cases of gastric cancer and four cases of colon cancer. Among the 12 lesions, eight were in the early stage. All the 10 patients were hepatitis B surface antigen negative. The incidence of coexisting liver cirrhosis and the retention rate of indocyanin green in 15 minutes among HCCs with EHM were significantly lower than those among HCC alone. These results suggest that the etiology of HCC with EHM is different from the etiology of HCC alone in Japan.

Adult↗
PubMedDate not supplied

Monitoring and regulating latissimus dorsi muscle performance for circulatory assist.

The purposes of this study were monitoring and regulating latissimus dorsi muscle (LDM) performance with muscle internal pressure and thickness, and with burst stimulation parameters, respectively. The unconditioned LDM flap of a pig was connected to a measurement system to examine force and contraction length. Internal pressure was measured using a catheter pressure transducer with a fluid-filled balloon inserted into the muscle, and correlated linearly with force during both contraction and relaxation. During contraction, thickness change correlated linearly with contraction length and the area enclosed within an internal pressure-thickness curve, and the X-axis was correlated linearly with muscle work. Stroke work increased incrementally according to the pulse width up to 6.72 msec or burst rate up to 120 Hz, and then plateaued at 240 Hz. The authors conclude that muscle work during contraction could be monitored with internal pressure and thickness, and that stroke work could be regulated with pulse width or burst rate.

Animals↗
PubMedDate not supplied

Congenital multiple arterioportal fistula: a case report treated with portocaval shunt.

A case of 48-year-old man, with diffuse arterioportal fistula (APF) considered congenital in origin, is described. The patient presented with recurring intractable variceal hemorrhage which was treated by endoscopic ligation or sclerotherapy. In this case, gastroduodenal artery and branches of mesenterial artery were diffusely involved, so these lesions could not be resected. Portocaval shunt between the superior mesenteric vein and the right iliac vein was successfully performed. Follow-up endoscopic examination one year later revealed no evidence of esophageal and gastric varices. To our knowledge, this is the second case in which a patient underwent portocaval shunt successfully for congenital APF.

Arteriovenous Fistula↗
PubMedDate not supplied

Posterior cricoarytenoid as a speech muscle.

It is well known that the posterior crioarytenoid muscle (PCA) is the only abductor of the vocal folds, but its role in speech has not fully been clarified. Our recent electromyographic (EMG) studies indicate active participation of PCA in the production of voiceless consonants and breathy phonation in different languages. In the experiments to be reported here, computer-averaged EMG data were obtained from PCA of native speakers of American English, Japanese, and Danish who uttered test words embedded in frame sentences. The results indicated that there was consistent increases in PCA activity for the voiceless portion of the test words. The EMG results were compared to the degree of glottal opening estimated by means of the fiberoptic technique. It was suggested that the degree and timing of PCA activity were directly responsible for determining the size and temporal course of the glottal opening for voiceless segments, although the suppression of the adductors might also have to be taken into consideration for a complete description of voiceless segment production.

Electromyography↗
PubMedDate not supplied

Aiming at establishment of "palliative day care"--attempt at providing an outpatient salon for cancer patients in the Department of Radiology.

Reflecting a trend toward reconsideration of medical care which concentrates only on the treatment of disease, a new paradigm of "palliative care" has recently been developed with a focus on the treatment of cancer patients. As part of our palliative care program, we have provided an "outpatient salon" for outpatients in the Department of Radiology of this hospital. The goal of the outpatient salon is to assist patients who live at home in coping with their disease. We regard this outpatient salon as a preparatory step in establishing a palliative day care center to support patients and their families at home and to improve patient QOL. Currently, two staff members are acting as counselors at the salon, and most of the patients visiting the salon are breast cancer patients. The salon appears to provide the following benefits to patients: 1) self-assurance, by allowing them to talk to others about their problems, 2) development of self-help skills, through involvement with other patients, 3) a place to relax, and 4) comfort from focusing. We have two future goals: to develop the salon into a day care center, and to nurture a self-help group within the salon.

Adult↗