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Biomedical subjects

H Irie

Publications and source records attributed to H Irie.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Intermediate to late results of aortic or mitral valvuloplasty by rasping procedure].

We have proposed Rasping procedure as one of the methods of aortic valvuloplasty (A-Rasping) and defined as debridement of the thickened surface of the rheumato-degenerative aortic valve using an electric rasper since 1986. Furthermore, we have extended this technique to mitral valvuloplasty (M-Rasping). The purpose of this study is to evaluate intermediate to late results of valvuloplasty by Rasping procedure. From 1986 to 1994, this method was carried out on 14 patients with mild-to-moderate aortic valve disease in severe mitral valve disease or coronary artery disease, and on 6 patients with mitral stenosis. In A-Rasping group, aortic regurgitation was found in 10 patients and aortic stenosis was found in 4 patients. The degree of regurgitation, the transvalvular pressure gradient, and the pre- and postoperative cardiac function in both group were investigated chronologically by echocardiography. In this series of patients, no hospital mortally including operative death was observed. Furthermore, reoperation for repaired aortic or mital valve was not required. In A-Rasping group, 2 late deaths (14.2%) occurred at 1 year and 4 years after operation. Cause of 2 late deaths was prosthetic valve endocarditis in mitral position. In A-Rasping group, at 1 year after operation, regurgitation was reduced to degree I or less in all patients. However, at the 3rd postoperative year, regurgitation increased to degree II in 2 patients. As compared with the preoperative values, the transvalvular pressure gradient significantly decreased in 4 patients (29.5 +/- 7.6 mmHg vs 12.5 +/- 5.0 mmHg, p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Evaluation for mitral valvuloplasty using rasping procedure].

From April 1992 through July 1994, 7 patients underwent mitral valvuloplasty using rasping procedure in conjunction with open mitral commissurotomy. All patients had satisfactory postoperative results without the complications such as restenosis, regurgitation, infection. However, thromboembolism was observed in 1 patient at the postoperative 6 months. And no reoperation for repaired mitral valve was observed. Transvalvular pressure gradient significantly decreased from 14.3 +/- 8.5 mmHg to 4.7 +/- 1.6 mmHg after operation. Mitral valve areas significantly increased from 1.01 +/- 0.31 cm2 to 1.78 +/- 0.41 cm2 after operation. As compared with preoperative value of 0.32 +/- 0.02, postoperative left ventricular fractional shortening (LVFS) significantly improved to 0.40 +/- 0.03. The advantages of this method is considered to be equable and safe débridement, and no anticoagulation at late period. Mitral valvuloplasty using rasping procedure, except for transmural calcified lesions, is useful and effective method. And excellent postoperative long-term results could be expected.

Aged↗
PubMed1995

[Successful valvuloplasty for isolated tricuspid regurgitation due to traumatic ruptured papillary muscle].

A 44-year-old man suffered from an traffic accident on May 27, 1994. He was transferred to a hospital because of emergent operation for a laceration of liver, right-sided hemothorax and pneumothorax. After surgical treatment for these lesions, he was doing well. However, systolic murmur appeared from August, 1994. By echocardiography and cardiac catheterization, he was diagnosed of isolated tricuspid regurgitation due to traumatic ruptured papillary muscle. Because right heart failure was progressive, an operation was recommended. At operation, annular dilatation of tricuspid valve and ruptured papillary muscle of anterior leaflet were found. And the ruptured end of right ventricular aspect was recognized. Therefore, we performed tricuspid valvuloplasty and annuloplasty. Postoperative course was uneventful. And residual regurgitation was not detected by right ventriculography. Especially, in patients with tricuspid regurgitation due to ruptured papillary muscle, symptoms usually begin soon after trauma. Therefore, an operation should be recommended promptly in the presence of right heart failure not relieved by medical treatment. And an earlier operation could increase the feasibility of tricuspid valvuloplaty, and the possibility of maintaining sinus rhythm.

Adult↗
PubMed1995

[Prevalence and founder effect of Huntington's disease in the San-in area of Japan].

After the DNA diagnosis, we evaluated the prevalence of Huntington's disease (HD) in the San-in area of Japan, and confirmed the founder effect. The population of the area was 1,387,000 on October 1st, 1993. There were 10 patients with HD in the San-in area, who were diagnosed clinically. They all had involuntary movement, mental disturbance, changes of character and atrophy of the caudate nucleus. However, one of the patients showed no positive family history of HD. The other nine patients had members with HD in their families, although those family members of the patients had already died. The expansion of the CAG repeat was observed in nine of the patients. In the patient who had no positive family history, expansion of the CAG repeat was not seen. According to the nine patients with expansion of the CAG repeat, the prevalence was 0.65/100,000. Haplotypes using polymorphism markers of D4S111 and D4 S136 were studied. The haplotypes which were observed in only 2.7% of the normal population were shown in all nine HD patients. Thus, the obvious disequilibrium was seen. These results suggested a common ancestor of these HD patients.

Adult↗
PubMed1994

Results of circulatory support for postoperative cardiogenic shock.

Over the last 5 years, 15 patients received ventricular assist devices (VADs) (Group 1) and 5 received percutaneous cardiopulmonary support (CPS) (Group 2) while in postoperative cardiogenic shock. Group 1 consisted of 8 men and 7 women ranging in age from 22 to 73 years (average age, 55 years). Nine of these patients underwent surgery for valve replacement, 5 for coronary artery bypass grafting, and 1 for closure of a ventricular septal rupture. The duration of VAD support ranged from 6 h to 9 days (mean, 3.9 days). Group 2 consisted of 4 men and 1 woman ranging in age from 49 to 68 years (average age, 57 years). One of these patients underwent surgery for valve replacement, 1 for coronary artery bypass grafting, 2 for replacement of a thoracic aneurysm, and 1 for left ventricular aneurysmectomy. The duration of CPS ranged from 4 h to 8 days (mean, 2.8 days). In Group 1, 13 patients were weaned from the VADs and 8 survived. Bleeding occurred in 5 patients, renal failure in 4, infection in 3, cardiac failure in 4, cerebral infarction in 1, perioperative myocardial infarction in 1, arrhythmia in 1, and ileus in 1. In Group 2, 4 patients were weaned from the CPS and 3 survived. Bleeding occurred in 3 patients, renal failure in 2, CNS injury in 2, and cardiopulmonary failure in 1. The 8 survivors in Group 1 have been followed for 2 to 56 months (mean, 28.7 months). Five patients were in NYHA class I, 2 were in class II and 1 was in class III.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Ectopic gastric mucosa in the upper esophagus: detection and radiographic findings.

PURPOSE: To detect and characterize the appearance of islands of ectopic gastric mucosa in the upper esophagus at routine examination of the upper gastrointestinal (GI) tract. MATERIALS AND METHODS: Well-distended upper esophagus was documented with spot radiographs obtained with routine double-contrast examination performed after administration of high-density barium in nine patients. Detected lesions were confirmed by means of endoscopy and biopsy. RESULTS: Twelve lesions were detected. Radiographic findings were characterized by either a discrete, shallow depression surrounded by a subtle, rimlike elevation on double-contrast images or by a pair of small indentations on the same wall on full-column, single-contrast images at the level of the thoracic inlet. Endoscopic examination revealed well-circumscribed areas of reddish mucosa located 15-26 cm from the incisors. CONCLUSION: Ectopic gastric mucosa in the upper esophagus is easily demonstrated at routine examination of the upper GI tract. Diagnosis can be based on location and characteristic radiographic appearance.

Adult↗
PubMed1994

Neuropathology of late cortical cerebellar atrophy in Japan: distribution of cerebellar change on an autopsy case and review of Japanese cases.

We report a Japanese autopsy case of late cortical cerebellar atrophy. The patient had showed clinically transient remission during thyrotropin-releasing hormone therapy. Our case suggests that thyrotropin-releasing hormone therapy is worth trying as a treatment of late cortical cerebellar atrophy. Neuropathological examination showed diffuse cerebellar cortical lesions and absence of neuronal loss in the dorsomedial part of the inferior olives. We studied qualitatively the detailed distribution of the cerebellar cortical lesions in 6 sections of the right cerebellum. The cerebellar lesions were more conspicuous in the most lateral hemisphere than in the vermis. We also reviewed 7 Japanese autopsy cases of late cortical cerebellar atrophy.

Aged↗
PubMed1994

Total syntheses of (2S)-antafumicins A and B.

To clarify the absolute configurations of antafumicins A and B, which are antifungal substances from Aspergillus niger NH-401, the total synthesis of (2S)-antafumicins was accomplished by starting from (S)-malic acid in 12 steps. Based upon the physicochemical data of the synthetic samples, the absolute configurations of naturally occurring antafumicins A and B were determined as (2R,4S)- and (2R,4R)-4-(3-acetyl-2,6-dihydroxyphenyl)-2-methoxy-4-butanolide, respectively.

4-Butyrolactone↗
PubMed1994

[The efficacy of both antegrade and retrograde cardioplegia in coronary artery bypass surgery].

We evaluated the efficacy of the cardioplegic myocardial protection by combining antegrade cardioplegic induction via the aortic root with retrograde cardioplegia via the coronary sinus in patients who had LAD stenosis or occlusion with collateral circulation. In study I, forty-six patients were divided into two groups: antegrade group (group A; 32 cases), which were perfused by only antegrade fashion via the aortic root, and bi-directional group (group B; 14 cases), which were perfused by combining antegrade with retrograde fashion. In study II, patients were divided into four groups: 32 cases in group A were divide into three subgroups by the direction of the collateral circulation to LAD in preoperative coronary angiograms: group I (antegrade collateral circulation; 18 cases), group II (retrograde collateral circulation; 7 cases), group III (99% stenosis with delayed filling; 7 cases) and group B was as group IV. Myocardial injury was assessed with the use of enzyme indexes (total CPK, CPK-MB, %MB, peak CPK, peak CPK-MB and peak % MB) in study I and study II. There was no significant difference between the two groups in study I and the four groups in study II in terms of patients' profile, graft materials, number of grafts, aortic cross-clamping time, total cardiopulmonary bypass time and surgical results. Total CPK level in group B was significantly lower (p < 0.05) compared with group A at the point of 12 hr and 1 day after surgery and peak CPK level was also significantly lower (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Collateral Circulation↗
PubMed1994

[Free arterial graft for coronary bypass grafting].

Free arterial grafts were aggressively placed in 39 patients (1991 to 1993). There were 34 males and 5 females, and mean age was 59.9 year old. Of 85 arterial grafts, 41 were free grafts, and their materials included left and right internal thoracic artery (LITA, RITA) and right gastroepiploic artery (GEA). There were one free LITA-left anterior descending coronary artery (LAD), seven free RITA-LAD, three free RITA-diagonal branch (Dx), 14 free RITA-left circumflex coronary artery (LCX), 10 free RITA-right coronary artery (RCA), two sequential RITA-Dx-LCX, one free GEA-Dx, two free GEA-LCX, and one free GEA-RCA bypass. Of 41 free arterial grafts, 38 were in the aorta-coronary position, and the proximal anastomosis was constructed first under single aortic cross-clamping to get the larger anastomotic sites for both at the proximal and distal ends of the arterial graft. The proximal sites of the remaining 3 arterial grafts were placed to concomitantly utilized saphenous vein grafts in two patients and RCA in one patient because of their shortness. Perioperative complications included no exploration for bleeding, myocardial infarction in one (2.6%), intra-aortic balloon pumping in three (7.7%), and wound complications in two (5.1%). 28 cases (72%) were completely revascularized with only arterial grafts. Of 41 free arterial grafts studied within one month after operation, all grafts were patent. All patients were free from angina after a 27 months mean follow-up. We believe that the proximal anastomosis technique for free arterial graft we used could be acceptable alternative for many surgeons. These excellent results justify wider use of free arterial grafts.

Abdominal Muscles↗
PubMed1994

[Quadruple coronary artery bypass grafting with arterial grafts--application of internal thoracic artery and right gastroepiploic artery].

Arterial graft has been widely applied for coronary artery bypass because of its excellent long-term patency. However, when more than four coronary bypass graftings should be carried out using internal thoracic arteries (ITAs) and right gastroepiploic artery (GEA), some surgical techniques must be devised. We performed quadruple coronary artery bypass grafting using three arterial grafts; bilateral ITAs and GEA, and obtained good results. We used free RITA graft for sequential grafting in one case. In another case, GEA was divided into two segments and used as two free grafts. From our experience, we believe it is possible to perform multiple coronary revascularization using only arterial grafts with one median skin incision.

Abdominal Muscles↗
PubMed1994

[A case report of disappearance of free internal thoracic artery graft stenosis].

We have experienced an interesting case of spontaneous disappearance of stenosis of the injured free internal thoracic artery graft six months after coronary artery bypass grafting. A 61-year-old male underwent coronary bypass surgery with in situ left internal thoracic artery (LITA)-left anterior descending (LAD) and free right internal thoracic artery (RITA)-first diagonal branch (D1) bypass at our hospital. Postoperative angiogram showed the stenosis of the distal portion of the free RITA. We judged it was the injury by the electrocautery when dissecting the RITA. He was admitted to our hospital and received repeat angiography because of recurrence of angina six months after surgery. Repeat angiogram showed the good patency of LITA and complete disappearance of the stenosis of the free RITA. We consider that this case proved the free ITA can be a living graft.

Coronary Artery Bypass↗
PubMed1994

[Breast sarcoidosis: 2 case reports and a review of 19 literature].

Case 1. A 40-year-old Japanese female with a 11 years history of sarcoidosis. Biopsy of a 0.5 cm-sized right breast nodule showed sarcoid granuloma. About two years later she had had bloody galactorrhoea and biopsy of an apparently normal site of the breast revealed periductal sarcoid granuloma and duct papillomatosis. Case 2. A 63-year-old Japanese female in whom biopsy of a 1 cm-sized right breast nodule revealed sarcoid granuloma. BHL, lung, eyes, muscle, lymph nodes and skin lesions were subsequently detected and the last two were histologically confirmed as sarcoidosis. After nine months all lesions disappeared. Some problems presented in the literature such as periductal sarcoid granuloma formation, latent sarcoidosis in the grossly normal breast and coexistent breast cancer are discussed briefly.

Adult↗
PubMed1994

[Surgical treatment of infective endocarditis].

Since 1976, 37 patients have undergone valve replacement for infective endocarditis at our institute. Twenty patients required surgery during the active stage and 17 in the inactive stage. The former group consisted of 17 native and three prosthetic valve endocarditis, and all patients in the latter group had native valve endocarditis. Eighteen patients had AVRs, 15 had MVRs and four had DVRs. Congestive heart failure was the indication for surgery in 80% of the active and 100% of the inactive group. There were nine early deaths (45%) and one late death in the active group, and one early (6%) and one late death in the inactive group. Operative mortality in the active group, however, has recently been reduced to 30% for the 10 patients operated upon in the past two years. Two patients with active endocarditis were complicated by rupture of cerebral mycotic aneurysms postoperatively and resulted in one early and one late death, respectively. It is suggested that timely surgical intervention according to the hemodynamic state of the patients is essential in reducing early mortality in infective endocarditis. Attention should be paid to cerebral mycotic aneurysm as one of the problems affecting on postoperative mortality and morbidity.

Adult↗
PubMed1993

Protection against ocular and cutaneous infection with herpes simplex virus type 1 by intragastric immunization with live virus.

Intragastric administration of live herpes simplex virus type 1 (HSV-1) was assessed for the induction of humoral immune responses and for protection against ocular and cutaneous challenge with virus. Mice showed no clinical abnormalities following intragastric inoculation with three different strains of virus (Miyama + GC, SC16, and P2C6, a thymidine kinase-defective mutant). Replication of virus was not detected in the oesophagus, superior cervical ganglia or coeliac ganglia of such animals and latent infection was not detected in these ganglia at later times after inoculation. Induction of a mucosal immune response was indicated by the presence of antibody (mainly IgG or IgA)-secreting cells in Peyer's patches. Intragastric immunization gave protection to some extent against ocular challenge and to a greater extent against cutaneous challenge with HSV-1. Following the latter challenge, particularly after intragastric immunization with strains SC16 and Miyama, the establishment of latency was almost completely prevented.

Administration, Oral↗
PubMed1993

Effect of PSK, a protein-bound polysaccharide preparation, on liver tumors of Syrian hamsters induced by Thorotrast injection.

The contrast medium Thorotrast, an agent well known to be carcinogenic, was injected into 400 congeneic Syrian hamsters. The resulting incidence of malignant hepatic tumors such as cholangiocarcinoma, hepatocellular carcinoma and hemangiosarcoma, was significantly higher in the male experimental group than in the control group, and the 50% survival period in the male group was shortened by about 100 days (P < 0.01). However administration of the antitumor drug PSK (Polysaccharide Kureha), a protein bound-polysaccharide extracted from basidiomycete fungi, prevented this carcinogenic effect. The incidence of malignant hepatic tumors in the experimental group was 22.5% compared with 2.8% in the control group (P < 0.01) and 10.5% in the PSK-treated group (P < 0.01). PSK also increased the 50% survival period by 61 days (P < 0.01).

Animals↗