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Biomedical subjects

H Kishimoto

Publications and source records attributed to H Kishimoto.

At least 217 records · Page 12Linked to original sources
PubMed1988

[A new surgical method for the creation of atrial septal defects].

For the creation of atrial septal defect (ASD), we have developed a new method (Method I) using modified Harken blade for the closed commissurotomy, in which the membranous septum of the fossa ovalis was incised in case of patent foramen ovale (PFO). When there was no or very narrow PFO, we applied Schuster's procedure to create defect in the muscular and membranous septum, however, it was sometimes found the bridging of remnant of membranous septum was left. So that, we have applied the Method I to cut it off (Method II). Up to date, eleven patients were operated with the Method I, and three patients with the Method II. As the results, nearly no pressure gradient between right and left atrium was detected postoperatively. In two cases, sufficiently created ASDs were confirmed at radical surgery. Because of the safety and reliability, our new procedures appear to be more advantageous in comparing to conventional Blalock-Hanlon or other procedures.

Child, Preschool↗
PubMed1988

[Assessment of pulmonary blood flow after total cavopulmonary shunt operation and the modified Fontan procedure for univentricular heart].

Pulsed Doppler echocardiography was utilized to elucidate the characteristics of pulmonary arterial (PA) blood flow in five patients without apparent pumping chambers in their right heart circulation after right heart bypass surgery for univentricular heart. Two of these patients underwent total cavopulmonary shunt operation, in which the total systemic venous return drained directly into the PA, bypassing the right atrium and ventricle. Three underwent the modified Fontan procedure with atrial partition, in which the right-sided atrium was reconstructed merely as a pathway from the vena cava to the PA, and atrial contraction was nearly entirely excluded. The flow pattern in the PA was biphasic and forward in all five patients. Pulmonary regurgitation was not observed in any of the patients. The first phase of PA flow had its peak during atrial systole; the second, during ventricular systole. Simultaneous observation of PA flow and pressures demonstrated an inverse relation between PA flow and pressure. Pulmonary venous (PV) blood flow pattern was also biphasic and similar to the PA blood flow pattern with time lags. In conclusion, in cases without pumping right heart chambers, PA flow reflects PV flow resulting from contraction and relaxation of the left atrium and ventricle.

Adult↗
PubMed1988

Acute liver dysfunction after modified Fontan operation for complex cardiac lesions. Analysis of the contributing factors and its relation to the early prognosis.

Acute liver dysfunction was analyzed in 15 patients who received a modified Fontan operation for single ventricle in nine (atrial isomerism, seven) and tricuspid or mitral atresia in six. Nine patients had elevation of serum glutamic-pyruvic transaminase levels above 1000 U/L during the first week. As an analysis of postoperative liver function during the first week, the highest values of serum glutamic-pyruvic transaminase and total bilirubin and the lowest prothrombin time were scored from 0 to 4 within each parameter, and totaled to give a liver dysfunction score. The liver dysfunction score was 0 to 2 (no or trivial injury) in five patients, 3 to 5 (mild) in two, and 6 to 11 (moderate or severe) in eight (53.3%). The group operated on for single ventricle had a higher incidence (67%) of a liver dysfunction score of 6 or higher than the other group (33%). A multivariate analysis for the prediction of the liver dysfunction score mainly from early postoperative hemodynamics showed the highest correlation with cardiac index, followed by urine output, systolic arterial pressure, and central venous pressure. One patient required plasmapheresis. Four died early (less than 1 month); three of these had a liver dysfunction score of 6 or higher. Those with scores of 6 or above had higher serum glutamic-pyruvic transaminase levels at 1 month after operation than those with scores less than 5. In three patients (single ventricle), hepatic venous oxygen saturation was monitored and showed a marked decrease to below 20% with subsequent acute liver dysfunction. These results indicate that acute liver dysfunction appears to occur in patients with complex lesions after a modified Fontan operation from possible hepatic hypoperfusion and that low cardiac output may be more crucial than high central venous pressure alone.

Acute Disease↗
PubMed1987

A case of variant angina exacerbated by administration of rifampicin.

Rifampicin, an antituberculosis agent, is known to be a potent inducer of microsomal drug-metabolizing enzymes in the liver. Elimination or clearance of many drugs has been reported to be enhanced, and their effectiveness reduced; however, no report in the literature has dealt with the interaction between rifampicin and dihydropiridine calcium entry-blocking drugs such as nifedipine. We present here evidence for the possible interaction between rifampicin and nifedipine in a patient with angina pectoris, which was exacerbated during coadministration or rechallenge with rifampicin. The peak plasma level and area under the curve were reduced and the apparent oral clearance of nifedipine was increased by rifampicin, suggesting that rifampicin enhanced the elimination of nifedipine via induction of a hepatic microsomal drug-metabolizing enzyme, as has been reported on other drugs widely metabolized in the liver.

Aged↗
PubMed1987

Modified Fontan operation for single ventricle with common atrium and abnormal systemic venous drainage: usefulness of an additional superior vena cava to pulmonary artery anastomosis.

In two patients (aged 15 and nine years old) with single ventricle, common atrioventricular valve, common atrium, and bilateral abnormally draining superior vena cava (SVC), a modified Fontan procedure was performed together with a SVC to pulmonary artery (PA) anastomosis. This avoided complex intraatrial septation. A bilateral anastomosis was carried out in one patient and a unilateral one in the other, the PA not being divided in either patient. This procedure provided simple intraatrial septation while avoiding possible obstruction of either the pulmonary or systemic blood pathways if complete intraatrial septation had been carried out.

Adolescent↗
PubMed1987

Three subtypes of chronic schizophrenia identified using 11C-glucose positron emission tomography.

The authors used positron computed tomography (CT) and 11C-labeled glucose to measure brain glucose utilization in 20 chronic schizophrenic patients (18 men, 2 women, mean age 38) and 5 male control subjects (mean age 38). Positron emission tomography (PET) revealed at least three subtypes: hypofrontal (type A), hypoparietal (right-sided disturbance in right-handed and left-sided disturbance in left-handed patients) (type B), and normal (type C). The significant count reduction in the frontal lobe (Brodmann's area 10) in type A patients was 38%, while that in the parietal lobe (Brodmann's area 40) in type B patients was 26% in each lobe of the brain.

Adolescent↗
PubMed1987

11C-glucose metabolism in manic and depressed patients.

The authors used positron emission tomography (PET) and 11C-labeled glucose to study 15 unmedicated patients with affective disorders and 7 control subjects. Diagnoses of affective disorders were based on DSM-III criteria, and symptomatology was evaluated by the Hamilton Rating Scale for Depression. Blood counts of 11C in both unipolar and bipolar patients did not differ from those in controls after oral administration of 11C-glucose. By contrast, brain counts of 11C in unipolar depressed patients were significantly lower, whereas those in bipolar manic patients were significantly higher, than in normal controls.

Adult↗
PubMed1987

Hemodynamic changes during dental extraction and post-extraction bleeding in patients with prosthetic heart valves.

Hemodynamic changes during dental extraction and postextraction bleeding were retrospectively evaluated in patients with prosthetic heart valves. It was found that the rate pressure product had a higher value in the period of anesthesia and during dental extraction. There was a tendency for a high RPP difference corresponding to an increased incidence of ECG changes, such as ST-T, QRS, P, and tachycardia. ECG changes were frequently observed high in procedures which required high doses of local anesthetic at one time or when multiple dental extractions were undertaken, whereas they seemed to have no positive relation to the number of heart valves replaced. Approximately 87% of the extractions were carried out under continuous anticoagulant therapy with a pretreatment coagulability level, of which 32% had bleeding during the first 24 h.

Adult↗
PubMed1987

Depressed cellular immunity in Mycoplasma pneumoniae pneumonia.

We studied the lymphocytes and serum suppressive factor in patients with Mycoplasma pneumoniae pneumonia. Skin testing for delayed hypersensitivity to tuberculin was performed in 44 patients with pneumonia associated with M. pneumoniae infection. These patients were tuberculin-positive. Twenty-five patients showed a transient negative tuberculin reaction in the acute stage and 19 had a positive reaction. In tuberculin-negative patients, peripheral blood T lymphocytes were not significantly reduced; however, the blastogenic lymphocyte response to purified protein derivative (PPD) and PPD-induced gamma-interferon production were significantly reduced when compared with those in tuberculin-positive patients and healthy tuberculin-positive controls. The lymphocyte response of healthy tuberculin-positive controls was not suppressed by adding the serum of the tuberculin-negative patients. These results suggest that tuberculin anergy in patients with M. pneumoniae pneumonia early after clinical onset is due to depressed lymphocyte functions and not to serum factors.

Adolescent↗