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H Kishimoto

Publications and source records attributed to H Kishimoto.

349 records · Page 20Linked to original sources
PubMedDate not supplied

New indicator for the Fontan operation: diameters of the pulmonary veins in patients with univentricular heart.

BACKGROUND: Operative survival after the Fontan procedure is good; however, there are some patients with disappointing results, especially those with atrial isomerism. OBJECTIVES: We tested whether the diameter of the pulmonary veins, which is reported as a useful indicator of pulmonary blood flow, predicts operative results after the Fontan operation. PATIENTS AND METHODS: We evaluated 30 consecutive patients undergoing either the bidirectional Glenn anastomosis (BDG) or the Fontan operation. Age at operation ranged from 3 to 81 months (mean 30). Diagnosis was right or left isomeric heart in 15 patients, double-outlet right ventricle in 4 and various other malformations in 11. BDG was performed in 16 patients and the Fontan operation in 14 patients. The diameters of the pulmonary veins were measured proximal to the entrance into the atrium in the late phase of a pulmonary arteriogram. The pulmonary vein (PV) index (in mm2/m2) was calculated from the sum of the cross-sectional areas of these veins divided by the body surface area. RESULTS: Of the patients undergoing BDG (+/- ancillary procedures), 12 had successful results and 4 had unsuccessful results. The PV index for hemodynamically successful patients was 361 +/- 153 and 275 +/- 60 mm2/m2 (mean +/- SD) for unsuccessful patients (p = 0.30). Of the patients who underwent the Fontan operation, 13 had successful and 1 had unsuccessful results. The PV index for successful patients was > 285 mm2/m2 and 137 mm2/m2 for the nonsuccessful patients. The new pulmonary vascular resistance (PVR) calculated by using the PV index (mean pressure difference between the pulmonary artery and the atrium/PV index) for BDG patients with successful or unsuccessful results was 2.0 +/- 0.5 or 3.5 +/- 0.2 mmHg/mm2 per m2, respectively (p < 0.01). The new PVR for Fontan patients with successful results was < 2.0 mmHg/mm2 per m2, while that for the patient with an unsuccessful result was 4.4. The new PVR completely separated patients into successful and unsuccessful groups, while conventionally calculated PVR did not (p = 0.63). CONCLUSIONS: PV index appears to be a useful morphological indicator of pulmonary blood flow and "new" PVR may improve the decision-making strategy for patients presenting with univentricular heart, especially those associated with isomeric heart.

Child↗
PubMedDate not supplied

Clinical studies on amyloidosis complicated with rheumatoid arthritis--with particular reference to nephropathy.

Twenty-two patients with definite or classical rheumatoid arthritis (RA) who were diagnosed as amyloidosis by biopsy or at autopsy were investigated. The average duration of RA prior to the diagnosis of amyloidosis was 16.5 +/- 12.5 years. The symptoms that led to the diagnosis of amyloidosis were renal symptoms in 11 cases and gastrointestinal symptoms in 5 cases. Urinary protein was positive in 16 cases (73%). The degree of proteinuria varied in each case. Nephrotic syndrome was observed in 5 cases. Azotemia (Cr greater than 1.5 mg/dl) was present in 18 cases (82%). The period from the diagnosis of amyloidosis to death was 3.0 +/- 2.2 years. The causes of death were uremia in 10 cases, heart failure in 2 cases, malignancy in 2 cases, sepsis in 2 cases and others in 2 cases. Thirteen patients were autopsied and the frequency of amyloidosis complicated with RA was 22.0% in autopsied rheumatoid patients. Although nephropathy was present in most cases of amyloidosis complicated with RA, proteinuria and azotemia greatly varied in both degree and course.

Adult↗
PubMedDate not supplied

Obstructive jaundice facilitates hepatic metastasis of B16F1 mouse melanoma cells: participation of increased VCAM-1 expression in the liver.

Obstructive jaundice facilitates experimental liver metastasis in the rat model, but the detailed mechanisms of this facilitation remain unclear. This study aimed to evaluate the contribution of vascular cell adhesive molecules-1 (VCAM-1) to augmented hepatic metastasis in cases of obstructive jaundice. Obstructive jaundice was induced in male C57BL/6 mice by common bile duct obstruction for 5 days using a Surgiclip. For the biliary decompression, obstructive jaundice was induced for 5 days, followed by removal of the Surgiclip. Liver specimens and blood samples were obtained from animals 5 days after biliary obstruction (OJ5) or sham operation and 2, 5, 11, 14 days after biliary decompression. The expression of VCAM-1 mRNA was increased in the livers from the OJ5 group. Western blot analysis demonstrated increased expression of VCAM-1 protein in the livers of the OJ5 group, in contrast with low VCAM-1 expression in the sham group. The expression of VCAM-1 protein was sustained at high levels at 2 days and decreased at 5 days after biliary decompression (BD5). For the induction of experimental hepatic metastasis, male C57BL/6 mice were randomized to three groups (sham, OJ5, BD5) of six animals each. B16F1 melanoma cells were introduced into the animals by an intraportal injection. Metastatic colonies in the livers were investigated 13 days after inoculation. The mean number of metastatic colonies was significantly increased in the OJ5 group (70.5+/-51.2) compared to that of the sham group (7.2+/-7.9) (p<0.05). This augmentation of hepatic metastasis was abrogated in the BD5 group (16.8+/-20.3). In conclusion, our results suggest that augmented hepatic metastasis in cases of obstructive jaundice are partly mediated through VCAM-1/VLA-4 interaction.

Animals↗
PubMedDate not supplied

Rudimentary meningocele presenting with an annular alopecia.

Rudimentary meningocele (RM) is a relatively rare developmental anomaly in which meningotherial elements are found in the skin. We present a case presenting with an annular alopecia over a rudimentary meningocele. Due to the occasional presence of connection or relationship to the central nervous system in RM, knowledge of the various clinical appearances including annular alopecia is clinically important.

Alopecia↗
PubMedDate not supplied

Real-time interactive MR imaging system: sequence optimization, and basic and clinical evaluations.

A real-time interactive MR imaging system (real-time MRI) is an MR scanner which has a fast image updating cycle and the ability to freely change slice orientation, just like an ultrasound imaging system. Recently, such a system has been developed and installed on a clinical 1.5-Tesla system. The purpose of this study was to optimize the pulse sequences for clinical use and to evaluate the clinical usefulness and basic functionality of real-time MRI. For T1-weighted imaging, FLASH (fast low angle shot) can be selected, and up to 5 frames per second can be acquired depending on the matrix size. For T2-weighted imaging, true FISP (fast imaging with steady-state precession) can be selected, and up to 4 frames per second can be acquired. Maximum C/N between liver and spleen was obtained at a flip angle of 20 degrees on FLASH. Maximum C/N between cardiac cavity and wall was obtained at a flip angle of 60 degrees on true FISP. Localization of the right and left coronary arteries could be performed within 30 seconds in three volunteers. Although the present real-time MRI system has drawbacks such as low spatial resolution and relatively low contrast resolution, we expect real-time MRI to be one of the most important tools for future clinical MRI.

Adult↗
PubMedDate not supplied

Aortoiliac stenooculusive disease and aneurysms: screening with non-contrast enhanced two-dimensional cardiac gated cine phase contrast MR angiography with multiple velocity encoded values and cardiac gated two-dimensional time-of-flight MR angiography.

PURPOSE: To evaluate the performance of two-dimensional cine phase contrast MRA with multi-velocity encoded values (multi-VENC cine PC) and ECG-gated two-dimensional time-of-flight MRA (ECG-2D-TOF) for the detection of stenoocclusive lesions and aneurysms in the aortoiliac area, when each method was used individually and when the two methods were used together. METHODS: Forty-one patients were included in this study. Multi-VENC cine PC and ECG-2D-TOF were obtained first, then contrast enhanced three-dimensional magnetic resonance angiography (CE-3D-MRA) was performed as the standard of reference. Two observers reviewed the images separately without knowledge of patients' symptoms or histories. Sensitivities and specificities were obtained separately for stenooclusive lesions and aneurysms by two reviewers. RESULTS: When the two methods were applied together, high sensitivities (93.0 by observer 1 and 91.9% by observer 2) and adequate specificities (87.6 and 82.3%) were obtained for stenoocclusive lesions. For aneurysms, moderate to high sensitivities (91.1 and 71.1%) and high specificities (98.8 and 99.4%) were obtained. CONCLUSION: These results suggest that the performance of two non-contrast enhanced MRA techniques may be valuable as a screening tool when the two methods are applied together.

Aged↗