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Biomedical subjects

H Kumano

Publications and source records attributed to H Kumano.

At least 55 records · Page 3Linked to original sources
PubMed1997

Hemodynamic and endocrine responsiveness to mental arithmetic task and mirror drawing test in patients with essential hypertension.

To evaluate the reactivity to psychological stress in patients with essential hypertension we investigated hemodynamic and endocrinologic changes during a mental arithmetic task (MAT) and a mirror drawing test (MDT) in 10 hypertensive subjects. Hemodynamic changes were assessed continuously using an ambulatory radionuclide cardiac detector. There were significant increases in systolic blood pressure (deltaSBP: +37.8 +/- 11.1 and +41.0 +/- 9.4 mm Hg during MAT and MDT, respectively, P < .01) and diastolic blood pressure (deltaDBP: +17.5 +/- 3.1 and +21.2 +/- 3.9 mm Hg, P < .01) and in heart rate (deltaHR: +17.1 +/- 5.3 and +12.5 +/- 2.9 beats/min, P < .01) during both tasks in association with an increase in cardiac output (CO). The plasma levels of norepinephrine and epinephrine increased during both the MAT (deltaNE: +0.074 +/- 0.022 ng/mL, P < .01; deltaEP: +0.068 +/- 0.025 ng/mL, P < .01) and the MDT (deltaNE: +0.067 +/- 0.034 ng/mL, P < .01; deltaEP: +0.030 +/- 0.011 ng/mL, .05 < P < .1). Although the deltaNE was similar in response to the MAT and MDT, the deltaEP during the MDT tended to be less than half the deltaEP during the MAT (.05 < P < .10). The deltaEP was positively correlated with the deltaDBP and the deltaCO during both tasks and with the deltaSBP and the deltaHR during the MAT. These findings suggest that MAT- and MDT-induced increases in BP were attributable mainly to an increase in CO, possibly as the result of stimulation of the sympathoadrenomedullary system. However, the sympathoadrenomedullary system appeared to be more closely associated with the hemodynamic responses during the MAT than during the MDT.

Adrenocorticotropic Hormone↗
PubMed1997

EEG-driven photic stimulation effect on plasma cortisol and beta-endorphin.

The effect of EEG-driven photic stimulation on stress-related endocrine function was studied. Subjects were 16 healthy males divided into a photic stimulation group (n = 8) and a control group (n = 8). Electrodermal and emotional lability measures were assessed by nonspecific skin conductance response and the Maudsley Personality Inventory, respectively. Plasma cortisol and beta-endorphin concentrations were measured both before and after EEG-driven photic stimulation as well as the resting condition. Subjects with electrodermal, emotional, or both lability showed comparable decreases of plasma beta-endorphin on photic stimulation as did the stable subjects. Under resting control conditions, however, they showed significant increases of beta-endorphin compared to both stable subjects as well as the photic stimulation condition. In addition, labile subjects showed significant alpha enhancement on photic stimulation compared to stable subjects and to the resting control condition. The data suggest that increases of plasma beta-endorphin in labile control subjects may denote a stress response to the conditions of these experiments, and that any decrease by EEG-driven photic stimulation may indicate a reduction of responsiveness to an acute stress.

Adult↗
PubMed1997

Changes of immunoregulatory cells associated with psychological stress and humor.

For 8 medical students influences of psychological stress or humor on T-cell subset percentages and natural killer cell activity were investigated by measuring these parameters before and after an examination and before and after watching a comedy video. Although T-cell subsets were not significantly affected by either stimulus and natural killer cell activity was not affected by the examination, the latter was significantly decreased after watching the comedy video.

Adult↗
PubMed1997

[Anesthesia for a patient with heparin-induced thrombocytopenia: a case report].

A 68 year-old man underwent a femoral-popliteal bypass surgery. He was diagnosed as heparin-induced thrombocytopenia (HIT) by platelet aggregation test when he underwent CABG 4 years ago. For the present surgery we administered nafamostat mesilate and urokinase for anticoagulation during surgery instead of heparin. After the operation, laboratory studies showed no thrombocytopenia.

Aged↗
PubMed1997

[Clinical and echocardiographic evaluation of the Medtronic-Hall 20A valve in the aortic position in patients with small aortic annulus: comparison with the 21 mmSJM valve].

We compared the results of Medtronic-Hall 20A aortic valve (MH20A) replacement with those of 21 mm SJM valve (SJM21A) replacement. The subjects were 17 patients who underwent aortic valve replacement with MH20A. The mean age was 65.4 +/- 8.8 years in the MH20A group. The average body surface area in the MH20A group was 1.37 +/- 0.08 m2, which was significantly smaller than in the SJM21A group (1.55 +/- 0.09 m2). The postoperative follow-up period was 51 months at maximum and 20 months on average. There was one hospital death and two late deaths in the MH20A group. The other patients were categorized NYHA I classification. The trans-valvular peak pressure gradient soon after surgery was 21 +/- 9.3 mmHg in the MH20A group, and 23.9 +/- 8.8 mmHg in the SJM21A group. Preoperative and late postoperative echocardiograms demonstrated significant decrease in mean left ventricular end-diastolic diameter and left ventricular end-systolic diameter in the both groups. Mean left ventricular hypertrophy was decreased to 22.8 +/- 4.6 mm from 25.0 +/- 3.9 mm in the MH20A group, and 24.1 +/- 4.3 mm from 28.5 +/- 5.6 mm in the SJM21A group. These data suggest that aortic valve replacement with MH20A is useful for patients who have smaller body surface area (< 1.50 m2) with a small aortic annulus.

Aged↗
PubMed1997

[A case of isolated tricuspid valve endocarditis caused by Campylobacter fetus].

We reported a rare case of isolated tricuspid valve endocarditis in a non-addict with no underlying cardiac disease. A 48-year-old man was presented with high fever and newly developed leg edema. The diagnosis of tricuspid endocarditis was established following detection of a large vegetation (3.0 cm) on the tricuspid valve on echocardiography. One blood culture showed positive for Campylobacter fetus. At operation, a large and a small vegetation were found attached to the anterior leaflet of the tricuspid valve, and the septal leaflet was also found to be involved by the infective endocarditis. These leaflets were therefore removed and the tricuspid valve was replaced with CarboMedics valve. He has remained free of endocarditis for nineteen months after surgery.

Campylobacter Infections↗
PubMed1996

Treatment of a depressive disorder patient with EEG-driven photic stimulation.

This study examined the effects of electroencephalographic- (EEG-) driven photic stimulation on a case of depressive disorder, as measured by a psychometric test of mood states, EEG parameters, and several autonomic indices. The EEG-driven photic stimulation enhances the alpha rhythm of brain waves using photic signals, the brightness of which is modulated by a subject's own alpha rhythm. The patient was a 37-year-old businessman, who was treated for depression with medication during the 13 months prior to his first visit to our hospital. He underwent two sets of inpatient treatment sessions, comprising first 16 and then 18 treatment sessions. The treatments brought about the following changes: an improvement in general mood state, alpha rhythm increase, cardiac parasympathetic suppression, and increased skin conductance level. In addition, significant correlations between alpha rhythm increase and cardiac parasympathetic suppression or cardiac sympathetic predominance were observed with each inpatient treatment. Significant correlations between alpha rhythm increase, cardiac parasympathetic suppression, or cardiac sympathetic predominance and the improvement of general mood state were also observed. Thus, from these observations, it was concluded that the alpha enhancement induced by EEG-driven photic stimulation produced an improvement in the patient's depressive symptomatology connected with cardiac parasympathetic suppression and sympathetic predominance.

Adult↗
PubMed1996

[Late pericardial effusion after open-heart surgery: usefulness of pericardiocentesis under echocardiographic guidance].

Late pericardial effusion (PE) after open heart surgery has a potential for serious complications, including tamponade necessitating urgent drainage. From October 1990 to March 1995 moderate to massive PE developed following 9 of 359 (2.5%) cardiac procedures between 11 and 55 days postoperatively (mean, 18.6 days). Only one of these nine patients had evidence of cardiac tamponade; the other 8 patients had moderate symptoms including malaise, weight gain, and dyspnea on exertion. All patients except one were being treated with warfarin and anti-platelet agents. Echocardiography detected posterior PE of variable magnitude in all 9 patients; anterior PE was present in only one of these patients. Pericardiocentesis under echocardiographic guidance using an echo transducer with a built in puncture needle was performed in all patients. A flexible catheter was left in place for 24 to 72 hours for suction. In each case, 300 to 712 ml of old bloody fluid (mean, 475 ml) was evacuated, with relief of symptoms. Despite continuing anticoagulant therapy, there was no recurrence of pericardial effusion. The technique we have described simplifies pericardiocentesis and helps to avoid complications in this procedure.

Adult↗
PubMed1996

[The effects of preoperative drinking and H2 blocker on gastric acid secretion].

We studied the effects of preoperative drinking and H2 blocker on gastric acid secretion in 63 patients (ASA I-II, > 18yrs) scheduled for afternoon surgery. Group A (n = 20), as a control, was not permitted to eat and drink from 9 pm, the day before surgery, and was then given 500 ml of maintainance fluid before anesthesia. Group B (n = 20) fasted from 9 pm the day before surgery, and was allowed to drink clear fluids until 2hs before anesthesia. Group C (n - 23) followed the same guidelines as group B, and was given famotidine (20mg) orally at 9 pm the day before and 2hs before anesthesia. After induction, a Salem sump tube was inserted into the stomach and a gastric fluid aspiration was performed. The fluid volume and pH were measured after collection. Gastric pH was significantly higher (P < 0.001) in group C (6.4 +/- 0.9) than in groups A (3.1 +/- 1.8) and B (2.7 +/- 1.8). Fluid volume was similar in each group (A; 11 +/- 9/B; 12 +/- 9/C; 12 +/- 13ml). The dilution of gastric acid by the ingested fluid was not observed. We conclude that preoperative drinking does not affect gastric contents in elective operative patients. To reduce the risk of developing aspiration pneumonia, we recommend that every patient should receive an oral H2 blocker.

Administration, Oral↗
PubMed1996

[A case of primary tissue failure in aortic bioprosthesis due to pannus formation].

A 22-year-old man, who had received aortic valve replacement with a 21 mm of Carpentier-Edward S.A.V Bioprosthesis for aortic regurgitation at 19 years of age, was readmitted to our hospital because of a new systolic murmur and his chest roentgenogram showed remarkable cardiomegaly. Cardiac catheterization showed a 55 mmHg pressure gradient across the bioprosthesis. Under the diagnosis of primary tissue failure, reoperation was undergone. At reoperation, the sewing ring and leaflets of the prosthesis were covered with pannus, which adhered to leaflets, and the thickness of these leaflets was seen. It was thought that these changes caused aortic stenosis. Primary tissue failure due to pannus formation has been reported a little, but if bioprosthesis is implanted in the supra-annular position, pannus formation may occur because cusps of bioprosthesis are attached to the host's annulus.

Adult↗
PubMed1996

[Successful surgical treatment for fungal endocarditis involving the aortic valve: report of a case].

A 50-year-old man who had undergone successful aortic valve replacement for fungal endocarditis was presented. He had been doing well until October 1993, when he suddenly developed shock with high fever. In two weeks he recovered from septic shock with vigorous medical treatment including intravenous administration of antibiotics. The infecting organism was not detected on repeated blood cultures. Four months later he was admitted to our hospital because of left heart failure. Although he was afebrile on admission, a two dimensional echocardiogram revealed vegetation on the aortic valve and massive aortic regurgitation. Inflammatory signs persisted and the vegetation increased in size, and therefore an aortic valve replacement was performed. A surgical specimen of the aortic valve revealed perforation in each of three cusps and vegetation on the non-coronary cusp. Pathological exploration revealed typical colonies of fungi. Following the diagnosis of fungal endocarditis, administration of an anti-fungal drug was started. His post-operative course was uneventful, and there was no evidence of recurrence with the anti-fungal medication for one year postoperatively.

Antifungal Agents↗
PubMed1996

[Pit fall of aprotinin administration during open heart surgery].

Aprotinin administration during open heart surgery has been attempted at various institutions to reduce hemorrhage and improve the rate of no-transfusion operations, and has been reported to be effective. The treatment has been effective also in the 45 patients operated on at our institution. However, we experienced LOS at weaning from extracorporeal circulation (8 cases) considered to be due to aprotinin administration, suggesting unexpected risk of the treatment. Evaluation was made by classifying the patients according to the aprotinin dose; A high-dose group administered aprotinin at 300 x 10(4) units (20 patients), a low-dose group administered aprotinin at 100 x 10(4) units (8 patients), and a control group not administered aprotinin (15 patients). The volume of postoperative hemorrhage increased with the dose of aprotinin, and was significantly lower in the high dose and medium-dose groups than in the control group, but was not significantly different in the low-dose group. The postoperative peak CPK and CPK-MB were not significantly differ but increased slightly with the aprotinin dose. Probably for this reason, IABP was needed in 8 (17.8%) of the 45 patients because of LOS at weaning from extracorporeal circuration. A diagnosis of perioperative myocardial infarction (PMI) was made in 7 of these patients. Factors other than aprotinin are unlikely to be the cause of LOS, and the condition is considered to have been induced by micro-embolism during extracorporeal circulation with aprotinin administration. We propose two points as basis for this speculation. The first is that the body temperature during extracorporeal circuration, which was 30-35 degrees C in the bladder, promoted antifibrinolytic activity of aprotinin. The second is poor control of ACT during extra corporeal circulation. Thus, we suggest the risk of the use of aprotinin without further reduction in the body temperature during extracorporeal circuration. At present avoidance of high body temperatures and strict control of ACT during extracorporeal circulation are important preventive measures against micro-embolism possibly caused by aprotinin.

Aprotinin↗
PubMed1996

[Effects of prostacyclin (PGI2) on pial vessel diameter and carbon-dioxide reactivity in cats].

We studied the effects of prostacyclin (PGI2) on the pial vessel diameter (D) and CO2 reactivity in cats. Nineteen cats, weighing 1.6-4.0 kg, were divided into two groups; PGI2 administration group (n = 10) and the control group (n = 9). The animals were anesthetized with midazolam, fentanyl, pancuronium and nitrous oxide/oxygen and ventilated mechanically. The pial vessels diameter (D) was classified into 4 groups (D < 50 microns, 50 < or = D < 100 microns, 100 < or = D < 200 microns, D > 200 microns). The vascular dynamics was examined through the closed cranial window with intravital epifluorescence microscopy on which a video camera was mounted. The measurements were carried out under the steady state of hypo-, normo-, and hypercarbia, respectively and the CO2 reactivity (delta %D/delta CO) was calculated. Under the induced hypotension with PGI2 (30% reduction in mean arterial pressure), pial vessels were significantly dilated, but there was no change in CO2 reactivity in terms of vessels diameter. The vessels with diameters of less than 50 microns were more dilated compared with those with larger diameters. We concluded that pial arterioles were dilated with PGI2 but it had no effects on CO2 reactivity.

Animals↗
PubMed1995

[A case of coronary artery bypass grafting using arterial grafts in a patient with Buerger's disease].

A 50-year-old male with Buerger's disease underwent coronary artery bypass grafting (CABG) using left and right internal thoracic arteries (LITA and RITA). In our case, his saphenous veins could not be used because of migrating thrombophlebitis, and we could not use right gastroepiproic artery because he had undergone gastrectomy for gastroduodenal ulcer. He underwent CABG with LITA-left anterior descending artery and free RITA-right coronary artery. Postoperative coronary angiogram showed good patency of both grafts, and his postoperative course has been uneventful for 42 months. To our knowledge, there is no report of CABG in a patient with Buerger's disease, but we think the use of arterial grafts is useful in such cases.

Coronary Artery Bypass↗