Biomedical subjects

H Makuuchi

Publications and source records attributed to H Makuuchi.

At least 145 records · Page 8Linked to original sources

PubMed1994

[A case of congenital ventricular diverticula].

Congenital ventricular diverticula are classified into muscular type and fibrous type. Muscular diverticula may be associated with congenital midline thoracoabdominal malformations. Fibrous diverticula, also called congenital ventricular aneurysm, are often seen in black american and South African Bantus, but very few such cases have been reported in our country. A 33-year-old Japanese male was admitted to our hospital for evaluation of chest X-ray and ECG abnormalities. UCG and cineangiography revealed an outpouching of the left ventricle. As it increased in size during the four-year follow-up, surgical resection was performed. The left ventricular diverticulum was multilobular and had a thin wall, which was excised and reconstructed with a patch. There was another small diverticulum on the free wall of the right ventricle, which was directly closed with a mattress suture. A rare case of multiple congenital fibrous ventricular diverticula with successful surgical resection was reported.

Adult↗

PubMed1994

[A case of operation for acute postinfarction mitral insufficiency due to papillary muscle rupture].

A 75-year-old man was brought to hospital with complaining of chest pain. He was diagnosed acute myocardial infarction and treated medically using thrombolytic drugs. Without chest pain relieved, cardiac catheterization revealed three coronary vessel disease and severe mitral insufficiency (MR). MR was diagnosed due to papillary muscle rupture by echocardiography. After being transferred to our hospital, the patient developed in shock and underwent emergency operation with IABP inserted. Triple CABGs (to LAD, PD and 4PL) and mitral valve replacement were performed using saphenous vein grafts and a mechanical valve (Carbomedicus 25 M). The patient recovered gradually and discharged one and a half month after operation.

Aged↗

PubMed1994

[A case of bronchial rupture and pulmonary laceration caused by blunt chest trauma].

A 37-year-old female was crushed by a traffic accident. She was in severe respiratory distress. A chest X-ray revealed right pneumothorax and multiple rib fractures. Shortly after the initiation of the positive pressure ventilation, severe subcutaneous emphysema developed and she became shock. The bronchoscopy showed the rupture of the right main bronchus which was repaired through a right posterolateral thoracotomy using interrupted monofilament PPP sutures. Pulmonary lacerations were also repaired by the same sutures. Postoperative bronchoscopic examination showed good healing without any stricture. It cannot be overemphasized that accurate diagnosis and urgent surgical management is mandatory in patients with bronchial rupture.

Accidents, Traffic↗

PubMed1994

[A case of acute aortic dissection associated with myxedema].

A 53-year-old female, who had been severe hypothyroidism for about ten years, was admitted Stanford type A acute aortic dissection. The replacement of ascending aorta with a composite graft and coronary artery bypass grafting were performed immediately. During the post operative period, many complications occurred including delayed awakening from anesthesia, paralytic ileus, colon perforation, hyperbilirubinemia, pulmonary edema, cerebral hemorrhage and bacterial endocarditis. In this case, intravenous administration of steroid and thyroid hormone was effective to keep hormone level in the normal range although enteral administration was ineffective. It was suggested that early active supplement therapy is mandatory to prevent postoperative complications.

Acute Disease↗

PubMed1994

[Early phase II study of FUT-187 (sepimostat mesilate) on reflux esophagitis--mainly on postgastrectomy reflux esophagitis].

An early phase II clinical study with the proteolysis inhibitor FUT-187 was carried out on patients with reflux esophagitis. FUT-187 was administered orally at the dose of 300 mg/day or 400 mg/day four times daily, after meals and at bedtime, for 4 consecutive weeks. The total number of patients admitted to this study was 40, of whom 9 were assigned to 300 mg/day group and 31 to 400 mg/day group. The rate of effectiveness on postgastrectomy reflux esophagitis was 88% (7/8) in 300 mg/day group and 85%(22/26) in 400 mg/day group when "improved" or better final general improvement ratings were taken into consideration, and 75% (6/8) in 300 mg/day group and 69% (9/13) in 400 mg/day group when "improved" or better endoscopic general improvement ratings were used. The overall safety rating "no problem as to the drug safety" was 89% (8/9) in 300 mg/day group and 71% (22/31) in 400 mg/day group. The main side effect was diarrhea, which was experienced in 6 patients in 400 mg/day group. However, it was resolved by discontinuation of the drug treatment. Other symptoms of gastrointestinal upsets, such as nausea and anorexia, were also induced. Based on these results, it may be concluded that FUT-187 can be a drug with clinical utility that benefits postgastrectomy reflux esophagitis at the dose level of 300 mg/day or less.

Administration, Oral↗

PubMed1992

[Clinical evaluation of operative and non-operative treatment in hepatocellular carcinoma with main portal vein tumor thrombus].

It has been well recognized that results of treatment in hepatocellular carcinoma with main portal vein tumor thrombus (Vp 3 HCC) are very poor. But we tried aggressive transcatheter treatment (one shot or continuous hepatic arterial infusion, TAE) and hepatectomy with postoperative TAE in 52 cases by Vp3 HCC in recent 10 years. Analysis of the results disclosed that PR or CR cases were observed only in the series of continuous hepatic arterial infusion therapy. And cumulative survival rate was the best in the series of hepatectomy (50% survival interval is 18 months). We concluded that hepatectomy and resection of the tumor thrombus with postoperative TAE is the best treatment in Vp3 HCC.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1992

[Controversy in the treatment of superficial esophageal carcinoma--indications and problems of the procedures].

In our institution, 152 cases have been treated, which are 24.3% of total 626 cases with esophageal carcinomas. Analysis of these 152 cases revealed that neither intraepithelial cancer (ep), nor mm2 cancer, in which the lesion is limited within the upper two-thirds of the proper mucosal layer, had any vessels invasion and lymph node metastases. In addition, only 25% of the cases with mm3 cancer, limited within the deeper one-third of the proper mucosal layer, had vessels invasion without lymph node metastases. The 5-year survival of the cases less than sm1 was as good as 100%. However, those of sm2 and sm3 patients were 58.9% and 54.2%, respectively. Thus, we made the treatment strategy for superficial esophageal cancer as follows: 1. For ep to mm2 cases, endoscopic mucosal resection could be applied. 2. For the cases whose lesions widely spread in the esophagus, blunt resection would be indicated. 3. For the cases with mm3 to sm3 cancer, thoracotomy and laparotomy with wide lymph node dissection from neck to abdomen should be employed. Since a radical operation for esophageal cancer has high operative risk and poor postoperative quality of life, we should properly pick up and apply more cases with mucosal carcinoma for endoscopic mucosal resection.

Esophageal Neoplasms↗

PubMed1992

[Extracorporeal shock wave lithotripsy for choledocholithiasis].

By the advent of extracorporeal shock wave lithotripsy (ESWL), the plan to manage choledocholithiasis has changed greatly. As a non-operative treatment, endoscopic sphincterotomy (EST) is intensively performed, but ESWL is much safer than EST in invasiveness and complications. Without EST, 5 Fr endoscopic naso-biliary drainage (ENBD) and percutaneous transhepatic biliary drainage (PTBD) aiming at preservation of the function of the papilla Vater were inserted to make drainage first for the patients with choledocholithiasis with obstructive jaundice who visited our hospital. After the cholangitis subsided, ESWL was performed under the direct cholangiography through ENBD and PTBD and excellent results were obtained which are herein reported. ENBD has been performed on 98 cases of choledocholithiasis over the past 4 years. ESWL has been performed on 42 cases (ENBD 36 cases and PTBD 6 cases). Choledocholithiasis completely disappeared in 31 cases (73.8%). For unsuccessful cases, EST, percutaneous transhepatic cholangioscopy (PTCS), or laparotomy was performed.

Aged↗

PubMed1991

Immunohistochemical studies of blood group-related antigens in human superficial esophageal carcinomas.

A total of 63 surgically resected esophageal carcinomas (including 49 superficial esophageal carcinomas) and histologically normal tissue adjacent to the superficial carcinoma (nontumorous epithelium) were examined immunohistochemically for the blood group antigens (BGA) A, B, H, Lewisa, Lewisb, Lewisx, and Lewisy. Deletion of an expected A, B or H antigen occurred in 12 (24.5%) of the 49 superficial carcinomas and three (21.4%) of the 14 advanced carcinomas. Incompatible expression of an unexpected A or B antigens occurred in only one case (1.6%) in the carcinoma. In the clinicopathologic study, there was a significant correlation between immunoreactivity of Lewisa and depth of cancer invasion (chi-square test, P less than 0.05). In the superficial carcinoma, there were significant correlations between immunoreactivity of Lewisx and lymph node status (chi-square test, P less than 0.05), immunoreactivity of Lewisy and prognosis (Z test, P less than 0.05), and incompatible expression of Lewisb for tumor against nontumorous epithelium and histologic variation (chi-square test, P less than 0.01). The functional significance of alternations in BGA expression that may be associated with oncogenesis is not clear. However, immunohistochemical determination of BGA may be a more advantageous marker to predict the patient's clinical course in superficial esophageal carcinoma.

ABO Blood-Group System↗

PubMed1991

Ultrastructure of oesophageal melanocytosis.

Four examples of an endoscopically detected oesophageal melanotic lesion were examined by light microscopy, light microscope histochemistry and transmission electron microscopy, and were compared with 13 control samples of normal oesophageal epithelium. By light microscopy, pigmented melanocytes lacking atypia and mitoses were observed amongst the keratinocytes in the basal layer of the oesophageal mucosa. Junctional activity was absent. The mechanism of pigmentation was studied and found to consist of: an increase in the number of melanocytes in the basal layer of the mucosa, an increase in the quantity of melanin in these melanocytes, transfer of melanin from melanocytes to keratinocytes and to macrophages and fibroblasts in the tunica propria. Since all the lesions demonstrated increased numbers of both melanocytes and melanosomes, the term oesophageal melanocytosis rather than melanosis is suggested, to emphasise the essential character of the lesion as a cellular proliferation. The value of sampling these pigmented lesions during endoscopy is emphasised as a means of obtaining well-preserved material for the evaluation of a lesion which some authorities have viewed as a possible precursor for oesophageal malignant melanoma.

Aged↗

PubMed1991

Intra-abdominal desmoid tumors in familial polyposis coli: a case report of tumor regression by prednisolone therapy.

A case of intra-abdominal desmoid tumors in familial polyposis coli (FPC), which regressed and disappeared by prednisolone treatment, is reported. A 37-year-old Japanese man with abdominal lumps was admitted to our hospital. He had had proctocolectomy two years before because of FPC with rectal cancer. At laparotomy, tumors were present in the abdominal wall, mesentery, and retroperitoneum. Only a small part of the tumors was resected and diagnosed microscopically to be desmoid tumors. With prednisolone administration (20 to 5 mg/day) subjective symptoms were ameliorated and desmoid tumors slowly regressed. Bilateral hydronephrosis continued and resulted in "retroperitoneal fibrosis." To our knowledge, this case is the first well-documented case of retroperitoneal fibrosis in a patient with FPC. The characteristics of the desmoid tumor in familial polyposis coli or in Gardner's syndrome and the methods for its management are discussed.

Abdominal Neoplasms↗

PubMed1991

Tracheal hamartoma--report of a case successfully treated with endoscopic surgery.

This report presents the case of an 88 year old man with tracheal hamartoma discovered through a chest X-ray film showing obstructive pneumonia before the manifestation of any symptoms associated with tracheal obstruction. Since surgical treatment was unfeasible, the tumor was removed with success through electric cauterization using a gastrointestinal fiberscope.

Aged↗

PubMed1991

[Current problems in valvular surgery].

Based upon our experiences of 661 valvular operations for these 10 years, we discussed about three major topics in valvular surgery. The first is the current status of valve repair versus replacement. The second is on the changing aspects of patients undergoing valvular surgery. Finally difficult problems in the treatment of infective endocarditis was discussed.

Aged↗

PubMed1991

[Cerebral infarction after coronary artery bypass surgery--its cause, management and prevention].

Among 535 cases of simple CABG, cerebral infarction was complicated in 5 cases (0.9%). Their mean age (65.2 years old) was high, and 80% of them had the history of hypertension or diabetes mellitus or both. The causes of the cerebral infarction were considered to be the embolism of atheromatous debris from the ascending aorta (3 cases), the cerebral hypoperfusion due to cerebral arterial disease and hypotension during cardiopulmonary bypass (1 cases), and the embolism of the left atrial thrombus formed during repeated supraventricular tachyarrhythmias (1 case). Both cases of the multiple infarctions were lost in-hospital 10 months and 21 months postoperatively. Two of the three cases of single infarction suffered from the permanent neurological deficits. To prevent cerebral infarction which might totally deprive of the efficacy of the CABG, it is important to check and properly manage the atheromatous change of the ascending aorta, the cerebral arterial disease, and also postoperative supraventricular tachyarrhythmias.

Adolescent↗

PubMed1991

[Mitral valve disease with pulmonary hypertension: two surgical cases].

Two surgical cases of mitral valve disease with severe pulmonary hypertension were reported, in which pulmonary hypertensive crisis (PHC) was a really serious problem to be treated. The first case (60-year-old woman) had atrial fibrillation and her pulmonary artery pressure was 68/32 mmHg (Pp/Ps = 0.63) and mean pulmonary wedge pressure was 26 mmHg with a high v wave (46 mmHg). PHC developed immediately after the cessation of artificial cardiopulmonary bypass, and intraaortic balloon pumping was performed. However, it was difficult to wean from the assist circulation, and then PGE1 and isoproterenol were given into the pulmonary artery and epinephrine and norepinephrine were given into the left atrium, and we succeeded in weaning from the assist circulation. The second case (58-year-old woman) had high pulmonary artery pressure (86/37 mmHg) and the Pp/Ps was 0.73. According to the experience of the first case, prevention of PHC started during cardiopulmonary bypass, giving PGE1, nitroglycerin and torazoline into the pulmonary artery. This led to the easy weaning from cardiopulmonary bypass. PHC may be seen even in cases of acquired valvular disease, and the prevention is mandatory for uneventful surgery.

Cardiopulmonary Bypass↗

PubMed1991

[Surgical approach and long-term results on replacement of the aortic valve and ascending aorta with a composite graft].

From March, 1980 to January, 1991, 18 patients, 14 male and 4 female patients ranging in age from 22 to 63 years, were operated on for aortic regurgitation associated with an aneurysm of the ascending aorta. Twelve patients had annuloaortic ectasia; six had DeBakey type I or II dissection; three had Marfan syndrome; and one had aortitis syndrome. The surgical treatment consisted of 16 Bentall operations and 2 modified Cabrol operations with a composite graft and aortic wrapping. The operative mortality was 5.6% (one death). The late mortality has been 4/15. The actuarial survival rate is 82.6% at 5 years and 72.3% at 7 years. Modified Cabrol technique consists of two short interposed grafts with equine pericardial miniskirts between coronary ostia and composite graft, in which Carbomedics mitral valve (No. 23 or 25) is placed 5-10 mm above the proximal extremity. This technique is a safe and reliable method with no bleeding nor mortality and excellent long-term results.

Adult↗

PubMed1991

[Results and problems of cardiac surgery in the elderly (70 years of age or older)].

Fifty-nine cardiac patients with 70 years of age or older were operated in our Department from 1979 to 1990. The mean age was 73.1 years old, and the male/female ratio was 27/32. The operative procedures performed were CABG in 35 cases, the closure of VSP in 4 cases, the valve surgery in 17 cases and the others in 3 cases. In CABG cases, the operative and late mortalities of the elderly patients were both 2.9% (1 case each), which were comparable to those of the younger patients. The restriction of the bypass grafting only to the key coronary arteries to reduce the operative time was considered to be important. In VSP cases, three of four patients were operated in the acute phase, one being lost because of in-hospital contamination. In the valve group, 24% (4 cases) were lost in the early postoperative period, which was much higher than that of the younger patients (7.2%). The earlier decision of the operation and the use of smaller prosthetic valve avoiding time-consuming aortic root enlargement were considered to be important to reduce the mortality. It is concluded that the results of cardiac surgery in the elderly patients could be satisfactory if one considers its peculiarity well.

Age Factors↗

PubMed1991

[Treatment of cases of cardiac surgery complicated with malignant neoplasms].

There were 10 (1.2%) cases of cardiac surgery complicated with malignant neoplasm among the total 863 cases of cardiac surgery in our hospital and 8 cases were treated also surgically against the neoplasms before and after the cardiac surgery. They all underwent coronary artery bypass grafting, and in one case concomitant mitral valve replacement and abdominal aortic aneurysm resection were carried out. The variety of the neoplasms in these cases were carcinomas of the stomach, pancreas, esophagus, renal pelvis, bile duct, colon and urinary bladder, and pleural mesothelioma. These patients were discharged without operative death or major complication, and there was only one evidence of recurrence among the eight cases treated surgically for the neoplasms. It was considered that patients who have critical cardiac problem also bearing neoplasmic combination could be treated excellently by means of both surgical measures.

Aged↗