Biomedical subjects

H Matsuda

Publications and source records attributed to H Matsuda.

At least 217 records · Page 12Linked to original sources

PubMed2000

Treatment of acute right coronary artery occlusion during anesthesia.

PURPOSE: Perioperative coronary artery occlusion is a potentially dangerous complication causing myocardial infarction and circulatory collapse. We report a case showing severe ST segment depression in leads II and V5 during anesthesia. Diltiazem and nifedipine, but not nitroglycerine, partially improved the ST changes which were normalized by a percutaneous cardiopulmonary system (PCPS). CLINICAL FEATURES: A 71-yr-old man with cerebrovascular disease was scheduled for coronary artery bypass grafting (CABG). Past medical history included myocardial infarction due to right coronary artery (RCA) occlusion. Both the femoral artery and vein were cannulated percutaneously before operation and the PCPS was prepared as a back-up system. Depression of the ST segments in leads V5 and II was observed following heparinization. Although hemodynamic stability was maintained with continuous infusion of catecholamines, the ST changes were not improved by intravenous nitroglycerine. Intravenous diltiazem followed by nasal nifedipine partially improved the ST changes. The changes were normalized after induction of PCPS. No neurological complications were observed. The postoperative coronary angiography confirmed the total occlusion of RCA. CONCLUSION: Calcium channel blockers were more effective than nitroglycerine in treating perioperative ST depression. However, none of them produced complete reversal of the ischemic changes which were normalized with PCPS.

Acute Disease↗

PubMed2000

Early experience of aortic valve replacement with the Freestyle stentless aortic bioprosthesis in elderly patients.

OBJECTIVES: Stentless bioprostheses have been gaining popularity in recent years as hemodynamically superior alternatives to conventional stented bioprostheses. METHODS: Between July 1996 and November 1998, 13 patients with aortic valve disease, 7 males and 6 females with a mean age (+/- SD) of 68 +/- 5 years, underwent an aortic valve replacement using the Medtronic Freestyle aortic bioprosthesis. The predominant lesions were stenosis in 8 patients and regurgitation in 5, while 2 patients had endocarditis. The operation was performed by a subcoronary technique in 9, root-inclusion technique in 3, and full root technique in 1 patient. RESULTS: Throughout the follow-up periods (with average follow-up period of 20.6 months), there was no hospital mortality, though there was one late death of unknown cause. The New York Heart Association class improved in all patients. The peak transvalvular gradient decreased from 18.4 +/- 9.8 to 12.6 +/- 9.6 mmHg, and the effective valve orifice area increased from 2.30 +/- 0.96 to 2.59 +/- 1.05 cm2 between the 1-month and the 6-month follow-up examinations. In patients with aortic regurgitation, the left ventricular end-diastolic/end-systolic volume index significantly decreased from 147 +/- 36/62 +/- 19 to 73 +/- 26/33 +/- 14 ml/m2 at 1 month after the operation. The left ventricular mass index also significantly decreased from 189 +/- 26 to 143 +/- 30 g/m2 in patients with aortic regurgitation and from 171 +/- 28 to 144 +/- 30 g/m2 in those with aortic stenosis. CONCLUSIONS: Although long-term follow-up is required for further evaluation, the early results appeared to indicate that the Freestyle aortic bioprosthesis was suitable for elderly patients requiring aortic valve replacement.

Aged↗

PubMed2000

Percutaneous cardiopulmonary support with heparin-coated circuits in postcardiotomy cardiogenic shock. Efficacy and comparison with left heart bypass.

OBJECTIVE: Percutaneous cardiopulmonary support, a simplified form of venoarterial bypass, using totally heparin-coated circuits, has recently come into clinical use. To clarify its efficacy in postcardiotomy cardiogenic shock to aid weaning from cardiopulmonary bypass, we compared results of percutaneous cardiopulmonary support with those of left heart bypass using a centrifugal pump. METHODS: We reviewed 18 patients treated between 1991 and 1998 who could not be weaned from cardiopulmonary bypass. Nine were aided by totally heparin-coated percutaneous cardiopulmonary support (PCPS group), and 9 supported by left heart bypass using a centrifugal pump (LHB group). In both groups, activated clotting time was controlled at 150-200 seconds using minimal doses of heparin as needed. RESULTS: Weaning and survival rates were higher in the PCPS group than in the LHB group (100% vs 55.6%, and 66.7% vs 22.2%). The PCPS group had a smaller amount of blood loss and needed a smaller amount of blood components in the immediate postoperative period. One percutaneous cardiopulmonary support patient required surgical re-exploration for postoperative bleeding (11.1%), but no clinical thromboembolic event occurred in the PCPS group. In the LHB group, 5 patients underwent surgical re-exploration for postoperative bleeding (55.6%), and 2 underwent thrombus extirpation in the left ventricle (22.2%). CONCLUSIONS: Although this study was retrospective and historical backgrounds could have been involved, our data suggest that totally heparin-coated percutaneous cardiopulmonary support system appears more effective as an aid to weaning from cardiopulmonary bypass and in short-term circulatory support for patients in postcardiotomy cardiogenic shock.

Adult↗

PubMed2000

Concomitant aortic root remodeling and coronary bypass in a patient with poor left ventricular function.

A 58-year-old man who had previously undergone rectal cancer surgery and who had poor left ventricular function underwent concomitant aortic root remodeling and coronary bypass for aortic root aneurysm with aortic regurgitation and severe coronary artery disease. Intermittent retrograde cold blood cardioplegia and leukocyte-depleted terminal blood cardioplegia were used for myocardial protection. Angiographic studies 1 month after surgery showed improved left ventricular function at an ejection fraction from 24 to 46%. During a 1-year follow-up, he has remained free of any cardiac event. Even though this report is limited to a case and follow-up, this technique is expected to be beneficial even in patients with severely depressed left ventricular function when the postoperative quality of life is considered.

Aortic Aneurysm↗

PubMed2000

Minimally invasive removal of infected pacemaker lead.

A 37-year-old woman with sick sinus syndrome suffered complications with recurring local infection at the generator pocket. Repeated debridement and antibiotic therapy was ineffective. Several attempts to remove leads via the implantation vein by direct traction were unsuccessful. We operated using cardiopulmonary bypass and applied a minimally invasive lower ministernotomy to obtain pleasing cosmetic results. After a right atriotomy, leads were removed. The minimally invasive approach gave satisfactory results, especially cosmetically.

Adult↗

PubMed2000

Coronary artery bypass graft in a renal transplant recipient.

A 47-year-old woman receiving predonine after renal transplantation underwent coronary artery bypass graft (CABG) surgery because of medically angina uncontrollable since 1996. Although she had an episode of acute renal rejection successfully treated with steroid pulse therapy, she had no angina or hemodialysis for over 2 years after CABG. We discuss postoperative management of renal recipient after cardiac surgery using lymphocyte-subpopulation monitoring.

Coronary Artery Bypass↗

PubMed2000

Ipsilateral recurrence frequency after video-assisted thoracoscopic surgery for primary spontaneous pneumothorax.

OBJECTIVE: We retrospectively evaluated the results of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax and recurrence. METHODS: A series of 424 patients with primary spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery-289 with an ipsilateral recurrent episode, 88 with persistent air leakage for 7 days or longer, 34 with a contralateral episode, 9 with hemopneumothorax, and 4 with tension pneumothorax. The commonest management was stapling of an identified bleb, undertaken in 375 patients (88.4%). Pleural abrasion was conducted in 250 (59.0%), but the abraded area was one-third or less of the thoracic cavity in 187 (74.8%). RESULTS: No operative deaths occurred. Revisional thoracotomy was required in 1 patient with postoperative bleeding and another with incomplete postoperative lung reexpansion; 26 had prolonged air leakage, but none required revisional thoracotomy. During a mean follow-up of 31.4 months, ipsilateral pneumothorax recurred in 40 patients (9.4%), with 26 (65.0%) having recurrence within 1 year postoperatively. A video-assisted thoracoscopic surgery was conducted again in 8, and thoracotomy in 14. CONCLUSIONS: The ipsilateral recurrence of primary spontaneous pneumothorax after video-assisted thoracoscopic surgery was high at 9.4%. If video-assisted thoracoscopic surgery is to be considered as a treatment for spontaneous pneumothorax, we must therefore reduce postoperative ipsilateral recurrence by training practitioners not to overlook blebs during the procedure and/or consider widening the area of pleurodesis.

Adolescent↗

PubMed2000

Cardioprotective effect of diadenosine tetraphosphate (AP4A) cardioplegia in isolated rat hearts.

Preischemic administration of diadenosine tetraphosphate (AP4A) has been shown to be cardioprotective. We evaluated the protective effect of AP4A when used as a cardioplegic adjuvant and tested contributions of the ATP-sensitive potassium channel (K ATP channel), adenosine receptor (AR), and purine 2y receptor (P2yR) to the effect of AP4A. Isolated buffer-perfused rat hearts were subjected to 23 min of ischemia (37 degrees C) followed by 20 min of reperfusion. Cardioplegia solution (St. Thomas Hospital solution) was infused during the first 3 min of ischemia. AP4A (10 microM) or AP4A with glibenclamide (K ATP channel blocker, 100 microM), 8-SPT (AR antagonist, 300 microM) or reactive blue (P2yR antagonist, 13 nM) were added to the cardioplegia solution. Compared with the cardioplegia solution alone, administration of AP4A with the solution significantly increased the recovery of rate-pressure production (75% +/- 11% vs 58% +/- 10%; P < 0.05) and dp/dt at the end of reperfusion, and reduced the leakage of creatine kinase (3.2 +/- 3.7 vs 13.2 +/- 10.1 IU/g; P < 0.05) during reperfusion. This effect was reversed by coadministration of glibenclamide or reactive blue but not 8-SPT. The addition of AP4A into the cardioplegia solution led to an added cardioprotective effect, either by opening the K ATP channel or by activating P2yR.

Adenosine↗

PubMed2000

Diadenosine tetraphosphate (AP4A) mimics cardioprotective effect of ischemic preconditioning in the rat heart: contribution of KATP channel and PKC.

Diadenosine tetraphosphate (AP4A) administration is reported to mimic the effect of ischemic preconditioning (PC) via purine 2y receptors (P2yR) and adenosine receptors. This study was designed to test the contributions of the ATP-sensitive potassium channel (KATP channel) and protein kinase C (PKC), two of the main regulator in PC, to the effect of AP4A. Isolated buffer-perfused rat hearts were subjected to 20 min of global ischemia (37 degrees C) and 20 min of reperfusion. Three cycles of 1-min ischemia and 3-min reperfusion induced PC. Chemicals were administrated for 2 min before 20 min of ischemia. AP4A (10 microM) administration was as effective as PC in improving the recovery of post-ischemic contractile function and reducing creatine kinase leakage after reperfusion, whereas adenosine (10 and 100 microM) have not effect. AP4A had not effect on reperfusion-induced arrhythmia, whereas PC significantly prevented it. These effects of AP4A and PC were reversed by co-administration of glibenclimade (KATP channel blocker, 100 microM) and GF109203X (PKC inhibitor, 10 microM); the effects of AP4A but not PC were reversed by co-administration of reactive blue (P2yR antagonist, 13 nM). AP4A appears to activate the KATP channel and PKC via P2yR mimic the effects of PC in part. The role of P2yR indicated that trigger mechanism of the effect of PC and AP4A administration might differ in rat hearts.

Adenosine Triphosphate↗

PubMed2000

Reduction in myocardial apoptosis associated with overexpression of heat shock protein 70.

It is reported that ischemia-reperfusion induces apoptotic cell death in myocardium. It is also demonstrated that heat shock protein 70 (HSP70) enhances myocardial tolerance. Therefore, it is hypothesized that HSP70 may play a role in the attenuation of myocardial apoptosis. To elucidate this goal, HSP70-overexpressing and control-transfected rat hearts were prepared using gene transfection by intra-coronary infusion of the hemagglutinating virus of Japan-liposome. In vivo experiment Hearts of both groups were subjected to global ischemia, followed by reperfusion in situ. Shorter recovery time to spontaneous beating (HSP70-transfected vs. control-transfected; 46.7+/-4.6 vs. 67.5+/-7.0 s, p = 0.033) and lower serum CPK levels (415+/-27 vs. 533+/-36 IU, p = 0.027) were observed in the HSP70-transfected group. The HSP70-transfected group also showed a lower percentage of cardiac myocytes positively stained by nick end labeling after ischemia-reperfusion (17.5+/-4.9 vs. 40.0+/-5.1%, p = 0.010). In vitro experiment Cardiac myocytes isolated from the hearts of both groups (prepared separately from the in vivo experiment) were subjected to hypoxia-reoxygenation. Flow cytometry was used to identify the cells that showed sub-G1 DNA content as apoptotic cells. Apoptotic cells as a percentage of viable cells increased more in the control-transfected group after hypoxia-reoxygenation (13.0+/-0.77 vs. 21.9+/-1.18%, p<0.0001). In conclusion, we demonstrated that apoptosis after ischemia-reperfusion was decreased in the HSP70-overexpressing heart in vivo and in vitro, leading to the suggestion that HSP70 could be associated with the reduction in myocardial apoptosis.

Adaptation, Physiological↗

PubMed2000

Laryngeal endocrine cells: topographic distribution and adaptation to chronic hypercapnic hypoxia.

The morphology, topographic distribution, effects of denervation, and exposure to hypercapnic hypoxia of endocrine cells were examined in rat larynx. The endocrine cells, which were immunoreactive for protein gene product 9.5 (PGP 9.5) and calcitonin gene-related peptide (CGRP), were observed within the epithelial layer of the laryngeal cavity and in the laryngeal gland, while solitary endocrine cells with apical and/or basal cytoplasmic processes appeared near the glottis. After denervation of the left cervical vagosympathetic trunk and the superior laryngeal nerve, the number of mucosal endocrine cells in the denervated side was not significantly different from that in the intact side. After exposure to hypercapnic hypoxia for 3 months, the number of endocrine cells with PGP 9.5 and CGRP was markedly increased. In conclusion, the secretion of laryngeal endocrine cells may be stimulated by CO2 rather than O2. Furthermore, the endocrine cells and the sensory and autonomic nervous system may regulate each other by an axon reflex mechanism. Endocrine cells appear to play a very important role in the local regulation of the laryngeal mucosa.

Animals↗

PubMed2000

Two dynamic processes for the induction of long-term potentiation in hippocampal CA1 neurons.

This work sets out to investigate fast and slow dynamic processes and how they effect the induction of long-term potentiation (LTP). Functionally, the fast process will work as a time window to take a spatial coincidence among various inputs projected to the hippocampus, and the slow process will work as a temporal integrator of a sequence of dynamic events. Firstly, the two factors were studied using a "burst" stimulus and a "long-interval patterns" stimulus. Secondly, we propose that, for the induction of LTP, there are two dynamic processes, fast and slow, which are productively activated by bursts and long-interval patterns. The model parameters, a time constant of short dynamics and one of long dynamics, were determined by fitting the values obtained from model simulation to the experimental data. A molecular factor or cellular factors with these two time constants are likely to be induced in LTP induction.

Action Potentials↗

PubMed2000

Laparoscopic intragastric surgery using a radially expandable sleeve.

Laparoscopic intragastric surgery (LIGS) has become more widely established in Japan as a therapy for early gastric cancers and some types of submucosal gastric tumors. However, there have been some technical difficulties with the original method of LIGS. Certain complicated procedures to access the gastric lumen are required, along with repair of the gastric wall after endoluminal procedures. Using a 5-mm radially expandable sleeve (RES) for the working ports in LIGS, it becomes easier to establish access to the gastric lumen, and repair of the port sites on the gastric wall is not required. Using RES makes LIGS a simpler, less invasive procedure.

Adenocarcinoma↗

PubMed2000

Laparoscopic-assisted surgery for Crohn's disease: reduced surgical stress following ileocolectomy.

Recent progress in laparoscopic techniques has enabled operations for various intestinal disorders to be performed under laparoscopic assistance. This study was conducted to assess the benefits of performing laparoscopic-assisted surgery (LAS) in patients with Crohn's disease. LAS was performed in 24 selected patients with Crohn's disease, most of whom underwent ileocolic resection for ileitis and/or colitis with stenosis. To determine the benefits of LAS, the postoperative inflammatory parameters of these patients were examined and compared with those of 17 patients who underwent conventional open surgery. Despite giving all patients total parenteral nutrition (TPN) for more than 2 weeks preoperatively, two patients with large inflammatory masses involving enteroenteric fistulas required conversion to laparotomy. No laparoscopic procedure was converted for adhesions after previous resection or intraoperative complications. The maximum C-reactive protein values and body temperatures were significantly lower, and the time taken to normalize body temperature and leukocyte counts was significantly shorter in the LAS group than in the laparotomy group. LAS should be performed for patients with Crohn's disease in the inactive phase after appropriate nutritional support. Patients with terminal ileitis without a fistula are considered to have the highest indication for this procedure.

Adolescent↗

PubMed2000

Importance of preoperative marking for minithoracotomy and for internal thoracic artery harvesting in minimally invasive direct coronary artery bypass grafting.

Minimally invasive direct coronary artery bypass has the potential to cause an anastomotic failure because of a limited exposure of the operative field and the difficulty of internal thoracic artery harvesting. In the present study, the importance of preoperative marking for an accurate minithoracotomy location and a successful internal thoracic artery harvest was assessed. A paperclip was placed on the left nipple and a chest X-ray was performed in the supine position. By aligning the position of the paperclip to the location of the left anterior descending coronary artery from a coronary arteriogram frontal view, the intercostal space for the minithoracotomy was thus determined. Marking the incisional intercostal space during preoperative left internal thoracic arteriography revealed the number and location of the internal thoracic artery branches at the beginning of the harvest. This preoperative marking technique allowed for a more adequate exposure of the operative field and an easier internal thoracic artery harvest which therefore contributed to an improvement in the operative results.

Aged↗

PubMed2000

Is median sternotomy invasive? A comparison between minimally invasive direct coronary artery bypass and off-pump bypass.

Although minimally invasive direct coronary artery bypass (MIDCAB) eliminates the need for median sternotomy and cardiopulmonary bypass, its indications are limited. Conversely, coronary artery bypass without cardiopulmonary bypass (off-pump bypass) enables complete surgical revascularization under an optimal surgical field established by median sternotomy, even if patients have multivessel disease. The present study was designed to determine the invasiveness of median sternotomy by comparing 11 patients who underwent MIDCAB and 5 who underwent off-pump bypass between May 1997 and April 1998. There were no significant differences between the MIDCAB group and the off-pump group in age, being 57 +/- 11 vs 66 +/- 8 years old, the operative time, being 321 +/- 149 vs 441 +/- 205 min, the number of grafts, being 1.0 vs 1.4/patient, peak creatine kinase (CK) values, being 662 +/- 436 vs 609 +/- 56 IU/l, the peak CK-muscle-brain values, being 12 +/- 9 vs 16 +/- 5 IU/l, and the postoperative blood loss, being 369 +/- 198 vs 541 +/- 204 ml. Although there was no significant difference in peak C-reactive protein, at 17 +/- 5 vs 20 +/- 2 mg/dl, the periods declining within the normal ranges were shorter in the MIDCAB group than in the off-pump group, at 7 +/- 1 vs 15 +/- 2 days (P > 0.01). The hospital stay was almost the same in both groups, at 16 +/- 8 vs 26 +/- 14 days. These findings suggest that off-pump bypass is more invasive than MIDCAB, which may be attributed to the median sternotomy.

Aged↗

PubMed2000

Clinical evaluation of leukocyte-depleted blood cardioplegia for pediatric open heart operation.

BACKGROUND: Blood cardioplegia (BCP) is widely used for myocardial protection during open heart operation. However, BCP may have a chance to induce neutrophil-mediated myocardial injury during aortic cross-clamping. We clinically evaluated the myocardial protective effect of leukocyte-depleted blood cardioplegia (LDBCP) for initial and intermittent BCP administration in pediatric patients. METHODS: Fifty patients undergoing open heart operation for congenital heart disease between January 1997 and March 1999 were reviewed. Twenty-five were administered LDBCP for myocardial protection during ischemic periods (LDBCP group), and the remaining 25 were given BCP without leukocyte depletion (BCP group). RESULTS: The difference in plasma concentrations of malondialdehyde between coronary sinus effluent blood and arterial blood just after reperfusion in the LDBCP group (1.68 +/- 0.56 micromol/L) was significantly lower than that in the BCP group (2.35 +/- 0.62 micromol/L; p < 0.01). The LDBCP group showed significantly lower plasma concentrations of human heart fatty acid-binding protein at 50 minutes after reperfusion (LDBCP group, 103.5 +/- 38.7 IU/L; BCP group, 144.8 +/- 48.8 IU/L; p < 0.01) and the peak value of creatine kinase-MB during the first 24 postoperative hours (LDBCP group, 17.0 +/- 8.5 IU/L; BCP group, 26.0 +/- 11.6 IU/L; p < 0.01) than did the BCP group. The maximum dose of catecholamine was significantly smaller in the LDBCP group (LDBCP group, 3.20 +/- 2.18 microg x kg(-1) x min(-1); BCP group, 5.60 +/- 2.83 microg x kg(-1) x min(-1); p < 0.01). CONCLUSIONS: These results suggest the usefulness of LDBCP for protection from the myocardial injury that can be induced by BCP administration during aortic cross-clamping.

Blood Transfusion, Autologous↗

PubMed2000

Surgical results for small cell lung cancer based on the new TNM staging system. Thoracic Surgery Study Group of Osaka University, Osaka, Japan.

BACKGROUND: Operation with combined chemotherapy has been recently recommended for very early stage of small cell lung cancer without lymph node metastasis. METHODS: A retrospective study was undertaken in 91 patients who had undergone pulmonary resection for small cell lung cancer according to the new international staging system. RESULTS: The 5-year overall probability of survival was 37.1%. The 5-year survival rate was 100% for p-stage 0, 56.1% for p-stage IA, 30.0% for p-stage IB, 57.1% for p-stage IIA, and 42.9% for p-stage IIB. In the p-stage IA-IIB patients who underwent a complete resection, the 5-year survival rate of the patients treated by operation with chemotherapy was better than that of patients treated by operation alone. In addition, the 5-year survival rate of the patients who had four or more courses of chemotherapy was 80.0%. CONCLUSIONS: These results suggest that operation should be considered for p-stage IA-IIB patients and more than four courses of combined chemotherapy might be desirable in these resectable cases.

Adult↗