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Biomedical subjects

H Moro

Publications and source records attributed to H Moro.

At least 55 records · Page 3Linked to original sources
PubMed1994

[The study on cerebral hemodynamics during selective cerebral perfusion].

This study was undertaken to clarify characterization on cerebral hemodynamics during deep hypothermic selective perfusion (SCP) in 18 pigs. Besides, the changes on cerebral hemodynamics were investigated with obstruction to venous drainage due to the clamp of superior vena cava (SVC) cannula. For SCP, blood was infused into aortic arch with the clamp of descending aorta, during 90 minutes at 20 degrees C. We measured regional cerebral blood flow (CBF), intracranial pressure (ICP), and carotid arterial flow (CAF), and carotid arterial pressure. The carotid arterial pressure as perfusion pressure was not significantly correlated with CAF, CBF and ICP. Although CAF increased as pump flow rate increased, the relationship between pump flow and CBF was not significant. Moreover, SVC pressure showed a tendency to increase, as CAF increased. Both ICP and internal jugular vein pressure (IJVP) were significantly (p < 0.01) increase, and CAF was significantly (p < 0.05) decrease with the clamp of SVC cannula. On the other hand, both ICP and IJVP were significantly decrease, and both CAF and CBF were increase, without unclamp of SVC cannula. The results suggest that cerebral autoregulation is intact during deep hypothermic SCP, and hyperperfusion cause the increase of shunt flow in extracranial area, and besides, the increase of ICP with obstruction to venous drainage cause decrease in cerebral blood flow.

Animals↗
PubMed1993

[Nutritional improvement after operation of valvular heart diseases with protein-calorie malnutrition].

We evaluated the nutritional states before and after operation in patients with severe valvular heart disease characterized by malnutrition. The patient population consisted of 6 females, age range between 42 and 60, average 52.2 years old. The valve lesions were mitral stenosis in 2, combined aortic and mitral valve diseases in additional 4 patients, and moderate to severe tricuspid regurgitation was noted in 5 of these 6 patients. All 6 patients underwent a successful mitral (c/s aortic) valve replacement, and 5 of 6 tricuspid annuloplasty. The ideal body weight increased significantly from 77.9 +/- 3.4% preoperatively to 84.6 +/- 3.9% postoperatively (p < 0.01). Late postoperative cardiac catheterization revealed an improvement of mixed oxygen saturation (61.3 +/- 3.8%, preoperatively vs 67.3 +/- 5.6%, postoperatively; p < 0.01). The postoperative serum prealbumin, retinol binding protein and K value in intravenous glucose tolerance test increased significantly (p < 0.05) compared to those before operation. In conclusion, our data suggested that corrective surgery would have a good effect on nutritional improvement of the protein-calorie malnutrition caused by valvular heart diseases.

Adult↗
PubMed1993

[An operative case of aortic valve regurgitation due to blunt trauma to the chest].

While a 70-year-old man was riding a motorcycle, he was hit by car on his chest on October 19, 1990. Medical check-up at the emergency room of another hospital was negative. However, he fell in to dyspnea on the night of next day which progressed to develop signs of orthopnea. He revisited the hospital where he was found to have aortic regurgitation and subsequent congestive heart failure after medical examination including echocardiography and was referred to our hospital 7 days after the accident. He was operated upon the following day. On opening the pericardium, about 100 ml of reddish black fluid was accumulated. The appearance of the heart was normal except for black discoloration of the epicardial fat pad at the base of the aorta. Opening the ascending aorta transversely, the right coronary cusp was found to be perforated. The aortic valve was considered preferable to replace than to repair. The aortic valve was replaced with a St. Jude Medical valve. His recovery was uneventful and he has been well thereafter.

Accidents, Traffic↗
PubMed1993

[Flow characteristics and responses to vasoactive drugs in canine gastroepiploic artery].

We studied flow characteristics and response to norepinephrine, Chlorpromazine and gastrin in 22 canine gastroepiploic artery (GEA) recirculation model. The GEA flow was obtained by a drip for a minute, opening the end of pedicle GEA. Furthermore, aortic flow and celiac arterial flow were measured by magnetic flow probe. The administration of chlorpromazine, vagostigumine, and gastrin induced a increase in both celiac arterial flow and pedicle GEA graft flow. Especially, the administration of gastrin induced significant increase in GEA flow and celiac arterial flow. Furthermore, adding norepinephrine step-wisely, the GEA flow increased remarkably, in spite of decrease of celiac arterial flow. This response was caused from difference in vascular resistance among celiac arterial branches. Therefore, the pedicle GEA graft has homogenous response as same as intact GEA that perfuses stomach, because its flow was affected by adrenergic and parasympathetic agent, alpha-blocker and gastric hormone.

Animals↗
PubMed1992

Mechanical circulatory assist by a roller pump system using hydrophilic heparinized polymer coated tubing.

We developed a circulatory assist system driven by a roller pump using hydrophilic heparinized polymer coated tubing. This system is easy to handle and does not require systemic heparinization. We applied it to 11 patients who failed to be weaned from cardiopulmonary bypass after open heart surgery. Left heart bypass was employed in 5 patients, right heart bypass in 1, combined left and right heart bypass in 2, and venoarterial bypass without oxygenation was done in 3 patients. The assisting flow rate ranged from 0.8 to 3.2 L/min, and the duration of the assist ranged from 5 h to 21 days. Six patients were weaned from this support, and 5 were discharged from the hospital. This system is beneficial for patients who failed to wean from cardiopulmonary bypass after cardiac surgery because of its simplicity and antithrombogenicity.

Aged↗
PubMed1992

[Clinical and experimental study of the production of renal hemodynamic effects of IABP-assisted pulsatile flow extracorporeal circulation].

Renal hemodynamics during IABP-assisted pulsatile flow extracorporeal circulation was assessed in terms of measurement values for intraoperative renal blood flow obtained by the local thermodilution method in human clinical patients. In addition, the effect of IABP on renal hemodynamics was investigated in an animal model of renal denervation in a study undertaken to elucidate the action mechanism of IABP. Eighteen patients with acquired heart disease were involved in the study and measured for the renal blood flow (RBF), cardiac output (CO), renal-systemic partition coefficient for blood flow (RBF/CO), renal vascular resistance (RVR) and perfusion pressure. In the pulsatile flow group, the RBF/CO increased as the number of pump runs increased, whole the RVR was conversely reduced with increasing pump runs. The experimental study without extracorporeal circulation was conducted on 19 mongrel dogs. During IABP runs RBF/CO increased, while the RVR decreased. After renal denervation, no noticeable influence of IABP upon renal hemodynamics was observed. Following a loading dose of noradrenaline (Norad), the RVR increased in a Norad concentration-dependent fashion, independently of IABP and renal denervation. These results indicate that IABP reduces the RVR and thereby exerts a favorable action on renal hemodynamics during pump times. The study thus warrants us to surmise that a mechanism involving the renal sympathetic nerves might play an important role in the production of favorable renal hemodynamic effects of IABP-assisted pulsatile flow extracorporeal circulation.

Animals↗
PubMed1991

[A modified translocation technique for recurrent periannular endocarditis after aortic valve replacement].

We reported a patient of 46-year-old man, who had undergone reinforced aortic valve replacement using a composite Björk-Shiley prosthesis for infective endocarditis on April 13, 1988. Because of recurrent periannular endocarditis and periprosthetic dehiscence, reoperation was undertaken eighteen months after the initial operation. Following debridement, a composite Dacron vascular prosthesis with a St. Jude Medical valve and two saphenous vein grafts were transposed in the ascending aorta. The operative procedures were entirely smooth. A modified Danielson's technique may be adequate for recurrent periannular endocarditis which make orthotopic re-replacement impossible in most cases.

Aortic Valve↗
PubMed1989

[Postpneumonectomy esophagopleural fistula--successful one-stage repair with omental flap and thoracoplasty].

A 69 year-old man, who had undergone left pneumonectomy for squamous cell carcinoma of the lung 21 months ago, was admitted with a high temperature and chest pain. A diagnosis of empyema was made, and a chest tube was inserted for drainage. Bronchopleural fistula was not noted. Noticing that food was leaking through the drainage tube, a diagnosis of esophagopleural fistula was made radiologically. Surgery was done in October, 1987, after irrigating an empyema space for two months. The fistula was approximately 4 cm below the carina, and it was closed directly. The omentum was sutured around the closed site to reinforce and obliterate the empyema space. Furthermore, additional thoracoplasty was done because the cavity was too large to close only with the omentum. The postoperative course was uneventful. He was able to eat specially prepared foods within 4 weeks, and was discharged on the 60th day after the operation. This patient could possibly be the first case who had undergone an omental flap for the closure of a postpneumonectomy esophagopleural fistula.

Aged↗
PubMed1989

[The effects of transfusion of irradiated blood upon cellular immune response in patients underwent open heart surgery].

The purpose of this paper is to demonstrate the effect of the transfusion of blood received 1500 rad exposure upon the immune response in 14 patients underwent various type of cardiac surgery. 13 patients received known amounts banked blood and irradiated fresh blood, while one patient received a lot of amounts of banked and irradiated and non-irradiated fresh blood. The authors studied the numbers of lymphocytes as well as lymphocyte subsets such as pan-T cells, B cells, helper/inducer T cells (TH/I), cytotoxic/suppressor T cells (Tc/s), active T cells, natural killer (NK) cells and NK cell activity during two weeks after surgeries. In all 14 patients, pan-T lymphocytes decreased markedly in a few days after surgeries, but increased to higher levels on the eight postoperative day than the levels preoperatively. TH/I and TC/S lymphocytes changed on the similar pattern as pan-T lymphocytes. Active T and B cells did not change significantly in two weeks. The number and activity of NK cells gave the lowest levels on the second postoperative day and did not recover to the preoperative levels in two weeks. One patient received non-irradiated fresh blood showed the similar immune response as other 13 patients, while he gave the lower levels than others did. This patient died of graft-versus-host disease (GVHD)-like syndrome on the 36th postoperative day. It may be thought that the transfusion of irradiated blood would prevent the host from GVHD and gave the better effects on the immune response than that of non-irradiated blood following open-heart surgeries.

Adult↗
PubMed1989

[A successful biventricular assist for postoperative patient with severe heart failure and hepatorenal dysfunction after mitral and tricuspid valve surgery].

We report a case of successful biventricular assist for severe heart failure after open heart surgery. A 62-year-old man suffering from advanced valvular disease accompanied with hepatorenal dysfunction underwent mitral valve replacement and tricuspid annuloplasty on September 22, 1988. Because of inability of weaning from cardiopulmonary bypass, left heart assisted circulation using a roller pump with heparin-coated tubing system was inserted. Following the left heart assist, an right ventricular assist device (RVAD) was subsequently applied to intractable right ventricular failure. He was successfully weaned from an RVAD after 24 hours, and from left heart assisted circulation after 46 hours. At present, he is doing well without significant complications. Earlier application of biventricular assist might be effective for biventricular failure with hepatorenal dysfunction.

Cardiac Output, Low↗
PubMed1989

[Angioplasty of the left main coronary artery--report of a case with left main coronary stenosis and aortic valve stenosis].

A 58-year-old woman was admitted to our hospital suffering from repeated chest pain. Selective coronary angiography (CAG) showed severely stenotic lesion in the left main coronary artery. There was no additional lesion in the left anterior descending and circumflex arteries. Aortography showed severe calcification in the aortic valve. The aortic was incised and divided completely at the aortic root 1 cm distal to the aortic valve. The incision was then extended toward the opening of the left coronary artery. An atheromatous plague was found and resected at the ostium. A saphenous vein patch was used to enlarge the internal diameter of the artery. The aortic valve was replaced using #21 SJM prosthetic valve. The patient recovered the surgery well, and anginal attacks have disappeared. Postoperative coronary angiograms revealed no stenotic lesion in the left main coronary artery.

Aortic Valve Stenosis↗
PubMed1989

[Complement activation during cardiopulmonary bypass: mechanism and prevention].

The mechanism of complement activation during cardiopulmonary bypass was studied for the prevention. In ten patients undergoing open-heart procedures, the serum levels of complement fractions (C3, C4, and C3 activator) were measured by a single radial immune diffusion method. In four of ten patients, the plasma levels of C3a, C4a, and C5a fractions were studied by the radioimmunoassay 2 antibodies method. The serum levels of C3, C4, and C3 activator decreased after cardiopulmonary bypass. The plasma levels of C3a, C4a, and C5a increased after bypass. The lower level of C3 activator shows that C3 activator was not excessively produced during cardiopulmonary bypass. Therefore it can be thought that much C4b2a from classical pathway as well as C3a over-production localizing extra-corporeal circuits and little inhibitors on alternative pathway resulted in increased complement activation. The prevention should be done from these etiologies.

Adult↗
PubMed1989

[Combined valvular and coronary artery surgery].

Combined valvular and coronary surgery were performed on 9 patients between 1973 and 1986. Valve replacements were consist of 5 AVR (including 1 translocated AVR and 1 Bentall operation), 2 MVR and 2 double valve replacement. Coronary surgery were of 6 aorto-coronary bypass using great saphenous veins, 1 innominate artery-coronary bypass using a Dacron prosthesis, 1 punch-out of coronary ostium and 1 dilatation of the left coronary ostium with a vein patch. Retrograde infusion of cardioplegic solution from the coronary sinus were done in patients with coronary ostial stenoses. One emergency case with acute cardiac failure died immediately after operation, and one with double valve and one with mitral valve replacement died of hepatic failure and multiple organ failure respectively within 1 year after surgery. Combined valvular and coronary surgery are necessary for patients with both diseases. Although the results of double valve replacement were not satisfactory, they would be improved using intra-aortic balloon pump and ventricular assist devices actively.

Adult↗
PubMed1982

Accuracy of ultrasound in the diagnosis of nonfunctioning kidneys.

The accuracy and reliability of ultrasound were assessed in 246 patients with 338 radiologically nonfunctioning renal units. The causes of nonfunction included hydronephrosis, pyonephrosis, renal parenchymal disease, renal agenesis, renal neoplasm and polycystic disease. Obstruction was proved in 158 patients, with an accuracy of 98.1 per cent. Retrograde pyelography was avoided. The diagnosis of a small end stage kidney was correct in 42 patients. In 9 patients with a unilateral nonfunctioning kidney less than 9 cm. long a thin coarsely textured cortex with dilatation of 1 or more calices was found. To our knowledge the presence of dilated calices in a small kidney, suggestive of chronic pyelonephritic changes, has not been described previously by ultrasound. Nonvisualization occurred in 16 cases (4.7 per cent) despite the anatomical presence of a kidney. An advanced degree of pyonephrosis with thick inspissated pus sometimes may mimic the ultrasonic appearance of a renal neoplasm.

Humans↗
PubMedDate not supplied

Development of an endocardioscope for repair of an atrial septal defect in the beating heart.

The purpose of this study was to evaluate the possibility of surgical treatment of an atrial septal defect in the beating heart without cardiopulmonary bypass. The first step was to develop an endocardioscope that permitted observation of the inside of the beating heart. To visualize the inside of the beating heart, the tip of the endoscope was covered with a glass adapter. The endocardioscope was inserted through the right atrial appendage in eight beagles. The atrial septum, foramen ovale, coronary sinus, tricuspid valve, and chordae tendineae were identified without hemodynamic derangement. The second step was to attempt to close the foramen ovale with clips or staplers. We were able to close the foramen ovale with these devices, but a safer, easier device is needed. The endocardioscope we developed should prove to be a useful tool for minimally invasive surgical treatment of heart diseases, such as atrial septal defect.

Animals↗