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Biomedical subjects

H Ohuchi

Publications and source records attributed to H Ohuchi.

At least 91 records · Page 5Linked to original sources
PubMed1996

Chronic solitary pulmonary nodule due to unsuspected pulmonary infarction from silent pulmonary embolism.

A case of pulmonary embolism showing a longstanding solitary pulmonary nodule is presented. An asymptomatic 57 year-old man with a solitary nodule in the right lower lobe was referred to our hospital. A pulmonary perfusion-ventilation scan following a sudden onset of dyspnoea established the diagnosis of recurrent pulmonary embolism. The nodule gradually disappeared after anticoagulant treatment, indicating that the nodule was pulmonary infarction from silent pulmonary embolism. Although the incidence of pulmonary infarction is low in Japan, this case suggests that pulmonary infarction from silent pulmonary embolism should be considered as one important cause of a solitary pulmonary nodule.

Chronic Disease↗
PubMed1996

[Carotid screening with duplex scanning before coronary artery bypass].

Seventy-one patients undergoing scheduled coronary artery bypass were preoperatively evaluated for the presence of carotid stenosis by duplex scanning. Prevalence of a moderate degree of stenosis (peak systolic flow velocity of internal carotid artery > 130 cm/sec) or a high degree of stenosis (peak systolic flow velocity > 250 or < 25 cm/sec) was 12.7% (nine patients). Predictive risk factors for carotid stenosis were diabetes mellitus and history of stroke. Compared with carotid angiogram, hemodynamically critical stenosis greater than 90% was found in three patients, severe stenosis (75-90%) in four, moderate stenosis (50-75%) in two. Bilateral carotid occlusion, complete occlusion of an internal carotid artery with contralateral 99% stenosis, was found in one patient. In the critical stenosis group (n = 3), simultaneous carotid endarterectomy and coronary artery bypass were performed in two and coronary artery bypass alone in one patient with unilateral complete occlusion of the internal carotid artery. There was neither operative death nor postoperative stroke in this series of patients. In conclusion, carotid screening with a duplex scan is very helpful to evaluate the presence of carotid occlusive disease in coronary artery bypass candidates. When significant carotid stenosis is detected, further examination should be done to clarify the carotid hemodynamics and brain protection during the operation should be employed.

Adult↗
PubMed1996

[Anomalous origin of the left coronary artery from the pulmonary artery coronary revascularization under normothermic coronary perfusion in an infant].

A 5-months-old baby was hospitalized with congestive heart failure. Anomalous origin of the left coronary artery from the pulmonary artery was diagnosed on echo cardiography and coronary angiogram. Preoperative examination revealed severe left ventricular dysfunction (left ventricular end-diastolic pressure was 32 mmHg, left ventricular ejection fraction was 16%). Coronary revascularization was performed by anastomosis of the neo-left coronary artery to the aorta using an autologous pulmonary arterial roll under normothermic coronary perfusion. Although postoperative CPK-MB was within normal limits, the patient died on the 12th postoperative day due to ventricular arrythmia. Autopsy revealed severe endomyocardial fibroelastosis.

Cardiac Surgical Procedures↗
PubMed1996

[Intrathoracic extramedullary hematopoiesis in a case of hereditary spherocytosis].

A 62-year-old man with a history of hereditary spherocytosis had an abnormal shadow on a chest X-ray film, but the shadow was not examined further. The patient was admitted to our hospital because of severe anemia, multiple gallstones, and splenomegaly. Acute cholecystitis developed due to gallstones. A smear of peripheral blood showed spherocytosis, and the osmotic fragility as measured by Parpart's method was abnormally high. These findings are consistent with hereditary spherocytosis. Splenectomy and cholecystectomy were done. The chest X-ray film, CT scan, and MRI revealed multiple well-demarcatd paravertebral masses. A biopsy of a mediastinal mass was done with an ultrasonically guided needle, and hyperplasic erythroid hemopoietic tissue was obtained. This finding led to the diagnosis of extramedullary hematopoeisis. We think extramedullary hematopoeisis should be included in the differential diagnosis of posterior mediastinal masses.

Hematopoiesis, Extramedullary↗
PubMed1996

[Reduction of homologous blood in elective cardiac surgery with miscellaneous autologous blood transfusion--especially with short-term predonation method].

The efficacy of homologous blood reduction in consecutive elective cardiac surgery by four different autologous transfusion methods was described. One hundred forty patients were divided into five different groups. No autologous blood transfusion in group A (22 cases), intraoperative autotransfusion with Cell Saver in group B (24 cases), additional intraoperative hemodilution method in group C (25 cases), additional preoperative predonation two weeks before operation in group D (15 cases), and predonation one week before operation with recombinant human erythropoietin administration in group E (55 cases) were performed. In group E, the criterion for patient selection of predonation was widely indicated (hemoglobin > 10 g/dl, body weight > 40 kg) and the period of the predonation technique was shorter compared with previous reports. The total homologous blood transfusion volume and the rate of the patients without homologous blood in each groups was 2216 +/- 1888 ml, 14.3% in group A, 2297 +/- 1789 ml, 4.2% in group B, 774 +/- 1043 ml, 36% in group C, 399 +/- 683 ml, 64.3% in group D, 135 +/- 276 ml, and 76.3% in group E, respectively. There were significant differences between group A, B or C and group D (p < 0.01), group A, B or C and group E (p < 0.001), and group D and group E (p < 0.05) with total homologous blood volume and between group A or B and group D (p < 0.01), group A or B and group E (p < 0.001), group B and group C (p < 0.05), and group C and group E (p < 0.01) with the rate of the patients without homologous blood. The reduction of homologous blood volume by patients was 1500 ml by the intraoperative hemodilution method, 370 ml by the preoperative prodonation technique, and 260 ml with predonation using erythropoietin. Ten of the thirteen patient (76.9%) who required homologous blood transfusion in group E had anemia (Hb < 12 g/dl) at preoperative blood pooling or postoperative massive bleeding (total mediastinal drainage > 1000 ml). Elongation of the predonation period before operation or postoperative autotransfusion of mediastinal shed blood and intraoperative aprotinin administration in such patients should be considered to reduce homologous blood transfusion.

Aged↗
PubMed1996

[Survival of a patient with postinfarction ventricular septal defect following venoarterial bypass with centrifugal pump and reoperation for residual shunt].

A 61-year-old man was hospitalized because of circulatory collapse due to postinfarction ventricular septal defect. As his hemodynamic condition deteriorated despite intraaortic counterpulsation, he underwent patch closure of VSP and patch reconstruction of the anterior left ventricular wall concomitant with coronary artery bypass grafting to the circumflex lesion immediately after admission. Femorofemoral circulatory assist with centrifugal pump was necessitated to wean from cardiopulmonary bypass because of severe left ventricular dysfunction. Circulatory assist was controlled to maintain mixed venous oxygen saturation of more than 70% under mild hypothermia. On the second postoperative day (POD), increased oxygen saturation from right atrium to pulmonary artery developed (Qp/Qs = 2.1). Further surgery was performed on an emergency basis for additional patch closure of VSP. Then he was successfully weaned from cardiopulmonary bypass successfully. The patient was extubated on the 14th POD and was ambulatory when he discharged on the 56th POD. Immediate surgical intervention should be performed for the patient with postinfarction ventricular septal defect when the hemodynamic state deteriorates under intraaortic counterpulsation.

Assisted Circulation↗
PubMed1996

[Long-term patency after the Blalock-Taussig operation--comparison between classic and modified shunts].

There is still a need for Blalock-Taussig shunt (BTS) in some situations involving complex heart diseases. This study demonstrates the long-term patency after shunt procedure in classic and modified BTS of different calibers using cineangiographic evaluation. Between January 1980 and December 1994, 150 patients 236 BTS including classic BTS (cBTS) in 62, modified in 174 procedures (GS: Golaski microknit graft in 112, EPTFE: expanded polytetrafluoroethylene graft in 62). Cineangiographic Evaluation for graft patency and freedom from stenosis (less than 50% in diameter) was performed a mean interval of 35 months after BTS. The five-year patency of cBTS was significantly superior to that of mBTS (EPTFE, p < 0.001). There was a significant superiority of three-year actuarial freedom from graft stenosis in cBTS compared to that after mBTS with GS (p < 0.01) and in mBTS with EPTFE compared to mBTS with GS (p < 0.05). In cases receiving small caliber grafts (4 mm or less), cBTS showed significantly better patency after five years compared to mBTS with GS (p < 0.05) and showed significant advantages in three-year actuarial freedom from graft stenosis compared to that after mBTS (p < 0.05). This study demonstrated the superior patency and freedom from stenosis after cBTS compared to that after mBTS, especially in cases receiving GS grafts. MBTS with GS graft and with small caliber EPTFE grafts could not be expected to maintain freedom from stenosis for three years.

Adolescent↗
PubMed1996

[Aortic valve injury due to blunt trauma--treatment in acute phase].

Aortic valve injury due to blunt trauma is rare and often difficult to diagnose. Therefore, most reported cases are operated on months or years after initial injury. Reported below is the case of a 55-year-old male, who was involved in a head-on collision with a bus. He was transported to Tsukuba Medical Center by ambulance, 34 minutes after the accident. The patient presented acute shock without obvious evidence of hemorrhaging. On physical examination a murmur was detected. The murmur was evaluated by Doppler echocardiography and revealed aortic regurgitation. On further physical examination he had gross hematuria and intratracheal bleeding. Computerized tomography (CT) showed evidence of contusions to his lungs, liver, and kidneys. The individual was diagnosed with an aortic valve injury, causing aortic insufficiency. It was necessary to continuously monitor the patients' hemodynamic state, assessing when conditions to operate were most favorable. However, in the hyper-acute phase the bleeding is difficult to control. We waited for his platelet count to recover before operating on the fifth day. When the patient underwent valve repair using extracorporeal circulation (ECC), aprotinin was added to the procedure. The surgery revealed a large laceration on the right coronary cusp of the aortic valve. Repair to the valve was impossible, so replacement of the aortic valve was required. A Carbomedics mechanical valve (phi 21 mm) was inserted. The patient did well after surgery, and eventually returned to work. To date, in Japan, there are eleven such cases of aortic valve injury on file. However, this is the first reported case that involved operating during the acute phase. This case demonstrates that, with careful evaluation of coexisting injuries and control of bleeding, successful treatment of aortic valve injury using ECC is possible, even in the acute phase.

Aortic Valve↗
PubMed1996

[Aprotinin reduces homologous blood transfusions when pediatric cardiac surgery must be redone].

The hemostatic effect of aprotinin in pediatric cardiac surgery is controversial. This study demonstrated the usefulness of aprotinin in cases undergoing additional surgery. In a retrospective study, three groups of children were investigated. In group I (n = 10), no aprotinin or Cell saver was used (control). In group II (n = 12), Cell saver was used intraoperatively. In group III (n = 14), aprotinin 30,000 KIU/kg was added to the prime of cardiopulmonary bypass, and another 10,000 KIU/kg was given every hour during extracorporeal circulation. Both blood loss and use of homologous blood during operation were significantly (p < 0.01) reduced in group III compared to those in the other two groups. In group III, blood loss both 12 and 48 hours postoperatively were one-third less than those in group I (no significant difference). The use of homologous blood 48 hours postoperatively was significantly reduced in group III compared to that in group I (p < 0.01) or group II (p < 0.05). We conclude that aprotinin administration during cardiopulmonary bypass reduced blood loss and homologous blood requirements both operatively and postoperatively when pediatric cardiac surgery must be redone.

Aprotinin↗
PubMed1995

Truncated type II receptor for BMP-4 induces secondary axial structures in Xenopus embryos.

BRK-3 is a vertebrate type II receptor for BMP-4 distantly related to invertebrate type II receptors for BMP-2/BMP-4/dpp, such as daf-4 and punt. BRK-3 has a long carboxy-terminal sequence following intracellular kinase domain and is capable of forming a high-affinity complex with a type I receptor, BRK-2. To examine the role of BRK-2 + BRK-3 receptor complex in BMP signaling during early embryogenesis, the dominant-negative form of BRK-3 was ectopically expressed in the Xenopus embryos. A secondary body axis expressing the Sonic hedgehog and N-CAM genes is induced by injecting mRNA encoding truncated form of BRK-3 into ventral marginal region, implicating the BMP signaling in axial mesoderm induction. Formation of the secondary axis depends on whether the deletion extends into the kinase domain, not into the carboxy-terminal tail, suggesting that the kinase domain, but not the tail region, is essential for BMP signaling.

Amino Acid Sequence↗
PubMed1995

A chicken Wnt gene, Wnt-11, is involved in dermal development.

We have isolated a new member of the Wnt gene family, Wnt-11, from chick embryo cDNA library and examined the expression pattern during embryogenesis by in situ hybridization. The Wnt-11 gene encodes Cys-rich secretory protein distantly related to Wnt-1 through Wnt-8 from the mouse and Xenopus. Expression of the Wnt-11 gene became evident at stage 14 in the dorsolateral region of somites and gradually restricted to the dermatome at stage 19 and later. In contrast to the other Wnt genes, Wnt-11 was not expressed in the neuroepithelium throughout stages 14-26. At stage 24 and later, Wnt-11 was expressed in the subectodermal mesenchyme of the limb and feather buds. The unique expression pattern of Wnt-11 in the paraxial mesoderm and dermatome suggests that Wnt-11 may play an important role in dermal development.

Amino Acid Sequence↗
PubMed1995

An additional limb can be induced from the flank of the chick embryo by FGF4.

To elucidate what initiates formation of the limb, we have attempted to induce an additional limb from the flank of the chick embryo by infecting retrovirus or implanting cells. We report here that an additional limb can be formed from the flank when we implant fibroblast growth factor 4 (Fgf4)-expressing cells into the lateral plate mesoderm at the pre-limb bud stage. In a newly formed limb bud, expressions of both Sonic hedgehog and chick Fgf4, which are authentic morphogenetic signals from the zone of polarizing activity and the apical ectodermal ridge, respectively, are induced by the implanted cells. Thus, it is concluded that the competence for limb development is present along the flank of the chick embryo and that FGF4 applied ectopically at the pre-limb bud stage can alter the developmental fate of flank cells to become limb cells. The present experimental system will contribute to a further elucidation on how the limb is formed.

Animals↗
PubMed1995

Involvement of the Sonic hedgehog gene in chick feather formation.

To elucidate the molecular mechanisms of chick feather formation, we observed expression patterns of the Sonic hedgehog (Shh) gene, which is one of the vertebrate homologs of the Drosophila segment polarity gene, hedgehog, and encodes a signaling molecule functioning in limb pattern formation and motor neuron induction. We found that the Shh gene is also expressed in the apical region of the feather placodes and then in nine to eleven longitudinal stripes along feather filaments. The stripe was found to correspond to one of the outer marginal zones of each barb ridge, termed the zone of Shh expression. No significant expression signal was detected in the scale bud of developing legs. Thus, Shh is likely to function as an epithelial signaling molecule in epithelio-mesenchymal interaction during feather formation. Furthermore, since genes of bone morphogenetic protein-2 (BMP-2) and fibroblast growth factor-4 (FGF-4) are coexpressed with Shh during feather formation as observed in limb morphogenesis, interactions among FGF-4, Shh and BMP-2 may be involved in formation of feather filaments and barbs in a similar fashion as elucidated in limb pattern formation.

Animals↗
PubMed1995

New gene, nel, encoding a M(r) 93 K protein with EGF-like repeats is strongly expressed in neural tissues of early stage chick embryos.

A new gene, nel, was isolated from a 9-day-old chick embryonic cDNA library. The gene encodes a protein of 835 amino acids (93,407 M(r)) consisting of two hydrophobic domains presumed to be the signal and transmembrane sequences, a histidine rich domain, two repeats of a cysteine rich structure similar to the C-terminal domain of von Willebrand factor, five EGF-like repeats, and again two repeats of the cysteine rich sequence similar to the C-terminal domain of von Willebrand factor in the presumed cytoplasmic domain. The expression of the nel gene was studied by Northern blot and in situ hybridization analyses of chick embryos. The mRNA of the gene was found in all tissues of 10- and 17-day-old embryos by Northern blot hybridization. Among the tissues examined, the level in the brain was highest and increased with age. After hatching, gene expression was retained in the brain at about the same level found in old embryos, increased in the retina, and disappeared from the other tissues. In situ hybridization with a nel gene probe revealed that the gene was strongly expressed in neural tissues such as brain, spinal cord, and dorsal root ganglia of early embryos. Gene expression was observed in the mantle layer of the neurepithelium of the brain and of the spinal cord. Gene expression in early embryos was not restricted to the neural tissues, but was also detected in the cells around cartilage, myocardium, lung mesenchymal cells, and in the liver, etc. One band of about 4.5 Kb mRNA was detected in all tissues and stages by Northern blot hybridization analysis. The possible function of the gene is discussed.

Amino Acid Sequence↗
PubMed1995

FGF can induce outgrowth of somatic mesoderm both inside and outside of limb-forming regions.

In the vertebrate embryo, only somatopleural cells in the limb-forming region are released from the mesodermal layer and undergo outgrowth from the embryonic body to form the limb bud. Molecular signals which regulate limb bud induction are unknown to date. In the present study we examined the ability of fibroblast growth factor (FGF) to induce limb bud formation in chicken embryos. A replication-defective retrovirus encoding FGF type 4 with a reporter, bacterial beta-galactosidase, was microinjected into lateral plate mesoderm inside and outside limb-forming regions. Effects of the ectopic and precocious expression of FGF were assessed at various stages after infection. Here we report that somatic mesodermal cells in both flanks and limb-forming regions can respond to FGF and induce limb bud-like outgrowth. The supernumerary limb bud induced within a limb-forming region differentiated into extralimb structures. These results strongly suggest potential roles of FGF signaling for induction of limb bud formation.

Animals↗
PubMed1995

[A repair of the aortic pseudoaneurysm after ascending aortic grafting in acute type A dissection--a case report].

A postoperative pseudoaneurysm of the ascending aorta is reported. The patient was a 73-year-old female with a history of graft replacement of the ascending aorta for acute type A dissection 5 years ago. She was referred to our hospital because of chest pain. Preoperative radiographic examination revealed a large pseudoaneurysm of the ascending aorta close to the distal anastomotic site of the graft as well as an aneurysm of transverse arch. During surgery, the pseudoaneurysm originated from a intimal defect in the aortic wall 1 cm distal to the suture line. It is suggested that the pseudoaneurysm was caused by a clamp injury during the initial operation. Replacement of the ascending aorta and transverse arch was successfully performed under selective cerebral perfusion. We should keep the clamp injury in mind when we apply an aortic clamp to a fragile dissected aorta.

Acute Disease↗
PubMed1995

[Dissection of the pseudointima followed by lethal obstruction of the prosthetic graft--a case report].

One-year-old boy who previously had modified Van Praagh procedure for interruption of the aortic arch (Celoria-Patton type A) and double inlet left ventricle with ventriculoarterial discordance was admitted for progressive cyanosis. He underwent reconstruction of the left pulmonary artery and additional left common carotid-left pulmonary artery shunt. During this procedure, severe hypotension of the lower extremities and heart failure occurred for unknown cause. He died on the 7 postoperative day for lung bleeding with disseminated intravascular coagulopathy. Autopsy revealed dissection of the pseudointima and obstruction of the prosthetic graft (interposed between the main pulmonary artery and the descending aorta). This complication seems very rare but a great care should be taken when a prosthetic graft is manipulated later.

Aorta, Thoracic↗