Biomedical subjects
Publications and source records attributed to H Ohzeki.
The successful surgical repair of the combination of septal perforation and cardiac rupture after myocardial infarction was underwent on a 73-year-old man. Complete correction could be performed under the fibrillated heart state employing cardiopulmonary bypass, resulted in the early postsurgical cardiac performance.
In order to prevent disadvantage of pulmonary regurgitation (PR) on cardiac function, pulmonary annuloplasty (PAP) was performed in a 58-year-old female. She suffered from severe mitral stenosis with right heart failure, and was in a state of cardiac cachexia. She was associated with PR due to pulmonary annular dilatation secondary to severe pulmonary hypertension. She underwent mitral valve replacement, tricuspid annuloplasty and PAP around the pulmonary annulus using a Teflon tape. No PR was observed by postoperative angiograms, and the operative method was proved to be effective on the treatment for PR. The PAP is recommended for patients with functional PR secondary to severe pulmonary hypertension.
From 1983 to 1985, Fontan type operation were successfully performed on five patients with single ventricle. Marked cyanosis disappeared soon after the surgery, and normal exercise tolerance was obtained in all cases but one in the late postoperative period. Compared to marked improvement in the exercise tolerance test, cardiac output remained subnormal both at rest and during exercise even in the late postoperative period. Several types of asymptomatic arrhythmias were observed during the acute postoperative days, but they were not recognized in the intermediate-term postoperative period. Routine blood chemistry studies showed that hepatic function was within normal limits, but hepatic dysfunction was suggested by Indocyanine Green clearance test. Renal function was well preserved after Fontan type procedure. Though cardiac output is subnormal, Fontan type procedure is a safe and effective operation, and intermediate-term state is satisfactory without any signs of heart failure.
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.
Seven patients with ventricular septal perforation or left ventricular free-wall rupture underwent myocardial resection in the acute stage of myocardial infarction. One of them received direct closure of the left ventricle, and the others replacement of myocardium with a Dacron prosthesis. One patient died of cardiac failure 5 days after surgery, and 4 in the late-stage between 2 months and 4 years. The following conclusions are obtained in our patients: 1. Echocardiography is very important for the diagnosis of cardiac free-wall rupture and determination of emergency surgery. 2. An intra-aortic balloon should be inserted in patients with VSP as soon as possible. If general state of the patients had been improved by the procedure, surgery might be withheld until the recovery, otherwise emergency surgery should be considered. 3. Myocardial replacement with a prosthesis seems to be useful when the left ventricular cavity is predicted to be small after resection of the myocardium. 4. The development of assisted circulation would improve a survival rate after the surgery. 5. Systemic managements are also important because the patients sometimes become fatal by non-cardiac complications even if they have survived from circulatory failure.
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A 61-year-old man with impending myocardial infarction was admitted and treated by percutaneous transluminal coronary recanalization (PTCR) therapy using Urokinase. Patient's symptoms subsided and his general condition maintained stable until the fifth hospital day, when he developed the signs of cardiac rupture. He was operated upon immediately, and the left ventricular rupture was confirmed and repaired successfully. Patient recovered from the surgery well. This report describes the rare successful surgical case of cardiac rupture secondary to acute myocardial infarction in Japan.
1. The Ca2+-ATPase activity in microsomes of rat submandibular gland was inhibited by pyridoxal 5'-phosphate in vitro. 2. The dissociation constant of the enzyme-pyridoxal 5'-phosphate complex was estimated to be 6.5 mM. 3. The inhibition of pyridoxal 5'-phosphate for both ATP and Ca2+ was competitive. 4. The order of inhibitory effectiveness of pyridoxal 5'-phosphate analogs was pyridoxal 5'-phosphate greater than pyridoxal HCl greater than pyridoxamine 5'-phosphate greater than pyridoxamine HCl. 5. The enzyme-pyridoxal 5'-phosphate complex was nonreducible with sodium borohydride.
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1. The Na+-K+-ATPase activity in the synaptic plasma membrane of rat brain was inhibited by PGA2 in vitro. 2. PGA2 concentration required for 50% inhibition was 8.91 x 10(-5) M. 3. Inhibition mode of PGA2 for both ATP and Mg2+ was uncompetitive type. 4. PGA2 was competitive and noncompetitive with Na+ and K+, respectively. 5. The Ki values for PGA2 inhibition for ATP. Na+, K+ and Mg2+ were 6.0 x 10(-5), 2.7 x 10(-5), 10.8 x 10(-5) and 0.6 x 10(-5) M, respectively.
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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.
BACKGROUND: Cardiopulmonary bypass (CPB) causes an inflammatory response and remarkably depresses the oxygenation capacity of the lung in pediatric patients with pulmonary hypertension. Although a heparin-coated circuit is more biocompatible than an uncoated circuit, the beneficial effect of a heparin-coated circuit on the postoperative lung function in the pediatric patients remains unknown. METHODS: Sixty patients younger than 3-years-old undergoing heart operations for ventricular septal defect were divided into three groups: group I = children (n = 11) without pulmonary hypertension who underwent CPB with an uncoated oxygenator; group II = children (n = 32) with pulmonary hypertension who underwent CPB with an uncoated oxygenator; and group III = children (n = 17) with pulmonary hypertension who underwent CPB with a heparin-coated oxygenator. A respiratory index (RI) was used to assess the oxygenation capacity of the lung. RESULTS: RI in group II was significantly higher than in group I and intubation time in group II was significantly longer than in group I. There was a positive correlation between preoperative pulmonary-systemic blood pressure ratio and RI at 3 hours post-CPB. Three and six hours post-CPB, RI in group III was significantly lower than in group II, but there was no significant difference in RI between both groups at 12 hours post-CPB. CONCLUSIONS: Pulmonary hypertensive pediatric patients were vulnerable to postperfusion lung injury. Beneficial effects of a heparin-coated oxygenator in a CPB circuit was limited to the early hours post-CPB and the postoperative clinical course was not modified by the heparin-coating of a membrane oxygenator.
UNLABELLED: Blood components were reported to be aggravating factors of ischemic cerebral injury. We previously reported that a partial blood replacement with Fluosol DA reduced ischemic neuronal injury. The purpose of this study is to elucidate whether pyridoxalated hemoglobin polyoxyethylene conjugate solution (PHP) exerts neuro-projective effects against cerebral ischemia. METHODS: 38 adult male gerbils were divided into 4 groups, such as normal group without ischemia or treatment, PHP group undergoing an exchanging blood transfusion with 5.0 ml PHP, ischemia group undergoing 5-min forebrain ischemia, and PHP-ischemia group with 5.0 ml PHP partial blood replacement prior to 5-min forebrain ischemia. Cerebral injury was assessed 7 days after treatment. In another group, effects of PHP on blood nitric oxide (NO) and cerebral blood flow (CBF) were studied. RESULTS: CA1 cell density was 140-2/mm in normal group and 142-5/mm in PHP group. The cell density was markedly reduced to 38-13 in ischemia group. The cell density was further reduced 27-10/mm in PHP-ischemia group. PHP was found to have a potent NO scavenger action and reduce CBF. CONCLUSION: Partial blood replacement with PHP prior to ischemia may cause cerebral vasoconstriction due to NO scavenger action and may worsen ischemic injury.
We report a case of a patient with a unique lymph node relapse after right hepatectomy and aggressive lymph node dissection for gallbladder cancer. There was extensive involvement of the hepatic parenchyma from the primary tumor, but no extension to the lymph nodes or other adjacent organs. Seventeen months later, the patient underwent re-dissection of the retroperitoneal lymph nodes with right nephrectomy and partial resection of the vena cava because of lymph node recurrence at the hilum of the right kidney. This pattern of lymph node metastasis to the right side of the vena cava from gallbladder cancer invading the liver is probably due to the distinct lymphatic drainage of the liver.