Biomedical subjects

H Toyohira

Publications and source records attributed to H Toyohira.

At least 73 records · Page 4Linked to original sources

PubMed1994

A review of 103 cases with elective repair for abdominal aortic aneurysm: an analysis of the risk factors based on postoperative complications and long-term follow-up.

From 1982 through 1992, 103 patients (mean age: 69 years) underwent an elective repair of an abdominal aortic aneurysm (AAA) at our institution. One or more postoperative complications occurred in 30 patients (29%), with a mortality rate of 1.9%. Factors which were found to be significantly associated with postoperative complications based on an univariate analysis included male sex (P = 0.0082), operation time (P = 0.0006), the size of the aneurysm (P = 0.0045), the amount of blood loss during operation (P = 0.0037), poor lung function (P = 0.0155), and the platelet count (P = 0.0468). A simple linear regression analysis showed that there were significant correlations among the AAA size, the duration of operation and the amount of blood loss. The age at operation, however, did not influence morbidity or mortality. Complete survival information was obtained in 96 (95%) patients, while the influence of preoperative risk factors on late survival was also examined by the Kaplan-Meier method. The factors influencing long-term survival were determined to be renal dysfunction and age at the time of operation.

Adult↗

PubMed1994

The surgical treatment of 30 patients with cardiac myxomas: a comparison of clinical features according to morphological classification.

Thirty patients with cardiac myxomas whose main clinical symptoms included congestive heart failure, tachyarrhythmia, chest pain and emboli, were successfully treated with surgery. The cardiac myxomas were found in the left atrium in 23 patients, the right atrium in 6, and the right ventricle in 1. Complete follow-up was conducted from 1 month to 15 years (mean 5.4 years) on 28 patients, 24 of whom were in New York Heart Association (NYHA) Class I, and 2 of whom were in NYHA Class II. The actuarial survival rate was 89% 15 years after surgery and no recurrent myxomas have been identified clinically or by echocardiography in any of the patients. Thus, an aggressive surgical approach is recommended prior to the development of heart failure or other complications whenever cardiac tumors are detected.

Adult↗

PubMed1994

Anticoagulant effects of warfarin and kinetics of K vitamins in blood and feces.

Patients (40 cases) were treated with daily dosage of warfarin of 2-7 mg after being undergone artificial valve replacements. Twenty one days after administration of warfarin, we examined the patients for kinetics of K vitamins and vitamin K-dependent coagulation factors in blood, and intestinal flora in feces, as well as the relationship between K vitamins and coagulation activity. The following results were obtained. (1) In warfarin-administered patients (Group B), blood levels of vitamin K1 and menaquinone-7, a vitamin K2 homologue, were similar to those in non-warfarin-administered patients. Therefore, administration of warfarin did not significantly decreased the levels. (2) In patients selected randomly from Group B (Group C), the vitamin K1 level in feces was higher than that in non-warfarin-administered patients. The menaquinone-7 level in feces was similar to that in non-warfarin-administered patients. For the total counts of bacteria and the detection rate of vitamin K2-producing bacteria, there was no significant difference between Group C and non-warfarin-administered patients. (3) The above mentioned results of (1) and (2) suggest that it is important for development of anticoagulant effects by warfarin to inhibit conversion from vitamin K1 to reduced vitamin K1, as well as to inhibit the reducing process from vitamin K1-epoxide to vitamin K1. (4) Vitamin K1-epoxide, a metabolite of vitamin K1, appeared in blood after administration of warfarin; there was a lower correlation between the blood level of vitamin K1-epoxide and the warfarin dosage. Further, PIVKA-II appeared in blood after administration of warfarin; there was a inverse lower correlation between the level of PIVKA-II and HPT, and between PIVIKA-II and TT. In conclusion, it has been clarified that vitamin K1-epoxide and PIVKA-II are useful parameters to evaluate anticoagulant effect of warfarin.

Adult↗

PubMed1994

[A case of pseudoxanthoma elasticum underwent coronary artery bypass grafting].

A case of pseudoxanthoma elasticum (PXE) underwent coronary artery grafting is reported. Coronary angiography of a woman with age of 41 with PXE revealed three vessels lesions. Coronary artery bypass grafting using saphenous vein grafts was performed. The left internal mammary artery was not able to use because of obstruction. Her postoperative course is uneventful for 3 years to date. Histological examination of a segment of ascending aorta revealed changes of PXE underwent CABG is extremely rare. This is the third reported case in Japan.

Adult↗

PubMed1994

[A successful case of two-staged operation for Stanford type B acute dissecting aneurysm complicated with total occlusion of the distal abdominal aorta].

A successful case of two-staged operation for Stanford type B acute dissecting aneurysm complicated with total occlusion of the distal abdominal aorta was reported. A 62-year-old male patient with a long history of systemic hypertension developed acute severe chest, back and bilateral legs pain. An enhanced CT demonstrated Stanford type B dissecting aneurysm with occlusion of the left renal artery and bilateral common iliac arteries. On the day of admission, an emergent right axillo-femoral bypass operation using 8 mm ringed EPTFE graft was undertaken to rescue the ischemic legs. The patient's postoperative course was complicated with acute renal failure and paralytic ileus, which were treated with medical treatment. Four months later, the second operation was done for the localized residual dissecting aneurysm in the proximal descending thoracic aorta. The aneurysm was excised, and the entry was closed with Dacron patch using the previously placed axillo-femoral bypass as a technique for preventing distal ischemia. He was recovered uneventfully and was discharged in a good condition.

Acute Disease↗

PubMed1994

[Surgical treatment of infective endocarditis--an analysis of the risk factors for operative mortality and long-term follow-up].

From September, 1978, through January, 1993, 67 patients (mean age: 44 years) underwent surgical treatment for infective endocarditis (IE) at Kagoshima University. Of 67 patients, 36 showed active endocarditis and 31 healed endocarditis at the time of operation. The over-all hospital mortality was 22.4% (15/67). Risk factors associated with operative mortality by univariate analysis included increased blood urea concentration (BUN), increased cardiothoratic ratio, higher New York Heart Association functional class, infection status (active/healed), aortic valve infection, prolonged aortic cross-clamp time, annular abscess, and calendar year. The patients were operated earlier in the latter part of this series (1988-1993. Multiple logistic regression analysis demonstrated three factors to be statistically significant: BUN, operative year, and aortic valve infection. Complete survival information was obtained in all 52 discharged patients with a mean follow-up time of 4.8 years. There were 5 late deaths including 3 patients with valve related complication. The actuarial survival rate at 10 years after operation excluding hospital mortality was 89%, 92% for active infection 88% for healed infection. The actuarial freedom from valve related complication was 86% at 10 years. The degree of activity of the infection is not a risk factor for operative mortality by multiple logistic regression analysis. We conclude that surgical intervention should be undertaken without delay in the patients with IE before development of hemodynamic deterioration causing renal dysfunction and hypercatabolism.

Adolescent↗

PubMed1994

[Multi-organ ischemia due to traumatic lesion of the descending thoracic aorta--a case-report].

This is a case of severe ischemic and reperfusion multi-organ failure due to descending thoracic aortic rupture. A 25 year-old man received a hard blow on his chest in a traffic accident. Chest X-ray, CT scans and aortogram elucidated descending thoracic aortic rupture. Emergency operation was performed 18 hours after the injury. The aortic rupture, 4/5 of the aortic circumference with intact adventitia was seen. The descending aorta 22 distal to the left subclavian artery was repaired under cardio-pulmonary bypass with selective cerebral perfusion. Ischemia due to aortic occlusion with thrombus and reperfusion injury after reconstruction of the aorta connected with rhabdmyolysis and severe multi-organ failure. Intestinal necrosis required laparotomy on the 9th and 15th post operative day. The patient died on 15th postoperative day of multi-organ failure.

Accidents, Traffic↗

PubMed1993

[Surgery for ventricular septal defect with aortic regurgitation].

Twenty-two patients (mean age of 12.9 years) with ventricular septal defect (VSD) associated with aortic regurgitation (AR) were treated surgically. Sixteen patients had subpulmonic VSD and six had infracristal VSD. Fourteen patients with subpulmonic VSD underwent VSD closure alone. VSD was closed by pulling up the inferior rim to the pulmonary valve thus support the prolapse aortic cusp. AR improved in two and has remained stable in eleven for 0.5 to 12.7 years (mean 4.4 years). Aortic valve replacement (AVR) was necessary in an adult patient later. Plication of the aortic valve was effective in a young patient but ineffective in an adult patient. In infracristal VSD, AVR was necessary in two adult patients. In a young patient, AR improved by plication. Direct VSD closure ceased progression of AR in three patients. The long-term follow-up shows that VSD closure with our technique has been sufficient to arrest progression of AR in subpulmonic VSD. Early closure of VSD should be emphasized to prevent aortic valve prolapse and regurgitation.

Adolescent↗

PubMed1993

[Gastrointestinal complication after open cardiac operation].

Seven cases of abdominal complications necessitated laparotomies within 30 days after open heart surgery are presented. They consist of five cases of mesenteric infarction, one acalculous cholecystitis and one hemorrhagic ulcer of the rectum. The incidence is 0.9 percent at our institute. They also had a very complex course after their cardiac surgery such as cardiogenic shock, respiratory failure and renal failure prior to the development of their acute surgical abdomen. It is proposed that the cause of acute abdomen is attributed basically to the low cardiac output state. Surgery must be performed without delay because unnecessary passage of time is accompanied by unacceptable mortality rate.

Abdomen, Acute↗

PubMed1993

[Surgical treatment of primary cardiac tumors].

Thirty-four cases of primary cardiac tumors, consisted of 11 men and 23 women, aged between 26 and 80 years have been operated on in our institution. A total of 30 myxomas and four malignant tumors were resected. The clinical presentations included congestive heart failure in 25 patients, tachyarrhythmia in 6, chest pain in 4, and embolism in 10. All 30 myxoma lesions were completely resected, although none of the malignant tumors could be resected completely because of invasion of the tumor to the surrounding tissues. Four patients with malignant tumors died of tumor recurrence within 9 months after operation. Histological diagnosis was rhabdomyosarcoma in two patients, round cell sarcoma in one and malignant fibrous histiocytoma in one. All patients with myxoma survived operation. Follow-up was completed in 28 patients (range 1 month to 15 years, mean 5.5 years): Twenty-four were in New York Heart Association Class I, and the remaining two in Class II. Actuarial survival rate was 89% at 15 years after operation. No recurrent myxoma have been identified clinically or by echocardiography. For malignant primary tumors, more effective adjuvant therapy with aggressive resection will be inevitable to improve long-term prognosis.

Adult↗

PubMed1993

[Surgical repair of total anomalous pulmonary venous drainage--four adult cases of successful operation].

We have experienced four adult cases of total anomalous pulmonary venous drainage (TAPVD). They were three females and one male, age between 18-51 with a mean of 33.8. In Darling's classification, they constituted of three cases of type Ia and one type IV. Cardiac catheterization revealed 1.71-5.93 with a mean of 3.92 in Qp/Qs and 0.34-0.49 with a mean of 0.38 in Pp/Ps. The pulmonary to systemic resistance ratio (Rp/Rs) was then calculated as 0.02-0.15 with a mean of 0.09. All cases showed short route type of drainage vein in pulmonary arteriography. None of them had stenosis or obstruction in the drainage veins. The operation was composed of anastomosis between the left atrium and the common pulmonary vein, closure of the atrial septal defect (ASD), and ligation of the drainage vein. Gersony-Malm's method was adopted in two cases and the posterior approach in two cases in anastomoses between the left atrium and the common pulmonary vein. Intraatrial approach combined with posterior approach was tried in a case with small left atrium. The mean size of ASD was 43 mm (35-55 mm) in diameter. Patch closure was performed in three cases. Important factors in survival for adult TAPVD are large ASD and short route type drainage vein without stenosis. All of four cases had good results. The operation method is variable and an easier approach must be adopted.

Adolescent↗

PubMed1992

[Bilocular pericardial cyst diagnosed by magnetic resonance imaging: a case report].

A 47-year-old female who had removal of pericardial cyst is reported. Preoperative examination including echocardiography, computed tomography and magnetic resonance imaging (MRI) demonstrated the cystic nature of the mass attaching to the right pericardial surface. MRI clearly revealed that the cyst was bilocular. MRI brings a more detailed information of pericardial cyst for surgery.

Female↗

PubMed1992

Variations in warfarin concentration in blood and coagulant factors after artificial valve replacement.

A proper dosage of warfarin after artificial cardiac valve replacements has been determined as an indication of coagulation activity. In some cases, the coagulation activity cannot be maintained within the therapeutic range because Prothrombin time (PT) values deviated from Thrombotest (TT) values. Here we studied each relationship between warfarin concentrations in blood, coagulation activity, vitamin Ks and other coagulation-related agents which were measured in patients administered warfarin after artificial cardiac valve replacements and whose coagulation activity was maintained within a therapeutic range, and in patients whose PT values deviated from TT values. The obtained results were interpreted as follows. 1) There was a high correlation between values from Thromborel S (a clot method) and values from Chromoquick (a method using a synthesized substrate). Since TT values had little variations compared to PT values, the former was an excellent indication of coagulation activity. 2) There was no correlation between warfarin concentrations in blood and coagulation activity in the group in which warfarin concentrations in blood vary within a day (Group B); but there was highly reverse correlation in the group in which warfarin concentrations in blood vary with days (Group A). 3) There was good correlation between warfarin concentrations and PIVKA-II concentrations in blood in Group A. Further, the concentration of Gla-Protein C was one microgram/ml or less on the fourth day from the initiation of warfarin administration. 4) For example, a patient whose PT value of 67% deviated from TT value of 19% on the eleventh day from the initiation of warfarin administration had vitamin K1-epoxide concentration of 2.68 ng/ml and MK-7 concentration of 1.26 ng/ml on the same day, respectively, which were higher levels than those in Group A.

Aged↗

PubMed1991

Surgical treatment of abdominal aortic aneurysm in the high-risk patient.

In an attempt to define the preoperative risk factors that predictably influence mortality after aneurysmectomy, this study reviews the surgical management of abdominal aortic aneurysms in a series of 110 consecutive patients who underwent elective resection. The preoperative risks to be added to the present study included pulmonary insufficiency, renal dysfunction, advanced age of over 80 years, ischemic heart disease, and associated other diseases such as thoracic aneurysms, atherosclerosis of the limbs and malignant tumors. Forty-six patients had one of these risk factors (one-risk group), 17 had two (two-risk group), and 9 had three (three-risk group). The operative mortality rates were 4.2 per cent for the high-risk patients and 0 per cent for the patients at no risk. As the number of risk factors increased, aneurysm repair was associated with an increased operative mortality; being 2.2 per cent in the one-risk group, 5.9 per cent in the two-risk group and 11.1 per cent in the three-risk group. The common risk factor in patients who died after aneurysmectomy was pulmonary insufficiency which induced prolonged periods of assisted ventilation. Thus, the optimal management of high-risk patients, particularly those with pulmonary insufficiency, may reduce the mortality after aneurysmectomy.

Aged↗

PubMed1991

[Myocardial protection with verapamil in open cardiac surgery--a clinical study for the optimal use].

To determine the optimal use of Verapamil as a myocardial protective agent during open heart surgery, patients were divided into 3 groups of 15 patients each of the same severity and operative difficulty. In group I, Verapamil was added to the blood cardioplegia in a concentration of 1 mg/L. In group II, 0.2 mg/kg of verapamil was added in the pump prime and in group III, in addition to the same amount of pump prime, an additional 0.1 mg/kg of Verapamil was added to the bypass circuit at 60 minutes after the start of bypass and continuous drip of 0.5 micrograms/kg/min for 24 hours after surgery. Only group III continued to maintain an effective concentration of verapamil, that was said in a range between 15 and 100 ng/ml in the serum during and after surgery. It is suggested from the present study that recommendable verapamil administration is as in group III with no severe arrhythmias, significantly less usage of catecholamines without mortality.

Cardiac Surgical Procedures↗

PubMed1991

[Surgical management of tricuspid regurgitation associated with acquired valvular disease].

The best means of managing tricuspid regurgitation associated with acquired valvular disease is still controversial. During the period from 1978 to 1988, 111 patients who had tricuspid regurgitation along with associated valvular dysfunction were treated in Kagoshima University Hospital. Patients with moderate to severe regurgitation underwent annuloplasty in 61 (Carpentier's in 39, DeVega's in 20, and Kay's method in 2) and valve replacement in 8. Forty-two patients were treated conservatively on the tricuspid valve because of mild regurgitation. We found the results to be less satisfactory with a high incidence of postoperative deaths and residual tricuspid regurgatation in the group treated by annuloplasty with a Carpentier ring than in the other two groups of annuloplasty or in the group of valve replacement. We conclude the modified DeVega's method is the first choice for annuloplasty in patients with mild to moderate regurgitation, and we believe it appropriate to replace the valve in an increasing number of subjects which have severe regurgitation.

Adult↗

PubMed1991

[Nonsurgical removal of the embolized catheter fragments from the heart and great vessels].

Embolized catheter fragments in the heart and great vessels were successfully removed in seven patients by nonsurgical techniques. All procedures for the retrieval were completed without complications or difficulty using instruments such as multipurpose grasping forceps, stone basket, loopsnare and myocardial biopsy catheters. Embolized catheter fragments should be removed promptly before fatal complications develop, and can be taken off safely and simply by nonsurgical technique.

Aged↗

PubMed1990

The necessity of reoperation for patients with Bjork-Shiley, St Jude Medical, Hancock and Carpentier-Edwards prostheses.

The purpose of this study was to determine the criteria of valve selection from the long-term results of Hancock, Carpentier-Edwards, St Jude Medical and Bjork-Shiley prostheses, taking into special account the frequency of reoperation. Reoperations on the Hancock bioprosthesis were performed on six patients for tissue leaflet disruption with an incidence of 2.2 per cent/patient-year. Reoperations on the Carpentier-Edwards bioprosthesis were performed on 24 patients for tissue leaflet disruption in 23 patients and prosthetic valve endocarditis (PVE) in one, with an incidence of 3.8 per cent/patient-year. Reoperations on the Bjork-Shiley prosthesis were performed in two patients for severe hemolysis, with an incidence of 0.32 per cent/patient-year. Reoperations on the St Jude Medical prosthesis were performed on 3 patients, for valve thrombosis in one patient, PVE in one, and hemolysis in one, with an incidence of 0.23 per cent/patient-year. The overall mortality rate was 20 per cent, or 7 patients, and the indications for reoperation affected this. Patients with primary tissue failure had a mortality rate of 10.3 per cent; those with a thrombosed valve, 0 per cent; those with hemolysis, 66.7 per cent; and those with valve infection, 100 per cent. A good chance of survival may be achieved in patients facing prosthetic valve complications by performing reoperation as soon as possible after early detection, since mortality is high following emergency reoperation and in patients with severe symptoms. Currently, we recommend mechanical prostheses for valve replacement except in patients over 70 years old and in younger patients with absolute contraindications to anticoagulative therapy.

Aged↗