[Venous ulcer].
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Diagnosis, Differential↗
Biomedical subjects
K Esato
Publications and source records attributed to K Esato.
Efficacy of benidipine hydrochloride on myocardial ischemia and reperfusion.
The efficacy of benidipine hydrochloride in preventing myocardial ischemia and reperfusion injury was evaluated in isolated rabbit hearts (n = 28). Isovolumic left ventricular function, coronary flow, creatine phosphokinase (CPK) release, and myocardial water content were measured after ischemia during both normothermia (37 degrees C; Group I) and hypothermia (23 degrees C; Group II). After baseline measurements, hearts were induced to arrest by chilled cardioplegic solution. Each group was divided into two subgroups, depending upon whether benidipine hydrochloride (10(-9) mole/liter) was added in the cardioplegia (A, without benidipine; B, with benidipine). After 30 min of ischemia for Group I and 180 min for Group II (which added another cardioplegia every 30 min), hearts were reperfused. Measurements the same as those at baseline were carried out every 15 or 30 min for up to 60 min. Benidipine-treated hearts started beating in a shorter time than did control hearts (Group I-B, 38.7 +/- 3.7 sec vs Group I-A, 59.9 +/- 5.6; Group II-B, 36.7 +/- 2.0 vs Group II-A, 47.8 +/- 3.3). The percentage of recovery of left ventricular developed pressure after 60 min of reperfusion was significantly better in benidipine groups (P < 0.05). With respect to changes in coronary flow and CPK release after reperfusion, benidipine groups were preserved extremely well. We conclude that the addition of benidipine hydrochloride to cardioplegic solution significantly improves ventricular function after myocardial ischemia and reperfusion.
Animals↗
Klippel-Trenaunay syndrome associated with splenomegaly: report of a case.
We report herein the case of a 19-year-old woman, diagnosed as having Klippel-Trenaunay syndrome at the age of 3 years, who presented to our hospital with severe abdominal pain. Abdominal computed tomography revealed splenomegaly, ascites, and paracentesis confirming an intraabdominal hemorrhage. Thus, an emergency laparatomy was performed for a suspected splenic rupture, and 2.5 L of blood was drained from the abdominal cavity. Splenomegaly was confirmed, and a splenectomy was performed. The patient's postoperative course was complicated by disseminated intravascular coagulation, but she recovered and was discharged 3 weeks following surgery. Pathological examination of the spleen suggested that the splenomegaly was caused by high venous pressure due to splenic vein stenosis. To our knowledge, this is the first reported case of Klippel-Trenaunay syndrome associated with marked splenomegaly.
Adult↗
Bronchogenic carcinoma: incidence of metastases to normal sized lymph nodes.
BACKGROUND: The incidence of metastases to mediastinal lymph nodes was evaluated in patients with normal sized mediastinal nodes on the computed tomographic (CT) scan who underwent thoracotomy. The use of hilar lymph nodes in predicting mediastinal lymph node metastases was also assessed. METHODS: Ninety patients with non-small cell lung cancer who later underwent thoracotomy wer prospectively examined by CT scanning. Lymph nodes with a short axis diameter of 10 mm or more were considered abnormal. RESULTS: Mediastinal lymph node metastases were present at thoracotomy in 19 patients (21%). In 14 these lymph node metastases were misdiagnosed because the nodes were normal in size on the CT scan. In only one of the 19 patients with N2 nodes was an N1 lymph node enlarged, and four of the 19 patients with N2 nodes had metastases to these mediastinal nodes without N1 disease ("skipping metastases"). CONCLUSIONS: Metastases in normal sized nodes seen on the CT scan are a major problem in staging. Hilar lymph nodes did not help to predict reliably the presence or absence of metastases to the mediastinal lymph nodes.
Adenocarcinoma↗
[Clinical evaluation of patients with cardiopulmonary bypass by plasma granulocyte elastase].
To evaluate the role of granulocyte elastase (GEL) at cardiopulmonary bypass (CPB), the plasma GEL level was measured in 24 patients who underwent elective cardiac surgery and 47 patients who underwent elective gastroenterological surgery. The cardiac surgical patients were divided into two groups: 5 patients with CPB less than 120 minutes (HL group), and 19 patients with CPB more than 120 minutes (HH group). The patients with gastro-enterological surgery were also divided into two groups: 15 patients with postoperative complications (GC group), and 32 patients without postoperative complications (GU group). All the patients of GU, HL and HH groups were alive. Two patients of GC group died because of multiple organ failure (MOF). The serum levels of GEL in both the HH group and the GC group remained higher than in the GU group at 6 postoperative day (POD). The high serum level of IL-8 gave rise to high serum level of GEL in the HH group, even after cardiac surgery. We assumed that anti-cytokine therapy and aggressive administration of Ulinastatin are useful against postoperative complications and that careful management is need after long CPB.
Cardiac Surgical Procedures↗
[Vein patch angioplasty for coronary revascularization to ischemic heart disease: report of two cases].
Two cases of vein patch angioplasty for ischemic heart disease were presented. The first case (59-year-old female) admitted to our hospital because of posterolateral infarction. Preoperative coronary angiogram (CAG) showed stenosis of 4-PD of RCA, proximal LAD and distal LCX. The second case (62-year-old male) admitted for operation of abdominal aortic aneurysm. Preoperative CAG showed stenosis of proximal RCA and mid LAD. Stenosis of 4-PD and proximal RCA was relieved by patch angioplasty using saphenous vein graft and coronary artery bypass to LAD was performed by left internal thoracic artery graft. Both cases showed successful enlargement of RCA stenosis and good graft patency at the postoperative CAG. Vein patch angioplasty is thought to be an alternative method for coronary revascularization to ischemic heart disease.
Female↗
[Experience of absorbable staple in lobectomy].
We examined the differences between absorbable staple and un-absorbable staple in inflammatory reaction during the early post-operative period in lung cancer patients. From october 1993 to august 1994, absorbable staples (GIA 75-.060; United States Surgical Co., Ltd.) or un-absorbable staples (Multifire GIS 60 Titanium (3.8mm); United States Surgical Co., Ltd.) were applied in 10 lung cancer patients each. Duration of air leakage, massive pleural effuion (more than 100 ml/day), and high fever (over 38 degrees C), as well as the changes of leukocyte counts in peripheral venous blood and C reactive protein were compared between the two groups. The absorbable staple group show a mildly increased inflammatory reactions than those of un-absorbable staple group, but those were not significant differences. Absorbable staple was shown to be completely absorbed until 6 months in animal model. Absorbable staple is thought to be superior to un-absorbable staple, instead of mildly increased inflammatory reaction during the early post-operative period.
Absorption↗
[Clinical analysis of the surgical therapy of DeBakey type I acute aortic dissection].
We investigated relation of operative mortality with factors such as during from onset to operation, cardiac tamponade, age (more than 70 years old), aortic regurgitation, and shock. Fourteen patients underwent emergent surgery for DeBakey type I acute aortic dissection. These patients were the basis for this reports. Operative mortality was 43% (6/14). Although not statistically significant, there was a trend toward preoperative cardiac tamponade, namely the patients with preoperative tamponade had a poor prognosis. Causes of death were as follows, two patients related to the residual false lumen, two patients to surgical procedure, one patients to ischemic heart and one to mis-swallowing after operation. Among two patients who related to the residual false lumen, one died of rupture of the descending aorta that the clamping was performed during operation and the other occlusion of superior mesenteric artery 43 days after operation. Causes of deaths in patients in relation with surgical procedure were brain death and postoperative bleeding in 1 each. We concluded that the residual false lumen is a risk factor in the peri-operative stage.
Adult↗
A double-blind, multi-center, dose comparison study of TTC-909 for the treatment of peripheral vascular disorders.
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Dose-Response Relationship, Drug↗
[Changes in intraoperative and postoperative colloid oncotic pressure after open heart surgery especially in relation to non-blood priming or blood priming].
In order to evaluate the colloid oncotic pressure (COP) is useful index of hemodynamics and respiratory recovery after open heart surgery, cardiac index (CI), pulmonary capillary wedge pressure (PCWP), (A-a) Do2 and COP were measured in 34 patients during 48 hours after the cardiopulmonary bypass (CPB). The patients were divided into non-blood priming group: 11 patients and blood priming group (23 patients). In addition, blood priming group divided into two groups, one with dopamine (more than 15 micrograms/kg/min), epinephrine or intraaortic balloon pumping (severe blood subgroup, n = 6) and the other without these treatments after open heart surgery (slight blood subgroup n = 17). The COP levels in the non-blood priming group were significantly higher than those in the blood priming group from aortic cross-clamp to 10 minutes after aortic declamping (p < 0.01). From 1 to 48 hours after CPB, COP in the non-blood priming group and slight blood subgroups was significantly higher than severe blood subgroups (p < 0.05). CI and COP-PCWP levels were significantly higher in the non-blood priming group and slight blood subgroups than those in the severe blood group (p < 0.05). It is concluded that COP is useful index of hemodynamics and respiratory recovery after open heart surgery and our priming system without blood is effective in order to eliminate the blood transfusion.
Aged↗
Ringed grafting for an abdominal aortic aneurysm in a 92-year-old patient: report of a case.
We report herein the case of a 92-year-old man with an abdominal aortic aneurysm who underwent successful surgical resection using a ringed graft. His postoperative course was uneventful, and he was discharged after 42 days, following which he attended the outpatient department twice a month for regular check-ups. He finally died of pneumonia which developed from an upper respiratory tract infection 6 months after his operation. Thus, surgical treatment should always be considered when an aneurysm is detected, even in very aged patients for whom the activities of daily living are possible.
Aged↗
The addition of glutathione (YM737) to a crystalloid cardioplegic solution enhances myocardial protection.
The effectiveness of a glutathione preparation, YM737, as a free radical scavenger when added to hypothermic (4 degrees C) crystalloid cardioplegic solution was evaluated in this study. Rabbit hearts were preserved for 3 h in cardioplegic arrest by infusing 20 ml crystalloid cardioplegic solution initially, with additional 10-ml boluses administered every 30 min, while maintaining a myocardial temperature of 10 degrees C. They were then reperfused with Krebs-Henseleit bicarbonate buffer at 37 degrees C in a perfusion circuit for 60 min. The hearts were divided into two groups of six: One in which crystalloid cardioplegic solution was perfused (group 1); and one in which crystalloid cardioplegic solution containing YM737 1 mg/ml was perfused (group 2). The postischemic developed pressure (mmHg) in group 2 was significantly greater than that in group 1 after 60 min of reperfusion, being 44.8 +/- 8.4 versus 87.8 +/- 5.2 in groups 1 and 2, respectively (P < 0.01). Moreover, group 2 exhibited significantly lower postischemic left ventricular compliance after 60 min than group 1 (P < 0.01) and a significantly higher postischemic peak LV dp/dt (mmHg/sec) after 60 min of reperfusion, being 925 +/- 213 versus 1,550 +/- 111 in groups 1 and 2, respectively (P < 0.05). Based on the comparisons of postischemic hemodynamics it was concluded that the addition of glutathione to crystalloid cardioplegic solution does in fact enhance myocardial protection.
Animals↗
Emergency operation for thoracic aortic aneurysm caused by the Ehlers-Danlos syndrome.
Two patients were treated emergently for impending ruptured thoracic aortic aneurysms caused by type IV Ehlers-Danlos syndrome. One patient had typical physical evidence of type IV Ehlers-Danlos syndrome. The other patient had a normal phenotype. Type IV Ehlers-Danlos syndrome was diagnosed by electrophoresis of the collagen extracted from the skin. The clinician must be aware of the variations in presentation of type IV Ehlers-Danlos syndrome.
Adolescent↗
[Congenital esophago-bronchial fistula in adult--report of a case].
A 52-year-old man had been having cough on drinking water since 30 years. He coughed out blood 20 years ago. Chest roentgenogram showed the infiltrating shadow in the right lower lung field and the left hilum. Chest computed tomogram in the left atrium level showed fistulous communication between the bronchus and the esophagus and cavity lesion. Esophagogram showed fistulous communication between the bronchus (rt. B7) and the middle third of the esophagus. Bronchogram showed the stenotic lesion of the right B7a and B*. And abnormal bronchus was revealed and fistula was suspected. The orifice of the fistula was seen by esophageal endoscopy. Through the right posterolateral thoracotomy, fistelectomy and covering with pleural flap over the esophageal suturing site were performed. Histologic finding of the resected specimen revealed fistula's wall composing of smooth muscle lined with squamous cell layer. This case is categorized as Braimbridge type II. The postoperative course was uneventful and the patient is now in free of complaints at the 6th month's P.O.D.
Bronchial Fistula↗
[Significance of AKBR as an indicator of liver injury after cardiopulmonary bypass].
AKBR is a metabolic indicator related to NAD-linked dehydrogenase system, according to the REDOX theory. In order to estimate whether AKBR is a sensitive indicator of liver injury or not, we measured AKBR before and immediately after cardiopulmonary bypass (CPB) in 20 patients undergoing cardiac surgery and thoracic aortic aneurysmectomy. Twenty patients were divided into two groups: one with AKBR more than 0.7 (normal group) and the other with AKBR less than 0.7 (abnormal group). The AKBR in the abnormal group was significantly decreased after CPB (p < 0.05), though the AKBR in the normal group was unchanged. In addition, the normal group significantly showed high AKBR compared to the abnormal group after CPB (p < 0.01). Among 5 patients with GPT more than 50 IU/l, the number of patients with AKBR more than 0.7 was zero and with AKBR less than 0.7 was 5 patients. The normal group has a lower risk of liver injury than the abnormal group. The normal group had a higher hepatic perfusion pressure compared with abnormal group. However, there were not significant differences in the cardiac functions (cardiac output, LVSWI and RVSWI) after the CPB between two group, whereas the CPB time and the aortic clamping time in the abnormal groups were longer than those in the normal group. We concluded that the AKBR is a sensitive indicator of liver function after the CPB.
Cardiac Surgical Procedures↗