Biomedical subjects

K Esato

Publications and source records attributed to K Esato.

At least 199 records · Page 11Linked to original sources

PubMed1994

[Influence of blood transfusion on cellular immunity after open heart surgery].

The effect of blood transfusion on cellular immunity was evaluated by measuring T cell subsets in 22 adult patients after open heart surgery. The patients were divided into two groups according to whether or not they received blood transfusions. There were no significant differences in pump time or aortic cross clamp time between the two groups. Leukocytosis was evident in both groups after open heart surgery, but the percentage to lymphocytes was reduced. The number of T cells were also reduced in both two groups. In the group that did not receive blood, the number of T cells were reduced the first day after surgery, but returned to preoperative levels two days later. Those that received blood transfusions had persistently low T cell counts three days after the operation. CD4 positive T cells were reduced the first day after operation but returned to preoperative levels three days after the operation in both groups. The percentage of CD8 positive T cells were unchanged in the group that didn't have a blood transfusion. CD8 positive T cells were significantly reduced three days post operatively in the group that received blood transfusions. The cellular immunity was disturbed for an extended period in the patients that received blood transfusions.

Adolescent↗

PubMed1994

[Modified Naclerio-Langer method under thoracoscopic procedure for pneumothorax due to rupture of a large bulla].

We managed a patient with pneumothorax caused by a large bulla by so called modified Naclerio-Langer method under thoracoscopic procedure. A 76-year-old female was hospitalized with recurrent left pneumothorax. Uncer the right lateral position, 3 Surgi ports were inserted through 5, 7, 9th intercostal space. There was a large bulla, 10 cm in diameter, with rupture at the ventral side. The bulla wall was partially resected and many bronchiolar openings were seen at the caudal side. Gregarious bronchiolar openings were resected with Endo GIA. Two residual openings were closed with 3-0 Dexon suture. The base of bulla was pleuralised by suturing the edges of the removed cyst with running suture of 3-0 Dexon. Because no air leaks was detected, a chest drain was inserted. Operation time was 215 minutes and she was discharged on 20th postoperative day. This procedure is usefull and not invasive.

Aged↗

PubMed1994

[A case of multiple primary malignant melanoma of the esophagus].

A case of multiple primary malignant melanoma of the esophagus was reported. A 66-year-old male was referred to the hospital with complaints of appetite loss and dysphagia. A barium swallow revealed two polypoidal tumors of approximate equal size, one in the lower third of esophagus and the other in the cardiac region of stomach. The tumors were shown blackish at endoscopy and biopsy yielded a histological diagnosis of malignant melanoma. Abdominal CT, abdominal ultrasonography and hepatic arteriography showed metastasis to liver and rt paracardiac lymph nodes. However, no primary lesion of malignant melanoma but esophagus was found through the preoperative clinical examination. Partial resection of the esophagus along with the proximal of stomach and the paracardiac lymph nodes was performed. Microscopically, the typical finding of junctional activity adjacent to the tumor mass was not obtained but we diagnosed as primary esophageal tumor because melanocytes were present along the basal layer of normal esophageal mucosa and groups of melanophages were found in the submucosal layer. However, we could not conclude which polypoidal tumor was the primary lesion. The patient received systemic chemotherapy postoperatively and is alive 5 months after surgery.

Aged↗

PubMed1994

[Ehlers-Danlos syndrome with impending ruptured thoracic descending aortic aneurysm in a young adult--a case report].

We here report on a rare case of Ehlers-Danlos syndrome type IV with impending ruptured thoracic aortic aneurysm in a young adult. A 38-year-old man complained of severe back pain and transient paralysis in both legs. He was diagnosed as having an impending ruptured thoracic descending aortic aneurysm. Emergency operation which was aneurysmectomy and reconstruction of the descending aorta was performed. The fact that the aneurysm (11 cm) in a patient was so large for his age and the abnormal subcutaneous fatty tissue suggested the existence of systemic metabolic disease. An analysis of collagen extracted from the patient revealed the absence of type III collagen. Furthermore, an electron microscopic analysis finding that the collagen fibrils was of non-uniform size lead to the diagnosis of Ehlers-Danlos syndrome, Type IV (arterial type). Postoperatively the patient suffered paralysis in both legs due to ischemia of the spinal cord. However, his general condition was stable. He was transferred to another hospital for rehabilitation of both legs 60 days after the operation. Although the physical signs usually associated with Ehlers-Danlos syndrome were absent in this case, diagnosis followed electrophoresis of collagen extracted from the patient. As a result of the above observation, we recommended analysis of collagen in cases where the size of the aneurysm or the age of the patient appear unusual even though physical signs of Ehlers-Danlos syndrome are absent.

Adult↗

PubMed1994

[Mediastinal lymph node dissection improves survival rate in N2(-) non-small cell lung cancer patients].

The effect of mediastinal lymph node dissection on survival rate in clinical N2(-) non-small cell lung cancer patients was assessed. N2(-) was evaluated by both pre-operative computed tomography studies and physical examination during surgery. Systematic mediastinal lymph node dissection, including nodes #1, 2, 3, 3a, 3p, 4, 7, 8 and 9 was performed in 27 patients (T1 or 2, N0 or 1, M0) since 1987 (dissected group). Survival rate and complications were compared with those in 21 patients treated before 1986, in whom mediastinal lymph nodes were not dissected (non-dissected group). 1, 3 and 5 year survival rates in the dissected group were 92.6%, 74.9%, and 74.9%, respectively, which were significantly higher than those in the non-dissected group (71.4%, 61.9% and 41.3%, respectively). Mediastinal lymph node metastases were detected histologically found in three patients, 11% of the dissected group. Respiratory complications showed a significantly higher incidence in the dissected group (p = 0.001). However these complications did not increase the mortality rate in that group. Among elderly patients over 70 years old (8 patients in the dissected group, 7 in the non-dissected group), survival rates were similar in the two groups. In conclusion, systematic mediastinal lymph node dissection significantly improved the survival rate in clinical N2(-) non-small cell lung cancer patients.

Aged↗

PubMed1993

Sequential bypass for multisegmental occlusive disease.

We evaluated the effectiveness of a sequential bypass for multisegmental occlusive disease. Forty-seven multiple bypass grafts were performed on 43 patients ranging in age from 55 to 83 years (mean: 70 years). The indications for operation included incapacitating claudication in 20 limbs, resting pain in 15, and nonhealing ulcers in 12. An anatomical arterial bypass was performed on 36 limbs, consisting of an aorto-femoro-popliteal bypass in 21 limbs, a femoro-popliteal-posterior tibial bypass in 8, an ilio-femoro-popliteal bypass in 4, an ilio-femoro-posterior tibial bypass in 2, and a femoro-popliteal-plantar bypass in 1. Similarly, an extra-anatomical arterial bypass was performed on 11 limbs, consisting of an axillo-femoro-popliteal bypass in 6, a crossover femoro-femoro-popliteal bypass in 3, an axillo-femoro-posterior tibial bypass in 1, and a crossover femoro-femoro-anterior tibial bypass in 1. The follow-up period ranged from 3 to 77 months (mean: 23 months). Twelve graft failures occurred, and 2 of them required major amputations. The cumulative graft patency rate was 85% at one year and 65% at 3 years. Arterial Doppler examination revealed a mean preoperative ankle-brachial index of 0.29 +/- 0.25. The early and late mean postoperative ankle-brachial indices, however, increased to 0.97 +/- 0.19 and 0.84 +/- 0.25, respectively. Midterm results have indicated that such multiple sequential bypass grafts are effective.

Aged↗

PubMed1993

Shock-reinfusion injury to the central organs and the effect of free radical scavengers in the rat.

Hemorrhagic shock-reinfusion injury produces critical changes in various organs with the generation of oxidant-free radicals. Some papers have reported that shock-reinfusion injury to the intestine is effectively reduced by the scavengers of free radicals; however, few reports mention the central organ damage caused by systemic hemorrhagic shock-reinfusion injury. Using a rat systemic hemorrhagic shock model, injury to the central organs, being the brain, heart, lungs, liver, and kidneys was assessed by measuring malondialdehyde (MDA). The MDA levels in the lungs, kidneys, and liver were elevated significantly after reinfusion, although there was no elevation of MDA in the brain or heart. These data show that the lungs, liver, and kidneys are easily damaged by shock-reinfusion, but that the brain and heart are relatively resistant. The efficacy of the free radical scavengers, superoxide dismutase plus catalase and allopurinol, were evaluated 30 min after reinfusion. Pathological examination showed that superoxide dismutase plus catalase and allopurinol reduced reinfusion injury in the lungs, liver, and kidneys. Moreover, superoxide dismutase plus catalase reduced MDA levels in both the liver and kidneys, whereas allopurinol reduced MDA levels only in the kidneys after reinfusion. However, these free radical scavengers could not suppress the elevation of MDA in the lungs after reinfusion.

Allopurinol↗

PubMed1993

The reticuloendothelial system and hepatocyte function in orthotopic liver transplantation.

The reticuloendothelial system function, especially phagocytic activity, and hepatocyte function were investigated in dogs undergoing an orthotopic liver transplantation. The donor's phagocytic index, measured by a lipid emulsion test, was higher in the Survivor group which survived more than 3 days after transplantation (0.063 +/- 0.008 vs 0.024 +/- 0.002; mean +/- standard error of the mean (SEM), P < 0.01). There was a statistically significant difference in the phagocytic index between the survivor and nonsurvivor groups. However, the hepatocyte function at an early phase after transplantation, indicated by the arterial ketone body ratio, hepaplastin test and lecithin cholesterol acyltransferase level, did not distinguish the Survivor group from the Nonsurvivor group at all. In the survivor group, the hepaplastin test and the lecithin cholesterol acyltransferase level were significantly decreased after liver transplantation, namely from 155 +/- 15% to 58 +/- 5% and from 57 +/- 12 unit/ml to 19 +/- 1 unit/ml on the 2nd day after transplantation (P < 0.01, P < 0.05), respectively. On the other hand, the reticuloendothelial system (RES) function, as estimated by the phagocytic index and serum complement activity (CH 50), demonstrated no change throughout the experimental period. The present study therefore demonstrated that the operative results might be affected by the phagocytic activity.

Animals↗

PubMed1993

Arterial reconstruction in elderly patients.

The surgical results of primary peripheral arterial reconstruction for arteriosclerosis obliterans during a 16-year period were examined as a function of age. Data in group 1 were of 121 procedures performed on 95 patients aged > or = 70 years and those in group 2 of 215 procedures performed on 148 patients aged < or = 69 years. There was no significant difference between the operative mortality rate of 4% (four of 95) in group 1 and 3.4% (five of 148) in group 2. The long-term mortality rate was 33% (31 of 95) in group 1, significantly higher (P < 0.05) than 18.9% (28 of 148) in group 2. The most common cause of death in both groups was cardiac failure. Cumulative 5-year survival rates in groups 1 and 2 were 56.3 and 78.3% respectively (P < 0.0001). The cumulative primary 5-year patency rates of suprainguinal bypass grafts in the two groups were 94.2 and 90.4%, respectively, while those of infrainguinal reconstruction were 67.7 and 55.0% respectively. The 5-year cumulative limb salvage rate was 93.1% in group 1 and 92.7% in group 2. None of these differences was significant. The results support an active approach to surgery in elderly patients with peripheral arterial obstruction caused by arteriosclerosis obliterans.

Adult↗

PubMed1993

[Successful surgical treatment of patent ductus arteriosus in adults: report of three cases].

Three elderly patients underwent surgery for patent ductus arteriosus successfully. In two patients without calcification of ductus arteriosus, its division through a left thoracotomy was performed. In another patient with massively calcified ductus arteriosus associated with pulmonary hypertension, transaortic patch-closure of the aortic end of the ductus arteriosus was performed under partial cardiopulmonary bypass. All three patients and uneventful postoperative course.

Calcinosis↗

PubMed1993

Effect of a thromboxane synthetase inhibitor on protamine-induced circulatory changes in sheep.

BACKGROUND: Rapid intravenous administration of protamine after procedures requiring cardiopulmonary bypass is occasionally associated with severe pulmonary hypertension, systemic hypotension, cardiac dysfunction, and lung edema. We hypothesized that the mechanism for these hemodynamic changes after protamine administration is the release of thromboxane. We therefore examined the effect of a thromboxane synthetase inhibitor (OKY-046) on these hemodynamic changes in a sheep model. METHODS: Ten female sheep were prepared with lung lymph fistulas and balloon-tipped pulmonary artery, left atrial, arterial, and venous catheters. After a 5-day recovery period, 2 mg/kg protamine was infused 10 minutes after 200 units/kg heparin, with (n = 5; OKY-046 group) and without (n = 5; heparin/protamine group) OKY-046 (10 mg/kg). RESULTS: In the heparin/protamine group, pulmonary arterial pressure and lung lymphatic flow were significantly increased soon after administration of protamine, from 19 +/- 1 to 51 +/- 2 mm Hg and 5 +/- 1 to 8 +/- 1 ml/hr, respectively. The circulating leukocyte count was significantly reduced, from 3304 +/- 318 to 903 +/- 898 mm3. Cardiac output was also reduced, from 5.8 +/- 0.3 to 3.4 +/- 0.7 L/min/m2. These changes were completely blocked in the OKY-046 group, except for the neutrophil depletion and the increase in lung lymphatic flow. CONCLUSIONS: We conclude that thromboxane plays a significant role in protamine-induced hemodynamic deterioration and pulmonary permeability changes.

Animals↗

PubMed1993

[Chondrosarcoma of the trachea--report of a case].

A case of chondrosarcoma of the trachea in a 64-year-old man was reported. He was pointed out of benign tracheal tumor in September 1988. He was transferred to our hospital in September 1991 with respiratory distress attributable to asthma-like attack after bronchoscopic examination. Under right posterolateral thoracotomy, 1.7 cm length (3 rings) of the mediastinal trachea was resected and the trachea was reconstructed by end-to-end anastomosis with 3-0 Maxon interrupted sutures. The pathological diagnosis was a moderately well differentiated chondrosarcoma (grade II) of the trachea. Postoperative clinical course was uneventful without serious anastomotic complications. No local recurrence was seen 1 year after operation. It is necessary to follow meticulously the patients with chondrosarcoma of the trachea after surgery because of its low grade malignancy.

Chondrosarcoma↗

PubMed1993

[Surgical treatment of ventricular septal defect associated with Down syndrome].

Twelve patients with ventricular septal defect with Down syndrome (Down group) underwent cardiac surgery. As they had pulmonary hypertension (Pp/Ps > or = 0.5), we chose twenty patients who had pulmonary hypertension (Pp/Ps > or = 0.5) with ventricular septal defect without Down syndrome as control group. After cardiac surgery, Pp/Ps in Down group decreased significantly from 0.81 +/- 0.14 to 0.48 +/- 0.25 (p < 0.01). Cardiac index (l/min/m2) between 24 hours after operation was 3.3-3.8 in Down and 4.1-4.8 in control group (NS). Oxygenation index (mmHg) between 24 hours after operation was 211-266 in Down and 230-314 in control group (NS). Eleven out of 12 patients in Down group had good operative result. One patient was complicated with post-operative pulmonary hypertensive crisis. Low output syndrome and death were not encountered in Down group. We were satisfied with operative results and encourage surgical treatment for ventricular septal defect with Down syndrome.

Child↗

PubMed1992

Immunologically induced coronary artery stenosis in allografts after heart and heart-lung transplantation in rats.

The role of the lung in suppressing immunologically induced coronary artery stenosis after heterotopic allograft transplantation was studied in rats. Thirty-nine recipients were divided into two groups: untreated and treated. The untreated group was divided into two subgroups--the heart allograft TH group and the heart-lung allograft THL group. The treated group was divided further into four subgroups depending on when the graft was harvested, after 30 days or 60 days (T30-H and T30-HL group, and T60-H, T60-HL, respectively). Rejection was assessed by Lurie's classification. The percent of intraluminal stenosis (PIS) was determined by planimetry. All treated animals received cyclosporin A 10 mg/kg/day intramuscularly for 20 days. In the untreated group, heart-lung allograft survival was longer than heart allograft survival. In the treated group, all grafts were still beating when the animals were killed. The rejection grade score in the T30-H and T30-HL groups were lower than those in the T60-H or T60-HL groups. The PIS in the THL group was slightly lower than that in the TH group. However the PIS increased over time in both the TH and THL groups. This study demonstrates that the lung suppresses but does not abolish immunologically induced coronary atherosclerosis-like occlusive lesions after cardiac transplantation.

Animals↗

PubMed1992

Sutureless anastomosis of blood vessels using cyanoacrylate adhesives.

On the assumption that the remaining suture threads of the anastomotic line play an important role in the progression of anastomotic neointimal hyperplasia, we performed an experimental study on the sutureless anastomosis of blood vessels. An expanded polytetrafluoroethylene graft, 5 mm in diameter and 2 cm in length, was implanted on the abdominal aorta of mongrel adult using one of three methods of anastomosis, namely; a continuous suture, a stay suture, or sutureless anastomosis. Overall patency rates were 83.3 per cent, 91.7 per cent and 75.0 per cent respectively. The thickness of the pannus in the distal anastomotic line after 12 months was 107 microns in one graft in the continuous suture group, 106 microns and 222 microns in 2 grafts each in the stay suture group, and 41 microns and 117 microns in 2 grafts each in the sutureless group. Because there were cases of patency even after 12 months with a very small pannus thickness, sutureless anastomosis is considered to be a useful method of preventing anastomotic neointimal hyperplasia.

Anastomosis, Surgical↗

PubMed1992

Optimal electric conditions in electrical impulse chemotherapy.

The relationship was examined between the tumoricidal effect and the electrical variables of in vivo electrical impulse chemotherapy. Donryu rats subcutaneously inoculated with AH-109AY hepatocellular carcinomas were given a single high-voltage electrical impulse of varying voltage and duration, 30 min after an intramuscular injection of 4 mg/kg bleomycin. As the voltage (V) was increased from 0 to 5 kV, the tumoricidal effect (E) increased in proportion to the square of the voltage. As the pulse duration (D) was increased from 2.5 to 5.8 ms, the tumoricidal effect increased in direct proportion to it. Combining these results yielded the formula, E = gamma V2D, which indicates that tumoricidal efficacy was proportional to the applied electrical energy. When the electrical energy was kept constant while varying the voltage and duration of pulse, the anticancer effect was the same, confirming this relationship for lower energy levels.

Animals↗

PubMed1992

[Cystic disease of right popliteal artery with spontaneous resolution].

The case was 50-year-old man. He was admitted to our hospital suffering from intermittent claudication. DSA and CT showed stenosis of the right popliteal artery due to compression by the tumor like lesion. The adventitial cystic disease was suggested. Three weeks later he had no symptom. DSA and CT revealed no reappearance of the adventitial cystic disease. The popliteal adventitial cyst spontaneously decreased in size. It is a very rare case.

Angiography, Digital Subtraction↗

PubMed1992

[The fate of patients with intermittent claudication-comparison of surgical and non-surgical treatment].

The purpose of this study was to determine the operative indication for patients with intermittent claudication because of arteriosclerosis obliterans, and to compare the late result of the surgical treatment group (182 cases, 250 limbs) with that of the non-surgical treatment group (35 cases, 43 limbs). There were 3 operative deaths and 34 late deaths in the surgical group, and 14 late deaths in the non-surgical group. The number one cause of death was heart failure, including ischemic heart disease, in both groups. The 4-year cumulative patency rates were 91% in the aorto-iliac, 71% in the femoro-distal and 79% in the aorto-femoro-distal arterial reconstructions. Long term symptom free rates of the surgical group and the non-surgical group, except fatal case, were 83% and 44% in the aorto-iliac, 79% and 27% in the femoro-distal, 87% and 33% in the aorto-femoro-distal arterial regions, respectively. Late result of intermittent claudication in the surgical group was better than that in the non-surgical group. We concluded that intermittent claudication should be considered to be the indication for surgery, except for the cases with high risk diseases or malignant diseases.

Aged↗