Search PubMed⌕ Search

Biomedical subjects

K Esato

Publications and source records attributed to K Esato.

At least 109 records · Page 6Linked to original sources
PubMed1998

Arterial reconstruction: justified for patients with intermittent claudication?

The objective of this study was to evaluate the effects of arterial reconstruction in patients with intermittent claudication. A total of 243 patients (305 limbs) underwent lower extremity vascular reconstruction at our institution from 1979 to 1995. They were assessed by physical examination, pulse volume recordings, segmental pressure, Duplex ultrasonography, and intravenous subtraction arteriography to evaluate the effects of arterial reconstruction. Surviving patients (220 limbs) were enrolled for evaluation of outcome during the follow-up period. There were 59 deaths during the follow-up period. The cumulative life-table 5-year patency rates were 90% +/- 3%, 73% +/- 6%, and 74% +/- 10% for aortoiliac, infrainguinal, and aortofemorodistal arterial reconstructions, respectively. Among 129 repairs in the aortoiliac region, Fontaine stages I, II, and III were found in 109 limbs (84.5%), 17 limbs (13.2%), and 2 limbs (1.5%), respectively. There was one (0.7%) minor amputation. There was Fontaine stage I in 50 limbs (76.9%), Fontaine stage II in 14 limbs (21.5%), and Fontaine stage III in 1 limb (1.5%) for repairs in the infrainguinal region. Among the 26 aortofemorodistal repairs, there was Fontaine stage I in 21 limbs (81%) and Fontaine stage II in 5 limbs (19%). There was a statistically significantly higher incidence of Fontaine stage I than Fontaine stage II or III in aortofemoral, infrainguinal, and aortofemorodistal arterial reconstructions (p < 0.0001). Arterial reconstruction for patients at Fontaine stage II offered benefits and improved quality of life at follow-up. Arterial reconstruction for patients at Fontaine stage II offers benefits and improved quality of life at follow-up. It was concluded that the significant improvement in quality of life after arterial reconstruction warrants continued use of the procedure in patients with intermittent claudication.

Adult↗
PubMed1998

Increased serum interleukin-8: correlation with poor prognosis in patients with postoperative multiple organ failure.

This study investigated whether cytokines and colony-stimulating factors can predict prognosis in patients with postoperative multiple organ failure (MOF). We evaluated 14 patients with postoperative MOF who underwent operation for cardiovascular disease. Seven patients recovered from MOF (survivors) and seven did not recover and died (nonsurvivors). The white blood cell (WBC) count, granulocyte colony-stimulating factor, monocytic colony-stimulating factor, interleukin-6 (IL-6), and IL-8 were measured on the day the patients were judged to be in MOF and each week thereafter until the patients recovered or died. Survivors and nonsurvivors were equivalent in terms of age, gender, proportion of use of extracorporeal circulation, operation time, volume of blood transfusion, time from operation to the onset of MOF, the MOF score, proportion of bacteremia, duration of MOF, and number of failed organs. The mean duration of MOF was less than 2 weeks in both groups; therefore the measurements were compared on the first day of MOF and 1 week later. No significant differences between the two groups in terms of WBC counts, colony-stimulating factors, and IL-6 levels were noted. However, the serum level of IL-8 was significantly higher in nonsurvivors than in survivors. Patients with a high serum levels of IL-8 at the time of MOF had a poor prognosis.

Aged↗
PubMed1998

Detection of type III collagen fragments in specimens of abdominal aortic aneurysms.

The purpose of this study was to analyze the collagens in aortic aneurysm walls and to investigate the mechanism of the formation of calcified abdominal aortic aneurysms (AAAs). Collagens were extracted from human aneurysmal aortic walls obtained during surgery, and from human nonaneurysmal aortic walls obtained at autopsy, using pepsin-acetic acid digestion. Electrophoresis and immunoblotting were performed. Type III collagen was found to be reduced in the arteriosclerotic aneurysmal aortic walls. The alpha1 chain of type II collagen/alpha1 chain of type I collagen ratio was 0.35+/-0.11 in the aortic aneurysms and 0.68+/-0.11 in the nonaneurysmal aortic walls (P=0.0111). All the calcified aneurysms were associated with type III collagen fragments having molecular mass of approximately 70 kDa and 30 kDa as estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Thus, we concluded that AAAs with calcification may be caused by an abnormal degradation of type III collagen.

Aortic Aneurysm, Abdominal↗
PubMed1998

Surgery for abdominal aortic aneurysms associated with malignancy.

Of 148 patients treated for abdominal aortic aneurysms (AAA), 33 (22%) also had cancer. According to the classification of Szilagyi, there were 13 patients in group I, 19 in group II, and 1 in group IV. In group I, the mean interval between the cancer and AAA operations was 7 years (range 1-14 years). Aneurysmectomy was performed in 9 patients, wrapping in 2, and no operation in 2. In group II, a two-stage operation was performed in 8 patients, a single-stage operation in 4, only surgery for cancer in 4, and no operation in 3. Of 4 patients undergoing single-stage operations, 3 had colorectal cancer, and there were no postoperative complications such as graft infection or anastomotic breakdown. In group I, 6 of 13 patients died, but there were no cancer deaths. In group II, 9 of 19 patients died, 6 from progressive cancer. The group IV patient also died of cancer. These results suggest that if a patient can tolerate surgery for both diseases, a single-stage operation is preferable.

Abdominal Neoplasms↗
PubMed1998

Satigrel, a new antiplatelet agent, inhibits platelet accumulation in prosthetic arterial grafts.

BACKGROUND: Early and late vascular obstruction are both related to platelet adhesion and aggregation in the grafts. We assessed the effect of satigrel, a new oral antiplatelet agent, on the accumulation of indium-labeled platelets in knitted Dacron grafts inserted proximal to the femoral artery. METHODS: Nine patients with arteriosclerosis obliterans receiving grafts were treated with satigrel, and 10 others were enrolled as untreated controls. Scintigraphy was performed in postoperative weeks 2 and 4, and the ratio of the scintillation count of the graft to that of the native artery was calculated to assess platelet accumulation. RESULTS: In both weeks 2 and 4, the ratio was significantly smaller in the satigrel group than in the control group for the whole graft, the proximal anastomosis, and the distal anastomosis. CONCLUSIONS: Satigrel significantly inhibited platelet accumulation in vascular grafts and thus may be useful for preventing postoperative graft occlusion.

Aged↗
PubMed1998

Granulocyte elastase release and pulmonary hemodynamics in patients with atrial septal defect.

BACKGROUND: In patients with increased pulmonary artery pressure, the pulmonary vascular endothelium is morphologically and functionally abnormal and may be vulnerable to neutrophil-mediated injury induced by cardiopulmonary bypass (CPB). We investigated the relation between levels of granulocyte elastase (GEL), interleukin-6, or interleukin-8 after CPB and preoperative pulmonary hemodynamics or changes in pulmonary function after the operation. METHODS: We measured plasma levels of GEL, interleukin-6, and interleukin-8 before and after CPB in patients who underwent closure of an atrial septal defect. Preoperative and postoperative respiratory index were evaluated. Preoperative pulmonary hemodynamics were determined within 1 month before the operation. RESULTS: The level of GEL rose significantly after CPB from baseline (164.8 +/- 81.3 versus 819.4 +/- 320.3 microg/L; p < 0.01). Levels of interleukin-6 and interleukin-8 showed no significant changes after CPB. Peak level of GEL was significantly correlated with preoperative systolic pulmonary artery pressure (r = 0.76; p = 0.017), mean pulmonary artery pressure (r = 0.75; p = 0.021) and pulmonary-to-systemic arterial pressure ratio (r = 0.77; p = 0.016), but not with the hemodynamic variables for pulmonary blood flow or pulmonary resistance. Moreover, the value of (postoperative respiratory index - preoperative respiratory index)/preoperative respiratory index was positively correlated with the peak level of GEL (r = 0.72; p = 0.030). CONCLUSIONS: The increase in GEL level after CPB is proportional to the increase in preoperative pulmonary artery pressure, which may cause the accordant pulmonary vascular damage.

Adult↗
PubMed1998

Prune belly syndrome with penile and urethral agenesis: report of a case.

The authors report the case of an infant born with prune belly syndrome associated with penile and urethral agenesis. At 15 weeks' gestation, antenatal ultrasonography showed a fetal giant bladder, congenital hydronephrosis, and oligohydramnios, and at 17 weeks' gestation, a fetal vesicoamniotic shunt operation was performed. A boy was born at 33 weeks' gestation with prune belly syndrome, an anocutaneous fistula, and penile agenesis. A cystostomy and cut-back operation were performed immediately, showing urethral agenesis, no urethral opening, and left renal hypoplasia. Thereafter, his renal system began functioning normally, and a urinary tract infection resolved. The authors speculate that the prune belly syndrome in this patient was caused by penile and urethral agenesis.

Fetal Diseases↗
PubMed1998

The lack of type III collagen in a patient with aneurysms and an aortic dissection.

We analyzed 79 consecutive patients with aneurysms and found a patient who lacked type III collagen. Collagen was extracted from the skin, and the lack of type III collagen was determined by means of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Only 1 of the 79 patients was found to lack type III collagen. This patient was a 55-year-old man who had sustained an abdominal aortic aneurysm and aortic dissection. He did not show any of the typical clinical symptoms of Ehlers-Danlos syndrome type IV, such as hyperextensible skin and joints. He had none of the usual risk factors nor any clear family history of the syndrome. Furthermore, his collagen fibrils demonstrated a homogeneous appearance. This case may represent a new form of type III collagen deficiency.

Aortic Dissection↗
PubMed1998

Changes in the morphology and components of the coronary arteries during the progression of coronary arteriosclerosis following cardiac transplantation in rats.

In order to examine the changes in coronary artery morphology following cardiac transplantation, the intimal and medial areas and vascular components were measured 30 and 60 days postoperatively in rats receiving both iso- (n = 5, each time) and allotransplantations (n = 7, each time). Although cyclosporine A was administered intramuscularly (10 mg/kg per day) for 20 days following transplantation, graft rejection progressed gradually in the allotransplanted group. There were no clear changes in the intimal or medial areas following transplantation in the isotransplanted group. The intimal area of the coronary arteries in the allograft group was significantly thicker 30 and 60 days following transplantation, while the medial area of the coronary arteries in this group was significantly thinner than that of the isotransplantation group at these same time points. In the thickened intimal areas in the allotransplantation group, only the density of smooth muscle cells was higher following transplantation. In the thinned medial areas in the allotransplantation group, the densities of the smooth muscle cells and collagen were less than those in the isotransplantation group. These changes suggest that following transplantation, smooth muscle cells proliferate in the intimal areas, while smooth muscle cells and collagen are degraded in the medial areas.

Animals↗
PubMed1998

Late postoperative respiratory function in adults after surgical correction of atrial septal defects. Analysis of respiratory dysfunction patterns.

Respiratory function after repair of atrial septal defect (ASD) was analysed in 44 adults (> 40 years), 21 of whom had preoperative respiratory dysfunction, 14 of restrictive type, defined as % vital capacity (% VC) less than 80% of predicted value, 3 with an obstructive pattern, defined as % forced expiratory volume/1 s (% FEV1) less than 70% of predicted value, and 4 patients with a mixed pattern. Increased % VC was found postoperatively in all 14 patients with restrictive respiratory dysfunction, with normal values in 8 out of the 14. Although the three patients with obstructive, and the four with mixed-pattern respiratory dysfunction improved preoperatively in % VC or % FEV1, or both, none had normalized values. We conclude that preoperative restrictive respiratory dysfunction in ASD patients frequently normalizes postoperatively, but not dysfunction of obstructive or mixed restrictive-obstructive type.

Adult↗
PubMed1998

Correlations among expression of intercellular adhesion molecule 1, cellular infiltration, and coronary arteriosclerosis during chronic rejection using the rat heart transplantation model.

Immunologic mechanisms contribute to the development of coronary arteriosclerosis. In this study the rat heart transplantation model was used to investigate correlations among the expression of intercellular adhesion molecule 1, cellular infiltrate, and coronary arteriosclerosis during chronic rejection. Lewis rats served as heart donors and F-344 rats as recipients. Heart transplantations were performed heterotopically. The recipients were treated with cyclosporin A (5 mg/kg/day) by daily intramuscular injection for 30 days, beginning on the day of transplantation. Rejection grade and the intimal area were measured. The expression of intercellular adhesion molecule 1 and the numbers of infiltrating CD4- and CD8-positive cells and macrophages were examined immunohistochemically. The area of the intima was significantly increased in the allograft group after transplantation. In the allograft group, the level of expression of intercellular adhesion molecule 1 was considerably increased over the same time period. There was increased cellular infiltration in the 60-day group, and many expressed intercellular adhesion molecule 1. The expression of intercellular adhesion molecule 1 in vascular endothelium, infiltrating cells, and the sarcolemmal membrane of myocytes remained constant up to 120 days in the allograft group. In the allograft group, the number of infiltrating CD4- and CD8-positive cells and macrophages increased significantly between 30 and 60 days, and the infiltration of these cells remained constant. Continuous expression of intercellular adhesion molecule 1 induces the infiltration of T cells and macrophages, and the inflammation caused by such cells and their soluble products contributes to the arteriosclerotic process.

Animals↗
PubMed1998

[Minimally invasive cardiac surgery for aortic valve disease].

Recent surgical advances leading to good operative results have contributed to the trend to useminimally invasive approaches, even in cardiac surgery. Smaller incisions are clearly more cosmetically acceptable to patients. When using a minimally invasive approach, it is most important to maintain surgical quality without jeopardizing patients. A good operative visual field leads to good surgical results. In the parasternal approach, we use a retractor to harvest an internal thoracic artery in coronary artery bypass surgery. Retracting the sternum upward allows for a good surgical view and permits the use of an arch cannula rather than femoral cannulation. When reoperating for aortic valve repair, the j-sternotomy approach requires less adhesiolysis compared with the traditional full sternotomy. No special technique is necessary to perform aortic valve surgery using the j-sternotomy approach. However, meticulous attention must be paid to avoiding left ventricular air embolisms to prevent postoperative stroke or neurocognitive deficits, especially when utilizing a minimally invasive approach. Transesophageal echo is useful not only for monitoring cardiac function but also for monitoring the persence of air in the left ventricle and atrium. This paper compare as the degree of invasion of minimally invasive cardiac surgery and the traditional full sternotomy. No differences were found in the occurrence of systemic inflammatory response syndrome between patients undergoing minimally invasive cardiac surgery and the traditional technique. Therefore it is concluded that minimally invasive surgery for patients with aortic valve disease may become the standard approach in the near future.

Aortic Valve↗
PubMed1998

[Repair of left ventricular free wall rupture with GRF glue associated with acute myocardial infarction: report of a case].

Histopathological examination of a repair of left ventricular free wall rupture associated with acute myocardial infarction using GRF glue was reported. A 63-year-old male with cardiac rupture due to LMT total occlusion was referred to our ward after unsuccessful PTCA with institution of IABP and PCPS. Left ventricular rupture repair by GRF glue and xenograft pericardial patch with concomitant myocardial revascularization (SVG-LAD, CX) was performed under cardiopulmonary bypass. Hemostasis around the ventricular rupture was easily accomplished. Unfortunately, the patient died at 14 POD because of low output syndrome caused by broad myocardial infarction. At autopsy, rupture site was examined histologically and was revealed that GRF glue made a tight adhesion between patch and myocardium. Neither abnormal inflammatory cells nor giant cells were found. We concluded that GRF glue might be a effective histocompatibly in hemostasis for left ventricular rupture associated with acute myocardial infarction.

Cardiac Surgical Procedures↗
PubMed1998

[Surgery for the treatment of infective endocarditis in the active and inactive stages].

Twenty-eight patients (16 M, 12 F, age 11 approximately 72 yr, mean 52.8 yr) underwent surgery for infective endocarditis. Of the 27 patients, 16 were in the active stage and 11 were in the inactive stage. In patients in the active stage, aortic valve replacement (AVR) was performed in 5, mitral valve replacement (MVR) in 7, AVR + MVR in 1, AVR + MVR + tricuspid valve plasty (TVP) in 1 and other procedures in 2. In patients in the inactive stage, AVR was performed in 3, MVR in 4, AVR + MVR in 2, and other procedures in 2. Causative organisms were detected in 56.3% of the patients in the active stage and 54.5% in the inactive stage. Also in patients in the active stage, infection was not prolonged. No deaths occurred among patients in the inactive stage but five patients (31%) died postoperatively; 4 of the five also died, for had severe heart failure before surgery, three died of multiple organ failure and one died of subarachnoid hemorrhage due to infective aneurysm. We recommend surgery for the treatment of infective endocarditis even in the active stage before emergence of heart failure.

Adolescent↗