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Biomedical subjects

K Esato

Publications and source records attributed to K Esato.

At least 127 records · Page 7Linked to original sources
PubMed1998

Progressive hyperthermia during thoracoscopic procedures in infants and children.

We describe the development of progressive hyperthermia during thoracoscopic procedures in infants and children. Twelve patients (four infants and eight children) underwent closure of a patent ductus arteriosus using the video-assisted technique. A progressive increase in body temperature of more than 2 degrees C occurred in six of the patients during surgery. The increase in body temperature correlated inversely with body weight and directly with duration of surgery (r = -0.76, P = 0.003 and r = 0.68, P = 0.01, respectively). We found that the thoracoscope produces 28.5 joule.min-1 of constant energy in vitro. Our findings show progressive hyperthermia during thoracoscopic procedures, due to energy release from the thoracoscope. This could be a significant complication in infants undergoing prolonged operations.

Age Factors↗
PubMed1998

Bidirectional blockade of CD4 and major histocompatibility complex class II molecules: an effective immunosuppressive treatment in the mouse heart transplantation model.

BACKGROUND: Anti-CD4 monoclonal antibodies (mabs) are powerful immunosuppressive agents. However, in experimental models anti-CD4 treatment alone is not always completely effective. Anti-major histocompatibility complex (MHC) class II mabs may have a synergistic effect with anti-CD4 mab therapy by blocking the function of both antigen-presenting cells and T cells. METHODS: C3H/He mice (H-2k: I-Ak, I-Ek) received a vascularized cardiac graft from C57BL/10 (H-2b: I-Ab) or BALB/c (H-2d: I-Ad, I-Ed) mice and were treated with a depleting anti-CD4 or a depleting anti-MHC class II antibody either alone or in combination. RESULTS: Anti-CD4 treatment alone prolonged graft survival in both strain combinations but was only minimally effective when BALB/c donors were used. However, when anti-CD4 and anti-MHC class II mabs were administered together, graft survival was significantly prolonged in both strain combinations. The ratio of interleukin-4 (IL-4)/interferon-gamma (IFN-gamma) expressed in both C57BL/10- and BALB/c-transplanted hearts 7 days after transplantation was significantly higher after combined treatment with anti-CD4 plus anti-MHC class II mabs compared with that found after either treatment alone. Twenty-one days after transplantation, the ratio of IL-4/IFN-gamma in BALB/c hearts after combined mab therapy was significantly lower than at 7 days after transplantation, but in contrast, the cytokine ratio in C57BL/10 hearts remained at an elevated level during the first 21 days after transplantation. CONCLUSIONS: These data demonstrate that bidirectional blockade of the antigen-presenting cell and T-cell interaction by use of anti-CD4 and anti-MHC class II mabs in combination is more effective than either treatment alone. Graft survival in this model seems to correlate with a prolonged elevation of the IL-4/IFN-gamma ratio in the transplanted heart, suggesting that in this model the induction of unresponsiveness may be associated with a shift toward a Th2-type T-cell response.

Animals↗
PubMed1998

Lung volume reduction surgery for pulmonary emphysema using dynamic Xenon-133 and Tc-99m-MAA SPECT images.

The usefulness of Xe-133 and Tc-99m-MAA single photon emission computed tomography (SPECT) in identifying areas to be resected during video-assisted thoracoscopic lung reduction surgery for emphysema was examined. Twenty-nine patients with advanced emphysema were examined using Xe-133 and Tc-99m-MAA SPECT prior to and following surgery. For the Xe-133 dynamic SPECT, patients inhaled Xe-133 gas for 6 minutes. Equilibrium and subsequent washout SPECT images were acquired every 30 seconds for 6 to 7 minutes during spontaneous breathing. Ventilation was quantified by Xe-133 clearance time (T1/2) in addition to visual assessment. The patients underwent unilateral thoracoscopic volume reduction in the regions with abnormal Xe-133 retention and Tc-99m-MAA defect. All patients demonstrated marked, heterogeneous Xe-133 retention and Tc-99m-MAA defects preoperatively. The worst functioning areas were identified as nonventilated and noflow areas, or areas with air trapping and low perfusion. These changes were found even in patients with diffuse and symmetrical impairments on chest CT. After surgery, most of these "target areas" disappeared and pulmonary function tests demonstrated significant improvement. T1/2 correlated closely with the percent predicted FEV1 (%FEV) and 6-minute walk distance before and after surgery (p<0.0001). Xe-133 and Tc-99m-MAA SPECT imaging was useful in identifying "target areas" in the emphysematous lung. Directed unilateral thoracoscopic volume reduction based on these SPECT images is an effective treatment for emphysema.

Aged↗
PubMed1998

[Relative valve area stenosis after replacement of a Starr-Edwards mitral valve (model 6520) for corrected TGA (S, L, L): report of a case].

The patient was a 38-year-old man who had undergone mitral valve replacement with a Starr-Edwards disc valve (model 6520, 3 M, phi 30 mm, functional valve area: 2.85 cm2) at the age of 15 years for TR combined with corrected TGA. He developed dyspnea on exertion and palpitations at the age of 30 years, and paroxysmal supraventricular tachycardia appeared at the age of 35 years. Cardiac catheterization revealed that the PCWP was 30 mmHg and the TVA was 1.1 cm2, and a diagnosis of stenosis of the prosthetic valve was made. Thus, replacement of the Starr-Edwards disc valve using a BICARBON double leaflet valve (phi 27 mm, functional valve area: 2.85 cm2) was performed. The operative findings of the Starr-Edwards disc valve revealed a normal appearance and no pannus growth. Postoperative echocardiography and cardiac catheterization found that the TVA was 3.7 cm2 and the PCWP was 13 mmHg. The actual valve area of the disc valve sewn on the ventrical, which was anatomically RV construction might have been smaller than the ideal area; however, the double leaflet valve proved efficient in our patient. This case report serves to demonstrate that because of the postoperative difference in measurement between the actual valve area and the prostheticin ball or disc valve, patients undergoing mitral valve replacement must be followed up carefully.

Adult↗
PubMed1997

Relationship between respiratory distress and cytokine response after cardiopulmonary bypass.

The influence of cytokines on the inflammatory response in surgery has recently been the subject of investigations. We measured tumor necrotic factor-alpha (TNF-alpha), interleukin 1 beta (IL-1 beta), interleukin 6 (IL-6), interleukin 8 (IL-8), and granulocyte elastase (GEL) in 26 patients undergoing elective cardiac operations using cardiopulmonary bypass (CPB), preoperatively, immediately after CPB, and on post-operative days (PODs) 1, 3, and 6. To evaluate the effect of these cytokines on pulmonary function, the patients were divided according to whether the oxygenation index (OI) on POD 1 was > 250 or < 250, into groups A and B, respectively. TNF-alpha and IL-1 beta were undetectable and there were no significant differences in the preoperative IL-6, IL-8, and GEL levels. However, immediately following CPB, the mean IL-6, IL-8 and GEL levels in both groups were significantly higher than the preoperative levels (P < 0.01). Moreover, all these levels were significantly higher in group B than in group A, at 162 +/- 150 pg/ml vs 64 +/- 53 pg/ml (P < 0.05) for IL-6; 53 +/- pg/ ml vs 22 +/- 20 pg/ml (P < 0.01) for IL-8; and 2477 +/- 1642 mg/ l vs 1397 +/- 774 mg/l (P < 0.01) for GEL. The IL-6 levels returned to the preoperative values in both groups on POD 1; however, the GEL levels remained significantly higher in group B than in group A postoperatively, at 616 +/- 326 mg/l vs 378 +/- 70 mg/l on POD 1, and at 292 +/- 70 mg/l vs 218 +/- 62 mg/ l on POD 3 (P < 0.05). Thus high levels of cytokines such as IL-6, IL-8, and GEL may be detrimental to respiratory function.

Adult↗
PubMed1997

Modified Bentall operation with concomitant total aortic arch replacement for DeBakey type I aortic dissection: report of a case.

The successful implementation of a reoperative Bentall procedure with concomitant total aortic arch replacement after ascending aortic replacement for acute aortic dissection is infrequently reported. We performed a modified Bentall procedure with total replacement of the aortic arch in a patient suffering from worsening aortic regurgitation (AR) and residual dissection. Our strategy involved the button method for coronary reconstruction, selective cerebral perfusion, the use of a composite graft with four branches for aortic arch replacement, and the administration of high-dose aprotinin to decrease bleeding.

Acute Disease↗
PubMed1997

Combined thoracoscopic lung resection and laser ablation for lung cancer with pulmonary emphysema: report of a case.

We report herein the case of the 71-year-old man with lung cancer and pulmonary emphysema requiring supplementary oxygen at 21/min by nasal cannula for whom thoracoscopic wedge resection of an adenocarcinoma in his left lower lobe was successfully performed. During the same procedure, thoracoscopic laser ablation of pulmonary bullae was also carried out. There were no postoperative complications, and the patient is currently well 12 months following surgery without any evidence of local or regional recurrence, or distant metastasis. His severe dyspnea on exertion improved, and he no longer requires supplementary oxygen.

Adenocarcinoma↗
PubMed1997

Differences in sarcoplasmic reticulum gene expression in myocardium from patients undergoing cardiac surgery. Quantification of steady-state levels of messenger RNA using the reverse transcription-polymerase chain reaction.

Little is known about any alterations in sarcoplasmic reticulum (SR) gene expression associated with cardiac diseases of varying degrees of severity. We assessed, using the reverse transcription-polymerase chain reaction (RT-PCR) technique, SR Ca2+ transport protein gene expression in small tissue samples from failing hearts in patients undergoing cardiac surgery. Total RNA was extracted from 30- to 50-mg samples from the hearts of 13 patients with coronary artery disease, congenital heart disease, or valvular heart disease. We used RT-PCR to synthesize and amplify cDNA encoding cardiac SR Ca(2+)-ATPase, ryanodine receptor (RYR), and glyceraldehyde-3-phosphate dehydrogenase (GAPDH). The amount of each mRNA in the sample was expressed relative to the amount of GAPDH mRNA. The expression level of each mRNA was correlated with the cardiac functional index. The mRNA levels for Ca(2+)-ATPase and RYR varied between heart samples, but showed a positive correlation with left ventricular ejection fraction. Ca(2+)-ATPase mRNA levels showed in inverse relationship with plasma brain natriuretic peptide. In addition, we isolated partial cDNA encoding a human cardiac RYR. The cDNA consisted of 487 nucleotides, and the nucleotide and deduced amino acid sequences showed 93% and 99% homology, respectively, to those of rabbit cardiac RYR. These results suggest that decreased levels of mRNA for SR Ca2+ transport protein could be related to abnormal cardiac function, regardless of the etiology of the heart disease. RT-PCR provides a rapid and economical way of quantifying the expression of multiple genes in small specimens and may, therefore, aid understanding of the pathophysiology and treatment of heart disease.

Adolescent↗
PubMed1997

A comparison of CORVITA and expanded polytetrafluoroethylene vascular grafts implanted in the abdominal aortas of dogs.

The utility of CORVITA vascular grafts, composed of an inner layer of meshed polyurethane fibers and an outer layer of meshed Dacron reinforcement, for replacement of the abdominal aorta was assessed in a canine model and compared with expanded polytetrafluoroethylene (ePTFE) grafts. CORVITA or ePTFE vascular grafts were implanted and left in place for 3 or 6 months. After removal, they were inspected macroscopically and histologically. Microspectrophotometry was used to quantify smooth muscle cells (SMCs), elastin (EL), and collagen (CL) in the media of the native artery. The patency rate of the CORVITA grafts after 6 months was 100%, whereas that of the ePTFE grafts was only 50%. Moreover, stenoses were apparent in all of the ePTFE grafts, but in only 43% of the CORVITA grafts. The intimal thickness at the distal anastomosis was significantly greater at 3 months in the ePTFE grafts (P < 0.01), and there were significantly more SMCs in the host arterial media at the proximal and distal anastomoses in these grafts. Thus, better long-term patency can be expected with CORVITA grafts than with ePTFE grafts. This conferred advantage is most likely attributable to the less pronounced intimal hyperplasia which results from the proliferation of SMCs in the media of the native artery.

Anastomosis, Surgical↗
PubMed1997

A video-assisted thoracoscopic surgical technique for interruption of patent ductus arteriosus.

We describe herein a technique for patent ductus arteriosus (PDA) closure using a method of video-assisted thoracoscopic surgical (VATS) interruption derived from video-assisted endoscopic surgery. This technique of repair was performed on five patients with a mean age of 3 years and a mean weight of 13.7 kg during 1994 and 1995. Under general anesthesia, two 10-mm trocars and two or three 5-mm trocars were inserted through the left thoracic wall. A video camera and specially designed surgical tools including scissors, dissectors, and a clip applicator were then introduced. The ductus was dissected, and two titanium clips were applied to interrupt the ductus completely. Successful closure of the PDA by this video-assisted technique was achieved in all patients. The only complication which developed in one patient was hoarseness for 2 weeks postoperatively. The hospital stay ranged from 7 to 12 days and there were no serious complications or deaths. There results indicate that video-assisted thoracoscopic surgical interruption is a safe and effective technique for achieving closure of PDA.

Child, Preschool↗
PubMed1997

Surgical stress and the development of complications in relation to polymorphonuclear leukocyte elastase (PMNE) levels.

This study was conducted to examine the effects of surgical stress on changes in polymorphonuclear leukocyte elastase (PMNE) levels, and to evaluate the relationship of these changes to the development of postoperative complication. A total of 69 patients who underwent alimentary surgery were subsequently divided into three groups: a complicated group, comprised of 25 patients; an uncomplicated group with a high blood loss (H) of more than 1000 ml, comprised of 18 patients; and an uncomplicated group with a low blood loss (L) of less than 1000 ml, comprised of 26 patients. The changes in the levels of PMNE, fibronectin (FN), and antithrombin III (AT III) were compared among these three groups. In the uncomplicated H and L groups the PMNE levels rose significantly on postoperative day (POD) 1. On POD 3, high levels of PMNE were still evident in the uncomplicated H group, but a decline was observed in the uncomplicated L group. From POD 7 onwards the levels decreased to the preoperative values in both uncomplicated groups; however, the complicated group continued to show high levels even on POD 14. Significantly decreased FN levels were observed for the first 3 PODs in each group. The uncomplicated H and L groups regained their preoperative levels on PODs 7 and 14, respectively, but no recovery was found in the complicated group. The AT III levels showed similar changes to the FN levels in all groups. These findings indicate that monitoring the PMNE levels could be a useful index for the early detection of postoperative complications following alimentary surgery.

Antithrombin III↗
PubMed1997

High submucosal blood flow and low anastomotic tension prevent anastomotic leakage in rabbits.

In many cases of long-gap congenital esophageal atresia, direct anastomosis is difficult. In these cases, the esophagus is first lengthened by myotomy before anastomosis. We determined the degree of submucosal blood flow and/or approximation force at the site of anastomosis in rabbits after (1) separation of the esophagus from the outer membrane, (2) 1 cm and 2 cm resection of the esophagus, and (3) circular or spiral myotomy of the esophagus after 2 cm resection. In the first experimental group, submucosal blood flow volume < 115.2 ml/min/100 g resulted in anastomotic leakage. In the second experimental group, a 1 cm resected esophagus with an approximation force of 33.3 +/- 8.2 g did not result in leakage, while a 2 cm resected esophagus with an approximation force of 111.7 +/- 13.3 g resulted in leakage. It was found that leakage occurred when the approximation force was higher than 49.1 g even if submucosal blood flow volume was greater than 131.8 ml/min/100 g. In the third experiment, both circular and spiral myotomy reduced the approximation force. Although there was no difference in the changes in submucosal blood flow volume between the two types myotomy, circular myotomy was superior to spiral myotomy in the reduction of the approximation force at the site of anastomosis. We conclude that both approximation force and submucosal blood flow are important factors in preventing anastomotic leakage.

Anastomosis, Surgical↗
PubMed1997

Chest wall implantation of lung cancer at the drainage tube site: report of a case.

We report herein the case of a 70-year-old man in whom a chest wall implantation of adenocarcinoma of the lung at the drainage tube site was found 4 months after a right lower lobectomy with mediastinal lymph node dissection had been performed for adenocarcinoma of the right lower lobe. The lesion was successfully treated by tumor extirpation. We believe that tumor seeding to the chest wall occurred at the time of thoracotomy. To prevent such tumor seeding, the pleural cavity should be washed out routinely with a massive volume of physiological saline solution prior to closure of the chest wall.

Adenocarcinoma↗
PubMed1997

The induction of operational tolerance is not prevented by simultaneous administration of cyclosporin A1.

In this study, the effect of combining anti-CD4 monoclonal antibody (mAb) and cyclosporin (CyA) therapy at the time of transplantation was examined. A mouse cardiac allograft model was used. Anti-CD4 mAb administered perioperatively induces long-term survival. The addition of a short course of CyA given subcutaneously in a regimen of either a high-dose treatment or a standard dose treatment to the anti-CD4 mAb treatment protocol did not have a detrimental effect on graft survival. Despite having no significant effect on graft survival, the addition of CyA to the treatment protocol did result in a significant decrease in the level of IL-2 present in the hearts 7 days after transplantation. The decrease in IL-2 production was directly related to the presence of CyA in vivo. When CyA treatment was continued throughout the period during which unresponsiveness to the graft is induced by anti-CD4 mAb therapy, 50% of the grafted hearts were rejected once the CyA was discontinued. In conclusion, the combined use of anti-CD4 mAb therapy and CyA did not have a negative effect on graft survival in this model when the two agents were used concurrently at the time of transplantation.

Animals↗
PubMed1997

Laparoscopic repair of a diaphragmatic hernia through the foramen of morgagni.

A 78-year-old woman is described who presented with a diaphragmatic hernia through the foramen of Morgagni. A definitive diagnosis was confirmed by a sagittal view on magnetic resonance imaging prior to surgery. The hernia was repaired laparoscopically under an abdominal wall lifting technique without pneumoperitoneum, and her symptoms completely resolved postoperatively with no evidence of recurrence. The laparoscopic repair was considered a suitable and safe procedure for the treatment of a Morgagni hernia.

Aged↗
PubMed1997

Evaluation of brain oxygenation during selective cerebral perfusion by near-infrared spectroscopy.

BACKGROUND: Although selective cerebral perfusion (SCP) has been used for cerebral protection in aortic arch operations, the appropriate perfusion conditions of SCP are unclear. METHODS: We used near-infrared spectroscopy, which evaluates brain ischemia noninvasively and continuously, to determine whether perfusion with SCP (core temperature, 20 degrees C; flow rate, 10 mL.kg-1.min-1) was acceptable in terms of oxyhemoglobin and deoxyhemoglobin in patients having SCP for aortic arch operations (SCP group, n = 6) versus patients having cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CPB group, n = 6). RESULTS: There were no significant differences in age (65 +/- 10 versus 63 +/- 12 years), CPB time (199 +/- 67 versus 199 +/- 52 minutes), changes in hematocrit (-12.9% +/- 3.7% versus -12.5% +/- 6.0%), lowest blood pressure (43 +/- 7 versus 45 +/- 10 mm Hg), or highest central venous pressure (8 +/- 2 versus 9 +/- 4 mm Hg) between the SCP and CPB groups. In the SCP group, the maximum decrease in oxyhemoglobin level and the maximum increase in deoxyhemoglobin level were -5.0 to -11.4 mumol/L and -0.1 to 3.9 mumol/L, respectively; in the CPB group, the respective changes were -3.2 to -14.2 mumol/L and -0.4 to 3.6 mumol/L. Changes of oxyhemoglobin and deoxyhemoglobin levels in the SCP group were almost within the range of those in the CPB group. There were no brain complications in either group. CONCLUSIONS: As described here, SCP is acceptable and safe for brain protection in aortic arch procedures.

Adult↗
PubMed1997

Congenital cystic adenomatoid malformation with extramedullary hematopoiesis of the lung: a case report.

The authors report a case of congenital cystic adenomatoid malformation of the lung (CCAM) with extramedullary hematopoiesis (EMH). A baby girl suffered from Rh incompatibility and hemolytic anemia. She exhibited respiratory distress. Chest radiography and magnetic resonance imaging findings showed a CCAM. A resection of the upper and middle lobes of the right lung was performed. Histological examination showed a CCAM of Stocker's type II with EMH. EMH in the lung is very rare. The authors speculate that the cause of our case originated from Rh incompatibility and development arrest in the CCAM lung.

Cystic Adenomatoid Malformation of Lung, Congenita↗