Search PubMed⌕ Search

Biomedical subjects

K Fuse

Publications and source records attributed to K Fuse.

At least 109 records · Page 6Linked to original sources
PubMed1994

[Cardiac surgery without homologous blood transfusion--the effectiveness and the indication of recombinant human erythropoietin].

In 376 patients who underwent cardiovascular surgery using extracorporeal circulation between May 1989 and December 1991, we assessed the effectiveness of recombinant human erythropoietin (rHuEPO) and the indications for its use. A total of 174 patients received rHuEPO, which was administered intravenously (100 U/kg/day) or subcutaneously (400-600 U/kg/week). Of 348 elective surgeries, the operation was routine in 335 and was expected to require massive blood transfusion, such as reoperation and aortic surgery, in 13. The former group was divided into two subgroups, i.e., 292 patients with a hemoglobin of 12 g/dl or higher and 43 patients with hemoglobin levels under 12 g/dl. In the former subgroup, the rate of patients not receiving homologous blood transfusion was 96.3% following autologous donation with rHuEPO and 91.4% following autologous frozen blood donation for prolonged preservation period without rHuEPO. In contrast, even in the same subgroup, the rate was 82.5% for the patients who donated autologous liquid stored blood for a short time without rHuEPO. In the latter subgroup, the rate was 80.6% when rHuEPO was administered, and it was significantly higher than the rate of 25% in patients not receiving rHuEPO (p < 0.01). The rate increased to 91.3% when the anemia improved and autologous blood could be donated preoperatively. Autologous blood transfusion is generally not considered for patients undergoing reoperation and aortic surgery. In 70.0% of such patients, however, the operation could be completed without homologous blood transfusion when rHuEPO was administered and about 2000 ml of autologous blood was available. Subcutaneous use of rHuEPO was as effective as intravenous use.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Dynamic cardiomyoplasty: current status and future perspective].

Dynamic Cardiomyoplasty is a new approach to manage patients with heart failure. The phase I study shows that the muscle stimulator and electrodes function as designed and that the operation is done without any impairment of the patient's motor function. The results of the phase II study has been made public. The hemodynamic effects on patients with dilated cardiomyoplasty have been reported to be excellent. The assisting mechanism of dynamic cardiomyoplasty is based on the conformational change of the wrapped muscle with the ability to restore its optimal length and tension. In the chronic postoperative stage, the muscle seems to form a layer outside the epicardium. This change is important for the myocardinal sparing and girdling effects which are related to the wall stress of the heart. The hypothesis that the wrapped muscle becomes another layer of the heart can explain these effects. Increasing the wall thickness of the left ventricle reduces the wall stress (myocardinal sparing effect) according to Laplace's law. Even if the wrapped muscle is not transformed or stimulated (adynamic cardiomyoplasty), the wall stress is reduced after conformation, and the dilatation of the heart may be protected (girdling effect). The systolic augmentation is shown as the increase of cardiac output, ejection fraction, and blood velocity of the ascending aorta and ejection time. The dynamic cardiomyoplasty might effect the remodelling of the impaired heart and delay its progressive dilatation. When the efficacy of dynamic cardiomyoplasty is proven by the phase III study, which has been going on in the centers of North and South Americas, it will be useful as a bridge to heart transplantation, or as one of the surgical treatment modalities for advanced heart failure.

Cardiomyopathy, Dilated↗
PubMed1993

[Effectiveness of erythropoietin for cardiovascular surgery to prevent homologous blood transfusions].

Erythropoietin (EPO) was used preoperatively in 109 cardiovascular surgery cases to prevent homologous blood transfusions. Operative procedures in all these cases were coronary artery bypass grafting in 80 cases, valve replacement in 14, and a few cases of aortic vascular replacement or others, aging about average 62 years and weighing about average 54 kg. EPO was administered concomitantly with oral iron sulfate in the following three different manners; 100 units per body weight daily intravenously, 300 U./B.W. twice in a week intravenously, and 600 U./B.W. once in a week subcutaneously. Autologous blood donations were also performed as long as the blood hemoglobin levels were over 12 (g/dl) and repeated until the date of operation, and these blood deposits were returned to each patient at the time of operation. The blood hemoglobin level had increased on average from 12.6 (+/- 1.5 SD) to 13.6 (+/- 1.2 SD) after 23 days (+/- 13 SD) administration of EPO, while autologous blood deposit of 536 ml (+/- 353 SD) was obtained. Homologous blood transfusions were unnecessary in 89% of all cases, especially good in 96.7% of the group with over 12 of hemoglobin level before EPO administration. However, it remained within 79.6% of those with lesser to 12, so there was still room for improvement in this anemic group. No adverse effects were recognized in all cases. It was concluded that preoperative use of EPO is efficient to promote autologous blood donation, and its application will be expanded to anemic cases. EPO could offer an excellent means of preventing homologous blood transfusion. Further study concerning the appropriate application of erythropoietin seems to be required.

Anemia↗
PubMed1993

[Histological study of saphenous vein graft disease after coronary artery bypass grafting].

In an attempt to determine the cause of pathological changes in saphenous vein grafts arising months or years after coronary artery bypass surgery, we studied 13 patients who underwent reoperation 7 months to 12 years after the first surgery. Four of 17 grafts occluded early in the postoperative period. In these four cases, only thrombosis was observed in the graft lumen, and there were no marked changes in the graft wall. The 13 grafts occluded in late postoperative period exhibited two significant pathological changes. One was fibrointimal proliferation, which was found to some extent in all 13 grafts. However, it was thought to be the cause of occlusion in only one case. This fibrointimal proliferation was interpreted as a remodeling process associated with arterialization of the vein graft and occasionally causing graft occlusion. The other long-term pathological change, observed in 11 grafts, was atherosclerosis. Atherosclerotic changes significantly contributed to the development of occlusive and stenotic lesions and are suspected to be a major cause of late saphenous vein graft deterioration. In conclusion, fibrointimal proliferation and atherosclerosis are different pathological process, and it is important to distinguish between them in the evaluation of saphenous vein graft disease.

Adult↗
PubMed1992

Subcutaneous use of erythropoietin in heart surgery.

The effect of subcutaneous administration of recombinant human erythropoietin (rHuEPO) in ameliorating anemia resulting from autologous blood donation was compared with intravenous administration of rHuEPO. Forty patients undergoing coronary artery bypass procedures were divided into three groups. Group I (12 patients) received intravenous administration of rHuEPO (100 U.kg-1.day-1) and intravenous iron preparations for 14 days before operation; group II (14 patients) had subcutaneous administration of rHuEPO (600 U/kg) on preoperative days 14 and 7 and oral iron preparations for 14 days; and group III (14 patients) received oral iron preparations alone and served as the controls. Each patient predonated 800 mL of blood in the 2 weeks before operation. The reticulocyte count increased significantly in groups I and II (p less than 0.01), but little in group III. The hemoglobin level just before operation was higher in groups I (p less than 0.01) and II (p less than 0.05) compared with group III. Four patients (29%) in group III required homologous blood transfusion versus none in groups I and II (p less than 0.05). Subcutaneous administration of rHuEPO once a week was as effective as daily intravenous administration. Preoperative autologous blood donation can be performed over a short period on an outpatient basis with subcutaneous administration of rHuEPO.

Aged↗
PubMed1992

[Myocardial revascularization for ischemic heart disease without in situ internal thoracic artery grafting].

CABG was performed in 327 patients from 1989 to 1991. We used ITA grafts for the arterial conduit whenever this was possible. Since ITA grafting has become a routine procedure in CABG, we investigated the reasons why in situ ITA grafts were used in some of our patients. The number of CABG patients without in situ ITA grafts was 42 in 1989, 35 in 1990, and 9 in 1991. There was three main reasons for this: 1) problems with the coronary arteries or myocardium, 2) problems with the ITA grafts, and 3) problems with the patient. Although ITA grafts were not used in these cases, the indications for ITA grafting have been changed by our review. Use of ITA grafts need not be restricted for reasons of age or native coronary artery problems, but some patients will still be unsuitable for these grafts.

Aged↗
PubMed1992

[Cryosurgery for left atrial myxoma with coronary artery bypass grafting].

This is the first report of cryoblasion of atrial myxoma which was performed in conjunction with coronary artery bypass grafting. A 63-year-old man was admitted for left atrial tumor and ischemic heart disease. Following coronary artery bypass grafting and resection of left atrial myxoma, cryosurgery was carried out for the residual tumor on atrial septum and left atrial posterior wall. Ultrasonic cardiogram after 1 year revealed no signs of recurrence. Cryoablasion was effective in preventing the recurrence of atrial myxoma.

Coronary Artery Bypass↗
PubMed1992

[Early and late results of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty].

The indication of coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) for coronary artery disease, especially for multivessel disease, remains controversial. We examined the characteristics and outcomes of the CABG group (799 consecutive patients) and the PTCA group (944 patients) from 1984 to 1991. The proportion of 3-vessel and left main disease in the CABG group was 77% and that of single-vessel in the PTCA group was 92%. The characteristics between 2 groups were distinct. But the results were good respectively. The occurrence of hospital death was similar (1.3% vs 0%). The early graft patency rate in the CABG group was 91% and primary success rate in the PTCA group was 90%. And over a 5-year follow-up the cumulative survival rate of 3-vessel disease undergoing CABG and single-vessel disease patients undergoing PTCA was 96% versus 98%, respectively. It is concluded that PTCA is suitable for single-vessel and 2-vessel without totally occluded artery disease patients, whereas CABG for other multivessel disease patients.

Angioplasty, Balloon, Coronary↗
PubMed1992

[A case report of isolated tricuspid valve endocarditis in a non-addicted adult person without underlying cardiac disease].

We report a rare case of isolated tricuspid valve endocarditis. A 46-year-old man who was non-addicted, non-alcoholic and had no underlying cardiac disease was admitted to our hospital for persistent pyrexia. Appropriate intravenous antibiotics therapy was unable to control the repeated infection and destruction of his tricuspid valve progressed. The patient was referred to our surgical division where on intraoperative inspection, tricuspid valve endocarditis was found to involve the entire anterior leaflet and part of the posterior leaflet. Following complete debridement of the infectious lesion, tricuspid valvuloplasty was not considered to be possible. So we performed tricuspid valve replacement using a mechanical valve (CARBOMEDICS 27 mm). His postoperative course was uneventful and he had no ventricular arrhythmia. After prophylactic antibiotic administration for 3 weeks, he was afebrile for 2 weeks without any medication. Thereafter he was discharged and has been free from any complications for over 1 year.

Endocarditis, Bacterial↗
PubMed1992

[Evaluation of calcified ascending aorta by thoracic computed tomography and technical pitfall for coronary artery bypass grafting].

The cumulative 94 coronary bypass patients were evaluated on calcification of the ascending aorta preoperatively by computed tomography (CT). CT demonstrated the calcification of the ascending aorta in 12 patients (12.8%). In these patients with severely calcified ascending aorta, we performed femoral cannulation (6 cases), distal anastomosis without aortic cross clamp (2 cases), proximal anastomosis through single aortic cross clamp (3 cases) and non proximal anastomosis to use arterial conduits (3 cases). In this series, we did not have any embolic episode. The thoracic computed tomography is effective for evaluation of calcified ascending aorta and in this situation, operative modifications are necessary for obviation of stroke.

Aged↗
PubMed1992

[Autologous blood transfusion with erythropoietin in heart surgery in an anemic patient].

A 78-year-old woman was diagnosed as having three-vessel coronary artery disease. A coronary artery bypass operation with autologous blood transfusion was indicated because of the irregular antibody and because homologous blood transfusion would lead to hemolytic complications. Since she had anemia (hemoglobin level, 10.7 g/dl) and autologous blood could not be collected, recombinant human erythropoietin (rHuEPO) and iron preparations were administered intravenously every day. The hemoglobin level reached 12.1 g/dl two weeks after administration, and then autologous blood was donated. The first 1200 ml of blood was stored frozen, and the last 400 ml as liquid in consideration of the blood preservation period. Surgery was performed uneventfully after 8 weeks of rHuEPO administration. No homologous blood transfusion was required during and after surgery. By using rHuEPO, it is thus possible to perform heart surgery without homologous blood transfusion even in patients with anemia, for whom blood transfusions have been considered necessary.

Aged↗
PubMed1992

[Acute aortic dissection complicating coronary artery bypass surgery].

We experienced a patient in whom acute ascending aortic dissection appeared to develop at the site of injection of the cardioplegic solution during coronary artery bypass surgery. The patient was a woman aged 70, who was demonstrated to have calcification of the posterior wall of the ascending aorta by preoperative CT scanning. When dissection developed at the cardioplegia injection site after removal of the aortic cross clamp, the aorta was transected and teflon felt was applied to the aorta internally and externally before end-to-end anastomosis was performed. Postoperative CT scanning revealed closure of the dissecting lumen, and the patient was discharged from hospital on the 33rd postoperative day.

Aged↗
PubMed1991

Autologous blood transfusion with recombinant human erythropoietin in heart operations.

The effects of recombinant human erythropoietin (rHuEPO) on improving the anemia associated with autologous blood collection before open heart operations and on improving the postoperative anemia were studied. The study was carried out on 18 patients undergoing coronary artery bypass operations; 400 mL of autologous whole blood was taken from each patient 2 weeks before operation and was subsequently used in the operation, and rHuEPO (100 U.kg-1.day-1) was given intravenously for 2 weeks before operation and for 1 week after operation. The group in which iron preparations were also administered intravenously was designated as group I (10 patients), and the group in which rHuEPO was given alone was designated as group II (8 patients). In group III, as a control group, 11 past patients were used in whom 400 mL of autologous whole blood was collected 2 weeks before operation but neither rHuEPO nor iron preparations were given. After autologous blood collections, the hemoglobin levels improved in group I, group II, and group III, in that order, and with significant differences among them. It was shown that rHuEPO was effective in ameliorating the anemia associated with preoperative autologous blood collection, and the effect was further enhanced with intravenous supplementing iron preparations. After operation, the anemia markedly improved while rHuEPO was administered, but the hemoglobin levels decreased rapidly when the administration was terminated. Further studies are needed regarding the use of rHuEPO after operation.

Aged↗
PubMed1991

[Autologous blood transfusion with recombinant human erythropoietin in heart surgery--studies on the volume of preoperative donation and postoperative administration].

Recombinant human erythropoietin (rHuEPO) was administered to 42 elective heart surgery patients, and the volume of autologous blood donated within the preoperative short period and effects of improving anemia by postoperative rHuEPO administration were studied. rHuEPO (100 U/kg/day) and chondroitin sulfate-iron (40 mg/day) were given intravenously for preoperative 14 days, and each 400 ml of autologous blood was donated on the 14th and 4th day before operation. Reticulocytes increased significantly 3 days after administration (p less than 0.01). The hemoglobin level, 13.4 +/- 1.0 g/dl before the first donation, returned to 13.4 +/- 1.1 g/dl just before operation. 800 ml of autologous blood, needed for usual open heart surgery, may possibly have been donated within 14 days without making patients anemic by intravenous rHuEPO administration. For postoperative rHuEPO administration, the patients were divided into 3 groups: Group I (10 cases): given for 14 days, Group II (12 cases): for 7 days, Group III (20 cases): no administration. Reticulocytes decreased rapidly after termination of rHuEPO administration in each group, and on the 7th day after termination, they returned to the level before administration. The hemoglobin level in Group I was maintained after termination of rHuEPO, and was +2.2 +/- 1.1 g/dl on the 21st postoperative day compared with the level of 1st postoperative day. The hemoglobin level in Group II fell after termination and was +0.9 +/- 0.7 g/dl on the 21st day, this being comparable to the level of Group III. There were significant differences between Group I and II (p less than 0.05), and between Group I and III (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗