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Biomedical subjects

K Goh

Publications and source records attributed to K Goh.

At least 55 records · Page 3Linked to original sources
PubMed1994

Clinical application of evoked spinal cord potentials elicited by direct stimulation of the cord during temporary occlusion of the thoracic aorta.

Evoked spinal cord potentials elicited by direct stimulation of the cord were used to monitor spinal cord ischemia in 68 patients undergoing temporary occlusion of the thoracic aorta (29 thoracic nondissecting aortic aneurysms, 9 nondissecting thoracoabdominal aneurysms, and 30 dissecting aneurysms). "Immediate" postoperative paraplegia developed in three patients and "immediate" paraparesis developed in one, whereas "delayed" paraplegia developed in two others. During aortic crossclamping, four response patterns of the spinal cord potentials were obtained: (1) no change (n = 53), (2) change with return (n = 10), (3) change with inconsistent return (n = 2), and (4) change without return (n = 3). Neurologic complications occurred in 2%, 0%, 100% of these groups, respectively. Delayed paraplegia developed on the second postoperative day in only one patient with a false-negative result, and the potentials correlated well with this patient's clinical neurologic recovery. The aortic crossclamp time was significantly longer in the patients with "change with inconsistent return" and "change without return" than in the other two groups (p < 0.01). Femoral artery pressure and the cardiopulmonary bypass flow rate were also significantly lower in these groups than in the other two groups (p < 0.02 and p < 0.01, respectively). We conclude that intraoperative monitoring of direct spinal cord responses is useful for the early detection of spinal cord ischemia for assessing the efficacy of surgical countermeasures.

Aortic Dissection↗
PubMed1993

[Results of arterial reconstruction in Buerger's disease].

One hundred and eight bypass operations for Buerger's disease were performed between November 1976 and August 1990. The bypass procedures, prostheses, cumulative patency rate and the influence of smoking on the results were discussed. Five-year cumulative patency rate of Aorto-femoral bypass was 88.2%. Aorto-femoral bypass should be always indicated as a standard procedure for the iliac lesion in Buerger's disease, because the patency rate was very low in aorto-iliac bypass group or ilio-femoral bypass group. Five-year cumulative patency rate of infrainguinal bypass using autogenous vein was 64.8%, and that in the patients who quit cigarette smoking was as high as to 73.3%. We should use autogenous vein as much as possible for infraiguinal bypass and discontinuance of cigarette smoking is considered to be one of the important factors to improve the patency rate in Buerger's disease.

Adult↗
PubMed1993

[Postoperative recurrence form of Crohn's disease: comparison between perforating and non perforating types].

Postoperative recurrence rate and recurrence form were analyzed in two clinical forms of Crohn's disease at primary resection, one of which was perforating and the other was non perforating. Forty four patients with Crohn's disease were included in this study, 18 of them were perforating type and 26 were non perforating type. Crude recurrence rates were 39% (7/18 cases) in perforating type group and 54% (14/26 cases) in non perforating type group, which were not significantly different. Cumulative recurrence rates 5 years after initial operation were 58% in perforating type group and 47% in non perforating group without statistically significance. The recurrence form was perforating type more frequently in perforating type group (86%) than non perforating group at primary resection (29%) with statistically significance (p = 0.013). Postoperative recurrence form had a tendency to be similar to the form at primary resection. It was suggested from this study that Crohn's disease had two different disease entities; perforating and non perforating types and that postoperative recurrence should be examined carefully from the view of primary resection.

Adolescent↗
PubMed1991

[Surgical management of congenitally corrected transposition of the great arteries].

From 1962 to 1990, we have experienced 12 patients with congenitally corrected transposition of the great arteries (CTGA). Associated cardiac defects were present in all cases, most frequently ventricular septal defect (100%), and pulmonary stenosis (67%), Palliative procedures were done in 5, corrective operations in 6. One patient underwent corrective procedure 27 years after palliation. The hospital mortality rate was 8% (1/12), and 1 late death (8%) was seen in this series. In most cases, we approached the defect through the mitral valve, and the deLeval method was very useful in placing stitches along the trabecular septum. AV conduction disturbance could be avoided in 5 of 6 patients who underwent the closure of ventricular septal defect. Pulmonary stenosis was relieved by valvotomy and/or infundibulectomy, or implantation of an extracardiac conduit according to their anatomy. Cardiac function of systemic ventricle (morphologic right ventricle) were well preserved in the case undergoing intracardiac repair and also in the palliative cases. Careful observation is needed in these cases.

Adolescent↗
PubMed1990

[A study of spinal cord ischemia during aortic cross-clamp--evoked spinal cord potential and histological analysis of the spinal cord].

The relationship between the evoked spinal cord potential (ESP) and the histological findings of the spinal cord after thoracic aortic cross-clamp was studied. Thoracic aorta was cross-clamped in 23 dogs and ESP was monitored before, during, and after cross-clamping. Incidence of paraplegia and histological findings were studied after the dogs recovered from the procedure. Aortic cross-clamp was maintained for 60 minutes in 20 dogs (Group A). And cross-clamp was released 10 minutes after the amplitude of ESP became lower than 20% of control in 3 dogs. (Group B). In group A, three types of ESP changes were detected; ESP became lower or lost during cross-clamping in type 1 response, ESP remained unchanged in type 2 response, and ESP returned after transient loss during cross-clamping in type 3 response. Four of five dogs with type 1, none of nine with type 2, two of five with type 3 response showed paraplegia. One of the dogs with type 2 response showed paraparesis. ESP could not detected in one dog, in which traumatic spinal cord injury during laminectomy caused paraplegia. In Group B, all dogs showed type 1 response and paraplegia. Characteristic histological finding of the spinal cords of the dogs with paraplegia was the ischemic necrosis mainly in the gray matter. Necrotic foci were limited in the posterior horn in mild, in the anterior and posterior horn in moderate changes. And neurons were lost in entire gray matter in severe histological changes. In the spinal cords of the dogs with spastic paraplegia, severe histological changes were limited in the lower lumbar region.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[Late results with biograft in peripheral arterial surgery].

A total of 106 vascular reconstructions below the inguinal ligament including axillo-femoral and femoro-femoral bypasses were performed using 137 Dardik's human umbilical veins. The indication for surgery was limb salvage in 29%. The distal anastomosis was done with the popliteal artery above the knee in 53 cases, below the knee in 31, and with a tibial artery in 1. The axillo-femoral bypass was performed in 21 cases, and femoro-femoral bypass in 32. The accumulated graft patency rates of femoro-popliteal bypass at 1 yr./3 yrs./5 yrs. were 93%/75%/75%, those of femoro-femoral bypass were 85%/85%/85%, and those of axillo-femoral bypass were 54%/27%/27%. No special risk factor influencing patency rate was found from this study. In long term period, graft aneurysm was observed in 3 cases. It is concluded that the human umbilical vein is the graft material of choice for femoro-popliteal or femoro-femoral bypass when the saphenous vein is not available, and the careful follow-up is important because of the risk of graft aneurysm.

Adult↗
PubMed1989

Production of interleukin-1-alpha and -beta by human peripheral polymorphonuclear neutrophils.

The mechanism of the production of interleukin-1 (IL-1) by human peripheral polymorphonuclear neutrophils (PMN) was investigated. Supernatants of PMN stimulated with 30 micrograms/ml lipopolysaccharide (LPS) were used as extracellular IL-1 and supernatants of their lysate as intracellular IL-1 source. IL-1 activity was measured by the C3H/HeJ thymocyte co-mitogenic assay. The supernatants from PMN stimulated with LPS for 72 h showed IL-1 activity which had an apparent molecular weight of 15-20 kilodaltons and pI of 5.0 and more than 8.5. It was neutralized with anti-IL-1 antibodies and it lacked IL-2 activity. Our time course study of the IL-1 assay with neutralization by anti-IL-1-alpha and -beta antibodies indicated that the extracellular IL-1-beta activity appeared predominantly in the early incubation periods, whereas alpha activity appeared predominantly in the late periods. Intracellular IL-1-alpha but not beta activity was detected mainly at the intermediate incubation periods. These data indicate that PMN stimulated with LPS produce both IL-1-alpha and -beta, and release IL-1-beta first and IL-1-alpha later.

Animals↗
PubMed1987

Modified versus classical Blalock-Taussig shunts for congenital cyanotic heart diseases: a comparison of long-term results.

Between March 1977 and December 1984, 103 Blalock-Taussig shunts were performed on 88 patients. Included in this study were 40 patients who underwent the modified BT shunt and 63 patients who underwent the classical BT shunt. 13 of the modified BT shunts (33 per cent) and 18 of the classical BT shunts (29 per cent) were performed during infancy and 10 of the modified BT shunts (25 per cent) were performed on patients under the age of 3 months. EPTFE grafts of varying sizes were used in the patients who underwent modified BT shunts--4 mm in 14 cases, 5 mm in 15 cases and 6 mm in 11 cases, respectively. The early mortality rate was 11 per cent (3 deaths) in the group who had modified BT shunts and 8 per cent (5 deaths) in the group who had classical BT shunts. Over a follow-up period of 6 years, 6 shunt failures were diagnosed in the modified BTS group by auscultation and/or angiographic study, and during a follow-up period of 8 years, 12 shunt failures were diagnosed in the classical BTS group. The patency rate 3 years after surgery was 88.8 per cent in the modified BTS group and 78.0 per cent in the classical BTS group. The patency rate 5 years after surgery was 88.8 per cent in the modified BTS group and 75 per cent in the classical BTS group.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1987

[Surgical treatment of "inflammatory" aneurysms of the abdominal aorta].

Two cases of "Inflammatory" aneurysm of the abdominal aorta and a review of this type of lesion were presented. The incidence of inflammatory aneurysm of the abdominal aorta in the literature is 2.5 to 15%, but there were no detail reports concerning with this in Japan. The pathogenesis is not clear, but it is evident both macroscopically and microscopically that the inflammatory aneurysms are different from athelosclerotic ones. They are characterized by perivascular peel of inflammatory fibrous tissue. It is possible that this type of aneurysms are merely a variant of Takayasu's disease. Until recently, the diagnosis of this type of aneurysm has not been made before surgery. The symptom of abdominal pain, weight loss, elevated ESR in a patient with abdominal aortic aneurysm are highly suggestive an inflammatory aneurysm. Characteristics of CT scan lead to more frequent preoperative diagnosis of inflammatory aneurysms of the aorta. It reveals a thickened often calcified aortic wall surrounded by a soft tissue mantle. Dynamic scanning shows an enhancing perianeurysnal mass. Graft replacement in these patients is often difficult and associated with increase in morbidity and mortality. At surgery, no attempt should be made to mobilize adjacent viscela in order to avoid injury. Arterial control should be obtained with as little as possible dissection. Some reports refer to successful steroid therapy resolving the inflammatory process and alleviating symptoms. Further research may resolve the treatment of choice for this type of lesion and optimize the timing of surgery.

Aneurysm, Infected↗
PubMed1987

[A case of ruptured aneurysm of the thoraco-abdominal aorta associated with Behçet's disease].

A 41-year-old male with incomplete type of Behçet's disease was operated on because of ruptured aneurysm of the thoraco-abdominal aorta. A saccular pseudoaneurysm developed by rupture of the aortic wall involved the left postero-lateral portion of the supra-renal abdominal aorta. The defect in the aneurysm was closed using Dacron patch. The post-operative course was uneventful. However, seven months after discharge, the patient developed severe back pain at midnight, and was referred to our institution. On physical examination, a pulsatile mass was found in the right epigastric area. CT and DSA showed saccular pseudoaneurysm at the patch anastomotic site. Extra-anatomic long bypass grafting was performed from the ascending aorta to the infra-renal abdominal aorta. The abdominal aorta was occluded just below the diaphragm and the supra-renal portion of the aorta. Reconstruction of coeliac artery and superior mesenteric artery was made using branch grafts attached to the long graft. Surgical treatment of the complicated Behçet's disease should include extra-anatomic bypass, especially in the re-operative cases of ruptured aneurysm of the aorta.

Adult↗
PubMed1985

Isochromosome 17q in Ph-negative chronic myelocytic leukemia.

No Ph chromosome was found in three clinically suspected chronic myelocytic leukemia (CML) patients, although one had metaphases with trisomy 13. An isochromosome of the long arm of chromosome 17 [i(17q)] was found in these patients when two of them were in acute blastic crisis (ABC) and the other in an early stage of transformation. Although an i(17q) is frequently seen in ABC of Ph-positive CML, it is rarely reported in Ph-negative CML. The finding of an i(17q) chromosome in Ph-negative CML appears to indicate, as in Ph-positive CML, that the disease is transforming into ABC. A series of cytogenetic studies in this group of patients may possibly aid in predicting the patients' pending ABC and may also lead to understanding the pathogenesis of ABC.

Adult↗
PubMed1984

Computer-based evaluation of cardiopulmonary function for the optimization of ventilatory therapy in the adult respiratory distress syndrome.

A computer based evaluation system has been developed for the assessment of respiratory pressure flow dynamics, pulmonary gas exchange and ventilation perfusion interrelationships. This system is based on the acquisition of primary data on-line from intubated and ventilated patients consisting of airway pressures, ventilatory flows and mass spectrometric quantification of inspired and expired gas concentrations. The system has been applied to the study of patients with the adult respiratory distress syndrome (ARDS) following trauma and/or sepsis. The programs developed for evaluation of these data permit an interactive graphic capability to be used by the physician or the respiratory technician in a specific patient to determine the nature of the abnormalities in respiratory function. By use of this system for quantification of the extent and complications of the ARDS condition the specific ventilatory or cardiodynamic therapy can be tailored to meet the patient's physiologic needs. Techniques for optimization of conventional ventilator therapy are described and its application to the specific instances of combined high frequency ventilation or differential lung ventilation are presented. The clinical experience with this unit in a major trauma center suggests that quantitative analysis of an individual patients' respiratory dysfunction permits a precise, accurate and more effective approach to determining corrective therapy in ARDS.

Computers↗
PubMed1984

Abnormal chromosome in Prader-Willi syndrome.

A Prader-Willi Syndrome (PWS) patient was found to have an extra satellite chromosome, smaller than the normal Chromosome 22, in 60% of her metaphases. G- and C-bandings showed that the extra chromosome did not derive from a Chromosome 15 as has been reported in some PWS patients. Because of variation in chromosomal abnormalities in the PWS patients reported, it was concluded that the chromosomal abnormalities found in them may be a secondary phenomenon rather than the cause of PWS.

Adult↗