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Biomedical subjects

K Hirao

Publications and source records attributed to K Hirao.

At least 91 records · Page 5Linked to original sources
PubMed1994

The response of atrioventricular junctional tissue to temperature.

To determine the optimal temperature for catheter heat mapping without damaging cardiac tissue, we studied the electrophysiologic and histologic responses of the atrioventricular (AV) conduction system exposed to a specific range of temperatures. In 18 closed-chest dogs, an electrode catheter with a thermistor, tip was positioned transvenously at the AV junction. Radiofrequency current (RFC) was applied in incremental temperature steps until transient 2nd-degree AV block was induced. Catheter tip temperature (CTT) was measured at each step. RFC was immediately discontinued when AV block occurred. AV conduction was evaluated before and 4 weeks after the procedure. Acute transient 2nd-degree AV block was induced in 45 applications, during which the average CTT was 48.7 +/- 2.7 degrees C. In another 40 applications in which 2nd degree AV block was not induced, the average CTT was significantly lower [46.3 +/- 2.5 degrees C] (p < 0.001). Eleven of 16 dogs showed acute 2nd-degree AV block, but had normal AV conduction at 4 weeks (Group A). In the other 5 dogs, 1st-degree AV block was seen at 4 weeks (Group B). The lowest CTTs in Groups A and B were 45 and 49 degrees C, respectively. Histologic findings in 2 dogs from Group A revealed that 10-15% (by area) of the AV node was fibrotic. These findings suggest that the induction of fully reversible AV block can be achieved by titration of RFC, during the application of RFC to the AV junction. In conclusion, RF energy was used to produce a tip temperature of between 45 degrees C and 49 degrees C, which induced reversible and significant interruption of conduction of in tissue in the AV junction, and presumably also in target sites in clinical RF ablation.

Animals↗
PubMed1994

Case report: ciliated foregut cyst of the pancreas mimicking teratomatous tumour.

A ciliated cyst of foregut origin is often found in relation to the tracheobronchial tree and the upper gastrointestinal tract, when it is called bronchogenic cyst and enterogenous cyst, respectively. Cysts of this type rarely occur in the pancreas. We report a case of ciliated foregut cyst involving the pancreas, and mimicking teratomatous tumour on radiology.

Adult↗
PubMed1993

Delayed oxidation of intramitochondrial pyridine nucleotide oxidoreduction state as compared with tissue oxygenation in human liver transplantation.

Intra- and post-operative oxygenation of graft liver and subsequent oxidation of the intramitochondrial oxido-reduction state of pyridine nucleotide were studied in partial liver transplantation from living related donors with the ratio of acetoacetate to beta-hydroxybutyrate in arterial blood (AKBR), the ratio of oxidized flavoprotein to reduced pyridine nucleotide (FP/PN ratio) and oxygen saturation of hemoglobin in liver tissue (hepatic SO2). Decreased hepatic SO2 and its heterogenous distribution after reflow of portal vein and hepatic artery were normalized by the end of operation, while the intramitochondrial oxido-reduction state was still reduced at the end of operation and was normalized only at 24 h after the operation. The observed delay in oxidation of the intramitochondrial oxido-reduction state as compared with tissue oxygenation indicates the transition of the intramitochondrial oxido-reduction state associated with the initiation of metabolic activity from the cold preserved state, and suggests an important role for microcirculation in the normalization of the oxido-reduction state.

3-Hydroxybutyric Acid↗
PubMed1993

Radiofrequency ablation of a concealed accessory pathway as treatment for incessant supraventricular tachycardia in a dog.

A new technique for the treatment of certain types of cardiac arrhythmias was used in a 3-year-old dog that was evaluated for incessant supraventricular tachycardia (220 to 280 beats/min), which had been refractory to several treatment regimens. The mechanism of supraventricular tachycardia was atrioventricular (AV) reentry, using a dorsoseptal accessory pathway (AP) for retrograde ventriculoatrial conduction (concealed AP). With the dog under general anesthesia and with fluoroscopic monitoring, electrode catheters were introduced into the heart via peripheral vessels. Electrical recordings allowed localization of the accessory AV pathway. Programmed electrical stimulation was used to verify the function of the abnormal AV connection. At the atrial insertion site of the AP, 2 applications of radiofrequency current (45 V, 21.6 W) were delivered to the dorsoseptal right atrium (near the coronary sinus ostium), which eliminated AP conduction and AV reentrant tachycardia. The dog has remained free of tachycardia and has not required medication during more than 1 year of follow-up.

Anesthesia, General↗
PubMed1993

[CT findings of invaginated mesentery in adult intussusception].

The CT findings of invaginated mesentery in adult intussusception were analyzed in 12 patients (three patients with four small bowel intussusceptions and nine patients with nine large bowel intussusceptions). In all small bowel intussusceptions, the neck was located near the superior mesenteric artery and vein (SMA & SMV) and showed a medial opening, and the vessels in the neck showed a continuity to the left side of SMA & SMV. In most of the large bowel intussusceptions, the neck was located distant from SMA & SMV, and the vessels in the neck did not show continuity to SMA & SMV. The difference in CT findings between small and large bowel intussusception is attributed to the difference in mesenteric anatomy; the small bowel and its mesentery move freely in the peritoneal cavity, whereas the large bowel is partially fixed to the retroperitoneum.

Adult↗
PubMed1993

Quantitative detection of hemoglobin saturation in the liver with near-infrared spectroscopy.

To quantify the changes in oxygen saturation of hemoglobin in the liver in hypoxia and liver transplantation, we applied a novel method using near-infrared spectroscopy. Instead of the conventional two-wave-length method, we obtained near-infrared data from a wide spectral range of 700 nm to 1,000 nm with continuous-wave spectroscopy. To correct the flattened spectral shape caused by photon scattering in living tissue, we then applied an equation taking into account the relationship between absorber concentration and actual absorption in scattering materials as assessed with time-resolved spectroscopy. Hepatic hemoglobin oxygen saturation was calculated with multicomponent analysis. In room air, hepatic hemoglobin oxygen saturation of rabbit was calculated as 57.4% +/- 2.5% (mean +/- S.E.M., n = 7). Arterial, portal and hepatic venous hemoglobin oxygen saturation were simultaneously measured as 97.5% +/- 0.7%, 77.1% +/- 3.4% and 55.5% +/- 4.6%, respectively. The changes in hepatic hemoglobin oxygen saturation seen in graded hypoxia were also close to those in hepatic venous hemoglobin oxygen saturation, suggesting that the average oxygenation state of sinusoidal blood approximates that in the central vein. We tested the clinical applicability of this method in a case of liver transplantation. It was determined that the hepatic hemoglobin oxygen saturation of the graft liver was heterogeneously distributed and that the initially low level of hepatic hemoglobin oxygen saturation was increased by the ligation of portal-systemic shunts.

Adult↗
PubMed1993

Nonuniformity of AH intervals during stimulation at different left atrial sites.

Studies in humans have found left atrial stimulation via the coronary sinus (CS) to elicit significantly shorter atrium-His (AH) intervals as compared to right atrial stimulation, but whether pacing at different left atrial sites (anterior vs posterior left atrium, i.e., far distal vs proximal CS) affects the AH interval has not been studied. Hence, in 22 patients, we compared the effects of stimulation from various atrial sites, including anterior high right atrium (HRA), distal CS, mid-CS, and proximal CS, on: stimulus-atrium (SA), AH, and stimulus-His intervals on the His bundle electrogram. Paced cycle length differed for each patient (range 900-350 msec, mean 532 +/- 140 msec), but conduction intervals from different atrial sites were compared using identical cycle length in each patient. The mean SA intervals were 34 +/- 10 msec, 57 +/- 10 msec, 44 +/- 11 msec, and 32 +/- 8 msec with stimulation, respectively, from HRA, distal CS, mid-CS, and proximal CS (each significantly different except for HRA vs proximal CS). The mean AH intervals were 123 +/- 23 msec, 104 +/- 28 msec, 95 +/- 15 msec, and 90 +/- 18 msec with stimulation, respectively, from HRA, distal CS, mid-CS, and proximal CS (each significantly different except for mid-CS vs proximal CS). In 13 patients, the discrepancy in AH intervals during distal versus proximal CS stimulation was > or = 15 msec; in 9 patients this difference was only < or = 10 msec, considered within the range of measurement error. Thus, in a significant portion of patients, discrepant AH intervals were demonstrated during stimulation from the distal versus proximal CS. These previously undescribed observations suggest that electrophysiological studies on atrioventricular nodal conduction that involve left atrial stimulation must take into account actual location of the stimulation site (anterior or posterior) in order to properly interpret the findings.

Adolescent↗
PubMed1993

"Paradoxical" AH shortening caused by proximal coronary sinus stimulation during orthodromic reciprocating tachycardia.

INTRODUCTION: During extrastimulation or entrainment of orthodromic atrioventricular (AV) reciprocating tachycardia (ORT), the atrium-His (AH) interval as measured at the His-bundle recording site is expected to lengthen due to extrastimulation-dependent or pacing rate-dependent slowing of AV nodal conduction by impulses that penetrate the tachycardia circuit. We report 6 patients in whom the AH interval "paradoxically" shortened during ORT in response to extrastimulation and rapid pacing from the proximal coronary sinus. METHODS AND RESULTS: Accessory pathway location was right anterior (1 patient), right anteroseptal (1 patient), and left anterior (4 patients). Cycle length of ORT was stable (variation < or = 5 msec) and ranged from 325 to 410 msec. During ORT, extrastimulation and rapid pacing were performed from the proximal coronary sinus and the right atrium. Extrastimulation from the proximal coronary sinus late in diastole caused significant shortening of AH interval in all patients by a mean of 18 +/- 3 msec (range 15 to 20 msec). AH shortening was demonstrated without a change of either the timing or morphologic appearance of the low septal right atrium at the His-bundle recording site. This phenomenon was not observed during right atrial extrastimulation. Rapid pacing from the proximal coronary sinus at cycle lengths of 305 to 390 msec (i.e., 15 to 20 msec shorter than the cycle length of each ORT) again demonstrated shortening of AH interval in all patients by a mean of 15 +/- 3 msec (range 10 to 20 msec). By contrast, rapid pacing from the right atrium demonstrated classical AH prolongation at any paced cycle length. CONCLUSION: AH shortening without a change of either the timing or morphologic appearance of the low septal right atrium at the His-bundle recording site confirms the existence of a distinct posterior atrial input to the AV node. In this setting low septal right atrial activation is not requisite for AV nodal conduction. Whether activation of the low septal right atrium is essential for, or contributes to, AV nodal conduction of atrial impulses from locations other than the proximal coronary sinus needs to be determined.

Adolescent↗
PubMed1993

The relationship between early afterdepolarization and the occurrence of torsades de pointes--an in vivo canine model study.

The relationship between early afterdepolarization (EAD) and the occurrence of torsades de pointes (TdP) was studied in a canine model. Twelve dogs of both sexes, weighing 9.9-16 Kg, were studied. After reducing the concentration of serum potassium to 3.0-4.0 mEq/l, by administration of calcium polystyrene sulfonate at 15-20 g/day for 1 or 2 weeks, a 6F electrode catheter was introduced via the femoral vein and positioned at the atrioventricular (AV) junction. Complete AV block was produced by catheter ablation using a high frequency current. A Franz 6F catheter was introduced into the right ventricle to record monophasic action potentials (MAPs) using the contact electrode technique. After a stable recording of the MAPs was achieved, cesium chloride (CsCl; 1 mM/Kg) was administered as an intravenous bolus over 15 sec. The MAPs and electrocardiogram (ECG) changes were simultaneously recorded for 30 min after the administration of CsCl. The administration was repeated several times at intervals 30 min. Sustained or non-sustained ventricular tachycardia was produced in all dogs. EAD appeared in 8 of 12 dogs. When EAD developed sufficiently high amplitude, ventricular premature beats occurred near the peak of EAD and TdP was induced in 3 of 8 EAD-positive dogs. TdP was not induced in EAD-negative dogs. Although TdP was comparatively difficult to induce, EAD-triggered activity was suggested to be one of the necessary conditions for TdP, because TdP occurred only when EAD reached a sufficiently high amplitude to produce ventricular premature beats.

Action Potentials↗
PubMed1993

Changes in the hepatic oxygenation state during hemorrhage and following epinephrine or dextran infusion as assessed by near-infrared spectroscopy.

Changes in the hepatic oxygenation state of rabbits during hemorrhage and subsequent epinephrine (n = 6) or dextran infusion (n = 6) were assessed by tissue near-infrared spectroscopy. Oxygen saturation of hemoglobin in the liver (hepatic SO2), and redox transition of cytochrome aa3 were analyzed by applying multicomponent analysis to the absorption spectrum of the liver. Hepatic SO2, representing extracellular oxygenation state, decreased from 62.4 +/- 2.7% (mean +/- SEM) to 21.1 +/- 7.3% after bleeding. It increased to 31.8 +/- 6.6% after epinephrine infusion, but returned to near-control levels after dextran infusion. Intracellular oxygenation state as assessed by the changes in the oxidized and reduced forms of cytochrome aa3 was impaired after bleeding, and remained as such even after epinephrine infusion. By contrast, it was normalized to near control levels after dextran infusion. Changes in the difference of hepatic SO2 and hepatic venous SO2 suggested that the intrahepatic blood flow was more heterogeneously distributed after bleeding, but that the heterogeneity of microcirculation was rather diminished after epinephrine infusion.

Animals↗
PubMed1993

Variant forms of AV and VA conduction in the canine heart.

In 19 pentobarbital anesthetized dogs subjected to right thoracotomy, plunge wire and catheter electrodes were positioned to record and pace from the high right atrium, coronary sinus os, aortic root (for His bundle electrograms), and the right ventricular outflow tract and apex. A deflectable-tip catheter electrode was placed under the septal tricuspid leaflet for pacing the right ventricular septal crest. Electrocardiographic leads II and aVR were also recorded during atrial and ventricular pacing in the control state and during low- and high-intensity left vagosympathetic trunk stimulation. Pacing from each A or V site in 12 dogs showed normal atrioventricular (AV) and ventriculoatrial (VA) conduction over a wide range of heart rates (120-360 beats/min) with progressive AV and VA delay at each heart rate until Wenckebach cycles occurred (AV Wenckebach cycle averaged 325 +/- 44 beats/min; VA Wenckebach cycle averaged 246 +/- 52 beats/min). In two dogs, pacing from the coronary sinus os showed a 30-beat/min difference in the Wenckebach cycle rate compared to high right atrium pacing, and the AH intervals for the former were relatively insensitive to vagosympathetic trunk stimulation compared with the latter. In five other dogs, retrograde VA and HA intervals showed little, if any, decrement over a wide range of heart rates, with no immediate response to low-intensity vagal stimulation. After 7-22 seconds of continuous vagal stimulation, VA intervals abruptly prolonged and/or blocked. In all, second-degree heart block occurred at ventricular pacing rates > or = 300 beats/min in the form of atypical Wenckebach cycles. In all cases, the earliest atrial activation, as measured by a close bipolar probing electrode, was in the posterior septum adjacent to the coronary sinus os. In one dog, VA block occurred as a Mobitz type II with paroxysmal complete VA block (sinus escape rhythm) during continuous ventricular pacing at 330 beats/min. After radiofrequency ablation of the earliest atrial activation site typical VA Wenckebach cycles, immediately responsive to vagal stimulation, was then observed at a ventricular pacing rate of 150 beats/min. These data suggest that AV and VA connections in some canine hearts show varying degrees of bypass of the AV node, similar to cases reported in the clinical literature.

Animals↗
PubMed1993

[A comparative study of the health conditions of elderly people living alone, elderly couples and the bedridden elderly at home in a rural area of Shiga Prefecture: special reference to morbidity rate and blood pressure, electrocardiograph and blood examination data].

For the purpose of obtaining basic data and for establishing a support system for elderly people with various health and social problems, a population survey was performed in 1990 to investigate the health and living conditions of elderly people living alone, elderly couples and the bedridden elderly in the town of Shigaraki, Shiga Prefecture. A total of 275 subjects (103 male, 172 female) 65 years of age and over were surveyed. The participation rate in this survey was 88.1%. Analysis of health conditions (morbidity rate, blood pressure, electrocardiograph and blood examination data) of elderly people living alone, elderly couples and the bedridden elderly produced the following: 1) Stroke was the main cause of being bedridden in men, while in women, bone and joint disease, especially fracture, was the main cause. 2) The combined prevalence of hypertension and borderline hypertension in elderly people living alone, elderly couples and the bedridden elderly was over 50%. The bedridden elderly had a lower prevalence than elderly people living alone and elderly couples. 3) Men in all of the above mentioned life styles, had a higher tendency of showing ECG abnormalities than women. The tendency for major ECG abnormalities was high for bedridden elderly, both male and female, with the tendency for men being higher. 4) In bedridden elderly, a tendency of higher prevalence of anemia, in both male and females, lower total serum cholesterol and triglyceride in males compared to elderly people living alone and in elderly couples, was observed.

Activities of Daily Living↗
PubMed1992

Atrioventricular nodal reentrant tachycardia with retrograde block induced by aprindine.

Two patients are described who had atrioventricular nodal reentrant tachycardia (AVNRT) with 1:1 relationship in the control state, but in whom a varying degree of VA block during AVNRT was observed during therapy with aprindine. Aprindine, however, did not cause anterograde blockade of conduction over the slow AV nodal pathway during tachycardia. These observations support the conclusion that the bulk of atrial muscle is not a requisite part of the tachycardia circuit in AVNRT and that antiarrhythmic drugs may have disparate effects on conduction in the retrograde and anterograde limbs of the circuit.

Adult↗
PubMed1992

Retrograde supernormal conduction, gap phenomenon in concealed accessory atrioventricular pathways.

We present four patients with the Wolff-Parkinson-White syndrome who exhibited retrograde supernormal conduction or gap phenomenon in concealed accessory pathways. In the first patient, ventricular extrastimulus testing revealed retrograde block at the coupling interval of 520 msec and reappearance of conduction at the coupling interval of 370 msec. In a second patient, 1:1 retrograde conduction was not present but supernormal conduction was demonstrated at coupling intervals of 360 msec to 310 msec during the ventricular extrastimulus testing when the basic drive consisted of atrioventricular (AV) simultaneous pacing. In a third patient, ventricular extrastimulus testing demonstrated retrograde conduction through the accessory pathway only at coupling intervals of 400 msec to 360 msec. In a fourth patient, retrograde block occurred at the coupling interval of 340 msec and retrograde "slow" conduction reappeared at coupling intervals of 300 msec to 250 msec (gap phenomenon) only when the basic drive consisted of AV simultaneous pacing. Thus, concealed accessory pathways may exhibit retrograde supernormal conduction or gap phenomenon. Ventricular extrastimulus testing consisting of AV simultaneous pacing during the basic drive may facilitate demonstration of these unusual properties.

Adult↗
PubMed1992

A study of fracture and inelastic behavior of bioactive glass-ceramics and glasses.

The fracture and inelastic behavior of A-W glass-ceramics, phosphate glasses, silicate glasses, and borate glasses were determined in simulated body fluid (SBF), kerosene, and water. By using the stable crack growth technique, an inelastic behavior was observed on the diagram of load versus load-point displacement. From these studies, it was suggested that the inelastic behavior of bioactive glass-ceramics was produced by the plastic deformation of glassy phase on the grain boundary.

Apatites↗