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Biomedical subjects

K Kawachi

Publications and source records attributed to K Kawachi.

At least 145 records · Page 8Linked to original sources
PubMed1991

[A quantitative angiographic study of characteristics of internal thoracic artery grafts in coronary artery bypass surgery].

In adult patients with atherosclerotic coronary artery disease and in pediatric patients with Kawasaki heart disease, characteristics of internal thoracic artery grafts (ITA grafts) used for coronary artery bypass grafting (CABG) were quantitatively assessed by postoperative angiography. In 142 adult patients with a ITA graft for the left anterior descending artery (LAD), the diameter ratio between ITA graft and recipient LAD at the point close to the anastomotic site (ITA/LAD diameter ratio) was determined by postoperative angiography. This ratio for the adult patients as a whole was 1.04 +/- 0.34. The multivariate analysis (Quantification I) was performed to assess the effects of the following 12 factors on the ITA/LAD diameter ratio: (1) age at the time of operation, (2) sex, (3) time-duration from the operation to angiography, (4) laterality of the ITA used, (5) presence of an undivided major side branch of the ITA graft, (6) presence of blood flow competition between the ITA graft and other grafts, (7) presence of distal stenosis of the recipient LAD, (8) severity of LAD stenosis after the operation, and (9-12) presence of hyperlipidemia, diabetes mellitus, hypertension, or smoking history. The standardized category scores of 25% LAD stenosis, 50% LAD stenosis, and blood flow competition between the ITA and other grafts were -0.815, -0.359, and -0.306, respectively. Insignificant stenosis of the recipient coronary artery was associated with reduction of the ITA/LAD diameter ratio, and this ratio strongly correlated with the severity of LAD stenosis (partial correlation coefficient: 0.627). However, no other factors significantly influenced on the ITA/LAD diameter ratio. In 15 pediatric patients, the length and diameter of 19 ITA grafts and 5 saphenous vein grafts (SVGs) which remained patent in the early (about one month) and late (14 +/- 4 months) postoperative period were determined. Only in the ITA graft, increases in graft length and diameter associated with patient growth were recognized. In the present study, the physiological characteristics of the ITA graft were demonstrated as a viable conduit with flow adaptability and growth potential.

Adult↗
PubMed1991

[A penetrating cardiac wound by a flying metallic fragment].

A 54-year-old man suddenly felt a strike on his chest while mowing with a machine. At first he had no symptoms except for wound pain, but several hours later, he suffered from high fever with chilliness. The chest roentgenogram showed a foreign body localized within the cardiac shadow. The echocardiogram revealed that the metallic fragment was embedded in the inferior wall of the left ventricle. It appeared that the fragment entered the left ventricular cavity through his anterior chest wall, the right ventricular outflow tract and the ventricular septum. At the operation, the location of the foreign body was again confirmed by the intraoperative echocardiography and the fragment was successfully removed through a left ventricular incision under cardiopulmonary bypass. The postoperative course was uneventful and the case was reported with a review of the literature.

Echocardiography↗
PubMed1990

Surgical treatment of renal cell carcinoma with a tumor thrombus extending into the right atrium.

We experienced surgical treatment on two patients having renal cell carcinoma with a tumor thrombus extending into the right atrium. In these patients, we performed nephrectomy, dissection of lymph nodes and removal of a tumor thrombus using cardiopulmonary bypass. One died of multiple organ failure 42 days postoperatively; the other was discharged from the hospital and is currently doing well 12 months after the operation. Cardiopulmonary bypass combined with hypothermia and low blood flow significantly facilitated removal of the tumor thrombus extending into the right atrium without the risk of pulmonary embolism or brisk hemorrhage.

Aged↗
PubMed1990

[A double monoclonal IgG1-kappa and IgG3-lambda with electrophoretically same mobility in a single patient].

The serum from a 78-year-old male (SY) with abdominal aneurysm was shown to contain monoclonal protein (MP) of IgG. Immunoelectrophoresis (IEP) and immunofixation electrophoresis (IFE) of SY serum revealed MP reacted with both of anti kappa and anti lambda antisera. To see whether the monoclonal IgG molecule possesses both types of light chains, an attempt to separate MPs isolated by zone electrophoresis was made by affinity chromatography using anti kappa and anti lambda Sepharose 4 B conjugates. Immunodiffusion (ID) of these separated MPs showed that kappa type of MP (MP-kappa) was IgG1, while lambda type of MP (MP-lambda) was IgG3. For preparation of anti-idiotype antibodies (Aid) against MP-lambda, antisera against MP-lambda raised in rabbits by immunization with affinity-chromatographic purified MP-lambda was absorbed with solid phase normal human serum. ID and IFE of these MPs (original MP, MP-lambda and MP-kappa) revealed MP-kappa did not react with Aid, suggesting idiotype of MP-kappa was different from that of MP-lambda. These results indicate that two types of MPs derived from different B cell clones happen to have same mobility electrophoretically.

Aged↗
PubMed1990

[A new method for closure of median sternotomy: applications of a stapler system].

Power driven staples were used in 20 patients for median sternotomy closure, and the staples were evaluated for clinical fixation. In each case four to six staples and two wires were used to secure closure. Clinically, in one patient prolonged sternal flail was observed, but this disappeared after six weeks. In the remaining 19 patients, good sternal fixation was secured. No cases required surgical procedures such as refixation of the sternum or removal of the staples. As a means of assessing the status of "backing out", which is a major cause of poor fixation, the backing out part of the staple leg was measured from lateral sternal radiographies. The ratio of the backing out portion to the staple leg, the backing out ratio (BOR), was calculated. The average BOR was found to be 32.7 +/- 21.4% (n = 102). The BOR was 70% or less in 91.2% of all staples, and 70% or more in 8.8%. The fragility of the sternum, poor sternal connection and inadequate technique to drive were suspected as factors accountable for backing out. In conclusion, the stapler system seems to be useful for sternal fixation and will become even more after improvement of the staple size and technical modifications to assure better connection at the driven site.

Adult↗
PubMed1990

[Clinical results, graft patency and flow reserve capacity of multiple coronary artery bypass with bilateral or sequential internal thoracic artery grafts].

Multiple coronary artery bypass grafting (CABG) was performed utilizing the internal thoracic arteries (ITA) in 87 patients ranging in age from 3 to 76 years. Bilateral ITAs were used in 67, sequential grafting was performed in 16, and the combination of both techniques was applied in 4 patients. Twelve patients had coronary arterial obstructions due to Kawasaki disease (mean age 9.7 +/- 3.3 years) and the remaining 75 patients had atherosclerotic coronary artery disease (mean age 53 +/- 10 years). Triple vessel disease and left main trunk disease occupied 85% of the patients. The number of grafts was 2 to 5 per patient with an average of 3.2 +/- 0.7 per patient. In bilateral ITA grafting, the combination of the RITA to LAD and LITA to LCX was most frequently used, and in sequential grafting, the LITA-diagonal artery-LAD was the most common use. There were no early or late mortalities in the present series. The patency rates for the RITA and LITA were 93% and 96%, respectively, and those of sequential grafting were 100% in both the proximal and distal anastomoses. The clinical outcome of multiple CABG with ITAs was quite satisfactory, and the bilateral ITAs could be used in the very wide range of patient's age from 3 to 76 years. In addition, blood flow reserve provided by bilateral ITAs was equivalent to that of the SVG alone or SVG plus ITA on the basis of the result of coronary sinus flow (CSF) measurements during exercise, and thus complete revascularization of the left ventricle could be accomplished by multiple CABG with ITAs.

Adult↗
PubMed1990

[Percutaneous balloon valvuloplasty of a stenosed bioprosthesis (Carpentier-Edwards xenograft) in the tricuspid valve position].

Two patients with increasing stenosis of a bioprosthesis in the tricuspid valve position were treated by percutaneous balloon valvuloplasty (PBV). Tricuspid valve replacement with a Carpentier-Edwards xenograft and mitral valve replacement with a Duromedics mechanical valve had been performed in both of them 2 to 3 years prior to PBV. Echocardiographic studies revealed tricuspid bioprosthetic stenosis with a prolonged pressure half time. After PBV, the calculated valve area and cardiac index increased and the pressure half time was shortened, although improvement of clinical symptoms was not apparent. Complications related to the procedure did not occur. Further studies are required to determine the indications and to see the long term results of PBV on stenosed bioprosthesis in the tricuspid valve position, but for the moment, we consider PBV be tried with caution for a stenosed bioprosthesis in the tricuspid valve position before the decision for re-replacement of the prosthesis.

Bioprosthesis↗
PubMed1990

[Surgery for postinfarction ventricular septal perforation under hypothermic fibrillatory arrest with pulsatile perfusion].

Surgery were performed by 2 different methods of myocardial protection in 17 patients with postinfarction ventricular septal perforation (VSP) from 1982 to 1989. Ten consecutive operations were performed using hypothermic fibrillatory arrest with pulsatile perfusion (VF group). Pulsatile flow was produced by an intra-aortic balloon pumping device. Other 7 consecutive VSP operations were performed using cardioplegic arrest (CP group). In the VF group, the mean age was 67 years (range 54 to 78 years), and VSP was located in the anterior wall in 7, in the inferior wall in 2, and in the anterior and inferior walls in 1 patients. The operation was performed 2.5 days after the onset of VSP. In the CP group, the mean age was 71 years (range 50 to 78 years), and VSP was located in the anterior wall in 6 and in the inferior wall in 1 patient. The operation was performed 4.7 days after the onset of VSP. Cardiogenic shock developed after septal rupture in 50% of the patients in the VF group and 71% in the CP group (N.S.). Prior to the operation, no significant differences were found in hemodynamic status between the 2 groups. Cardiac index in the VF group was higher than that of the CP group (p less than 0.05) shortly after cardiopulmonary bypass. The operative mortality rate was 10% in the VF group and 57% in the CP group. From these clinical results, hypothermic fibrillatory arrest with pulsatile perfusion can be beneficial as a method of myocardial protection during surgery for VSP and presently this has become the method of choice in our department.

Aged↗
PubMed1990

Bilateral internal mammary artery grafts for coronary artery bypass operations in children.

We performed myocardial revascularization with bilateral internal mammary arteries in eight children for coronary artery complications consequent to Kawasaki disease. Subjects included seven boys and one girl, ranging in age from 3 to 13 years (mean age, 8.3 +/- 3.4 years). The body surface area ranged from 0.65 to 1.65 m2 (average, 1.08 +/- 0.35 m2). Three patients had a previous myocardial infarction. The right internal mammary artery was anastomosed to the right coronary artery and the left internal mammary artery was sutured to the left anterior descending artery in all patients. The patients received an average of 2.4 grafts. Magnifying loupes of 3.5 X were used for anastomosis with 8-0 monofilament polypropylene sutures. Subjects were followed up from 12 to 38 months (23 +/- 10.8 months) after operation. All were doing well with no recurrence of angina, and body development was normal, including the sternum and thorax according to chest x-ray films and computed tomography of the chest. Patency of the bilateral internal mammary arteries was 100% in the early (within 1 month) postoperative period and remained so in the late (over 1 year) postoperative period. Anastomotic junctions between the internal mammary artery and the coronary artery developed well angiographically in the late postoperative period. The internal mammary artery is the graft of choice for pediatric myocardial revascularization because of its excellent long-term patency and growth potential. Bilateral internal mammary arteries should be used whenever indicated, and the use of bilateral internal mammary arteries did not adversely influence chest wall development in the children.

Adolescent↗
PubMed1990

[Surgery of aortic valvular disease with congenital bicuspid or quadricuspid aortic valve].

Twelve patients (age 18 to 69 years old) with surgical treatment for congenital bicuspid aortic valve and one (age 26 years old) for quadricuspid aortic valve were reported. These 13 patients occupied 12.3% of the total number of patients with aortic valve replacement during the same period. Among the patients with bicuspid aortic valve, 10 patients were male (83%) and 2 were female (17%). Seven patients exhibited aortic stenosis and 5 showed predominant aortic regurgitation. The mean age of patients with aortic stenosis was higher than that of patients with aortic regurgitation. (63.3 years vs 32.0 years old). Infective endocarditis occurred in 2 patients (17%). Three patients had pure aortic regurgitation without evidence of endocarditis. One 26-year-old female patient who had a quadricuspid aortic valve presented with aortic regurgitation associated with PDA. All patients underwent aortic valve replacement with no early and late deaths.

Adult↗
PubMed1990

[An operative case of chronic constrictive pericarditis with silicosis and lumbar caries].

We reported a case of chronic constrictive pericarditis complicated with silicosis and lumbar caries, who was improved by the operation. The patient was a 65 year old man whose past occupation was a mason. He was admitted to our hospital with chronic heart failure on March, 1986. Atypical silicosis was diagnosed from the occupational history and the histopathological silicotic changes in mediastinal lymph nodes and fibrosis of alveolar wall. The diagnosis of chronic constrictive pericarditis was made from chest roentgenogram and intracardiac catheterization. The symptoms of chronic constrictive pericarditis was improved by the pericardial resection. The exact pathogenesis of the chronic constrictive pericarditis could not be identified from the histology of pericardial tissue, but tuberculosis was suspected because of the past history of tuberculous pleurisy and the recurrence of lumbar caries.

Aged↗
PubMed1990

[Hemolysis and red cell deformability during cardiopulmonary bypass--the effect of prostaglandin E1 for prevention of hemolysis].

Prevention of hemolysis which is related to renal failure during cardiopulmonary bypass (CPB) is very important. We discussed the relationship between hemolysis and red cell deformability during CPB, and moreover the effect of PGE1 to reduce hemolysis. PGE1 was given during CPB (10 approximately 20 ng/kg/min). Red cell deformability was measured using 20% Ht red cell suspension and Nucleopore Microfilter (pore size: 5 mu). Red cell filtration rate (RFR: microliter/sec) was calculated as a value of red cell deformability. Red cell deformability (RFR: microliter/sec) was reduced during CPB in almost all patients. Secondly, plasma Hb (mg/dl) was measured in the controls (n = 8) and PGE1 group (n = 12). The mean pre-bypass level were 20.6 in the control group and 23.8 in the PGE1 group. The mean values of plasma Hb at 30, 60, 90 and 120 min of CPB were 37.8, 52.4, 52.3 and 61.2 in the control group and 24.1, 25.0, 26.3 and 29.0 in the PGE1 group. Our study showed conclusively that CPB has a detrimental effect on red cell deformability and that this effect is accentuated by prolongation of CPB time. PGE1 lessened the decrease in red cell deformability during CPB and was shown to be very effective for prevention of hemolysis.

Alprostadil↗
PubMed1990

[Comparison of early clinical results of contact laser thermal angioplasty with a metal hot tip with balloon angioplasty].

Contact laser thermal angioplasty with a metal hot tip heated by an Argon laser system (Trimedyne Inc.) was performed on 34 peripheral arterial occlusive or stenotic regions (7 iliac, 20 femoral and 7 popliteal arteries) in 22 patients with ASO. The early clinical results of laser angioplasty were investigated by comparing those of 15 patients treated by percutaneous transluminal balloon angioplasty (PTA). There was no perforation of the arterial wall caused by thermal ablation with the hot tip heated by repeated pulses under power conditions of 10 watts of laser energy for 5 seconds. Detachment of the hot tip caused by frequent healing without a sufficient period of tip cooling was observed in 2 cases. Acute thrombosis was observed in 1 patient during reconstruction of the proximal artery. The initial success rate of laser angioplasty and PTA was 91.2% and 86.7%, respectively. Re-stenosis or occlusion was observed in 7 of 31 regions 6 months after laser angioplasty. Satisfactory results were not obtained in the femoral artery. The overall patency rate of laser angioplasty and PTA was 77.4% and 69.2%, respectively. The initial success rate of laser angioplasty in totally obstructed arterial regions was higher than that of PTA.

Aged↗
PubMed1989

Different responses of coronary artery and internal mammary artery bypass grafts to ergonovine and nitroglycerin in variant angina.

The dynamic responses of a coronary artery and an internal mammary artery (IMA) graft to pharmacological intervention were examined by arteriography in 5 patients with variant angina who had undergone coronary artery bypass grafting with an in situ IMA to the left anterior descending coronary artery. Preoperative electrocardiographic findings included elevated ST segments in chest leads during attacks of angina, and all patients had severe fixed lesions in addition to marked spasm of the left anterior descending coronary artery after the administration of ergonovine maleate. Postoperatively with ergonovine stimulation, complete occlusion or marked subtotal narrowing was again observed at the primary fixed lesion in the proximal portion of the left anterior descending coronary artery, but the IMA graft and the coronary artery distal to the anastomotic site maintained satisfactory patency with no further occurrence of anginal pain or ST segment elevation. By computer-assisted graphic analysis, which allows highly reproducible measurements of vascular internal diameters, the diameter of the IMA showed only small changes under ergonovine (p = not significant) or nitroglycerin (p less than 0.05) stimulation in contrast to the marked vascular reactivity of the coronary artery (p less than 0.05 and less than 0.01, respectively). These findings indicate that the IMA graft is unresponsive to ergonovine at least in the amount required to produce coronary artery spasm in patients with variant angina and fixed lesions. The IMA graft appears to function well from a clinical and pharmacological viewpoint in patients with variant angina.

Adult↗
PubMed1989

Clinical results and in vivo valve function after implantation of a Bicer valve prosthesis in the aortic position.

Between December 1981 and June 1987, 71 patients underwent aortic valve replacement with a Bicer monostrut tilting disc prosthesis. Clinical results and in vivo function of the artificial valve were assessed. The average age of the 71 patients at the time of operation was 51.3 +/- 11.5 years. The hospital mortality rate was 2.8% (two patients) and there were no further deaths during a mean (+/- SD) follow-up period of 2.4 +/- 1.6 years (range 1 month to 5.5 years) after surgery. There was also no occurrence of thromboembolism or valve dysfunction. Function of the Bicer valve prosthesis was assessed in 17 patients: 5 with a 21 mm valve, 7 with a 23 mm valve and 5 with a 25 mm valve. Examination was performed on average 10.3 +/- 8.1 months after surgery. Valve function was examined at rest and during exercise performed with a bicycle ergometer. Pressure gradients at rest were low: 21 mm valve = 8 mm Hg, 23 mm valve = 3 mm Hg and 25 mm valve = 2 mm Hg; the gradients during exercise were 11, 8 and 8 mm Hg, respectively. The valves had the following effective orifice area at rest: 21 mm valve = 1.54 cm2, 23 mm valve = 4.20 cm2 and 25 mm valve = 3.76 cm2; during exercise, the respective areas were 1.57, 3.48 and 3.01 cm2. These valves are deemed to be sufficiently wide for effective valve function. Aortographic observation indicated mild regurgitation that was within reasonable limits and posed no problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1989

[Coronary artery bypass surgery with internal mammary artery grafts: clinical and angiographic results].

We report clinical and angiographic results of coronary artery bypass grafting (CABG) surgery in 307 patients. IMA grafts can be utilized in the wide ranges of patient ages and/or coronary lesions including left main trunk disease, and have good adaptive capability to coronary flow demand with very low probability of atherosclerotic changes. Postoperative (5.2 +/- 4.4 months) patency rates for IMA grafts and SVG were 96% and 86%, respectively; a significant difference (p less than 0.001). From the benefits of this graft, the use of IMA has become a routine procedure in our CABG surgery and the rate of multiple bypasses with IMA grafts has increased recently. The late cardiac events have significantly (p less than 0.05) decreased in patients with the IMA graft than in those without it. We believe that the use of IMA has improved the quality of CABG in Japanese patients and this operative modality can bring better late results than multivessel PTCA.

Adolescent↗
PubMed1989

[A right common iliac aneurysm perforating into the inferior vena cava with resultant congestive heart failure].

A 69 year-old male with a right common iliac aneurysm perforating into the inferior vena cava was admitted with severe cardiomegaly and dyspnea. He had been suffering from recurrent congestive heart failure for the last 8 years prior to surgery. At operation, the fistula of 15mm diameter was closed with interrupted sutures of 3-0 nylon with pledgets within the aneurysm by controlling bleeding from the fistula by digital compression. The right common iliac aneurysm was resected and replaced with a double velour knitted dacron graft of 10mm diameter. The postoperative course was uneventful. The CTR was reduced to 57% from 70%, and the cardiac index was normalized from 6.10 to 3.39 l/min/m2. This complication is rare with only 4 previous reports in Japan. Hemodynamic improvements were dramatic after surgery in spite of poor response to medical treatments. This complication should be surgically managed as soon as the diagnosis is confirmed.

Aged↗