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Biomedical subjects

K Kikuchi

Publications and source records attributed to K Kikuchi.

At least 631 records · Page 35Linked to original sources
PubMed1995

[Change of the cognitive function after open heart surgery].

The changes of cognitive function after open heart surgery was examined using the Hasegawa's Dementia Scale (max. 30 points) in 47 patients with average age of 61.7 years. The patient's score was obtained preoperatively, and 1st and 7th postoperative days. Patients with postoperative scores above 24 points were classified as Non-Decline group, and those below 23 points as Decline group; comparative analyses were done on the relationship between various perioperative factors on both groups. Anesthesia was induced with low-dose fentanyl and isoflurane-nitrous oxide in oxygen. The average operating time was 331 minutes, and the cardiopulmonary bypass time was 108 minutes with normothermia. There were 31 Non-Decline cases, and 16 (34%) Decline cases on the 1st and 5 (10 %) on the 7th postoperative day. The largest decrease in the Decline group was seen on the 1st postoperative day, and there were 4 cases of dementia. The factors in which a significant difference was observed between the 2 groups were age, amount of transfusion, extubation time, preoperative complications and postoperative cardiac index, and these was not related to the operation or ECC time. Moreover there were high incidences of postoperative complications, especially LOS, in the Decline group. It was concluded that one of the largest contributing factors of abnormality of the cognitive function postoperatively was age, and other factors such as pre- and postoperative general conditions of the patients, especially cardiac function, might also be related. The length of hospitalization in the cases of decreased cognitive function was longer.

Adult↗
PubMed1995

[Postoperative management following open heart surgery by thoracic epidural anesthesia].

The significance of thoracic epidural anesthesia as a postoperative analgesic-sedative was evaluated. Ninety-seven open heart surgery patients with average age of 64 years, were classified into: Non-Epidural (N) group, Epidural with butorphanol (B) group and Epidural with morphine (M) group, in each of which the pulmonary, circulatory and sedative states were studied. Anesthesia was induced with low-dose fentanyl and isoflurane-nitrous oxide-oxygen, and epidural catheter was inserted through Th 7-10 on the day before the operation for Epidural groups. Butorphanol 0.5-1.0 mg was administrated in B group, and morphine 2-5 mg in M group. The Epidural groups required only small amount of fentanyl, 5 micrograms.kg-1, were extubated earlier compared to N group, and showed higher postoperative cardiac index. As for the respiratory state, although PaCO2 was slightly higher in the Epidural group, there was no difference in oxygenation. The incidence of administration of postoperative analgesic-sedative was extremely low in the Epidural especially in M group. As long as the indication is appropriately selected, the epidural anesthesia will not have negative effect on the postoperative pulmonary and circulatory state, allows for an earlier extubation and has excellent sedative effect. It is an effective method for patient management following open heart surgery.

Aged↗
PubMed1995

[A case of large cell carcinoma of the lung arising from the inner surface of a pulmonary bulla and complicated by hematoma].

A 64-year-old man with a history of smoking was admitted to our hospital, because he was noted to have a solitary mass lesion at the apex of the right lung on a chest roentgenogram. Eight months before admission, he had come to our hospital because of hemoptysis. At that time, however, no abnormal shadow was seen on his chest roentgemogram, except for multiple bullae at both apexes. Based on chest CT findings on admission, the tumor appeared to be a hematoma growing inside the bulla. The resected tumor was found to contain a large amount of coagulated blood in the bulla. Histopathological examination of the bulla revealed a proliferation of large atypical cells from the inner surface of the bulla toward the inner space. Thus, the diagnosis was large cell carcinoma within the wall of the pulmonary bulla, the inside of which was filled with hematoma. We believe that the hematoma in the bulla allowed us to make an early diagnosis, and thus to succeed in curing the patient.

Carcinoma, Non-Small-Cell Lung↗
PubMed1995

Laparoscopic retrieval of disconnected ventriculoperitoneal shunt catheters: report of two cases.

Two patients previously treated with ventriculoperitoneal shunt for hydrocephalus had the distal catheters disconnected, and they migrated to the free peritoneal cavity. The signs and symptoms of increased intracranial pressure occurred as a result of mechanical failure of the shunt system. Both patients successfully underwent a laparoscopic retrieval of the catheters using endoscopic grasping forceps, and revision of the ventriculoperitoneal shunt by inserting the new catheters into the peritoneal cavity was performed through a small entrance for the laparoscope. Recently, conventional laparotomy has been often replaced by laparoscopic surgery, and general surgeons are well familiar with the laparoscopic procedures. The significant advantage of this procedure is the ability to explore the entire peritoneal cavity for both diagnosis and treatment, and it is by far a less invasive approach than conventional laparotomy. The present report describes the laparoscopic procedure for removal of the migrated catheters and discusses its advantages over conventional laparotomy.

Adult↗
PubMed1995

[Neurofibromatosis associated with multiple intracranial vascular lesions: stenosis of the internal carotid artery and peripheral aneurysm of the Heubner's artery; report of a case].

Neurofibromatosis (NF), or von Recklinghausen's disease, is an autosomal dominant disorder of both mesoderm and ectoderm dysplasia commonly characterized by numerous neurofibromas and cafe-au-lait spots. However, cerebrovascular diseases associated with NF are rare, and among them occlusive vascular lesions have already been reported in the literature. It is postulated that the pathogenesis of the associated vascular lesions may be attributable to the proliferation of Schwann cells and the subsequent degeneration in the vessel wall. We documented here an uncommon case of NF associated with massive intracerebral hemorrhage caused by an aneurysm at the distal portion of the dilated Heubner's artery. Intracranial hemorrhage in association with NF is reviewed in the literature, and the clinical profiles, type and origin of bleeding, and associated occlusive vascular lesions are discussed. A 55-year-old man was admitted to our hospital on January 12, 1994, after he had suddenly become comatose. The patient was known to be affected by NF from both the family and past histories. On admission, the patient demonstrated a decerebrate posture in response to painful stimuli, and was then graded as 200 according to the Japan Coma Scale (JCS). CT scan showed a significant amount of blood clots present at the base of the right frontal lobe and in the lateral and third ventricles. After bilateral ventriculostomies were carried out for continuous drainage of bloody cerebrospinal fluid, the patient continued to regain partial consciousness to the level of JCS grade 3 until the seventh day, when he again suddenly deteriorated and became comatose.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm, Ruptured↗
PubMed1995

[Hypersensitivity pneumonitis induced by dust from an automatic bed cleaner].

A 49-year-old woman used an automatic bed cleaner on October 18, 1990. Eight hours later, she was admitted to a hospital complaining of coughing and fever. The chest X-ray film showed small granular shadows in both lower lung fields. After a few days of antibiotic therapy, these symptoms had disappeared. She used the bed cleaner again on the afternoon of November 15, 1990. The next day, she was admitted to our hospital because of coughing and fever. An environmental provocation test with the bed cleaner induced the same symptoms. Dust from the bed cleaner stimulated her lymphocytes. Hypersensitivity pneumonitis from the dust of a bed cleaner was diagnosed.

Allergens↗
PubMed1995

Laparoscopic Billroth I gastrectomy for gastric ulcer: technique and case report.

A laparoscopic distal gastrectomy with gastroduodenostomy (Billroth I) was performed on a patient with intractable gastric ulcer. The patient was a 56-year-old man, complaining of severe epigastralgia, who had a 10-year history of peptic ulcer. Gastroscopy had revealed a UL-IV gastric ulcer on the lesser curvature at the angle of the stomach and a deformity of the bulbus. A diagnosis of intractable gastric ulcer was made, and the patient underwent laparoscopic distal gastrectomy and gastroduodenostomy. On postoperative day 1, he was able to walk. On postoperative day 4, he started on a clear liquid diet and was discharged on postoperative day 14.

Dissection↗
PubMed1995

[Mitral valve plasty for better long term results].

Between July 1991 and January 1995, 74 patients with pure mitral valve regurgitation (MR) underwent mitral valve plasty (MVP) at out institute. Our procedure includes chordal replacement of the anterior leaflet with PTFE sutures (42 patients). There were one hospital death (1.4%) and two late deaths (2.7%) in this series. Only 2 patients (2.7%) needed valve replacement after unsatisfactory repair during the same operation. Late postoperative doppler echocardiographic study (mean follow-up, 12.0 months) showed less than mild regurgitation in 66 patients (95.7%) of 69 patients who are alive. In April 1993 we decided to complete the repair with no or only trivial regurgitant flow by intraoperative transesophageal echodoppler study (TEE). The results have remarkably improved. Late postoperative echodoppler study revealed less than mild reguritant flow in all 49 patients having undergone mitral valve repair with no or trivial regurgitation by intraoperative TEE. It is clear than the TEE study has contributed to the better quality of mitral valve plasty, and we believe that it is important for better long term results to complete mitral valve plasty with no or only trivial regurgitant flow.

Adult↗
PubMed1995

[Arrhythmias, autonomic function and spectral analysis of heart rate variation in patients with stable chronic pulmonary disease].

Autonomic function, the frequencies of arrhythmias, and outcome were studied in patients with stable chronic pulmonary disease (n = 67. Old tuberculosis, n = 35. Chronic pulmonary emphysema, n = 32) and in age-matched healthy elderly. The frequencies of arrhythmias were computed and spectral analysis was done with data obtained from 24-hour Holter ECG monitoring. The minimum heart rates of the patients were high. The minimum heart rate fell at night in the controls, but not in the patients. The patients had more PVCs than the controls, however sudden death due to arrhythmias did not occur. The LF/HF ratios obtained by spectral analysis of heart rate were lower in the patients than in the controls. There were no significant differences in age, respiratory rate, arterial blood gases, pulmonary-function tests, arrhythmias, or in the hourly distribution of the minimum heart rate between patients who died within 3 years and those who lived for more than 5 years. However, the LF/HF ratio in those who died was significantly lower than in the other groups. These results suggest that functional disturbance of the autonomic nervous system is related to outcome in patients with stable chronic pulmonary disease.

Aged↗
PubMed1995

[Myocardial structural proteins in cor pulmonale. Analysis by two-dimensional electrophoresis].

Changes in cardiac structural proteins caused by cor pulmonale were studied with two-dimensional electrophoresis. Sprague-Dawley rats were exposed to an oxygen-poor gas mixture (10% O2/90% N2) for three weeks. These rats (the hypoxic group) were compared to a control group that was kept in room air. Hemoglobin, hematocrit, and right ventricular systolic pressure were greater in the hypoxic group than in the control group. After the third week, desmin content of both ventricular muscles had increased in the hypoxic group, and was significantly greater in the hypoxic group than in the control group. The contents of other cardiac structural proteins did not change. These data suggest that increases in desmin are caused by adaptation of the myocardium to pressure overload associated with pulmonary hypertension. However, increases in the desmin content of the left ventricular muscle might be caused by volume overload, humoral factors, or might be a direct effect of hypoxemia.

Animals↗
PubMed1995

[A case of complex brain anomaly with arachnoid cyst treated well by cyst-cisternal shunt].

A rare case of complex anomaly, composed of schizencephaly, polymicrogyria, heterotopic gray matter, agenesis of the septum pellicidi and arachnoid cyst at the right middle cranial fossa was encountered. A 38-year old man, complaining of epileptic seizure, was admitted to our department. His past history included cerebral palsy. Plain skull roentgenogram showed protrusion of the right temporal bone and thinning of the ipsilateral sphenoidal wing. CT revealed arachnoid cyst and parietal crest surrounded by cortical layer on the right side. MRI also demonstrated the arachnoid cyst, parietal crest and agenesis of septum pellicidi. MRI, especially proton density weighted image, well demonstrated cortical layer surrounding the parietal crest, right opercular polymicrogyria and left heterotopic gray matter. The crest was diagnosed as schizencephaly. The arachnoid cyst was treated by cyst-cisternal shunt with a silicone tube (Sapporo shunt) after fenestrating the cyst. The tube was inserted into the sylvian fissure from the cyst and sutured to the inner wall of the cyst. Despite slight intratumoral hemorrhage in the CT at 1.5 months after the operation, the cyst markedly decreased in size. As to the diagnosis of the brain anomaly, MRI gives extremely useful information. Particularly for the diagnosis of anomalies of migration of neuronal cells, MRI, especially proton density weighted image, has been regarded as an indispensable examination. In the operation of subarachnoid cyst, to maintain the flow between the inside of its cyst and the basal cistern, cyst-cisternal shunt with a silicone tube had satisfactory results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Cooperative study of surgical adjuvant chemotherapy for colorectal cancer. Cooperative Study Group of Surgical Adjuvant Chemotherapy for Colorectal Cancer in Japan].

With the cooperation of 357 institutions nationwide, during the two years from January 1984 to December 1985, curative resection cases of colorectal cancer were divided into two groups and treated in the following method: A group with chemotherapy received MMC 12 mg/m2, on the day of operation, followed by 6 mg/m2 every two months, 6 times. From the second week after operation, 800 mg/body/day of FT was administered for one year. The other was a control group with operation only. In this study, targetting those cases in which recurrence was observed within 5 years, among eligible cases histologically curative resection, recurrence forms were examined by prognostic factors and usefulness of adjuvant chemotherapy after operation. Regarding the recurrence of liver metastasis, in the case of colon cancer, the effect of chemotherapy was observed in highly positive cases of lymph node metastasis and positive cases of lymphatic vessel invasion. In rectal cancer, it was noticed in Dukes C cases. For the local recurrence of rectal cancer, it was observed in Dukes C and cases of relative curative resection. Chemotherapy tended to inhibit recurrence within one year after the operation in both liver metastasis and local recurrence.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

[Systemic and regional myocardial distribution of 123I-BMIPP in normal subjects].

We estimated the systemic and left ventricular (LV) regional myocardial distribution of 123I-BMIPP (beta-methyl-p-iodophenyl-pentadecanoic-acid) in normal subjects (n = 13, mean age 43.9). In planar studies, the count ratios of heart, lung and liver to mediastinum were 2.63, 1.28 and 3.80 in the early images, and 2.23, 1.20 and 2.26 in the delayed images, respectively. The uptake in liver was almost identical with that in heart in the delayed images. In SPECT studies, the regional relative counts in anterior, septal, posterior and lateral LV walls were 100, 98, 96 and 108 (%) in the initial images, and 100, 98, 99 and 107 (%) in the delayed images, respectively. The regional relative uptake was significantly higher in the lateral wall than those in the other parts of LV walls in both images. The relative counts in the basal, mid- and apical portions were 100, 111 and 87 (%) in the initial images, and 100, 113, 92 (%) in the delayed images, respectively. These results suggest that the myocardial regional distribution of BMIPP is not always uniform even in normal subjects. Thus, it is necessary to interpret with caution in the light of these findings, especially for detect in a myocardial lesion in an early phase of cardiomyopathy or a mild myocardial ischemia.

Adult↗