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Biomedical subjects

K Kosuga

Publications and source records attributed to K Kosuga.

At least 73 records · Page 4Linked to original sources
PubMed1994

A study of reservoir implantation--especially with saphenous vein graft catheterization.

Intra-arterial infusion chemotherapy is commonly used to treat hepatocellular carcinomas (HCC) and metastatic liver cancer after hepatectomy or in unresectable patients, and it has been adopted at Kurume University Hospital as a treatment for HCC. As complications of reservoir implantation have been encountered, the implantation procedure needs improvement. Procedures were compared in a study with 109 patients who were available for follow-up observation among 116 patients who underwent reservoir implantation. Fifty-six of the patients received intraoperative implantation through the gastroduodenal artery (GDA catheterization), 31 received external catheterization (EXT catheterization) and 22 received catheterization using a saphenous vein graft (SVG catheterization). The complication rates were 75.0%, 9.7% and 13.9% and the one-year patencies were 44.1%, 70.6% and 79.4%, respectively. GDA catheterization was no better than the other two procedures and it had a higher incidence of complications and a lower patency. SVG catheterization achieved good patency, although it had a little higher incidence of complications than external catheterization. It was presumed to be a procedure that would ensure reservoir implantation even in patients with a winding or variation of hepatic artery.

Catheters, Indwelling↗
PubMed1994

Long-term results of valve replacement with the St. Jude Medical valve.

Between 1980 and 1992, 908 patients underwent single aortic (n = 178), single mitral (n = 577), or double aortic and mitral (n = 153) valve replacement with the St. Jude Medical valve at our hospital. There were 392 male patients and 516 female patients whose ages ranged from 1.2 to 74 years (mean, 52 years). The early mortality rate was 5.0% (45 patients). A 94% complete follow-up was accomplished for 863 patients who were discharged from the hospital (4682.3 patient-years). Sixty-nine of these patients died, for a late mortality rate of 8.0%. Fifty-two patients, including four patients (0.3%/100 patient-years) had anticoagulant-related hemorrhage, 4(0.1%/100 patient-years) had prosthetic valve endocarditis, 11 (0.2%/100 patient-years) had nonstructural valve dysfunction, and 16 (0.3%/100 patient-years) underwent reoperation. There were no structural valve failures in this series. The total number of valve-related deaths was 22. Of those patients who survived, 98% were in New York Heart Association functional class I or II at the date of the last follow-up. The probabilities of freedom from thromboembolism and anticoagulant-related hemorrhage at 10 years were 94% +/- 2% and 97% +/- 2% in aortic valve replacement, 89% +/- 2% and 98% +/- 4% in mitral valve replacement, and 89% +/- 6% and 92% +/- 6% in double valve replacement, respectively. Significant hemolysis related to the St. Jude Medical valve occurred in 8 of the 577 patients who received mitral valve replacement in our early experience, and modifying the valve orientation appeared to play an important role in reducing hemolysis. The event-free rate, including all complications and late deaths, at 10 years was 75% +/- 7%, 74% +/- 3%, and 81% +/- 6% in aortic valve replacement, mitral valve replacement, and double valve replacement, respectively. On the basis of these results, the St. Jude Medical valve seems to be an excellent mechanical valve in terms of durability and low thrombogenicity and remains our prosthetic valve of choice when valve replacement with a mechanical valve is indicated.

Adolescent↗
PubMed1994

[Surgical treatment for postinfarction ventricular septal perforation].

Between August 1981 and August 1992, operation for ventricular septal perforation (VSP) after acute myocardial infarction (AMI) was performed in 12 patients and the results were studied. During this period, medical treatment was attempted as a standard therapy for more than two weeks after AMI, followed by operation. However, only four patients received elective operation two weeks after the onset of AMI. Regarding the relationship between the preoperative circulatory status and timing of surgery, elective operative could not be performed in seven patients showing a pulmonary to systemic flow ratio (Qp/Qs) of more than 3.0, while four out of five patients with a ratio of less than 3.0 received operation more than two weeks after the onset of AMI. Two patients with severe right heart failure after the repair of VSP died on table without weaning from the pump. Ten operative survivors were weaned from the pump without any difficulty of hemostasis and intraaortic balloon pumping was removed after operation. However, three patients died of multiple organ failure which had been deteriorating before operation. Postoperative activity improved to New York Heart Association Functional Class I or II in six survivors for the late follow-up period. In the case of high Qp/Qs due to VSP, early operation is recommended to prevent multiple organ failure.

Aged↗
PubMed1994

Ruptured aneurysms of the sinus of Valsalva.

Sixteen patients underwent operation for ruptured aneurysm of the sinus of Valsalva (RASV) between 1979 and 1992. The age ranged from nine to 57 years (mean 31.8 years). Four patients were asymptomatic and 12 symptomatic and among symptomatic patients, five patients underwent emergency operation. Associated congenital anomalies were subpulmonary ventricular septal defect in 11 patients and infundibular pulmonary stenosis in one patient. Aortic regurgitation (AR) was mild in four, moderate in two, and severe in five. Surgical approach for RASV was a double incision for 12 patients (incision of ascending aorta and pulmonary artery, seven; that of ascending aorta and right ventricle, five), and single incision in four (pulmonary artery, three; right ventricle, one). Concomitant aortic surgery was performed in seven patients: aortic valve replacement (AVR), six and aortic valvuloplasty, one. One patient with emergency operation after cardiac arrest died one day after operation, while four emergency and 11 elective patients were uneventful after operation. In a follow up period of a mean of 90.3 months, there were no leaks of VSD closure and no recurrence of aneurysm. In 10 patients without AVR, mild AR remained in two, while the others showed no AR. The New York Heart Association functional class after operation was class I for 14 and class II for one. It seems that RASV requires early examination and operation to prevent an acute deterioration of symptoms and AR.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Emergency coronary artery bypass grafting with warm blood cardioplegia for a patient with acute myocardial infarction and severe left ventricular dysfunction].

Emergency coronary artery bypass grafting was performed in a 61 year old man who developed acute severe cardiac and respiratory dysfunction after myocardial infarction. At operation cardiac arrest was obtained by warm blood cardioplegia in antegrade intermittent fashion. The left anterior descending artery, diagonal branch, and right coronary artery were revascularized by saphenous vein (SVG). After declamping the aorta, spontaneous heart beating was obtained and postoperative course was uneventful. Postoperative examination showed patent all SVGs and improved cardiac function. Although the delivery of the warm blood cardioplegia was controversial, our recent study revealed that the intermittent antegrade delivery of warm blood cardioplegia showed no ischemic changes of the heart during the procedure.

Coronary Artery Bypass↗
PubMed1993

Partial brachiocephalic perfusion in aortic arch replacement.

Eleven patients who underwent replacement of the aortic arch or adjacent areas for aneurysmal disease between 1989 and 1991, using hypothermic cardiopulmonary bypass at 20 degrees to 23 degrees C with partial brachiocephalic perfusion, were studied. Selective perfusion of the innominate artery was performed in all 11 patients through the right axillary artery, while partial brachiocephalic perfusion was carried out using a separate arterial roller pump with a perfusion flow rate of 10 ml/kg per min. Direct cannulation to the left common carotid and left subclavian artery was not performed in this method. There were 4 men and 7 women who ranged in age from 26 to 78 years, with a mean age of 56 years. The etiology of aneurysmal disease was aortic dissection in 10 patients, and aortitis syndrome in 1. The cardiopulmonary bypass time was 214.3 +/- 39.3 min, aortic cross-clamp time 131.5 +/- 33.4 min, and partial brachiocephalic perfusion time 57.6 +/- 15.1 min. There were three operative deaths (27.3%), the causes being multiple organ failure, acute peritonitis, and infection of the composite graft in the ascending aorta, in one patient each, respectively. However, there were no deaths related to the technique of partial brachiocephalic perfusion and no neurological complications were seen in this series. Thus, we believe that partial brachiocephalic perfusion under hypothermic cardiopulmonary bypass is safe and effective in surgery for aortic aneurysms involving the aortic arch.

Adult↗
PubMed1993

Biplane transesophageal echo-Doppler studies of atrial septal defects: quantitative evaluation and monitoring for transcatheter closure.

Forty-four patients with atrial septal defects, aged 7 months to 18 years (median 8.9), underwent biplane transesophageal (TEE) and transthoracic (TTE) echocardiography. The size of the defect and the shunt flow volume were measured by TEE and compared with the actual size at surgery (N = 14) or the shunt volume measured by the Fick method (N = 34), respectively. In all cases the location and morphology of the defect were clearly demonstrated by TEE; on the other hand, two patients with sinus venosus-type and multiple-type defects, respectively, and one with a small ostium primum defect did not have a complete diagnosis by TTE. The defect size determined by TEE correlated well with the surgical measurement. Similarly a significant correlation was demonstrated between the shunt volume measured by TEE and that obtained by the Fick method. In three patients transcatheter closure of the atrial septal defect by means of a clamshell device was accomplished successfully with TEE monitoring. We conclude that biplane TEE provides a better appreciation of cardiac anatomy and hemodynamic evaluation than TTE in this setting, and TEE is essential for monitoring during transcatheter closure.

Adolescent↗
PubMed1993

Obstruction of the St. Jude Medical valve--diagnostic and therapeutic values of cineradiography.

Between 1984, and 1992, we observed 8 patients with an obstructed St. Jude Medical (SJM) valve. Of these, 1 had an obstructed SJM valve in the aortic position, 3 in the mitral position, and 4 in the tricuspid position. Diagnosis of obstruction of the SJM valve was made by cineradiography combined with echocardiography in all 8 patients. Restriction or absence of movement of the leaflet of the SJM valve was observed by cineradiography in all of the 8 patients. Normal range of leaflet mobility of the SJM valve was measured by conventional cineradiography in 70 patients with a normal SJM valve, and the results were compared with the leaflet mobility obtained from the 8 patients with an obstructed SJM valve. In this study, leaflet function in the obstructed SJM valve was strikingly abnormal, with both opening and closing angles, and leaflet motion clearly outside the normal range. Of the 8 patients, 4 underwent urgent prosthetic valve replacements after cineradiography and echocardiography were carried out. Thrombolysis using urokinase was performed in 4 patients, and this treatment was successful in 1 patient. Efficacy of thrombolytic therapy was evaluated by repeat cineradiography. Three of the 4 patients who received thrombolysis showed no significant improvement of leaflet mobility after at least 72 hours of thrombolytic therapy, and finally required surgical correction for the obstructed SJM valve. We believe that cineradiography combined with echocardiography is the optimal method for the diagnosis of obstruction of the SJM valve, and to follow the effect of thrombolytic therapy on prosthetic valve function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Stabilization of inducible nitric oxide synthase by monoclonal antibodies.

We have produced 14 monoclonal antibodies to inducible nitric oxide synthase purified from rat peritoneal cytotoxic activated macrophages. None of the antibodies showed neutralizing activity, but some of them enhanced the enzyme activity through stabilization of the enzyme.

Amino Acid Oxidoreductases↗
PubMed1993

Left atrial plication and mitral valve replacement for giant left atrium accompanying mitral lesion.

Between January 1982 and November 1992, 38 patients received simultaneous mitral valve replacement (MVR) and left atrial plication (LAP) because of giant left atrium accompanying mitral lesion. Their ages ranged from 33 to 70 years, and the mitral lesion was caused by rheumatic heart disease in all patients. MVR was performed with a St. Jude Medical prosthesis for all patients and the left atrial wall was plicated with running 3-0 Nespolene to reduce the width to 3 to 5 cm. Respiration requiring mechanical ventilation more than 48 hours after operation occurred in four patients (10.5%) and postoperative low cardiac output requiring a high dose of dopamine HCl or intraaortic balloon pumping in nine patients (23.7%). The left atrial diameter measured by echocardiogram was a mean of 7.3 +/- 1.0 cm before operation and 5.8 +/- 1.0 cm postoperatively. The cardiothoracic ratio on the chest roentgenogram registered a preoperative mean of 73.3% +/- 9.8% and was 65.7% +/- 8.4% after operation. The pre- and postoperative values were significantly different (p < 0.01). The postoperative exercise level was a mean of 5.3 metabolic units for 24 patients and the postoperative New York Heart Association functional classification indicated Class I or II for 37 patients with no evidence of left atrial thrombus except in the case of one early death. LAP with MVR for patients with giant left atrium due to mitral lesion appeared to result in improvement in respiratory and circulatory functions.

Adult↗
PubMed1993

Beneficial effect of the addition of nitroglycerin to the cardioplegic solution on the cold-stored reperfused isolated rat heart.

We discuss here the effect of the addition of trinitroglycerin to the cardioplegic solution on the isolated rat heart after eight hours of storage. This effect was evaluated by measuring cardiac function as well as myocardial calcium and enzymes. Male Wistar rats were divided into three groups based on the concentration of trinitroglycerine in the cardioplegic solution. In the control group, the fluid used was a crystalloid cardioplegic solution (K+ 25 mEq/L) without trinitroglycerin and for groups I and II, trinitroglycerin was added at concentrations of 2 micrograms/ml and 5 micrograms/ml, respectively. All hearts were arrested with the cardioplegic solution at 4 degrees C and then immersed for eight hours in Euro-Collins' solution at 4 degrees C. The postperfusion coronary flow showed higher rates for groups I and II than for the control group (p < 0.05), while the difference between groups I and II was not significant. In group I, the total concentrations of creatine kinase-MB, lactate and malondialdehyde after reperfusion showed the lowest levels; this group also had the lowest content of myocardial calcium. These results indicate that the addition of nitroglycerin, especially at a concentration of 2 micrograms/ml, to the cardioplegic solution elicits better cardiac function for immersed rat heart.

Animals↗
PubMed1993

Transfusion-associated graft versus host disease following hepatectomy for hepatocellular carcinoma--a case report.

A case of transfusion-associated graft versus host disease (TA-GVHD) following hepatectomy for hepatocellular carcinoma is described in a 53 year-old male patient. The intraoperative bleeding was estimated to be 1220 ml, and he was transfused with 4 units of fresh whole blood. On postoperative day (POD) 12, a fever of 38 degrees C developed, followed by a systemic erythema on POD 14, and a marked progressive leukopenia starting from POD 19. The patient died of multiple organ failure (MOF) on POD 29. Just before death, the results of skin, bone marrow, and liver biopsies had no physical evidence of GVHD. TA-GVHD was found in the HLA typing of the patient's family. This TA-GVHD case was considered to be a reduced immunity due to severe surgical stress or preoperative transcatheter arterial embolization (TAE), in view of the fact that he was transfused with fresh whole blood during the operation. TA-GVHD has frequently been reported in patients after open heart surgery, but also after hepatectomy. It is therefore necessary to take all available means to prevent it by restricting the use of blood preparations as much as possible, and if hetero blood transfusions are performed, blood should be irradiated prior to transfusion.

Carcinoma, Hepatocellular↗
PubMed1993

Clinical study of 47 patients with reoperation after open mitral commissurotomy.

Mitral lesion in 47 patients who received reoperation after an initial open mitral commissurotomy (OMC) for mitral stenosis (MS) was studied. The diagnosis before OMC consisted of pure MS in 38 patients, with mild mitral regurgitation (MR) in 8 and with moderate MR in 1. At OMC the diameter of the mitral orifice was a mean of 1.3 +/- 0.5 cm and a mobile cusp was found in 12 and a thickened cusp in 35 patients. Subvalvular fusion was seen in 15 patients, calcification of cusp or subvalvular region in 10 and left atrial thrombus in 6. After OMC, the diameter of the mitral orifice was opened to a mean of 3.2 +/- 0.3 cm. The interval between the initial operation and the time of reoperation was a mean of 124 months. The mitral lesion necessitating reoperation was MS in 18, moderate to severe MR in 10, and MSR in 19. At reoperation the mitral orifice ranged in diameter from 0.8 to 4.2 cm (mean, 2.3 +/- 0.8 cm). There was no correlation between the occurrence of MR or restenosis and the subvalvular division at initial OMC. Left atrial thrombus was identified in four and calcification in 17 patients. At reoperation 46 patients received mitral valve replacement, while only 1 received a second OMC. The removed valve showed no pathological findings of active rheumatic lesion but more severe calcification and hyalinization of the valve than those at initial operation. There were three early deaths (6.4%) after reoperation. The recurring mitral lesion seemed to consist of deteriorated pathological changes of the valve and MR and thus mitral valve replacement was recommended to provide a favorable operative result for non-flexible lesion after OMC.

Adult↗
PubMed1993

[The preventive effect of additional albumin in crystalloid cardioplegic solution on myocardial reperfusion injury].

The effect of additional albumin in crystalloid cardioplegic solution (CS) was investigated for infant with open heart surgery. Patients were divided into two groups; CS containing with or without 1% albumin. CS without albumin was administered for Group-I in 13 patients and CS with albumin for Group-II in 14 patients. The blood samples were collected from radial artery and coronary sinus at 5, 15 and 30 minutes after reperfusion and blood gas analysis, hemoglobin, lactate, creatine kinase-MB (CK-MB) and malondialdehyde (MDA) were measured. In percentage of CK-MB secretion, no significant differences were seen between two groups. However, in oxygen consumption, lactate and MDA secretion, significant differences between the groups were noted at five minutes after reperfusion. In conclusion, additional albumin in CS solution, especially in infant cases was effective for myocardial preservation immediately after reperfusion.

Albumins↗
PubMed1993

Doppler echocardiographic evaluation of St. Jude Medical valves in the tricuspid position.

Sixteen of 20 patients who underwent tricuspid valve replacement with a St. Jude Medical valve at our hospital were followed for three to 164 months. Doppler echocardiographic and cineradiographic examinations of the replacement device were performed in 13 patients. There were six males and seven females in the study, with a mean age of 41.9 years. A St. Jude Medical prosthesis had also been implanted in the mitral or mitral and aortic positions of eight of these thirteen patients. Ten patients had normally functioning valves in the tricuspid position and three were diagnosed as malfunctioning. The peak velocity in those patients with normally functioning tricuspid valves was 1.3 +/- 0.2 m/sec. The calculated peak and mean pressure gradients were 6.7 +/- 1.9 mmHg and 2.6 +/- 1.1 mmHg, respectively, and the mean pressure half-time was 120 +/- 22 msec. All normally functioning valves in the tricuspid position had peak velocities of less than 1.55 m/sec, and peak and mean pressure gradients of less than 9.6 mmHg and 5 mmHg, respectively, with the pressure half-time being less than 140 msec in all cases, except for one of the three Doppler studies performed in one patient. However, three Doppler studies performed in two patients with a malfunctioning tricuspid valve revealed peak velocities, peak and mean pressure gradients and pressure half-times which were above these values. After replacement of the malfunctioning valve, or thrombolysis, all of the Doppler-derived values returned to the range found in normally functioning valves.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗