Biomedical subjects

K Mashiko

Publications and source records attributed to K Mashiko.

At least 55 records · Page 3Linked to original sources

PubMed1992

[A case report of pulmonary embolectomy for acute pulmonary embolism].

In recent years, case reports of the pulmonary thromboembolism which had been comparatively less in our country, have been gradually increasing. However, this disease is more often reported in the chronic stage, and case reports of severe cases in the acute stage are still less. The case reported here was admitted to our hospital by emergency ambulation with severe chest pain. On the second day after the admission, respiratory standstill developed suddenly following recurrent chest pain, which necessitated cardiopulmonary resuscitation. The patient was intubated and the IABP was instituted because of hemodynamic instability. An emergent cardiac catheterization under the mechanical ventilation and the IABP supported displayed massive shadow defect on the pulmonary arteriogram, which was indicating acute pulmonary embolism. The pulmonary pressure was 58/18 mmHg despite of the shock state (the aortic pressure: 60/28 mmHg). Subsequently, a pulmonary thrombectomy was carried out under the emergency cardiopulmonary bypass. The cardiac catheterization performed two weeks after the operation. Revealed that the pulmonary pressure returned to the almost normal volume (38/18 mmHg) in association with the aortic pressure of 113/72 mmHg. The venogram of lower extremities revealed thrombi in the deep veins, suggesting the cause of the thromboembolism in the pulmonary arteries. The Bird's nest filter was inserted for the prevention of recurrence of pulmonary embolism. This patient is doing well 10 months postoperatively.

Acute Disease↗

PubMed1992

[Clinical study of intracranial pressure and auditory brain stem response in the cases of diffuse axonal injury].

The course of intracranial pressure (ICP) and the finding of auditory brain stem response (ABR) was discussed in the cases diagnosed as diffuse axonal injury (DAI) established by Gennarelli. ICP was measured in twenty-six cases which were divided into three groups according to the course of ICP: Group (1), in which ICP remained below 20 mmHg (group I, 9 cases). Group (2), in which ICP rose above 20 mmHg but was controlled by therapy (group II, 8 cases). Group (3), in which ICP rose above 20 mmHg and could not be controlled by any therapies (group III, 9 cases). Glasgow outcome scale 3 months after the injury in the cases of group I and II was severe disability (SD) and/or persistent vegetative state (PVS), but all of the cases in group III died. The findings of serial ABR were divided into 3 groups. These were group A (2 cases) which showed normal record, group B (5 cases) which showed elongation of latencies between the first and fifth waves, and group C (5 cases) in which there was no response in ABR. GOS in group A or B was SD and/or PVS, but all of the cases in group C were shown to be dead in GOS. Our studies suggest that the level of ICP in DAI is rather higher than that published in previous reports, and the continuous measurements of ICP and serial records of ABR are useful for evaluating the outcome of DAI.

Adolescent↗

PubMed1992

[A case with cerebral embolism due to the recurrence of thrombotic valve five years after the reoperation].

Between April 1972 and May 1990, a total of 300 patients in our institution underwent insertion of a Björk-Shiley aortic valve prosthesis, and development of a thrombosed valve was observed only in 4 female cases. It was considered that the thrombosed valves in all 4 cases were caused by inadequacy of the anticoagulant agents. As reoperative procedures, thrombectomy, resection of the excessive granulation under the valve, and a method of turning the opening direction of the valve 180 degrees were used. These procedures were reported previously. One case died late in the day after the operation, while the remaining 3 cases progressed favorably. Although control of one of these three cases was favorably maintained after reoperation, a restriction of 43.2 degrees of the opening angle of the valve was again observed by valve-fluoroscopy performed in the 3rd postoperative year. However, progress of this patient was observed on an outpatient basis because flow velocity at the position of aortic valve was also within normal range. This was shown Doppler's test using ultrasonic waves and the patient showed no symptoms. However, this patient was admitted to our institute due to sudden right hemiplegia on May 1990 in the 5th year after reoperation. The cerebral embolism due to the recurrent thrombosed valve was diagnosed because a low density in the middle cerebral area was observed by CT, and increase of the opening angle of the valve (compared with that at ambulation) was also noted by valve-fluoroscopy. The hemiplegia remained even though this patient was saved from death. (ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗

PubMed1992

[Magnetic resonance imaging in diffuse brain injury].

Forty cases diagnosed as diffuse brain injury (DBI) were studied by magnetic resonance imaging (MRI) performed within 3 days after injury. These cases were divided into two groups, which were the concussion group and diffuse axonal injury (DAI) group established by Gennarelli. There were no findings on computerized tomography (CT) in the concussion group except for two cases which had a brain edema or subarachnoid hemorrhage. But on MRI, high intensity areas on T2 weighted imaging were demonstrated in the cerebral white matter in this group. Many lesions in this group were thought to be edemas of the cerebral white matter, because of the fact that, on serial MRI, they were isointense. In mild types of DAI, the lesions on MRI were located only in the cerebral white matter, whereas, in the severe types of DAI, lesions were located in the basal ganglia, the corpus callosum, the dorsal part of the brain stem as well as in the cerebral white matter. As for CT findings, parenchymal lesions were not visualized especially in mild DAI. Our results suggested that the lesions in cerebral concussion were edemas in cerebral white matter. In mild DAI they were non-hemorrhagic contusion; and in severe DAI they were hemorrhagic contusions in the cerebral white matter, the basal ganglia, the corpus callosum or the dorsal part of the brain stem.

Adolescent↗

PubMed1991

[Therapeutic effects of thromboembolectomy and caval Günther filter insertion in chronic pulmonary embolism].

Two cases of chronic-stage pulmonary embolism which had occurred at least one month before the operation were presented. Pulmonary thromboembolectomy under the cardiopulmonary bypass was performed and followed by the insertion of Günther filter to prevent recurrence of embolism. Both cases revealed severe obstruction occupying over 50% of the pulmonary arteries which were presented by the remarkable increase of pulmonary arterial systolic pressures up to 100 and 80 mmHg respectively. After thrombectomy the pulmonary artery pressure declined to 45 and 28 mmHg, even though the pulmonary embolism was in subchronic state. The respiratory symptoms and abnormal findings on the ECG and chest X-ray were also improved. Since the phlebothrombosis of the inferior limb might be the cause of pulmonary embolism, the insertion of the filter in the inferior vena cava was thought to be indispensable for the prevention of recurrence.

Female↗

PubMed1990

[Successful re-reconstruction for complete disruption of the right main bronchus by blunt chest trauma].

A 22 year-old man was brought to our hospital about twenty-three minutes following a high-speed motorbicycle accident in which he had blunt chest trauma. He was in severe respiratory distress with marked dyspnea and restless with extensive subcutaneous emphysema involving anterior chest wall, cervical and bilateral inguinal regions. A chest X-ray revealed bilateral pneumothorax involving mediastinal emphysema and also fracture of right submandibular and clavicula. In spite of orotracheal intubation and insertion of bilateral chest tube, continuous air leak and pneumothorax did not improve. Bronchoscopy revealed the disruption of mucosa of the right main bronchus at the bifurcation. Emergency right thoracotomy was performed and there was the complete disruption of the right main bronchus. Anastomosis of the right main bronchus with circumferential resection was undertaken on May 30, 1987 about two hours after trauma. About three months after reconstruction, bronchoscopic examination revealed stomal stenosis with deformation of tracheobronchial cartilage and granulation. The stenosis showed severe irregularity by deformed cartilage and thickened scar, so widening by Nd-YAG laser vaporization was inadequate in effect. Seven months after first reconstruction, we performed re-reconstructive operation, right upper sleeve lobectomy with partial resection of carcina and right wall of trachea for scar with severe deformation of cartilage. Following the operation, the patient suffered from sepsis with pneumonitis accompanied by lung edema. This complication was treated successfully. We considered that acute pneumonitis was caused by reventilation with increase of perfusion after tracheobronchial reconstruction. Consequently, we thought it important to treat such patients with long term IPPB postoperatively with adequate medication for respiratory system.

Accidents, Traffic↗

PubMed1989

[Usefulness and problems of peritoneal tap & lavage on the diagnosis of blunt abdominal trauma--efficacy for diagnosis of intestinal injury].

It is difficult to diagnose blunt intestinal injury, despite of the progress of radiological diagnostic procedures, if patient has an altered mental status or an associated injury which hampers abdominal physical findings. So we conducted a prostective study about usefulness of peritoneal tap and lavage on the diagnosis of blunt abdominal injury. From September 1987 to August 1988 we performed peritoneal lavage in 36 patients and investigated the diagnostic accuracy of this method for detecting each organ injuries. We adopted conventional criteria "RBC greater than or equal to 100000/mm3, WBC greater than or equal to 500/mm3" and also employed new supplementary criteria "WBC greater than or equal to RBC/150 (if RBC/is positive), Amylase or Alkaline phosphatase greater than or equal to RBC/10000, GOT or GPT greater than or equal to RBC/40000". The diagnostic accuracy rates were 1) intestinal injury: WBC-sensitivdty (se) 75%, Specificity (sp) 100% 2) small intestinal injury; AMY-se 100%, sp 90%, Alp-se 100%, sp 100% 3) hepatic injury; GOT or GPT-se 100%, sp 91%. These satisfactory results can be obtained by employment of the new supplementary criteria. Peritoneal tap and lavage is easy to perform but is sometimes found to have poor fluid return. So we recommend to adopt the authentic method of peritoneal lavage. We concluded from this study that if these new supplementary criteria are employed peritoneal lavage can be useful to diagnose blunt intestinal injury.

Abdominal Injuries↗

PubMed1989

[Complications of IABP in the postoperative management of open-heart surgery--a review of 108 cases in the last 10 years].

During the past decade from May 1978 to July 1988, intraaortic balloon pumping (IABP) was used in a total of 108 patients following open-heart surgery at our department. Eleven complications depend on IABP have occurred in nine of theses patients, i.e. five of circulatory disorder on account of ischemia of the lower extremity ipsilateral to balloon catheter insertion, three of ischemia of the abdominal viscera, one of aorto-esophageal fistula, one of gas embolism resulting of balloon rupture and one of damage of the abdominal aorta caused by a Fogarty balloon catheter. Five of these patients died of these complications depend on IABP. Especially, four of five patients died of vascular accidents. These complications were due to operation of the balloon catheter or the driving unit, bat that was no complication related to insert of the balloon catheter. Then, we have to paid more careful attention to driving the intra-aortic balloon.

Adolescent↗

PubMed1989

[Aortic and tricuspid valve replacement in a case of corrected transposition of the great arteries].

It is well known that corrected transposition of the great arteries (C-TGA) is accompanied with tricuspid valve regurgitation, but very few reports have described complication of this anomaly with aortic valve regurgitation (AR). We have performed aortic valve replacement (AVR) in a case of C-TGA associated with AR which had been evaluated the grade of 3/4 according to Sellers' classification, simultaneously done the valve replacement for the dysplastic tricuspid valve and annuloplasty for the right-side atrioventricular valve (mitral valve). The patient has a favorable postoperative course.

Aortic Valve Insufficiency↗

PubMed1989

[Clinical study on stab wounds of chest--factors that may influence their mortality].

Stab wounds of the chest occupy an important position in penetrating thoracic injuries in Japan. A retrospective review of 117 patients with stab wounds of the chest admitted to our hospital over the past 12 years (from 1975 to 1987) revealed some factors that might influence their mortality. Seven patients died from trans-diaphragmatic injuries of intra-abdominal organs. The management of intra-abdominal injuries was very important in thoracic stab wounds. Many of the patients with stab wounds of the precordial chest (danger zone) had cardiac or major vascular injuries, and the mortality rate of them was high. The mortality rate of the patients with stab wounds of the right lateral thorax was high, because many of them had trans-diaphragmatic liver injuries. We thought that right lateral thorax as well as precordial chest is the danger zone in thoracic stab wounds. Survival rate in the patients whose circulatory condition had been unstable when they admitted was very low. Five DOA (dead on arrival) patients with stab wounds of the chest required emergency room thoracotomy (ERT). One of them survived. Survival rate in the DOA patients with stab wounds of the chest was higher than that in the DOA patients with blunt thoracic injuries. ERT for cardiac insufficiency following stab wounds of the chest was thought an effective procedure for surviving. Survival rate of the patients with cardiac stab wounds was 63.6 per cent.

Adolescent↗

PubMed1988