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Biomedical subjects

K Mizuguchi

Publications and source records attributed to K Mizuguchi.

At least 109 records · Page 6Linked to original sources
PubMed1992

A quantitative study of postoperative luminal narrowing of the internal thoracic artery graft in coronary artery bypass surgery.

We used quantitative angiography to determine the postoperative diameter of the internal thoracic artery graft at the point close to the anastomosed site in 147 patients who received the graft for the left anterior descending coronary artery. We performed generalized multiple linear regression analysis (Type I quantification method) to assess the effects of the following factors on the internal thoracic artery graft diameter: age, gender, time of angiography, laterality of the internal thoracic artery used, presence of an undivided major side branch of the internal thoracic artery, presence of a saphenous vein graft having blood flow competition with an internal thoracic artery graft, presence of distal stenosis of the recipient left anterior descending coronary artery, severity of postoperative left anterior descending coronary artery stenosis, and presence of coronary risk factors. The standardized category scores for 25% left anterior descending coronary artery stenosis, 50% left anterior descending coronary artery stenosis, and presence of a saphenous vein graft having blood flow competition with an internal thoracic artery graft were -1.418, -0.767 and -0.622, respectively. Thus, the internal thoracic artery diameter was smaller in patients with well-preserved flow of the recipient coronary artery. The internal thoracic artery diameter had a particularly strong correlation with the degree of left anterior descending coronary artery stenosis (partial correlation coefficient: 0.670). The other factors seemed to have little or no correlation with the postoperative internal thoracic artery diameter. With the criterion that the internal thoracic artery diameter below 1.0 mm represents the "string sign" of internal thoracic artery graft, this phenomenon was observed in nine patients (6.1%). In all of these patients, left anterior descending coronary artery flow was well-preserved, and no ischemia was disclosed in the left anterior descending coronary artery-perfused area. These results indicate that internal thoracic artery grafts have flow adaptability responding to the flow demand of the recipient coronary artery and that the string sign of internal thoracic artery grafts is mainly an outcome of its physiologic characteristics.

Adult↗
PubMed1992

[Intra-atrial implantation of mitral valve prosthesis in 2 patients with active infective endocarditis complicated by mitral annular destruction].

This is a report of two patients with extensive destruction of the mitral annulus due to active infective endocarditis. Patient 1 was a 66-year-old female and the patient 2 was a 59-year-old male. In both patients medical therapy had failed to control endocarditis and emergency mitral valve replacements were carried out. At the operation special surgical techniques were necessitated, since insertion of artificial valves in the annulus was impossible because of the lack of the annular tissue due to destruction and excision. On the posterior commissure side, mitral valve prosthesis were sutured to the left atrial wall just above the anatomical mitral ring. Furthermore, in patient 2, a bovine pericardium collar attached to the prosthetic valve was sutured to the left atrial wall to secure fixation of the prosthetic valve. The postoperative courses were uneventful in both patients. This technique seems to be useful in patients with mitral annular destruction.

Aged↗
PubMed1992

[Delayed sternal closure; a simple sternal splint].

A simple and inexpensive sternal splint for delayed sternal closure was described. Sternal edges were splinted open using an edge-cut disposable syringe. This method has been employed successfully in 10 patients (one adult, 9 children). This syringe splint is a simple, inexpensive and effective method for delayed sternal closure.

Child, Preschool↗
PubMed1990

[Evaluation of a latex agglutination method for the rapid identification of Campylobacter jejuni/coli].

A latex agglutination assay was developed to identify Campylobacter jejuni and Campylobacter coli. We evaluated the specificity, reproducibility and utility of the assay for clinical use and the following results were obtained. 1) To prepare standardized antigen, bacterial cells must be suspended to a density of 1 to 5 McFarland unit, and heated at 121 degrees C for 10 to 30 min. 2) Bacterial cells may be suspended either in the solution provided with the kit, or in physiological saline, without affecting the results. 3) Of C. jejuni, 94 strains, 6 of C. coli, and 3 of "Campylobacter upsaliensis", all tested positive without exception. All other Campylobacter species, encompassing 13 species and 80 strains, were negative. An additional 9 species and 30 strains, of non-Campylobacter gram negative bacteria, isolated on the Campylobacter selection agar medium, also were uniformly negative. Based on these results, we conclude that bacteria testing positive with the kit can be identified as C. jejuni/coli. Interestingly, "C. upsaliensis", although isolated very rarely from the clinical specimens, also tested positive.

Campylobacter↗
PubMed1990

[A case of bilateral adrenal myelolipoma].

We reported a case of bilateral adrenal myelolipoma. Low height, obesity and and elevation of 17-KS were found in this case. Tumors were hypovascular adrenal masses with low attenuation numbers on CT. MRI was useful in demonstrating the relation of tumors to adjacent organs. It should be considered that, although very rare, bilateral myelolipoma is possible.

Adrenal Gland Neoplasms↗
PubMed1990

[A case of Goodpasture's syndrome with IgA antibasement membrane antibody].

This is a very rare case report of Goodpasture's syndrome with IgA antibasement membrane antibody. A 43-year old male was admitted because of severe dyspnea with slight hemoptysis. Chest X-ray demonstrated extensive bilateral infiltrates with air bronchogram, predominantly in the right lung. Laboratory data on admission showed severe anemia and moderate renal impairment. The pulmonary infiltrates resolved spontaneously within 10 days. Goodpasture's syndrome or collagen vascular disease was suspected and he underwent a percutaneous renal and transbronchial lung biopsy. The renal biopsy showed crescent formation affecting 70-80% of glomeruli. Linear IgA deposits, but not IgG, were demonstrated along the glomerular basement membrane by the direct immunofluorescence procedure. The lung biopsy contained many hemosiderin-laden macrophages in the lumen of the alveoli and showed mild thickening of alveolar walls. However, linear immunoglobulin deposits on the alveolar capillary basement membrane were not demonstrated by direct immunofluorescence. The diagnosis of Goodpasture's syndrome with IgA antibasement membrane antibody was made. His serum was negative for antibasement antibody by indirect immunofluorescence. He was treated with prednisone, 30 mg daily. His pulmonary symptoms and anemia improved markedly, but his renal function did not change. Thirteen months after his first admission, he suffered from severe bacterial pneumonia, which was complicated by disseminated intravascular coagulation. He died of respiratory failure. Autopsy was rejected.

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↗
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

[Ulcerative colitis complicated by early carcinoma of the rectum and cholecystolithiasis].

Reported is a case of a 73-year-old male with a history of ulcerative colitis that had started at the age of 57. In 1985, on receiving a barium enema, a polypoid lesion was found in his rectum. In 1986, the results of a colonoscopy showed that the polypoid lesion had reached an IIa-aggregated elevation, and biopsies of this lesion were diagnosed as an adenoma or a hyperplastic polyp. A year later, in 1987, another biopsy specimen was taken and was histologically diagnosed as being an adenomatous cancer. Thus, a pull-through operation and a cholecystectomy were performed. The lesion was 4.5 x 3.0 cm in diameter, and the histological findings showed it to be a well-differentiated adenocarcinoma with a submucosal invasion. Accordingly, physicians should be advised that patients with a longstanding ulcerative colitis ought to undergo periodic examination that includes a colonoscopy and a biopsy of any suspicious growth.

Adenocarcinoma↗
PubMed1989

[Intrahepatic portal vein aneurysm: report of two cases].

We present two cases of intrahepatic portal vein aneurysm. The lesions were seen as low density mass on precontrast CT, hypoechoic mass with connecting vascular structures on ultrasonogram and dilatated branch of portal vein on MRI. Definite diagnosis were obtained by arteriogram. Only 15 cases of portal vein aneurysm were reported in Japan up to now in the literature.

Aged↗
PubMed1989

[Immunohistochemical study of idiopathic bronchiolitis obliterans organizing pneumonia].

To examine the characteristics of idiopathic BOOP and to compare them with those of organizing pneumonia (OP) with known causes, immunohistochemical examinations using monoclonal antibodies against T- and B-lymphocytes which are available for formaldehyde-fixed and paraffin-embedded sections, and polyclonal antibodies against human IgG, IgA and IgM, and bovine S-100 protein, were carried out, along with conventional histopathological examinations. Histopathological observations demonstrated that both of the 7 BOOP cases and 5 OP cases had polypoid masses of organizing tissue in the lumen of small airways, alveolar ducts, and some alveolar sacs, and infiltration of pulmonary interstitium by a large number of lymphocytes and moderate number of plasma cells, eosinophils and mast cells. Degree of bronchiolo-alveolitis was greater in idiopathic BOOP. Immunohistochemically, the majority of lymphocytes which had diffusely infiltrated into the interstitium were T-lymphocytes, the degree of which was higher in the cases of BOOP. On the other hand, B-lymphocytes were seen mainly in the lymphoid follicles. Furthermore, S-100 protein positive dendritic cells were noted in the lymphocyte rich interstitium in the all cases of both groups, and similarly between two groups. Immunoglobulin (Ig) positive plasma cells were also seen, but there was no evidence indicating the preferential increase of plasma cells which produce a particular class of Ig. These observations suggest that there might be some immunological mechanisms in the pathogenesis of BOOP in which T-lymphocytes, mast cells and eosinophils are involved.

Adult↗
PubMed1989

[Surgical treatment of postinfarction ventricular septal perforation--the difference between a cardiogenic shock group and a congestive heart failure group].

Twelve patients with postinfarction ventricular septal perforation (VSP) were divided into 2 groups based upon the preoperative status and the time interval between the operation and the occurrence of VSP after acute myocardial infarction (AMI). Group I were in cardiogenic shock unresponsive to either pharmacologic supports or IABP, and needed an emergency repair of VSP. The other group (group II) were in congestive heart failure responding to some extent to pharmacologic supports and IABP, and VSP of this group was repaired on the elective or semiemergency basis. Group I comprised of 7 patients, 5 males and 2 females, with a mean age of 65.9 +/- 12.6 years, and group II included 5 patients, 2 males and 3 females with an averaged age of 72.6 +/- 3.4 years. The mean time duration between AMI and the operation, and between the occurrence of VSP and the operation were 3.1 and 1.6 days in group I and 13.4 and 8.0 days in group II. The operative mortalities were 57% in group I and 0% in group II, a remarkable difference. The reasons why group I had a poor prognosis were analysed and were found as follows: (1) group I sustained a larger AMI of anteroseptal area together with the lateral and/or inferior infarctions more often than group II. (2) Group I had frequently multiple organ failure (MOF) even prior to operation due to cardiogenic shock. (3) Group I had severer right ventricular failure than group II, in which the right atrial pressure was markedly elevated. In group I, the right heart failure remained and was prolonged even after surgery reflected by the RAP/LAP ratio over 1 and finally resulting in MOF. To improve surgical results in group I, the operation should be undertaken on the emergency basis before MOF is completed, and patch reconstruction of the left ventricular free wall is recommended in patients with a wide AMI and a high positioned anterior septal perforation. When RV failure is dominant, not only a LV assist device but also a RV assist device may also improve the results.

Aged↗
PubMed1989

[A case of primary pulmonary sporotrichosis].

We report the first case of primary pulmonary sporotrichosis in Japan. A 53-year-old man was admitted to our hospital for further examination of the abnormal shadows on chest X-ray film. Six months before admission, he was admitted to another hospital because of alcoholic liver disease and diabetes mellitus. Since the initial chest film showed cavities with infiltration in the left upper lung field, he was treated with antituberculous drugs despite negative sputum cultures for mycobacterium. In spite of the medication, his chest X-ray film revealed another cavitary lesion, so he was referred to our hospital. He had been asymptomatic during this period. Chest X-ray on admission disclosed multiple cavities in the left upper lobe and a cavity in the right lower lobe. Repeated sputum specimens, bronchial washings and brushings for cytology and cultures were all negative. In an attempt to clarify the pathogen, percutaneous lung aspiration (PLA) was performed. The PLA sample yielded a positive culture of Sporothrix shenckii. After the diagnosis, S. schenckii was also cultured from sputa. A sporothrix skin test and yeast agglutination test for S. schenckii were positive. In the absence of a history for skin lesion, the patient was diagnosed as a primary pulmonary sporotrichosis. As iodide therapy was ineffective, he was started on a regimen of intravenous amphotericin B. However his renal function progressively deteriorated, so amphotericin B was discontinued. Now he receives miconazole intravenously and is still under careful observation. As far as we know, this is the first report of primary pulmonary sporotrichosis in Japan. The possibility of sporotrichosis should be considered in any cases of undiagnosed cavitary lung diseases.

Hemagglutination Tests↗