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Biomedical subjects

K Ohishi

Publications and source records attributed to K Ohishi.

At least 217 records · Page 12Linked to original sources
PubMed1990

[Valve thrombosis of St. Jude Medical prosthesis; report of three cases].

Three cases with valve thrombosis of St. Jude Medical prosthesis (SJM valve) are reported. Incidence of valve thrombosis of SJM valve was 0.15%/patient-year. Cineradiography was useful to make the diagnosis. SJM valves were implanted with the hinges anatomically oriented in mitral position, and in both aortic and tricuspid positions with the leaflet opening parallel to the ventricular septum. Therefore, we recommend that SJM valve should be placed with the hinge antianatomically oriented in mitral position, and in both aortic and tricuspid positions with the leaflet opening to be perpendicular to the interventricular septum, respectively.

Adult↗
PubMed1990

[Four operated cases of traumatic tricuspid regurgitation].

Four cases of tricuspid regurgitation due to nonpenetrating chest trauma are presented. From five to twenty five years after the initial blunt chest trauma, they were admitted because of dyspnea or palpitation on exertion. In all cases echocardiogram showed severe tricuspid regurgitation and enlarged right atrium and ventricle. Cardiac catheterization revealed increased right atrial pressure with high v wave. At operation, their tricuspid valves or chordae tendineae were revealed ruptured without other valvular injury. Ruptured chordae tendineae of the anterior leaflet were in three cases and their valves were replaced with mechanical prosthesis. Tear of the anterior leaflet was in one case and it was sutured directly, but mild tricuspid regurgitation was left after the operation. Twenty cases have been reported in Japan up to date and fifteen of them have surgical treatment; tricuspid valve replacement (TVR) is performed in 10 cases, tricuspid valvuloplasty (TVP) is in 3 cases, suture of ruptured chordae tendineae is in 2 cases. Five cases are treated medically. How to diagnose and how to treat them are discussed. And, in the conclusion, we consider that the surgical treatment is recommended for the case of traumatic tricuspid regurgitation with uncontrollable heart failure.

Adult↗
PubMed1990

[Left atrial thrombosis after mitral valve replacement].

Thrombosis of the left atrium is a rare but troublesome complication of the mitral valve replacement (MVR). In our series of MVR, seven patients had thrombus formation of the left atrium late after MVR. These seven cases (LAT group) are compared with 53 cases (no LAT group), who are picked up randomly and have no thrombus of the left atrium after MVR, concerning to some risk factors. And the result is that the left atrial volume shows a significant difference between two groups among the risk factors. We consider that the cases with enlarged left atrium have a high risk of thrombus formation after MVR and so they also need a plication of the left atrium at the primary operation.

Adult↗
PubMed1990

[Surgical treatment of massive pulmonary embolism--the time of the operation and its effectiveness].

The records of 6 patients undergoing pulmonary embolectomy for massive pulmonary embolism (MPE) at Kurume University Hospital during 17 years were reviewed to determine the management of surgery. The patients consisted of 2 men and 4 women. The patients' ages ranged from 29 to 68 years (mean age, 49.3 years). The records showed that one patient died of brain death after operation and the others survived. All the patients complained of chest pain, anterior chest discomfort and dyspnea. Sudden syncope was observed in 2 patients. Artificial mechanical ventilation was performed preoperatively on 3 patients. Right ventricular load was demonstrated on electrocardiograms and ultrasonograms. Pulmonary angiograms were attempted on two patients and one of them had cardiac arrest during this examination. MPE was suspected by perfusion defect of 50% to 80% of pulmonary vasculature demonstrated on lung perfusion scintigram in 4 patients. Open pulmonary embolectomy with cardiopulmonary bypass (CPB) was performed on all patients using crystalloid cardioplegia and topical cooling. Intraoperative pulmonary angiograms were performed in 4 patients to prevent residual thromboemboli. Since most thromboemboli originate below the level of the vena cava, acute double ligation of the vena cava just below the renal vein was performed to control recurrent embolism. Oral anticoagulant, warfarin, was administered for 3 months after embolectomy as prophylaxis against postoperative recurrent embolism. It is our opinion that an aggressive attitude toward pulmonary embolectomy on CPB is necessary to save lives of MPE patients. This surgical procedure is very easy and safe.

Adult↗
PubMed1990

[Availability of DDAVP in hemostasis control for the breast tumor resection in a patient with thrombasthenia (type II)].

We reported a 33-year-old woman with thrombasthenia (type II) in whom 1-deamino-8-D-arginine vasopressin (DDAVP) was available for the hemostasis control during breast tumor resection. She has had recurrent nasal bleeding and purpura since 2 years old. On the first admission to our hospital because of hematuria at 18 years old, she was diagnosed as thrombasthenia (type II) from hemostatic studies. At 20 years old, she had a healthy baby by the cesarean section with transfusion of fresh blood and platelet concentrates. On the 5th admission for the breast tumor resection, defect of glycoprotein II b-III a of her platelets was confirmed by using SDS gel electrophoresis. Recently, there are some reports on availability of DDAVP for hemostatic control in platelet dysfunction of various etiologies as well as mild hemophilia and von Willebrand disease. So, DDAVP (0.4 microgram/kg) was used for hemostasis control. After 1 hour, the bleeding time was shortened from over 10 to 4 min, platelet adhesiveness to glass beads increased from 1.8 to 37%. Furthermore, the levels of Ristocetin cofactor and von Willebrand factor antigen (especially large multimer) also increased. But platelet aggregation with various inducers remained unchanged before and after infusion. Breast tumor (fibroadenoma) resection.

Adult↗
PubMed1989

Salivary prostaglandin concentrations: possible state indicators for major depression.

Salivary prostaglandin concentrations were determined in 42 patients with major depressive disorder, 16 patients with minor depressive disorder, and 39 healthy control subjects. The diagnoses were made according to the Research Diagnostic Criteria. The patients with major depressive disorder had higher salivary prostaglandin concentrations than the control subjects, but the patients with minor depressive disorder did not. Furthermore, the salivary prostaglandin concentrations of the patients with major depressive disorder showed a high correlation with the severity of the depression. These results suggest that high salivary prostaglandin concentrations may be state indicators for major depression.

Adult↗
PubMed1989

[Clinical study of the effect to myocardial protection with crystalloid cardioplegic solution during open heart surgery in infants under age 3 months].

We investigated the effect to myocardial protection with crystalloid cardioplegic solution (Kurume solution I (S-I)) during open heart surgery in 21 infants less than 3 months old. The mortality was 28.6% (6 cases) including 2 patients having peroperative severe acidosis or shock. It was suggested that about half of them died of inadequate myocardial preservation. Comparing factors in the deaths with the survivors, there were significant differences between them in extracorporeal circulation time (ECCT) (196.7 +/- 50.1 min versus 133.2 +/- 45.8 min, p less than 0.01) and aortic-cross clamping time (ACCT) (120.0 +/- 45.8 min versus 78.3 +/- 30.5 min, p less than 0.05). In survivors, 86.7% of them required the effective dose (more than 6 micrograms/kg/min) of catecholamine and 33.3% presented low cardiac output syndrome (with the dose of more than 10 micrograms/kg/min and more than for 48 hours). The incidence of LOS was related to ECCT and ACCT. Thus it seemed that infant was more susceptible than older patient to the effects of ECC and the operation was carried out safely with ECCT less than 150 minutes and ACCT under age 3 months, it is necessary to use the cardioplegic solution fitting immature myocardium and to design operative technique and assist device for open heart surgery to shorten ECCT and ACCT.

Cardiac Surgical Procedures↗
PubMed1989

[Clinical studies on childhood urolithiasis during the past 22 years].

We have studied retrospectively 68 children who presented with urolithiasis between 1965 and 1986. Male to female ratio was 1.83 to 1 and the mean age was 9.5 years. Fifty four children (79%) had calculi in the upper urinary tract, 9 (13%) had in the lower, and 4 (6%) had calculi both in the upper and lower urinary tract. The most common presenting symptoms were gross hematuria (53%) and abdominal or flank pain (38%). Predisposing factors could be found only in 21 children (31%). Twenty four of the 68 patients (35%) had open surgery and 16 patients (24%) passed their stones spontaneously. Twenty one stones were analyzed by infrared spectroscopy. Infectious stone was more frequent than in adult cases. Among children five years old and younger, infectious stone was the most frequent. Among children over five years old, the number of idiopathic calcium stone has been on the increase with the years.

Adolescent↗
PubMed1989

[A case report of double orifice mitral valve (DOMV) associated with incomplete endocardial cushion defect (ECD)].

A case of DOMV associated with incomplete ECD in a 17-year old girl is presented. Preoperatively, the mitral valve was suspected to have two orifice divided by the bridging tissue with sector echocardiography. DOMV is very rare congenital malformation, and 25 cases of DOMV are reported in Japan. Two of them were diagnosed as DOMV preoperatively with sector echocardiography. Sector echocardiography is useful to diagnose DOMV and to know the shape of it preoperatively.

Adolescent↗
PubMed1989

[Four successfully operated cases of ball thrombus in the left atrium].

The authors report four cases of the left atrial ball thrombus associated with mitral stenosis. Three of four which had floating ball thrombus in the left atrium presented with syncopal attacks and systemic embolism. Echocardiography was the most effective method for preoperative diagnosis of ball thrombus in the left atrium and mitralstenosis. After having accurate diagnosis of ball thrombus in the left atrium by echocardiogram, all of cases were treated urgently with removal of the thrombus and mitral valve replacement or mitral commissurotomy. During operation, the head down position and slight right lateral position had been maintained to prevent the impaction of the ball thrombus into mitral valve orifice and the immediate cardiopulmonary bypass by ascending aortic, superior and inferior venous cannulation were placed through midsternal splitting incision. Because of high frequency of peripheral embolism and sudden death, left atrial ball thrombus should be recommended to be removed urgently.

Aged↗
PubMed1989

[Operation methods and results in repeated open heart surgery for acquired valvular disease].

Fifty-six patients who underwent repeated open heart surgery for acquired valvular disease are presented. Their mean ages were 48 years and mean interval between initial and second operation were 6 years. Preoperative functional status (NYHA) were class II in 11, class III in 40 and class IV in 5. The indications for repeated open heart surgery were mitral re-stenosis in eight, mitral and aortic regurgitation after valvuloplasty in 26, artificial valve failure in 32, perivalvular leakage in 2, left atrial thrombus formation in 1 and aggravation of rheumatic changes of non-operated other valves in 3. Dissection of adhesive tissue around the heart was limited to the aortic root for prevention of cardiac injuries and minimizing bleeding. In all cases, myocardial protection was achieved with intermittent infusion of cold crystalloid cardioplegic solution with topical myocardial cooling during single period of aortic clamping. Adequate left ventricular hypothermic protection was obtained by cold physiological saline that was filled in left pleural cavity. Postoperative low cardiac output syndrome was developed in only 2. Three patients (5.4%) died of left ventricular rupture and of multiple organ failure within thirty days and 4 patients (7.1%) died of prosthetic valve endocarditis, cerebral bleeding and sudden death in late follow-up periods. These results suggested that the operative mortality and morbidity for repeated valve surgery with the aid of cardiopulmonary bypass was not different from that for initial valve surgery. So we believe that repeated open heart surgery for acquired valvular disease should be done prior to deterioration of patient's clinical condition.

Adult↗
PubMed1989

Changes in lymphocyte subsets, mitogen responsiveness, and interleukin-2 production after cardiac operations.

We studied 104 patients after cardiac operations to search for changes in peripheral blood lymphocyte subsets, mitogen responsiveness, and interleukin-2 production. Mononuclear cells obtained from 10 patients with cholecystectomy were examined as control samples. Cultures for phytohemagglutinin and interleukin-2 production were incubated in microtiter plates for 24 hours with cells labeled with tritium thymidine used as target cells. Lymphocyte subsets were measured by using monoclonal antibodies. The results obtained with preoperative blood samples were compared with those from the first, third, and seventh days after operation. In patients having cardiac operations, mitogen responsiveness was low on both the first and the seventh days after operation and interleukin-2 production was markedly depressed (greater than 90% depressed) on the first postoperative day. However, in control samples from patients having cholecystectomy, lymphocyte subsets, mitogen responsiveness, and interleukin-2 production showed no significant changes. Improvement in interleukin-2 production occurred immediately in patients without blood transfusion from random donors and reached normal levels by postoperative day 3. However, interleukin-2 production remained depressed on day 3 in all patients with transfusion from random donors and remained significantly diminished even on day 7 in such patients in New York Heart Association classes III and IV. We conclude that heart operations for which cardiopulmonary bypass is used are associated with depression of cellular immunity, including interleukin-2 production. Furthermore, it appears that both blood transfusion from random donors and the general preoperative condition of the patients contribute to suppression of measures of cell-mediated immunity.

Adult↗
PubMed1989

[Studies of pathogenicity of GVHD induced by blood transfusion after open heart surgery].

We compared the case like acute GVHD (graft versus host disease) induced by blood transfusion with the cases after open heart surgery which received blood transfusion by the measurement of cell-mediated immunity. Furthermore, we investigated the etiology of GVHD in comparison with cases according to age. Seventy-three cases (under 60 years old: 55 cases, over 60 years old: 18 cases) underwent open heart surgery and the mean blood transfusion volume was 2368cc and the mean age was 52.8 years old. After open heart surgery the rate of peripheral OKT3+ and OKT4+ cells, lymphocyte transformation and IL-2 (interleukin 2 product) were significantly decreased at postoperative day (POD) 1 and recovered to preoperative value until POD 14. However, in the cases like GVHD the rate of OKT4+ cell was decreased in contrast with the change of OKT8+ cell, and lymphocyte transformation and IL-2 production did not recover to normal range postoperatively. In conclusion, in the cases like GVHD the postoperative charge of cell-immunity is similar to the acute GVHD induced after bone marrow transplantation and we must take care about the blood transfusion to the older patients after open heart surgery because there is a possibility that cell-mediated immunity may be more depressed in the elder patient pre and postoperatively.

Acute Disease↗
PubMed1989

[Case reports of fistula formation between aortic pseudo-aneurysms and atria after Bentall's operation].

Fistula between aortic pseudo-aneurysm and atrium occurred in two patients ten or thirteen years after initial Bentall's operation. Their chief complaints were edema of lower extremity, oliguria and dyspnea. Because the pseudo-aneurysm and fistula was suspected by continuous murmur and echocardiogram, cardiac catheterization and aortography were performed to make accurate diagnosis. In these cases, both the fistula and the leakage at the site of initial anastomosis were repaired as soon as the diagnosis was made. To our knowledge, there have been no such reports of aortic pseudo-aneurysm penetrating into the atrium after Bentall's operation.

Adult↗