Use of the pedicled right gastroepiploic artery for coronary artery bypass grafting in the presence of calcified ascending aorta.
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Aortic Diseases↗
Biomedical subjects
K Ohishi
Publications and source records attributed to K Ohishi.
The right gastroepiploic artery and its growth potential.
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Arteries↗
[Report of a case of small cell lung cancer associated with Lambert-Eaton myasthenic syndrome and subacute cerebellar degeneration--with a review of the Japanese literature].
We report a patient with small cell lung cancer associated with Lambert-Eaton myasthenic syndrome (LEMS) and subacute cerebellar degeneration (SCD). The patient was a 71-year-old man suffering from weakness of the limbs and a gait disturbance who developed limb ataxia and dysarthria one month after admission. Electrophysiologic studies confirmed the diagnosis of Lambert-Eaton myasthenic syndrome. Chest X-rays 2 months after admission revealed an abnormal shadow, and small cell lung cancer was diagnosed on the basis of biopsy specimens. Anti-voltage-gated calcium channel antibody was positive. Anti-Yo and -Hu antibodies were negative. The patient was treated by plasmapheresis and chemotherapy, which resulted in a transient improvement in the LEMS symptoms but not in the SCD. Fifteen cases of LEMS associated with SCD have been reported in the Japanese literature, and all were accompanied by small cell lung cancer. We discuss the frequency of association with LEMS and SCD and the effects of plasmapheresis and chemotherapy in both diseases.
Aged↗
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↗
[A case of superficial hemosiderosis of the central nervous system with normal CSF findings and unknown source of bleeding].
A 65-year-old woman had suffered from slowly progressive hearing loss for one year. She had neither repeated episodes of headache or vomiting nor a past history of neurosurgical operation. Neurologic examination revealed moderate diminution in hearing, pyramidal tract sign and cerebellar ataxia without dementia. CSF was under normal pressure, clear and colorless, with total protein 35 mg/dl, glucose 59 mg/dl and a cell count of 2 WBC/mm3. T2-weighted images (TR200/TE80) of high-field MRI demonstrated marginal hypointensity of the brainstem, the Sylvian fissures and the entire spinal cord. Angiography of the cerebral vessels failed to identify the source of bleeding. To our knowledge, this is the first report of superficial hemosiderosis of the central nervous system with normal CSF findings and an unknown source of bleeding confirmed by MRI.
Aged↗
[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↗
[Reoperations for prosthetic heart valves: operation techniques and determinant factors of operative mortality].
Between 1982 and 1993, 93 patients underwent reoperation for prosthetic heart valves at our hospital. There were 41 male and 52 female patients who ranged in age 2 to 70 years with a mean age of 47 years. Twenty-four patients were in New York Heart Association (NYHA) functional class II, 52 in class III, and 17 in class IV, preoperatively. The indications of reoperative valve surgery were primary tissue failure of a bioprosthesis in 57 patients, valve thrombosis in 10, nonstructural valve dysfunction in 12, cloth wear of a ball valve in 5, endocarditis in 5, and others in 4. In reoperation, the heart was not mobilized from the pericardium to prevent tearing the heart and great vessels. All operative procedures were performed through the pericardium which adhered tightly to the heart. Adequate myocardial protection was obtained without total dissection of the heart with cold crystalloid cardioplegic solution and topical cooling which was accomplished by filling the left pleural space with cold saline. The operative mortality was 7 of the 93 patients (7.5%), falling from 4/36 (11.1%) in 1982 through 1987 to 3/57 (5.3%) in 1988 through 1993. Advanced New York Heart Association functional class, prolonged cardiopulmonary bypass and aortic cross clamping times were the determinant factors of operative mortality. These results suggest that reoperation for dysfunctioning prosthetic heart valves should be performed before deterioration of the hemodynamic condition of the patient.
Adolescent↗
Expression of MDR1 gene in acute leukemia cells: association with CD7+ acute myeloblastic leukemia/acute lymphoblastic leukemia.
MDR1 gene expression was examined in acute leukemia cells from 75 Japanese patients at diagnosis (50 with acute myeloblastic leukemia [AML]: 10 M1, 18 M2, 5 M3, 8 M4, 9 M5; 25 with acute lymphoblastic leukemia [ALL]: 13 B-precursor, 12 T-lineage). The results of MDR1 mRNA expression by reverse transcriptase polymerase chain reaction were confirmed by immunostaining using the anti-P-glycoprotein monoclonal antibody UIC2 and by a functional study using the rhodamine efflux test. Morphologically, AML M1 cases had the highest incidence of MDR1 gene expression (6 of 10 patients). Phenotypically, CD7 and CD34 were the only surface markers that were significantly associated with MDR1 gene expression (P < .01). In CD7+CD4-CD8- ALL, which is thought to originate from the lymphohematopoietic stem cell, expressed the MDR1 gene with a high incidence (six of eight patients), whereas three surface CD3+ and one CD4+CD8+ T-cell ALL (T-ALL) did not have detectable MDR1 transcripts. Only two cases of 13 B-precursor ALL had MDR1 mRNA, one of which had the Philadelphia (Ph1) chromosome. No association was observed between MDR1 gene expression and CD34 positivity in ALL. Our results that MDR1 mRNA was frequently expressed in CD7+ AML and CD7+CD4-CD8- ALL, together with the previous reports indicating clinical similarities between these leukemias, provides a clue to clarify a relationship between CD7+ AML and CD7+CD4-CD8- ALL. In addition, MDR1 expression in CD7+ AML/ALL might be responsible for the poor response to conventional chemotherapies of these types of leukemia.
Adult↗
Biologic characteristics of acute leukemia after myelodysplastic syndrome.
Ten patients with acute leukemia after primary myelodysplastic syndrome (MDS-AL) were examined to clarify the biologic nature of the leukemic cells in comparison with that of de novo acute myelocytic leukemia (AML). The morphologic and cytochemical features of the leukemic cells from all these patients corresponded well to those of de novo AML, and they were diagnosed with MDS-AML. Phenotypically, the frequent expression of the lymphocyte activation antigens, CD25 and CD30, was characteristic in MDS-AML. The in vitro response of MDS-AML cells to various growth factors was similar to that of de novo AML cells. Transforming growth factor beta 1 (TGF beta 1) suppressed growth factor-dependent colony formation by normal bone marrow cells, MDS bone marrow cells, and de novo AML cells, but did not inhibit colony formation by MDS-AML cells. The number of TGF beta 1 high-affinity binding sites of MDS-AML samples (< 5 to 47 sites/cell) was markedly lower than that in de novo AML samples (120 to 221 sites/cell). Our results indicate that the reduced TGF beta 1 may represent disregulation of the proliferation system in MDS-AML cells. This is thought to occur during the MDS phase, and may be related to the poorer response shown to conventional chemotherapy of AML.
Adult↗
Effect of myasthenic IgG on degradation of junctional acetylcholine receptor.
We investigated the effect of the IgG from patients with myasthenia gravis (MG) on the degradation of normal rat junctional acetylcholine receptor (AChR) labeled with 125I-alpha-bungarotoxin (BuTx) and calculated the degradation rate (DR). The DR for the IgG from these patients was significantly higher than that from healthy volunteers and patients with other autoimmune diseases. For MG, DR was significantly correlated with the severity of the disease but not with anti-AChR antibody titer. DR was accelerated by IgG from patients with generalized MG whose antibody titers were in the normal range and by IgG from patients with ocular MG. These results indicate that measurement of the DR of junctional AChR in normal rats is more closely correlated with the severity of the disease than is measurement of anti-AChR antibody and that the former is a sensitive and confirmatory method for evaluating MG.
Adolescent↗
Dose-response relation and time course of action of pipecuronium in patients anesthetized with nitrous oxide and sevoflurane.
The dose-response relation of pipecuronium, the time course of its neuromuscular blocking effects, and the reversibility of the residual block by neostigmine have been investigated in patients under sevoflurane/N2O Anesthesia using a neuromuscular transmission analyzer (Accelograph, Biometer, Denmark). After an initial dose of pipecuronium (0.04 mg.kg(-1), i.v.), the maximum block rate, onset time, the time from administration until 25% recovery and 50% recovery of control twitch height of the first response to train-of-four nerve stimulation and the interval time of administration of maintenance dose (0.005 mg.kg(-1), i.v.) were 93.7 +/- 7.68%, 5.0 +/- 1.84, 55.4 +/- 23.92, 73.0 +/- 29.44 and 38.7 +/- 15.50 minutes, respectively. The average intubation score (excellent; 0, good; 1 fair; 2, poor; 3) was 0.63 +/- 0.56 at the level of 95.88 +/- 5.06% block. Neostigmine (1.5 mg) promptly reversed the residual neuromuscular blockade induced by pipecuronium (reversal time: 10.1 +/- 2.98 minutes). No side effects attributable to pipecuronium was seen in this study. In conclusion, pipecuronium is a very useful nondepolarizing neuromuscular blocking agent especially for moderately long surgical procedure over 4-5 hours.
Journal Article↗
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↗
Heparin treatment in patients with human T-lymphotropic virus type I (HTLV-I)-associated myelopathy: a preliminary study.
Ten patients with HTLV-I-associated myelopathy (HAM) were treated in an uncontrolled preliminary trial of heparin. In 7 patients, motor dysfunction improved substantially and the effect continued for more than a month after the discontinuation of therapy. Sensory and urinary disturbances also improved in 3 of 4 and in 2 of 10 patients, respectively. Heparin did not alter the subsets of peripheral blood lymphocytes nor the titers of anti-HTLV-I antibodies in serum and cerebrospinal fluid. Spontaneous proliferation of peripheral blood lymphocytes, however, was depressed significantly (P < 0.05) in all cases. Heparin therapy has some advantages in cost, ease of administration and fewer side effects compared to other therapies such as plasmapheresis and interferon-alpha. We conclude that heparin can be administered safely to HAM, and that a double-blind placebo-controlled trial is warranted to determine its efficacy in HAM.
Adult↗
Cell-mediated immunity to BLV replication: analogous to HIV immunopathogenesis?
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Animals↗
Use of the right gastroepiploic artery as a pedicled arterial graft for coronary revascularization.
Between April 1988 and August 1991, the right gastroepiploic artery (RGEA) was used as a pedicled arterial graft for coronary arterial bypass grafting (CABG) in 44 patients. Their ages ranged from 8 to 72 years (mean: 58.7 years), and body size was small for 21 patients (body surface area < 1.6 m2). The mean number of distal anastomoses was 3.2 +/- 0.7 per patient. The RGEA was anastomosed to the right coronary system in 35 patients and to the left in 9 patients. Perioperative vasospasm of the RGEA occurred in 4 patients, but no vasospasm was seen after intraluminal injection of diluted papaverine hydrochloride was used in the last 9 patients. The size of the RGEA at the site of anastomosis was 1.9 +/- 0.4 mm in diameter. The RGEA was harvested in 48 patients; however, two of the RGEAs were smaller than 1.0 mm in diameter and two showed severe calcification with stenosis of more than 75%. Consequently, those conduits were not used. Indications for the use of the RGEA were: relatively young age for 17, matching size of the coronary artery and the RGEA for 11, poor quality of the internal thoracic artery (ITA) or saphenous vein graft (SVG) for 10, lower leg atherosclerosis in 3, a diseased ascending aorta in 2, and Kawasaki disease in 1. The patency rate of the RGEA for 36 patients was 94.4% and relief of angina 95.5%. An exercise tolerance test performed within 2 months after operation showed improved capacity (mean 7.2 metabolic units).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Three cases of symptomatic infantile spasms closely related to the occipital epileptic discharges before their onset.
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Anticonvulsants↗
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↗
Involvement of CD8+ T cells in delayed-type hypersensitivity responses against bovine leukemia virus (BLV) induced in sheep vaccinated with recombinant vaccinia virus expressing BLV envelope glycoprotein.
Delayed-type hypersensitivity responses against bovine leukemia virus (BLV) envelope glycoprotein (gp60) were induced in the skin of sheep vaccinated with recombinant vaccinia virus (RVV) expressing BLV glycoprotein. The lesions were characterized by marked infiltration of lymphocytes, slight migration of neutrophils, eosinophils, and macrophages in the dermis to hypodermis, and partial intercellular edema in the reticular layer. Immunohistochemical analysis with monoclonal antibodies demonstrated that the lymphocytic infiltrates consisted mainly of CD8+ T cells (53.7-55.8% at 48 hours post-challenge of BLV), CD4+ T cells (24.7-26.7%), and B cells (11.5-16.9%). The role of CD4+ and CD8+ T cells in suppressing BLV growth in RVV-vaccinated animals is discussed.
Animals↗