Biomedical subjects
M Aoshima
Publications and source records attributed to M Aoshima.
[Clinical study of the hypogastric plexus preserving operation for Y-prosthesis replacement for abdominal aneurysm--operative technique for avoiding postoperative sexual disorders].
We studied the effect of the hypogastric plexus preserving operation for Y-prosthesis replacement in abdominal aneurysm. The hypogastric plexus preserving operation was performed for avoiding postoperative sexual disorders such as the impotence and the abnormalities of ejaculation. With wide abrasion of retroperitoneum as usually, postoperative abnormalities of ejaculation occurred in 70% and postoperative impotence occurred in 50% of cases undergoing Y-prosthesis replacement. More reliable nerve preserving operation was the minimum abrasion of retroperitoneum and the aorta had not to he abrased at the origin of the inferior mesenteric artery, bifurcation of the aorta and the common iliac artery. Then with this nerve preserving operation, abnormalities of ejaculation occurred in 30% (p < 0.05) of cases and impotence occurred in 20% of cases. The results indicate that sexual dysfunction may he prevented to minimize by the nerve preserving operation.
Complex formation of human T-cell leukemia virus type I p40tax transactivator with cellular polypeptides.
We examined cellular components which associate with p40tax, the viral transactivation molecule of human T-cell leukemia virus type I. Such molecules were searched by immunoprecipitation with polyclonal and monoclonal antibodies specific for p40tax. Two cellular proteins with molecular masses of 95 kDa (p95) and 60 kDa (p60) were specifically coprecipitated with p40tax from extracts of all p40tax-producing cell lines but not from p40tax-negative cell lines. The p60 component was also shown to associate with p40tax in vitro, by using radiolabel-chase experiments. Rabbit antisera specific for p60 and p95 were prepared by immunization with electrophoretically purified molecules. While anti-p95 antiserum coprecipitated p40tax, no p40tax could be identified in immunoprecipitates by using a polyclonal anti-p60 antiserum. The partial amino acid sequence of p60 demonstrated that p60 is identical to the human 60-kDa heat shock protein (a member of the chaperonin family of proteins). Although the biological significance of the complex formation of p40tax with p95 and p60 has yet to be determined, it may be that the complex formation is one of the mechanisms by which the biological activity of p40tax can be regulated.
[Effect of ursodeoxycholic acid (UDCA) therapy for compensatory liver cirrhosis on liver function tests and serum bile acid metabolism].
Effect of ursodeoxycholic acid (600 mg/day 12 weeks) on liver function tests and bile acid metabolism were investigated in 6 patients with compensatory liver cirrhosis (CLC) and 6 with chronic active hepatitis (CAH). Serial determination of serum GOT, GPT and gamma-GTP after the initiation of UDCA revealed significant reduction in mean levels of these enzymes after 4 weeks, and further improvement was observed at the end of the 12-weeks treatment regimen (CLC: 79.3%, 81.1%, 51.5% of initial values, respectively, CAH: 61.2%, 59.3%, 42.8%). On the other hand, after UDCA administration, serum total bile acid increased and UDCA became the predominant bile acid in CLC and CAH patients. Other endogenous bile acids decreased in both groups, but reduction rate of serum chenodeoxycholic acid level in CLC was smaller than that in CAH group (CLC: 86.1% of initial values, respectively, CAH: 54.2%). During UDCA treatment, apparent side effect was not observed. We suggest that UDCA administration might constitute effective treatment for compensatory liver cirrhosis as well as chronic hepatitis.
[Successful surgical treatment of subdural hematoma following mitral valve replacement].
A 56-year-old woman, followed after mitral commissurotomy, was admitted to the hospital because of congestive heart failure of NYHA IV. Cardiac catheterization demonstrated severe MSR and TR. MVR using a SJM prosthetic valve and TAP with DeVega's method were performed under cardiopulmonary bypass with moderate hypothermia (25 degrees C). Postoperative hemodynamic condition was good with a uneventful convalescence. But disturbance of consciousness was seen with gradual deterioration and anisocoria developed on the 4th postoperative day. CT scan revealed a subdural hematoma in the right frontal and parietal region. Irrigation of the hematoma was performed immediately by neurosurgeons. She resumed full consciousness and was discharged from the hospital without any sequelae on the 49th postoperative day. The importance of the early diagnosis and the immediate treatment for the subdural hematoma following open heart surgery was emphasized.
[A case of theophylline-induced rhabdomyolysis following therapy of bronchial asthma].
A case of a 81-year-old asthmatic male with Theophylline-induced rhabdomyolysis was reported. After intravenous administration of 250 mg of Aminophylline, he developed muscle weakness in the lower extremities. Serum CPK was 31,450 IU, and other enzymes escaping from skeletal muscles were elevated. Serum and urine myoglobin were also elevated. Cessation of Theophylline administration and conservative therapy resulted in improvement of rhabdomyolysis without concomitant acute renal failure. The present case was the 11th case of Theophylline-induced rhabdomyolysis in the world and the second case Japan.
[A case of follicular bronchiolitis with broncho-pleural fistula in rheumatoid arthritis].
A 67-year-old male diagnosed clinically as having rheumatoid pleuritis and bronchiolitis was treated with adrenocorticosteroid. His clinical findings improved, but following the tapering of the steroid dose, exacerbation occurred. After the steroid dose was increased, serological findings improved, but chest X-ray findings revealed no improvement. To re-evaluate the etiology of the bronchiolar lesion, open lung biopsy was performed. The biopsy specimen showed lymphocytic infiltration and formation of lymphoid follicles in and around the bronchioles. The pulmonary lesion was diagnosed as follicular bronchiolitis.
[Clinical features of aortic dissection with early thrombosis of the false lumen].
There are cases of dissecting aortic aneurysm in which thrombotic formation occurs in the false lumen at an early stage, preventing dissection of the vessel wall and enlargement of the aneurysm. We studied such early thrombotic obliteration of false lumina in 12 (28.6%) of 42 patients with dissecting aortic aneurysm who underwent transesophageal two-dimensional echocardiography in the acute phase from June 1986 to October 1989. It was the first employment of a transesophageal approach at our hospital. In this study, we examined the clinical profiles of these patients as well as the usefulness of transesophageal two-dimensional echocardiography in establishing the diagnosis of dissecting aortic aneurysm and characterizing the disease. The patients were classified as Type I (2 patients) and Type III (10 patients; 6 Type IIIa and 4 Type IIIb) according to DeBakey's classification. The minimum and mean intervals from the onset of symptoms to transesophageal two-dimensional echocardiography were 1.5 hours and a mean of 38.2 hours, respectively. These results indicated that thrombotic obliteration of the false lumen had already occurred at a very early stage in some patients. The maximum diameter of the descending aorta was mean 37.6 mm with only 2 patients having that of 40 mm or more. Since left intrapleural hemorrhage was observed in these 2 patients (1 received emergent replacement of the descending aorta), enlargement of the aortic diameter may be indicative of unpredictable outcome, even in patients with early thrombotic obliteration of the false lumen. The long-term clinical course was favorable in all patients, including those who were treated surgically, over a mean follow-up period of 14.5 months.(ABSTRACT TRUNCATED AT 250 WORDS)
[Definitive myocardial blood flow evaluated by contrast echocardiography: experimental and A-C bypass flow studies].
We evaluated the feasibility of a new method for calculating definitive myocardial flow using contrast echocardiography in canine experiments and in patients who had undergone ACBG surgery. The principle for calculating flow was based on Kety-Schmidt method using time-intensity curve analysis between the epicardial and endocardial aspect. Inlet and outlet flows were hypothesized at the epicardium and endocardium, respectively. Analysis of time-contrast-intensity curves between the epicardium and endocardium, the difference of the area to the saturated point between epicardium and pericardium (A), and the saturated value (H) theoretically lead to the equation: Flow = 100 x (H/A) (Kety-Schmidt) in a 100-gram myocardium. No factors of intensity and time were included. Using this equation, the flow in 7 experimental canine and the flow of 9 patients who had ACBG surgery were compared to the electromagnetic flow. In the canine experiments, the left circumflex coronary artery was dissected free and was connected with contrast injector, a magnetic flowmeter and pneumatic occluder, proximal to distal in this order. Flow was controlled either by the occluder or drugs (papaverin and dipyridamole). Manually-agitated contrast media were injected rapidly (1 ml/2.5 sec), and M-mode echocardiographic recordings were densitometrically translated into time-intensity curves. Thirty-eight trials in 7 dogs showed close correlations (r = 0.901) between the electromagnetic flow and contrast echo flow. For the patients with ACBG, M-mode contrast echo recordings were made using transesophageal echo during the operations with contrast injections via the bypass grafts. Analysis of time-intensity curves was made and recorded in the same way as during the experiments.(ABSTRACT TRUNCATED AT 250 WORDS)
[Problems in patients with use of a ventricular assist device].
The purpose of the present study was to review the results obtained in patients with a ventricular assist devices (VAD) in our hospital, and to discuss various problems concerning a VAD use, such as indications, right ventricular failure, and evaluation of cardiac function. Fourteen VADs were applied to 11 patients for left ventricular assist, including two for right ventricular assist and for one as biventricular assist with a VAD in the left and a biopump in the right. The clinical diagnoses of the patients were as follows: 10 ischemic heart disease, two valvular disease, one acute aortic dissection, and one corrected transposition of the great arteries. VADs were indicated in 11 patients because of difficulty in weaning from cardiopulmonary bypass (CPB), and in three patients because of cardiogenic shock after discontinuing CPB. Among the 14 patients, 11 had an effective VAD, six were successfully weaned from a VAD, and two survived. The VAD was ineffective due to uncontrollable bleeding and improper indications for the device, as in applying a one-sided heart assist when a biventricular assist was necessary. In spite of an effective VAD, five patients could not be weaned from VAD because of brain damage, sepsis, and hypoxia. After removing a VAD, four patients died; one due to mediastinitis, two due to respiratory failure, and one due to low output syndrome. All the four patients had renal failure followed by multi-organ failure finally, because of prolonged CPB time. The CPB time was shorter among the long survivors than in others. Cardiac function during assist and the weaning probability from a VAD were evaluated not only by the so-called on-off test, but also by transesophageal Doppler echocardiography. Ventricular wall motion and pulmonary venous flow pattern were analyzed by transesophageal Doppler echocardiography. The pattern of monophasic forward flow in the pulmonary vein was associated with reduced wall motion during deteriorated cardiac function, while the flow pattern became biphasic as cardiac function recovered. From these results, we concluded as follows: 1. Early decisions as to whether VAD is indicated are important. 2. A right VAD should be considered in cases with biventricular failure, during left ventricular assist, if right atrial pressures elevated more than 18 mmHg constantly. 3. The evaluation of cardiac function by transesophageal Doppler echocardiography is useful for making decisions as to wean patients from a VAD.
[Transesophageal Doppler echocardiography in the diagnosis of atrial septal defect].
To assess the usefulness of transesophageal Doppler echocardiography (TEE) in diagnosing atrial septal defect (ASD), we studied eight cases with secundum type ASD, in which the diagnosis was confirmed by cardiac catheterization and surgery. In all cases, TEE provided clear images of the interatrial septum with its defect. Shunt flow through the defect was observed by color Doppler technique, and its velocity was measured using the FFT mode. In two cases, right-to-left shunt blood flow was detected. Two types of probes were used in this study, a lateral scanning probe and a longitudinal scanning probe. The scanning plane of the former was perpendicular to the axis of the probe, and that of the latter was parallel to it. The two probes facilitated the measurement of the two right-angled dimensions, with which we could calculate the defect area, assuming the defect to be an ellipse. The volume of a left-to-right shunt was obtained by multiplying the defect area by the integration of flow velocity against time. Shunt volume per cardiac cycle obtained by this method correlated well with that obtained by the Fick's method during cardiac catheterization. In six cases without a right-to-left shunt, the coefficient of correlation was 0.98, and in all eight cases it was reduced to 0.72. Thus, we concluded that TEE is useful for diagnosing and evaluating ASD.
[Clinical usefulness of transesophageal Doppler echocardiography].
The usefulness of transesophageal Doppler echocardiography (TEE) was assessed in patients with various cardiovascular diseases including 15 patients with dissecting aortic aneurysm (DAA), two with thoracic aneurysm, 16 with ischemic heart disease and 14 with acquired valvular diseases. In dissecting aortic aneurysms, TEE provided clear images of the intimal flaps even in the aortic arch and descending aorta in which clear images could not be obtained by conventional external Doppler echocardiography. The entry site was detected in 11 of the 15 (73%) cases using TEE, but in only three of the 15 cases using conventional Doppler technique. In two cases of true aortic aneurysms, TEE provided clear images of the aneurysm in the descending thoracic aorta, which was discriminated precisely from DAA. In valvular disease, all four valves (aortic, pulmonary and atrio-ventricular valves) were easily observed without disturbance by any other tissues using a transesophageal approach. In addition, valve aneurysms in the posterior mitral leaflets were detected using TEE in two cases. In two cases of mitral stenosis, a thrombus was observed in the left atrial appendage. These findings were confirmed during surgery, but could not be obtained by the conventional external studies. In 16 cases, TEE was performed during aorto-coronary bypass surgery under general anesthesia. In two of these cases, left ventricular assist devices were applied after surgery. In these cases, where conventional Doppler echocardiography was not applicable, cardiac function could be monitored by TEE. Thus, TEE is useful not only in evaluating morphological function in the cardiovascular system but also in monitoring cardiac hemodynamics during and after heart surgery.
[Two cases of Mycoplasma pneumoniae pneumonia with obstructive ventilatory disturbance].
Mycoplasma pneumoniae (M. pneumoniae) pneumonia is usually considered as a benign disease, but in rare cases, the disease is fatal. Fatal cases requiring mechanical ventilation and many extrapulmonary complications have been reported. Cases accompanied with obliterative bronchiolitis also have been reported. Two cases of M. pneumoniae pneumonia with obstructive ventilatory disturbance were reported. In both cases clinical diagnosis of M. pneumoniae pneumonia was confirmed by a rise in the complement fixation antibody titer, a rise of the cold hemagglutinin titer and isolation of M. pneumoniae from sputum and pharynx. In one case we performed transbronchial lung biopsy (TBLB). The lung biopsy specimen showed bronchiolitis, so histological findings were thought to be compatible with ventilatory function. In both cases arterial oxygen pressure (PaO2) was below 60 Torr, by administration of erythromycin (EM) and adrenocorticosteroids, chest X-ray findings, atrial blood gas analysis findings and ventilatory function were improved.
[A case report of emergency Bentall re-operation].
A 51-year-old male of Marfan syndrome with annuloarotic ectasia underwent the Bentall operation. One and a half months later, he suddenly fell into the left ventricular failure associated with lung edema. Echocardiogram revealed total occlusion of the graft and aortic valve detachment was suspected. An emergency operation was performed. The aortic valve was completely detached due to infectious endocarditis. As anastomosed portions of the proximal coronary arteries and distal aorta were intact, these rims of the old graft were reserved. A new composite graft was anastomosed distally to the above reserved graft rims and sutured proximally to the trimmed aortic valvular ring. The patient survived the re-operation despite many post-operative complications such as mediastinitis, colon bleeding, renal failure and severe hepatic dysfunction.
[A case of proliferative sparganosis associated with PIE syndrome and pulmonary embolism].
A 48-year-old man was admitted because of ischialgia. The CT scanning revealed tumors in the right pelvic cavity and the gluteal muscle. The bodies of Sparganum proliferum and granulation tissues were revealed by the tumor biopsy. In this hospital course, the chest roentgenogram revealed patchy infiltrative shadows in both lungs and left pleural effusion while chest CT scanning revealed multiple nodular shadows. Eosinophils increased in the peripheral blood and transbronchial lung biopsy (TBLB) showed non-destructive vasculitis with eosinophilic infiltration. The pulmonary lesion was diagnosed as intrapulmonary migration of Sparganum proliferum and PIE syndrome caused by this worm. Thiabendazole and prednisolone were administrated, but he died of pulmonary embolism.
Limited capability of the systemic-pulmonary shunt alone to prepare the left ventricle for anatomic correction in simple complete transposition.
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[Early bypass grafting following intracoronary thrombolysis in acute myocardial infarction].
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[A case report of mitral valve aneurysm detected by transesophageal echocardiography].
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