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Biomedical subjects

M Endo

Publications and source records attributed to M Endo.

At least 379 records · Page 21Linked to original sources

Cell surface c-kit receptors in human leukemia cell lines and pediatric leukemia: selective preservation of c-kit expression on megakaryoblastic cell lines during adaptation to in vitro culture.

We produced a monoclonal antibody MTK1 which recognized c-kit protein. Using MTK1, 31 leukemia cell lines and 76 leukemia blasts from pediatric patients were analyzed for expression of the c-kit receptor by flow cytometry. The c-kit receptor was detectable on four of four cell lines assigned to the megakaryo/erythromegakaryoblastic lineage and on one of seven cell lines of myeloid lineage. C-kit expression was not seen on any of 20 cell lines of erythroid and lymphoid lineages. Furthermore, c-kit was expressed on 16 of 24 nonlymphoid blasts without platelet surface antigens (67%) and on six of eight non-lymphoid blasts with platelet surface antigens (75%), but was not detectable on 44 lymphoid blasts from pediatric leukemia patients. In these cases CD34 was expressed on 26 of 32 myeloid blasts (81%) and on 27 of 44 lymphoid blasts (61%). The findings indicate a dominant expression of the c-kit receptor on established cell lines assigned to the megakaryo/erythromegakaryoblastic lineage, though a high percentage of leukemic myeloblasts also expressed the c-kit receptor on their surface.

Antibodies, Monoclonal↗

Enlarging splenic vein aneurysm associated with stagnation of splenic venous blood flow.

We report a case of splenic vein aneurysm (SVA) that was enlarged during a 17-month follow-up. A 62-yr-old female with liver cirrhosis was followed up in our hospital. Real-time ultrasonography initially detected aechoic space at the middle part of the splenic vein, confirmed as SVA by contrast-enhanced computed tomography, magnetic resonance imaging and angiography. Magnetic resonance imaging showed the stagnation of blood flow in SVA, which suggests the presence of hypertension in the portal venous system. Moreover, SVA enlarged in parallel with the development of esophageal varices. These observations suggest that the persistent stagnation of blood flow in the portal venous system may have played a major role in the increase in size of the SVA in this case.

Aneurysm↗

[Surgical treatment for ischemic cardiomyopathy].

From June 1970 to Aug. 1995. We were experienced 2,235 coronary surgical patients at the Heart Institute of Japan. Among them, the ischemic cardiomyopathy (ICM) was defined as the elective, isolated CABG with the EF of less than 20%. Among the 1,640 cases of elective, isolated CABG, the cases with the EF of less than 20% were 29, 1.8% of the total. The hospital mortality was 2 cases (6.9%). The late mortality was 2 cases. The graft patency rate was 96.6%. An actuarial survival rates at 1 year, 3 years and 5 years were 93%, 93 and 87%. Operative mortality and 5-year survival rate of CABG for ICM are acceptable, and appear comparable to that achieved in similar patients after transplantation.

Adult↗

[Evaluation of blood absorption, hemostatic ability and purity of a polyepoxy compound cross-linked cotton type collagen hemostat].

A polyepoxy compound cross-linked cotton type collagen hemostat (CCH) made of highly purified atelocollagen in a fine filament shape was developed. To evaluate blood absorption, hemostatic ability and purity of the CCH, Avitene and Oxycel were used for comparison. Blood absorption speed of the CCH was faster than Avitene and Oxycel. The handling characteristics of the CCH were much better than those of Avitene and Oxycel. Hemostatic ability was better in the CCH compared to Avitene in a canine study. The purity of the CCH was better than in Avitene which contained albumin and other proteins. Those results suggest that the developed hemostat with excellent blood absorption, handling characteristics, hemostatic ability and purity, could be useful in clinicals.

Absorption↗

[Hemodynamic plus series of St. Jude medical valve prosthesis in aortic position: early clinical outcome and reconsideration of its application].

St. Jude Medical Hemodynamic plus bileaflet valve prosthesis (HP) was employed in 7 cases undergoing aortic valve replacement since December 1993. Echocardiographic evaluation of left ventricular dimension and transvalvular pressure gradient was performed in 5 cases with 19 HP before and after operation. Each data was compared with those of 21 cases having undergone aortic valve replacement with 19 mm Standard model (19 SD). There was no significant postoperative change in left ventricular end-diastolic dimension (50 +/- 4 mm to 44 +/- 8 mm; p = NS) and left ventricular end-systolic dimension (34 +/- 4 mm to 34 +/- 9 mm; p = NS) in 19 HP cases. However, left ventricular end-diastolic dimension (51 +/- 11 mm to 41 +/- 8 mm; p < 0.05) and left ventricular end-systolic dimension (35 +/- 12 mm to 28 +/- 9 mm; p < 0.05) decreased in 19 SD cases. Transvalvular systolic peak pressure gradient was reduced significantly in both groups (19 HP: 94 +/- 38 mmHg to 43 +/- 19 mmHg; p < 0.05, 19 SD: 73 +/- 49 mmHg to 33 +/- 14 mmHg; p < 0.05). Poor reduction of left ventricular volume and high residual systolic pressure gradient in patients with 19 HP might be due to relatively high incidence of stenotic lesion in original aortic valve disease. In some cases with these critical aortic stenosis, radical annular enlargement procedure would provide more fundamental release of left ventricular outflow tract stenosis rather than one size increase of effective orifice area by employing HPs. Structural examination demonstrated that 19 HP had the same outer diameter of sewing flange with identical orifice ring as 21 SD (24 mm) did, and 17 HP had that of 19 SD (22 mm). Therefore, precise attention is needed for application of SJM-19 HP in patients with small aortic annuli.

Adolescent↗

[Long-term results and special issues of operation for infective endocarditis].

Between 1977 and June 1996, 183 patients underwent operation for infective endocarditis (IE) at our institution. Long-term mortality and morbidity were analyzed according to the STS/AATS guidelines (1988). Operative mortality including hospital deaths was 4.9% in all patients. Actuarial survival (including all deaths) at 10 postoperative years was 79.6% after AVR (n = 91), 87.9% after MVR (n = 40) and 90.0% after DVR (n = 46). There was no significant difference among 3 groups. Reoperation free and freedom from all valve-related mortality and morbidity at 10 years were 94.0% and 70.4% after AVR, 90.9% and 83.7% after MVR and 93.4% and 79.7% after DVR, respectively. And the differences among 3 groups were not significant in both freedom proportions. Overall results in this series of patients were acceptable. However, several patients with active IE and extensive perivalvular abscess were not saved even if translocation method and/or other advanced surgical procedures were applied. Introduction of aortic valve homografts might be a key factor for successful treatment for patients with extensive IE lesion.

Adolescent↗

[Successful redo-AVR with cryopreserved allograft for prosthetic valve endocarditis : report of a case].

A 20-year-old male undergoing mechanical aortic valve replacement suffered from prosthetic valve endocarditis by Coagulase negative Staphylococci 3 months postoperatively. Echocardiography revealed left ventricular distention, severe paravalvular leakage, valve detachment and large periannular abscess adjacent to the left main coronary artery. Redo-AVR was successfully performed with a cryopreserved aortic allograft by cylinder technique. The orifice of abscess was covered with the aortic wall of the graft. Postoperative echocardiography showed trivial central regurgitation and the abscess cavity went on vanishing. He discharged from hospital 2 months later without any symptom.

Abscess↗

[A case of saccular aneurysm of the coronary artery].

A 42-year-old man with chest oppression was diagnosed as having a saccular aneurysm of the coronary artery by cardiac catheterization. At the time of operation on April 26, 1993, the aneurysm, measured 15 mm in diamer, and arose from the proximal segment of the first septal branch of the left anterior descending coronary artery. Several coronary arteriovenous fistulae from the aneurysm to the pulmonary artery were also noted. The stem of the aneurysm and the coronary arteriovenous fistulae were ligated and the aneurysm was resected. We considered the etiology to be mainly arteriosclerosis on the basis of the aneurysm pathology. And this aneurysm was also considered to have congenital factors because of the existence of arteriovenous fistulae. There were no symptoms after the operation and he was discharged at 24th postoperative day. Now he continues to do well.

Adult↗

Clinical application of a newly developed autoflow control system for the Terumo centrifugal pump: from external control to built-in direct control.

We have developed an autoflow control system for the Terumo Capiox centrifugal pump, the SP-101. First, we made an external control system regulated by a personal computer through a serial communications line. Although an in vivo experiment using a goat showed excellent performance in regulating the flow, a communication error that caused an abrupt and instantaneous flow fluctuation was noted occasionally. Therefore, we incorporated a check-sum function to solve this problem. After this improvement, 5 patients safely underwent cardiopulmonary bypass using a pump having this autoflow control. As the next step for more practical usage, we developed a built-in autoflow control system in which the control device is entirely incorporated into the console without a communications line. This system demonstrated better response and reliability than the external control system and was applied successfully in 3 patients. In conclusion, this autoflow mode will expand the usage of centrifugal pumps through improved handling.

Algorithms↗

Less blood damage in the impeller centrifugal pump: a comparative study with the roller pump in open heart surgery.

A centrifugal pump with an impeller (Nikkiso Centrifugal Pump, Model HPM15; Nikkiso Co. Ltd.) was applied to cardiopulmonary bypass (CPB) in 14 patients who underwent elective coronary artery bypass grafting. Serum hemoglobin level, platelet count, and serum beta-thromboglobulin (beta TG) level were measured during CPB. The results were compared with those obtained in a comparative roller pump (RP) group (n = 10). There was no difference in the time on CPB between the NP (109 min) and RP (121 min) groups. The serum beta TG level (ng/ml) was lower in the NP group than in the RP group (obtained 90 min after the initiation of CPB). The plasma-free hemoglobin level also was lower in the NP group than in the RP group (obtained 90 min after the initiation of CPB, 120 min after the initiation of CPB, immediately after the termination of CPB, 3 h after termination of CPB; p < 0.01). There was no significant difference in platelet depletion. The HPM15 pump showed excellent hemodynamic performance with less blood trauma compared with the roller pump in its clinical application to open heart surgery.

Adult↗

Biventricular bypass with oxygenation for postcardiotomy ventricular failure.

Between January 1984 and March 1995, biventricular bypass (BVB) with oxygenation was used in 17 patients for postcardiotomy ventricular failure at the Heart Institute of Japan, Tokyo Women's Medical College. Of the 17 patients, 12 (70.6%) were weaned from the circulatory support, and 8 (47.1%) were discharged from the hospital. The time interval from the endo of cardiopulmonary bypass to the start of BVB was significantly shorter in weaned patients than in unweaned patients. The duration on support also has been shortened significantly in the last 6 years, compared with the earlier 6 years. Causes of death were severe heart failure or ventricular arrhythmia in 6 patients and multiple organ failure in 3 patients. These results suggest that early application and timely weaning from biventricular bypass with oxygenation might be the effective circulatory support of choice for treatment of postcardiotomy ventricular failure.

Adult↗

Increased plasma atrial natriuretic peptide and endothelin concentrations after surgery in patients with esophageal and gastric cancer.

Endothelin-1 (ET-1) and human atrial natriuretic peptide (hANP) are known as vasoactive substances. In the present study, an attempt was made to evaluate the mode by which these substances are secreted in patients having severe surgical stress. Plasma ET-1 and hANP concentrations were measured in 15 patients with esophageal carcinoma who underwent subtotal esophagectomy via right-thoraco-ventrotomy (EC group) and 10 patients with gastric carcinoma who underwent total gastrectomy via ventrotomy (GC group). The volume of intraoperative hemorrhage was significantly larger and operation time was significantly longer in the EC group than in the GC group. Plasma ET-1 concentration in the EC group increased remarkably on the first operative day (1st POD), whereas that in the GC group did not. Plasma levels of hANP in both the EC and GC groups gradually increased until they peaked on the 2nd POD. The increment of plasma hANP secretion for the EC group was significantly higher than that for the GC group on the day of the operation, suggesting that ET-1 stimulated hANP in the EC group. Plasma hANP levels reached their peak values on the 2nd POD and returned to the preoperation level on the 5th POD, while PCWP did not change significantly after the surgery. Since this discrepancy between the postoperation patterns of PCWP and hANP cannot be explained by changes in the circulating blood volume, hANP secretion may be regulated by certain factors in addition to the left ventricular pressure experienced by patients receiving heavy operation stress, such as those in the EC group.

Atrial Natriuretic Factor↗

[Emergency coronary artery bypass in an 84-year-old patient with severe left main disease and cardiogenic shock].

An 84-year-old male was admitted to pur hospital because of unstable angina. The patient presented in cardiogenic shock with a cardiac index of 1.3 l/min/m2 associated with hypotension (systolic blood pressure < 80 mmHg) and oliguria, and in ventricular fibrillation after an acute broad anterolateral infarction due to severe left main coronary disease. The patient received an intra-aortic balloon pumping (IABP) and underwent emergency CABG. After completion of CABG, left ventricular contractility was markedly diminished to maintain systemic circulation. Because the patient could not be weaned from cardio-pulmonary bypass (CPB) in spite of IABP and high-dose of catecholamines, we decided to continue CPB. It was continued for 163 minutes and the patient was successfully weaned from CPB. In spite of the high risk of operative mortality with CABG for left main shock syndrome in elderly patients, CABG could be performed safely. The patient ran an uneventful postoperative course and is now doing well.

Aged↗

[Differentiation of extravillous trophoblast during normal pregnancy].

The implantation site in 25 pregnant uteri was studied morphologically and immunohistochemically to clarify the developmental process of extravillous trophoblasts (EVTs). 1. Dense trophoblastic invasion of the decidua was observed. Multinuclear trophoblasts appeared in the deciduo-muscular junction from the 10th week. Trophoblasts infiltrated decidual vessel walls, where extensive perivascular degeneration existed. EVTs may be indispensable for construction of the placenta. 2. In villous trophoblasts (VTs) the location of hCG and hPL was limited to multinuclear cells, whereas in EVTs hCG was present in a few mononuclear cells and hPL was observed in most mononuclear and multinuclear cells. The immunoreactivity of trophoblast-related monoclonal antibodies also differed: neither anti-Tropl (reactive with cytotrophoblasts (CTs)) nor NDOG1 (reactive with syncytiotrophoblasts (STs)) was reactive with EVTs. 3. The absence of hCG and hPL in mononuclear trophoblasts of the cell column indicates that EVTs differentiate after invading the decidua. Kurman et al. proposed the term intermediate trophoblast, indicating cells in transition from CTs to STs and EVTs, and this is based on the concept that the developmental processes of EVTs and VTs are identical. But the results of this study suggested an independent developmental process for EVTs and therefore it seemed that the term intermediate trophoblast should not be employed for EVTs.

Cell Differentiation↗

[Cardiac surgery in patients on chronic hemodialysis].

From March 1993 to February 1993, 36 patients with chronic renal failure underwent cardiac surgery with intraoperative hemodialysis (HD). We examined and compared the medium term results of those patients cased upon the time periods of operation and types of heart disease. With respect to the time periods of operation, the 1st term (n = 12) was between March 1985 and February 1989, and the 2nd term (n = 24) was between March 1989 and February 1993. Concerning types of disease, Group A was comprised of 24 patients with ischemic heart disease, and Group B was comprised of 12 patients with valvular or congenital heart disease. Only one early death was observed in the 1st term (8.3%: LOS). As for late death, 5 cases were observed in the 1st term (45.3%), and 2 cases were observed in the 2nd term (8.3%). The actuarial survival rate (post 3 years) was 72.7% in the 1st term and 91.3% in the 2nd term. In each case, the survival rate of the 2nd term was significantly better than the that of the 1st term (p < 0.025). When compared cased upon the types of disease, the actuarial survival rate (post 6 years) was 84.6% in Group A, and 45.5% in Group B, respectively. This difference was statistically significant (p < 0.05). Causes of late death were cerebral hemorrhage in 5 cases, sudden and unknown in one and DIC in the remaining one patient. There were many postoperative complications in this series in addition to the above stated fatal ones. The majority of them, however, were successfully treated, if early diagnosis of them was obtained. During the perioperative period through the long-term period, incidents of fatal hemorrhage among patients on chronic dialysis were reduced by 1) strict management of hypertension; 2) HD without use of Heparin; and 3) with respect to patients who required Warfarin after valve replacement, through the careful anti-coagulant therapy which maintained the thrombo-test (TT) value at precise levels.

Adult↗

[A surgical case report of an atrial septal defect combined with stenosis of the left main coronary artery caused by a dilated pulmonary artery in adult].

We encountered a 40-year-old male patient diagnosed to have an atrial septal defect combined with pulmonary hypertension and left main coronary artery stenosis of 50% caused by a dilated pulmonary artery. Preoperative Trazoline tolerance test revealed an increase in pulmonary artery pressure from 77/22(40) to 85/24(42), and a decrease in pulmonary vascular resistance from 4.2 U.m2 to 3.6 U.m2. Moreover, his treadmill exercise test was positive. We performed only a patch closure of the atrial septal defect. The postoperative catheterization examination showed normal pulmonary artery pressure, mild mitral valve regurgitation, and improvement of the left main coronary artery stenosis from 50% to 41%. After 6 months, his treadmill exercise test was negative. We believe that it is important to estimate preoperatively for the possible reversibility of pulmonary hypertension in a patient with an atrial septal defect combined with a left main coronary artery stenosis caused by a dilated pulmonary artery.

Adult↗

[Ruptured peripheral lenticulostriate artery aneurysm in a child: case report].

We report a 12-year-old with intracerebral hematoma and subarachnoid hemorrhage secondary to the rupture of a peripheral lenticulostriate artery aneurysm. We carried out proximal clipping of the lateral lenticulostriate artery at the middle cerebral artery following six days of continuous ventricular drainage for acute hydrocephalus. Postoperative angiography confirmed the obliteration of the aneurysm. The girl was discharged without any neurologic deficits. To our knowledge, this is a first reported case in the literature of a ruptured peripheral lenticulostriate artery aneurysm in childhood. The pathogenesis of such an aneurysm and the treatment modalities are discussed.

Aneurysm, Ruptured↗