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Biomedical subjects

M Endo

Publications and source records attributed to M Endo.

At least 433 records · Page 24Linked to original sources
PubMed1995

[Flow competition of right gastroepiploic artery graft in coronary artery bypass surgery].

We evaluated the competitive flow between the right gastroepiploic artery (RGEA) and native coronary artery in coronary artery bypass surgery with respect to anastomosis in a retrograde fashion and the relationship of the degree of proximal stenosis with the flow dependency. The RGEA has been used in 157 patients and was anastomosed in a retrograde fashion in 22 patients. There was no significant difference between the retrograde anastomosis and the antegrade anastomosis on revascularization to the left anterior descending coronary artery in terms of diameter (2.0 +/- 0.5, 1.68 +/- 0.2 mm), flow (21.8 +/- 13.2, 24.5 +/- 19.4 ml/min), early patency (100%, 100%) and string sign (0%, 0%). We examined angiographically the relationship between the preoperative degree of proximal stenosis and postoperative pattern of flow dependency in the right coronary artery distal to the RGEA anastomosis in 98 patients. With a proximal stenosis of 75% (n = 19), RGEA occlusion was observed in two patients (11%), native coronary-dependent flow in four (21%), balanced flow in nine (47%) and RGEA-dependent flow in four (21%). With a proximal stenosis of 90% (n = 16), native-dependent flow was observed in one (6%), balanced flow in six (38%) and RGEA-dependent flow in nine (56%) patients. With a proximal stenosis of 99%-100% (n = 63), RGEA occlusion was observed in three (5%) and RGEA-dependent flow in sixty (95%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[A successfully treated case of thoracoabdominal aortic aneurysm complicated with the coagulation disorder].

We could performed the safe operation for thoracoabdominal aortic aneurysm complicated with pre-DIC. A diagnosis of pre-DIC was made by laboratory data. Low heparin pretreatment was performed for the short term because we presumed the cause for pre-DIC was thromboses in aneurysm. That treatment was effective for the temporal remission of pre-DIC. In addition, during partial ECC low heparin (1 mg/kg) and nafamostat mesilate (2 mg/kg/h) were used. As a result, during and after the operation blood loss was a little. In summary heparin pretreatment is useful therapy for DIC and pre-DIC in aortic aneurysm patients.

Aged↗
PubMed1995

[Myeloablative chemotherapy with autologous bone marrow and/or peripheral blood stem cell transplantation in children with high-risk solid tumor].

Autologous bone marrow transplantation (ABMT) and peripheral blood stem cell transplantation (PBSCT) are increasingly used to support high-dose chemotherapy for solid tumors of childhood. In this review we described practical aspects of myeloablative chemotherapy rescued by ABMT, PBSCT or combination of ABMT and PBSCT for the treatment of children with high-risk solid tumor, involving our experiences in 15 cases. Indication, method of harvesting bone marrow and peripheral blood stem cells, cryopreservation, transplantation, selection of anti-neoplastic agents for preconditioning, nutritional and G-CSF support, engraftment and outcomes for prognosis were discussed. In comparing the engraftment of stem cells between ABMT and PBSCT, the acceleration of platelet and erythrocyte recovery is less impressive, although there is a tendency to more rapid recovery of granulocyte in PBSCT group. The outcomes are distinctly improved only in patients who showed complete remission after induction chemotherapy, radiation and surgical excision. A better prognosis will be conferred especially in neuroblastoma and entities of small round cell tumor. It is noteworthy that relapses can occur as distant metastasis considerable years after complete clinical remission. This may be largely contributed by contaminated malignant cells in both harvested bone marrow and peripheral blood stem cells. There is no significant difference between the relapse rates after ABMT and PBSCT.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Surgery for synchronous double cancer in the hypopharynx and thoracic esophagus.

Problems involved in the surgical treatment of synchronous double cancer comprising hypopharyngeal and thoracic esophageal cancers were considered from the aspects of the radicality of treatment and the quality of life following surgery. Advanced esophageal cancers were treated by resection with lymph node dissection via right thoracotomy, and early cancers by transhiatal esophagectomy or endoscopic mucosal resection. When the entire thoracic esophagus was extirpated, the gastric tube was usually used for reconstruction. When the hypopharyngeal cancer extended to the higher oropharynx or when resection of the tongue was combined, complex reconstruction was undertaken using free grafting with a combination of the gastric tube and the jejunum or a flap such as a forearm flap or rectus abdominis musculocutaneous flap. Since endoscopic esophageal mucosal resection allows the preservation of the thoracic esophagus, the hypopharyngeal cervical esophagus was reconstructed using a free jejunal graft. Although surgical treatment provided no sufficient improvement in prognosis, postoperative quality of life was satisfactory.

Adult↗
PubMed1995

[Surgical results of aortic stenosis with or without left ventricular dysfunction--postoperative change of left ventricular function].

Between January 1980 and December 1992, 82 patients with aortic stenosis underwent isolated aortic valve replacement at our institution. Age of the patients ranged from 26 to 72 (58 +/- 6.4) years, and 58 were men and 24 were women. The patients were divided into two groups according to preoperative left ventricular ejection fraction (LVEF): 23 patients (LVEF < 50%, mean 39.7%; Group D) and 59 patients (LVEF > or = 50%, mean 62.6%; Group N). By means of echocardiography, LV function were evaluated before and at one month after operation in terms of left ventricular fractional shortening (LVFS), left ventricular systolic internal diameter (LVIDs), left ventricular mass index (LVMI), and left ventricular end systolic wall stress (ESWS). Postoperative early mortality including hospital death was 8.7% in group D (2 cases; myocardial infarction 1, cerebral complication 1) and 3.3% in group N (2 cases; myocardial infarction 1, low output syndrome 1), and this difference was not significant (NS) between two groups. The 5- and 12-year actuarial survival rate were 87.8% and 87.8% in group D, 91.5% and 87.6% in group N, respectively (NS). LVFS (pre/post) was 0.25 %/- 0/08/0.24 +/- 0.10 in group D, 0.38 +/- 0.10/0.32 +/- 0.10 in group N. The difference were significant before (p < 0.0005) and after (p < 0.005) operation between two groups. LVIDs (mm; pre/post) were 39.0 +/- 7.9/35.0 +/- 9.6 in group D, 28.7 +/- 7.3/229.3 +/- 7.6 in group N. The difference were significant before (p < 0.0005) and after (p < 0.01) operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Clinical characteristics of pancreatitis after cardiovascular surgery].

Increases in pancreatic enzyme levels after cardiovascular surgery were studied, and their clinical characteristics evaluated. The subjects were 128 patients who had undergone cardiovascular surgery (65 patients after valve replacement, 32 after coronary bypass surgery and 31 after aortic artificial graft replacement). The pancreatic enzyme (serum amylase and lypase) levels were monitored serially before and after operation, and amylase fractions were measured at their peaks. The relationships of the peak lypase level with underlying cardiac diseases, background factors, factors related to surgery, factors related to the extracorporeal circulation, presence or absence of symptoms, and treatments were examined. The amylase level exhibited biphasic changes consisting of a peak in which salivary glands amylase (S type) was dominant and a peak in which pancreatic amylase (P type) was dominant. The second peak coincided with the peak lypase and occurred mostly 3 to 10 days after operation. The peak lypase level exceeded the normal range in 78% of all the patients. It exceeded 564 U/l, 4 times the normal value in 28% of the patients, many of whom were symptomatic. So, we recommended that these cases should be treated as "postoperative pancreatitis". A high peak lypase level showed a significant correlation with the history of gallbladder and pancreatic diseases and diabetes mellitus among the background factors and emergency operation and the use of IABP among the surgery-related factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Clinical evaluation of anticancer effect of methionine-depleting total parenteral nutrition with 5-fluorouracil and/or mitomycin C].

Methionine-depleting total parenteral nutrition (Met-deplete TPN), infusing AO-90 amino acid solution (lacking both L-methionine and L-cysteine) as a sole nitrogen source, showed synergistic effects with several antineoplastics including 5-fluorouracil (5-FU). In the recent multi-center, randomized, controlled study, advanced gastric cancer patients were randomly allocated to RT group and Control group. RT group received AO-90 amino acid solution, while Control group infused Amiparen (commercial methionine and cysteine containing amino acid solution) as protein source for 14 days' TPN with 5-FU and mitomycin C (MMC). The over all clinical response rate (PR+CR) in RT and Control groups were 26.3% and 8.1%, respectively, with significant statistical difference in both values at p = 0.015. Fourteen advanced gastric cancer patients allocated to RT and Control group randomly and received each amino acid as protein source for 7 days TPN with 5-FU administration. All cases were performed gastrectomy without waiting period, and resected material was examined the histological response. In the 7 cases of RT group, grade 2 was seen in 4 cases, grade 1-b in 1, grade 1-a in 1 and grade 0 in 1. In the 7 of Control, 3 cases were grade 1-a and the remaining 4 were grade 0. There were significant differences in both degree and incidence of the histological response at p = 0.016. A stage IV gastric cancer patient with marked liver metastasis received 2 times RT therapy with 5-FU and MMC for 14 days and undertaken gastrectomy after 22 day, waiting period. Resected gastric cancer showed grade 2 to 3 histological response, and the liver metastasis showed marked effect as PR to CR.

Amino Acids↗
PubMed1995

Different functional recovery of the left ventricle after valve replacement for aortic regurgitation: correlation between grade of ventricular arrhythmia and long-term mortality.

Although aortic valve replacement for aortic regurgitation relieves left ventricular volume overload, ventricular size often remains abnormal after operation, particularly in the setting of marked or prolonged preoperative left ventricular dysfunction. The aim of this study is to assess the relationship between the grade of ventricular arrhythmias before operation and the recovery of left ventricular function after aortic valve replacement. Between January 1980 and August 1993, 229 patients with pure aortic regurgitation underwent aortic valve replacement at our institution. In this group, 50 patients (21.8%) who showed left ventricular end-systolic volume index (LVESVI) of 150 ml/m2 or greater received 24-hour ambulatory electrocardiographic recordings before and after operation. According to the preoperative grade of ventricular arrhythmias, the patients were divided into three groups. Group A included 20 patients with severe and frequent ventricular premature beats (VPBs). Group B included nine patients with severe and non-frequent ventricular premature beats (VPBs). Group C included 21 patients with non-severe and non-frequent VPBs. Left ventricular end-systolic dimension (LVDs), end-diastolic dimension (LVDd) and fractional shortening (LVFS) were measured in each echocardiogram before, and one year and five years after operation. LVDd significantly decreased at one year after operation in all three groups. At one year after operation, LVDs significantly decreased in group B (42.0 +/- 7.6 mm) and group C (42.6 +/- 8.6 mm), while LVDs showed no significant change in Group A (55.4 +/- 11.1 mm). After five postoperative years, further significant decrease of LVDs was found in group C (32.4 +/- 7.1 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Chronic inflammatory demyelinating polyneuropathy associated with chronic liver disease due to type B and type C hepatitis virus].

A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) associated with type B and type C hepatitis virus infection is reported. A 54-year-old female who had a blood transfusion at the age of 31 years was diagnosed as a carrier of hepatitis B virus at the age of 43. Liver dysfunction was first noted in 1987 and gradually grew worse year by year. Beginning in early June 1992, the patients general fatigue became worse, her serum GOT and GPT levels became elevated, and she complained of a tingling sensation in her arms and legs. Neurological examination revealed moderate sensory disturbance of the glove-and-stocking type in all of her extremities. Deep tendon reflexes were all diminished. Hepatitis C antibody was detected in the serum at this time. On June 12, 1993, progression of her sensory disturbance was found to be associated with generalized muscle weakness. Cerebrospinal fluid studies showed increased protein without pleocytosis. Motor nerve conduction studies revealed marked prolongation of terminal latencies, reduction of conduction velocities, and abnormal temporal dispersion of the motor potentials. No sensory potentials could be evoked at any of the sites stimulated. Sural nerve biopsy showed segmental demyelination and severe loss of large myelinated fibers as well as some onion bulb formation. A diagnosis of CIDP was made. Treatment with corticosteroids was started, but there was little improvement in neurological function. The liver dysfunction progressed further and ultimately the patient died of hepatic failure. An autopsy demonstrated liver cirrhosis, but no malignant tumors were evident.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Disease↗
PubMed1995

[Thoracoscopic enucleation of leiomyoma of the esophagus--report of two cases].

Thoracoscopic enucleation of leiomyoma of the esophagus was successfully performed in two cases. This paper mainly describes a 53-year-old man who experienced with a slight dysphagia and retrosternal discomfort when moving. Esophagoscopy showed a mass beneath normal mucosa located at 26 cm from the incisor of the left anterior esophagus. Endoscopic ultrasonography showed a sharply delineated low echoic mass with regular echo-pattern, measuring 4 cm along the axis. The lesion was diagnosed as leiomyoma. The operation was performed under general anesthesia, keeping the patient on the left postero-lateral position. A double-lumen endotracheal tube was utilized and the right lung was collapsed. Six trocars were inserted through right intercostal spaces for operation. The azygos vein first of all was dissected and divided by an EndoGIA. The esophagus was then mobilized lengthwise enough to rotate the left side to the right with two slings traction for better visualization of the lesion site. Intraluminal balloon-mounted esophagoscope was useful enough to expose the tumor inner side out of the esophageal wall and the tumor was easily enucleated. After resection, intact esophageal mucosa was confirmed by endoscopy and the proper muscle layer of the esophagus was closed with 2-0 Vicryl. In the 2nd case, leiomyoma located at 32 cm from the incisor of the right esophageal wall, 4 x 1.5 x 1 cm in size, was removed by the same technique using five trocars, where neither the azygos vein divided nor the esophagus mobilized. Both patients showed uneventful recovery and the symptoms disappeared after operation. Intraluminal balloon-mounted esophagoscope was useful to do this kind of thoracoscopic procedure.

Adult↗
PubMed1995

Current strategy of circulatory support for profound heart failure.

The purpose of this study is to assess the current strategy of mechanical circulatory support for profound heart failure. In the last 10 years, 37 patients with profound heart failure underwent mechanical circulatory support after open heart surgery and 9 patients with non-cardiotomy cardiogenic shock received emergency circulatory support. All patients showed severe cardiac failure and/or fatal ventricular arrhythmia and required circulatory support as a life-saving measure. After cardiovascular surgery, 12 of those patients underwent venoarterial bypass (VAB), 13 had biventricular bypass (BVB), 8 had left ventricular bypass (LVB) and the remaining 4 patients received left ventricular assist device (LVAD). And 9 patients with non-cardiotomy cardiogenic shock received percutaneous cardiopulmonary support (or PCPS) as an emergency assist system. Weaning and discharge rates of the patients by the type of circulatory supports were 41.7% and 25.0% with VAB, 69.3% and 46.2% with BVB, 87.5% and 37.5% with LVB, 75.0% and 50.0% with LVAD, and 44.4% and 11.1% with PCPS, respectively. Clinical results of post-cardiotomy circulatory support (64.9% of weaning and 37.8% of discharge) were acceptable, but the patients with non-cardiotomy cardiac failure needed early application of more advanced circulatory support.

Adult↗
PubMed1995

[Geometrical study on intra-arterial aortoinfundibuloplasty].

Newly-developed procedure for aortic annular enlargement was geometrically examined on its optimal annular augmentation. Valve prosthesis is accommodated by anterior annular split extending into aortopulmonary and infundibular septum and, eventually, protrudes into pulmonary valvular orifice in this procedure. Relationship between residual pulmonary valvular area (PVA) and aortic annular incremental radius (x) is given by: PVA = (r+x)2 [pi - 2 pi x/(r+x) + sin (2 pi x/(r+x))], where r is original aortic annular radius. Optimal aortic annular augmentation maximizing PVA and saving original PVA is 1.33 times and 1.70 times of original diameter respectively. Animal experiments employing six mongrel dogs demonstrated no significant increase of systolic peak pressure gradient in right ventricular outflow tract after the procedure standardized by this geometrical idea. Our procedure would bear radical enlargement of small aortic annulus.

Aortic Valve↗
PubMed1995

[A controlled study of AO-90, a methionine-free intravenous amino acid solution, in combination with 5-fluorouracil and mitomycin C in advanced gastric cancer patients (surgery group evaluation)].

The results of recent preclinical and clinical studies suggest that AO-90, a methionine-free intravenous amino acid solution (7.43%), potentiates the antitumor effect of 5-fluorouracil (5-FU). In the present multi-center, randomized, controlled study conducted at the surgery departments of 53 institutions between July 1991 and March 1993, patients with advanced gastric cancer were randomly allocated to receive either AO-90 (500-750 mL/day, AO/MF group) or Amiparen, a commercial intravenous amino acid solution (600-800 mL/day, C/MF group) by total parenteral nutrition for 14 days. Both groups received MF therapy which consisted of a continuous infusion of 5-FU at 350 mg/m2/day for 14 days and an i.v. push of mitomycin C 7 mg/m2 on days 7 and 14 (one course). Additional treatment courses were initiated after a withdrawal period when appropriate. Of the 138 subjects enrolled, 129 (93.5%) were eligible and 119 (86.2%) completed the scheduled treatment (AO/MF group: 57, C/MF group: 62). The overall clinical response rates in the completed cases were 26.3% (15/57) in the AO/MF group and 8.1% (5/62) in the C/MF group, and the difference between the groups was significant (p = 0.015). In particular, the response rate in the postoperative recurrent patients with measurable lesions was 42.9% (12/28) in the AO/MF group versus 12.0% (3/25) in the C/MF group (p = 0.016). Further, in the patients who were previously treated with fluoropyrimidine drugs, 29.0% (9/31) responded to the AO/MF therapy versus 8.6% (3/35) in the C/MF group (p = 0.053). The treatment-related adverse reactions observed were mainly hematologic and subjective/objective symptoms, such as decreased leukocyte count and hemoglobin level, nausea/vomiting and stomatitis. The differences in the incidence were not significant between the groups. Based on these results, AO-90 in the MF regimen appears to be effective in the treatment of patients with advanced gastric cancer by significantly potentiating the effects of 5-FU.

Adolescent↗
PubMed1995

[Relation between preoperative ventricular arrhythmias and postoperative results in aortic valve regurgitation].

Sudden death is a well known complication of aortic valve regurgitation and remains a common cause of late mortality after aortic valve replacement. Although malignant arrhythmias have been suggested as the cause of these outcome, there has been little information concerning the frequency and severity of ventricular arrhythmias in patients with aortic valve regurgitation. In order to evaluate the relation between the severity and/or frequency of ventricular arrhythmias and late postoperative results in patients with pure aortic valve regurgitation, 24-hour ambulatory electrocardiographic recordings were obtained before surgery in 107 patients without coronary artery disease. Grading of ventricular arrhythmias was based on a Lown method and compared with hemodynamic data. Ventricular premature beats were observed in 101 patients (94.4%) before operation. Multiformity was found in 10 patients (9.3%) couplets in 19 patients (17.8%) and ventricular tachycardia in 32 patients (29.9%). Patients with severe ventricular arrhythmias (Lown grade 3 or 4: 57.0%) had a higher left ventricular end systolic volume index (LVESVI) 153.1 +/- 76.4 ml/m2 vs 96.5 +/- 35.0 ml/m2 (p = 0.0001); a higher left ventricular end diastolic volume index (LVEDVI) 257.0 +/- 85.4 ml/m2 vs 206.5 +/- 58.3 ml/m2 (p = 0.0009); a lower left ventricular ejection fraction (LVEF) 43.4 +/- 12.5% vs 54.2 +/- 9.8% (p = 0.0001). LVESVI was not related to the severity of ventricular arrhythmias, but was significantly related to the frequency (p < 0.05). All patients with late death were belonging to Lown grade 3 or 4 in severity and more than 30 beats per hour in frequency (28.6%). This study indicates that ventricular arrhythmias are common in patients with aortic valve regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1995

[The modified Bentall's operation for the prosthetic valve malfunction with annuloaortic ectasia due to aortitis syndrome--a successful case of the operation on steroid therapy].

A 23-year-old female was undergone the modified Bentall's operation for the prosthetic valve malfunction with annuloarotic ectasia due to aortitis syndrome. For she was in active inflammatory phase at the first admission to our hospital, the glucocorticoid steroid therapy was started to control the inflammation. After the good control was induced, the re-operation was done. In the operation, the prosthetic valve was detached from the annular ring and the motion was restricted by small thrombus and the remnant of right coronary cusp, and the right coronary orifice was not noticed. The right coronary artery was not able to be reconstructed, and slightly ischemic change was occurred postoperatively. She was treated by glucocorticoid steroid also in the postoperative period. Her postoperative course has been uneventful of three years.

Adult↗
PubMed1995

[Anesthesia for a patient with Creutzfeldt-Jakob disease].

We reported anesthetic as well as perioperative management for a patient with Creutzfeldt-Jakob disease, a very rare transmissible neuropathy. A 51 year-old woman was scheduled for extirpation of recurrence of acoustic neurinoma. Three months before the operation, she had complained vertigo. After admission to our hospital, she had become progressively dementiated and developed disturbed consciousness. Anesthesia was induced with thiamylal and maintained with 0.7-1.5% isoflurane, nitrous oxide and oxygen. The anesthetic course was uneventful and the recovery from anesthesia was smooth. Postoperatively dementia progressed and myoclonus of extremeties appeared sixth weeks after the operation. Two months after the operation, a diagnosis of Creutzfeldt-Jakob disease was established by characteristic EEG and clinical course. Anesthesia for a patient with dementia was discussed.

Adult↗
PubMed1995

[Assessment by three-dimensional CT of pleural indentation or invasion by peripheral lung cancer].

We evaluated the effectiveness of three-dimensional (3D) CT for pleural indentation or invasion by peripheral lung cancer adjacent to pleura. Pleural indentation was shown in three of nine cases on conventional CT, and six cases were demonstrated three-dimensionally. 3D-CT was superior to conventional CT in demonstrating pleural indentation. Pleural invasion could not be assessed on 3D-CT because the pleura adjacent to the tumor was not visualized.

Humans↗