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Biomedical subjects

M Endo

Publications and source records attributed to M Endo.

At least 757 records · Page 42Linked to original sources
PubMed1989

[Cutaneous malignant lymphoma in childhood].

Two cases of malignant lymphoma in childhood were studied. The first case was a Japanese girl aged 8, in whom the primary site was skin of the right temple. The second case was a 4-year-old Japanese boy, who had metastases to the abdominal skin. Histochemical findings indicated B-cell lineage in both cases. Primary cutaneous lymphoma is extremely rare in childhood. Fourteen such cases that have been reported in Japan and our case added to them, were reviewed. The relationship between their morphologic, immunohistochemical and clinical findings were summarized and discussed. Although the prognosis of lymphoma confined to skin in childhood has been reported not to be bad as compared with other types of lymphoma, our first such case was fatal. This suggests that appropriate initial treatment is very important. Recent advances in science may clarify the clinical and biologic characteristics of this tumor in the near future.

Abdominal Neoplasms↗
PubMed1989

[Diagnosis and surgical treatment of early esophageal cancer].

144 cases of the superficial esophageal cancer, of which invasion was limited to the submucosa, have been resected for the last 23 years. 94 cases (65%) were early cancer, and 50 cases (35%) were superficial cancer with metastasis. The 5-year survival rate of early cancer cases was 65%, otherwise, that of superficial cancer cases with metastasis was 24%. There was a significant difference between these two groups. As for the depth of cancerous invasion, the 5-year survival rate of mucosal cancer cases was 100%. That of submucosal cancer cases was 70% even in cases without nodal involvement. Analyzing the cancerous depth of the superficial cancer and its nodal involvement and its vascular invasion, the lymph node metastasis and the vascular invasion were not observed in 90% of mucosal cancer cases, otherwise these were negative only in 30% of submucosal cancer cases. So to obtain the remarkable improvement of the long term results of esophageal cancer, the diagnosis and the treatment of mucosal cancer of the esophagus are essential. The endoscopic examination have come to play a large role for the diagnosis of mucosal cancer of the esophagus. Moreover, the endoscopic dyeing with Lugol's solution is important in the diagnosis of flat type of esophageal lesions, that is mucosal cancer and epithelial cancer. At present time, the treatment of early esophageal cancer is in principle surgery. And the operative mortality was low, 1.4%. However, the non-invasive treatments; endoscopic LASER therapy, radiation, endoscopic strip-biopsy etc., will be performed more frequently in minute mucosal cancer.

Aged↗
PubMed1989

[Pharmacokinetics and the lung uptake of lidocaine during epidural anesthesia].

In order to investigate the pharmacokinetics of lidocaine especially the lung uptake during epidural anesthesia, we measured the lidocaine concentrations of arterial and central venous blood simultaneously using a homogeneous enzyme immunoassay. Then the lung extraction ratio was calculated as (1-arterial lidocaine concentration/central venous lidocaine concentration) X 100%. With only epidural anesthesia, the lung uptake of lidocaine was above 30% during the first 40 minutes, but was less after additional administration. After general anesthesia with thiamylal, enflurane, nitrous oxide and oxygen, the lung uptake was 30 approximately 40% following initial and additional administrations. There was a positive correlation between the lung extraction ratio and the central venous lidocaine concentration 5 minutes after the initial administration. Having used laryngotracheal lidocaine spray during endotracheal intubation, the lung extraction ratio could not be calculated since this resulted in direct lidocaine administration to the lungs. In conclusion, the lung plays an important role in keeping the arterial lidocaine concentration low.

Adult↗
PubMed1989

[Prognostic factors in gastric cancer with serosal invasion--importance of the extent of cancer infiltration in the subserosal layer].

The extent of cancer infiltration in the subserosal layer has been examined in 214 stomachs resected for cancer with a serosal invasion. The extent was 4 cm or less in 109 patients (Group A) and 5 cm or more in 105 patients (Group B). The resection was estimated as being non-curative in 26% of Group A and in 52% of Group B (p less than 0.001). Peritoneal dissemination was the outstanding non-curative factor in the latter. The five-year survival rate was 39% in Group A and 14% in Group B (p less than 0.001). The survival rate after the curative resection was 49% and 26%, respectively (p less than 0.01). In Group B, peritoneal dissemination was the main mode of recurrence after the curative resection.

Adult↗
PubMed1989

[A successful cryosurgical treatment of malignant ventricular tachycardia following left ventricular aneurysm].

A 61-year-old man underwent cryoablation in addition to aneurysmectomy and single aorto-coronary bypass for sustained ventricular tachycardia (VT) following left ventricular aneurysm. Two types of VT were observed clinically and electrophysiologically with programmed stimulation. During operation, VT was induced but could not be maintained on normothermic cardio-pulmonary bypass. Therefore cryoablation was performed on the two sites where the delayed potentials were recorded. Postoperatively recurrence of VT was never recognized clinically and electrophysiologically.

Cryosurgery↗
PubMed1989

Gastric cancer in elderly patients--results of surgical treatment.

Between 1972 and 1984, a total of 848 patients underwent gastrectomies for gastric cancer. One hundred and thirty-nine patients (16%) were aged 70 and over (elderly group), the remaining 709 being under 70 (control group). The operative morbidity and mortality rates were 29.5% and 4.3% in the elderly group, as compared with 23.0% and 1.8% in the controls. The 5-year survival rate was 47.2 +/- 5.3% in the former and 53.9 +/- 2.4% in the latter. In neither comparison was the difference statistically significant. The mortality rate after total gastrectomy in the elderly group was 8.6% for the overall period, but it has reduced to 5.3% in the past five years. These data would seem to justify a liberalized indication for radical surgery in elderly patients. In the elderly group, the mean operating time and the amount of bleeding in the operative-death patients significantly exceeded those in the surviving patients. Non-curative resection in elderly patients could not be generally accepted, since the mean survival time was only 11 months, with high morbidity (40.5%) and mortality rates (8.1%).

Age Factors↗
PubMed1989

[Mitral insufficiency due to ruptured chordae tendineae--clinical features, early and late results of valve replacement and repair].

To evaluate the early and late results of mitral valve replacement and reconstruction for mitral insufficiency due to ruptured chordae tendineae respectively, 74 consecutive cases were analyzed. Fifty-five (74.3%) of the patients were men, and the mean age was 48 +/- 12 years old (range 16 to 76). The causes of the mitral disease were idiopathic in 50 (67.6%), rheumatic in 7 (9.4%) and infective endocarditis in 11 (14.9%) patients. In idiopathic 50 cases, 24 had mitral valve prolapse and 16 had both mitral valve prolapse and hypertension. Forty-one (55.4%) of the patients were in NYHA functional class III or IV preoperatively. Thirty (40.5%) cases underwent surgery within one year after their initial symptoms of heart failure onsets including six emergency operation cases due to uncontrollable acute lung edema. Chordae to anterior mitral leaflet were ruptured in 31 (a5, m16, p10)[41%] patients, to the posterior mitral leaflet in 45 (a4, m23, p18)[59%], and to both leaflets in one patient. Mitral valve replacement was performed in 68 patients (91.9%) and 6 patients (8.1%) underwent mitral valve repairs. Twenty cases underwent associated procedures that included tricuspid valve annuloplasty in 8, aortic valve replacement in 5 and myocardial revascularization in 4 cases. There were two operative deaths (2.4%); both occurred after replacement, left ventricular rupture in one and DIC in one. Mean follow-up period was 4.5 years (range 1 to 17) in 67 cases. There were four late deaths; all occurred after replacement. However five patients sustained mild mitral insufficiency after mitral valve repair including one that became worse of regurgitation three years after isolated Kay's annuloplasty, there were no cases that had needed reoperation and no late death after reconstruction. Left ventricular function and pulmonary arterial pressure were almost normalized in more than 90% cases postoperatively. Our data indicated that mitral valve reconstruction (McGoon's plus Kay's method as standardized maneuver) was the procedure of choice for selected patients with mitral insufficiency owing to ruptured chordae tendineae to the posterior mitral leaflet, including more limited patients with ruptured chordae to the anterior mitral leaflet.

Adolescent↗
PubMed1989

[Clinical study on the effects of assist bypass on left ventricular contractility].

This study was undertaken to evaluate the effects of circulatory support on cardiac function in 7 patients. They were 2 men and 5 women with of age 34-54 years; Six patients underwent mitral valve replacement and one had mitral valve plasty. End-systolic pressure/volume (ESP/ESV) representing left ventricular contractility was measured just before ECC starting and after cardiac beating began in the process of rewarming. Measurements were repeated at every, interval of 10 minutes up to 60 minutes. ESP/ESV (mmHg/ml) [% of that before ECC] were as following; before ECC: 1.69 +/- 0.68 (mean +/- SD) [100], after 10 minutes; 0.40 +/- 0.24 [25.1 +/- 13.8], after 20 minutes; 0.52 +/- 0.26 [31.5 +/- 12.9], after 30 minutes; 0.77 +/- 0.28 [47.6 +/- 10.5], after 40 minutes; 0.97 +/- 0.26 [60.5 +/- 11.3], after 50 minutes; 1.18 +/- 0.46 [70.6]8.0], after 60 minutes; 1.36 +/- 0.56[80.4 +/- 12.7]. It took 39.6 minutes to recover up to 69% of that before ECC. These data suggested that the myocardial ischemia associated with aortic cross clamping continued for at least 60 minutes after cardiac beating resumed. We concluded that assist bypass should be applied to those who could not be weaned from ECC despite adequate use of catecholamine and volume loading.

Adult↗
PubMed1989

[Direct arrhythmia surgery in ventricular tachycardia: an experience with 18 consecutive patients].

18 patients with ventricular tachycardia (VT) underwent direct arrhythmia surgery between 1984 and 1988. There were 8 patients with ischemic VT, and 10 with nonischemic VT. Operative technique consisted of ablative procedures of the arrhythmogenic area determined by pre- and intraoperative mapping. Induced VT was usually unstable and transient during operation, so that instantaneous multi-point mapping was necessary in almost cases. For VT originated in the left ventricle or interventricular septum, the earliest excitation point determined by the epicardial mapping did not always predict the endocardial arrhythmogenic focus. Pre- and/or intraoperative endocardial mapping was important in this regard. Cryocoagulation (-150 degrees C, 120 sec) was mainly used as an ablative procedure; for ischemic VT, endocardial resection was added, and in nonischemic VT originated in the right ventricular outflow tract, transmural resection was combined with the cryoablation. In performing surgery for nonischemic VT, care must have been taken to make transmural cryocoagulation because the arrhythmogenic focus could exist intramurally. There were no operative deaths. In one patient with nonischemic VT, reoperation was required. After a mean follow-up of 17 month, all the patients are free from sustained VT.

Adolescent↗
PubMed1989

[Anesthetic management of elderly patients in open heart surgery].

In the National Cardiovascular Center, 46 patients whose ages were above 70 underwent open heart surgery from 1977 to 1986. Twenty of them received AC bypass and 5 had repair of the rupture of ventricular septum or left ventricular aneurysm. Among them 2 had also insertion of left ventricular assist device because of acute myocardial infarction (MI). Eighteen underwent mitral and/or aortic valve replacement. The other 3 were operated on because of atrial myxoma etc. Preoperatively, in ischemic heart disease group, due to resultant heart failure, one third of the patients were given catecholamines. In valvular heart disease group, angina pectoris and old MI were also common. Beside arrhythmias, respiratory complications, renal dysfunction and diabetes mellitus, neurological complications such as brain infarction were prominent in both groups. Hospital mortality was 15% in AC bypass group, 40% in acute MI group and 11.1% in VHD group. In 36 patients who left hospital, mean NYHA class improved after operation. The mortality rate and symptomatic improvement demonstrate that cardiac surgery can be performed with acceptable risk in elderly patients. Anesthesiologists should manage them carefully, considering the problems stated above.

Aged↗
PubMed1989

[Clinical significance of intracranial hemorrhage caused by cerebral arteriovenous malformations: with special reference to intraventricular hemorrhage].

Forty-two cases with intracranial hemorrhage caused by cerebral arteriovenous malformation (AVM), which was diagnosed by CT scan, were reviewed with regard to the clinical significance of intracranial hemorrhage, especially intraventricular hemorrhage (IVH). Twenty-one patients were defined as poor risk cases whose level of consciousness at admission was 100 to 300 according to the Japan Coma Scale, whereas the remaining 21 patients were defined as good risk cases. Surgical excision of AVM was undertaken in 35 out of the 42 cases. Urgent surgical removal of intracerebral hematoma and AVM within 24 hours following onset was undertaken in 11 cases. In 14 patients, urgent continuous ventricular drainage was carried out. The effects of the following factors on the level of consciousness at admission, and on the result of AVM treatment were investigated to clarify the clinical significance of intracranial hemorrhage; 1) cast formation of 3rd and/or 4th ventricle, 2) volume of intraventricular hematoma, 3) accompanying intracerebral hematoma and 4) acute hydrocephalus. It was confirmed that all these factors significantly contributed to the development of serious disturbance of consciousness in the acute stage following intracranial hemorrhage. For good risk cases, the rate of patients who showed a good recovery or only moderate disability according to the Glasgow Outcome Scale reached 91%, whereas for poor risk cases, it was only 43%. The presence of large intracerebral hematomas of more than 4 cm in diameter accompanied with IVH was significantly correlated with the result of AVM treatment. The presence or absence of cast formation of 3rd and/or 4th ventricle, volume of intraventricular hematoma and acute hydrocephalus were not significantly related to the result of AVM treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

Measurement of regional myocardial blood flow in hypertrophic cardiomyopathy: application of the first-pass flow model using [13N]ammonia and PET.

Positron emission tomography (PET) has become an important tool in the study of regional myocardial blood flow. The purpose of the present study was to measure regional myocardial blood flow using dynamic [13N]ammonia PET and the first-pass flow model. Thirteen patients with hypertrophic cardiomyopathy, and with a considerably thickened ventricular wall (25 mm or greater), were selected for the study in order to minimize errors due to spillover of radioactivity from blood to the myocardium and to the underestimation of myocardial activity caused by the partial volume effect. Arterial input function was determined by assigning a region of interest to the left atrial cavity on the PET images. Using left atrial and myocardial time-activity curves, regional myocardial blood flow was calculated using the first-pass flow model. Mean myocardial blood flow ranged from 47.8 to 76.5 ml/min per 100 g (63.0 +/- 9.4). Regional myocardial blood flow in the septum was significantly lower than in the anterior and lateral walls of the left ventricle (P less than .01). These results indicate the potential usefulness of dynamic PET in the measurement of regional myocardial blood flow in man.

Adult↗
PubMed1989

[Selection of candidates for a ventricular assist device as a bridge to heart transplantation].

This study was undertaken to see how many people could receive the ventricular assist device (VAD) as a bridge to heart transplantation and to get selection criteria of the recipient. From January 1984 to December 1987, 9916 patients were admitted to our institute and 399 cases of them were dead. All dead cases were examined in terms of age, heart disease, other organ function, infection, and so on. There were 42 possible candidates for VAD, 31 men and 11 women. The average age was 50 years with a range from 22 to 63 years. Ten cases (23.8%) of them had the indication for VAD bridge to transplantation. The criteria for transplantable patients included the following three categories: I) Cardiogenic shock: Irreversible left or double ventricular failure with or without life-threatening dysrhythmia during IABP therapy--4 cases. II) End-stage valvular heart disease; Operation under VAD stand-by--2 cases. III) Postoperative refractory ventricular pump failure: Failure to wean from assist circulation after IABP trial or sustained ventricular failure under IABP support--4 cases. It was indicated that continuous precise evaluation of the deteriorating hemodynamics and the intensive care for major organ functions (renal, pulmonary, neurologic, hepatic, coagulation, etc.) were important to select the candidate for VAD bridge to heart transplantation.

Adult↗
PubMed1989

[A rare case of left atrial thrombus after left upper pulmonary lobectomy].

A 75-year-old man was operated for left atrial thrombus. He had received left upper pulmonary lobectomy for epidermoid carcinoma of the lung, 6 months previously. Thrombus, 5.2 X 1.5 X 0.8 cm in size, was grown up from the inside of the left upper pulmonary vein into the left atrial cavity. It was removed and left upper pulmonary vein orifice was sutured and closed. There was no abnormal findings in the endocardium of the left atrium and mitral valve. A case of the left atrial thrombus after the pulmonary lobectomy is very rare and this may be the first report in world literature.

Aged↗
PubMed1989

[Unilateral pulmonary venous obstruction: a case report].

A 3-month-old girl with right common pulmonary venous obstruction and severe pulmonary hypertension underwent pulmonary venous reconstruction (venoplasty). However, pulmonary hypertension persisted and she died on the 69th postoperative day. Autopsy revealed a widely opened pulmonary vein at the site of the venoplasty. Histological examination showed thickened alveolar walls, thromboembolism in pulmonary arterioles and venous hypoplasia in the right lung. The venoplasty for unilateral pulmonary venous obstruction with severe pulmonary hypertension may not be the proper treatment, since pulmonary hypertension usually continues or progresses postoperatively. Pneumonectomy may be a better choice to be applied.

Child, Preschool↗