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Biomedical subjects

M Hirai

Publications and source records attributed to M Hirai.

At least 253 records · Page 14Linked to original sources
PubMed1995

[Surgical treatment for total anomalous pulmonary venous connection of Darling type Ib and IIb, using SVC-appendage anastomosis and pedicled right atrial flap].

A eight-day-old girl with total anomalous pulmonary venous connection of type I b + IIb underwent a total correction. Right atrium (RA) was entered through a vertical incision. Atrial septal defect (ASD) in the caudal aspect of fossa ovalis was enlarged by cutting the primum tissue. RA flap was sutured to ASD and intracardiac orifice margin of SVC to create a roof of pulmonary venous channel. SVC just cranial to entrance of common pulmonary vein was oversewn. Anastomosis between the cephalad SVC and opened right atrial appendage was made. Postoperative angiography showed wide PV channel and SVC channel.

Anastomosis, Surgical↗
PubMed1995

[Stanford type A acute aortic dissection involving an aberrant right subclavian artery--a successful operative case].

A 64-year-old woman was admitted with chest (pain) and back pain. We found aortic dissecting area from ascending aorta to aortic arch and thoracic descending aorta by enhanced computed tomography. She was diagnosed Stanford type A acute aortic dissection. Emergent operation was performed on Jan. 20th, 1994. During operation, we found an aberrant right subclavian artery from Jan. 20th, 1994. During operation, we found an aberrant right subclavian artery from descending aorta. Using non-clamping selective cerebral perfusion, we could succeed this operation. As far as we know, this is the first report in Japanese literatures.

Acute Disease↗
PubMed1995

[Bypass grafting of left subclavian artery to descending thoracic aorta for relative stenosis of bypass graft after total correction for type A IAA with VSD].

A 4-year-old child underwent one-stage total correction for type A IAA with VSD in 1975 as the first successful case in Japan. At age 21, a gradual rise in her upper limb pressure to 190 mmHg prompted repeat catheterization, which showed a pressure gradient across the EPTFE graft of 58 mmHg. Under general anesthesia in the right lateral position, the patient's left thorax was reopened. The EPTFE graft had undergone patchy calcific degeneration and was significantly hardened. An 18-mm Toray graft preclotted with fibrin glue was anastomosed to the left subclavian artery in side-to-end fashion. Its distal end was anastomosed to the descending aorta distal to the EPTFE bypass during a 20-minute aortic occlusion. The postoperative recovery was uneventful and the pressure gradient between the upper and lower limbs fell to 0 at discharge. We chose this method for reoperation of type A IAA and CoA because of the reduced need for dissection and better effectiveness.

Adult↗
PubMed1995

[Detected Epstein-Barr virus genome using polymerase chain reaction in peripheral mononuclear cells--subacute necrotizing lymphadenitis].

A 23-year old woman was admitted to our hospital because of fever, leukocytopenia, thrombocytopenia and cervical lymphadenopathy. From pathological findings of the cervical lymphnode she was diagnosed as subacute necrotizing lymphadenitis (SNL). Bone marrow aspiration was hypocellular with proliferation of mature histiocytes with hemophagocytosis. Lactate dehydrogenase was elevated to 1863 IU/l and mild liver dysfunction was observed. Hepatosplenomegaly, lymphnode swelling in abdominal cavity, pleural effusion and pericardial effusion were detected. After glucocorticoid therapy all such disorders were normalized. In this course, Epstein-Barr (EB) virus genome was detected by a polymerase chain reaction method from peripheral mononuclear cells. After normalization, EB virus genome became not to be detected. From present case we concluded that EB virus was expanded in clinical course and was associated with pathogenesis of SNL.

Adult↗
PubMed1995

[A case of acute dissecting aortic aneurysm associated with congenital bicuspid aortic valve].

The congenital bicuspid aortic valve is recognized as a cause of aortic dissection. But in Japan, the case of aortic dissection associated with bicuspid aortic valve is rare. A 66-year-old man was referred to our hospital with a diagnosis of acute Stanford A type dissecting aneurysm associated with stenotic bicuspid aortic valve. The chest computed tomography showed thrombosis of the pseudo lumen. An operation consisting of aortic valve replacement and graft replacement of the aneurysm was performed on emergency basis because of remarkable dilation of the ascending aorta. He has been doing well after the operation and discharged from the hospital on the 46th postoperative day. It is though to be important to follow up with special concern about possible dilation of sinus of Valsalva due to intrinsic weakness of the aortic wall.

Aged↗
PubMed1995

[Evaluation of repolarization abnormalities in patients with WPW syndrome by QRST isointegral maps].

The presence of repolarization abnormalities and the effects of radiofrequency (RF) catheter ablation of the accessory pathway on QRST isointegral maps in patients with WPW syndrome were studied. Locations of the minimum in Rosenbaum types A and B differed significantly from normals. Before ablation, abnormally low QRST area (-2SD area) was located over the back and right mid-chest in types A and B WPW syndrome, respectively. Following ablation, the minimum gradually normalized and the -2SD area gradually disappeared over a week. Conclusions. 1) WPW syndrome is often associated with repolarization abnormalities; 2) RF ablation gradually normalizes the abnormalities; 3) ST-T abnormalities in 12-lead ECGs after ablation may be attributable to "cardiac memory."; and 4) QRST isointegral maps may provide useful information about repolarization properties before and after ablation in patients with WPW syndrome.

Animals↗
PubMed1995

[Body surface mapping in diagnosing the severity of left ventricular hypertrophy].

Body surface mapping is constructed from numerous electrocardiographic data, obtained from many lead points distributed over the entire thorax. It is generally accepted that the electrocardiographic features of ventricular hypertrophy consists of increase of voltage and prolongation of conduction time. In this report, the usefulness of body surface mapping in diagnosing the quantitative evaluation of left ventricular hypertrophy is reviewed. Finally, we attempted to diagnosis the severity of repolarization abnormalities from QRST isointegral map of patients with left ventricular hypertrophy.

Body Surface Potential Mapping↗
PubMed1995

[Reoperation for coarctation of the aorta and interrupted aortic arch].

This report presented four patients who underwent surgery for restenosis after repair of coarctation of the aorta (CoA) or interrupted aortic arch (IAA) at our institution between January 1980 and October 1994. Case #1 underwent primary repair for IAA, VSD, and PDA consisting of aortic arch reconstruction using a EPTFE (expanded polytetrafluoroethylene) graft of 10 mm in diameter at the age of four years. After 17 years, pressure gradient of 58 mmHg between the ascending aorta and the descending aorta prompted the reoperation. Case #2 underwent primary repair for CoA, VSD, and PDA consisting of a bypass between the ascending aorta and the descending aorta with an EPTFE graft of 11 mm in diameter at the age of three years. After 13 years, he had reoperation because of pressure gradient of 64 mmHg. Case #3 had pressure gradient of 20 mmHg between the upper and lower limb at the hospital discharge following patch angioplasty for CoA at five years of age. He underwent unsuccessful percutaneous transluminal balloon angioplasty at age 12 and had reoperation at age 15. Case #4 underwent subclavian flap angioplasty as the first stage operation for CoA, VSD, and PDA at 1 month after birth. About 9 months after the initial operation, the pressure gradient between the upper and lower limb had reached 40 to 50 mmHg, and the patient had reoperation at the age of 1 year. The reoperation method for cases #1, #2 and #3 consisted of bypass grafting from the left subclavian artery to the descending aorta under a simple cross clamping of the thoracic aorta.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Spatial ventricular gradient in patients with Wolff-Parkinson-White syndrome in comparison with normal subjects: vectorcardiographic evidence for significant repolarization changes due to preexcitation.

We investigated the use of the spatial ventricular gradient (VG) from vectorcardiogram (VCG) to determine whether significant repolarization differences were present in patients with WPW syndrome compared with normal subjects and also examined which VG parameter (i.e., elevation, azimuth, and magnitude) reflected the differences in repolarization properties during preexcitation. VG was calculated in 49 patients of Wolff-Parkinson-White (WPW) syndrome (group A: left-sided accessory pathway, n = 29; group B: right-sided, n = 20). Group N consisted of 607 normal subjects. In group A, the azimuth of VG was significantly (p < 0.01) greater than in groups B and N. In group B, the elevation of VG was significantly (p < 0.01) greater than in groups A and N. There were no significant differences in the magnitude of VG among groups. QRS duration was significantly (p < 0.01) related with the elevation of VG in group B. These findings suggested that VG is useful for spatial evaluation of repolarization abnormalities during preexcitation, which are related to the site of the accessory pathway.

Adolescent↗
PubMed1995

Immunogenetic analysis of the human leukocyte antigen DQA1 locus in patients with duodenal ulcer or chronic atrophic gastritis harbouring Helicobacter pylori.

AIM: To examine the human leukocyte antigen (HLA)-DQA1 locus in patients harbouring Helicobacter pylori with chronic atrophic gastritis or duodenal ulcer as part of an investigation into immunogenetic differences in the host. SUBJECTS AND METHODS: We examined 116 patients harbouring H. pylori (55 patients with chronic atrophic gastritis, 61 with duodenal ulcers) and 28 H. pylori-negative healthy controls for HLA-DQA1 genotypes. H. pylori infection was determined by culturing biopsy samples from the gastric body and antrum and by enzyme-linked immunosorbent assay. HLA-DQA1 typing was carried out by the polymerase chain reaction-restriction fragment length polymorphism method. RESULTS: The allele frequency of DQA1*0102 was significantly higher in H. pylori-negative controls (0.250) than in H. pylori-positive duodenal ulcer patients (0.090). In contrast, the allele frequency of DQA1*0301 was significantly lower in H. pylori-negative controls (0.214) than in H. pylori-positive duodenal ulcer patients (0.418). CONCLUSION: These results suggest that there are genetic differences in the HLA-DQA1 locus between H. pylori-positive duodenal ulcer patients and H. pylori-negative healthy controls.

Adult↗
PubMed1995

Differences in urease activity in live Helicobacter pylori cultured from patients with gastroduodenal diseases.

AIM: To develop a reliable method for measuring urease activity in live bacteria, and to determine whether there are any differences in urease activity among the Helicobacter pylori strains involved in gastroduodenal disease. DESIGN: The stability of the method was examined in the first phase of the study, and in a second phase the mean urease activity in clinical isolates from different groups of patients was compared. MATERIALS AND METHODS: To assess the stability and reliability of the method, we assessed the relationship between bacterial proliferation and urease activity, the relationship between the number of bacteria and the optical density, and differences in urease activity among bacterial generations. Ten of the 3-day-old colonies in the third generation were suspended in phosphate-buffered saline, and urease activity was measured as 10(5) colony-forming units/ml bacteria. RESULTS: The assay system appeared to be effective, because the urease activity of live bacteria in the logarithmic growth period was constant, the number of bacteria and the optical density showed a linear correlation on a bilogarithmic graph and there was no significant difference in urease activity over three generations. With this method, urease activity varied from 0.192 to 80.42 mIU/10(5) colony-forming units of bacteria/ml. There was no significant difference in the mean urease activity of live bacteria from controls, gastric ulcer patients and duodenal ulcer patients. However, the mean urease activity in bacteria from cancer patients was significantly higher than that of controls or duodenal ulcer patients. CONCLUSIONS: H. pylori strains derived from cancer patients, which have relatively high levels of urease activity, might easily colonize the stomach and lead to much mucosal damage during the long course of H. pylori infection.

Adult↗
PubMed1995

Genetic differences between duodenal ulcer patients who were positive or negative for Helicobacter pylori.

This study investigated genetic differences between Helicobacter pylori-positive and -negative duodenal ulcer patients. Seventy-two patients with duodenal ulcer (61 H. pylori positive and 11 H. pylori negative) were examined for HLA-DQA1 genotype. The allele frequency of DQA1*0102 was higher in H. pylori-negative than in H. pylori-positive patients. Moreover, the genotypes that possessed the DQA1*0102 allele were significantly more common in H. pylori-negative than in H. pylori-positive patients. In contrast, the allele frequency of DQA1*0301 was lower in H. pylori-negative than H. pylori-positive patients. The genotypes that possessed DQA1*0301 were significantly more common in H. pylori-positive than in H. pylori-negative patients. These results suggest that there are genetic differences between H. pylori-positive and -negative duodenal ulcer patients and that immunogenetic factors for susceptibility or resistance to H. pylori infection exist in the host.

Adolescent↗
PubMed1995

[Surgical treatment of congenital atypical coarctation of the aorta and postoperative management for hypertension].

A 10-year-old boy was admitted to our hospital with severe hypertension due to unusual aortic coarctation at the level of the diaphragm without renal artery stenosis. We made left interior thoracotomy and left para-rectal incision through extraperitoneal approach, and extra-anatomic bypass was established with a 16 mm knitted Dacron graft from the descending aorta to the infrarenal abdominal aorta, under a circulatory assist. Postoperatively, he complained of abdominal pain with residual hypertension and required an intensive anti-hypertensive treatment to avoid intestinal necrosis. Pressure gradient between upper and lower extremities disappeared 3 weeks after repair. High level of plasma renin activity still continued 4.5 months after surgery in spite of oral administration of beta blockade and ACE inhibitor.

Administration, Oral↗
PubMed1994

High prevalence of neutralizing activity to Helicobacter pylori cytotoxin in serum of gastric-carcinoma patients.

Helicobacter pylori infection is causally related to chronic type-B gastritis, and may also be associated with an increased risk of gastric carcinoma. Vacuolating cytotoxin, which is an 87-kDa protein secreted by H. pylori, induces eukaryotic cell vacuolation in vitro. To determine whether there is an association between H. pylori vacuolating cytotoxin and gastric carcinoma, we investigated several characteristics of H. pylori infection, i.e., isolation of H. pylori from gastric biopsies, antibodies specific for H. pylori, detection of neutralizing activity to vacuolating cytotoxin in serum and immunological detection of cytotoxin by serum. Out of 6 sera from gastric-carcinoma patients, all showed the neutralizing activity to vacuolating cytotoxin, in contrast to 3 of 5 sera from peptic-ulcer patients. Normal individuals showed no neutralizing activity. All sera possessing the neutralizing activity recognized an 87-kDa protein band by Western blot analysis. Our results confirmed that cytotoxin-neutralizing activity in human sera was associated with immunodetection of an 87-kDa protein. To further evaluate neutralizing activity in serum from gastric-carcinoma patients, we retrospectively analyzed frozen-stocked serum samples from 22 gastric-carcinoma patients. Sera from 21 of these 22 patients exhibited neutralizing activity. These sera were also checked for antibodies to H. pylori, using an ELISA; 16 sera showed positive results. Our results indicate that detection of cytotoxin-neutralizing activity in sera is strongly associated with H. pylori infection, and probably with gastric carcinoma, and is also of interest in the diagnosis of H. pylori infection.

Adult↗
PubMed1994

Transplantation of allogeneic peripheral blood stem cells after myeloablative treatment of a patient in blastic crisis of chronic myelocytic leukemia.

A 48-year-old man in blastic crisis of chronic myelocytic leukemia received a transplant of allogeneic peripheral blood stem cells. The donor was his HLA-identical sister, who refused to donate bone marrow cells, but agreed to donate peripheral blood stem cells. The patient received standard transplant conditioning with cyclophosphamide (120 mg/kg) and busulfan (16 mg/kg). Peripheral blood stem cells were mobilized with granulocyte colony stimulating factor and collected by apheresis. After transplantation, the white blood cell count and the result of microscopic analysis of the bone marrow became normal, and the leukocyte karyotype became 46XX. DNA fingerprinting showed complete chimerism. Graft-versus-host disease was suppressed with cyclosporine and methyl-prednisolone. The patient died of recurrence of leukemia on day 102+.

Blast Crisis↗