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Biomedical subjects

M Kawashima

Publications and source records attributed to M Kawashima.

At least 235 records · Page 13Linked to original sources
PubMed1992

[A case report of Candida prosthetic endocarditis: an autopsy review].

Most of the increasing numbers of cases of Candida endocarditis have developed after cardiac surgery. We report a case of Candida parapsilosis endocarditis after mitral valve replacement in a patient with no predisposing factors. In this report we mainly examined the pathological findings in this patient with postmortem examination. A woman, age 55, underwent valve replacement with a Björk-Shiley prosthesis for mitral stenosis. The spike fever occurred on the 22nd postoperative day and Candida parapsilosis was cultured from the blood. On the 76th day, a conscious disturbance with the right side hemiplegia was experienced. A CT scan revealed massive hemorrhagic infarction. Despite the intensive care the patient died of cerebral damage. Pathologic findings showed that the vegetation in the major orifice of the Björk-Shiley valve was composed of both necrotic debris and tissue, with Candida organisms being scattered throughout the interstices. Additionally there were also multiple myocardial abscesses with necrotic tissue.

Candidiasis↗
PubMed1992

[Operative results with total composite replacement of the aortic valve and ascending aorta].

From December 1980 to December 1990, ten patients, 9 male and 1 female, ranging in age from 21 to 68 years, were operated on for aortic valve insufficiency associated with an aneurysm of the ascending aorta. The surgical treatment in all cases consisted of total replacement of the ascending aorta with Bentall's procedure (n = 4), or Cabrol's procedure (n = 6). In 5 patients an uncomplicated annulo-aortic ectasia existed. Three of them had annulo-aortic ectasia with an aortic dissection. One had aortitis syndrome, and one had syphilitic aortitis. The operative mortality for the entire group was 0% (0 death). Hospital survivors revealed satisfactory clinical improvement in NYHA class (mean value: 3.2 to 1.0). Late complications developed in 2 of the 10 patients. They had a picture of pseudoaneurysm formation at the anastomoses between the graft and the right coronary 46 months and 15 months, respectively, after the initial operation. Despite the reoperation, one died of hepatic failure 30 days after the operation, and the other died of postoperative bleeding at the anastomosis sites. We, furthermore, considered the difference in aortic cross clamp time and cardiopulmonary bypass time between Bentall's procedure and Cabrol's procedure. Aortic cross clamp time and cardiopulmonary bypass time were significantly shorter in Cabrol's procedure than in Bentall's procedure, if a probability value less than 0.20 was considered to be of statistical significance. We were able to conclude that the treatment of aortic valve regurgitation associated with an aneurysm of the ascending aorta by insertion of a composite graft is a reliable method with low operative mortality and excellent long term results, especially in Cabrol's procedure.

Adult↗
PubMed1992

[Pseudoaneurysm of the left ventricle following mitral valve replacement].

This report describes a false aneurysm of atrioventricular groove in the patients who underwent the reoperation of the mitral valve replacement (MVR). Patient 1 underwent reMVR with a SJM prosthesis because of the malfunction of the previous prosthetic valve. A large hematoma was observed in the posterior atrioventricular groove with bleeding at weaning from cardiopulmonary bypass. Ventricular rupture was repaired under the cardioplegic arrest successfully from the epicardial surface with a woven Dacron felt. The postoperative left ventriculogram revealed the false ventricular aneurysm along the atrioventricular groove. Patient 2 underwent reMVR with Carpentier-Edwards prosthesis because of the malfunction of the previous Carpentier-Edwards prosthesis. Cardiopulmonary bypass was discontinued uneventfully, and there were no clinical symptoms suspicious of the formation of the false left ventricular aneurysm. The left ventriculogram at the discharge showed the false left ventricular aneurysm along the atrioventricular groove. Although both patients are in good condition without significant complications, we should involve in the postoperative care of the patients on a regular outpatient basis.

Aged↗
PubMed1992

Spitz naevus of the toe.

A 68-year-old Japanese woman presented with a brownish macule, containing two papules, on her left fourth toe. Histological examination revealed an intradermal epithelioid cell tumour with irregularly shaped, bizarre giant cells. In the upper portion of the tumour, the epithelioid cells contained abundant melanin. A low amount of 5-S-cysteinyldopa and a diploid DNA distribution histographic pattern were helpful in differentiating the lesion from malignant melanoma. This location of a Spitz naevus is exceptional.

Aged↗
PubMed1992

[Comparative study of anticoagulant management after coronary artery bypass surgery--warfarin versus dipyridamole].

A prospective randomized study was performed in 137 coronary artery bypass surgery cases to determine if the administration of antiplatelet drugs would improve the patency of coronary artery bypass grafts. The warfarin group received warfarin and thrombotest was controlled to 20% or so. The dipyridamole group received both 300 mg of dipyridamole and 250 mg of aspirin orally each day. These two groups were compared for study in grafts patency. Results were analyzed by chi-square. In the warfarin group, 66 patients had three ITA-LAD grafts and 115 saphenous vein grafts (including 4 sequential grafts). In the dipyridamole group, 71 patients underwent 38 ITA grafts and 167 saphenous vein grafts (including 56 sequential grafts). Eighty-eight of the 107 grafts (82%) were patent in the warfarin group, and 190 of 205 grafts (95%) were patent in the dipyridamole group (p less than 0.01). Of the two ITA grafts in the warfarin group, no graft was occluded, a patency of 100%. In the dipyridamole group, 35 of 38 ITA grafts (92%) were patent. In the warfarin group, 86 of 105 saphenous vein grafts (82%) were patent. In the dipyridamole group, 155 of 167 saphenous vein grafts (95%) were patent (p less than 0.01). In the study of grafted coronary vessel, the patency of left anterior descending coronary artery, diagonal branch and right coronary artery was not significant between two groups. In the dipyridamole group, the patency of left circumflex coronary artery was 93%, and that of the warfarin group was 50% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Percutaneous fiberoptic angioscopy of the cardiac valves.

The feasibility of percutaneous translumial angioscopy of the cardiac valves was examined in eight patients with and in 11 patients without valvular disease. In eight of these patients, a guiding balloon catheter (9F) was introduced into the aortic root, a guide wire (0.014 or 0.025 inch) was introduced through the catheter into the left ventricle to prevent dislocation of the catheter, and a fiberscope (1.6 or 4.6F) was advanced to the distal tip of the catheter. The balloon was then inflated with carbon dioxide and was manipulated against the aortic valve; a body temperature heparinized saline was infused through the catheter for observation. Similarly, the balloon catheter was advanced transseptally into the left atrium for observation of the mitral valve in four patients. Also, the balloon catheter was advanced through the right femoral vein into the right atrium for observation of the tricupid valve in three patients. In patients with a normal aortic valve, the aortic cusp surface was smooth and white and the edges were sharp. They opened briskly during systole and coapted each other completely during diastole. In rheumatic aortic regurgitation, the cuspus were thick and blunt and their coaptation insufficiency was observed during diastole. In a patient with rheumatic AS, globular and yellow cusps were observed. Mitral valve leaflets were smooth and white in a patients without mitral valvular disease, while the leaflets were yellow, thick and irregular, and blood regurgitation from the left ventricle into the left atrium could be observed in two patients with rheumatic MSR. The process of opening and closure of a tricuspid valve was also observed in three patients without tricuspid valvular disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Decreased level of ceramides in stratum corneum of atopic dermatitis: an etiologic factor in atopic dry skin?

Stratum corneum lipids are an important determinant for both water-retention function and permeability-barrier function in the stratum corneum. However, their major constituent, ceramides, have not been analyzed in detail in skin diseases such as atopic dermatitis that show defective water-retention and permeability-barrier function. In an attempt to assess the quantity of ceramides per unit mass of the stratum corneum in atopic dermatitis, stratum corneum sheet was removed from the forearm skin by stripping with cyanoacrylate resin and placed in hexane/ethanol extraction to yield stratum corneum lipids. The stratum corneum was dispersed by solubilization of cyanoacrylate resin with dimethylformamide, and after membrane filtration, the weight of the stratum corneum mass was measured. The ceramides were quantified by thin-layer chromatography and evaluated as microgram/mg stratum corneum. In the forearm skin of healthy individuals (n = 65), the total ceramide content significantly declined with increasing age. In atopic dermatitis (n = 32-35), there was a marked reduction in the amount of ceramides in the lesional forearm skin compared with those of healthy individuals of the same age. Interestingly, the non-lesional skin also exhibited a similar and significant decrease of ceramides. Among six ceramide fractions, ceramide 1 was most significantly reduced in both lesional and non-lesional skin. These findings suggest that an insufficiency of ceramides in the stratum corneum is an etiologic factor in atopic dry skin.

Adolescent↗
PubMed1991

Sclerotic fibromas of the skin.

We report a case of a 34-year-old Japanese woman with a fibrous tumor on the left palm that fulfilled the criteria of sclerotic fibroma of the skin. Immunohistochemically, the tumor cells were positive for vimentin, but negative for S-100 protein and neuron-specific enolase. Ultrastructurally, the cross-striations of collagen microfibrils were less prominent. Our case supports the concept that sclerotic fibroma of the skin is a distinctive lesion which may represent a hamartoma of the skin.

Adult↗
PubMed1991

Eccrine porocarcinoma.

We describe a 78-year-old woman with eccrine porocarcinoma presenting a zosteriform appearance on the lateral upper part of the buttock. Erosion and bleeding were observed in the center of a 50 X 80 mm, erythematous indurated plaque with an elevated border. Posterior to the plaque, there was another erosive plaque, 50 X 20 mm in diameter, with peripheral induration overlaid by two reddish papules. Based on the previous reports of 21 patients with eccrine porocarcinoma in Japan, we discuss the relationship between the clinical pattern and lymph node metastasis. The pedunculated eccrine porocarcinoma has less tendency to metastasize to the regional lymph nodes than the nonpedunculated form.

Adenoma, Sweat Gland↗
PubMed1991

Porokeratosis with large skin lesions. Histologic, cytologic and cytogenetic study of three cases.

Three porokeratosis patients with large skin lesion(s) are reported. The histopathology of the large lesions revealed that the epidermis 1) frequently presented slight or marked acanthosis and/or elongation of the rete ridge, and 2) contained abnormal cells, e.g. hyperchromatic, large, multinucleated, and/or irregular shaped nuclei. The DAPI-DNA microfluorometric study revealed DNA polyploidy and/or an increased population of epidermal cells with hyperdiploid and/or tetraploid DNA content. These results indicate the proliferating potential of the epidermis and the existence of a neoplastic clone or clones therein. This finding may explain the enlargement of skin lesions and possibly the development of malignancy, as sometimes occurs in large skin lesions. Furthermore, cultured skin fibroblasts from a patient's skin lesion or its surrounding skin revealed various kinds of chromosomal structural abnormalities, which may serve as a basis for the development of abnormal neoplastic clones in the porokeratotic epidermis.

Aged↗
PubMed1991

[A case report of a thrombosed mitral prosthesis diagnosed by 111In-oxine platelets scintigraphy].

The purpose of this report was to evaluate the efficacy of 111In-oxine labeled platelets scintigraphy for detection of thrombus in the prosthetic valve. A 50-year-old man underwent re-mitral valve replacement with a Björk-Shiley prosthesis because of malfunction of the xenograft in a previous operation. Almost one year later, this patient suffered from peripheral embolism and sight disturbance. There was no evidence of a thrombosed valve although it was suspected. Cineradiography showed the valve almost fully open, and there were no abnormal sounds when the valve closed. 111In-oxine labeled platelets scintigraphy was performed for the detection of thrombus in the mitral position. Hot areas of high quality in the scintigram were demonstrated in the mitral position. As a result, Björk-Shiley prosthesis was replaced with a Duromedics prosthesis. A small thrombus (10mm) surrounded by fresh tiny thrombi was found in a minor orifice of the Björk-Shiley prosthesis.

Heart Valve Prosthesis↗