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Biomedical subjects

M Kitamura

Publications and source records attributed to M Kitamura.

At least 91 records · Page 5Linked to original sources
PubMed1996

Familial occurrence of electrocardiographic abnormalities of the Brugada-type.

Electrocardiographic abnormalities were pointed out in a 51-year-old Japanese male whose major complaint was dizziness. His electrocardiogram showed a complete right bundle branch block, and a prolonged His bundle-ventricle (HV) interval of 100 msec. Two members of his family died of heart disease and 3 members, including a case of sudden death, presented an abnormal electrocardiogram of the Brugada-type with persistent ST segment elevation in the right precordial leads and right bundle branch block. The signal-averaged examination was made in the children of cases that died with the diagnosis of sudden death. Four cases showed a tendency of delay in the HV interval and a positive finding in the late potential. Further studies are necessary to clarify the relationship between electrocardiographic abnormalities of the Brugada-type and atrioventricular conduction disorder as well as to clarify the genetic basis of this disorder.

Adolescent↗
PubMed1996

[Quality control of surgery in multicenter study--interinstitutional and individual differences].

UNLABELLED: In a prospective randomized controlled trial (PRCT) of adjuvant chemotherapy for gastric cancer patients participated by 6 cancer center hospitals, inter-institutional and inter-individual differences about several factors related to the surgery and remote survivals were analyzed. From 1988 to 1992, 1,049 evaluable patients were enrolled and stratified to 6 groups according to the grade of the serosal invasion and curability, and analyzed statistically. RESULTS: 1) There were no inter-institutional differences about postoperative survival rate, but there were slight differences about patient's background factors and entry policy of each institution. 2) There were no inter-institutional differences about several factors related to the surgery such as operative time, bleeding volume during operation, and the length of the administration periods. 3) There were no inter-individual differences about the length of the administration periods, but there were a little differences about operative time and the volume of hemorrhage. When the PRCT of adjuvant chemotherapy of which the end point is survival would be designed, no inter-institutional differences about remote survival and surgical operation in each institution should be confirmed before starting the trial.

Chemotherapy, Adjuvant↗
PubMed1996

[Analysis of specificity of resected esophageal cancer patients with a history of apoplexy].

We studied 15 resected cases with a history of apoplexy (2.5%) among 599 cases of esophageal cancer admitted between 1972 and 1993. Fourteen were male, and female, aged 48 to 77 years. Twelve had suffered from cerebral infarction, 2 intracerebral hemorrhage, and one subarachnoid hemorrhage. Duration from apoplexy to operation was between 2 months and 19 years in the cerebral infarction cases, between 8 and 10 years in the intracerebral hemorrhage cases and 4 years in the subarachnoid hemorrhage case. Preoperative neurological disturbance was found in 7 of the 12 cerebral infarction cases, and in both intracerebral hemorrhage cases. Four cases showed hemiplegia, and the other 5 cases showed partial paralysis of limbs. Preoperative complications were found in 7 of the 15 cases, and consisted of diabetes mellitus in 5, hypertension in 4, bronchial asthma in one, and renal dysfunction in one case. Intra- and postoperative complications were found in 11 of the 15 cases, and consisted of anastomotic leakage in 5, delirium in 3, apoplexy in 2, peritonitis in one, ARDS in one, intraoperative cardiac arrest in one, and wound infection in one. Postoperative disorders of consciousness were found in 5 cases, consisting of delirium in 3, and excitation at awakening of anethesia in 2 cases. Rate of direct operative death was 6.7% in preoperative apoplectic patients, and 8.5% in non-apoplectic patients, and there was no significant difference between the 2 groups. On the other hand, rate of postoperative apoplexy was 13.3% in the preoperative apoplectic patients, and 0.4% in non-apoplectic patients. There was a significant difference between them (p < 0.01). But they were cured of it, and left our hospital. It is concluded that active surgical treatment can be indicated for esophageal cancer patients with a history of apoplexy, if more attention is given to the management of diabetes mellitus or hypertension.

Aged↗
PubMed1996

[Clinico-pathological studies and problems on para-aortic lymph node dissection--D4 dissection].

The advantage or disadvantage of para-aortic lymph node dissection was studied from the viewpoint of clinicopathological findings and their prognosis. No 16 lymph node dissection was performed in 427 cases, and metastasis was observed in 100 (23%). The metastatic rate increased with the depth of cancer. High metastatic rates were seen in type 3 and 4, and in the histologically undifferentiated type. Five year survival rate of patients with No. 16 metastasis (PoHo) was 14%. The n3 (-) group among cases with n4 showed a significantly better outcome than the n3 (+) group. Concerning total gastrectomy with pancreato-splenectomy procedure, blood loss was greater and length of surgery was longer in the D4 group than D2 group. The exudate volume was much higher in D4 and serum albumin significantly decreased in D4 than D2. Almost the same findings were seen in D4 with subtotal gastrectomy. Postoperative complications in D4 group were the same as D2 excluding abscess around pancreatic stump which was higher in D4. In conclusion, D4 dissection does not have an obvious disadvantage for the patients. Randomized clinical trials between D4 and D2 should be done in order to clarify an efficacy of the D4 dissection.

Aorta↗
PubMed1996

[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↗
PubMed1996

[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↗
PubMed1996

[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↗
PubMed1996

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↗
PubMed1996

[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↗
PubMed1996

[Arterial infusion chemotherapy for advanced gastric cancer by sequential MTX/5-FU].

Intra-aortic infusion chemotherapy by low-dose sequential MTX/5-FU was performed in 46 advanced or recurrent gastric cancer patients. Partial response was found in 13 cases (28%). The major lesion of 13 responders was inoperable Borrmann Type 4 gastric cancer in 4 cases, peritoneal recurrence with an abdominal wall in 6 cases, recurrence in the abdominal mass in 2 cases and Douglas pouch in one. The mean duration of effectiveness in the responders was 6.7 months and the median survival time was 19 months after the treatment. The side effects were mainly related to the digestive organs, but the symptoms were mild. Leucopenia of grade 3 and 4 was found in 6 (13%) and thrombocytopenia of grade 2 in one patient. Arterial infusion chemotherapy by sequential MTX/5-FU proved to be effective in poorly differentiated and signet ring cell carcinoma, such as Borrmann type 4 gastric cancer.

Adenocarcinoma↗
PubMed1996

[Transition of renal function after repeated intraperitoneal CDDP administration].

The purpose of this study was to clarify the development of renal dysfunction in 20 patients intraperitoneally administered CDDP after gastrectomy and to determine whether this treatment is tolerable for outpatients. The initial dose of CDDP was 100 mg/body and the successive dose was 40-50 mg/body. Subjects received 96 intraperitoneal CDDP administrations in all, and their total doses ranged 90-400 mg (median: 249 mg). As a result, renal dysfunction up to grade 2 developed in 7 patients (35%) with high frequency, while the rate to all administrations was 12% (12/96). Although the creatinine clearance decreased with the increase of cumulative dose, serum creatinine or BUN did not relate to this change. Therefore, we concluded that this treatment for outpatients could not be recommended because there was nothing to indicate renal function easily or sensitively at the present time.

Adult↗
PubMed1996

[Induced hypertensive chemotherapy with angiotensin-II for liver metastases from gastric cancer].

The theoretical purpose of induced hypertensive chemotherapy used together with injection of Angiotensin-II is to increase the delivery of anticancer drug to the target tumor tissue by increasing blood flow in the tumor. Angiotensin-II (0.1 mg) was dissolved in 50 ml of normal saline, and given through a peripheral vein by a microinfusion pump. When systolic pressure rose to about 140 to 150 mmHg, Mitomycin C (10 to 20 mg/body) was given for 10 minutes via implanted port, whose tip was located in hepatic artery, followed by continuous infusion of 5-FU at 250 mg/day for 5 days. Response could be measured in 4 of all cases (66.7%). CR was found in 2 and PR in 2. Bone metastases or systemic lymph node metastases occurred after a few months in one CR case and one NC case. We concluded that this mode of chemotherapy was a useful measure for the treatment of liver metastases from gastric cancer.

Aged↗
PubMed1996

Infrared thermometry for rapid, noninvasive detection of reflux of spermatic vein in varicocele.

PURPOSE: We evaluated infrared thermometry for measurement of reflux of blood via the internal spermatic vein. MATERIALS AND METHODS: The change in scrotal temperature in patients with varicoceles and controls with different positions was measured with an infrared thermometer. RESULTS: Scrotal neck temperature in the patients increased during Valsalva's maneuver with upright position (mean plus or minus standard deviation 34.62 +/- 1.20 to 36.05 +/- 1.42C), while no statistically significant increase occurred in the controls (32.91 +/- 0.92 to 33.42 +/- 1.15C). Two weeks after high ligation of the internal spermatic vein the scrotal temperature in the patients decreased to the same level (0.59 +/- 0.84C) as in the controls. Using this method 2 subclinical varicoceles were also found on the right side in patients with a left varicocele. CONCLUSIONS: Infrared thermometry is noninvasive, rapid and simple for documenting varicoceles, including subclinical disease.

Adult↗
PubMed1996

[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↗