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Biomedical subjects

M Kitamura

Publications and source records attributed to M Kitamura.

At least 109 records · Page 6Linked to original sources
PubMed1997

Hypertrophic obstructive cardiomyopathy with abnormalities of the mitral valve complex.

The mechanism of obstruction of the left ventricular outflow tract (LVOT) in hypertrophic obstructive cardiomyopathy (HOCM) is mainly due to dynamic systolic anterior motion (SAM) of the mitral valve. We report a case of HOCM with mitral regurgitation (MR) associated with complicated abnormalities of the mitral apparatus which contributed to a high pressure gradient through the LVOT. A small, 53-year-old woman was admitted for chest pain and palpitation. Examinations revealed asymmetric septal hypertrophy of the left ventricle, MR, SAM of the mitral valve and a high pressure gradient (108 mmHg) through the LVOT. Operative findings revealed an abnormally hypertrophied interventricular septum, an extensively thickened and enlarged anterior mitral leaflet (AML), malposition of the origin of the anterior papillary muscle arising closer to the aortic annulus than normal, and its direct insertion into the AML without any distinguishable chordae tendineae. The hypertrophied septum and the large and protruding AML appeared to obstruct the LVOT, resulting in a loss of subaortic clearance that was recovered after mitral valve replacement and myectomy. Pathology of the papillary muscle was characteristic of HOCM, showing disorganization and disarray of myocardial fibers, bizarre-shaped nuclei, and intercellular fibrosis, while those of the mitral leaflets negated both rheumatic changes and endocarditis.

Cardiomyopathy, Hypertrophic↗
PubMed1997

[A case of DVR with Nicks's procedure for active infective endocarditis with periannular abscess].

We successfully performed DVR with aortic annular reconstruction by Nick's procedure for a case of active infective endocarditis (IE) with perianular abscess. The patient was 26-year-old woman, who suffered from acute AR and MR due to active IE. At operation, a bicuspid aortic valve was noted with scattered vegetations. The periannular abscess extended from the aortic annulus to the anterior mitral leaflet on which there was a leaflet aneurysm. The complete debridement of infected lesions resulted in the defect of aortic annulus at the area of the aorto-mitral fibrous continuity. We reconstructed the aortic annulus by the equine pericardial patch and performed DVR, followed by the reconstruction of the aortic root by Nicks's procedure. After the operation the antibiotics had been administrated to the patient until CRP became completely negative. The patient was discharged from our hospital at 59 POD with no evidence of recurrence of IE. In such cases, we acknowledge the importance of as much complete debridement of infected lesions as possible and regard Nicks's procedure useful as one of the options for reconstruction of aortic root after debridement.

Abscess↗
PubMed1997

[Simultaneous tricuspid valve operation in patients undergoing aortic and mitral double valve replacement].

In triple valvular surgery, AVR+MVR+TVR or TVP, there are some problems around operation, because patients impaired cardiac function after a long history of the disease and some of them are reoperation cases. The sixty-five patients operated from May in 1980 to June in 1993 were examined. They were divided into two groups, group P and group R, depending upon procedure of tricuspid position. Group P consisted of 51 patients and group R of 14 patients. There were 22 (34%) reoperations. In group P, organic changes in tricuspid valve were mild, however in group R, there were commissural fusion in 8 patients, destruction of leaflet due to infectious endocarditis in one patient, and marked tricuspid annular dilatation in five patients. There was one early death in group R, no early death in group P. Actuarial survival rate at the 10th postoperative year was good as 81.6% in group P and 85.7% in group R. There were no significant differences in operative mortality and actuarial survival between group P and R.

Adult↗
PubMed1997

Remitting seronegative symmetrical synovitis with pitting edema associated with gastric carcinoma.

We report a case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome) associated with gastric carcinoma in an 80-year-old woman who developed polyarthritis with marked pitting edema of the dorsa of both hands and feet 7 days after fiberscopic examination of the stomach. A mass lesion was identified and histology of the biopsy specimen revealed gastric carcinoma. Polyarthritis and edema were partially relieved by an intraarticular injection of corticosteroid. Shortly after resection of the gastric carcinoma, her symptoms and signs disappeared. She has been free of symptoms for 3 yrs without medication.

Adenocarcinoma↗
PubMed1997

[Aortic valve replacement with the Toronto stentless porcine valve in a patient with clipping for cerebral arterial aneurysm].

A 48-year-old man, who had a cerebral arterial aneurysm, was admitted in our institution for operation of aortic valve stenosis. At first, he underwent clipping for cerebral arterial aneurysm under precise management of his hemodynamic condition. After the clipping operation, we performed aortic valve replacement with the Toronto stentless porcine valve because no anticoagulant therapy was ideal for patient with cerebrovascular disease and larger effective orifice area was preferable for stenotic aortic annulus. By means of echocardiography, mean pressure gradient of the aoric valve decreased from 42 mmHg to 22 mmHg after the valve operation. He was discharged from the hospital on the 23rd postoperative day, and he has been doing well without thromboembolic events and bleeding complications for five postoperative months. This experience suggest that the Toronto stentless porcine valve might be one of the valve of choice for patients with aortic valve disease and cerebrovascular disease.

Aortic Valve Stenosis↗
PubMed1997

[Detection of pulsated blood flow by cine mode 3D angiography].

The phase contrast(PC) has an advantage to get an information about flow speed of blood along the gradient axis. The cine mode 3D-PC MRA was performed by a 1.5T clinical MR system(GE; Signa) using multi-slices gradient echo sequence with ECG gating and velocity-encoding gradient along three orthogonal axes. The cine mode 3D-PC data in three axes was constructed from 10 cardiac phases, respectively. The black and white cine mode 3D-PC MRA enabled to get an information of blood flow speed. The color MRA, in which flow direction was assigned with RGB colors, enabled to observe flow orientation of blood. Furthermore, the flow speed vector in each pixel showed a detail flow information in the intravascular space.

Basilar Artery↗
PubMed1997

[Evaluation of clinical trials on adjuvant chemotherapy for curatively resected gastric cancer].

Reports of the results of clinical trials on adjuvant chemotherapy for curatively resected gastric cancer in Japan and other countries were reviewed. The efficacy of adjuvant chemotherapy outside Japan was not recognized except in two trials. Japanese trials did not reveal a significant survival benefit compared with surgery alone. However, a consensus was achieved in Japan on its efficacy by understanding some results of subset analysis as definite proof. Recently, it has been recognized that the re-evaluation of adjuvant chemotherapy should be carried out with the control group of surgery alone. The results of the trials of JCOG and N.SAS-GC, comparing adjuvant chemotherapy versus surgery alone, are much awaited. At the present time, carefully designed randomized controlled trials with sufficient sample size, which include surgery alone for control arm, are the only way to establish the efficacy of adjuvant chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Implantation of the Novacor left ventricular assist device in a patient with dilated cardiomyopathy].

The Novacor left ventricular assist device has been widely applied as a bridge to heart transplantation. The patient, a 29-year-old, male had severe left ventricular failure due to dilated cardiomyopathy. The heart failure had progressively worsened and showed severely reduced wall motion of the left ventricle with fraction shortening of 0.03. His cardiac catheterization data with 7 r of dopamine infusion was as follows; RA(12), RV46/9EDP(12), PA(w)(31), cardiac Index 1.73 l/min/cm2. Novacor implantation was performed on March 11th, 1996. After the implantation the patient was extubated on day 3 and recovered rapidly. No complications, such as bleeding or thromboembolic episodes were seen. The patient was flown to the USA for cardiac transplantation on 24th, September, 1996. During the 11-hour flight from Narita to Los Angeles, he experienced no adverse effects. The patient underwent a successful cardiac transplant at UCLA Medical Center. His post-operative course was uneventful. We believe that either chronic circulatory support or the bridge to transplant using Novacor LVAS will be a significant breakthrough for the treatment of Japanese patients with severely deteriorated cardiomyopathy.

Adult↗
PubMed1997

Gastric hyperemic response during vagally mediated acid secretion by TRH analog in rats.

The mechanisms of gastric hyperemic response during vagally mediated acid secretion induced by YM-14673, an analog of thyrotropin-releasing hormone, were investigated in urethane-anesthetized rats. The stomach was mounted on an ex vivo chamber and perfused with saline, and gastric mucosal blood flow (GMBF) was measured using a laser Doppler flowmeter, simultaneously with acid secretion. The i.v. injection of YM-14673 (0.1 approximately 1 mg/kg) increased both GMBF and acid secretion in a dose-dependent manner, and these responses persisted during a 90-min test period. The increases in GMBF and acid secretion induced by YM-14673 (0.3 mg/kg) were totally abolished by either bilateral vagotomy or atropine. Sensory ablation by capsaicin also significantly attenuated GMBF response without affecting acid secretion. On the other hand, N(G)-nitro-L-arginine methyl ester (L-NAME), but not D-NAME, significantly attenuated the increase in GMBF in an L-arginine-sensitive manner, although acid secretion was slightly augmented; in particular, gastric hyperemic response during the first 30 min (early period) was almost totally abolished. In contrast, omeprazole significantly attenuated GMBF response only in the late period, although it completely inhibited acid secretion in response to YM-14673. Combined treatment of omeprazole and L-NAME totally abolished hyperemic responses induced by YM-14673 during the test period. YM-14673 significantly elevated the release of nitrite and nitrate into the gastric lumen, and this response was inhibited by either atropine or L-NAME. These results suggest that YM-14673 increases GMBF as well as acid secretion, mediated by vagal-cholinergic pathways, and that gastric hyperemia is further regulated by two distinct mechanisms. The response in the early period is independent of acid secretion and mediated mainly by nitric oxide, whereas that in the later period occurs in association with acid secretion and may be mediated by nitric oxide and sensory neurons.

Animals↗
PubMed1997

Acute hemorrhagic gastritis associated with acetazolamide intoxication in a patient with chronic renal failure.

Acetazolamide (Diamox) is a carbonic anhydrase inhibitor commonly used in patients with glaucoma in order to reduce intraocular pressure. Acetazolamide (AZ) is mostly excreted in the urine, therefore, the blood levels of AZ often tend to increase in patients with chronic renal failure. We experienced a case of chronic renal failure in a patient suffering from acute hemorrhagic gastritis associated with AZ intoxication. A 66-year-old female with chronic renal failure was referred to our hospital because of drowsiness and an acute deterioration of renal function. She had been treated with AZ, 500 mg per every day for eleven days for the treatment of glaucoma. Laboratory studies showed leukocyturia, thrombocytopenia, severe anemia, and tarry stools. The serum concentration of AZ was elevated to a maximum of 76.5 mg/ml. She was thus diagnosed as having AZ intoxication. On further examination, acute extensive hemorrhagic gastritis was also found by gastroscopy. Despite of the administration of intensive therapies, she died of disseminated intravascular coagulation (DIC) and septic shock due to bone marrow depression 6 days after admission. It is generally known that excessive blood levels of AZ inhibit not only the gastric juices but also prostaglandin levels and HCO3- excretion in the gastric mucosal barrier. We thus concluded that an excessive dose of AZ had probably destroyed the gastric mucosal barrier or thrombocytopenia due to bone marrow disorder and thus eventually led to the development of hemorrhagic gastritis. As far as we know, this is the first case report of acute hemorrhagic gastritis associated with AZ intoxication. Even though AZ tends to strongly bind to plasma protein and its clearance is generally poor by hemodialysis (HD), in our patient, HD was observed to be rather effective since the clearance of AZ was 45.8 ml/min on HD and 66 ml/min on direct hemoperfusion (DHP). DHP often reduces the number of platelets, also DHP needs a lot of heparin, therefore, we should have performed HD alone instead of DHP. In patients with an impaired renal function, AZ should therefore be administered very carefully in order to avoid an accumulation of the drug. In addition, HD alone should be used to remove any excessive amounts of AZ from the blood.

Acetazolamide↗
PubMed1997

[Evaluation of intraperitoneal chemotherapy using CDDP/MMC or CDDP for gastric carcinomatous peritonitis].

The prognosis of positive cytology case (cy (+)) without peritoneal dissemination (P0) and P (+) cases were poor. In this study, the efficacy of intraperitoneal chemotherapy (i.p. therapy) for these patients was evaluated in 26 gastric cancer patients. Intraperitoneal repeated administration of MMC 10 mg/body and CDDP 40-50 mg/body (15 cases) or CDDP 40-50 mg/body (11 cases) alone was performed once a month via the drug delivery system. Negative change of cytology was observed in 13 out of 19 patients, and the prognosis of these patients was better than that of the unchanged cytology group. The prognosis of P0/cy(+) was better than that of P(+) patients. Two year survival rate of P0/cy(+) with i.p. therapy was better than that of P0/cy(+) without i.p. therapy (58.3% vs 22.5%). Adverse drug reaction such as severe gastro-intestinal symptoms and bone marrow toxicities were not recognized. In conclusion, this report suggests that i.p. therapy is more useful for P0/cy(+) cases than that of P(+) cases in gastric cancer. Randomized controlled trials should be done to confirm the efficacy of the intraperitoneal chemotherapy regarding the prolongation of life.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Extra-arterial dislocation of indwelling catheter in hepatic arterial infusion chemotherapy--special reference to tissue destruction by 5-fluorouracil].

The causes of extra-arterial dislocation of indwelling catheter (EAD), which was one of the serious complications in arterial infusion chemotherapy, were examined. Subjects were six cases of EAD among the 45 cases of gastric cancer with liver metastases treated with hepatic arterial infusion chemotherapy. According to the route of cannulation, EAD occurred more frequently in the cases of cannulation via gastroduodenal artery (18.5%) than in those via subclavian artery (5.5%). Concerning the drugs and their administration, all cases of EAD were treated by continuous injection of 5-fluorouracil (5-FU). Main symptoms of EAD were high fever, abdominal pain and anemia, which developed after administration of total doses from 4.0 g to 30.5 g of 5-FU. In conclusion, it was strongly suggested that arterial destruction due to the toxicity of 5-FU caused EAD in hepatic arterial infusion chemotherapy, especially in cases of cannulation via gastroduodenal artery due to the high concentration of 5-FU in a limited part of the arterial wall.

Aged↗
PubMed1997

[Correlation between anti-tumor effects and serum hepatocyte growth factor level in patients with liver metastases from gastric cancer treated by induced hypertensive chemotherapy with angiotensin II].

To clarify the clinical significance of serum hepatocyte growth factor (HGF), the possible correlation between anti-tumor effect and serum HGF level was examined in six patients with liver metastases from gastric cancer. These patients were treated by induced hypertensive chemotherapy with angiotensin II (IHC). We measured the serum concentration of HGF and compared them with the anti-tumor effect and conventional tumor makers (CEA, CA 19-9). The cut-off level of serum HGF was prescribed at 0.4 ng/ml from healthy volunteer's samples. As the result, anti-tumor effects were one case of CR, two of PR, one of NC and two of PD. Serum HGF levels before IHC were positive in all cases (0.44 to 1.35 ng/ml), whereas the levels were not related to the extent of liver metastases. With regard to the anti-tumor effect, the serum HGF level after IHC was more sensitively reflected compared with conventional tumor markers. In conclusion, it is considered that the serum HGF level might be a useful indicator for the treatment effect in gastric cancer.

Aged↗