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Biomedical subjects

M Kusagawa

Publications and source records attributed to M Kusagawa.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Surgical treatment and long-term results of aneurysms of Valsalva sinus in 24 cases].

Twenty-four patients with aneurysm of Valsalva sinus were surgically repaired over a 23 year period (1965-1988). These patients were ranged 2 to 54 years of age and eleven of them were male. Rupture of aneurysm of Valsalva sinus was combined with aneurysm in 20 cases, ventricular septal defect in 12 cases and aortic regurgitation in 6 cases. At present, our routine operative procedure for ruptured aneurysm is direct closure of the defect with patch closure of aneurysm after resection of the aneurysm, but when the diameter of aneurysm is smaller than 7 mm, direct closure of the defect of the aneurysm was used. Only one patient after patch closure of ruptured sinus of Valsalva (Konno type I) required reoperation for penetration into left ventricle. This case might be avoided if patch was sutured to annulus of aortic valve. There were two operative death and one late death. The former died of cerebral infarction and low output syndrome, the latter died of sepsis. The mean follow-up period (+/- standard deviation) was 8.2 +/- 6.0 years. All patients that were followed were thirteen and found to be in New York Heart Association class I.

Adolescent↗
PubMed1989

Alterations in coagulation and fibrinolysis associated with cardiopulmonary bypass during open heart surgery.

The effect of heparin as an anticoagulant was examined and the extent of fibrinolytic activity during cardiopulmonary bypass (CPB) was measured. Twenty patients undergoing valve replacement or aortocoronary bypass surgery were studied. Fibrinopeptide A (FPA) levels gradually became elevated as CPB proceeded, and antithrombin III (AT III) decreased during CPB. This indicates that despite the use of heparin, the coagulation system was activated, leading to fibrin formation in the microcirculation. On the other hand, fibrinopeptide B (FPB beta 15-42) also increased to four times the preoperative value at two hours on CPB. Intrinsic fibrinolytic activity, as determined by the activity of kaolin-activated euglobulin, was transiently increased only at the beginning of CPB. The C1 inactivator-resistant fibrinolytic activity and tissue plasminogen activator antigen (t-PA;Ag) increased sharply during CPB and reached maximum levels one hour after the start of CPB, indicating that enhanced fibrinolytic activity during CPB is predominantly of extrinsic origin as the result of t-PA release from the vascular walls. It is concluded from the above findings that thrombin activity continues during CPB. Enhanced fibrinolytic activity during CPB appears to be important because t-PA activates plasminogen predominantly where fibrin is formed, leading to dissolution of the microthrombi formed during CPB.

Adult↗
PubMed1989

[Treatment of prosthetic valve endocarditis--analysis of eleven cases].

A retrospective examination was made of eleven patients that developed prosthetic valve endocarditis (PVE) during the period from January 1960 to December 1987. Infection occurred in one patient within 60 days after surgery and in 10 thereafter. Causative organism was found in 6 patients. As organism, Staphylococcus species were noted in 4 patients and Peptstreptococcus was noted in one patient and Aspergyllus was noted in one patient. Three of eleven patients received medical treatment only and the other 8 patients were received surgical treatment. Mortality rate was 67% in medical group and 29% in surgical group. Two patients with medical treatment died of cerebral infarction about 40 days after the onset of PVE. In surgical group one patient died of uncontrollable Aspergillus infection and the other one died of dyspnea. No survivors who was treated surgically have developed reinfection or relapse of infection but four of them developed perivalvular leakage and needed reoperation. Absolute removal and closure of the valve ring abscess and reconstruction of defect should be considered for those needed surgical treatment to prevent reinfection and relapse developing.

Adolescent↗
PubMed1989

[Surgical treatment for aortic diseases associated with coronary artery stenosis].

Three hundred and one patients undergoing aortic surgery (247 aneurysm cases and 54 arteriosclerotic obstruction cases) were evaluated in respect to the treatment for the associated coronary artery stenosis. Twenty-four among total cases (8%) showed the presence of coronary artery stenosis; 16 cases among aneurysm cases (6.5%) and 8 cases among arteriosclerotic obstruction cases (14.8%). Coronary revascularization was performed in 10 cases and the early operate death was observed in one case. Two abdominal aneurysm cases and 4 arteriosclerotic obstruction cases received two-staged aortic and coronary operation, since either aortic or coronary lesion was considered lethal. However, 3 cases of dissecting aneurysm (type I or II), and case of arteriosclerotic obstruction case having left ventricular aneurysm received simultaneous aortic and coronary surgery, since both of the lesions were highly lethal. These data are consistent with the conclusion that the combined aortic and coronary lesion should be treated with the two-staged operation, and that the simultaneous aortic and coronary surgery should be performed only when the both lesions are lethal.

Adult↗
PubMed1989

[Surgical treatment of lung cancer with chest wall invasion].

From 1955 through 1987, 64 cases underwent operation at Mie University Hospital for carcinoma of the lung invading the chest wall (p-T3). According to the classification by Mishina et al, the extent of tumor invasion of the chest wall was p3a-b in 63%, p3c in 18%, and p3d in 19%. Histologically, the tumors were epidermoid carcinoma in 565, adenocarcinoma in 31%, large cell carcinoma in 11%, and small cell carcinoma in 2%. The post surgical staging of N factor was N0 in 39%, N1 in 33%, and n2 in 28%. Extrapleural resection was performed in 27 cases and extended resection (en block resection of chest wall and lung) was performed in 30 cases with an operative mortality of 0%. The actuarial three-year survival rate (Kaplan-Meier method) for patients with p3d was 18.2% but three-year survival for patients with p3a-b and p3c was more than 30%. In spite of p3a-b, however, four-year survival for patients without extended resection was decreased to 11.6%. Four-year survival of patients with adenocarcinoma, epidermoid carcinoma, and large cell carcinoma was 5.9%, 28.4% and 75% respectively, lymphatic metastases reduced survival, with a three-year survival rate of 52.8% for patients with N0 disease and 8.35 for those with N2 disease. Among patients with extended resection, four-year survival for patients 60 years of age of less was 50.8%, greater than the 13.3% four-year survival for the patients more than 61 years of age. We conclude that long-term survival can be influenced by the extent of tumor invasion. In factor, histologic type, and the patient's age, and that extended resection and adjuvant therapy should be applied for treatment of lung cancer with chest wall invasion.

Adult↗
PubMed1989

[The results of experimental study of six-hour heart-lung preservation by autoperfusion method--its evaluation of optimal conditions and lung function after preservation].

Up to date, it has been reported that the maintenance of ideal function of the preserved lungs were much more difficult than that of the hearts in heart-lung preservation. In this communication the authors have reported the results of experimental study for optimal conditions for preserving better function of the lungs by autoperfusion method by means of heart-lung preparation using 43 dogs. In this study the conditions of the preservation were fixed as following: perfusing blood temperature 29 degrees C, blood flow 30 ml/kg/min., FiO2 30%, FiCO2 5%, tidal volume 15 ml/kg, ventilation rate 10/min., and PEEP 5 cmH2O. Glucose-Insulin-Potassium (0.03 gm., 0.05 U., 0.02 mEq/kg/hr. respectively) were administered continuously by an infusion pump. The results showed that extravascular lung water contents after 6 hours of preservation was 0.79 (mean) +/- 0.01 (SD), which was increased only 1% over than the control group: 0.78 +/- 0.01. There was no significant difference of static lung compliance in two groups: the preserved group was 0.47 +/- 0.02 ml/gm.cmH2O compared to 0.51 +/- 0.06 in the control group. These results suggest that the autoperfusion method on our preserving conditions seems to be very promising and very effective to keep much better condition of the lungs in heart-lung preservation.

Animals↗
PubMed1989

[Successful removal of ball thrombus in the left atrium].

Two cases of left atrial ball thrombus associated with severe mitral stenosis in which echocardiography provided the clue to the diagnosis preoperatively were reported. First case was a 58 years old man who was admitted because of dyspnea and frequent syncopal attacks. An echocardiographic examination revealed a tight mitral stenosis and a floating ball thrombus in the left atrium. Under the extracorporeal circulation, the ball thrombus, 30 X 40 mm in size, weight 20 g was taken out. The other case was a 51 years old woman who had undergone surgery for closed mitral commissurotomy 14 years ago. She had a episode of syncope attack and a sudden loss of consciousness. The removed thrombus was 20 X 26 mm in size and weighed 5 g. Their cut surfaces showed an laminated structure in both cases. These mitral valves were replaced by Björk-Shiley prosthetic valves.

Echocardiography↗
PubMed1989

[Surgical treatment of left ventricular aneurysm associated with mitral regurgitation].

The purpose of this study is to analyze the early and late results of left ventricular aneurysmectomy in patients with mitral regurgitation secondary to myocardial infarction. Twenty patients who had left ventricular aneurysm combined with mitral regurgitation underwent the isolated or combined aneurysmectomy during the last 10 years. There were 18 male cases and 2 female cases, and their age ranged from 31 to 64 (mean age 52.6 years). In 19 cases, the left ventricular aneurysm were caused secondary to antero-septal infarction due to the occlusion of the left anterior descending coronary artery. In one case, the coronary spasm of circumflex artery provoked the posterolateral myocardial infarction and the tendon rupture of posterior papillary muscle. The isolated left ventricular aneurysmectomy were performed in 6 cases and the combined operations were coronary artery bypass grafting in 11 cases, mitral annuloplasty in 1 case, mitral annuloplasty and bypass grafting in 1 case, and mitral replacement in 1 case. There were no operative death cases. The preoperative mean functional class (NYHA classification) was 2.9 and the postoperative class was 1.4. The preoperative mitral regurgitation of grade 1 in Sellers' classification was observed in 11 cases. Grade 2 regurgitation was observed in 6 cases, grade 3 in 2 and grade 4 in 1. After surgery, mitral regurgitation more than grade 2 was recognized in 3 cases (group A) and regurgitation less than grade 1 was seen in 17 cases (group B).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[The effects of administration of haptoglobin for hemolysis by extracorporeal circulation].

It is well known that hemolysis by extracorporeal circulation is major cause of renal failure after open heart surgery. The purpose of this study is to investigate the effects of administration of haptoglobin (Hp) during extracorporeal circulation. The patients were divided into two groups: Group I 10 patients underwent open heart surgery for extracorporeal circulation; Group II 10 patients underwent open heart surgery for extracorporeal circulation with the administration of 4,000 IU of Hp. The serum level of total Hp was elevated in group II during bypass, and reduced at 1st day in both groups more than pre-operative level. The serum level of total Hb was elevated in both groups during bypass, and reduced at 1st day within normal limits. Free serum Hb was found in group I at 30 min after start bypass and increased during bypass and urinary Hb was also found. However, in group II free Hb was not found during and after bypass. Urinary NAG and alpha 1 Mg levels of group I were significantly higher than those of group II. The administration of Hp during extracorporeal circulation prevents the increment of serum free Hb and is effective for protection of renal function.

Acute Kidney Injury↗
PubMed1988

[The evaluation of operability for patients with severe valvular disease].

The present study was designed to evaluate and determine the factors which affected the prognosis of the surgical patients with severe valvular diseases. Four hundred and forty six cases which underwent valvular surgery from 1977 to 1987 were used for this study. There were 16 early death cases (3.6%) and 16 late death cases (3.6%), respectively. The early death rate after surgery was significantly high in the cases which had 1) poor LV function (LVEF less than 35%), 2) liver dysfunction (T-Bil greater than 1.3mg/dl, ICG-Rmax less than 1.0 mg/kg/min, Ch-E less than 0.6PH, K-ICG 0.10/min), and/or 3) PVE after valve replacements. These factors were recognized in 9 (56.3%) of the early death cases and 10 (62.5%) of the late death cases. Thus, we consider that these factors affect the surgical prognosis and that the border line values for the factors are: 1) LVEF less than 0.3%, LVDI greater than 40 ml/m2 in MS group and 50 mg/m2 in other valvular groups. 2) T-Bil greater than 2.7 mg/dl, ICG-Rmax less than 0.5mg/kg/min in cardiac cachectic cases, and 3) active PVE cases which showed drug-resistance. Furthermore, these values should be corrected by IVH and immunosupportives during the pre- and post-operative periods.

Adolescent↗