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Biomedical subjects

M Murase

Publications and source records attributed to M Murase.

At least 55 records · Page 3Linked to original sources
PubMed1997

Early experience of retrograde cerebral perfusion.

Since 1990, retrograde cerebral perfusion has been applied in aortic arch surgery in the Nagoya University group to protect the brain. This study reviews the group's early clinical results, and especially of neurological outcome in patients undergoing aortic arch surgery via mid sternotomy by using retrograde cerebral perfusion only via the superior vena cava. Seventy-three cases (47 men, 26 women; mean age 62.3 (range 26-82 years)) participated in the study. True aneurysm was diagnosed in 17 cases and aortic dissection in 56. Emergency operations were performed in 49 cases (67%). The proximal aortic arch was replaced in 38 cases, the total aortic arch in 21, the distal arch in six, and the aortic root in two. Mean (s.d.) retrograde cerebral perfusion duration was 55(23) (range 12-115) min and superior vena cava flow rate 350(143) ml/min. Excluding four cases of early surgical death, a total of 10 patients (14.5%) showed neurological dysfunction. Symptoms were coma in eight cases and motor paralysis in two. Three of these 10 cases were recovered without symptoms and six died. The early mortality rate was 19.2%. Significant differences in retrograde cerebral perfusion duration (49(20) versus 83(18) minutes, P < 0.001), superior vena cava pressure (23.2(7.2) versus 28.2(7.4) mmHg, P = 0.046), and preoperative cardiac arrest P < 0.05) were evident between groups with and without neurological dysfunction. There were no neurological dysfunctions in patients undergoing retrograde cerebral perfusion for < 60 minutes at under 30 mmHg of superior vena cava pressure. In conclusion, retrograde cerebral perfusion may be used to extend the duration of safe cerebral circulatory arrest.

Aortic Dissection↗
PubMed1997

The omental flap with skin grafting for treatment of a difficult sternal closure.

A case report of difficult sternal closure is described. Chest closure following cardiac operation in critically ill patients can be a problem. Techniques have been described so that sternal closure can be delayed until the patient is hemodynamically stable and hemostasis has been achieved. However, in some instances, the sternal closure can not be performed because of prolonged cardiopulmonary instability. We describe the use of transposition of an omental flap with skin grafting in a 74-year-old patient with aortic valve stenosis, poor pulmonary function, and a thoracic deformity. This technique enabled incomplete sternal closure which maintained hemodynamic stability.

Aged↗
PubMed1997

Intra-abdominal bleeding after repair of total anomalous pulmonary venous connection.

A case is reported of sudden rupture of a subcapsular hematoma of the liver (SHL) due to birth injury occurring after complete repair of a total anomalous pulmonary venous connection in a 3-day-old male infant. Autopsy showed a wide bruised surface of liver parenchyma. Although making a diagnosis of SHL may be difficult before neonatal cardiac surgery, special care on this quite rare complication must be taken in neonates with difficult delivery.

Birth Injuries↗
PubMed1997

Blood cardioplegia infusion using a recirculation type circuit generates bradykinin in significant amounts during open heart surgery.

The single pass type (SP) of blood cardioplegia is commonly used in North America during open heart surgery. However the recirculation type (RC) of blood cardioplegia is still widely used in other areas including Japan. Infusion blood cardioplegia using the latter technique often decreases the perfusion pressure. To determine the cause for this, blood levels of bradykinin (BK) were measured in cardiopulmonary bypass (CPB) and the 2 types of blood cardioplegic circuits. As the BK levels in the RC cardioplegia (>3,000 pg/ml) rose, the perfusion pressure decreased abruptly with the increase of the BK levels in the CPB circuit. With SP cardioplegia, the BK level was not increased either during cardioplegia (p < 0.009) or CPB (p < 0.009), and the perfusion pressure was not decreased (p < 0.02). We concluded that the SP circuit is superior to the RC one because of the lesser production of BK and thus lesser fluctuation of perfusion pressure.

Aged↗
PubMed1997

Hemolytic effect of the secondary vane incorporated into the back side of the impeller.

The hemolytic effect of the secondary vane system, the antithrombogenic structure incorporated into the back side of the impeller of the C1E3 Gyro pump, was investigated. Impellers with 0, 2, 3, and 4 secondary vanes and an additional impeller with 2 secondary channels were fabricated and incorporated into the C1E3 pump casings. Hemolysis tests were performed under cardiopulmonary bypass conditions (flow rate 4.5 L/min, total pressure head 350 mm Hg) using flesh bovine blood. The normalized indices of hemolysis (NIH) of the pumps with 0, 2, 3, and 4 secondary vanes and the pump with 2 secondary channels were 0.0797, 0.0866, 0.104, 0.157, and 0.0591, respectively. These results indicated that design of the impeller with 2 secondary channels, which was the original design of C1E3 Gyro pump, was less hemolytic than the design with secondary vanes. Additionally, the possibility of the secondary channel system for the impeller bottom was demonstrated favorably.

Animals↗
PubMed1997

Clinical study of totally roller pumpless cardiopulmonary bypass system.

We have developed a low negative pressure vacuum suction system in which cardiotomy suction is performed by the negative pressure of the venous reservoir controlled by a vacuum controller. We have employed this vacuum suction system with a centrifugal pump as a totally roller pumpless cardiopulmonary bypass (CPB) system. In this study, the clinical availability and hemocompatibility of our totally roller pumpless CPB system were evaluated by a randomized prospective study. Thirty patients undergoing aortocoronary bypass grafting were assigned to the study. Data from seventeen patients treated with a totally roller pumpless CPB system were compared with data from 13 treated with a conventional roller pump CPB system. Totally roller pumpless CPB reduces hemolysis, showing lower plasma free hemoglobin levels (81.8 +/- 25.0 versus 42.0 +/- 16.3 at 30 min after CPB initiation, p < 0.05), higher plasma haptoglobin levels (37.8 +/- 36.6 versus 77.2 +/- 31.3 at 120 min after CPB, p < 0.05), and lower blood lactate dehydrogenase (LDH) levels (1391 +/- 497 versus 972 +/- 187, p < 0.01) than those of CPB with a roller pump suction with no significant difference between platelet counts. Arterial blood oxygen tension after using a totally roller pumpless CPB system was slightly better than that with a roller pump (396 +/- 48 versus 437 +/- 43, p = 0.069); however, there was no significant difference in intubation times between groups. A totally roller pumpless CPB system provides sufficient biocompatibility for the blood to reduce hemolysis significantly and simplifies and miniaturizes the entire CPB system to achieve good visuality and handling for control as well.

Aged↗
PubMed1997

[Three cases of mediastinal neurogenic tumors originating from the intrathoracic vagal nerve].

Three cases of mediastinal neurogenic tumors originating from the intrathoracic vagal nerve is reported. Two of those is neurilemmomas. One tumor was located in the site to the branching point of the recurrence nerve. The tumor was enucleated. Postoperative hoarseness arose. Another tumor was located in the vagal nerve. The tumor was resected. One of those is neurofibromatosis in the vagus nerve with the axillary tumor. The tumors arose from the vagus nerve was resected. Careful follow-up are required in two patients.

Adult↗
PubMed1997

[Emergency surgery making use of video-assisted thoracoscopy--2 case reports].

We recently experienced two emergency operating cases using video-assisted thoracoscopy. First case was a 17-year-old male with foreign body and pneumothorax in the right thorax. He was emergencilly treated by means of video-assisted thoracoscopic surgery. The operation was carried out using double-lumen endotracheal anesthesia. Short trocars were inserted through the right intercostal spaces to introduce a flexible video thoracoscope and surgical instruments. Foreign body was looked for easily and removed out. Second case was a 22-year-old male with hemo-pneumothorax at the right side. He was treated using video-assisted thoracoscopy emergencilly. Bleeding point was searched and hemostasis was done by the electrical mess and the clip. Bulla was removed out with surgical instruments. These were good adaptation of emergency operation using video-assisted thoracoscope. The advantages of this thoracoscopic surgery are: less operative invasion and postoperative pain, early recovery and short hospital stay, and cosmetic preservation.

Adolescent↗
PubMed1997

[Long-term late results of pericardiectomy for constrictive pericarditis].

Twenty-four cases of the constrictive pericarditis were operated on pericardiectomy from 1966 to 1990. One case died because of massive bleeding, LOS, and respiratory failure immediately after the operation. A long-term follow up study was performed up to 27 years (mean 13.1 years) in other cases. Ten cases died during the follow up period (cardiac: 6, non cardiac: 4). Five cases of the cardiac deaths had major complications: tabes dorsalis, chronic respiratory failure, pacemaker implantation, mitral regurgitation, emergency operation at high age (78 years old). The survival rates of 5, 10, and 15 years were 85%, 67%, and 58.2%, respectively (Kaplan-Meier). All of survival cases are now in NYHA I or II class in satisfactory. We concluded that pericardiectomy is a very effective treatment for constrictive pericarditis but a more careful follow up is required especially in cases complicated with other major problems because cardiac function is not so recovered as normal level after surgery due probably to readhesion and fibrotic changes of the myocardium.

Adult↗
PubMed1997

Video thoracoscopic resection of neurogenic tumor in a superior-posterior mediastinum: three case reports.

Neurogenic tumors of the thorax can originate in any neurogenic structure within the chest. Surgical resection is considered the primary treatment of such tumors and usually is performed through a thoracotomy. Recently, using a new approach, we applied the technique of video thoracoscopic surgery to resection a posterior mediastinal tumor. In this paper, we report three patients with superior-posterior mediastinal neurogenic tumors in which the approach to the tumor is technically difficult. Cases 1 and 2 were a 26-year-old man and a 50-year-old asymptomatic man, respectively, and case 3 was a 45-year-old asymptomatic woman. The sizes of the three tumors were 3.0 x 2.5 x 1.8 cm (case 1), 6.0 x 4.0 x 2.0 cm (case 2), and 3.0 x 2.0 x 2.0 cm (case 3). In one case (case 2), minithoracotomy was added to video thoracoscopic surgery for adhesion to the spinal artery and intraspinal extension. A standard thoracotomy was avoided in all three cases. All patients had uncomplicated postoperative courses. Video thoracoscopic resection of a neurogenic tumor in the superior-posterior mediastinum may be a safe and useful approach with improved cosmetic results.

Adult↗
PubMed1997

[Successful emergency surgical management following cardiac massage in a patient with acute myocardial infarction due to total obstruction of the left main trunk].

The prognosis in patients manifesting shock following acute myocardial infarction due to total occlusion of the left main trunk (LMT) is usually very poor and so is the lifesaving rate. Accurate judgement and rapid response are key to the successful management of this disease. We experienced a successful case with emergency coronary artery bypass grafting (CABG) on the 14 the day after initial attack. The patient, who had total occlusion of LMT, underwent a PTCA (percutaneous transluminal coronary angioplasty) during the initial attack under cardiac massage. We think in situations where patients have cardiac arrest, shock, elevated CPK levels suggesting devastation of myocardium due either to LMT or severe triple vessels disease, early catheter intervention rather than emergency CABG would be much more tolerable as long as hemodynamic situation allows. Our previous experience taught us that immediate surgical intervention with CABG usually resulted in poor outcome. Further refinements regarding the surgical procedure, technique, assist circulatory supports, cardioplegia, etc., are indispensable before trying to have a successful emergency CABG.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Antimicrobial activities of roxithromycin against recently obtained clinical isolates].

The purpose of our investigation was to monitor current trends in the susceptibility patterns of clinical bacterial isolates to roxithromycin (RXM). We measured the MICs of macrolide antibiotics, such as RXM, erythromycin (EM), clarithromycin (CAM), rokitamycin (RKM) and midecamycin (MDM), and other classes of antibacterial compounds against various clinical isolates at seven institutions between October and December in 1994 and 1995. RXM had excellent antibacterial activities for S. pyogenes, S. agalactiae, M. (B.) catarrhalis and methicillin sensitive S. aureus. Against methicillin sensitive S. epidermidis, RXM activity was fairly good but about 20% of the strains had MIC > or = 128 micrograms/ml. The activity against S. pneumoniae was not so potent and similar to activities of EM, CAM, MDM, and clindamycin. The vast majority of methicillin resistant S. aureus and S. epidermidis were also resistant to macrolide antibiotics and other classes of compounds tested. In conclusion, RXM is an unique macrolide antibiotic by retaining potent activity against S. pyogenes, S. agalactiae, S. aureus except MRSA, M. (B.) catarrhalis and M. pneumoniae.

Amoxicillin↗
PubMed1996

Expression of MRP and mdr1 in human gastrointestinal cancer cell lines: a correlation with resistance against doxorubicin.

The mRNA expression of mdr1 and MRP, each of which codes for a transport protein belonging to ATP-binding cassette superfamily and are reported to be responsible for multidrug resistance phenotype, were semi-quantified by RT-PCR in a panel of gastrointestinal cancer cell lines. Although the expression of MRP was predominant in esophageal cancer cell lines, expression of either or both of the genes was detected in all the cell lines tested. Expression of these two genes added together correlated significantly with chemosensitivity against doxorubicin, implicating that expression of both genes should be evaluated in the future analysis of multidrug resistance phenotype. The ID50 values for pirarubicin, although generally lower than the values for doxorubicin, correlated well with the latter, suggesting that the similar phenotype as that for doxorubicin might be responsible for drug resistance against this semisynthetic anthracycline glycoside.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1996

Early clinical results of retrograde cerebral perfusion for aortic arch operations in Japan.

BACKGROUND: In Japan, retrograde cerebral perfusion (RCP) has been used for protection of the brain since 1986. The techniques vary by institution, and thus the optimum perfusion conditions have not yet been established. METHODS: A survey of 49 institutions was performed to investigate the early results of RCP in Japan. There were 228 patients collected, 46 (20.2%) of whom sustained brain complications. Twenty-seven patients had permanent and 19, temporary neurologic dysfunction. There were 31 early deaths (13.6%) and an additional 14 hospital deaths (6.1%). Significant predictors of brain complications and mortality were evaluated by univariate analysis and multivariate analysis using stepwise logistic regression. RESULTS: By multivariate analysis, preoperative cardiac arrest (odds ratio 8.901, p = 0.0004) and RCP duration longer than 60 minutes (odds ratio 3.234, p = 0.0352) were significant predictors of permanent neurologic dysfunction. Preoperative hemodynamic compromise (odds ratio 6.150, p = 0.0070), presence of preoperative neurologic symptoms (odds ratio 7.155, p = 0.0283), and left thoracotomy (odds ratio 2.37, p = 0.0335) were significant predictors of early death. Duration of RCP was the single RCP-related factor predictive of a brain complication (odds ratio 1.025 per minute, p < 0.0001). The incidence of permanent neurologic dysfunction was less than 10% when the RCP time was shorter than 60 minutes but increased abruptly when the RCP time exceeded 100 minutes, and it remained approximately 15% between 60 and 99 minutes. CONCLUSIONS: Less than 60 minutes of RCP can be tolerated with minimal risk of brain complication. Retrograde cerebral perfusion is one method of cerebral protection during circulatory arrest. This method is not the complete answer for brain protection, but, given specific guidelines, it may help prolong the safe time of circulatory arrest.

Aorta, Thoracic↗
PubMed1996

Nafamostat mesilate reduces blood-foreign surface reactions similar to biocompatible materials.

BACKGROUND: Nafamostat mesilate (FUT-175) is a synthetic serine protease inhibitor that inactivates coagulation, fibrinolysis, and platelet aggregation. Nafamostat mesilate may suppress the blood-foreign surface reaction similar to biocompatible materials by blocking factor XIIa. METHODS: We performed an in vitro study of cardiopulmonary bypass (CPB) with fresh human blood among the following three groups: standard CPB sets (C), biocompatible CPB sets (B), and standard CPB sets with FUT-175 (10 mg/L) (F). A clinical study using these same CPB groups also was performed in 45 patients undergoing aortocoronary bypass operations (15 patients each). We injected FUT-175 at 40 mg/h during CPB. RESULTS: In the in vitro study, both groups B and F showed significantly lower levels of coagulation factors, thrombin-antithrombin III complex, fibrinopeptide A, beta-thromboglobulin, complement C3a, granulocyte elastase, and free hemoglobin than group C at the conclusion of the study. Thrombin-antithrombin III complex and free hemoglobin in group F also were lower than in group B. The platelet count remained at a higher level in group F than in the other groups. Separation of bradykinin was suppressed most significantly in group F. In the clinical study, group F also showed significantly lower levels of alpha 2-plasmin inhibitor plasmin complex and C3a than both groups C and B. There were minimal levels of free hemoglobin in group F. CONCLUSIONS: Nafamostat mesilate may contribute major beneficial effects toward conservation of blood during CPB and prevention of coagulopathy after CPB.

Benzamidines↗
PubMed1996

Protective effects of dimethyl amiloride against postischemic myocardial dysfunction in rabbit hearts: phosphorus 31-nuclear magnetic resonance measurements of intracellular pH and cellular energy.

The effects of 5-(N,N-dimethyl)amiloride, a potent and specific Na(+)-H+ exchange inhibitor, were investigated in isolated perfused rabbit hearts subjected to ischemia and reperfusion. Phosphorus 31-nuclear magnetic resonance spectroscopy was used to monitor intracellular pH, creatine phosphate, beta-adenosine triphosphate, and inorganic phosphate. After cardioplegic arrest with St. Thomas' Hospital solution, normothermic (37 degrees C) global ischemia was induced for 45 minutes, and the hearts were reperfused for 50 minutes. Dimethyl amiloride at 10 mumol/L, which has minimal inotropic and chronotropic effects on the nonischemic heart, was added to the cardioplegic solution. Treatment with dimethyl amiloride reduced the elevation of left ventricular end-diastolic pressure during and after the ischemia and improved the postischemic recovery of developed pressure from 76% +/- 3.2% at 30 minutes of reperfusion in control hearts (n = 6) up to 99% +/- 1.9% in hearts treated with dimethyl amiloride (n = 8). Dimethyl amiloride did not affect the decline in intracellular pH during ischemia for up to 30 minutes but enhanced the intracellular acidosis thereafter. The intracellular pH at the end of ischemia was 6.21 +/- 0.05 in control hearts compared with 5.24 +/- 0.17 in hearts treated with dimethyl amiloride (p < 0.05). During reperfusion, intracellular pH of hearts treated with dimethyl amiloride was less than control for 5 minutes, but subsequent recovery of intracellular pH was similar to control. Treatment with dimethyl amiloride did not affect creatine phosphate breakdown, inorganic phosphate accumulation, and beta-adenosine triphosphate depletion during 45 minutes of ischemia. The creatine phosphate resynthesis and inorganic phosphate reduction during reperfusion were also unaffected. These findings suggest that Na(+)-H+ exchange plays an important role not only during reperfusion but also during ischemia for the development of postischemic cardiac dysfunction most likely by inducing primary Na+ and secondary Ca2+ overload. Specific Na(+)-H+ exchange inhibitors like dimethyl amiloride would have a potential therapeutic profile in cardiac surgery, especially if added before ischemia.

Acidosis↗
PubMed1996

Severe acute metabolic acidosis and Wernicke's encephalopathy following chemotherapy with 5-fluorouracil and cisplatin: case report and review of the literature.

A 28-year-old woman with inoperable gastric carcinoma was given continuous infusion of 5-fluorouracil (5-FU) and low-dose cisplatin (CDDP) for 4 weeks while receiving intravenous hyperalimentation (IVH). Eleven days after her last treatment, she developed acute diplopia, deafness and gait ataxia, followed by severe confusion. She became markedly acidotic and hypotensive with a systolic blood pressure of 60 mmHg, necessitating intubation, dopamine treatment and hemodialysis for 7 h. She was also given thiamine. Thereafter, her blood pressure stabilized, the acidosis improved, and her deafness, diplopia, and confusion were resolved. This case suggests that FP (5-FU/CDDP) therapy toxicity, manifested as acute metabolic acidosis and Wernicke's encephalopathy, may be associated with IVH and thiamine deficiency.

Acidosis↗