Biomedical subjects

M Nishiwaki

Publications and source records attributed to M Nishiwaki.

At least 55 records · Page 3Linked to original sources

PubMed1994

The rash of measles is caused by a viral infection in the cells of the skin: a case report.

Measles skin rash was immunohistochemically examined in an effort to detect virus antigen in skin samples taken from a 15-year-old girl with measles. A sectioned specimen obtained by punch biopsy from a 2nd-day skin lesion showed localized parakeratosis and acanthosis with multinucleated giant cells in the epidermis, thickening and cellular edema of epithelia in the hair follicles, and vascular dilation in the papillary plexus. Measles virus antigen was detected by ABC immunoperoxidase in the epidermis, follicular epithelia, and lympho-histiocytic cell infiltrates in the upper of the dermis. This rash deemed to be caused in part by direct viral infection of the epidermal cells.

Adolescent↗

PubMed1994

[Change of mitral regurgitation before and after myocardial revascularization--is mitral repair required for ischemic mitral regurgitation?].

In twenty seven patients, intraoperative change of ischemic mitral regurgitation before and after coronary artery bypass grafting (CABG) was assessed using transesophageal echocardiography. The size of mitral regurgitation (MR) was determined by the area of MR color flow on the doppler echocardiogram. After CABG, MR area decreased in 20 patients (average: 3.7 cm2-->1.5 cm2), unchanged in one patient and increased in 6 patients (average: 17 cm2-->2.9 cm2). The change of MR area corresponded with the change of mitral annular diameter in 23 patients but uncorresponded in 2 patients. MR areas correlated exponentially with mitral annular diameters and the fair linear relation was observed between the postoperative to preoperative ratio of MR area and the postoperative increase in mitral annular diameter with the correlation of r = 0.81. When the larger MR area or mitral annular diameter before CABG was observed, the larger MR area after CABG remained, but annular diameter before CABG had more effect on postoperative MR area. No significant correlation was found between MR area and infarcted region, revascularized region, segmental wall motion etc. In conclusion, when the moderate or marked mitral annular dilatation was found in association with prominent ischemic mitral regurgitation, mitral annuloplasty with CABG should be considered.

Adult↗

PubMed1993

A comparison of the metabolic changes after the distal splenocaval and portacaval shunts.

The distal splenorenal shunt (DSRS) is the recommended procedure for selective variceal decompression, but its use may be limited in patients who have undergone left nephrectomy, those with an anatomically aberrant relationship between the splenic and left renal veins, and those whose preoperative angiographic findings suggest a risk of developing postoperative renal vein hypertension. For these clinical situations, the selective distal splenocaval shunt (DSCS) is a useful alternative to the DSRS. However, the metabolic consequences of the DSCS have not yet been studied in detail and therefore, using a canine model, the metabolic changes following the DSCS and the portacaval shunt (Eck) were compared. The metabolic changes observed following the Eck were hyperammonia and amino acid imbalance, while those following the DSCS were similar to those of the control dogs. In terms of the hepatic adenosine triphosphate level, which reflects hepatic mitochondrial function, the DSCS dogs were also similar to the control dogs. These data suggest that there was no metabolic disadvantage of the DSCS compared to the control.

Adenosine Triphosphate↗

PubMed1993

Atypical exanthema in a patient with infectious mononucleosis.

A 19-year-old male with a sore throat developed numerous, indistinct, erythematous, maculopapular lesions on the trunk. The eruptions, which mimicked secondary syphilis, continued for seven weeks and faded away without pigmentation or scarring. The laboratory examinations revealed lymphocytosis with atypical lymphocytes, seroconversion of Epstein-Barr virus titers, and elevation of transaminase in liver function.

Adult↗

PubMed1993

Delayed catabolism of high density lipoprotein apolipoproteins A-I and A-II in human cholesteryl ester transfer protein deficiency.

Deficiency of the cholesteryl ester transfer protein (CETP) in humans is characterized by markedly elevated plasma concentrations of HDL cholesterol and apoA-I. To assess the metabolism of HDL apolipoproteins in CETP deficiency, in vivo apolipoprotein kinetic studies were performed using endogenous and exogenous labeling techniques in two unrelated homozygotes with CETP deficiency, one heterozygote, and four control subjects. All study subjects were administered 13C6-labeled phenylalanine by primed constant infusion for up to 16 h. The fractional synthetic rates (FSRs) of apoA-I in two homozygotes with CETP deficiency (0.135, 0.134/d) were found to be significantly lower than those in controls (0.196 +/- 0.041/d, P < 0.01). Delayed apoA-I catabolism was confirmed by an exogenous radiotracer study in one CETP-deficient homozygote, in whom the fractional catabolic rate of 125I-apoA-I was 0.139/d (normal 0.216 +/- 0.018/d). The FSRs of apoA-II were also significantly lower in the homozygous CETP-deficient subjects (0.104, 0.112/d) than in the controls (0.170 +/- 0.023/d, P < 0.01). The production rates of apoA-I and apoA-II were normal in both homozygous CETP-deficient subjects. The turnover of apoA-I and apoA-II was substantially slower in both HDL2 and HDL3 in the CETP-deficient homozygotes than in controls. The kinetics of apoA-I and apoA-II in the CETP-deficient heterozygote were not different from those in controls. These data establish that homozygous CETP deficiency causes markedly delayed catabolism of apoA-I and apoA-II without affecting the production rates of these apolipoproteins.

Adult↗

PubMed1993

Surgical treatment of cardiac myxoma and its complications.

A total of 20 patients (15 women, five men) were operated on for cardiac myxoma. Their ages ranged from 17 to 74 (mean 56) years. Myxoma was located in the left atrium in 18 patients and in the right in two. Systemic embolism occurred in eight patients, causing cerebral infarction in three, ischaemia of the extremities in two, occlusion of the external carotid artery with cerebral infarction in one, myocardial infarction in one and pulmonary infarction in one. Five patients with severe congestive heart failure required emergency surgery. All myxomas were removed using cardiopulmonary bypass with excision of the attachment walls. Details are given of additional surgery performed on some of the patients. Two patients died, one from pulmonary insufficiency after emergency surgery and the other from an unrelated problem. The remaining 18 patients showed a good recovery and are doing well with no intracardiac recurrence, although one with cerebral infarction underwent clipping of an aneurysm, which was detected later in the infarcted area.

Adolescent↗

PubMed1993

[Aortic arch reconstruction without aortic cross-clamping using separate extracorporeal circulation].

Between March 1991 and October 1992, 21 consecutive patients underwent aortic arch reconstruction without aortic cross-clamping using separate extracorporeal circulation in combination with retrograde blood cardioplegia (Non-clamping selective cerebral perfusion). Twelve patients had true arch aneurysm, 3 had acute aortic dissection and 6 had chronic aortic dissection including 2 redo cases. Cardiopulmonary bypass (CPB) was instituted with an arterial cannula in the femoral artery and 2 cannulae in both vena cavae. When tympanum temperature was lowered to 20 degrees C by central cooling, CBP was stopped temporarily. As soon as the aortic arch was incised longitudinally together with aneurysm, flexible 12 Fr. balloon cannulae were inserted into the three arch arteries via their orifices and selective cerebral perfusion was started. The perfusion flow was kept between 0.3 L/m2/min and 0.35 L/m2/min with the pressure of catheter tip from 30 to 60 mmHg to keep tympanum temperature 18 degrees C. Heart was protected by retrograde continuous cold blood cardioplegia. During arch correction, the descending aorta was occluded by a balloon then abdominal viscera were perfused via a femoral return cannula and rewarming to 25 degrees C was started to prevent visceral organ failure and coagulopathy. The time of separate perfusion ranged 20 to 161 minutes with a mean of 99.9 minutes. Except one patient who died of pneumonia, 20 patient (95.2%) were discharged and doing well. No cerebral complication, myocardial infarction, lung bleeding and coagulopathy occurred. In order to prevent the infarction by debris and to protect vital organs, this method is reliable for aortic arch reconstruction.

Aged↗

PubMed1993

Analysis of hepatic encephalopathy after distal splenorenal shunt--PTP image and pancreatic hormone kinetics.

The Warren-Zeppa selective distal spleno-renal shunt is aimed at decompressing esophageal varices while at the same time ligating left gastric, gastroepiploic and umbilical veins. But in the long term follow-up loss of shunt selectivity was observed in a number of cases (7/76), with hepatic encephalopathy resulting in 9.3%. In this study, we carried out percutaneous transhepatic portography and investigated pancreatic hormone kinetics in portal blood after arginine load, mainly in cases of hepatic encephalopathy after distal splenorenal shunt compared with non-encephalopathy cases of LC + Varix. These data suggested that as a cause of encephalopathy after distal splenorenal shunt, (1) a marked decrease in portal blood flow due to portal systemic shunt via the pancreatic vein was considered from PTP image, (2) a marked decrease in I/G ratio was considered from pancreatic hormone kinetics in portal blood.

Blood Glucose↗

PubMed1993

[Surgical treatment of left atrial myxoma with coronary arterial lesion].

We experienced two patients of left atrial myxoma with coronary arterial lesion. One patient, who was a 52-year-old female, was transferred to our institute with the diagnosis of acute myocardial infarction. The coronary angiogram showed an abrupt 99% stenosis of posterolateral branch of circumflex artery with no atherosclerotic lesion, and the echocardiography revealed a left atrial myxoma disturbing the blood flow across the mitral valve. She was in congestive heart failure with pulmonary hypertension, and underwent an emergency removal of the myxoma under cardiopulmonary bypass. Another patient, who was a 70-year-old male, was admitted to our institute with the chief complaint of chest pain. The coronary angiogram showed an 75% atherosclerotic stenosis of the right coronary artery, and the echocardiography revealed the left atrial myxoma. He received a removal of myxoma and a coronary artery bypass grafting simultaneously. These 2 patients went a good postoperative course and live a lively life with no local recurrence. In this paper, the surgical treatment of left atrial myxoma with coronary arterial lesion was reviewed.

Aged↗

PubMed1993

[Surgical treatment for true aneurysm of the deep femoral artery, and a review of literatures in Japan].

A true aneurysm of the deep femoral artery is very rare among peripheral aneurysms because of its anatomical position and characteristics of wall tissue. An early operation is mandatory because it has a tendency to become a large size and to rupture. During the last eight years, we experienced two cases. One ruptured case underwent only resection of aneurysm and another case received an additional reconstruction of deep femoral artery using saphenous vein graft. Both of them are doing well postoperatively. In this paper, a review of 24 cases including these two in Japanese literature was discussed.

Aged↗

PubMed1993

[Medtronic model 6500 temporary myocardial pacing lead: a report of clinical assessment until three weeks after cardiac surgery].

Medtronic model 6500 heart wire as a right ventricular electrode was assessed in 41 postoperative cases. R-wave amplitude, slew rate, peak-to-peak, output, current, and resistance were measured by Medtronic A-V pacing system analyser, model 5311, for three weeks after open heart surgery. These parameter changed until the 7 th postoperative day, but did not change significantly thereafter. Output and current did not exceed beyond 10 V and 20 mA respectively, where there is limitations of usually available pacemaker. No complication was encountered. These results showed that this heart wire was reliably useful even until 3 weeks after open heart surgery.

Adolescent↗

PubMed1993

[Surgical treatment of thoracic and thoracoabdominal aneurysm during partial cardiopulmonary bypass].

We operated on 3 patients with thoracic or thoracoabdominal aneurysm using partial cardiopulmonary bypass with right atrial drainage. The first patient was in the preshock state with severe chest and back pain. The aortography and enhanced computed tomography showed a thoracic aneurysm of 70 mm in maximum diameter ruptured into the extrapleural space and an emergency surgery was performed. The second patient was also in the preshock state with chest and back pain. The enhanced computed tomography showed a thoracoabdominal aneurysm of 120 mm in maximum diameter ruptured into the bilateral pleural spaces and an emergency surgery was performed. The third patient had a thoracoabdominal aneurysm of 60 mm in maximum diameter with a low pulmonary function. In all 3 cases, a perfusion cannula was inserted in the femoral artery and a drainage cannula was placed in the right atrium through the femoral vein. In the first case, an additional perfusion cannula was inserted into the axillary artery in order to secure the cerebral flow even at the time of intraoperative massive bleeding from the aneurysm. In all 3 cases, the approach for aneurysm was through spiral incision and aneurysms were replaced by graft inclusion technique. All 3 patients had an uneventful postoperative course and are doing well. In surgical treatment of thoracic and thoracoabdominal aneurysm, usefulness of partial cardiopulmonary bypass using right atrial drainage was discussed.

Aged↗

PubMed1993

[Surgical treatment of ruptured sinus of Valsalva aneurysm].

We operated on 3 patients with ruptured sinus of Valsalva aneurysm (RSVA). According to the classification by Konno, 2 of them had type I RSVA where aneurysm originated from the right coronary sinus rupturing into the right ventricle, and another type IV where it arose from the non-coronary sinus draining into the right atrium. Both of the 2 with type I RSVA had accompanied ventricular septal defect (VSD) of Kirklin type I. One of them had infective endocarditis with vegetations clinging to the aortic valve, the pulmonary valve and the right ventricular wall adjacent to VSD, and aortic regurgitation of grade II consequently occurred. In this patient, the aortic cusps and the wall of sinus of Valsalva aneurysm were taken out with vegetations. The defect of sinus and VSD were closed with one large patch and a 25 mm SJM aortic valve was implanted using the patch as a part of annulus. The other patient with type I RSVA received a direct closure of defect of Valsalva sinus and VSD. Another patient with type IV RSVA underwent a direct closure of right atrial wall where aneurysm protruded. All 3 patients are doing well without shunt and aortic regurgitation. In this paper, diagnosis, surgical treatment and outcome of RSVA were reviewed.

Adult↗

PubMed1993

[Surgical treatment of left atrial myxoma with concomitant acquired heart disease].

Among 21 patients with left atrial myxoma treated during the past 11 years in our institute, 3 patients had associated acquired heart disease which required concomitant cardiac surgery. Two patients had atherosclerotic coronary arterial disease, and underwent single coronary artery bypass grafting (CABG) and 4 CABGs in addition to removal of myxoma, respectively. Both of them received CABGs after removal of myxoma, because the intraoperative heart protection using retrograde coronary perfusion could afford the situation. Another patient had a huge left atrial myxoma associated with mitral and tricuspid regurgitation. She suffered from sudden heart failure caused by tumor obstruction of blood flow across the mitral valve, and an emergency surgery was performed. She underwent mitral valve replacement for annular dilatation with prolapse of both leaflets and tricuspid annuloplasty for annular dilatation, in addition to removal of myxoma. All of these 3 patients went a good postoperative course and are doing well now with no local recurrence. In this paper, preoperative and intraoperative evaluation, and surgical treatment of associated heart disease with left atrial myxoma were discussed.

Aged↗

PubMed1992

Evidence for conversion of human salivary alpha-amylase family A to family B by an enzyme action.

SDS-PAGE showed that human salivary alpha-amylase family A (HSA-A) was converted to family B (HSA-B) in human saliva. This conversion did not occur in the supernatant of saliva which had been centrifuged at 105,000 x g for 60 min. An enzyme which catalyzed the conversion existed in the insoluble fraction of human saliva. The enzyme was solubilized with nonionic or zwitterionic detergents, and showed the maximum activity around pH 6. It was stable between pH 4 and 10, and at a temperature lower than 40 degrees C. The enzyme reduced the molecular weight of HSA-A (62,000) to the same molecular weight (58,000) as that of HSA-B without forming any intermediate. It also changed the PAGE pattern of multiple forms of HSA-A to the same pattern as that of HSA-B. It was not inhibited by protease inhibitors, and it did not destroy the reactivity of HSA-A with anti-human salivary alpha-amylase antiserum. The enzyme diminished the reactivity of HSA-A with concanavalin A. These results indicate that HSA-A was converted to HSA-B through the release of sugar chains by the action of the enzyme in the insoluble fraction of human saliva.

Catalysis↗

PubMed1992

Severe hypoxia due to ventilation-perfusion mismatch caused by aortic arch aneurysm.

We report a very rare case of hugh aortic arch aneurysm associated with aortic restenosis, which caused severe hypoxia due to ventilation-perfusion mismatch by compression of the left main bronchus and the right pulmonary artery. Aortic arch replacement was performed under circulatory arrest and deep hypothermia in addition to aortic valve replacement as a redo operation, and consequently such hypoxia was relieved.

Adult↗

PubMed1992

[Efficacy of nicorandil on myocardial protection during coronary artery bypass grafting--a comparison with diltiazem].

Diltiazem (DTZ), a calcium slow channel blocker, is estimated to be highly effective for myocardial protection and the prevention of perioperative coronary spasms (PCS). However, the use of high doses of DTZ sometimes results in difficulty in coming off cardiopulmonary bypass due to negative chronotropic activity. Nicorandil (NCD) has remarkable coronary vasodilating effect but possesses little negative chronotropic activity. The purpose of this study was to compare NCD with DTZ with respect to effect on myocardial protection during coronary artery bypass grafting (CABG). As parameters, excess lactate (delta XL), redox potential (delta Eh), left and right ventricular stroke work indices (LVSWI, RVSWI), cardiac index (C.I.), systemic vascular resistance index (SVRI.), myocardial isoenzymes (CK-MB, LDH1), number of PCS and recovery time of chronotropic action were used. delta XL, delta Eh, LVSWI, RVSWI, C.I., SVRI, CK-MB, LDH1 were measured at 0, 1, 3, 6, 9, 18 and 24 hours after the removal of aortic cross clamping. The degree of chronotropic action was evaluated by the length of the recovery time to self beat or normal sinus rhythm after the removal of aortic cross clamping. Forty patients who underwent CABG with retrograde cold blood cardioplegia between Dec. 1989 and May 1991 were divided into the NCD group (n = 20), in which 1.1 micrograms/kg/min NCD was continuously administered from the beginning of the operation and the DTZ group (n = 20), in which the initial St. Thomas cardioplegia containing 5 mg/L and subsequent cold blood cardioplegia solution contained DTZ 3.5 mg/L, for a total DTZ dose of less than 10 mg.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardioplegic Solutions↗

PubMed1992

[Ischemic cardiomyopathy associated with ischemic mitral regurgitation--a case report of successful repair].

We experienced a case of 62-year-old man with ischemic cardiomyopathy and mitral regurgitation. He had a heart failure of New York Heart Association class IV together with unstable angina. His further examination showed an enlarged left ventricle with markedly reduced ejection fraction (12.9%) and ischemic mitral regurgitation of grade III associated with 3-vessel disease. He underwent three coronary artery bypass graftings and mitral annuloplasty by a modification of Kay's method. He showed a remarkable improvement of heart failure and cardiac function together with a disappearance of mitral regurgitation. He discharged from hospital in NYHA class II on the 50th postoperative day and lives an almost normal life now. Operative indication and management of ischemic cardiomyopathy and mitral regurgitation were discussed.

Coronary Artery Bypass↗