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Biomedical subjects

M Okada

Publications and source records attributed to M Okada.

At least 1,027 records · Page 57Linked to original sources
PubMed1993

[Surgical treatment of the patients with pulmonary atresia, ventricular septal defect associated with major aorto-pulmonary collateral arteries--a report of two cases].

Two patients undergoing corrective operation for pulmonary atresia with ventricular septal defect associated with major aortopulmonary collateral arteries (MAPCAs) were reported. Both patients underwent staged surgical repair, first stage: unifocalization, and second stage: Rastelli type operation. Case 1 was a 13-year-old female who had a confluent central pulmonary artery and 1 MAPCA, unifocalized at 10 years of age. After the corrective operation, the ratio between peak right ventricular and peak left ventricular pressure (pRV/LV) was 0.5 and she followed a satisfactory post-operative course. Case 2 was a 11-year-old female who had a severe hypoplastic central pulmonary artery (3 mm in diameter) and 3 MAPCAs, and she underwent unifocalization twice. After the corrective operation, pRV/LV was 0.65 and her postoperative course was also satisfactory.

Adolescent↗
PubMed1993

[A case of surgical correction of sinus venosus atrial septal defect, mitral cleft, and interruption of inferior vena cava with azygos continuation in viscero-atrial heterotaxic syndrome].

A successfully corrected case of a 39-year-old female with viscero-atrial heterotaxic syndrome was reported. The cardiovascular anomalies were sinus venosus atrial septal defect, mitral cleft, and interruption of inferior vena cava with azygos continuation. She also had bilateral bilobed lungs, symmetric liver, right sided stomach, and malrotation of the bowel, indicating left isomerism. The atrial septal defect was closed with Teflon patch and mitral cleft was repaired with direct suture of the cleft. The postoperative course was uneventful and mitral regurgitation was trivial postoperatively.

Abnormalities, Multiple↗
PubMed1993

[Effect of dynamic cardiomyoplasty on the left ventricular function and hemodynamics in chronic canine models].

This study was undertaken to examine the effect of cardiac assist and left ventricular function after dynamic cardiomyoplasty (DCMP). In the first group (GI) of 10 mongrel dogs DCMP was drived immediately after wrapping both ventricles by latissmus dorsi muscle flap (LDMF). In the second group (GII) of 10 mongrel dogs DCMP was derived over 6 weeks after production of DCMP for achievement of complete adhesion between LDMF and myocardium. In the both groups, aortic pressure, cardiac output, left ventricular systolic pressure, and ejection fraction of the left ventricle were significantly increased by DCMP driving (p < 0.001). But left ventricular systolic pressure was remarkably increased in GII compared with that of GI (21.2 +/- 10.2% versus 14.0 +/- 9.6%, p < 0.001), and end diastolic pressure of the left ventricle was apparently decreased in GII (61.6 +/- 42.3% p < 0.05). Thus, satisfactory results were recognized that cardiac assist for left ventricular function was enhanced after completion of adhesion between myocardium and LDMF. Echocardiography in GII demonstrated that left ventricular systolic dimention was significantly decreased from 33.8 +/- 1.0 mm to 27.6 +/- 1.2 mm (p < 0.001). Thus, left ventricular fractional shortening was significantly increased from 24.0 +/- 2.4% to 38.0 +/- 2.6% (p < 0.001). However, left ventricle end-diastolic dimention was not changed even during DCMP driving. So disturbance in left ventricular function during diastole could not be recognized. In conclusion, especially after adhesion of both muscles of LDMF and myocardium, effect of cardiac assist was remarkably enhanced, and disturbance of diastolic function of the left ventricle could not be observed.

Animals↗
PubMed1993

[Effect of dynamic cardiomyoplasty on coronary arterial blood flow].

We investigated whether or not dynamic cardiomyoplasty adversely affected coronary arterial blood flow (CABF) through compression of the coronary arteries by muscular contraction during systole and incomplete relaxation of the skeletal muscle flap during diastole. Dynamic cardiomyoplasty was performed in 20 mongrel dogs using a left latissimus dorsi muscle flap, paced synchronously with the R wave of the electrocardiogram. A Doppler catheter (3 F in diameter) was placed in the left main trunk of the coronary artery to analyze the instantaneous changes of coronary arterial blood flow velocity by fast Fourier transformation analysis. We compared both systolic and diastolic properties during assisted versus unassisted cardiac cycles by calculating the peak velocity and the time velocity integrate (TVI). A significant enhancement of systolic CABF was recognized by increases in the systolic peak velocity (26.5 +/- 29.2%) and TVI (20.2 +/- 38.6%). The improved systolic CABF was consistent with an increase in systolic aortic pressure (15.5 +/- 4.3%) and stroke volume (42.8 +/- 11.2%). CABF was also enhanced in diastole because a significant increase of diastolic peak velocity (4.4 +/- 9.4%) and TVI (11.0 +/- 16.7%) was observed. Enhancement of diastolic CABF was associated with the augmentation of cardiac function and the reduction of left ventricular end-diastolic pressure. It could be concluded that CABF was increased by the enhancement of cardiac function as a result of dynamic cardiomyoplasty leading to an increase of cardiac output and aortic pressure and a decrease of left ventricular end-diastolic pressure.

Animals↗
PubMed1993

[Traumatic tricuspid regurgitation--report of two cases and review of operated cases].

Two cases of nonpenetrating traumatic tricuspid regurgitation were reported. The first case, a 46-year-old man who had an episode of traffic accident 21 years ago, was admitted with complaints of peripheral edema and dyspnea on exertion. The second case was a 16-year-old man who noted to have cardiac murmur and cardiomegaly after 4 years of a traffic accident. In both cases, cardiac catheterization showed increased right atrial pressure with high v wave, and echocardiogram showed severe tricuspid regurgitation with ruptured chordae tendineae of the anterior leaflet. Tricuspid valve replacement was performed successfully in both the cases. Twenty-two operated cases of traumatic tricuspid regurgitation have been reported in Japan; 17 of ruptured chordae tendineae, 3 of ruptured papillary muscle, and 2 of primary laceration of anterior leaflet. The patients with ruptured papillary muscle were operated from 2 months to 7 years (average 4 years) after trauma, while those with ruptured chordae tendineae were operated from 5 months to 25 years (average 10 years) after trauma. Tricuspid valve replacement was performed in 17 of 22 cases. From the review of 22 cases, tricuspid valve replacement should be indicated for traumatic tricuspid regurgitation in consideration of the severity of valve destruction regardless of the interval after trauma.

Adolescent↗
PubMed1993

[An adult case of left ventricular-right atrial communication with a false aneurysm of membranous septum].

A case of left ventricular-right atrial (LV-RA) communication associated with a false aneurysm of membranous septum is presented. The patient was a 51-year-old woman. Using a left ventriculography this case was diagnosed preoperatively as LV-RA communication. We found that the right atrium was directly communicated with the left ventricle through a fibrous membranous aneurysm adhering to the septal leaflet of the tricuspid valve. It was suggested that a false aneurysm, made by jet lesion from the left ventricle, perforated to the right atrium. So the current case was considered an acquired infravaluvular type LV-RA communication formed in the course of the natural closure of the membranous ventricular septal defect.

Aneurysm, False↗
PubMed1993

[Septic attack during percutaneous nephrolithotripsy under epidural anesthesia].

A 59-year-old man was scheduled for percutaneous nephrolithotripsy (PNL) for renal calculus. Anesthesia was maintained by epidurally administered mepivacaine 1.5% under prone position. During surgical manipulation, the patient complained of shivering and chill accompanied with fever and tachycardia. His temperature peaked at 40.7 degrees C and decreased gradually by cooling. Serratia was detected from arterial blood obtained in the operating room. It was thought that fever attack was due to excessive increase of intrarenal pressure by irrigation fluid which might have led to septicemia. Therefore, careful attention for septic attack must be paid during PNL procedure as well as postoperatively.

Anesthesia, Epidural↗
PubMed1993

[Surgical results of thoracic aortic aneurysm in the elderly].

Thirty-four patients with arteriosclerotic aortic aneurysm including 25 of the descending aorta and 9 of the thoracoabdominal aneurysm were divided into two groups. Group 1 consisting of 12 patients over 70 years of age, and Group 2 consisting of 22 patients under 69 years of age were compared. Preoperative complications were not significantly different between the two groups. The diameter of the aneurysm was 7.3 +/- 0.7 cm in Group 1 and 6.7 +/- 1.6 cm in Group 2. Calcification of the aorta on CT was prominent in Group 1 (82%) with presumal marked intimal change. Aortic cross clamp time was 72.5 +/- 27.3 min in Group 1 and 60.3 +/- 25.2 min in Group 2. However, in Group 1, 50% required proximal clamping between the left common carotid artery and left subclavian artery. Overall operative mortality for Group 1 was 41% versus 13% in Group 2. The causes of death in Group 1 were intraoperative dissection of the aorta, intraoperative myocardial infarction, intraoperative cerebral infarction, acute embolism of the superior mesentric artery, and pneumonia. In Group 2, excluding two cases of rupture, only one patient died of acute renal failure. In conclusion, patients over 70 years of age died of embolism related to aortic clamping. Thus surgical results may be improved by devising an aortic cross clamp method.

Age Factors↗
PubMed1993

[Detection of carbohydrate antigens of malignant cells in sputum with panel of monoclonal antibodies].

Serum tumor markers are useful for post-operative follow up, however, they are not necessarily useful for early stage diagnosis. Because the lesion is so small that it is unable to detect a tiny amount of their molecules in serum. If we could detect those antigens directly in cells from cytological specimens, it would provide a new diagnostic method for early stage cancers. The expression of carbohydrate antigens were examined with panel of specific anti-carbohydrate monoclonal antibodies (MAbs) on cytological specimens of sputum. In total, 146 sputa were collected in Sacomano's solution; 69 malignant cases (35 squamous cell carcinomas, 13 adenocarcinomas and 21 other primary lung cancers), 19 benign cases (pneumonia and bronchitis) and 58 borderline-malignancy cases which were defined by the standard of Japan Society of Lung Cancer. After removing mucus, the cells were stained with Vector's ABC method. Evaluation was performed by counting positively-stained cells among benign or atypical cells. As we examined previously in lung cancer tissue sections, there was statistical significance of frequency of positive stain between malignant and benign cases especially in MAbs AH6, THK2, SH1 and SNH3. Borderline malignancy gave intermediate value which means certain number of cells with cancerous biochemical character are mixed in the borderline specimens. In most cases, cell membrane was positively stained and sometimes, cytoplasm. Although the high sensitivity was observed in AH6 and SNH3, their specificity was lower than that of SH1, and visa versa. Those results indicate that the combination of anti-carbohydrate MAbs is useful for cytological diagnosis of lung cancer.

Antibodies, Monoclonal↗
PubMed1993

[Evaluation of serum protein fractions using nonlinear least squares method].

We developed a method to evaluate the contents of serum protein fractions using nonlinear least squares approach. Parameters that determined the distributions of fractions of a densitogram were estimated assuming that each fraction obeys Gaussian distribution. One hundred test results of patients and one hundred and fourteen simulated patterns were analyzed with the proposed method and the traditional method. For patient data, the traditional method tended to give higher values in beta-globulin fraction and lower values in alpha 2-globulin and gamma-globulin fractions compared with our method. For the simulated data, the traditional method also tended to give higher values in beta-globulin fraction and lower values in gamma-globulin fraction, whereas our method gave the correct values.

Blood Proteins↗
PubMed1993

[The improvement of colorimetric determination of lipid peroxide in human serum].

The present work details an improved application of kit to the measurement of lipid peroxides in human serum. Kits based on the reaction of lipid hydroperoxides with a leucomethylene blue derivative in the presence of hemoglobin. Overall sensitivity was increased by taking samples 5 times larger than those indicated in product literature for the system. It was necessary, however, to compensate actual data for protein error. To do this, the following empirically obtained formula was employed: A = a/(-3.45x + 98) x 100, where A (nmol/ml) indicates compensated data for lipid peroxides, a (nmol/ml) indicates the data for the actual measurement of lipid peroxides, and x (g/dl) indicates the total protein. We obtained what we considered to be satisfactory results by the above formula, as it allowed us to observe that lipid peroxides in fresh human serum undergo a change, momentarily.

Colorimetry↗
PubMed1993

[Cerebral protection during aortic arch replacement: usefulness of continuous O2 saturation monitoring of internal jugular bulb to optimize cerebral perfusion].

How to optimize cerebral perfusion pressure and flow during selective extracorporeal circulation is a crucial problem for cerebral protection in surgical repair of aortic arch aneurysm. Among 47 cases of aortic arch replacement between 1980 and 1992, extracorporeal circulation (ECC) for the first 17 cases [group-1] were hypothermic ECC with selective cerebral perfusion (SCP) and 8 cases [group-2] with hypothermic ECC with hypothermic cardiac arrest. For the latest 16 cases [group-3] we introduced continuous O2 saturation monitoring by oximetry catheter placed in internal jugular bulb (SIJVO2) and maintained SIJVO2 value above 90% to effectively adjust pump flow to optimize cerebral perfusion pressure and flow for cerebral protection. We have retrospectively compared the effectiveness of SIJVO2 monitoring among these three groups. The mortality was 35% (6 cases: group-1), 37% (3 cases: group-2) and 6% (1 case: group-3) respectively. Cerebral dysfunction which were diagnosed in immediate postoperative period were 23% (4 cases: group-1), 0% (0 case: group-2) and 6% (1 case: group-3) respectively. We conclude continuous monitoring of SIJVO2 during selective ECC in aortic arch replacement is useful to optimize cerebral perfusion pressure and flow thereby reducing postoperative cerebral damage by selective ECC.

Adult↗
PubMed1993

[Retrograde cerebral perfusion with circulator arrest for aortic arch aneurysm].

Past over two years, thirteen cases of aortic arch aneurysm, including 5 proximal arch aneurysms, 5 transverse arch aneurysms and 3 distal arch aneurysms, were operated under retrograde cerebral perfusion with deep hypothermia. In the operation, tympanic temperature, rectal temperature and SEP were monitored. When the rectal temperature fell to 20 degrees C, circulatory arrest was done and retrograde cerebral perfusion was started through SVC venous cannula, at the rate of 200-300 ml/min. During cerebral perfusion, PGE1, Mannitol, Solumedrol were administered and defroxamine as radical scavenger was injected before reperfusion for protection of the brain edema. The duration of retrograde cerebral perfusion was from 28 min to 67 min. (mean 42.8 min). In the retrograde cerebral perfusion, cerebral embolization was prevented and good operative field without cannulation was obtained. Of 13 patients, 3 patients were died of intraoperative myocardial infarction and acute renal failure. Ten patients were alive and recovery of consciousness was complete. In conclusion, retrograde cerebral perfusion method is very simple and useful for the operation of aortic arch aneurysm.

Adult↗
PubMed1993

Monitoring both serum amyloid protein A and C-reactive protein as inflammatory markers in infectious diseases.

We examined serum amyloid protein A (SAA) and C-reactive protein (CRP) as inflammatory markers of viral and bacterial infections. Both acute-phase reactants increased in the acute stage and thereafter decreased in the convalescent stage. In viral infections, the mean serum concentrations of SAA during the acute stage were 141 mg/L in infections with adenovirus, 77 mg/L with measles virus, 63 mg/L with influenza virus, 55 mg/L with parainfluenza virus, 31 mg/L with respiratory syncytial virus, and 31 mg/L in aseptic meningitis. The mean serum concentration of CRP was 19 mg/L for adenovirus infection and < 7 mg/L in all other viral infections. The SAA concentrations were 5- to 11-fold greater than the CRP concentrations. Both the SAA and the CRP concentrations were higher in bacterial infections than in viral infections. Changes in the concentrations of serum SAA paralleled those in serum CRP in bacterial infection; during the course of viral infection, however, serum SAA tended to disappear more quickly than CRP did. SAA appears to be a clinically useful marker of inflammation in acute viral infections, with or without significant changes in the CRP concentration.

Bacterial Infections↗
PubMed1993

[Successful 24-hour pulmonary preservation in the use of hyperbaric oxygen].

24-hour lung preservation with modified Euro-Collins (E-C) solution under hyperbaric oxygen (OHP) was studied in the canine single lung transplantation model. A prostaglandin I2 (PGI2) was administered before cardiac arrest by St. Thomas solution. Lungs were flushed with modified E-C solution, then heart and lungs were excised en-bloc and immersed in 4 degrees C modified E-C solution for 24 hours in control group (N = 5). In OHP group (N = 5), heart and lung block were preserved similarly in the control group but placed in hyperbaric chamber (mixed gas 95% O2, 5% CO2) under 2 atmospheres absolute pressure. In the hyperbaric chamber, the lungs were expanded continuously by pressure difference between the inside and the outside of the lung. The left lung was transplanted into recipient dog and reperfused for 3 hours. Pulmonary function was assessed serially by measuring oxygen and carbon dioxide tensions in arterial blood and pulmonary vascular resistance by clamping the right pulmonary artery for 5 minutes. ATP before and after preservation was measured. In the control group, PaO2, after 24 hours preservation followed by reperfusion, was 177 +/- 88 mmHg, but decreased to 75 +/- 34 mmHg at 3 hours of reperfusion and bloody foamy sputum appeared in 4 dogs. Alternatively, PaO2 was 256 +/- 58 mmHg at 3 hours of reperfusion and foamy sputum did not appear in OHP group. There was a significant difference between the 2 groups (p < 0.05). PaCO2 at 3 hours of reperfusion was 41 +/- 3 mmHg in the control group, and 31 +/- 2 mmHg in the OHP group (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Focal glomerular sclerosis in a sibling].

We described here one sibling with focal glomerular sclerosis. Proteinuria was noticed at the age of five in brother and four in sister. Both of them developed nephrotic syndrome shortly after the discovery of proteinuria. The nephrotic syndrome was resistant to corticosteroid, immunosuppressive agents or the combination of these drugs. Percutaneous renal biopsy in them revealed morphological and immunohistological features compatible to focal glomerular sclerosis. HLA typing in HLA-A, B, C and DR loci was identical to both. This observation suggests that genetic factors is associated with the pathogenesis of focal glomerular sclerosis.

Adolescent↗