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Biomedical subjects

M Onoe

Publications and source records attributed to M Onoe.

At least 37 records · Page 2Linked to original sources

Surgical repair of ventricular septal defect associated with absence of right superior vena cava and persistent left superior vena cava: a case report.

A nine-month-old boy, weighing 4840 g, with VSD associated with absent right superior vena cava and persistent left superior vena cava, successfully underwent surgical repair of VSD. This anomaly is rare and causes some surgical and electrophysiological problems. We discussed these problems and described the details of surgery in our case.

Heart Septal Defects, Ventricular↗

Myxoma of the aortic valve.

Myxoma of the aortic valve is exceedingly uncommon. In this article, we report a 58-year-old man with myxoma arising from the aortic valve. Aortic valve replacement was performed, and postoperative histologic examination showed myxoma of aortic valve.

Aortic Valve↗

The relation between arterial oxygen tension and cerebral blood flow during cardiopulmonary bypass.

OBJECTIVES: Neurological impairment occurs in up to 25% of infants undergoing cardiopulmonary bypass with or without circulatory arrest. Potential causes include alterations in cerebral blood flow, hypoxia and embolisation. During cardiopulmonary bypass, arterial oxygen tension is maintained at levels which under normal conditions cause cerebral vasoconstriction; this is a potential mechanism for ischaemia. The aim of this study was to explore the relation between arterial oxygen tension and cerebral blood flow during cardiopulmonary bypass. METHODS: Near infrared spectroscopy was used to explore the relation between arterial oxygen tension and cerebral blood flow in 14 patients (median age 8 months; range 1 month to 10 years 11 months). The relations between arterial oxygen tension, arterial carbon dioxide tension, temperature, haematocrit, pump flow rate, mean arterial pressure and cerebral blood flow, were examined using multivariate analysis. RESULTS: There was no relation between cerebral blood flow and arterial oxygen tension, but a highly significant relation was observed between cerebral blood flow and pump flow rate, with cerebral blood flow decreasing 4.2-fold per L.m-2.min-1 decrease of pump flow rate. CONCLUSION: There was no relation between arterial oxygen tension and cerebral blood flow during cardiopulmonary bypass, but low pump flow rate may lead to reduced cerebral blood flow.

Blood Flow Velocity↗

[Successful repair of right atrial rupture due to nonpenetrating trauma of the chest].

A 24-year-old male was brought to our hospital after being injured in a traffic accident. On arrival, his blood pressure was 70/44 mmHg and his pulse rate was 135/min and regular. Chest X-p revealed cardiomegaly but there was no pleural effusion or bone fracture. Echocardiogram revealed cardiac tamponade and he was diagnosed as cardiac rupture due to non penetrating trauma. Under midline sternotomy, right atrial rupture was repaired. The patient developed cardiac arrest lasting approximately 8 minutes during anesthetic induction, so he needed to be ventilated for 8 days. However his postoperative course was not so eventful and he was discharged 38 days after surgery without any neurophysiological disturbance.

Accidents, Traffic↗

Pseudoaneurysm of the left ventricle following repair for ventricular septal perforation.

The patient was a 64-year-old man who was treated surgically for an infarct-related ventricular septal perforation. Pseudoaneurysm of the left ventricle was recognized on the 38th postoperative day. Emergency surgery was performed. It seemed that insufficient resection of the infarcted myocardium was performed during the initial surgery to avoid narrowing the ventricular dimension by direct closure of the left ventricle, but this resulted in pseudoaneurysm of the left ventricle. Left ventricular free wall plasty with a patch should be performed during the initial surgery.

Aneurysm, False↗

[Tricuspid pouch].

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Diagnosis, Differential↗

Effects of auricular acupuncture stimulation on nonobese, healthy volunteer subjects.

Effects of auricular acupuncture stimulation on nonobese healthy volunteers were investigated. Subjects (n = 35) averaged 34.5 years old, and BMI was 25.3 kg/m2. Small (0.15 x 2.0 mm) auricular needles were applied intracutaneously into the bilateral cavum conchae that was identified by having less than 100 k omega resistance. Body weight was measured four times a day and charted by the subjects themselves. Results showed that, in the period 11-2, in which only body weight was measured, without auricular acupuncture stimulations, 57.1% of the subjects reduced their body weight. This indicates that charting body weight themselves might be useful to maintain their weight. In the auricular acupuncture treated period, 19 (70.4%) out of 27 decreased (p < 0.01), 5 (18.5%) was increased, and 3 (11.1%) had no change in body weight. In conclusion, the results suggest that success in maintaining weight reduction can be attributed to graphic illustration of one's weight pattern. Bilateral auricular acupuncture stimulation can also reduce body weight of healthy non-obese subjects. This is consistent with the suggestion that it might be effective in the treatment of obese patients.

Acupuncture Points↗

Clinical significance of reverse redistribution phenomenon after coronary artery bypass grafting.

The reverse redistribution (RR) phenomenon is a decrease in thallium 201 uptake during redistribution compared with 201Tl uptake immediately after exercise. We evaluated RR in 23 patients after coronary artery bypass grafting. Postoperative RR was present in 48% and was significantly more common in patients with a history of myocardial infarction (62%). The patients were classified according to the presence (+) or absence (-) of RR. An analysis of left ventricular wall motion showed significant improvement after coronary artery bypass grafting in the RR+ group (n = 12) but not in the RR- group (n = 11). Quantitative myocardial viability was evaluated using the defect volume ratio, mean defect severity, and defect severity index. The preoperative defect volume ratio was higher in the RR+ group than in the RR- group (p < 0.05). In the RR- group, no improvement in these indices was observed after operation. In contrast, the RR+ group showed significant improvement in all three indices (p < 0.05). These results indicate that after coronary artery bypass grafting, an adequate blood supply to the remaining myocardium may induce RR. This phenomenon, therefore, may be a significant indicator of postoperative myocardial viability.

Adult↗

Effects of auricular stimulation on feeding-related hypothalamic neuronal activity in normal and obese rats.

It is known that auriculotherapy occasionally affects dramatic body weight reduction for obese patients, although the physiological and anorexigenic functions are not clear. Effects of auricular stimulation on feeding-related lateral (LHA) and ventromedial (VMH) hypothalamic neuronal activity in normal and experimental (hypothalamic and dietary) obese rats were investigated. The LHA and/or VMH neuronal activity were recorded from feeding-related regions in Wistar SPF/VAF male and experimental (hypothalamic and dietary) obese rats, anesthetized with urethane-chloralose, under stereotaxic coordination. Recording was through 3 M KCI glass microelectrodes, while stimulating the ipsilateral vagal innervated region of the auricle. This is equivalent to the cavum conchae in the human, and was identified by resistance less than 10-50 k omega. The stimulating electrode was a stainless steel ear acupuncture (0.12 x 2.0 mm). The latency of potentials evoked in the LHA by unilateral stimulation of a specific site in the ear was 28.1 +/- 3.3 ms (8-92, n = 41). LHA neuronal activity was depressed 45.6% (n = 12, p < 0.01), and VMH activity was excited (60.5%, n = 18, p < 0.01). The auricular acupuncture stimulation clearly modulates feeding-related hypothalamic neuronal activity of experimental (both hypothalamic and dietary) obese rats. These auricle acupuncture stimulation effects were correlated to the degree of obesity. In conclusion, the results suggest that auricular acupuncture stimulation may not reduce appetite, but is more likely concerned with satiation formation and preservation. Thus, auricular acupuncture should be more effective on obese rats than on normal rats.

Acupuncture Therapy↗

Surgical repair of a ventricular septal defect in a patient with trisomy 8 syndrome.

We surgically repaired a ventricular septal defect (-VSD) in a patient with trisomy 8 syndrome. This case illustrated a number of characteristic clinical features associated with trisomy 8 syndrome patients which have previously been reported in the literature. However, our patient's VSD was not found to be particularly different from the VSD of patients without chromosomal abnormalities during either the surgery or the postoperative course.

Child, Preschool↗

Effects of hypothalamic paraventricular nucleus: electrical stimulation produce marked analgesia in rats.

The effect of the electrical simulation induced analgesia (ESIA) on the hypothalamic paraventricular nucleus (PVN) was investigated by the paw pressure test, which was used to avoid any tissue damage to the paw of Wistar-SPF/VAF male rats. A stimulating electrode was chronically implanted in the parvocellular (PVN-prv) or magnocellular (PVN-mgn) divisions of the PVN. The ESIA was examined at least 10 days after surgery. The electrical stimulation of the PVN markedly showed analgesia (ESIA), but stimulation of most locations outside the PVN did not produce ESIA. Stimulation threshold for the ESIA was lower from PVN-prv than from PVN-mgn, but neither region was affected by naloxone administration (10 mg/kg, i.p.). These results indicate that the PVN is a part of the pain inhibitory system in the CNS, and show that PVN-ESIA might not be mediated either by opioids or by neuropeptides such as vasopressin.

Analgesia↗

Bilateral main bronchial compression caused by the ductal ligament.

Several authors have reported cases of respiratory distress resulting from bronchial compression due to a hypertensive pulmonary artery in the setting of a large left-to-right shunt. However, respiratory distress due to bilateral main bronchial compression due to an enlarged pulmonary artery suspended posteriorly by the ductal ligament following repair of a ventricular septal defect is extremely rare. In this report, we advocate the necessity of dividing the ductal ligament in some patients with large left-to-right shunts when there are episodes of idiopathic respiratory distress before operation.

Airway Obstruction↗

Optimal perfusion pressure for experimental retrograde cerebral perfusion.

We evaluated cerebral metabolism during retrograde cerebral perfusion (RCP) and circulatory arrest during profound hypothermia, and also investigated the effects of perfusion pressure on RCP. Twenty-four adult mongrel dogs were placed on cardiopulmonary bypass and cooled to a nasopharyngeal temperature of 20 degrees C. At this temperature, hypothermic circulatory arrest (HCA; n = 6), and RCP with a perfusion pressure of 10 mmHg (RCP10; n = 6), 20 mmHg (RCP20; n = 6), and 30 mmHg (RCP30; n = 6) were carried out for 60 minutes. RCP was performed with oxygenated blood via the bilateral maxillary veins, and the retrograde flow rate was regulated to maintain a mean perfusion pressure of 10, 20, or 30 mmHg in the external jugular vein. At 60 minutes of RCP, we measured nasopharyngeal temperature; regional cerebral blood flow (rCBF); cerebral oxygen consumption, carbon dioxide excretion, and excess lactate; cerebral tissue adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP) and energy charge; and cerebral tissue water content. In the RCP10 group, there was excess cerebral lactate, and ATP and energy charge were low. In the RCP30 group, the water content of cerebral tissue was significantly higher than in other groups. In the RCP20 group, temperature was maintained in a narrow range, oxygen consumption and carbon dioxide excretion could be observed, there was no excess lactate, and ATP and energy charge were significantly higher than in the HCA group. In conclusion, RCP can provide adequate metabolic support for the brain during circulatory arrest, and a perfusion pressure of 20 mmHg is most appropriate for RCP.

Animals↗

A clinical study on the effects of pulsatile cardiopulmonary bypass on the blood endotoxin levels.

Levels of endogenous endotoxins have been reported to increase after cardiopulmonary bypass. Endotoxin levels have also been implicated in multiple organ failure and may contribute to the immunocompromised state seen after bypass. We evaluated the effects of pulsatile cardiopulmonary bypass circulation on endogenous endotoxin levels. The study population consisted of 15 consecutive adult patients who underwent cardiac operations with cardiopulmonary bypass. Pulsatile flow was used during aortic crossclamping in eight patients (group I) and nonpulsatile flow was used in the remaining seven patients (group II). Changes in blood endotoxin levels were monitored during aortic crossclamping, after release of the clamp, and after weaning from bypass. The blood endotoxin level at each stage was expressed as a percentage of the level at the beginning of bypass. Group I patients a significantly lower blood endotoxin percentage than group II (from 20 to 120 minutes after the initiation of aortic crossclamping). In group I, the blood endotoxin percentage was nearly constant during aortic crossclamping. After release of aortic crossclamping, group I also had a lower blood endotoxin percentage than group II. Endogenous endotoxin levels appear to increase in the presence of intestinal congestion and ischemia. Improvement in intestinal circulation by pulsatile cardiopulmonary bypass may prevent increases in endogenous endotoxin levels by reducing these factors.

Adult↗

[Experimental study of optimal perfusion pressure during retrograde cerebral perfusion].

The effects of retrograde perfusion pressure on the brain was experimentally investigated during profound hypothermic circulatory arrest. Fifteen adult mongrel dogs were placed cardiopulmonary bypass and induced profound hypothermia of 20 degrees C at nasopharyngeal temperature. Retrograde cerebral perfusion (RCP) with perfusion pressure of 10 mmHg (RCP10; n = 5), 20 mmHg (RCP20; n = 5), 30 mmHg (RCP30; n = 5) underwent for 60 minutes. The oxygenated blood was infused via the bilateral maxillary veins, and the flow rate was kept to maintain a desired pressure in the external jugular vein for each group. Regional cerebral blood flow (rCBF), excess lactate, cerebrospinal fluid pressure (CSFP), adenosine triphosphate (ATP) concentration of cerebral tissue, and water content of cerebral tissue were measured. In the RCP10 group, cerebral excess lactate was positive and ATP concentration was low. In the RCP30 group, the water content of cerebral tissue was significantly higher than those in the other groups. In the RCP20 group, the excess lactate was maintained in a negative range, and ATP concentration was significantly higher than in the RCP10 group. In conclusion, RCP may provide metabolically adequate support for the brain and a perfusion pressure of 20 mmHg was appropriate for RCP in dogs.

Animals↗

The effect of pulsatile perfusion on cerebral blood flow during profound hypothermia with total circulatory arrest.

In 39 mongrel dogs, regional cerebral blood flow was measured during pulsatile and nonpulsatile deep hypothermic cardiopulmonary bypass with total circulatory arrest. Total circulatory arrest was performed at 20 degrees C cerebral temperature for 40 minutes in 15 dogs, 60 minutes in 12 dogs, and 80 minutes in 12 dogs. Cerebral blood flow in both groups decreased as cerebral temperature fell and there was no significant difference in cerebral blood flow between the two groups during the cooling period. After circulatory arrest for 40 minutes, as cerebral temperature increased to 35 degrees C, cerebral blood flow in both groups recovered to values as high as the respective initial values, which were measured just after the beginning of cardiopulmonary bypass for cooling (102.5% +/- 10.2% in the pulsatile group and 97.2% +/- 12.6% in the nonpulsatile group). After circulatory arrest for 60 minutes, cerebral blood flow in the pulsatile group increased to 141.8% +/- 16.1% of its initial value when the cerebral temperature became 35 degrees C, but it remained significantly lower (64.5% +/- 9.2%) in the nonpulsatile group (p < 0.01). After circulatory arrest for 80 minutes, cerebral blood flow in both groups remained lower than the respective initial values. These results suggest that pulsatile perfusion maintains cerebral blood flow even during profound hypothermia and that it may protect the brain from ischemic and hypoxic damage caused by profound hypothermia and total circulatory arrest in cardiac operations.

Animals↗