Biomedical subjects
Publications and source records attributed to M Yamaguchi.
Two cases of abdominal bronchogenic cyst were reported. In the first case, the cyst was communicated with gastric fundus and existed as gastric abscess. In the second case, the cyst showed high CT number and chemical analysis of the contents revealed high range of Ca, Fe and Amylase levels.
A 9-year-old boy had a successful surgical correction of truncal valve regurgitation and obstruction of extracardiac conduit which ensued previous Rastelli operation. He underwent Rastelli operation at the age of 10 months with the diagnosis of truncus arteriosus (Collet & Edwards Type I). At the age of 8 years, he was admitted because of slow weight gain and cardiomegaly (CTR 64%). Cardiac catheterization showed elevated RV pressure, increased pressure gradient across the conduit and severe truncal valve regurgitation. The extracardiac conduit was replaced with a 22 mm Hancock valved conduit and the truncal valve with 23 mm St. Jude Medical aortic valve. Postoperative catheterization revealed a normal RV pressure, only slight pressure gradient across the conduit and no truncal valve regurgitation. He is doing quite well 2 years after the operation.
A case of cor triatriatum associated with coarctation of the aorta (CoA) and VSD is reported. A 4-month-old boy underwent subclavian flap aortoplasty and ligation of PDA with the diagnosis of CoA and VSD. At the age of 1 year and 2 months, echocardiography revealed an abnormal subdividing membrane in the left atrium. Under the definite diagnosis of cor triatriatum (Lucas & Schmidt type I B1) and VSD, complete removal of the abnormal septum, patch closure of ASD and VSD was performed with the aid of cardiopulmonary bypass, blood cardioplegia and topical cardiac cooling. Postoperative course was uneventful and the patient was discharged from the hospital on the 38th postoperative day. An association of cor triatriatum, VSD, and coarctation of the aorta is very rare, and to our knowledge, the case presented here seems to be the first report of successful total correction by a staged approach in the literature.
Recombinant human erythropoietin was administered to an anemic patient with multiple myeloma (IgD, lambda type) and renal dysfunction who had been dependent on blood transfusions. Three thousand units of the recombinant human erythropoietin was given intravenously three times a week. Thereafter transfusion requirements, hemoglobin level, and reticulocyte responses have been monitored. An increase in hemoglobin level and reticulocyte counts was observed within 10 days and then further blood transfusion was not necessary. Neither organ dysfunction nor toxic effects were observed. The administration of recombinant human erythropoietin can be a new method to treat anemia associated with multiple myeloma and renal dysfunction.
Explore the source record for details and available documents.
An eight-year-old girl with partial atrioventricular canal defect and hypoplastic right ventricle was treated successfully by a palliative open-heart surgery. The preoperative right ventricular pressure was 58/7 mmHg (RVP/LVP = 0.67) and morphology of the right ventricle showed severe tricuspid stenosis and small outflow portion. The preoperative RVEDVI was 31 (41% of normal and tricuspid annulus was 17 mm (47% of normal). The right ventricular outflow was reconstructed with insertion of MVOP and the ASD was partially left open (the amplitude of the interatrial communication was 7 mm). Angiocardiogram two and half years after the operation demonstrated significant right ventricular growth with no right to left shunt through interatrial communication. The RVEDVI was 46 (56% of normal) and tricuspid annulus was 36 mm (90% of normal). This technique can be a procedure of choice in patient with right ventricular hypoplasia, who is not candidate for simple right ventricular reconstruction nor Fontan procedure, as the growth of the right ventricule is expected in the future.
Several cis-acting transcriptional silencer elements that are dispersed over a long (more than 1 kb) region upstream of the mouse DNA polymerase-beta gene repress transcription not only of this gene but also of heterologous promoter-enhancers of other genes. The effect of DNA replication on the functions of these silencer elements was examined by combining them with transiently replicating plasmids carrying the chloramphenicol acetyltransferase (CAT) gene and the replication origins (ori) of polyoma virus and SV40 DNA. The silencers functioned efficiently when these plasmids were transfected into mouse NIH 3T3 and monkey CV1 cells. These cells lack T antigen and therefore do not allow replication of the plasmids. The silencers also functioned when the plasmids contained nonfunctional SV40 ori. In contrast, the negative effect of the silencer was not observed when the plasmids were transfected into cells producing large T antigens, such as MOP8 cells and COS1 cells. The observed differences in the silencer function between the permissive and nonpermissive cells was not due to differences in plasmid copy numbers in the cells. The results indicate that ongoing DNA replication can completely overcome the negative effects of the silencer elements on transcription.
The effects of beclomethasone dipropionate (BD) 800 micrograms on steroid-dependent adult asthmatics were examined. The study consisted of two groups; 20 patients on 800 micrograms and another 20 patients on 400 micrograms. In addition, 800 micrograms was administered to an additional 12 patients receiving 400 micrograms with insufficient effects. After two weeks of observation period, BD was administered for 12 weeks, and its effects adverse reactions were analyzed on the basis of asthma patients' diary etc. As the results, effects appeared earlier in the 800 micrograms group than in the 400 micrograms group and marked efficacy was seen. The 800 micrograms group was much better than the 400 micrograms group in the achievement of weaning from or of dose reduction of systemic steroid. A significant increase of serum cortisol levels which was considered to be due to the decrease of the systemic steroid usage was noted. Considerable efficacy was also observed in patients whose dosage had been increased from 400 micrograms to 800 micrograms. High dose administration usually increases topical side effects such as hoarseness and stomatitis, however the use of spacers was effective in the prophylaxis and treatment of those symptoms.
Successful surgical correction of supravalvular aortic stenosis (SAS) syndrome associated with severe peripheral pulmonary stenosis by a staged approach in a 6-year-old boy is reported. Right ventriculogram demonstrated bilateral severe peripheral pulmonary stenoses and cardiac catheterization revealed severe pressure gradient of 94 mmHg between the trunk of pulmonary artery and right and left peripheral pulmonary arteries, respectively. Bilateral severe peripheral pulmonary stenoses were relieved successfully by staged operations. Initially, a stenotic portion of the right pulmonary artery and its bifurcation was removed and a DeBakey Knitted Dacron graft was interposed between the right pulmonary artery and the peripheral pulmonary artery which was enlarged by arterioplasty. Nine days later, stenosis of the left peripheral pulmonary artery was relieved by arterioplasty using a Rygg patch. Finally, 8 months after the initial operation, the patient underwent definitive repair of SAS by extended aortoplasty. The postoperative course of the patient was uneventful. Our experience indicates that in the surgical treatment of the patient with SAS and associated severe multiple peripheral pulmonary stenoses, a staged approach, that is initial staged repair of the bilateral pulmonary stenoses by arterioplasty through thoracotomy followed by definitive intracardiac repair of SAS, is the procedure of choice.
For use in artificial insemination with husband's semen (AIH), a continuous-step Percoll density gradient technique was used to wash and concentrate sperm from ejaculate. To evaluate usefulness, the pregnancy rates were analyzed by the life table method. 1. After washing by the continuous-step Percoll density gradient method, sperm density increased from 28.8 X 10(6)/ml (original semen) to 40.9 X 10(6)/ml and sperm motility improved from 52.4% (original semen) to 77.0% respectively. 2. A group of 119 infertile patients whose diagnosis involved oligoasthenozoospermia, cervical factor and unexplained infertility were selected for AIH. After 640 insemination cycles, 37 women conceived with a pregnancy rate of 31.1%. By using life table analysis, the cumulative conception probability rate reached 0.652 after 13 insemination cycles. 3. Cumulative pregnancy rates by diagnostic category were 0.494 in male factor and 0.745 in cervical factor after 12 cycles, respectively. 4. The poorest results were obtained in unexplained infertility with a cumulative pregnancy rate of only 0.355 after 12 cycles. 5. In the follow up study, 24 viable babies were born and seven (18.9%) resulted in spontaneous abortion in the first trimester. These results indicate that the continuous-step Percoll density gradient technique is useful for improving the pregnancy rate in AIH.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A 57-year-old male was admitted to our hospital because of high fever and dyspnea. He had convulsive attacks after the operation for subarachnoid hemorrhage. He received an anticonvulsant, Hydantol F (Phenytoin + Phenobarbital), for 20 days before hospitalization. The white cell count on admission was 900/microliters without any neutrophils. Pseudomonas was demonstrated from blood cultures. After the anticonvulsant was discontinued and potent antibiotics were administered, his symptoms improved. Neutrophils appeared in the peripheral blood. We investigated the effect of phenytoin on the granuloid precursors using in vitro colony assay (CFU-C) after recovery from agranulocytosis. There was substantial decrease in CFU-C colony numbers when phenytoin or peripheral T-lymphocytes incubated with phenytoin was added in the culture. The addition of sera from acute phase did not affect the colony formation. These results suggested that direct toxic effect of the drug and cellular immunity played an important role in phenytoin induced agranulocytosis.
Severe obstructive lesion of the trachea combined with complex congenital cardiac anomaly has generally been regarded as a fatal disease. Herein we report the successful concomitant repair of severe tracheal stenosis and complex cardiac anomaly with the use of cardiopulmonary bypass in two cases. The first patient was a 5-year-old boy with tetralogy of Fallot associated with a localized intrathoracic tracheal stenosis caused by complete cartilaginous rings. Tracheal resection and end-to-end anastomosis combined with total correction of tetralogy of Fallot was performed with the aid of cardiopulmonary bypass. The second patient was a 5-month-old girl with a pulmonary artery sling, scimitar syndrome, and extensive tracheal stenosis. The patient underwent definitive correction of cardiac lesions and complete tracheal reconstruction with a cartilaginous graft with the aid of cardiopulmonary bypass. Utmost care was paid to avoid contamination during the operation. Both of the patients are doing well at present without any signs of complication, 2 years 5 months and 1 year 10 months after the operation, respectively. We advocate concomitant repair of both lesions, with cardiopulmonary bypass, in the surgical managements of infants and small children who have a difficult and otherwise fatal combination of complex congenital cardiac anomaly and severe intrathoracic tracheal stenosis.
A total of 267 infants and children who underwent the arterial switch operation for transposition of the great arteries in the 6 years before Jan. 1, 1988 in six main Japanese institutions were entered into this review. The current status of patients surviving more than 1 year after the operation were evaluated along with early operative results. One hundred forty-six patients had an intact ventricular septum, 103 had a significant ventricular septal defect, and 18 had so-called Taussig-Bing anomaly of the transposition type. Eighteen patients were less than 28 days of age, 73 were 1 to 5 months of age, and 176 were older than 6 months of age at the time of operation. The overall mortality rate was 35% in the first 3 years and 12% in the more recent 3 years. There was a significant difference between the overall mortality rate of primary and two-stage repair (22% versus 10%, p = 0.047) in patients with intact ventricular septum. The overall mortality rate in patients with type B or C coronary arteries of Yacoub, and Radley-Smith's classification was significantly higher than that of other types of arteries (86% versus 18%, p = 0.0001). A total of 156 patients survived more than 1 year after the operation, and 44 children (28%) were noted to have supravalvular pulmonary stenosis (greater than 20 mm Hg). This complication was more common in patients operated on in the newborn period. Trivial or mild aortic regurgitation was noted in 29 patients (19%) and was more common in patients with two-stage than with primary repair (24% versus 14%). Aortic regurgitation was significantly more prevalent in patients in whom coronary arteries were implanted into slits or U-shaped defects than in those whose arteries were implanted into punched-out holes made on the pulmonary root (28% versus 8%, p = 0.049). Normal sinus rhythm was present in 97% of 154 patients and left ventricular ejection fraction was within the normal range in 97% of 115 patients at catheterization 1 to 5 months after the operation.
The effectiveness of various methods of myocardial protection were evaluated retrospectively in 59 infants less than 12 months of age who underwent open heart surgery for ventricular septal defect with severe pulmonary hypertension. Intermittent aortic clamping and electrically induced ventricular fibrillation (EF) were employed in 13 infants (Group I), and potassium induced cold cardioplegia and topical cardiac cooling (TC) were used in 14 infants (Group II). Six infants in Group II had additional EF after declamping of the aorta (Group II-A) but the rest of Group II infants did not have any EF (Group II-B). Profound hypothermia and circulatory arrest were utilized in 17 infants (Group III). Cold blood cardioplegia with TC were used in 15 infants (Group IV). Moderate hypothermia were used during cardiopulmonary bypass in Group I, II and IV. The operative mortality for Group I was 15% and was 0% for Group II, III and IV. The incidence of spontaneous resumption of cardiac beat following declamping of the aorta were 33.3, 0, 100, 94.1, 93.3% for Group I, II-A, II-B, III and IV respectively. The urinary output obtained in the postoperative 72 hours was significantly lower in Group I than in Group II, III and IV (Group I less than II less than IV less than III).(ABSTRACT TRUNCATED AT 250 WORDS)