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Biomedical subjects

Masahiro Endo

Publications and source records attributed to Masahiro Endo.

At least 73 records · Page 4Linked to original sources
PubMed2003

Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis.

BACKGROUND: Takayasu arteritis is associated with a low incidence of coronary artery involvement, such as stenosis, obstruction, aneurysm, and coronary steal syndrome, but coronary ischemia can be fatal. METHODS: Between 1972 and April 2001, 81 of 130 patients given a diagnosis of Takayasu arteritis underwent selective coronary angiography, and among them, 31 patients (4 male and 27 female patients; mean age, 41.1 +/- 13.2 years) had abnormal coronary angiographic findings and were recruited for this study. RESULTS: Abnormal coronary findings consisted of 24 coronary artery stenoses of greater than 75%, 3 coronary artery-bronchial artery anastomoses, 3 aneurysmal coronary ectasias, and 1 combined coronary ectasia and anastomosis. Among 24 patients with coronary stenosis, the ostium was most frequently involved (87.5%). Twenty-three of 24 patients with coronary artery stenoses were treated surgically. The mean follow-up duration was 9.65 +/- 6.9 years, with a 100% follow-up rate. Four fistulas and 4 aneurysms in 7 patients were not treated surgically. Coronary steal phenomenon was always associated with occluded pulmonary arteries and pulmonary hypertension. Aneurysmal coronary ectasia was related to severe aortic hypertension with or without aortic regurgitation and atypical coarctation. There were 2 (8.7%) in-hospital deaths and 3 (13%) late deaths. The actuarial survival rate, including in-hospital deaths, was 86.5% +/- 7.3% at 5 years and 81.4% +/- 8.4% at 10 years. CONCLUSION: The incidence of coronary abnormalities is relatively low in patients with Takayasu arteritis; however, surgical treatment is recommended for patients with coronary ostial stenoses because coronary ischemia can be one of the major causes of death.

Actuarial Analysis↗
PubMed2003

[Cost-effectiveness of weekly paclitaxel for patients with advanced non-small cell lung cancer].

Paclitaxel is known to be efficacious in treating non-small cell lung cancer (NSCLC). We initiated a phase II trial of weekly paclitaxel (W-PTX) therapy in advanced NSCLC, and found that W-PTX was feasible for advanced NSCLC patients. We evaluated the cost of W-PTX from receipts and compared it with a standard cisplatin-vinorelbine (VC) regimen. The aim of this study was to assess the cost of W-PTX therapy. Previously untreated patients with stage IV NSCLC and patients with stage III B/IV NSCLC after at least one previous cisplatin based regimen were eligible if they had preserved organ function for treatment. Paclitaxel was administered at a dose of 80 mg/m2 for 3 consecutive weeks on a 4-week cycle. Patients received at least 1 course of W-PTX in our hospital and then, if possible, were treated on outpatients basis. All patients receiving the VC regimen were treated in the hospital. The mean cost of W-PTX for one month was approximately 699,000 yen per inpatient and 236,000 yen per outpatient. On the other hand, the mean cost of VC for one month was approximately 816,000 yen per patient. Although the cost of W-PTX for inpatient did not differ greatly from the cost of VC, the cost of W-PTX for outpatients was significantly lower than that of VC. The findings of this study suggest that W-PTX is feasible as a cost-effective chemotherapy for patients with advanced NSCLC.

Aged↗
PubMed2002

Reconstruction of biologically equivalent dose distribution on CT-image from measured physical dose distribution of therapeutic beam in water phantom.

From the standpoint of quality assurance in radiotherapy, it is very important to compare the dose distributions realized by an irradiation system with the distribution planned by a treatment planning system. To compare the two dose distributions, it is necessary to convert the dose distributions on CT images to distributions in a water phantom or convert the measured dose distributions to distributions on CT images. Especially in heavy-ion radiotherapy, it is reasonable to show the biologically equivalent dose distribution on the CT images. We developed tools for the visualization and comparison of these distributions in order to check the therapeutic beam for each patient at the National Institute of Radiological Sciences (NIRS). To estimate the distribution in a patient, the dose is derived from the measurement by mapping it on a CT-image. Fitting the depth-dose curve to the calculated SOBP curve also gives biologically equivalent dose distributions in the case of a carbon beam. Once calculated, dose distribution information can be easily handled to make a comparison with the planned distribution and display it on a grey-scale CT-image. Quantitative comparisons of dose distributions can be made with anatomical information, which also gives a verification of the irradiation system in a very straightforward way.

Humans↗
PubMed2002

Acute occlusion of coronary artery bypass graft with nonionic contrast medium.

The use of nonionic contrast media should be beneficial in patients with cardiac disease because such media are less chemotoxic. Using iopamidol under heparinization, we treated 4 cases of acute thromboembolic occurrence including occlusion of coronary artery bypass grafts and associated native coronary arteries. While the majority of patients do not experience this complication, care must be taken to avoid major adverse effects.

Aged↗
PubMed2002

Acute aortic dissection in a patient with idiopathic dilated cardiomyopathy.

Surgical treatment of acute aortic dissection in a patient with idiopathic dilated cardiomyopathy is rare. A 57-year-old man diagnosed with idiopathic dilated cardiomyopathy with left ventricular dimension of 59 mm in diastole, left ventricular dimension of 47 mm in systole, and fractional shortening of 0.19 on echocardiography developed type A acute aortic dissection. Emergency surgery was conducted for ascending aorta and hemiarch repair for ascending aorta redissection and dilation. The postoperative course was uneventful under appropriate hemodynamic control. Standardized criteria for aortic dissection in a patient with poor left ventricular contraction have not established, but surgery should be considered for all patients in good preoperative condition when it is the only effective life-saving alternative.

Aortic Dissection↗
PubMed2002

Extracorporeal membrane oxygenation and left ventricular assist device: a case of double mechanical bridge.

A 14-year-old boy with dilated cardiomyopathy with cardiac arrest was successfully implanted with a left ventricular assist device (LVAD) after 6-day extracorporeal membrane oxygenation (ECMO). He had multiple organ failure at the initiation of ECMO, but the failed organs recovered during assisted circulation, leading to LVAD implantation. This case showed the advantages of the "double bridge" such as: (1) quick and easy installation for acute cardiogenic shock, (2) providing intervention time for complications refractory to LVAD implantation, and (3) providing evaluation time for potential LVAD implantation and transplant candidates.

Adolescent↗
PubMed2002

Effects of milrinone for right ventricular failure after left ventricular assist device implantation.

Right ventricular failure after left ventricular assist device implantation sometimes requires additional mechanical right ventricular support. The effectiveness of nitrates, prostaglandin, or nitric oxide inhalation in such cases has already been reported. However, there are few reports on the administration of phosphodiesterase inhibitor for right ventricular failure after left ventricular assist device implantation. We report two patients with right ventricular failure after left ventricular assist device implantation successfully treated with milrinone. Both had residual pulmonary hypertension due to high pulmonary vascular resistance after left ventricular assist device implantation. However, intravenous milrinone caused a significant reduction in pulmonary vascular resistance and an increase in left ventricular assist device flow. Milrinone acts as both an inotropic agent and a direct vasodilator, and thus may avoid the need for mechanical support for right ventricular failure due to residual pulmonary hypertension after left ventricular assist device implantation.

Adolescent↗
PubMed2002

Subepicardial aneurysm after anticoagulant therapy for a mural thrombus following anterior myocardial infarction.

A subepicardial aneurysm became evident in a male patient after anticoagulant therapy. On admission, it appeared to be an old anterior infarction accompanied by a mural thrombus. After warfarin administration, the thrombus disappeared and an echo-free space emerged outside the apical myocardial wall. The echo-free space communicated with the left ventricular cavity through the apical myocardial wall. Emergency surgery was undertaken and the patient survived. The aneurysm was covered with epicardium and there was an endomyocardial rupture of the muscle in the apical wall, which was the entrance of the aneurysm. This case suggests that cautious follow-up with echocardiography is necessary when anticoagulant therapy is selected for thrombi following myocardial infarction.

Anticoagulants↗
PubMed2002

Non-linear dynamics applied to human respiratory movement during sleep.

We investigated the relationship between approximate entropy (ApEn) and correlation dimension (D2) in respiratory movement to reveal the non-linear dynamics in respiration during sleep. Seven healthy volunteers participated in this study. We recorded respiratory movement during sleep at night. We estimated the values of D2 and ApEn in respiratory movement. A significant relationship was observed between ApEn and D2 during sleep (r = 0.67, P < 0.001). Surrogate data analysis revealed that the respiratory movements had significant non-linear property. This evidence suggests that ApEn and D2 may become new indices to evaluate non-linear respiratory dynamics during sleep.

Adult↗
PubMed2002

Aortic root replacement using composite valve graft in patients with aortic valve disease and aneurysm of the ascending aorta: twenty years' experience of late results.

The purpose of this study was to evaluate the clinical outcome of composite valve graft replacement in 193 patients with aortic valve disease and aneurysm of the ascending aorta from January 1980 to June 1999. The clinical outcome was compared between the patients diagnosed with Marfan syndrome (M group) and those without Marfan syndrome (non-M group), between those with aortic dissection (AD group) and without dissection (non-AD group), between 2 different techniques for coronary artery reattachment (modified Bentall [mB] and modified Piehler [mP]), and between the time of operation (1980-1989 and 1990-1999). Long-term outcome of this procedure was almost satisfactory with actuarial survival of 71.5 +/- 4.4% at 10 years and freedom from reoperation of 76.5 +/- 4.4% at 10 years. Freedom from cardiovascular events and freedom from reoperation were significantly lower in the M group and AD group than in the non-M and non-AD groups. Also, actuarial survival was significantly higher in the latter 10 years compared with the former 10 years. It was concluded that the improvement of perioperative management and proper selection of the technique for coronary artery reattachment could have improved the clinical outcome. In patients with Marfan syndrome or aortic dissection, there still remains a higher risk of cardiovascular event and future reoperation. Extensive aortic reconstruction or staged operation should be performed in such patients.

Adolescent↗