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Biomedical subjects

N Atsumi

Publications and source records attributed to N Atsumi.

At least 37 records · Page 2Linked to original sources
PubMed1995

Influence of bypass grafting to the infarct artery on late potentials in coronary operations.

BACKGROUND: Late potentials (LPs) after myocardial infarction identify the risk of arrhythmic events and sudden death, and the absence of anterograde flow in the infarct-causing occluded coronary artery frequently is associated with LPs on signal-averaged electrocardiography. The present study was designed to clarify the influence of revascularization of the infarct artery on the LPs in the late course after myocardial infarction. METHODS: We studied 21 patients after myocardial infarction with positive LPs who had at least one occluded infarct coronary artery. We investigated the LPs on signal-averaged electrocardiograms on the day of elective coronary artery bypass grafting (CABG) and 1 week after CABG. RESULTS: There were 25 infarct arteries in the study patients, 13 of which were grafted. The positive LPs disappeared soon after CABG in 13 patients, 10 of whom had grafts to all of the infarct arteries. The LPs persisted in 8, who received no graft to the infarct artery. One week after CABG, the LPs were still present in 4, all of whom had no graft to the infarct right coronary artery. CONCLUSIONS: In patients with positive LPs late after myocardial infarction, grafting to the infarct artery eliminated the LPs soon after CABG.

Aged↗
PubMed1995

Relief of airway compression by enlarged pulmonary artery--modified palliative suspension of the artery after plication.

A new modification of the technique for plication and suspension of the pulmonary artery in critically ill infants and children is described. The technique consists of (1) left lobe thymectomy, (2) insertion of a polytetrafluoroethylene sheet to provide complete coverage of pericardium, (3) plication of dilated pulmonary artery and (4) suspension of plicated pulmonary artery to the left side of the anterior chest wall. We employed this technique in 7 patients with respiratory distress due to tracheal and/or broncheal compression with massive left-to-right shunt (5 patients) and with absent pulmonary valve (2 patients). Five of these patients (71%) could be weaned from the respirator in the postoperative phase with this surgery. Although this procedure is palliative, this simple technique might be one of the choices for critically ill infants and children.

Airway Obstruction↗
PubMed1995

[Citrate and ionized calcium on extracorporeal circulation in pediatric cardiac surgery].

The control of optimum concentrations of ionized calcium Ca2+ during cardiopulmonary bypass is important in maintaining cardiac function and reducing reperfusion injury. Ca2+ may be in part dependent upon the serum level of citrate Cit in use of hemodiluted prime in pediatric cardiac surgery. The purpose of this study was to ascertain fluctuations of Ca2+ during bypass in relation to Cit and to study control of optimum Ca2+. Ca2+ and Cit was measured prior to and every 10 or 20 minutes during bypass in 12 children aged 21 days to 6 years. Of 6 patients (body weight less than 6 kg) received acid-citrate-dextrose (ACD) solution 20 ml before aortic declamp to give low Ca2+ for reducing reperfusion injury. Ca2+ showed initial drop and then gradually increased as the result of decreasing Cit. Ca2+ was inversely correlated with Cit (r = 0.85, p = 0.0001). When ACD 20 ml was added, Ca2+ significantly decreased from 1.00 +/- 0.13 to 0.65 +/- 0.13 mmol/l. However, Cit remained 24.3 +/- 13.3 mg/dl at the end of bypass. In conclusion, the results of this study suggest that gradually increasing Ca2+ during bypass may be related to the rate of citrate metabolism and the use of citrate for the control of Ca2+ remains questionable.

Calcium↗
PubMed1995

[A percutaneously controllable pulmonary artery banding device: clinical application].

An optimal pulmonary artery banding is often difficult with a conventional banding technique. It often requires readjustment after closing the chest. So we developed a percutaneously controllable pulmonary artery banding device and applied it in three patients. This device consists of silicone balloon being pasted on a reinforced silastic plate and silicone reservoir. The balloon is applied around the pulmonary artery and the reservoir is implanted subcutaneously. The control of the banding is accomplished percutaneously through the reservoir using a needle with fluid-filled syringe. This device worked successfully in two patients for percutaneous readjustment of pulmonary constriction and congestive heart failure was decreased. This device may offer proper constriction of the pulmonary artery without any surgical procedures after banding and may reduce surgical morbidity and mortality of sick children.

Animals↗
PubMed1995

[Postoperative bronchial stenosis associated with IAA complex and transendoscopic resection of intrabronchial granulation].

Problem with stenosis of the left bronchus was encountered in a patient with type B interrupted aortic arch complex after the arch reconstruction and pulmonary artery banding. Bronchoscopic study disclosed the intraluminal granulation of left bronchus and transendoscopic resection of the granulation successfully relieved the stenosis and brought the patient to full recovery.

Airway Obstruction↗
PubMed1995

[Application of large curved forceps for taping in cardiovascular surgery].

A new large curved forceps was manufactured for trial with the object of taping in cardiovascular surgery. Widely used and commercially available forceps could be utilized on the taping of large vessel less than 5 to 5.8 cm in diameter. With this new forceps, aneurysmally dilate great vessels (less than 8 cm in diameter) could be safely taped without compression of aortic wall. This forceps has already applied not only for the major vascular surgery, but also for the wearing of cardiac net in coronary artery bypass grafting.

Aortic Aneurysm↗
PubMed1994

[Thrombolytic therapy of thrombosed Björk-Shiley aortic valve prosthesis--report of four cases].

Prosthetic valve thrombosis is associated with high mortality. Thrombolytic therapy is a promising alternative to valve replacement in the management of prosthetic valve thrombosis. To determine the efficacy and safety of thrombolytic therapy for thrombosed Björk-Shiley aortic valve prosthesis, 4 patients who received urokinase intravenously for this disorder were analyzed. In 3 patients, the successful outcome was sustained in that they remained asymptomatic and did not require operative intervention during follow-up, which ranged from 17 to 101 months. In one patient clinical signs of mild congestive heart failure occurred. This patient was surgically treated by thrombectomy and debridement of the prosthetic valve. Failure of urokinase treatment to resolve the thrombus after 1 week indicates that tissue overgrowth or fibrous, organized thrombus is the cause of prosthetic malfunction. Surgical intervention for this problem should be considered only after thrombolytic therapy has been tried and has failed. Our experience with urokinase treatment of thrombosis of aortic Björk-shiley prostheses indicates that this form of treatment should always be applied before surgical intervention. We also attempted to define the optimum protocol of fibrinolytic therapy by clinical evaluation. A protocol for the safe treatment of thrombosed valve is urokinase in initially administered in the doses as 960,000 units for 24 hours, then followed by a maintenance infusion at the half dose every 24 or 48 hours later. Thrombolytic therapy should be continued for 1 week at least to prevent rethrombosis even normalization of valve function was documented clinically. Simultaneous heparin infusion of 10,000 units for 24 hours is then started to replaced by warfarin treatment adjusted to obtain optimal prothrombin times.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Early repair of postinfarction ventricular septal perforation: a case report of an improved surgical technique].

Accurate repair of postinfarction ventricular septal perforation (VSP) has mainly depended on the technique for friable septal reinforcement. Modified closure of VSP with Xenomedica patch was performed in 63-year-old male. Friable border of the septum was successfully sandwiched between horse-shoe shape prejett (right side) and main patch (left side). The advantages of this modified surgical procedure are as follows: (1) septum can be seen through horse-shoe shape patch (even when tying the mattress sutures; (2) Xenomedica patch is flexible enough for avoiding the cutting for friable septum, and is strong enough for sandwiching the septum.

Heart Rupture, Post-Infarction↗
PubMed1994

[A case of coronary artery bypass grafting (CABG) in which root mean square total (RMST) improved markedly after redo-distal anastomosis].

A 59-year-old man underwent CABG with left internal thoracic artery (LITA) to the first diagonal branch and saphenous vein graft (SVG) to the right coronary artery (RCA). Pump off was quite uneventful, but re-anastomosis was done because bypass graft flow measured before the closure of chest was 6 ml/min, which was most likely due to sclerotic right coronary artery and technical error. After re-anastomosis, bypass flow of SVG to RCA was measured 95 ml/min. Root mean square total (RMST) immediately after aortic declamp for the first time was 39% compared with that measured prior to operation, but improved to 49% after aortic declamp at the second time. It recovered to 127% 2 days after operation, and 137% at 7th postoperative day. RMST indicates the total electropotential per unit time from the beginning to the end of QRS. It has the specificity to predict VT and postoperative pump failure. In this case, it is suspected that RMST may be a predictor that revascularization would be complete or incomplete in operations for ischemic heart disease.

Anastomosis, Surgical↗
PubMed1994

[Influence of ionized calcium concentration during cardiopulmonary bypass on pediatric cardiac surgery].

Changes of serum ionized calcium concentration (Ca2+) during cardiopulmonary bypass (CPB) were analyzed in 30 pediatric cardiac patients less than 15 kg body weight. Ca2+ decreased suddenly after the start of CPB, and it gradually increased to the normal value. Citrate added to the stored blood for priming and its metabolism might play a role in these changes of Ca2+. Addition of adequate volume of calcium chloride to the priming prevented sudden decrease of Ca2+. Although addition of citrate before aortic declamp effectively decreased Ca2+ and may prevent reperfusion cardiac injury associated with hypercalcemia, there were no correlation between predeclamp level of Ca2+ and serum CPK and GOT levels.

Body Weight↗
PubMed1994

[A case of Cabrol's procedure in which selective cerebral perfusion was necessitated].

A 69-year-old man underwent Cabrol's procedure for annuloaortic ectasia and complicated multiple cerebral infarction. Preoperative CT scan showed atherosclerotic changes from the aortic arch to descending aorta. During extracorporeal circulation, arterial cannulation was made through left subclavian artery to prevent cerebral infarction due to detouched atheroma from the descending aorta. Intraoperatively, the ascending aorta was also atheromatous and ulcerative. In this case, cerebral infarction was most likely due to detouched atheroma from the aortic arch in retrograde blood flow during extracorporeal circulation. To prevent this complication, selective cerebral perfusion during extracorporeal circulation should have been selected.

Aged↗
PubMed1993

A reconsideration of surgery for mitral stenosis based on the extent of valvular distortion shown by two-dimensional echocardiography preoperatively.

A twelve-year follow-up study was carried out with 98 consecutive patients operated on for pure mitral stenosis with open mitral commissurotomy (OMC) or valve replacement with porcine valves (MVR). Each patient had the extent of valve distortion diagnosed preoperatively by two-dimensional echocardiography as either grade I of the dome-formation type, grade II of the intermediate type, or grade III of the mass-formation type. Thirty grade I patients and 24 grade II patients underwent OMC and 44 grade III patients received MVR. The long-term survival and reoperation rates were significantly poorer with grade II than grade I patients and there was no statistical significance between grades II and III. However, the clinical conditions set by NYHA are significantly worse in grade II than in grade III. This can be clearly explained by the fact that the left atrial volume decreasing ratio (LAVDR) in the latest period, which was measured in patients with more than 7 years survival, remained nearly at the early postoperative value in grade III, while the LAVDR of grade II at the latest period grew worse and became insignificantly different from the preoperative values. This study clearly shows that when OMC is applied to grade II patients, frequent reoperations might be necessary because of poor hemodynamic conditions. Thus, it might be better to adopt MVR rather than OMC with grade II patients with moderately distorted mitral valves.

Actuarial Analysis↗
PubMed1993

The sedative effect of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 1. The effect of a 0.2 mg/kg dose.

The purpose of this study was to determine the sedative effect of a 0.2 mg/kg dose of midazolam, administered intranasally, prior to performing various restorative dental procedures on a group of mentally disabled patients under local anesthesia and nitrous oxide/oxygen analgesia. Twenty-one patients, aged 4 to 21 years, all of whom had previously exhibited highly combative and resistant behavior toward dental treatment under local anesthesia, were sedated with 0.2 mg/kg midazolam. Only patients assessed as ASA anesthesia status I or II were admitted to the study. After administering the midazolam, each patient was allowed to rest before initiating the dental procedures. Behavioral patterns during the various procedures were rated on a behavioral rating scale of 1-7. Each patient served as his or her own control, comparing behavior with or without intranasal midazolam. The results showed a marked improvement in behavioral patterns after administration of intranasal midazolam. Ratings on a scale of 1-7 were noted as "markedly effective" and "effective" for 69.2% of those patients who received infiltration injection anesthesia, 93.8% under rubber dam, 76.2% during cavity preparation, 84.2% for restoration placement and 87.5% during pulpotomy procedures. The majority of patients were discharged within 150 minutes of intranasal instillation. Further studies are indicated to ascertain the most appropriate dose of intranasally administered midazolam.

Administration, Intranasal↗
PubMed1993

[Right thoracotomy to approach mitral or tricuspid valve in reoperation].

Four patients underwent mitral valve re-replacement, and required tricuspid annuloplasty in two, through a right thoracotomy. There was no major postoperative morbidity and recovery was full and uneventful. The indications for selection of this approach were isolated mitral valve disease or combined tricuspid and mitral valve disease, severe adhesion between heart and sternum on CT scan, intact aortic valve and no severe reduction of respiratory function. We recommend right thoracotomy to approach atrioventricular valves in selected situations in patients for reoperations.

Aged↗
PubMed1993

[Two cases of coarctation complex associated with congenital esophageal atresia (Gross type C)].

Two cases of coarctation complex (CoA + VSD + PDA) associated with congenital esophageal atresia (Gross type C) were successfully treated with esophageal and two-staged cardiac surgery. The perioperative management of the two cases is discussed with special reference to circulatory, respiratory and nutritional problems. Case 1; A newborn was diagnosed as esophageal and cardiac anomalies and gastrostomy was performed followed by end to end anastomosis of the esophagus under receiving Prostaglandin E1 infusion. Although subclavian flap angioplasty (SFA) and pulmonary artery banding (PAB) were performed 1 month later, she had recurrent respiratory complications and malnutrition postoperatively due to bronchomalacia and gastroesophageal reflux (GER). Case 2; A newborn was diagnosed as esophageal atresia and underwent corrective surgery of it on the 1st day of life. After esophageal surgery congestive heart failure (CHF) developed progressively and CoA complex was evident by echocardiography 5 days later. SFA and PAB were performed 26th day of life. In spite of the palliative surgery for cardiac lesions, both patients had growth failure because of CHF, respiratory complications and malnutrition. As soon as the circulatory and respiratory condition improved, corrective surgery was performed and resulted in full recovery.

Aortic Coarctation↗
PubMed1992

[MRSA infections in multiple trauma patients].

Multiple trauma patients requiring prolonged intensive care are at high risk of MRSA infections. Surgical debridement and proper antibiotic prophylaxis combined with isolation of this compromised host from indigenous bacteria are the mainstays of initial therapy to prevent this complication. If this develops postoperatively, the sites of infection vary among the patients, such as urinary tract, surgical wounds, the abdomen, respiratory tract, vascular catheters, etc. Clinical evidence of sepsis suggests that intra-abdominal and respiratory tract infection are major contributors to mortality. In a postoperative multiple trauma patient, with pneumonia, thoracic empyema, intraabdominal abscess, wound infection and sepsis caused by MRSA, surgical drainage of the abscess with systemic infusion of vancomycin was effective and resulted in full recovery.

Adult↗
PubMed1992

[Biventricular heart assist using centrifugal pump and roller pump in profound ventricular failure after open heart surgery: a case report].

A forty-seven-year-old female with profound biventricular heart failure probably caused by coronary artery spasm after open mitral commissurotomy was successfully survived by mechanical circulatory support. Centrifugal and roller pumps were applied to left and right side circulatory assist respectively. Recovery of cardiac function was evaluated by transesophageal echocardiography and hemodynamic parameters during intentional low flow assist. Finally, she was weaned from assist after 136 hours. No systemic thromboembolism was recognized after pump removal. Combination of centrifugal and roller pumps could be applicable to biventricular heart assist without crucial complication.

Cardiac Output, Low↗