Search PubMed⌕ Search

Biomedical subjects

N Mukohara

Publications and source records attributed to N Mukohara.

66 records · Page 4Linked to original sources
PubMed1990

[The causes of prolonged postoperative respiratory care in mitral valve disease with a giant left atrium].

Whether a giant left atrium in mitral valve disease itself prolongs postoperative respiratory care or does not is an important problem. We investigated it in 39 patients who underwent MVR without plication of the left atrium. A giant left atrium (GLA) was defined when CT-LA volume exceeded 300 ml by rapid sequential CT or left atrial diameter exceeded 60 mm by echocardiography. According to this criteria, the 39 patients were divided into two groups: 18 patients of GLA group and 21 of non-GLA group. Eight GLA (44%) and 11 non-GLA patients (52%) needed postoperative respiratory care with intratracheal intubation for more than 24 hours. Four GLA (22%) and 2 non-GLA patients (9.5%) needed reintubation. There was no significant difference between the two groups concerning the duration of postoperative respiratory care and the frequency of reintubation. The reintubated patients had three prominent preoperative clinical profiles, such as poor general condition, poor cardiac function and poor respiratory function. Consequently, it is concluded that in mitral valve disease with a GLA the prolongation of postoperative respiratory care is largely due to poor cardiac and respiratory function rather than to the compression to the bronchus by a GLA.

Cardiomegaly↗
PubMed1990

[A case of Marfan syndrome with recurrent bilateral pneumothorax and anuloaortic ectasia].

A 17-year-old male patient with Marfan syndrome was admitted due to recurrent bilateral pneumothorax which had recurred totally 11 times during the past 3 years. For the treatment of obstinately continuing right pneumothorax resection of bullae in combination with pleuropexy using OK 432 was effective. Two months thereafter Bentall operation with a composite graft consisting of a woven Dacron tube and a Björk-Shiley 27 mm aortic valve prosthesis was performed for his anuloartic ectasia. Left pneumothorax recurred 2 weeks after Bentall operation. But it was treated successfully with OK 432 injection into the left pleural cavity. Now, he is doing well as a student.

Aged↗
PubMed1989

[Effective thromboexclusion for repeating bleeding tendency caused by dissecting aneurysm: a case report].

A 75-year-old woman developed general fatigue and left chest pain in October 1986, and Chest CT showed DeBakey IIIb dissecting aneurysm. During the next 8 months, she repeated abdominal pain, tarry stool and subcutaneous hemorrhage for three times and after an angiography large hematoma at puncture site appeared. The laboratory data showed the decrease in platelet and fibrinogen and the increase in FDP every time when she developed the symptoms. Because this bleeding tendency was thought to be the "local DIC" caused by dissecting aneurysm, we performed thromboexclusion on July 27, 1987. Immediately after the operation, 60 packs of platelet and 3 g of fibrinogen was transfused, then laboratory data remarkably improved and bleeding tendency disappeared. The patient died 12 days after the operation of sudden ventricular tachycardia. At autopsy, precise cause of death was not determined, but the purpose of thromboexclusion seemed to be achieved, because good thrombus formation was observed in the descending aorta and the graft was patent.

Aged↗
PubMed1989

[A modified technic for coronary to graft anastomosis and coronary perfusion in Bentall operation].

From September 1987 to January 1989, we performed 7 consecutive Bentall operations using a modified technique for the coronary artery to graft anastomosis with a satisfactory result. Six patients with annuloaortic ectasia and one with type 1 aortic dissection underwent the operation. After suturing a composite graft to the aortic annulus, side-holes about 8 mm in diameter were made in the graft at points corresponding to the coronary ostia. Then the graft was cut longitudinally on the side of the non-coronary cusp so as to make operative procedure easier. Four buttressed mattress sutures of 4-0 polypropylene thread were placed in the aortic wall around the coronary ostia and connected to the corresponding part of the graft. These threads were tied and then used for running sutures from inside of the graft. Even in a case where the coronary ostium was close to the aortic annulus, this procedure permitted easy and secure accessibility. Additionally, retrograde continuous cold blood cardioplegia via the coronary sinus made Bentall procedure easier and safer. Postoperative angiography revealed no stenosis or deformity of the coronary artery and no leakage from the suture line. All patients are doing well in NYHA functional class I.

Adolescent↗
PubMed1989

[Surgical treatment of acute aortic dissection].

Sixty-seven patients subjected to this study composed of 32 patients treated surgically, 15 patients treated medically and 20 patients examined by autopsy for the past 8 years. Out of 32 surgical cases, 16 were operated on in an acute stage, within 2 weeks after onset and 9 out of these 16 acute cases belonged to DeBakey type I or II and 11 out of 15 autopsy cases belonged to type I or II either. Contrarily most of the medical cases were type III. Both causes of death in the acute autopsy group and operative indications in the acute surgical group were cardiac tamponade, heart failure due to aortic insufficiency, myocardial infarction and aortic rupture. Operative mortality rate was 12.5% in the acute cases and 19% in the chronic cases, late mortality rate was 19% in the acute cases and 0% in the chronic cases. Two cases of operative death had massive bleeding due to aortic rupture and massive myocardial infarction. These were the most dangerous complications of acute aortic dissections. We conclude that all patients with type I or II dissections should be operated on before fatal complications occur.

Acute Disease↗
PubMed1989

[A clinical study on cefuzonam concentrations in myocardium in open heart surgery].

The distribution of cefuzonam (CZON) was studied in 20 adults undergoing open heart surgery. In groups I (n = 11) and II (n = 9). CZON (2g) was intravenously infused at the time of induction of anesthesia; and in group II an additional 2 g was administered at the time of commencement of extracorporeal circulation (ECC). Just prior to and following the ECC, samples of blood and right auricle were taken for examination. CZON concentrations in serum and myocardium were measured using the thin-layer cup method with Esherichia coli NIHJ as the test organism. CZON concentrations in myocardium prior to ECC were 48.9 micrograms/g and 39.0 micrograms/g for groups I and II, respectively. The ratios of intramyocardial to serum CZON concentration were 0.40 and 0.45 for groups I and II, respectively, revealing no significant difference between the 2 groups. Following ECC, intramyocardial CZON concentrations were 20.8 micrograms/g for group I and 33.2 micrograms/g for group II; while the ratios were 0.43 and 0.59 for groups I and II, respectively. Again, there were no significant differences. From the above findings it may be concluded that: 1. There was good distribution of CZON in myocardium, with a concentration well above MIC80. 2. Therapeutic concentrations of CZON were maintained in myocardium for 6 hours, suggesting that initial infusion of 2 g CZON is sufficient for prophylaxis in routine open heart surgery.

Cardiac Surgical Procedures↗
PubMed1989

[Surgical treatment of a right atrial myxoma with pulmonary embolism].

We report on an 18-year-old man with a right atrial myxoma complicated by widespread pulmonary infarction. Under cardiopulmonary bypass, a typical gelatin-like myxoma of 65 g in weight and the segments of pulmonary infarction were simultaneously removed. From the excised lung specimens, pulmonary tissue infarction caused by myxoma acting as a blocker was recognized. This was a very rare case of myxoma complicated by pulmonary infarction, and we report here the successful removal of the right myxoma and partial pneumonectomy.

Adolescent↗
PubMed1986

[Magnetic resonance diagnosis of aortic dissection: with special reference to the communicating orifice between the true and false lumens].

Magnetic resonance imaging (MRI) was performed in thirty-one patients with aortic dissection to evaluate its usefulness in diagnosing the site of communicating orifice between the true and false lumens and the presence of retrograde dissection. MRI revealed the site of the entry as a defect in the intimal flap in the images of 12 of 15 patients (80%). The site of the communicating orifice between the true and false lumens in the abdominal aorta could be determined in six of eight patients (75%). MRI diagnosis of retrograde dissection was successful in three patients. Cross-sectional analysis of the abdominal aorta based on the location of the true lumen revealed that the celiac and superior mesenteric arteries tended to arise from the true lumen when the latter was situated in the anterior part of the abdominal aorta. The right and left renal arteries arose from the true lumen when it was positioned anterolaterally. In conclusion, MRI was a useful diagnostic method for aortic dissection, especially for determining the site of entry in the thoracic aorta. The changes in signal intensity in the false lumen provided useful information for locating the communicating orifice between the true and false lumens and for diagnosis of retrograde dissection. Cross-sectional analysis of dissection in the abdominal aorta was useful for predicting the branching of the main arteries from the true or false lumen.

Adult↗
PubMed1982

Tracheoplasty for congenital stenosis of the entire trachea.

Congenital stenosis involving the entire length of the trachea has generally been regarded as a fatal disease. Tracheoplasty using costal cartilage grafts to enlarge the lumen was successfully employed in such a case, and the technique is described. A 12-mo-old female was referred with recurrent severe respiratory distress since birth. By tracheoscopy and bronchography, the entire trachea was seen to be stenotic. The left bronchus was of normal caliber by bronchogram and the left lung was over inflated, while the right lung was aplastic. Through a midsternal thoracotomy, the left bronchus was incised and cannulated for ventilation. Longitudinal incision of the entire length of the anterior wall of the trachea permitted the advance of a nasotracheal tube along the inner surface of the divided trachea to the carina. Two pieces of costal cartilage were used to fill the defect in the anterior wall of the trachea. The grafts were attached to the tracheal edges by interrupted 5-0 Dexon sutures. The endotracheal tube was successfully removed two months later. The subsequent course of the patient has been satisfactory.

Cartilage↗