[A case of T cell-malignant lymphoma of the duodenum].
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Duodenal Neoplasms↗
Biomedical subjects
R Koike
Publications and source records attributed to R Koike.
[Similarity between internal thoracic artery and gastroepiploic artery graft: pharmacological point of view].
The pharmacological responses of internal thoracic artery (ITA), gastroepiploic artery (GEA) and saphenous vein (SV) obtained from patients receiving coronary artery bypass grafting (CABG) were assessed by isometric contraction records. The concentration-response curves for ergonovine and serotonin showed the leftward shift in SV compared with ITA and GEA. The 50% effective dose values of SV for ergonovine and serotonin were significantly less than those of ITA and GEA. The concentration-response curves for phenylephrine were similar among three kinds of grafts. There were no significant differences in the 50% effective dose values for phenylephrine among them. The effect of 0.4% papaverine chloride on the free graft flow was assessed in 15 patients receiving CABG with mean body surface area of 1.62 +/- 0.12 M2. The free flow of ITA graft was 71 +/- 32 ml/min before intraluminal papaverine injection, and that increased to 112 +/- 41 ml/min after injection. The free flow of GEA graft was 82 +/- 39 ml/min before injection, and that also increased to 128 +/- 40 ml/min after injection. The patency rates at the mean 2.2 months after grafting were 98% in ITA, 93% in GEA, and 88% in SV. In conclusion, both GEA graft and ITA graft can be expected as an excellent conduit in myocardial revascularization.
Adult↗
[Intracoronary thrombolysis and coronary artery bypass grafting--the favorable results of combined revascularization for myocardial infarction].
The results of coronary artery bypass grafting performed in 10 patients receiving intracoronary thrombolysis were reviewed. There were 9 males and 1 female. The mean age was 60.5 years old ranged from 41 to 77 years old. The obstructed vessels were the left anterior descending artery: 6, the right coronary artery system: 1, both the left anterior descending artery and the right coronary artery system: 1, and the left main trunk: 2. All patients survived after successful recanalization with constrict monitoring, systemic heparinization and oral anti-coagulants. All the patients received elective coronary revascularization for the occluded vessels and the other vessels, and the mean number of distal anastomoses was 2.8 ranged from 1 to 4. There were no operative deaths, no perioperative myocardial infarction, no use of balloon pumping or no serious complications. Symptomatic relief was obtained 10 of 10 patients. Left ventriculographic studies showed significant improvement in regional and global left ventricular ejection fraction after coronary artery bypass grafting compared with after thrombolysis. In conclusion, successful thrombolysis for acute myocardial infarction reduces early mortality. Additional coronary artery bypass grafting is beneficial for not only definite correction of the underlying arteriosclerotic lesion, but also improvement of left ventricular function.
Adult↗
[The effect of isosorbide dinitrate spray on patients receiving coronary artery bypass grafting].
The effect of isosorbide dinitrate (ISDN) spray on hemodynamics and coronary artery diameter was studied in 10 patients with ischemic heart disease. Significant decrease in systolic blood pressure and systolic and diastolic pulmonary artery pressure was recognized at 2 minutes after spray. But there were no significant changes in heart rate and diastolic blood pressure. The diameter of the right coronary artery was 2.6 +/- 0.3 mm before ISDN, which significantly increased to 3.5 +/- 0.4 mm after ISDN. Then, the effect of ISDN on saphenous vein (SV) graft and internal thoracic artery (ITA) graft in 5 patients receiving coronary artery bypass grafting was assessed. The diameter of ITA was 1.7 +/- 0.2 mm before ISDN, and that was 2.0 +/- 0.2 mm after ISDN. The increase was recognized in all patients. The diameter of SV was 4.0 +/- 0.3 mm before ISDN, and that was 4.0 +/- 0.3 mm after ISDN. The diameter of the left anterior descending artery was 1.9 +/- 0.2 mm before ISDN, and that was 2.4 +/- 0.4 mm after ISDN. It was concluded that ISDN spray had a vasodilation effect on ITA graft as well as coronary artery. ISDN spray was expected to be useful for the solution of graft spasm and rapid abortion of anginal attacks even after coronary surgery.
Administration, Oral↗
[A case of idiopathic hypereosinophilic syndrome (HES) complicated by pulmonary infarction].
We experienced a case of idiopathic hypereosinophilic syndrome (HES) associated with pulmonary infarction. The case was a 22-year-old woman with marked eosinophilia (16835/microliters) and peripheral edema and cyanosis. During hospitalization, she suddenly developed lower right chest pain, and infiltrative lesions with pleural effusions in the right lung were prominent. A diagnosis of pulmonary infarction was made after perfusion scan and angiography of the lung. Lupus anticoagulant was found to be positive and a transient increase of anti-cardiolipin antibody slightly in her serum was also observed. Recurrent thrombosis is known to be complicated by HES but its mechanism remains to be clarified. There has also been no study reported in the literature on the role of lupus anticoagulant in this process; its possible role in this patient is discussed.
Adult↗
[Simultaneous coronary artery bypass grafting and cholecystectomy: a report of three cases].
The frequency of patients requiring non-cardiac surgery complicates ischemic heart disease (IHD) is increasing, however, there have been few reports of combined coronary revascularization and abdominal surgery. In this paper, we describe three patients with IHD and cholecystolithiasis in whom simultaneous coronary artery bypass grafting (CABG) and cholecystectomy was successfully performed. Initially, CABG was performed employing standard extracorporeal circulation through median sternotomy. After closure of chest, cholecystectomy was carried out through right pararectal laparotomy. Their postoperative course was uneventful. Relief of angina and freedom from epigastralgia were obtained in all patients. Combined CABG and cholecystectomy is beneficial for the selected patients.
Aged↗
Favorable behavior of the internal thoracic artery graft in a patient with coronary artery spasm.
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Coronary Vasospasm↗
Right ventricular myocardial infarction and late cardiac tamponade due to right coronary artery aneurysm--a case report.
Coronary artery aneurysm is a relatively rare disease, which may cause angina, myocardial infarction, or sudden unexpected death due to thrombosis, embolization or rupture. This report describes a case of a 46 year old male who suffered an inferior myocardial infarction with right ventricular involvement, third degree atrioventricular block, cardiogenic shock and late cardiac tamponade, all caused by a right coronary artery aneurysm. He was successfully treated with emergency coronary artery bypass grafting. A review of the literature is also given to emphasize the importance of prompt recognition and correct management of the coronary artery aneurysm.
Cardiac Tamponade↗
Simultaneous coronary and abdominal aortic surgery--a report of two cases.
Myocardial infarction is a major cause of operative mortality following abdominal aortic surgery. For this reason, routine coronary angiography and, if indicated, coronary revascularization prior to aneurysm repair is recommended. Nevertheless, some controversy still exists concerning the risks of aneurysm rupture and myocardial ischemic events when repair or coronary surgery is staged. This report describes two successful cases of simultaneous surgery for an expanding aneurysm and severe coronary artery disease, emphasizing the usefulness of gastroepiploic artery grafting in such cases.
Aged↗
Comparison of prostacyclin production of human gastroepiploic artery and saphenous vein.
The prostacyclin production of the gastroepiploic artery (GEA) and saphenous vein (SV) were studied in 5 patients undergoing coronary artery revascularization. The GEA produced 90.0 +/- 11.9, 132.4 +/- 13.7, and 191.1 +/- 21.8 pg/mg tissue (mean +/- standard error of the mean) of 6-keto-prostaglandin F1 alpha (prostacyclin metabolite) after 2.5, 5.0, and 10.0 minutes, respectively, of incubation in Krebs-Henseleit buffer at 37 degrees C. The SV produced 39.8 +/- 7.0, 66.7 +/- 9.1, and 123.6 +/- 15.1 pg/mg tissue of 6-keto prostaglandin F1 alpha after 2.5, 5.0, and 10.0 minutes, respectively, of incubation. The GEA produced significantly more 6-keto-prostaglandin F1 alpha than SV at all three sampling times up to ten minutes of incubation (p less than 0.01). Prostacyclin is a potent vasodilator and an inhibitor of platelet aggregation. Prostacyclin production by the internal mammary artery was reported to be much higher than that of SV, and the patency rate of internal mammary artery grafts is reported to be better than that of SV grafts in coronary artery revascularization. Therefore, our results suggest that the patency rate of GEA grafts may be better than that of SV grafts in coronary artery revascularization. The GEA is a promising and excellent graft from the biochemical point of view.
6-Ketoprostaglandin F1 alpha↗
Free arterial graft as internal mammary artery-Y complex.
Because of excellent surgical results obtained with in situ internal mammary artery grafts, recent efforts have been made to extend the use of arterial conduits. In this study 2 cases of coronary revascularization using free internal mammary artery and gastroepiploic artery grafts as an internal mammary artery-Y complex are described. We believe that complete revascularization with only arterial conduit can be achieved more widely by using this technique.
Aged↗
Pharmacological response of internal mammary artery and gastroepiploic artery.
Pharmacological response of coronary artery bypass conduit is of great importance. This study was designed to clarify the contractile properties of internal mammary artery and gastroepiploic artery obtained from coronary revascularization. The response to ergonovine, serotonin, and phenylephrine was examined by isometric contraction recording apparatus. The concentration-response relation of both internal mammary artery and gastroepiploic artery to ergonovine, serotonin, and phenylephrine showed similar sigmoid curves. There were no significant differences in developed tension between internal mammary artery and gastroepiploic artery at any concentration for any agent. There were no significant differences in the 50% effective dose value for any agent between internal mammary artery and gastroepiploic artery. Internal mammary artery and gastroepiploic artery are reported to be similar in terms of size, flow capacity, and freedom from atherosclerosis. This study shows their equivalence from a pharmacological viewpoint.
Arteries↗
The Bioflow graft for coronary artery bypass: a preliminary report.
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Journal Article↗
[A review of coronary artery bypass grafting distal to the total obstruction].
Coronary artery bypass grafting (CABG) distal to the total obstruction has been carried out in 10 patients during 17 month period. There were neither operative deaths nor perioperative myocardial infarction. All patients were free from angina pectoris postoperatively. There were 13 completely obstructed coronary arteries. CABG was successfully placed on 9/9 (100%) of the distal artery filled with collaterals including thread-like caliber, but 0/4 (0%) without opacification suggesting no collaterals. The graftability to the left anterior descending branch was 6/6 (100%), to the circumflex system was 3/5 (60%), and to the right coronary system was 0/2 (0%). Postoperative regional ejection fraction and cardiac index improved significantly. In conclusion, CABG distal to the total obstruction should be performed in case of the distal lumen opacified by collaterals. Especially CABG to the left anterior descending artery might be worth-while.
Adult↗
[Contractile properties of coronary artery bypass conduit--comparison between saphenous vein and internal mammary artery].
This study was designed to examine the response of coronary artery bypass conduit to serotonin, phenylephrine, and ergonovine as provocation agents of vasoconstriction. Saphenous veins (SV) and internal mammary arteries (IMA) were obtained during coronary artery bypass grafting (CABG), and their contractile properties were measured using isometric contraction recording apparatus. Both SV and IMA showed sigmoid contraction curves indicating dose dependence to ergonovine, serotonin, and phenylephrine. The concentration-response relations for phenylephrine showed a similar curve in both SV and IMA, however, those for ergonovine and serotonin showed a leftward shift in SV compared with IMA. Half maximum effective dose for ergonovine and serotonin were less in SV than IMA. From these results, it was suggested that "perioperative spasm" during CABG might occur not only in coronary arteries but also in the graft conduit itself. Graft spasm might be a possible mechanism for occlusion of the bypass graft. In conclusion, greater hyperreactivity of SV compared with IMA in response to ergonovine and serotonin was suggested, so it is concluded that, from this point of view, IMA is more suitable for use in CABG.
Coronary Artery Bypass↗
[Coronary revascularization for patients requiring steroids. A report of three cases].
Three patients with systemic disease requiring steroids, in whom coronary artery bypass grafting (CABG) was performed, are reported in this paper, Anesthetic problems and operative managements for such patients are also discussed. Patient 1, 57-year-old male with thrombocytosis underwent emergency double CABG using saphenous vein and the Bioflow graft. He discharged with freedom from angina. Patient 2, 59-year-old male with polymyositis who had been receiving steroid for 10 years underwent quadruple CABG using bilateral internal thoracic arteries with sequential technique and the Bioflow graft, but he died of multiple organ failure on 16 days after operation. Postmortem examination revealed that coronary artery sclerosis progressed more severely than we had expected from angiography. All the graft anastomosed were completely patent. Histological examination showed that the saphenous vein was fragile. The pathological changes might be due to steroid administration. On the other hand, arterial grafts were completely normal. Patient 3, 37-year-old male with idiopathic thrombocytopenic purpura who had been on steroids underwent combined triple CABG using internal thoracic artery, gastroepiploic artery and the Bioflow graft and splenectomy. He discharged with freedom from angina and tendency to bleed. Postoperative angiography showed both arterial grafts were well patent and left ventricular wall motion vastly improved. From our experience, a careful consideration of the bypass conduit is a major problem in such patients requiring steroids.
Adult↗
[Left ventricular rupture following the procedure of percutaneous transluminal coronary angioplasty: a case report].
A 50-year-old man with 90% concentric stenosis at the proximal portion of the left anterior descending artery was tried to be treated with percutaneous transluminal coronary angioplasty (PTCA). The guide wire did not pass through the stenotic portion, and the staining out of coronary artery was recognized. Four hours after the procedure, he fell to shock status with a sign of electro-mechanical dissociation. An emergent operation confirmed the left ventricular rupture. Repair of the tear and saphenous vein bypass to the left anterior descending artery were performed rapidly, however, he was not weaned from cardiopulmonary bypass. Close communication between cardiologist and surgeon, and immediate surgical back up are essential for saving these patients from severe ischemic events following PTCA failure.
Angioplasty, Balloon, Coronary↗
[Free arterial graft in coronary artery bypass surgery].
Free arterial graft of the internal mammary artery (IMA) and the gastroepiploic artery (GEA) has been utilized for coronary artery bypass grafting in 10 patients during 44 months period. There were 6 males and 4 females and age ranged 42 to 73 year old with the mean of 60.8 year old. Eight IMA and 2 GEA were used as a free graft. Sites of distal anastomosis of the free graft were 3 at anterior descending arteries, 3 at diagonal branches and 4 at circumflex arteries. Sites of proximal anastomosis of those grafts were ascending aorta in one, concomitantly utilized saphenous vein graft in 5 and in situ IMA graft in 4 patients. Mean number of grafts was 2.9 (2-5) and mean aortic cross clamp time was 56.2 minutes (16-90 minutes). There was neither operative death, nor perioperative myocardial infarction and intra-aortic balloon pumping was not required. Postoperative angiography was made in 9 patients within 3 postoperative months. Eight (89%) free arterial grafts were patent. Relief of angina was obtained in all patients. We concluded that the complete revascularization with only arterial graft can be achieved more widely by utilizing the free arterial graft with an acceptable patency.
Adult↗