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Biomedical subjects

S Furuta

Publications and source records attributed to S Furuta.

At least 271 records · Page 15Linked to original sources
PubMed1990

[Investigation of primary tissue failure in mitral bioprostheses].

A study was conducted on 118 Hancock (HX) porcine valves, 251 Carpentier-Edwards (CE) porcine valves, and the biological valves in children used in the mitral position. Twenty-three HX valves, twenty-seven CE valves, and all valves except one operative death in children were diagnosed as primary tissue failure (PTF). Freedom from PTF for HX valves was 70.1 +/- 6.0% at ten years and for CE valves was 45.7 +/- 17.0% at ten years, although for children it was calculated 0% at eight years (significantly poor results compared with adults). No relation was found between the degree of calcified cusps and the duration of PTF valves used. The ruptures and calcifications of the cusps were most commonly observed in commissure. The peeled off commissures were characteristic in CE valves. Three adults and two children died without reoperation caused by calcified stenotic valves. Since the risk of reoperation was higher in NYHA functional class four, we recommend earlier elective reoperation.

Adult↗
PubMed1990

[A case of bioprosthetic mitral valvular dysfunction due to pannus-formation].

A case of bioprosthetic mitral valvular dysfunction accompanied by mitral stenosis due to pannus is reported. A 69-year-old woman, whose mitral valve had been replaced with a Hancock bioprosthetic valve in June 1979, underwent the second mitral valve replacement in September 1988 because of valvular dysfunction. The ring and cusps of this Hancock valve was partially covered with hard and milky white pannus which resulted in mitral stenosis. The tear of cusp was observed at the point of contact with pannus, which resulted in mitral regurgitation. Histologically, pannus was consisted of two-layered structure, fibrin and collagen fiber, which demonstrated this over-growth was based on thrombus. Main causes of bioprosthetic valve dysfunction are calcification and tear of cusps. But, valvular dysfunction due to pannus-formation described in this case has been experienced very rarely.

Aged↗
PubMed1989

Seroepidemiology of hepatitis A, B, and D viruses and human T-lymphocyte tropic viruses in Japanese drug abusers.

To evaluate the prevalence of hepatitis virus markers and human T-cell lymphotropic virus infections among drug abusers in Japan, serum samples were collected from 91 male drug abusers at the Shinshu University Hospital and the rehabilitation facility in Matsumoto and from 519 healthy male blood donors as controls. Sera were tested for antibody to hepatitis A virus (anti-HAV), hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), antibody to hepatitis B core antigen (anti-HBc), immunoglobulin M anti-HBc (IgM anti-HBc), antibody to hepatitis D virus (anti-HDV), antibody to HTLV type 1 (anti-HTLV 1), and antibody to human immunodeficiency virus (anti-HIV). The prevalence of anti-HAV was 13.2% in drug abusers and 10.8% in controls (not significant). The prevalences of HBsAg, anti-HBs, anti-HBc and exposure rate to hepatitis B virus (HBV) were 4.4%, 24.2%, 31.9%, and 35.2%, respectively, in drug abusers and 0.8%, 6.7%, 9.6%, and 9.6% in controls. The exposure rate to HBV was significantly different (P less than 0.001). IgM anti-HBc and anti-HDV were not detected in any sera. Anti-HTLV I was detected in three drug abusers (3.3%) and in one (0.2%) of the controls (P less than 0.01). All sera were negative for anti-HIV in all subjects. Infection with HBV and HTLV I is more common among drug abusers than in the general population of blood donors in Japan.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Treatment of chronic non-A non-B hepatitis with human interferon beta: a preliminary study.

Twenty-four patients with chronic non-A non-B hepatitis were randomly assigned to receive either human fibroblast interferon (HuIFN-beta) at doses of 1 or 3 million international units (MIU) per day for 4 or 12 weeks (12 patients) or to receive no therapy (12 patients), and were then compared with 5 patients with chronic type B hepatitis who were treated with HuIFN-beta. Elevated serum aminotransferase levels decreased more rapidly during the treatment of chronic non-A non-B hepatitis than of chronic hepatitis B. Variations in serum aminotransferases were not observed in any of the untreated chronic non-A non-B hepatitis patients. In 3 of the 9 patients with chronic non-A non-B hepatitis who responded to HuIFN-beta therapy, serum aminotransferase levels remained normal 15, 21 and 31 months after therapy was discontinued; liver biopsy specimens obtained after therapy from 2 patients showed marked histological improvement. In the six other patients aminotransferase activity levels became again elevated following cessation of interferon therapy. No response to HuIFN-beta was seen in the remaining 3 patients with chronic non-A non-B hepatitis.

Adult↗
PubMed1989

Comparison of anamnestic history, alcohol intake and smoking, nutritional status, and liver dysfunction between thorotrast patients who developed primary liver cancer and those who did not.

In order to clarify the differences in past history, nutritional condition and, consumption of alcohol and tobacco, and liver dysfunction between the thorotrast patients who developed primary liver cancer and those who did not, 103 persons who had no primary liver cancer in January 1980 were studied. All subjects were military men who had undergone angiography with thorotrast between 1943 and 1946. Twenty persons developed hepatocellular carcinoma and 16 developed intrahepatic bile duct carcinoma by April 1987, whereas 67 are still alive without any cancer. There was no difference in age or period after thorotrast infusion between those two groups of patients in January 1980. A difference in history of hepatitis and/or jaundice and presence of hepatic dysfunction was found between the subjects who developed primary liver cancers and those who did not. These findings suggest that an anamnestic history of hepatitis and liver dysfunction are risks for development of thorotrast-induced liver cancer. On the basis of the above findings, early detection of liver dysfunction offers a possibility of early diagnosis of primary liver cancer.

Aged↗
PubMed1989

Semiquantitative correction of posttraumatic enophthalmos with sliced cartilage grafts.

A simple surgical technique for correcting posttraumatic enophthalmos is described. The steps are as follows: (1) a plaster mold is obtained of the patient's face, (2) wax is added to the enophthalmic eye of the plaster mold until it becomes symmetrical, (3) the quantity of wax is measured, and (4) the same amount of sliced costal cartilage is implanted beneath the periosteum of the extended orbital wall behind the vertical axis of the globe. Using this technique, we have successfully treated six patients with traumatic orbital floor defects without complication. This approach is useful for decreasing the orbital volume using a semiquantitative procedure to estimate the amount of graft material required. In this respect, costal cartilage demonstrates a marked advantage, with stability and cosmetic appearance verified over 12 months of follow-up.

Adult↗
PubMed1989

Change of intrahepatic expression of hepatitis-B core antigen during the clinical course of type-B chronic hepatitis.

The intrahepatic expression of hepatitis-B core antigen (HBcAg) was investigated in 54 liver biopsy specimens from 24 chronic type-B hepatitis patients, by the peroxidase-anti-peroxidase technique. The HBcAg localization pattern in the hepatocyte correlated with the evolution of serum alanine aminotransferase (ALAT) values. The clinical course were classified into three phases, as follows: pre-exacerbation phase (A phase), with minimal abnormal range of ALAT (40-100 KU) for 6 to 12 months; exacerbation phase (B phase) with elevated ALAT (more than 100 KU) for 3 to 6 months; and post-exacerbation and subsiding phase (C phase) for 3 months after phase B, showing decreased ALAT values. Nineteen of the 54 biopsied specimens belonged to the A phase, 21 to the B phase, and 14 to the C phase. In the A phase the hepatocytic HBcAg was variably expressed as nuclear, cytoplasmic, and membranous in location in the same specimens. In the B phase, HBcAg expression decreased in the nucleus, but increased in the cytoplasmic-membranous pattern. The intrahepatic HBcAg expression in the C phase decreased in all patterns. The mean level of ALAT in cases of cytoplasmic-membranous HBcAg expression was higher than that in cases of nuclear HBcAg expression. Four of six patients who underwent liver biopsies in the A, B, and C phases showed remarkable decreases of cytoplasmic and membranous HBcAg expression in the C phase. These findings suggest that cytoplasmic and membranous localization of HBcAg can be related to both liver cell injury and active inflammatory processes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Infection by non-A, non-B acute viral hepatitis in hospital employees].

The aim of this study is to evaluate the risk of infection of non-A, non-B acute hepatitis (NANB-AH) in hospital employees. Among 593 patients with acute viral hepatitis (AVH), hospital employees were 3/147 (2%) in type A, 19/174 (11%) in type B and 21/272 (8%) in non-A, non-B (NANB). All 43 patients were medical staffs such as doctors, nurses and laboratory technicians. Out of 21 patients with NANB hepatitis of hospital employees, 7 were doctors, 14 nurses and 6 laboratory technicians. Eight of them had preceding accidental needlestick exposures. Out of 17,290 employees of our hospital during 18 years, 27 medical persons developed AVH. They were 2 hepatitis A, 10 hepatitis B and 15 hepatitis NANB. No non-medical staff developed AVH. Out of 15 NANB hepatitis patients, 7 had needlestick accidents 4 to 6 weeks before development of the illness, and all donor patients showed liver diseases. During 3 years (1985 to 1987), there were 116 needlestick accidents in our hospital which happened in medical staffs alone, and 50 of them were NANB hepatitis-related accidents. Three ml of human immune serum globulin (ISG) was administered intramuscurally just after accidents to 23 persons but not to 27 persons. NANB hepatitis were developed in 2 doctors who were not treated with ISG. In conclusion, NANB hepatitis occurred in hospital employees especially in medical staffs.

Accidents, Occupational↗
PubMed1989

[Long-term results of mechanical valves in aortic position and biological valves in mitral and tricuspid positions].

The long-term results of patients undergoing aortic valve replacement (AVR) with a mechanical valve (AM), mitral valve replacement with a biological valve (MB), and tricuspid valve replacement (TVR) with a biological valve (TB) operated upon from 1977 to 1988 were retrospectively analysed. A total of 899 patients received 1117 valves (381 AM, 633 TB, 103 TB) with a follow-up 3778 patient-years and 4582 valve-years. A significant incidence of thromboembolism, hemorrhage, and endocarditis was not found among AVR, MVR, TVR, or multiple valve replacement. We found a significantly decreased incidence of survival rate in multiple valve replacement compared with AVR or MVR, and a significantly increased incidence of reoperation in MB compared with AM and TB. We use AM and TB in any adult patients as a first choice. However, we prefer a mechanical valve in the mitral position except in patients over 65 years old, who have a short life expectancy, in whom anticoagulation is thought to be difficult, and who desire a biological valve.

Adolescent↗
PubMed1989

[A case of traumatic tricuspid regurgitation].

Tricuspid regurgitation due to nonpenetrating trauma occurred in a 60-year-old male patient who had received chest trauma in a motorcycle accident. He was admitted because of shortness of breath and palpitation on exertion. On admission physical examinations revealed pulsated and dilated jugular veins, hepatomegaly, and systolic murmur. The chest X-ray film showed an enlarged heart and electrocardiograms revealed complete right bundle branch block. Echocardiography demonstrated systolic prolapse of the tricuspid anterior leaflet into the right atrium. Right atrial v wave pressure was 20 mmHg. Tricuspid valve replacement with a Carpentier-Edwards 33 mm using super interpose method was performed successfully 13 years after the trauma. At operation, it was found that the chordae tendineae of the anterior leaflet was ruptured.

Chordae Tendineae↗
PubMed1989

[A thoracic aortic aneurysm with respiratory failure caused by the mechanisms of stenosis of the left bronchus and ipsilateral pulmonary artery--report of a case and review of the literature].

Clinical symptoms of thoracic aortic aneurysm vary widely from symptoms resulting from its rupture to those due to compression of surrounding organs. Furthermore, the onset of symptoms is frequently followed by a fatal outcome unless emergency measures are taken. We have recently experienced a patient who developed respiratory insufficiency caused by an aneurysm of the descending thoracic aorta compressing the left primary bronchus and the right pulmonary artery, the former causing ventilatory failure in the left lung and the latter interfering with blood flow in the right lung. The patient underwent emergency prosthetic graft replacement and showed temporary symptom improvement. However, a postoperative complication of esophageal perforation due to ischemic necrosis occurred and eventually caused acute empyema followed by death. The patient was a 48-year-old male who presented with symptoms similar to bronchial asthma. Angiographic examination (iv-DSA) revealed compression of right pulmonary artery by an aneurysm of the descending thoracic aorta. Bronchoscopic findings included extramural stenosis of the left bronchus accompanied by arterial pulsation. As an emergency measure, artificial blood vessel replacement of the descending thoracic aorta was performed. However, the patient developed postoperative acute empyema and died on the 19th postoperative day. Autopsy revealed ischemic necrosis on the esophageal wall where the aneurysmal lesion had touched before operation. This seems to have formed a perforation into the left thoracic cavity and ultimately to have caused acute empyema. Since we believe that the pathogenesis and clinical course observed in this patient is rather rare, the case is reported in accompanied by relevant data from the literature.

Aorta, Thoracic↗
PubMed1989

[Usefulness and limitations of transesophageal echocardiography in anesthetic practice].

Transesophageal echocardiography (TEE) has been used as a monitor of cardiovascular function and as a diagnostic tool in anesthetic practice. TEE is the only available monitor to detect anatomical abnormalities such as of wall motion as well as valvular abnormalities. Doppler TEE has wider diagnostic functions. TEE is a very sensitive monitor to detect myocardial ischemia by recognizing wall motion abnormalities and loss of systolic wall thickening. Preload defined by left ventricular end-diastolic volume may not correlate with left ventricular end-diastolic pressure or pulmonary capillary wedge pressure (PCWP) when left ventricular compliance changes such as after coronary artery surgery. PCWP can be misleading when transmural pressure across cardiac chambers are undetermined such as in patients with cardiac tamponade or those on high positive end-expiratory pressure. In these situations, TEE is a powerful tool to link physiologic parameters and anatomy. TEE is also a very sensitive monitor to diagnose air embolism during cardiac surgery and neurosurgery in sitting position. There are, however, several shortcomings such as its cost, "too much sensitivity", requirement of some experience, interobserver variability, and so on. The computer-assisted on-line analysis would greatly augment usefulness of TEE. When these shortcomings are overcome, TEE would be one of the most important monitors in anesthetic practice.

Anesthesiology↗
PubMed1989

[Long-term results of the 19 mm low-profile bileaflet valve prosthesis in the small aortic anulus].

Between April, 1979, and November, 1986, 20 patients underwent aortic valve replacement (AVR) in the small aortic anulus with either 19 mm St. Jude Medical valve prosthesis or 19 mm Duro-Medics valve prosthesis, which are relatively new, low-profile bileaflet valve prostheses. There were two male and 18 female patients ranging from 35 to 69 years old (mean, 54.7 years). Average body surface area was 1.37 +/- 0.11 m2 (range 1.20 to 1.55 m2). One patient died of arrhythmia at 22 postoperative day. The 19 survivors have been followed up for as long as 61 months (mean, 31.2 months). There were two late complications, cerebral infarctions, and event free ratio was 0.85 at five years. All long-term survivors were in New York Heart Association Functional Class I (15 patients) and Class II (three patients). Preoperative and postoperative echocardiograms demonstrated significant decreases in mean left ventricular end-diastolic diameter (LVDd) (48.9 +/- 8.3 mm vs 42.2 +/- 5.7 mm; p less than 0.01) and in left ventricular end-systolic diameter (LVDs) (32.2 +/- 8.2 mm vs 25.7 +/- 4.9 mm; p less than 0.01). Mean left ventricular wall thickness was decreased to 24.5 +/- 3.7 mm from 25.8 +/- 6.4 mm. The average peak systolic gradient at rest with Doppler ultrasound was 26.0 +/- 9.3 mmHg (range nine to 36 mmHg). Though transprosthetic gradient did occur in patients who received 19 mm low-profile bileaflet valves in narrow aortic roots, progressive prosthetic stenosis was not observed and small aortic prostheses provide acceptable palliation for long-term results clinically.

Adult↗
PubMed1989

[Report of 108 patients with valvular heart disease who underwent re-operations through repeated median sternotomy incision].

108 patients who underwent redo median sternotomy between January 1975 and April 1988 were studied to determine factors affecting risk of cardiac reoperations. (1) Seventeen of 108 patients died, yielding an overall mortality of 15.7%. (2) Preoperative diagnosis had a significant correlation with mortality, which was higher with prosthetic valve endocarditis (50.0%) than with all other indications for reoperation. (3) Operative mortality was related to pre-reoperation functional class: 8.7% for New York Heart Association (NYHA) class II, 9.8% for class III and 27.8% for class IV. (4) Based on the degree of urgency, elective reoperation had a mortality of 5.4%, while emergency procedures carried a mortality of 61.5%. (5) Cardiac catheterization information was available in 53 patients. The pulmonary artery pressure was higher in the died group. There were no significant differences in pulmonary capillary wedge pressure and cardiac index between the survived and died. (6) Operation time, aortic cross clamp time and pump run were significantly longer in the died than in the survived group. The died had more blood loss during operative procedure. To decrease operative mortality, technical improvement and increased experience were necessary for surgeons. We prefer to free entirely pericardial adhesion to facilitate mobilization and evacuate air, and to make intra-cardiac procedure more easier and safety. Furthermore early reoperation before irreversible deterioration occurs was necessary since myocardial function was found to be a major determinant of surgical results.

Adult↗
PubMed1989

[Biological versus mechanical valves in the mitral position].

The long-term late results of isolated mitral valve replacement before April 1981 were retrospectively evaluated in 54 patients receiving a Hancock valve (HX) with a total follow-up of 424 patient-years (py) and 37 patients receiving a Björk-Shiley valve (BS) with a total follow-up of 366 py. There was no significant difference in regard to preoperative age, cardiothoracic ratio, electrocardiogram, or New York Heart Association functional class between the two groups. All of the BS group and 43 of the HX patients received long-term anticoagulant therapy. No significant difference was notable between the two groups in hospital mortality. Actuarial survival rate excluding hospital deaths was 75.5 +/- 6.7% for the HX group, and 80.8 +/- 7.1% for the BS group at ten years (not significant). There was no significant difference between the two groups in overall incidence of thromboembolism (HX 1.4% py, BS 1.9% py), anticoagulant related bleeding (HX 0.5% py, BS 0.8% py), or endocarditis (HX 0.5% py, BS 0.3% py). Actuarial freedom from reoperation at ten years was 69.6 +/- 8.1% for the HX group, and 93.5 +/- 4.4% for the BS group (p less than 0.01). Event free survival excluding hospital deaths at ten years was 49.2 +/- 8.1% for the HX group, 70.6 +/- 8.3% for the BS group (p less than 0.05). We prefer a mechanical prosthesis except in patients over 65 years old, who have a short life expectancy, in whom anticoagulation is thought to be difficult, and who hope a biological valve.

Adult↗
PubMed1989

[Clinical significance of aortic ring dilatation and changes in aortic root configuration in the pathogenesis of non-rheumatic aortic regurgitation].

This study was undertaken to determine the etiology of non-rheumatic aortic regurgitation (AR) by two-dimensional echocardiography. Dimensions of the aortic root at the levels of the surgical aortic ring (ARDs), sinus of Valsalva (AOD), and anatomical aortic ring (ARD) were measured in 23 patients who underwent aortic valve replacement due to AR with idiopathic aortic root dilatation, in 15 hypertensive patients without AR and in 15 normal controls. The 23 patients with AR were classified as annuloaortic ectasia (AAE) (seven cases) and non-AAE (16 cases) groups. In the AAE group, the ascending aorta and aortic root were markedly dilated and had a pear-like configuration on aortography while the aorta had a normal configuration in the non-AAE group. ARDs was significantly larger in the non-AAE and AAE groups than in the hypertension and normal control groups. AOD and ARD were significantly larger in the hypertension and non-AAE groups than in the normal controls, and those in the AAE group were greater than those in any other group. The end-diastolic shape of the aortic valve in the long-axis view was "Y" shaped in the normal control and hypertension groups, "T" shaped in the non-AAE group, and the patients with AAE showed no cuspal coaptation. AR due to aortic ring dilatation, mainly reported by pathologists, were due to marked degree of ARD dilatation. However, our two-dimensional echocardiographic study showed that moderate dilatation of the entire aortic root in the non-AAE group seemed to be an important factor in the genesis of AR, even without dilatation of ARD.

Adult↗