Biomedical subjects

S Ishimaru

Publications and source records attributed to S Ishimaru.

At least 37 records · Page 2Linked to original sources

PubMed2001

[Survival after oozing type cardiac rupture associated with subepicardial aneurysm evaluated by echocardiography: a case report].

A 64-year-old woman was admitted to our hospital with acute myocardial infarction. She underwent emergent percutaneous transluminal coronary angioplasty. Transthoracic echocardiography revealed mild pericardial effusion on the third day. Pericarditis or cardiac rupture were suspected, so transthoracic echocardiography was repeated serially. On the sixth day, transthoracic echocardiography showed increasing pericardial effusion and abrupt interruption of the apical myocardium of the left ventricle and intact epicardial imaging with systolic expansion. The diagnosis was oozing type cardiac rupture of a subepicardial aneurysm. Surgical treatment was successful and the accuracy of the echocardiographic diagnosis was established.

Angioplasty, Balloon, Coronary↗

PubMed2001

[Surgical treatment of coronary artery-pulmonary artery fistula with coronary aneurysm].

We experienced 4 cases of coronary artery-pulmonary artery fistula with coronary aneurysm, three patients had symptoms of chest pain, and 1 patient had cardiac murmur. Coronary arteriography showed that three patients had fistulas from the left coronary artery to the pulmonary artery; and that 1 patient had a fistula from both the right and left coronary arteries to the pulmonary artery. Moreover, 1 patient had 90% diameter stenosis of segment 7. The maximum diameter of the coronary aneurysm ranged from 12 to 20 mm (average: 15.3 mm). One patient underwent closure of the opening of the fistula, 2 patients underwent multiple ligatures of fistulas, and 1 patient underwent multiple ligatures of fistulas with coronary artery bypass grafting. The postoperative course of every patient was uneventful. There have been 42 reports on this abnormality in Japan. We should treat the fistula as early as possible to prevent cardiac complications such as myocardial ischemia and rupture of coronary aneurysm.

Adult↗

PubMed2000

Glycoprotein IIb/IIIa receptor inhibitor attenuates platelet aggregation induced by thromboxane A2 during in vitro nonpulsatile ventricular assist circulation.

A recent development in antithrombotic research allows the inhibition of platelet aggregation via protection of the glycoprotein IIb/IIIa receptor on the platelet membrane. We hypothesized that a GP IIb/IIIa receptor inhibitor would inhibit thromboxane-induced platelet aggregation during circulation in our in vitro ventricular assist device (VAD) circuit and preserve long-term platelet function. Twenty-one in vitro nonpulsatile centrifugal VAD circuits were simulated for 4 days using 450 ml of fresh human whole blood with or without glycoprotein IIb/IIIa receptor inhibitor (tirofiban). Platelet aggregation and degranulation were measured in whole blood induced by ristocetin, collagen, ADP, and thromboxane A2 (TXA2). The tirofiban-treated group preserved the platelet count and tended to exert these beneficial effects by inhibiting pathologic platelet aggregation induced by TXA2, collagen, and ADP as well as degranulation. Tirofiban may be useful in preserving platelet number and function during clinical VAD use.

Adenosine Diphosphate↗

PubMed2000

Effect of flow competition on internal thoracic artery graft: postoperative velocimetric and angiographic study.

OBJECTIVES: To assess the effects of competitive blood flow on internal thoracic artery grafts, we investigated postoperative flow velocity characteristics and angiographic findings of the grafts with various grades of native coronary artery stenosis. METHODS: Fifty patients who had an internal thoracic artery graft to the left anterior descending artery underwent intravascular Doppler graft velocimetry during postoperative angiography. Patients were divided into 3 groups according to the grade of native coronary stenosis: group H (28 patients), 80% stenosis or greater; group M (16 patients), 60% to 79% stenosis; and group L (6 patients), 40% to 59% stenosis. Phasic flow velocity of the grafts was measured with an intravascular Doppler ultrasound-tipped guide wire during angiography. Graft flow volume was calculated from the diameter and the average peak velocity. RESULTS: Average peak velocity (group H, 27.1 +/- 8.6 cm/s; group M, 16.9 +/- 3.9 cm/s; group L, 7.2 +/- 3.7 cm/s), distal graft diameter (group H, 2.27 +/- 0.23 mm; group M, 2. 00 +/- 0.28 mm; group L, 1.07 +/- 0.27 mm), and calculated graft flow volume (group H, 33.1 +/- 12.0 mL/min; group M, 16.2 +/- 5.8 mL/min; group L, 2.3 +/- 2.0 mL/min) significantly differed among the 3 groups. Graft flow in diastole and systole also differed among the 3 groups. CONCLUSIONS: Competitive blood flow reduces internal thoracic artery graft flow and diameter according to the grade of the native coronary artery stenosis. These data suggest that grafting the internal thoracic artery to the coronary artery with stenosis of a low grade can cause graft atrophy and failure.

Aged↗

PubMed2000

A case of pyoderma gangrenosum on the stump of an amputated right leg.

We present here a case of pyoderma gangrenosum (PG) on the stump of an amputated leg. The patient was a 69-year-old woman who had both of her legs amputated due to acute arterial occlusion. An ulcer first appeared nine years later, after which point it continued to fluctuate in size. Complications included regional blood flow disorder at the amputated stump, diabetes, and secondary infection. Despite various therapies, the ulcer exacerbated, and hypoproteinemia, increased CRP, and fever were confirmed. The patient was diagnosed as having PG based on her clinical symptoms and because the ulcer did not respond to various therapies. The ulcer improved significantly in response to administration of 40 mg/day of prednisolone, and complete epithelialization was later achieved. Given the presence of multiple complications, it was extremely difficult to confirm PG. Therefore, it is important for physicians to consider PG as one of the causes of intractable ulcers.

Aged↗

PubMed1999

CMS: an adapter molecule involved in cytoskeletal rearrangements.

Cas ligand with multiple Src homology (SH) 3 domains (CMS) is an ubiquitously expressed signal transduction molecule that interacts with the focal adhesion protein p130(Cas). CMS contains three SH3 in its NH2 terminus and proline-rich sequences in its center region. The latter sequences mediate the binding to the SH3 domains of p130(Cas), Src-family kinases, p85 subunit of phosphatidylinositol 3-kinase, and Grb2. The COOH-terminal region contains putative actin binding sites and a coiled-coil domain that mediates homodimerization of CMS. CMS is a cytoplasmic protein that colocalizes with F-actin and p130(Cas) to membrane ruffles and leading edges of cells. Ectopic expression of CMS in COS-7 cells resulted in alteration in arrangement of the actin cytoskeleton. We observed a diffuse distribution of actin in small dots and less actin fiber formation. Altogether, these features suggest that CMS functions as a scaffolding molecule with a specialized role in regulation of the actin cytoskeleton.

Adaptor Proteins, Signal Transducing↗

PubMed1999

Activation of the Drosophila C3G leads to cell fate changes and overproliferation during development, mediated by the RAS-MAPK pathway and RAP1.

The cellular signal transduction pathways by which C3G, a RAS family guanine nucleotide exchange factor, mediates v-crk transformation are not well understood. Here we report the identification of Drosophila C3G, which, like its human cognate, specifically binds to CRK but not DRK/GRB2 adaptor molecules. During Drosophila development, constitutive membrane binding of C3G, which also occurs during v-crk transformation, results in cell fate changes and overproliferation, mimicking overactivity of the RAS-MAPK pathway. The effects of C3G overactivity can be suppressed by reducing the gene dose of components of the RAS-MAPK pathway and of RAP1. These findings provide the first in vivo evidence that membrane localization of C3G can trigger activation of RAP1 and RAS resulting in the activation of MAPK, one of the hallmarks of v-crk transformation previously thought to be mediated through activation of SOS.

Amino Acid Sequence↗

PubMed1999

Successful surgical treatment of aortogastric fistula after an esophagectomy and subsequent endovascular graft placement: report of a case.

An aortogastric fistula is a rare but fatal complication after an esophagectomy and intrathoracic esophagogastric anastomosis. A 54-year-old man underwent an esophageal resection due to carcinoma in his lower esophagus. The alimentary tract continuity was restored by intrathoracic esophagogastric anastomosis. Forty-six days later, he suffered a massive hematemesis due to an aortogastric fistula which had formed at the esophagogastric suture line. The fistula was surgically obliterated twice, but each operation was followed by pseudoaneurysm formation. The patient was finally successfully treated with an endovascular stent graft placement. This is the first report of a patient surviving after developing this complication.

Anastomosis, Surgical↗

PubMed1999

Coronary revascularization with arterial conduits collateral to the lower limb.

A 62-year-old man with left main coronary artery disease had coronary artery bypass grafting. Angiography disclosed total occlusion of the left common iliac artery. The left internal thoracic artery and the left inferior epigastric artery were well developed as collateral pathways to the left external iliac artery. With concomitant femoro-femoral crossover bypass, these two large arterial conduits were harvested and grafted to the coronary artery.

Blood Vessel Prosthesis Implantation↗

PubMed1999

Endovascular stent graft repair of aortopulmonary fistula.

Two patients who had aortopulmonary fistula of postoperative origin with hemoptysis underwent successful repair by means of an endovascular stent graft procedure. One patient had undergone repeated thoracotomies two times, and the other one time to repair anastomotic aneurysms of the descending aorta after surgery for Takayasu's arteritis. A self-expanding stainless steel stent covered with a Dacron graft was inserted into the lesion through the external iliac or femoral artery. The patients recovered well, with no signs of infection or recurrent hemoptysis 8 months after the procedure. Endovascular stent grafting may be a therapeutic option for treating patients with aortopulmonary fistula.

Anastomosis, Surgical↗

PubMed1999

Neurenteric cyst of the craniocervical junction--case report.

A 60-year-old female presented with occipital headache and limitation of neck movement. Neurological examination showed weakness of the right sternocleidomastoid muscle. Magnetic resonance imaging revealed a cystic lesion at the craniocervical junction and posterior compression of the brain stem. The lesion was totally removed through the transcondylar approach. The histological diagnosis was neurenteric cyst. The transcondylar approach provides a direct operative view of the clivus and anterior craniovertebral junction.

Craniotomy↗

PubMed1999

[Current appraisal of endoscopic thoracic sympathectomy: results of the national questionnaire surgery].

A questionnaire survey was performed in order to investigate the current status of endoscopic thoracic sympathectomy in Japan. Four hundred and twenty-nine (429) university, national or public hospitals with a minimum of 400 beds were included. A total of 248 of these hospitals responded. Among them 63 (25%) performed this procedure. The total of the cases was 1116. The number of access port and the technique for defunctioning the sympathetic chain were broadly divided into three methods. These methods were equally carried out among the departments. The clinical results were judged as satisfactory in the great majority of patients and the frequency of complications was low. On the other hand, the overall incidence of compensatory sweating remained relatively high and accumulated as the number of cases increased. But the reported frequency differed strikingly from hospital probably for lack of an objective way of quantifying following sympathectomy. Although overall complications were infrequent, the need for conventional thoracotomy to stop bleeding occurred in some cases. Therefore even this simple endoscopic operation demands the utmost surgical care, skill and experience. A few recurrences of preoperative symptoms were seen in the follow-up suggesting that all patients must be continually monitored after the operation.

Endoscopy↗

PubMed1999

[Endovascular stent graft].

Endovascular stent grafting for aortic aneurysms using metallic stents covered with conventional vascular grafts has attracted attention as a catheter-based, minimally invasive alternative to open surgery. Since the first clinical experience with endovascular stent grafting for an abdominal aortic aneurysm was reported in 1991, experimental and clinical investigations have between undertaken world wide. Although several commercial bifurcated stent grafts for abdominal aortic aneurysms are currently available in Europe and Australia, none of the devices are approved for clinical use in Japan and the USA. Hand-made devices are still used in each institution particularly for thoracic aortic aneurysms. Endovascular stent grafting is feasible for aneurysm repair within limited conditions. However, several unsolved issues remain concerning not only delivery devices which require precise skill in stent-graft deployment, but also concerning patient selection and proper indications. Further investigation is necessary to clarify graft durability, aneurysmal neck enlargement, and the fate of the excluded aneurysm sac for long follow-up periods.

Aortic Aneurysm↗

PubMed1999

Surgical management of arteriosclerotic coronary artery aneurysm.

A 60-year-old man suffered antero-septal myocardial infarction at the age of 56. Coronary angiography demonstrated total occlusion of the left anterior descending artery and a large saccular aneurysm of the right coronary artery. Diffuse coronary ectasia was also shown in the right coronary artery adjacent to the aneurysm. Despite anticoagulant therapy, the aneurysm formed a thrombus and developed coronary artery stenosis distal to the aneurysm. Ligation of the aneurysm and in situ gastroepiploic artery grafting were performed. Sudden heart failure was developed during skin closure. As this condition was considered to be graft hypoperfusion, supplemental saphenous vein grafting was placed. Ligation is a simple, reliable technique to prevent future complications for a large saccular right coronary artery aneurysm, however, gastroepiploic artery might be an inappropriate bypass conduit for the ligated coronary artery with diffuse ectasia.

Arteries↗

PubMed1998

The gene encoding dipeptidyl aminopeptidase BI from Pseudomonas sp. WO24: cloning, sequencing and expression in Escherichia coli.

We have isolated the dipeptidyl aminopeptidase BI (DAP BI) gene from the plasmid library of Pseudomonas sp. WO24 chromosomal DNA by the enzymatic plate assay using a chromogenic substrate. The DAP BI gene, designated dap b1, was further subcloned and sequenced. Sequence analysis of an approx. 3-kb fragment revealed an open reading frame of 2169 nucleotides, which was assigned to the dap b1 gene by N-terminal and internal amino acid sequences. The predicted amino acid sequence of DAP BI containing a serine protease Gly-X-Ser-X-Gly consensus motif displays extensive homologies to the several proteases belonging to the prolyl oligopeptidase family, a novel serine protease family possessing the catalytic triad with a specific array of Ser, Asp and His in this order, which is the hallmark of the member of this family including DAP IV. The dap b1 gene was expressed in Escherichia coli and the expressed enzyme was purified about 230-fold with 2.6% recovery from the cell-free extracts. The enzymatic properties such as molecular mass, substrate specificity and effect of inhibitor were similar to the native enzyme from Pseudomonas sp. WO24.

Amino Acid Sequence↗

PubMed1998

[Clinical results of acute closing aortic dissection].

The therapeutic outcomes of 43 patients with acute closing aortic dissection treated during the past 10 years were evaluated. The patients consisted of 30 men and 13 women with a mean age of 65 +/- 9 years. Ten were classified as Stanford type A, and the remaining 33 as type B. During follow-up (6 to 120 months; average 55 months), recanalization and an enlarged ulcer-like projection (ULP) were observed in 5 and 2 type a patients. Although recanalization was not observed in type B patients, enlarged ULP was observed in 10 of them, in 6 of whom developed aneurysm. During the follow-up period, ULP was observed at 30 sites in 26 patients. Monitoring the change in ULP over time showed that the ascending and the proximal descending aorta frequently tended to be enlarged and progressed to aorta frequently tended to be enlarged and progressed to aneurysm. Surgery was performed in 3 patients with recanalization, 5 with enlarged ULP, and 3 with atheroscloerotic aortic aneurysm. Although one patient died of cerebral complications, the other 10 patients showed favorable postsurgical courses. Among 8 patients who died, the actuarial survival rate was favorable, being 96, 91 and 83% at 1, 3 and 5 years. However, the survival rate free from complications related to aortic dissection, defined as rupture, ercanalization, enlarged ULP and aneurysmal change, was 78, 58 and 54% at 1, 3 and 5 years, indicating that aortic dissection-related complications are likely to develop within 3 years. This being the case, conservative therapy may be selected for closing aortic dissection when there are no serious complications in the acute phase. However, closely following patients with diagnostic imaging techniques is essential as there may be complications such as recanalization or enlarged ULP. Such complications should be surgically treated because they may affect long-term prognosis.

Aged↗

PubMed1998

[Postoperative changes in the coagulation and fibrinolytic systems in endoluminal stent-graft treatment of thoracic aortic aneurysms].

We studied changes in blood coagulation and fibrinolytic system in 18 cases of thoracic aortic aneurysm and 5 cases of aortic dissection treated with stent grafts. The mean operation time was 259 +/- 67 minutes and the amount of blood loss during operation was 472 +/- 456 ml. Although blood transfusion of 220 +/- 360 ml was performed in 7 cases, 16 of 23 cases (70%) received no homologous blood transfusion. Consequently, the endoluminal stent graft treatment was minimally invasive compared with the conventional surgical procedure. On the 1st postoperative day, platelet counts and AT-III decreased and TAT increased. The promotion of blood coagulability was found in these patients on the 1st day after the operation. Changes in the fibrinolytic system were less marked than that in coagulation. These results suggest that the thrombosed aneurysm was excluded from systemic blood flow by the stent graft. There was no consumption coagulopathy in any case with aneurysm excluded by stent graft deployment. Stent-graft treatment for thoracic aortic aneurysm can be successfully performed without consumption coagulopathy when the aneurysm is completely excluded.

Aged↗

PubMed1998

[Clinical results of endovascular stent graft repair for fifty cases of thoracic aortic aneurysms].

Between February 1995 and December 1997, 50 cases (55 lesions) of thoracic aortic aneurysms including 20 cases of aortic dissections were treated with an endovascular technique using the stent grafts. All patients were treated in the operating room under general anesthesia and the stent grafts were implanted through 18 Fr. or 20 Fr. sheaths via femoral arteries under fluoroscopic guidance. The stent graft was composed of several units of self-expanding stainless-steel Z stents covered with an ultra-thin polyester fabric. Stent graft deployment was technically successful in 53 of 55 lesions (delivery success rate: 96.4%). Exclusion of the aneurysms and entry closing without endoleak were achieved within two weeks after the operation in 43 of 53 lesions (initial success rate: 81.1%). Endoleak was found in 10 lesions (minor endoleak: 8 and major endoleak: 2 lesions). Two patients died in the periopertive period of delivery failures as injury to external iliac artery and damage to the delivery sheath caused by tortuous and narrow access routes. Endovascular stent graft repair of thoracic aortic aneurysms is minimally invasive operation in comparison with conventional surgical graft replacement with extracorporeal circulation. These early results suggest that the stent graft repair is possibly safe and useful treatment for the patients of thoracic aortic aneurysms especially in high risk patients. However, careful long-term follow-up is necessary to prove the value and the effects of this endovascular treatment and improvement of the stent graft system and technical training of endovascular surgery for operators are required to reduce the delivery failure and to determine the stent graft repair is reliable treatment.

Adult↗