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S Kitamura

Publications and source records attributed to S Kitamura.

At least 703 records · Page 39Linked to original sources
PubMed1989

[A case of progressive muscular dystrophy with pulmonary hypertension].

A case of progressive muscular dystrophy of the limb girdle type is reported. The patient, a 37-year-old man, showed severe hypoxemia upon blood gas analysis, which had been predicted by pulmonary function tests, together with elevated pulmonary arterial pressure revealed by cardiac catheterization. He showed abnormal symptoms of respiration during the night, and so a sleep study was performed. The results revealed central type apnea not only during REM sleep but also frequently during NREM sleep. Acidosis and hypoxemia induced by sleep apnea caused vasoconstriction of the pulmonary artery and long-term repetition of this had caused pulmonary hypertension.

Adult↗
PubMed1989

[Effects of thromboxane A2 synthetase inhibitor, DP-1904 on the action of vasoactive substances in rabbit blood vessel smooth muscle preparations].

Thromboxane A2 (TxA2) is a potent platelet aggregator as well as a vascular and bronchial constrictor. DP-1904, a newly synthesized imidazol TxA2 synthetase inhibitor, is a potent and long-acting agent. The present investigation was conducted to explore the effect of DP-1904 on the contractile responses in rabbit pulmonary artery and descending aorta strips induced by various vasoactive substances. Fourteen Japanese albino rabbits, weighing about 3 kg, were sacrificed. Rabbit pulmonary artery and descending aorta were removed, cut spirally, set up in bioassay glass jackets and superfused with Krebs-Henseleit solution at 37 degrees C, saturated with oxygen and carbon dioxide. Contraction of tissues was detected by an isotonic transducer and displayed on a polyrecorder. Arachidonic acid-induced contractile responses in rabbit pulmonary artery and descending aorta strips were attenuated significantly by the continuous infusion of DP-1904 in a dose-dependent fashion. Prostaglandin F2 alpha-induced contractile responses in rabbit pulmonary artery and descending aorta strips were attenuated significantly by the continuous infusion of DP-1904, dose-dependently. Angiotensin II-induced contractile responses in rabbit pulmonary artery and descending aorta strips were attenuated significantly by the continuous infusion of DP-1904, dose-dependently. Norepinephrine-induced contractile responses in rabbit pulmonary artery and descending aorta strips were attenuated significantly by the continuous infusion of DP-1904, dose-dependently. The above results suggest that DP-1904 might be a useful therapeutic agent for treatment of pulmonary hypertension in patients with chronic obstructive lung diseases.

Animals↗
PubMed1989

[A case of the bare lymphocyte syndrome with clinical manifestations of diffuse panbronchiolitis].

Touraine et al reported some cases lacking HLA-class I antigens on the cell surface of their lymphocytes as "Bare lymphocyte syndrome" (BLS). Recently we experienced a case of BLS the clinical features of which are very similar to those of diffuse panbronchiolitis (DPB). Namely, she had chronic pansinusitis, diffuse nodular shadows on her chest X-ray film, obstructive impairment of pulmonary function tests and continuous increase of cold hemagglutinin titer. The pathogenesis of DPB is not confirmed. However, this case and other cases with sino-bronchial syndrome suggest that patients with DPB may have some immunodeficiencies. In addition the immunosuppressive action of erythromycin and its effectiveness on DPB were interesting. From these points of view, we discussed the relationship between this case and DPB, and the pathogenesis of DPB.

Adult↗
PubMed1989

[Surgical treatment of the prosthetic valves in reoperation].

Surgical treatment and problems in patients required reoperation for malfunctioning prosthetic valves are reviewed in our institute. The cinefluoroscopy and pulse doppler echocardiography were helpful for diagnosis of artificial valve dysfunction. In recent two decades valve replacement were performed in 382 cases and number of re-implanted valve were 469. Among them the cases of reoperation were 21 and reimplanted valves were 25 (5.6%); 4.7% in aortic, 5.0% in mitral, 6.7% in tricuspid position. Three cases of those patients had three operations. Main causes of reoperation were primary tissue failure in Carpentier-Edwards porcine xenograft (6 cases, 23%) and cloth wear in Starr-Edwards ball valve (9 cases, 38%) and thrombosis in St. Jude Medical bi-leaflet valve (3 cases, 15%). In most cases St. Jude Medical valve were chosen for the alternative prosthetic valve in reoperation. We applied IABP support to seven patients for severe low cardiac output syndrome after the operation and overall mortality was 24% in reoperation. It concluded that St. Jude Medical valve may be most reliable because of low incidence of postoperative complication in our institute.

Adult↗
PubMed1989

[The lung as a metabolic organ].

The fundamental importance of the lung in providing oxygen and eliminating carbon dioxide is well known. However the lung has another critical role as the site of numerous and important metabolic events. Some of these metabolic activities are essential to the normal performance of pulmonary gas exchange. Impairment of pulmonary metabolic activities can, therefore, have far-reaching repercussions on many organ systems. Special features of pulmonary vascular beds which are helpful for the metabolism of various vasoactive substances through pulmonary circulation are described. The lung can uptake or metabolize various vasoactive substances including acetylcholine, serotonin, bradykinin, prostaglandin E2 (PGE2), PGF2 alpha, leukotriene C4 (LTC4), LTD4 and LTE4. On the other hand the lung can synthetize and release various vasoactive substances including histamine, serotonin, LTC4, LTD4, LTE4, thromboxane A4 (TXA4), PGD2, PGE2, PGF2 alpha, PGI2, LTB4, and PAF (platelet activating factor). We also investigated the metabolism of LTC4 and LTD4 through isolated perfused guinea pig lung lobes. And it is clarified that the infused LTC4 was converted to LTD4 and LTE4, while the infused LTD4 was converted to LTE4. Seventeen years ago, we demonstrated the release of prostaglandins from the lung during mechanical ventilation at large tidal volumes in anesthetized mongrel dogs. We thought this PG is PGE2 which dilates pulmonary vasculatures. In the present study we investigated the release of PG from healthy volunteers by spontaneous hyperventilation. We demonstrated that serum levels of 6-keto PGF1 alpha and PGE2 showed a marked increase following the spontaneous hyperventilation. Various humoral factors related to the pulmonary vascular responses and various humoral factors which related to the tracheobronchial responses were also presented.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcholine↗
PubMed1989

[CT findings of cases of pulmonary alveolar proteinosis].

The CT findings of pulmonary alveolar proteinosis were studied. The subjects consisted of five cases; 4 men and 1 woman with an average age of 47.4 years old. The total of 19 CT views were analyzed with a mean follow-up duration of 5.7 +/- 1.2 years. The interval from the estimated onset to the first CT examination day was considered to be 6.0 +/- 3.1 years. The purposes of this report were; 1) Whether one could obtain useful information for the diagnosis by initial CT? 2) What were the changes of imaging with the passage of time on CT? 3) How one could predict the prognosis of the patients by CT? From the results of initial CT, pulmonary alveolar proteinosis showed diffuse, non-segmental densities with a mixture of various degrees of consistency, with peripheral clear zone which could be detected under posterior and lateral chest wall and/or interlobar area, and occasional air bronchograms. Irregular shaped patchy densities attached to the anterior chest wall were detected in 4 cases. These densities made the anterior pleural line irregular. In two cases, densities which were thought to represent the deposition of protein-like material in alveolar spaces decreased in the clinical course. Interstitial changes of the lung field were thought to cause the loss of lung volume, dilatation of bronchi and bronchioles, resulting in cystic changes and respiratory difficulty increased. In another case, the densities spontaneously disappeared during a period of one year.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Effects of nicotine and cigarette smoke extracts on plasma level of complement C3a and C5a, thromboxane B2 and 6-keto PGF1 alpha in rabbits].

In the present investigation we measured plasma levels of complement C3a and C5a, thromboxane B2 (TxB2) and 6-keto PGF1 alpha in anesthetized rabbits by radioimmunoassay after the intravenous injection of nicotine and cigarette smoke extracts. Plasma levels of complement C3a in rabbits showed a significant increased and reached a maximum value 60 minutes after the intravenous injection of nicotine and cigarette smoke extract. Plasma levels of complement C5a in rabbits showed a significant increase and reached a maximum value 30 minutes after the intravenous injection of nicotine. Plasma levels of complement C5a in rabbits showed a significant increase and reached a maximum value 60 minutes after the intravenous injection of cigarette smoke extract. Plasma levels of TxB2 in rabbits showed a significant increase after the intravenous injection of nicotine and cigarette smoke extract. Plasma levels of 6-keto PGF1 alpha in rabbits did not show any change after the intravenous injection of nicotine and cigarette smoke extracts. The above results may suggest that the intravenous injection of nicotine and cigarette smoke extracts induces an increase of plasma levels of complement C3a and C5a and TxB2 in anesthetized rabbits.

6-Ketoprostaglandin F1 alpha↗
PubMed1989

[A right common iliac aneurysm perforating into the inferior vena cava with resultant congestive heart failure].

A 69 year-old male with a right common iliac aneurysm perforating into the inferior vena cava was admitted with severe cardiomegaly and dyspnea. He had been suffering from recurrent congestive heart failure for the last 8 years prior to surgery. At operation, the fistula of 15mm diameter was closed with interrupted sutures of 3-0 nylon with pledgets within the aneurysm by controlling bleeding from the fistula by digital compression. The right common iliac aneurysm was resected and replaced with a double velour knitted dacron graft of 10mm diameter. The postoperative course was uneventful. The CTR was reduced to 57% from 70%, and the cardiac index was normalized from 6.10 to 3.39 l/min/m2. This complication is rare with only 4 previous reports in Japan. Hemodynamic improvements were dramatic after surgery in spite of poor response to medical treatments. This complication should be surgically managed as soon as the diagnosis is confirmed.

Aged↗
PubMed1989

[Surgical treatment of postinfarction ventricular septal perforation--the difference between a cardiogenic shock group and a congestive heart failure group].

Twelve patients with postinfarction ventricular septal perforation (VSP) were divided into 2 groups based upon the preoperative status and the time interval between the operation and the occurrence of VSP after acute myocardial infarction (AMI). Group I were in cardiogenic shock unresponsive to either pharmacologic supports or IABP, and needed an emergency repair of VSP. The other group (group II) were in congestive heart failure responding to some extent to pharmacologic supports and IABP, and VSP of this group was repaired on the elective or semiemergency basis. Group I comprised of 7 patients, 5 males and 2 females, with a mean age of 65.9 +/- 12.6 years, and group II included 5 patients, 2 males and 3 females with an averaged age of 72.6 +/- 3.4 years. The mean time duration between AMI and the operation, and between the occurrence of VSP and the operation were 3.1 and 1.6 days in group I and 13.4 and 8.0 days in group II. The operative mortalities were 57% in group I and 0% in group II, a remarkable difference. The reasons why group I had a poor prognosis were analysed and were found as follows: (1) group I sustained a larger AMI of anteroseptal area together with the lateral and/or inferior infarctions more often than group II. (2) Group I had frequently multiple organ failure (MOF) even prior to operation due to cardiogenic shock. (3) Group I had severer right ventricular failure than group II, in which the right atrial pressure was markedly elevated. In group I, the right heart failure remained and was prolonged even after surgery reflected by the RAP/LAP ratio over 1 and finally resulting in MOF. To improve surgical results in group I, the operation should be undertaken on the emergency basis before MOF is completed, and patch reconstruction of the left ventricular free wall is recommended in patients with a wide AMI and a high positioned anterior septal perforation. When RV failure is dominant, not only a LV assist device but also a RV assist device may also improve the results.

Aged↗
PubMed1989

[Changes in serum pancreatic secretory trypsin inhibitor (PSTI) during and after heart surgery].

Serum pancreatic secretory trypsin inhibitor (PSTI) is considered to be one of the acute phase reactants which increase after tissue injuries like surgery or major trauma. 25 patients were studied to investigate the changes in serum PSTI during and after heart surgery. 18 patients underwent the operation with the aid of cardiopulmonary bypass (CPB)-CPB group, and the other 7 patients, all pediatric cases, were treated under simple deep hypothermia by surface cooling without CPB-simple hypothermia group. Serum amylase, serum C reactive protein (CRP), cardiac index and A-aDO2 after surgery were examined, and the duration of CPB or circulatory arrest were recorded. The correlation between serum level of PSTI after surgery and these parameters were also studied. During surgery, a transient elevation of serum PSTI was noticed in the period of CPB, but no significant change of serum PSTI was seen under simple deep hypothermia and circulatory arrest. On the first post operative day, a slight but significant increase of serum PSTI was seen in CPB group, on the other hand no significant increase was seen in simple hypothermia group. Postoperative increase of serum PSTI was correlated to circulatory arrest time in simple hypothermia group, and was inversely correlated to cardiac index determined immediately after the operation in CPB group. No correlation was seen between serum level of PSTI after surgery and serum amylase, CRP, A-aDO2 or duration of CPB. The magnitude of increase of serum PSTI after heart surgery was small, and did not seem to be well correlated to the extent of surgical insults.

Adult↗
PubMed1989

[A case of necrotizing sarcoid granulomatosis diagnosed by open lung biopsy].

A 32-year-old female complained of productive cough and bloody sputum. Infiltrative shadows and cavitary lesions with thick and irregular wall in the bilateral lung fields and the swelling of mediastinal lymph nodes were pointed out on the chest radiography. Physical examination revealed no abnormal findings. ESR and the level of the serum angiotensin converting enzyme were slightly elevated. In the BAL (broncho-alveolar lavage) fluid, lymphocytes and neutrophils increased, and the OKT4/OKT8 ratio of the lymphocytes was 0.81. Open lung biopsy revealed numerous sarcoid granulomas with granulomatous vasculitis in the cavity wall, surrounding infiltrative lesions and hilar lymph nodes. After the administration of prednisolone, the infiltrative shadows and the cavitary lesions showed marked improvement. It was concluded that open lung biopsy is necessary for the diagnosis of NSG because the differential diagnosis between NSG and limited form of Wegener's granulomatosis is extremely difficult from such a small lung specimen as that obtained by trans-bronchial lung biopsy.

Adult↗
PubMed1989

[Clinical experiences with a new membrane oxygenator with low priming volume (D702 MASTER FLO 51), studies during pulsatile and constant flow perfusion].

The newly developed oxygenator "D702" is a compact hollow fiber membrane oxygenator with a priming volume of 170 ml. The maximum flow allowance is 4 liters per/minute. We used this oxygenator in 16 patients (11 infants and children, and 5 adults) undergoing various open heart surgery, and function of this oxygenator was studied. Pulsatile cardiopulmonary bypass was performed in 8 patients and nonpulsatile constant flow perfusion was employed in the remaining 8 patients. Our clinical experience showed excellent maintenance of PaO2 and PaCO2 during both pulsatile and constant flow bypasses. A low pressure drop was encountered across the membrane oxygenator, and therefore, this oxygenator is applicable for pulsatile cardiopulmonary bypass. The D702 is a very useful and applicable for a wide range of patients from infants to adults with a small body structure.

Adolescent↗
PubMed1989

[Successful recovery and long-term survival following postcardiotomy (mitral valve replacement) cardiogenic shock by means of a left ventricular assist device].

A 48-year-old woman who had had mitral regurgitation associated with hypertension and left ventricular hypertrophy underwent mitral valve replacement with a 29 mm xenograft. Following the uneventful procedure, she could not come off cardiopulmonary bypass for 6 times even with an aid of IABP and with re-replacement of the mitral valve using a 29 mm Duromedics prosthesis because of the fear of xenograft malfunction. A left ventricular assist device (LVAD) was then utilized with a resultant dramatic recovery from profound postcardiotomy cardiogenic shock, and cardiopulmonary bypass was successfully terminated. Postoperatively, her hemodynamics were maintained with a LVAD and IABP. Heparin was used to keep the prosthesis from blood clotting by monitoring the ACT. The heart recovered gradually from intraoperative myocardial damage and the LVAD was successfully removed at the 5th postoperative day. Postoperative cardiac catheterization studies showed decreases in left ventricular wall motion and ejection fraction, although improvements of pulmonary hypertension and left ventricular end-diastolic pressure at rest were observed. At present, 1 year and 9 months after the use of LVAD, she is leading nearly normal life of NYHA grade 1. Because of the excellent present clinical condition of this patient, the benefit of a LVAD in perioperative cardiogenic shock is stressed.

Female↗
PubMed1989

[CT findings of hypersensitivity pneumonitis].

CT findings of 22 cases of hypersensitivity pneumonitis (HP) were evaluated on 1 cm slices. All cases were diagnosed by transbronchial lung biopsy and clinical information. The study population included 8 men and 14 women with a mean age of 43 years. The causative antigens were considered to be so-called summer type in 17 cases, air humidifier in 1, pigeon in 1 and paint spray (isocyanate was suspected) in 3. CT examination were performed at a mean of 1.5 weeks after admission. In conclusion, characteristic CT findings of HP include combination of small nodular shadows and slight elevation of lung density. The size of nodular shadows was usually within 1 cm diameter, and their distribution was considered to be a centrilobular pattern, representing alveolitis and granuloma formation in a secondary lobule. It was though that the slight elevation of lung density developed when the disease extended all over the secondary lobule and the nodules developed when the disease was limited to the centrilobular lesion. In most cases, significant changes in proximal bronchi and pulmonary vasculatures could not be detected. The presence of segmental or lobar distribution of the shadows was also suggested. In addition to the typical findings, various other findings were also revealed; irregular shaped dense shadows, subpleural curvilinear shadow and honeycombing formation, especially in chronic cases. These findings have caused some difficulty in distinguishing HP from other interstitial diseases. More precise information can probably be obtained by thin slice CT than by 1 cm slice thicknesses, nevertheless, the standard method of CT should yield a useful diagnostic imaging.

Adult↗
PubMed1989

[Vasoactive intestinal peptide (VIP) protects against acid-induced acute lung injury in isolated perfused rat lungs].

Acute, diffuse lung injury, the principal lesion in ARDS, is often refractory to treatment. Recently, pretreatment with several pulmonary vasodilators that increase cAMP levels: isoproterenol, terbutaline, theophylline, and prostacyclin, was found to reduce the severity of lung injury in animal models. We have investigated the possible modulation of HCl-induced pulmonary edema in rats by VIP, a lung neuropeptide with potent vasodilator and cAMP-producing properties. The lungs of rats were perfused in situ at 10 ml/min with Krebs-4% albumin solution, and ventilated at constant tidal volume (6.5 ml/kg). Peak airway pressure (PAW), mean pulmonary arterial pressure (PPA) were measured throughout the experiment, and wet to dry lung weight ratio (W/D), afterwards. All animals were observed for one hour. In 6 rats receiving HCl only, 0.2 N-HCl was instilled intratracheally at 2 ml/kg. Four rats received 2 ml/kg of physiological saline intratracheally as control. In 6 other animals, VIP was infused into the pulmonary artery at 1 micrograms/kg/min, beginning 10 minutes before HCl and for the rest of the experiment. Another 6 rats were pretreated with atrial natriuretic peptide (ANP, atriopeptin II) just like the VIP group. Lungs of saline control animals showed little or no chage in PAW or PPA. With HCl alone, PAW increased immediately and continued to rise for the rest of the hour, reaching 500% of basal value at 30 minutes. PPA increased by 68% and W/D by 74% compared to saline-instilled lungs. In the VIP + HCl group, all abnormalities were significantly reduced relative to the HCl group. The rise in PAW was attenuated by 79% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

[The results of surgical treatment of post-infarction left ventricular aneurysms].

The surgical results of post-infarction left ventricular aneurysmectomy have been evaluated in 24 patients approximately 1 year after operation. In 20 patients coronary artery bypass grafting (CABG) was also carried out. In 8 patients mechanical circulatory assist such as intra-aortic balloon pump (IABP) or left ventricular assist device (LVAD) was undertaken for the purpose of weaning from cardiopulmonary bypass. Postoperative left ventricular function, such as ejection fraction and cardiac index, and classification of the New York Heart Association were improved significantly after aneurysmectomy. However, postoperative improvement of these parameters was not remarkable in cases of poor preoperative left ventricular function. Preoperative left ventricular function revealed to be poor in multiple vessel disease, and concomitant coronary artery bypass grafting with aneurysmectomy can be performed with good long-term results and significant improvements of postoperative cardiac function. In patients that had showed the end-diastolic perimeter more than 40% and the shortening rate of transverse axis at the left ventricular base less than 20%, postoperative improvement of cardiac function revealed unsatisfactory. Mechanical circulatory assist showed lifesaving effect, but in cases that required IABP or LVAD postoperative cardiac function has not improved significantly.

Adult↗