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Biomedical subjects

S Komatsu

Publications and source records attributed to S Komatsu.

At least 145 records · Page 8Linked to original sources
PubMed1994

[A successful surgical treatment for type IA cor triatriatum with an unroofed coronary sinus].

The combination of type IA cor triatriatum (Lucas-Schmidt's classification) and unroofed coronary sinus is very rare in congenital heart diseases. We have presented the first successful surgical treatment for an infant who had this combination. The patient was 10-month-old infant who admitted with cardiac murmur and short stature. Echocardiography revealed that an abnormal septum in the left atrium and dilated coronary sinus. Under cardiopulmonary bypass she underwent surgical treatment which consisted of a resection of the intra-left-atrial diaphragma, closure of ASD with an equine pericardial patch. During operation, unroofed coronary sinus (partially unroofed terminal portion of the coronary sinus) was revealed. Her postoperative course was uneventful.

Cor Triatriatum↗
PubMed1994

[A successful case of PA debanding after percutaneous transluminal angioplasty for restenosis of coarctation complex].

A 11-year-old boy, who had undergone the initial surgical repair for Coarctation complex at 6 months of age was readmitted to our hospital for radical correction. The initial repair at 6 months of age was patch angioplasty of coarctation, PDA division and PA banding. When he was 5 years old, a cardiac catheterization revealed spontaneous closure of VSD, restenosis of coarctation and RV outflow tract stenosis due to PA banding. This time he was treated with 2 steps of procedures. The first step was percutaneous transluminal angioplasty for restenosis of coarctation. Then RV outflow tract repair was performed at the second step. Postoperative course was uneventful.

Angioplasty, Balloon↗
PubMed1994

[Reoperation after corrective surgery for tetralogy of Fallot].

Thirty-two of 460 patients (6.9%) who had corrective surgery for tetralogy of Fallot in our institute between January, 1955 and March, 1994 required intracardiac reoperation. The indications for reoperation included residual lesions alone or combination of other lesions. The reoperation consisted of a new patch or direct closure of a residual ventricular septal defect in 28 (73%), reconstruction of a residual pulmonary stenosis in 18 (47%) and pulmonary regurgitation in 6 (16%), repair of tricuspid regurgitation in 11 (29%), recurrent infective endocarditis in 5 (13%), repair of a left ventricle-right atrium communication in 4 (11%). Six patients (19%) had required second reoperation of recurrent infective endocarditis in 3, other three patients required the repair of tricuspid valve disease. There were one operative death (3%) in reoperation and one death (17%) in second reoperation. Three patients (9%) died at follow-up periods of 1-21 years (mean of 9.6 years). Twenty-seven patients (84%) survived operation and 24 (89%) are now in NYHA class I and 3 patients are in class II. Reoperation after correction of tetralogy of Fallot is able to perform with low mortality and with excellent long-term results.

Adolescent↗
PubMed1994

[Results of reoperation for prosthetic dysfunction in the mitral position].

We analyzed surgical results of 91 patients who underwent re-mitral valve replacement (reMVR) for valve morbidity between January 1981 and March 1994 in an attempt to draw some therapeutic guidelines. The study population consisted of 38 men and 53 women, ages 32-73 (mean 52 +/- 10) years. The causes of valve morbidity were structural deterioration in 71 patients, nonstructural dysfunction manifested by paravalvular leakage in 5 valve thrombosis in 7 and prosthetic valve endocarditis in 8. Twelve of ninety-one patients (13.2%) died postoperatively in the hospital. All the patients were divided into the survivors (n = 12) and the nonsurvivors (n = 79). Mean right atrial pressure, extracorporeal circulation time, concomitant coronary artery bypass grafting, and application of intra-aortic balloon pumping were significantly different between the groups. Twenty preoperative and intraoperative variables were analyzed by means of univariate and multivariate analysis. By univariate analysis, male gender, NYHA IV, history of congestive heart failure, renal insufficiency and prosthetic valve stenosis were related to a higher incidence of hospital death. Multivariate analysis revealed that male gender and NYHA IV were risk factors in reMVR, and indicated no differences in intraoperative parameters between survivors and deaths. It is recommended to examine patients with bioprostheses thoroughly and to perform early elective reMVR before a patient develops NYHA IV.

Adult↗
PubMed1994

[A case of pulmonary hypertensive crisis (PHC) treated with prostaglandin E1 and tolazolin after surgery of ventricular septal defect in an adult].

A 32-year-old woman was diagnosed with ventricular septal defect (VSD) with severe pulmonary hypertension (PH). Though Pp/Ps was 0.98, an operation was carried out because the index of pulmonary vascular disease (IPVD) was 1.73. Pp/Ps on the operation day was 0.51 and extubation was carried out on the next day. Five days after the operation, she suffered shock, convulsions and loss of consciousness, but these were relieved by endotracheal intubation. On the 7th day, because Pp/Ps was 0.97, we confirmed the diagnosis of PHC. PHC was treated by intravenous continuous infusion of a high dose of PGE1 (220 ng/kg/min) and tolazolin (Tz) (7-18 micrograms/kg/min) in combination with norepinephrine (0.07 microgram/kg/min) via a catheter in the descending aorta. Pp/Ps soon decreased and was 0.60 at 15 hours after administration of PGE1 and Tz. To prevent recurrent PHC, she was administered with PGE1 (20-60 ng/kg/min) intravenously for 3 weeks after improvement of PHC. As side effects of PGE1, she showed swelling and arthralgia of the hands and feet after 2 weeks. Those side effects improved after discontinuing of administration of PGE1.

Adult↗
PubMed1994

[Comparative study of type of prosthesis on late results after double valve replacement].

This study was performed to clear the influence of combination of prostheses on late results by comparing our patients. The patients were divided into two groups. Group I patients received a mechanical valve in the aortic position and a bioprosthesis in the mitral position (n = 25): and group II, dual mechanical valves (n = 89). The duration of follow-up ranged from 0.2 to 13.5 years, with a total of 466 patient-years. There was no difference between the two groups in terms of actuarial survival or incidence of reoperations, thromboemboli, or nonstructural dysfunction. Group I, however, had a significantly greater incidence of structural valve deterioration, anticoagulant-related hemorrhage, and all valve-related morbidity and mortality when compared with group II. In conclusion, 1. combining a mechanical valve and a bioprosthesis is disadvantageous: 2. dual mechanical valves have excellent long-term results.

Aortic Valve↗
PubMed1994

[Mediastinal lymph node dissection in left lung cancer].

It is usually impossible to perform a complete systemic mediastinal lymph node dissection in left-side pulmonary carcinomas because the aortic arch gets in the way. The purpose of this study was to determine if incomplete lymph node dissection influences late mortality. We retrospectively analyzed 222 patients who had complete resection of non-small-cell lung cancer, 141 on the right lung and 81 on the left lung. There were 155 men and 67 women. They ranged in age from 35 to 78 years. 146 patients were in Stage I, 41, in the Stage II and 35, in the Stage III A, except for T3 diseases. The 5-year survival rates of left lung cancer were 82% and 35% in the Stage I group and the Stage II group, respectively. There was no difference when compared with the corresponding groups with right lung cancers. The 3-year survival, however, was 0% in the Stage III A group with left lung cancer excluding T3 diseases; this was significantly lower than that of right lung cancer (p < 0.01). The results recommend extended mediastinal lymph node dissection on the left-side squamous cell carcinoma to improve the survival of patients with left-side N2 diseases, when the tracheobronchial lymph nodes are involved.

Adult↗
PubMed1994

[Symbas's operation in a case of congenital fistula of the right coronary artery to left ventricle].

Congenital fistula between a coronary artery and the left cardiac ventricle are extremely rare. Since Blakeway (1918) first described this type of anomaly, only 72 cases have been reported up to the present, within our knowledge. A surgical correction of congenital fistula of the right coronary artery to left ventricle in a 36 year-old woman who suffered from easy fatigability is reported. This lesion was deduced after echocardiography identified a dilated right coronary artery and fluttering of the posterior cusp of the mitral valve throughout the diastole, the diagnosis was confirmed by retrograde aortography and coronary angiography. The fistula was closed by Symbas's operation under cardiopulmonary bypass with cardiac arrest and mild hypothermia. Postoperative recovery was uneventful. Coronary angiography one month after the operation revealed that the right coronary artery was still dilated with thrombus; there were no signs of myocardial ischemia or infarction. This diagnosis and successful treatment were based on careful study of the documentation of the 72 previously reported cases.

Adult↗
PubMed1994

[A successful case report of redo composite graft and total aortic arch replacement for active prosthetic graft endocarditis].

A successful redo composite graft and total aortic arch replacement for active prosthetic graft endocarditis is reported in the 31-year-old female with Marfan syndrome who had undergone Bentall procedure and proximal aortic arch replacement for type A acute aortic dissection 21 months previously. Echocardiography revealed massive vegetation in the composite graft and left ventricular outflow tract, and blood culture suggested Candida endocarditis. The composite graft and arch grafts were completely removed, and the reconstruction was carried out with a new composite graft using Piehler's technique. Finally, the total aortic arch was replaced and the all branches were reconstructed. The post-operative course has been uneventful, and she is now doing well 12 months after the operation without any evidence of recurrence of endocarditis.

Adult↗
PubMed1994

[Clinical study on re-surgery of the combined valvular disease: simultaneous double valve replacement].

Between June, 1984 and December, 1993, 36 patients who underwent simultaneous double valve replacement for re-surgery of combined valvular disease were analyzed in this study. The indications for re-surgery were malfunction of mechanical valve in the aortic position, primary tissue failure of biological valve in the mitral position, deterioration of valvular disease and prosthetic valve endocarditis. Re-surgery was performed ranging from 4 to 15 years, with a mean period of 9.5 years, following initial operation. Early operative mortality was 5.5% (2 cases) and late mortality 8.3% (3 cases). There were no cardiac deaths during the late postoperative period. Despite of technical difficulty due to dissection of the adhesion around the heart and re-replacement of prosthetic valve, the operative mortality and morbidity were relatively low because of the improved operative technique and myocardial protection.

Adult↗
PubMed1993

Microsequence analysis of the N-terminally blocked proteins immobilized on polyvinylidene difluoride membrane by western blotting.

A technique has been developed for efficient deblocking and subsequent microsequencing of N-terminally blocked proteins immobilized on a polyvinylidene difluoride (PVDF) membrane at the picomole levels. In this technique, proteins were first separated by polyacrylamide gel electrophoresis and then transferred onto a PVDF membrane by Western blotting. The electroblotted proteins with N-terminal acetylserine or acetylthreonine could be deblocked on-membrane by treatment with trifluoroacetic acid vapor and sequenced by a gas-phase protein sequencer. Similarly, N-formylated proteins could be deblocked on-membrane in HC1 solution and then directly sequenced from the N-terminal amino acid. Proteins with N-terminal pyroglutamic acid were enzymatically deblocked by in situ pyroglutamyl peptidase digestion, and N-acetylated proteins were also enzymatically deblocked with acylamino acid-releasing enzyme (AARE) after on-membrane digestion with trypsin to generate the N-terminal peptide fragment. This tryptic digestion was required since AARE can remove the acetylamino acid only from a short peptide. Based on these four deblocking methods, we present a strategy for sequential deblocking and subsequent N-terminal sequence analysis of N-blocked protein immobilized on PVDF membrane.

Acetylation↗
PubMed1993

Helicobacter pylori infection and chronic atrophic gastritis among Japanese blood donors: a cross-sectional study.

To evaluate an association between Helicobacter pylori (H. pylori) infection and chronic atrophic gastritis (CAG), an established precursor of gastric cancer, we performed a cross-sectional study using IgG antibody against H. pylori and pepsinogens of blood donors in four prefectures in Japan. Although a geographic correlation between the age-adjusted prevalence rates for H. pylori infection and those for CAG was not seen, the age-adjusted odds ratios (OR) of H. pylori infection for CAG were high in each area (around five for men and from four to 12.6 for women). The association between them weakened with advancing age; the ORs in the youngest age group (16-29 yrs) and in the oldest age group (50-64 yrs) were 12.5 and 2.8 for men, and 11.5 and 5.2 for women, respectively. These findings suggest that H. pylori infection is strongly associated with CAG, while there are some other factors interacting in the development of CAG. A prospective cohort study in which CAG and H. pylori infection are taken into account will be necessary to assess the risks of gastric cancer.

Adolescent↗
PubMed1993

Left ventricular pseudoaneurysm and intracardiac fistulas after replacement of mitral valve prosthesis.

Operation was performed on a 61-year-old woman with left ventricular pseudoaneurysm, left ventricular-right atrial fistula, and left ventricular-coronary sinus fistula after mitral valve replacement. The diagnostic and therapeutic approaches to these complications are described briefly, and the literature on intracardiac fistula after mitral valve replacement is reviewed.

Cardiomyopathies↗
PubMed1993

Surgical treatment of active infective endocarditis--early and late results of active native and prosthetic valve endocarditis.

The purpose of this study was to determine the clinical predictors of active infective endocarditis in 45 cases we treated between January 1971 and August 1991 (30 native valve endocarditis (NVE) and 15 prosthetic valve endocarditis (PVE). The indication of surgery in 45 patients was progressive congestive heart failure (CHF), septicemia and systemic embolization. The aortic valve was involved in 24 (53%) of 45 patients (13 of 30 NVE and 11 of 15 PVE) and there was significantly higher early mortality in aortic PVE (36%) than in aortic NVE (8%). The 9 patients with severe cardiac failure (NYHA Class V) before surgery were associated with a significantly higher incidence of early mortality (5/9 = 56%) than those in Class III (2/14 = 14%) and Class IV (3/18 = 17%). We concluded that aortic valve infection is more prevalent than mitral valve infection and is more often associated with staphylococcus infection, including abscess formation. Early surgical intervention should be performed despite the risk of cardiac failure and extensive infection.

Abscess↗
PubMed1993

Female systemic lupus erythematosus in Miyagi Prefecture, Japan: a case-control study of dietary and reproductive factors.

To investigate risk factors of systemic lupus erythematosus (SLE) in relation to diet and reproduction, a population-based case-control study was conducted during the period from October 1988 to October 1989 in Miyagi Prefecture in northeastern Japan. Included in the study were 52 female patients with the recent SLE onset. Two sex- and birth year-matched (+/- 2 years) controls for each patient were selected from the general population. The analysis on diet showed that the frequent intake of meat was associated with an increased risk (frequent vs. rare, relative risk (RR) 3.36; 95% confidence interval (CI) 1.10-10.24) and that the patients preferred fatty meat such as beef or pork. The analysis on menstrual history revealed that menstrual irregularity was also associated with an increased risk (RR 3.79; 95% CI 1.43-10.01). These results suggest that dietary and reproductive factors may be responsible for the onset and the progression of SLE.

Adolescent↗
PubMed1993

[Rastelli procedure for 32-year-old male with truncus arteriosus--a case report].

A 32-year-old male with a diagnosis of truncus arteriosus (Van Praggh Type A3) underwent successfully a total correction by the modified Rastelli procedure. The bilateral pulmonary arteries (PA) were disconnected from the truncus, and the ventricular septal defect was rerouted with a Dacron patch from the left ventricle to the true aorta. A new outflow from the right ventricle to the bilateral PA was established by the use of a T tube graft which consisted of a Rygg's valved conduit and a Rygg's pericardium. The patient had recent cardiac catheterization with slight elevated pulmonary hypertension (Rt-PA 40/10 mmHg, Lt-PA 30/10 mmHg), but is doing well at 5 years postoperatively.

Adult↗
PubMed1993

[A coronary aneurysm of left main trunk associated with localized dissecting aneurysms of thoracic and abdominal aorta].

A 47-year-old man who had undergone surgery of a dissecting thoracic aortic aneurysm was admitted for a localized, dissecting abdominal aortic aneurysm. Preoperative coronary arteriogram incidentally showed a coronary artery aneurysm (CAA) of the left main trunk. Prior to the operation for abdominal aortic aneurysm, that for the CAA was performed under standard cardiopulmonary bypass conditions with antegrade and retrograde coronary sinus cold blood cardioplegia. A longitudinal incision of the aneurysmal wall was made for the removal of a small thrombus and, the ostia of the left anterior descending artery (LAD), circumflex artery (LCX), intermediate artery (IM) and main trunk were closed from the inside of the aneurysm. The aneurysmal wall was closed without resection of the whole aneurysm. Finally, coronary artery bypass grafting to LAD, LCX and IM was performed. Postoperative course was uneventful with patency of all grafts. The retrograde coronary sinus cardioplagia is effective to prevent thromboembolism of distal coronary arteries due to the antegrade cardioplagia.

Adult↗