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Biomedical subjects

S Kyo

Publications and source records attributed to S Kyo.

At least 109 records · Page 6Linked to original sources
PubMed1995

[Clinical result of left ventricular free wall rupture resulting from acute myocardial infarction].

We have treated 10 patients of left ventricular free wall rupture (LVFWR) resulting from acute myocardial infarction (AMI) in our intensive care unit (ICU) from Oct. 1984 to Dec. 1993. Nine of 10 patients underwent surgical repair, however, one patient was treated with pericardocentetesis in ICU and fibrin-glue was infused into the pericardial space (fibrin-glue therapy:FG therapy). The survival rate of surgical repair was only 33% (3/9), especially that was only 17% (1/6) when cardiopulmonary bypass (CPB) was required. One patient (49-year-old, male) suffered from cardiogenic shock following AMI in the posterior wall was performed coronary angioplasty (PTCA) in emergency and IABP support was required. Fourth day after PTCA, a sudden hemodynamical collapse had occurred on this patient due to cardiac tamponade. This patient was treated with pericardiocentetesis in ICU and FG therapy was performed, because all surgical teams were occupied in their operations. After FG therapy hemodynamical stability was obtained, the patient was survived and discharged at 2 months after LVFWR. In conclusion, the surgical result of LVFWR is still not good, especially when CPB was utilized. FG therapy was successful in one patient, suggesting FG therapy can be an alternative therapy for LVFWR when surgical team is not available.

Aged↗
PubMed1995

[Usefulness of intracardiac echocardiography for guidance of transseptal puncture procedure].

The clinical usefulness of intracardiac echocardiography (ICE) for the guidance of transseptal puncture procedure during percutaneous left heart bypass support (PLHBS) and percutaneous transvenous mitral commissurotomy (PTMC) was investigated to replace intraoperative transesophageal echocardiography monitoring which requires mild sedation and causes patient discomfort. The ICE procedure was assessed in 3 patients with PLHBS and 18 with PTMC using a 10 MHz rotating 8 French probe system especially developed for the purpose. Transseptal puncture procedure was observed by intraoperative ICE monitoring in the right atrium. The ICE images showed the transseptal puncture (Brokenbrough) needle as a point casting an acoustic shadow. By moving the ICE probe up and down, the excursion of the needle and its approach to the septal wall could be clearly observed. If the puncture needle is forced into the intra-atrial septum, the septal wall was clearly observed to protrude into the left atrium (tent-formation). In a tent-formation the puncture site could be determined by ICE alone. Intracardiac echocardiography guidance was useful and may improve the safety and reliability of the transseptal puncture procedure in PLHBS and PTMC.

Adult↗
PubMed1994

Coexpression of the c-kit receptor and the stem cell factor in gynecological tumors.

The protooncogene c-kit encodes a transmembrane receptor-type tyrosine kinase which belongs to the beta-PDGER/CSF-1 receptor tyrosine kinase family. The interaction between c-kit receptor and its corresponding ligand, stem cell factor (SCF), has been suggested to be involved in embryogenesis as well as carcinogenesis via the autocrine/paracrine system. In the present study, cancer cell lines and normal/benign/malignant tissues of the human female genital tract were examined for the expression of both c-kit and SCF by Northern blot and immunohistochemical analyses. Two of 16 cell lines showed mRNA expression of both c-kit and SCF, while 2 and 12 cell lines expressed c-kit and SCF, respectively. In tissues, several cases of malignant tumors, including three cervical cancers, one ovarian cancer, and one ovarian immature teratoma, expressed mRNA of both c-kit and SCF. In normal tissues, squamous epithelium expressed SCF immunohistochemically, while c-kit protein was detected only in melanocytes. Some tissues of malignant tumors, one squamous cell carcinoma of the cervix, two small cell carcinomas of the cervix, two serous adenocarcinomas of the ovary, and two immature teratomas of the ovary, expressed both c-kit and SCF proteins immunohistochemically. It is also notable that c-kit protein was expressed only in malignant germ cells of dysgerminomas, while SCF was expressed in the connective tissues surrounding germ cells. The present study suggests that the c-kit/SCF system may play an important role in the carcinogenesis of the female genital tract.

Endometrial Neoplasms↗
PubMed1994

Regulation of early gene expression of human papillomavirus type 16 by inflammatory cytokines.

The host's immune reaction against human papillomavirus (HPV) infection remains poorly understood. Inflammatory cytokines undoubtedly play a key role through activating and coordinating the immune response. However, their direct interactions with the HPV genes remain unclear. In the present study, the effects of various inflammatory cytokines on HPV16 gene expression were investigated. In a CAT assay, tumor necrosis factor (TNF) alpha and interleukin-1 (IL-1) alpha were shown to repress HPV16 early gene expression at the transcriptional level through the noncoding region (NCR), whereas IL-6 and interferon-gamma did not. In Northern blot analysis, TNF and IL-1 were also shown to repress HPV16 E6/E7 mRNA expression in the HPV16-immortalized human keratinocyte cell line. The TNF- and IL-1-responsive elements in the HPV16 NCR were determined to lie within the cell-type-specific enhancer, where there are several binding sites for nuclear factors involved in HPV16 early gene regulation, suggesting the participation of these factors in TNF and IL-1 regulations. Thus, TNF and IL-1 were shown to have antiviral effects on HPV through down-regulation of its gene transcription. This is the first demonstration that TNF and IL-1 are involved in HPV gene regulation. These functions of inflammatory cytokines are presumed to contribute to the host's defense against HPV infection.

Cell Transformation, Viral↗
PubMed1994

Evaluation of ventricular septal defect by transesophageal echocardiography: intraoperative assessment.

The miniaturization of transesophageal echocardiography (TEE) probes, together with the development of the capability for biplane imaging from the esophagus, have increased the use of TEE in pediatric cardiology. The aim of this study was to evaluate the TEE findings in patients with ventricular septal defect (VSD) before and after closure primarily by means of pediatric biplane probes. This study group included 69 patients who underwent VSD closure as an isolated repair or as a part of a definitive repair of a more complicated lesion. Ages ranged from 6 days to 15.6 years (median 1 year, 4 months), with operative weights ranging from 2.9 kg to 68 kg (median 10 kg). Preoperative and follow-up transthoracic echocardiograms (TTE) were also performed. Intraoperative TEE was performed without complication in all 69 patients. Preoperative results: (1) anatomic findings: Two muscular VSDs were detected by matrix TEE but could not be observed by TTE. A patient with preoperative TTE diagnosis of an ostium primum ASD was found to have atrioventricular (AV) canal by TEE. In three of six AV canal type VSDs, both TTE and TEE demonstrated left ventricular-right atrial shunting (2) aortic regurgitation associated with VSD: Aortic regurgitation as a result of right coronary cusp prolapse was detected in one of five supracristal VSDs in which the biplane or matrix TEE was used.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Detection of high-risk human papillomavirus in the cervix and semen of sex partners.

To investigate the possibility of sexual transmission of human papillomavirus (HPV), 53 married couples were examined for the presence of HPV-16 and -18 DNAs in the uterine cervix and semen using the polymerase chain reaction method. Twenty-three of the 53 women and 12 of the 53 male partners were positive for HPV-16 DNA. No HPV-18 DNA was detected in samples from any of the partners. In 27 pairs, both partners were negative for HPV DNA in cervix or semen; in the remaining 26 pairs, at least 1 of the partners was HPV-16-positive. In 9 (35%) of these 26 pairs, both partners were infected. Furthermore, 9 (75%) of the 12 women with HPV-positive partners were HPV-positive, while 9 (39%) of the 23 men with HPV-positive female partners were HPV-positive. These findings suggest an increased risk of HPV transmission via sexual intercourse, thereby underscoring the importance of preventive care against HPV infection during intercourse.

Adult↗
PubMed1994

Correlation between tumorigenicity and expression levels or splicing patterns of transcripts of the human papillomavirus type 16 E6 gene.

For determination of the correlation between tumorigenicity and the expression levels or splicing patterns of E6 mRNAs of the human papillomavirus type 16 in established cells, a vector containing the intact E6 open reading frame which expresses both unspliced and spliced mRNAs, one expressing only unspliced E6 mRNA, and one expressing both unspliced and spliced mRNAs but producing only truncated E6 proteins were constructed. In transformation assays and analyses of E6 mRNAs, a higher expression level of unspliced E6 mRNA was found to be closely associated with tumorigenicity. Furthermore, it was also related with anchorage-independent growth and a decreased serum requirement of the cells.

Alternative Splicing↗
PubMed1994

[Effects of subcutaneous administration of erythropoietin on autologous blood predonation in open heart surgery: Japanese multicenter double-blinded dose-study].

The effects of subcutaneous administration of recombinant human erythropoietin (EPO) on harvesting autologous blood predonation (ABP) and decreasing homologous blood transfusion (HBT) in open-heart surgery were examined prospectively in 132 patients treated in a 32-institute multicenter study. Single doses of 6000, 12,000, 18,000 and 24,000 unit (IU) of EPO with intravenous iron (40 mg) were administered once a week for 3 weeks with ABP (400 ml/week) before surgery. ABP volume (ml), change of blood hemoglobin level (C-Hb), preoperative net blood hemoglobin increase (delta Hb [g/dl] including ABP, perioperative blood loss (ml), and HBT rate, were as follows; [table: see text] Preoperative reduction of Hb (C-Hb) was less in administration dose of 18,000 IU and 24,000 IU than 6000 IU (p < 0.05). The increase of delta Hb was highest in 18,000 IU and HBT rate was lowest in administration dose of 24,000 IU, however, there was no statistical difference. In conclusion, both 18,000 IU and 24,000 IU of EPO treatment is effective to minimize the progression of anemia according to ABP for open heart surgery.

Blood Transfusion, Autologous↗
PubMed1993

Variomatrix--a newly developed transesophageal echocardiography probe with a rotating matrix biplane transducer. Technological aspects and initial clinical experience.

The recently developed multiplane transesophageal echocardiography (TEE) probes cannot provide real-time synchronous biplane imaging. We have developed a new "Variomatrix" probe that combines the advantages of the rotating mechanism of the multiplane probe with the capability of providing simultaneous, side-by-side imaging. Its advantages are: (1) easy manipulation to obtain the optimal planes; (2) avoidance of excessive movement of the probe inside the esophagus; (3) assessment of oblique planes that are not viewed with the usual biplane probe; (4) better understanding of the continuity of structures by the simultaneous, side-by-side biplane, rotating images, providing clearer three-dimensional conception; and (5) shorter examination time by providing a 180 degrees imaging range by rotating the transducer just 90 degrees .

Echocardiography, Doppler↗
PubMed1993

NF-IL6 represses early gene expression of human papillomavirus type 16 through binding to the noncoding region.

The expression of human papillomavirus type 16 (HPV16) early genes, including E6 and E7 transforming genes, is regulated by several cellular factors binding to the noncoding region (NCR), such as the glucocorticoid receptor, NF-I, and AP1, all of which are positive regulators. We demonstrated that the nuclear factor for interleukin 6 expression (NF-IL6) specifically binds to the HPV16 NCR ranging from nucleotides 7007 to 7766 and represses the early gene expression of HPV16. The responsive element in HPV16 NCR was determined within the region ranging from nucleotides 7454 to 7766. In this region, many binding sites for other cellular transactivators, such as NF-I and AP1, have been detected. Interestingly, three of seven binding sites for NF-I and two of two binding sites for AP1 in this region overlap with the putative NF-IL6 binding sites identified by computer analysis. Competition experiments with the oligonucleotides containing such NF-I or AP1 sites indicated that NF-IL6 certainly binds to them. Furthermore, in a chloramphenicol acetyltransferase assay using mutant NF-IL6 expression vectors, the DNA binding domain of NF-IL6 was shown to be necessary for repression, whereas the functional domain was not. These findings indicate that repression may be caused by competition with other transcriptional activators, such as NF-I and AP1. Thus, NF-IL6 may play a significant role in the regulation of viral transcription as a part of the host's resistance to viral infection.

Acute-Phase Reaction↗
PubMed1993

Reduction of reperfusion injury by recombinant human superoxide dismutase administered intravenously just prior to reperfusion.

The reduction of reperfusion injury by intravenous administration of recombinant human superoxide dismutase (r-hSOD) was evaluated in a dog model. Two hours of left anterior coronary artery clamping were followed by 30 min of partial reperfusion and 30 min of full reperfusion. In the SOD group, r-hSOD (100,000 U/kg) was given intravenously 5 min before reperfusion. Measured left ventricular (LV) segments were classified thermographically by temperature drop into central (> or = 2 degrees C) and marginal (< 2 degrees C) areas. The regional LV functions were evaluated by percentages of both segmental (%SS) and active (%AS) shortening. In the central area, the %SS values after reperfusion were -9% in the control group and -3% in the SOD group (p < 0.05). The respective %AS values were 6 and 29% (p < 0.01). In the marginal area, both groups had %SS values of -3% and respective %AS values of 34 and 22% (all not significant) after reperfusion. In the central area, there was significantly better LV function recovery in the SOD group than in the control group.

Animals↗
PubMed1993

[Balloon atrioseptostomy under color flow Doppler echocardiography guidance].

The clinical effectiveness and safety of balloon atrioseptostomy (BAS) under color flow mapping Doppler echocardiography (CFM) guidance was evaluated in 21 BAS procedures performed on 19 patients with cyanotic heart disease (d-TGA 15, PA 1, TA 2, Ebstein's anomaly PA + supramitral ring 1) in the cardiac catheterization laboratory (16 patients) or in the intensive care unit (ICU 3 patients). The indication for BAS was established based on CFM diagnosis. BAS was performed with combined CFM and X-ray guidance on 16 patients prior to cardiac catheterization, and with CFM guidance only on 3 patients in the ICU. A series of BAS was performed until satisfactory interatrial opening was obtained and a complete hemodynamic study was performed by CFM and catheterization after BAS, if possible. In all 19 patients BAS was performed very safely with positioning of balloon in the left atrium, selection of appropriate size of balloon, and the confirmation of the effect of BAS provided by CFM guidance at each step. The size of the interatrial opening was significantly increased from 2.6 to 8.1 mm (p < 0.01) after a series of BAS and the arterial oxygen saturation was significantly increased from 44 to 75% (p < 0.01). CFM provides effective diagnosis and guidance for BAS in severely cyanotic neonates with congenital heart disease, and should significantly contribute to the speed, efficacy, and safety of the procedure.

Catheterization↗
PubMed1993

[Cerebral protection with selective cold blood cerebral perfusion by gravity during aortic arch reconstruction].

Selective cold blood cerebral perfusion by gravity using specially designed reservoir with a built-in heat exchanger was applied to 30 consecutive patients who required aortic arch reconstruction. Rectal and brain temperature during cerebral perfusion were maintained at 22 degrees C and 16 degrees C respectively. Patients were divided into two groups according to postoperative condition of consciousness. Twenty three patients had uneventful recovery of consciousness (Group-1), and 7 patients showed delayed recovery or disturbance of consciousness (Group-2). Age, sex, causes of aneurysm, rectal temperature and conditions of cerebral perfusate were not statistically significant in both groups. Selective cerebral perfusion time in Group-1 was 68 +/- 36 min and 85 +/- 31 min in Group-2 (statistically not significant). Extracorporeal circulation time in Group-2 (243 +/- 61 min) was significantly longer than in Group-1 (187 +/- 56 min) (p < 0.05). Five of seven patients (71%) in Group-2 were in shock pre- or early post-operative period contrary to 0% in Group-1 (p < 0.001). These results suggest that selective cold blood cerebral perfusion protects effectively the brain during aortic arch reconstruction in the patients without hemodynamic deterioration.

Adult↗
PubMed1992

Percutaneous introduction of left atrial cannula for left heart bypass: utility of biplane transesophageal echocardiographic guidance for transseptal puncture.

For introduction of a left atrial (LA) cannula by the transseptal puncture technique, we examined the feasibility of using biplane transesophageal echocardiography (B-TEE). A transseptal puncture was performed on 15 patients (3 male; 12 female; mean age, 48.9 +/- 11.2 years) by B-TEE guide during percutaneous transvenous mitral comissurotomy (PTMC). The entire Brocken-brough needle and the position of its tip were clearly observed in the right atrium by a longitudinal image of B-TEE in all patients (100%), and in 2 (13%) of them also by the transverse image of B-TEE. The puncture was about 1 cm caudal from the center of the fossa ovalis to avoid any large residual atrial septal defect. After transseptal puncture, a Mullin's sheath (7 Fr) and a dilator (14 Fr) were inserted into the left atrium in order, and then an Inoue's balloon catheter (12 Fr) was introduced without difficulty into the left atrium in all patients. With contrast injection, the position of the sheaths's tip was clearly confirmed by B-TEE. Left heart bypass support (left atrial-femoral artery bypass or AAB) was performed on 2 patients after percutaneous introduction of the LA cannula using this technique, and both were successfully supported and survived. With B-TEE guidance, the Brockenbrough atrial septal puncture and introduction of the LA cannula into left atrium can be performed easily. Thus, percutaneous left heart bypass can be set up quickly and safely even in an intensive care unit or outpatient emergency room without radiographic guidance.

Adult↗
PubMed1992

Evaluation of biplane color Doppler transesophageal echocardiography in 200 consecutive patients.

BACKGROUND: We developed the first biplane transesophageal echocardiography (TEE) probe with two orthogonal transducers, allowing synchronous side-by-side displays of the heart on a monitor TV, and compared its diagnostic value with that of conventional single-plane TEE using commercially available Doppler equipment in 200 consecutive patients intraoperatively, perioperatively, or on an outpatient basis. METHODS AND RESULTS: Insertion was easy, except in one patient with a mediastinal tumor, and no complications were encountered. Both transverse and longitudinal scans allowed correct identification of true and false lumina in all 30 aortic dissection examinations, but longitudinal scanning was slightly superior in detecting types I and III entry sites. Three entries that were not detected by transverse scanning (two of DeBakey type I and one of type III) were visualized by longitudinal scanning. Among 37 cases of mitral regurgitation (MR), longitudinal scans were significantly superior (p less than 0.05) in revealing multiple jets (nine compared with two with transverse scanning). Although both planes yielded almost identical mean values for the maximum jet areas, a difference of over 50% in jet area size on the two planes was observed in 19 cases. The measured jet areas showed significant correlation with the angiographic MR grading, especially for the larger of the biplane measurements (p less than 0.01), and different grades showed little overlap. Longitudinal images increased the acoustic window of the heart and aorta from the esophagus. Moreover, longitudinal scanning provided good visualization of both ventricular outflow tracts, the ascending aorta, main pulmonary artery, and superior vena cava. CONCLUSIONS: This modality greatly facilitates a three-dimensional comprehension of cardiovascular lesions and flow dynamics, especially in aortic dissection and MR, and its safety was demonstrated. Our data demonstrate the usefulness of this new technique in comparison with conventional single-plane TEE.

Aortic Dissection↗
PubMed1992

Outcome of Stanford type B acute aortic dissection.

BACKGROUND: The optimal timing of surgery in patients with Stanford type B aortic dissection remains controversial. This report reviews retrospectively early and long-term outcomes of patients with Stanford type B acute aortic dissections at our institute. METHODS AND RESULTS: From April 1979 through January 1991, 75 patients were diagnosed with Stanford type B aortic dissection, and 58 of them were hospitalized within 2 weeks from onset. They were treated initially as follows: emergent surgery was performed in 13 patients for rupture or impending rupture, and the remaining 45 were treated medically. In the former group, nine patients (69%) died; in the latter, eight (18%) needed surgery because of enlargement or rupture of the aneurysm in the follow-up period, and only one of these (13%) died. Of the other 37 patients treated medically, three (8%) died within 2 weeks and seven died (19%) in the chronic phase, four of them from rupture. Among 42 discharged patients initially treated medically, rupture occurred in 11.9% (five of 42). CONCLUSIONS: In acute-phase cases, surgical mortality is so high that medical treatment is preferable unless there are major complications. However, even in patients who had undergone successful initial medical treatment, expansion of the aneurysm, requiring surgery, often occurred. If careful observation reveals any sign of expansion, because elective surgery can be performed at low risk, it should be considered as soon as possible before a rupture develops.

Actuarial Analysis↗
PubMed1992

Effect of human recombinant erythropoietin on reduction of homologous blood transfusion in open-heart surgery. A Japanese Multicenter study.

BACKGROUND: Recombinant human erythropoietin (EPOCH) has been shown to increase erythropoiesis; therefore, EPOCH has been used in conjunction with autologous blood predonation (ABP) before surgery. However, the administration methods of EPOCH to obtain an adequate volume of ABP before open-heart surgery have not been determined. METHODS AND RESULTS: The effects of EPOCH on harvesting ABP and decreasing homologous blood transfusion (HBT) in open-heart surgery were examined prospectively in 205 patients treated in a 29-institute multicenter study. Single dose of 3,000, 6,000, or 9,000 IU of EPOCH were administered for 2 weeks (two or three times per week) without ABP (group 1, n = 69) or for 3 weeks (two or three times per week) with ABP (group 2, n = 97) and compared with control subjects (n = 39). Preoperative blood hemoglobin increase (delta Hb[g/dl]) was < 1.0 g/dl in group 1. When EPOCH was given three times a week, the delta Hb in each subgroup of group 2 was 0.6 +/- 1.1 (control), 2.1 +/- 1.3 (3,000 IU), 2.4 +/- 1.4 (6,000 IU), and 2.8 +/- 1.5 (9,000 IU), which was significantly higher than the control (p < 0.05) and was dose dependent. The HBT rates in patients with a moderate perioperative blood loss of between 15 and 50 ml/kg were 75.0% (control), 35.7% (3,000 IU), 52.9% (6,000 IU), and 66.7% (9,000 IU) in group 1, and respective volumes in group 2 were 40.0% (control), 20.0% (3,000 IU), 26.9% (6,000 IU), and 12.5% (9,000 IU). The overall HBT rate of EPOCH-treated patients with a moderate blood loss was 50% (20 of 40) in group 1 and 21% (13 of 62) in group 2. The HBT rate was significantly reduced by combination of preoperative EPOCH treatment (three times per week) and ABP (p < 0.0001). CONCLUSIONS: Dose-dependent increase of blood hemoglobin level was observed by EPOCH treatment with ABP; combination of EPOCH treatment and ABP can reduce HBT during open-heart surgery.

Blood Transfusion↗