Search PubMed⌕ Search

Biomedical subjects

S Shimokawa

Publications and source records attributed to S Shimokawa.

At least 145 records · Page 8Linked to original sources
PubMed1990

Direct revascularization of bronchial arteries for lung transplantation: an anatomical study.

Direct revascularization of the bronchial arteries for both single-lung and double-lung transplantation would improve airway healing and reduce airway complications after transplantation. We studied the anatomical pattern of bronchial arteries in 30 autopsy cases. In 28 of 30 cases (93.3%), at least one left bronchial artery arose directly from the anterior wall of the descending thoracic aorta. In 25 of the 30 cases (83.3%), at least one right bronchial artery was related to the first right intercostal artery. Injection studies showed that this right intercostobronchial artery supplies the proximal left main bronchus and carina as well as the right bronchus. We developed a technique for extracting the lungs along with the right intercostobronchial artery and a patch of aorta at its origin and applied it to 19 of the dissections. In 17 of the 19 cases studied (89.4%), the right intercostobronchial artery pedicle obtained had a length varying from 6.5 to 8.5 cm, sufficient for attachment of its origin to the ascending aorta of the recipient after double-lung transplantation. The right intercostobronchial artery pedicle provides the possibility for direct bronchial revascularization in right single-lung, double-lung, and lung-heart transplantation. A similar technique, utilizing the left bronchial artery, can be used to revascularize a left lung transplant.

Aorta, Thoracic↗
PubMed1990

[The optional usage of blood cardioplegia through eleven-year experience of open-heart surgery].

We propose two clinical studies in this paper for the optimal usage of cold blood cardioplegia (CBC) to evaluate 1) the effects of increasing the volume of CBC, and 2) the optimal use of verapamil, on postischemic myocardial recovery. First, patients with valvular heart surgery were divided into three groups according to the initial dose of CBC: Group I, 5 ml/kg in 368 patients; Group II, 10 ml/kg in 41; and Group III, 12 ml/kg in 86. In all groups CBC was infused every 25 to 30 minutes. Although the preoperative conditions of Group III patients tended to be more serious compared to Groups I and II, there was no difference in cardiac-related hospital mortality among the three groups. Second, 45 patients who had undergone valvular or coronary heart surgery were divided into three groups according to the usage of verapamil: Group A, infusion of verapamil of 1 mg/L into CBC; Group B, infusion of verapamil of 0.2 mg/kg into a perfusate; and Group C, the same method as Group B with additional administration of verapamil of 0.1 mg/kg into a perfusate at 60 minutes after the commencement of cardiopulmonary bypass and a continuous drop of 0.5 micrograms/kg/min for the succeeding 24 hours. Each group consisted of nine patients who had valvular surgery and six patients who had aorto-coronary bypass surgery. There was no difference in the severity of the patients' conditions between the groups. The optimal concentration during and after the operation and good clinical results were obtained in Group C. We conclude that the initial optimal dose of CBC is 12 ml/kg, and that the combination of an infusion of verapamil into a perfusate and a succeeding continuous drop is the appropriate method.

Adult↗
PubMed1990

[Surgical treatment of descending thoracic aortic aneurysm under temporary bypass with antithrombogenic tube and bio-medicus centrifugal pump].

Four patients with descending thoracic aortic aneurysm were successfully operated on under temporary bypass with an antithrombogenic tube and a Bio-Medicus centrifugal pump. The bypass flow ranged from 1.0 to 2.4 l/min with the mean femoral artery pressure of 50 to 70 mmHg. No complications such as paraplegia, hepatic dysfunction or renal failure were encountered in all the patients. Temporary increment of the serum amylase level occurred in all the patients, but any apparent clinical symptoms were not present. The temporary bypass method with an antithrombogenic tube and a centrifugal pump is useful and reliable for surgical treatment of descending thoracic aortic aneurysm.

Aged↗
PubMed1989

The oxygen dependence of the energy state of cardiac tissue: 31P-NMR and optical measurement of myoglobin in perfused rat heart.

The relationship between the energy state and intracellular oxygen concentration was established with cardiac tissue, where the former could be monitored by 31P-NMR and the latter by optical method for myoglobin absorption. The ratio of creatinephosphate to inorganic phosphate, PCr/Pi, started to fall at higher intracellular oxygen concentration than oxygen consumption (10IM). The pH shift measured by frequency shift of Pi paralleled the increase of lactate-release, of which half maximum was approximately 3IM. The critical oxygen concentrations differed nearly 5-fold when determined by energy state and oxygen consumption.

Adenine Nucleotides↗
PubMed1989

[Noonan's syndrome associated with cardiovascular anomalies; report of three cases].

Noonan's syndrome has a phenotype similar to Turner's syndrome, but has no chromosome abnormalities. This syndrome is frequently associated with congenital heart diseases, particularly valvular pulmonary stenosis. Three patients of Noonan's syndrome with congenital heart disease were successfully operated upon. Diagnostic criteria, frequency of anomalies and the association of cardiac malformations have been discussed together with special surgical points of view.

Adolescent↗
PubMed1989

[Simplified technique for closure of median sternotomy incision: the use of bone stapler].

A new technique with the bone stapler (Staplizer) was applied in 11 patients undergoing open-heart surgery for closure of a median sternotomy incision. The staplers were used for fixation of the sternum following partial trans-sternal fixation with two wires. The method was quick and easy to perform, and effective in establishing firm and permanent approximation of the sternum. There were no instances of dehiscence among all the patients with stapler closure. We therefore recommend this technique in median sternotomy closure except for patients with the osteoporotic or elastic sternum.

Adolescent↗
PubMed1989

[Portal and hepatic circulation during cardio-pulmonary bypass in chronic congestive liver--an experimental study].

Hemodynamic changes of portal and hepatic circulation in dogs with chronic congestive liver (CCL) have been studied with reference to cardio-pulmonary (C-P) bypass. The CCL dogs were provided by means of cut of the chordae of tricuspid valve followed by breeding for 4 to 41 months. Five of CCL dogs and 10 of control dogs were served for C-P bypass for 90 minutes. The measurements of portal venous pressure (PVP), wedged hepatic venous pressure (WHVP) and hepatic tissue blood flow (HBF) by hydrogen gas clearance method were made before and during C-P bypass. Results were as follows. 1. HBF of CCL dogs after laparotomy decreased significantly (p less than 0.001) in comparison of control dogs (31.7 +/- 14.4 vs. 62.7 +/- 23.3 ml/min/100g). 2. During the C-P bypass, the rates of rise of PVP and WHVP in CCL dogs revealed a lesser prominent than those of control dogs. 3. No reduction of the HBF was seen during the C-P bypass in CCL dogs. These results lead the conclusion that the portal and hepatic circulation of CCL dogs poorly adapted to an unphysiological condition of C-P bypass. It is considered, however, that CCL itself is not a state of absolute contraindication for C-P bypass in open cardiac surgery.

Animals↗
PubMed1987

Fatal hemolysis due to unidentified causes following mitral valve replacement with bileaflet tilting disc valve prosthesis.

Fatal hemolysis after mitral valve replacement with the St. Jude bileaflet tilting prosthesis is reported in two patients. Although one underwent re-replacement of the valve, both died from multiple organ failure and acute renal failure, respectively. Scanning electron microscopy revealed microthrombi adherent to a leaflet in one and irregular leaflet surfaces in the other. Such defects are rare but are possible causes of hemolysis in patients with the St. Jude mitral valve prosthesis.

Acute Kidney Injury↗
PubMed1986

Ruptured abdominal aortic aneurysm: factors influencing operative mortality.

Of fifty-eight consecutive patients surgically treated for aneurysm of the abdominal aorta, twenty were emergency cases following the rupture. Associated diseases were found in 85 per cent of patients; hypertension being the most common. Fifty per cent of patients were in shock on admission. The duration between rupture and operation was three hrs to two weeks with the average of 115.5 hrs. In six patients, the diagnosis of abdominal aortic aneurysm was known for over six months. The operative mortality rate in case of ruptured abdominal aortic aneurysm was 45 per cent. The most important determinants of survival were the incidence of shock on admission, the incidence of associated disease, the known duration of the aneurysm, and the time interval from rupture to admission. The intraoperative factors most influencing survival were the type of rupture, intraoperative hypotension, and total blood loss. Comparison of the mortality rate in elective surgery of abdominal aortic aneurysms (5.3 per cent) with that in ruptured aneurysms (45.0 per cent) suggests the necessity for early elective operations whenever abdominal aortic aneurysms are diagnosed.

Adult↗