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S Takamoto

Publications and source records attributed to S Takamoto.

At least 163 records · Page 9Linked to original sources
PubMed1998

[Snare injury in coronary artery bypass grafting on the beating heart: report of 2 cases].

From June to November 1997, 8 patients underwent coronary artery bypass grafting on the beating heart. The first 2 patients had snare injury. Postoperative angiography showed coronary stenosis distal to the LITA-LAD anastomosis in the first case and a pseudo-aneurysm at the septal branch of the LAD in the second case, most likely due to snaring maneuver with 3-0 prolene or 3-0 GORE-TEX suture with a sharp needle. Since then, we have been satisfactorily utilizing the RETRACT-O-TAPE (a silicone tape with blunt needle, QUEST Medical, Inc.) for coronary occlusion to avoid injury to the native vessels and their branches.

Angina Pectoris↗
PubMed1997

Coagulation and fibrinolysis system in aortic surgery under deep hypothermic circulatory arrest with aprotinin: the importance of adequate heparinization.

BACKGROUND: Coagulation and fibrinolysis parameters were compared between two strategies of heparinization during cardiopulmonary bypass (CPB) in patients who underwent aortic surgery with deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RGCP) with aprotinin. METHODS AND RESULTS: From January 1994 to January 1996, 94 patients underwent aortic surgery with DHCA with aprotinin; replacement of the ascending aorta took place in 14 patients, arch in 69, and descending aorta in 11. Two million units of aprotinin was administrated in the priming of CPB, and 3 mg/kg heparin was given before CPB. During CPB, 49 patients had an additional 1 mg/kg/h heparin regardless of activated clotting time (ACT) [group A], whereas 45 patients had an additional 1 mg/kg/h heparin when ACT was less than 500 seconds [group B]. ACT, PT, aPTT, fibrinogen, AT-3, plasminogen, alpha2-PI (plasmin inhibitor), fibrin/fibrinogen degradation products (FDP), DD (D dimer), TAT (thrombin-antithrombin complex), PIC (plasmin-plasmin inhibitor complex), beta-TG (thromboglobulin), and PF-4 (platelet factor-4) were assayed. No difference was detected between the two groups regarding the duration of operation, CPB, aortic cross-clamping, DHCA, RGCP, and time from the end of CPB to admission to ICU. The heparin dose was greater in group A, but the protamine dose was similar. There was no difference in bleeding after perfusion or in ICU. Levels of TAT, fibrinogen, and DD were lower in group A. PIC, alpha-PI, and FDP value showed no difference. PF-4 and beta-TG were lower in group A, and the platelet count at the end of operation and the day after the operation was higher in group A. CONCLUSIONS: Platelets were better preserved and activation of the coagulation system during CPB was less severe in patients who had a regular additional constant heparin regimen irrespective of ACT in surgery for the aortic aneurysm with DHCA and aprotinin usage. An accurate monitoring system for heparinization is necessary to maintain appropriate anticoagulation during CPB in patients who are undergoing aortic surgery with DHCA using aprotinin.

Adult↗
PubMed1997

Expression of cell division cycle 2 kinase transcription in chronically rejected cardiac allografts of nonhuman primates.

Accurate diagnosis and prevention of graft arteriosclerosis, known as chronic rejection, is critical to the success of cardiac transplantation, but often is difficult to attain. Expression of cell division cycle (cdc) 2 kinase, which plays a critical role in cell transition through the G2/M phase, is critical to the proliferation of vascular smooth muscle cells. To evaluate the usefulness of cdc2 kinase expression for pathophysiological analysis of chronic rejection, heterotopic cardiac transplantation was performed in Japanese monkeys (n = 7). Standard reverse transcriptase-polymerase chain reaction (RT-PCR) and in situ RT-PCR were performed to evaluate the expression. In the coronary arteries of chronically rejected allografts, enhanced cdc2 kinase expression was observed in thickened intima and media, while none was expressed in native hearts. The cdc2 kinase was also expressed before the intimal thickening occurred. These results indicate that enhanced expression of cdc2 kinase is a sensitive indicator for chronic cardiac rejection; targeting cdc2 kinase may be a viable gene therapy for prevention of this vasculopathy.

Animals↗
PubMed1997

Pulmonary autograft implantation in the dilated aortic annulus.

The application of the pulmonary autograft (Ross) procedure in the treatment of dilated aortic annulus is still controversial, because technical errors of implantation are more likely to occur as the host annular diameter increases. The Ross procedure was successfully employed in a 28-year-old woman with a dilated aortic annulus after simple annular plication. The annulus was plicated beneath the three commissures where the pulmonary autograft was subsequently attached. The diameter of the annulus was reduced from 32 to 26 mm. This technique may provide a number of advantages compared with aortic valve replacement, especially for women of child-bearing age.

Adult↗
PubMed1997

Surgical management of Behçet's aortitis: a report of eight patients.

BACKGROUND: Behçet's aortitis is one of the most severe manifestations of Behçet's disease. However, there have been few reports of this rare entity. This article we describe our experience with surgical treatment of Behçet's aortitis in 8 patients. METHODS: From May 1978 to February 1995, we operated on 8 patients with Behçet's aortitis. All patients were followed up for a total of 54.4 patient-years (mean, 6.8 years). RESULTS: There were no operative deaths, but 1 patient died in the hospital of ventricular fibrillation. Another death occurred as a result of pseudoaneurysm rupture 10 months after operation. Fourteen operations were performed on eight patients: a second operation was performed on four patients, and a third operation was performed on two patients. The translocated Bentall procedure, a modified Bentall procedure, was performed six times. One patient required a second operation for graft detachment, but the others have done well without further surgical intervention. Aortic valve replacement was performed six times, and three reoperations were needed after aortic valve replacement. CONCLUSIONS: The translocated Bentall procedure may be effective for Behçet's aortitis, but further investigation is necessary.

Adult↗
PubMed1997

Repair for aneurysms of the entire descending thoracic aorta or thoracoabdominal aorta using a deep hypothermia.

OBJECTIVE: Replacement of the entire descending aorta or of the thoracoabdominal aorta still has a significant risk for postoperative paraplegia. Surgical strategies using a deep hypothermia to protect the spinal cord or viscera are discussed. METHODS: From April 1994, 25 patients underwent graft replacement of the entire descending aorta (13 patients) or thoracoabdominal aorta (12 patients) using a deep hypothermia. Five patients had atherosclerotic aneurysms and 20 had aortic dissection. There were 20 males and 5 females, whose age ranged from 26 to 72 years old, 47 years old in average. Surgery consisted with proximal anastomosis using deep hypothermia (18 degrees C) with retrograde cerebral perfusion by elevating central venous pressure to 20 mmHg, reconstruction of the intercostal arteries, and distal open anastomosis, while perfusing the brain and heart. Proximal open anastomosis was used with retrograde cerebral perfusion technique in 18 patients. Averaged number of reconstructed intercostal arteries was 2.1 for each patient. RESULTS: No early mortality was found and one patient died of respiratory failure 6 months after surgery. One patient had a postoperative stroke and one had a delayed onset of paraplegia 2 days after operation. The cause of paraplegia was secondary hypoxemia and hypotension due to pneumonia. CONCLUSION: Utilization of the deep hypothermia in surgery for aneurysms of the entire descending aorta or of the thoracoabdominal aorta provided an adequate protection of the spinal cord as well as the abdominal viscera, eliminated clamp injury or cerebral embolization of debris or thrombi, and afforded excellent surgical exposures.

Adult↗
PubMed1997

Long-term results of patch repair for saccular aneurysms of the transverse aortic arch.

OBJECTIVE: Long-term results of patch repair in patients with a saccular aneurysm of the aortic arch were investigated. PATIENTS: From December 1984, 43 patients with a saccular aneurysm of the arch underwent patch repair. Indications for patch repair were determined as orifice diameter of aneurysm being less than 1/3 of the total circumference of the aorta. METHOD: Midsternotomy was used in 38 patients, and left thoracotomy in five. Selective cerebral perfusion was used in 28 patients, deep hypothermic circulatory arrest with retrograde cerebral perfusion in eight during the last 3 years, and partial cardiopulmonary bypass in seven. RESULTS: There were five (11.6%) early deaths, and causes were respiratory failure in two patients, low cardiac output in two, and gastrointestinal bleeding in one. Stroke was found in three patients (6.9%). During follow-up, seven patients died, two due to rupture of a residual or pseudoaneurysm, one due to reoperation of pseudoaneurysm, one due to stroke, two due to respiratory failure, and one due to unknown cause. Postoperative survival, including early death, was 69.3% at 5 years and 43.3% at 9 years. Aortic reoperation was done in three patients with a pseudoaneurysm formation and two survived. Freedom from reoperation was 91.7% at 5 years and 38.2% at 9 years. Event free ratio was 79.3 +/- 9.8% at 5 years and 37.6 +/- 18.6% at 9 years. CONCLUSION: Because of a high incidence of pseudoaneurysm or residual aneurysms after patch repair for a saccular aneurysm of the aortic arch, strict criteria for the patch repair should be applied or graft replacement of the aorta is recommended.

Aneurysm, False↗
PubMed1997

Comparison of cytomegalovirus (CMV) antigenemia and CMV in bronchoalveolar lavage fluid for diagnosis of CMV pulmonary infection after bone marrow transplantation.

A comparative cytomegalovirus (CMV) diagnostic study was carried out on 30 bone marrow transplant patients. Forty-three bronchoalveolar lavage fluid (BALF) samples from these patients were examined for CMV by viral culture, polymerase chain reaction (PCR), shell vial and cytology. In parallel, peripheral blood samples were subjected to CMV antigenemia assay. CMV was detected in 12 (27.9%) of the 43 BALF samples (10 samples in viral culture, 10 samples in PCR, eight samples in shell vial and three samples in cytology). The CMV antigenemia assay yielded a positive result for six samples. The rates of agreement between results of the CMV antigenemia assay and results of each of the BALF tests were as follows: 81.4% with viral culture, 76.7% with PCR, 86.0% with shell vial, and 88.4% with cytology. Although the sensitivity of the CMV antigenemia assay was inferior to the sensitive tests of BALF samples, statistically significant correlations were demonstrated between the CMV antigenemia assay, viral culture, shell vial and cytology. Although the CMV antigenemia assay was shown to be useful for detection of CMV, it may be necessary to confirm not only the sensitivity but also the specificity of this method for prevention of CMV disease after BMT.

Adolescent↗
PubMed1997

Effects of inhaled nitric oxide on postoperative pulmonary circulation in patients with congenital heart disease.

We studied 22 patients with residual pulmonary hypertension or symptoms of postoperative pulmonary hypertensive crisis. They received low-dose inhalation (10 ppm) of nitric oxide (NO), a selective pulmonary vasodilator, after total correction for congenital heart anomalies. Fifteen minutes of NO inhalation improved the pulmonary circulation and lessened the imbalance in the ventilation-perfusion ratio in both groups. Thus, NO inhalation is effective in the treatment of pulmonary hypertension and in the prevention of pulmonary hypertensive crises after total correction for congenital heart anomalies. All patients continued to receive NO therapeutically. The duration of such therapeutic NO inhalation was well correlated with postoperative Qp/Qs (p = 0.014) and Rp/Rs (p = 0.029).

Administration, Inhalation↗
PubMed1997

Helium/oxygen breathing improves hypoxemia after cardiac surgery.

The effects of helium/oxygen (He/O2) on oxygenation (respiratory index [PaO2/FiO2] and intrapulmonary shunt [Qs/Qt]) and on lung parameters (dynamic compliance [Cdyn] and peak inspiratory pressure [PIP]) were studied in 12 patients. After cardiac surgery, they had impairment of oxygenation without physiological findings and with normal chest radiographs despite having a positive end expiratory pressure of up to 10 cm H2O. After 90 min of inhalation of He/O2, oxygenation had improved significantly; that is, PaO2/FidO2 increased significantly (from 113 to 174 mm Hg; mean values are given; p < 0.01), and there was a significant fall in Qs/Qt (from 29 to 19%; p < 0.001) together with an increase in Cdyn (from 60 ml/cm H2O to 64 ml/cm H2O; p < 0.05). These results suggest that He/O2 may have improved oxygenation by recruiting previously obstructed small airways and alveoli.

Administration, Inhalation↗
PubMed1997

Successful thromboendarterectomy for chronic pulmonary embolism in a patient with systemic lupus erythematosus and antiphospholipid syndrome.

Chronic pulmonary thromboembolism is known to be associated with poor prognosis with conservative medical treatment. Pulmonary thromboendarterectomy for chronic pulmonary thromboembolic disease is a potentially lifesaving procedure that prevents right-sided cardiac failure as a result of secondary pulmonary hypertension caused by pulmonary thromboembolism. We report a rare case of systemic lupus erythematosus with antiphospholipid syndrome in a patient who presented with pulmonary hypertension secondary to chronic proximal multiple pulmonary thromboembolism. To our knowledge, this is the first case report of chronic pulmonary thromboembolism complicated by systemic lupus erythematosus with antiphospholipid syndrome. Thromboendarterectomy was performed with satisfactory results.

Adult↗
PubMed1997

[Serum bone Gla-protein increases following short-term oral administration of active vitamin D3 in the elderly with vitamin D deficiency].

Serum bone Gla-protein (BGP) is produced by osteoblasts in a vitamin K-dependent process. It is well known that serum BGP levels increase after oral administration of active vitamin D3 in postmenopausal women and patients with chronic renal failure before dialysis. These findings indicate that active vitamin D3 increases the BGP production by osteoblasts. In the present study, a daily oral dose of 2 micrograms of 1 alpha (OH)D3 was administered to 10 elderly males (age, 75.0 +/- 10.9 years) and 8 young males (age, 29.0 +/- 3.2 years) to compare the changes in serum BGP levels between the two groups. None of the subjects had severe renal or hepatic dysfunction or abnormalities in calcium (Ca) metabolism. Serum BGP and 1,25(OH)2D levels in both groups were measured before the initial administration, at 24 h and at 1, 2 and 3 weeks after the start of administration. Serum parathyroid hormone (m-PTH), alkaline phosphatase (ALP), Ca and phosphorus levels were also measured in the elderly group. Serum BGP levels before the initial administration were 4.63 +/- 1.8 ng/ml in the elderly group and 4.33 +/- 0.92 ng/ml in the young group, with no significant difference between the two groups. In both group serum 1,25(OH)2D levels were slightly increased at 24 h after administration. In the elderly group serum BGP levels increased significantly to 11.5 +/- 3.0 ng/ml, an increase of approximately 250%, 1 week after the initial administration and the increase was maintained for up to 3 weeks after the administration commenced. However, no changes in serum BGP levels were noted in the young group. In the elderly group serum m-PTH levels were 544 +/- 257 pg/ml, almost the upper normal limit, before, and decreased slightly after, the administration of 1 alpha (OH)D3. Serum ALP levels also decreased slightly after the administration and serum Ca levels were slightly increased, however, the changes were within normal limits. We conclude that osteoblastic function is activated after short-term administration of active vitamin D3 in vitamin D deficient elderly subjects.

Administration, Oral↗
PubMed1997

[A clinical study of retrograde cerebral perfusion in long duration].

The safety limit of retrograde cerebral perfusion (RCP) in aortic arch reconstruction was evaluated in comparison with long (> or = 60 min: group A = 28 cases) and short (< 60 min: group B = 88 cases) RCP time (RCPT). RCPT was 60-94 min in group A and 24-59 min in group B. Hospital mortality was 7.1% and 6.8% in group A and B, respectively. There was no case who was died due to cerebral insufficiency. Postoperative neurological complication was observed 3 in group A and 3 in group B. There was no significance between 2 groups. There were no significant differences in the time to awake, ICU stay, electroencephalogram, and cognitive functions between 2 groups. Based on these results, the safety limit of RCP is over than 60 min and, maybe, about 90 min. We monitored the increase of deoxygenated hemoglobin (HbR) during RCP using a near infrared spectroscopy (n = 55). Since HbR increased gradually during RCP, HbR reflects oxygen metabolism non-invasively in the brain. HbR can be one of useful indexes of the brain protection during RCP.

Aged↗
PubMed1997

Modified "elephant trunk" procedure obliterating the false lumen in aortic dissection.

We describe a new application of the "elephant trunk" procedure for repairing aortic dissection. The false lumen of the distal aorta is obliterated between an external sheath of Teflon felt and an internal Dacron graft used as the "elephant trunk". This simple technique makes possible secure anastomosis with the distal friable tissue, and prevents suture hole leaks.

Adult↗
PubMed1996

Is use of aprotinin safe with deep hypothermic circulatory arrest in aortic surgery? Investigations on blood coagulation.

BACKGROUND: The perioperative blood coagulation and fibrinolysis system in patients who underwent aortic surgery under deep hypothermic circulatory arrest with or without aprotinin usage was investigated. METHODS AND RESULTS: Of 112 patients who underwent aortic surgery between December 1993 and April 1995, 60 had repair under deep hypothermic circulatory arrest. Thirty-nine patients had 2 million U aprotinin in pump priming and had no additional aprotinin. There were 20 patients with aortic dissections and 17 with atherosclerotic aneurysms. Twenty-two patients had left thoracotomy, and 17 had midsternotomy. Surgery consisted of replacement of the ascending aorta in 9 patients, total arch replacement in 11, distal arch replacement in 11, replacement of the descending aorta in 3, and replacement of thoracoabdominal aorta in 5. The control group was 21 patients who underwent operation under deep hypothermic circulatory arrest and retrograde cerebral perfusion but without aprotinin. Blood coagulation and fibrinolysis tests, consisting of activated clotting time, prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin III, plasminogen, alpha 2-plasmin inhibitor, thrombin-antithrombin complex, plasmin inhibitor complex, fibrin degenerative products, and D-dimer complex, were performed at various stages of surgery, before heparin administration, after heparin, 60 minutes and 120 minutes after beginning of the extracorporeal circulation, 1 hour after protamine administration, and 6 hours after protamine. Statistical analysis was performed with Student's t test, chi 2 test, and ANOVA. The amount of bleeding after perfusion was less in the aprotinin group, and bleeding during first 24 hours in the intensive care unit was less. Blood examination revealed that prothrombin time was higher after cessation of cardiopulmonary bypass in the aprotinin group. Thrombin-antithrombin III complex and alpha 2-plasmin inhibitor were higher during and after bypass in the aprotinin group. There was no difference in activated clotting time, activated partial thromboplastin time, fibrinogen, antithrombin III, plasminogen, plasmin inhibitor complex, fibrin degenerative products, and D-dimer complex. CONCLUSIONS: Clinical advantages of hemostatic effects of low-dose aprotinin and no apparent deleterious effects were demonstrated in patients who underwent aortic surgery under deep hypothermic circulatory arrest with retrograde cerebral perfusion. However, blood coagulation and fibrinolytic studies revealed subclinical hypercoagulation. Therefore, and adequate dose of heparin is required during deep hypothermic circulatory arrest.

Aged↗
PubMed1996

Etoposide with/without G-CSF with busulfan and cyclophosphamide as conditioning for bone marrow transplantation. The BMT Team.

To increase the efficacy of bone marrow transplantation (BMT), we have tried to add etoposide (VP-16) to busulfan/cyclophosphamide (BU/CY). Twelve patients received 16 mg/kg of BU and 120 mg/kg of CY with 15-30 mg/kg of VP-16. Another two patients received 5 micrograms/kg of G-CSF with 30 mg/kg of VP-16. Patients tolerated escalating doses of VP-16 without any significant hepatotoxicity. Their maximal level of bilirubin was 37.6 micromol/L (2.2 mg/dl), and there was no significant skin toxicity or mucositis. By contrast, two patients who received G-CSF with 30 mg/kg of VP-16 developed hyperbilirubinemia and veno-occlusive disease, which terminated this phase I study. VP-16 can be safely combined with BU/CY < or = 30 mg/kg in three divided doses, and its effect on survival should be evaluated. G-CSF added to this regimen, however, should be used with great caution.

Adolescent↗