Search PubMed⌕ Search

Biomedical subjects

S Teramoto

Publications and source records attributed to S Teramoto.

At least 253 records · Page 14Linked to original sources
PubMed1993

[Successful weaning from mechanical ventilation in an aged subject with severe apneas due to brain damage].

A 73-year-old male was admitted to Tokyo University Hospital due to cardiac arrest secondary to ventricular arrhythmias. Although the patient survived after cardiopulmonary resuscitation, he needed mechanical ventilation. When we tried to wean the patient from mechanical ventilation, we found that he suffered from frequent sleep apneas of over 40 times/hour. To evaluate the severity and frequency of the apneas, we performed polysomnographic study on the patient under assist ventilation. The polysomnographic study revealed that frequency of apneas was very high but the magnitude of desaturation was not so severe during the night. Since we confirmed the lowest SaO2 in this patients was over 90% during day and night, we tried to wean from the patient from the ventilator again and succeeded. The clinical application and usefulness of nocturnal ventilatory monitoring for patients with mechanical ventilation was discussed.

Aged↗
PubMed1993

[Two elderly cases with acute exacerbation of interstitial pneumonia].

We studied two cases of the elderly with acute exacerbation of interstitial pneumonia to elucidate a prognostic role of super oxide generation in peripheral whole blood. The first case was a 70-year-old man, who presented with acute exacerbation of interstitial pneumonia and was hospitalized. Following steroid-pulse therapy, CRP, ESR, blood-gas and his physical condition improved, resulting in successful discharge. In this case, super oxide generation standardized by the number of neutrophils (K) decreased to less than 1.0 in association with the improvement of physical condition. The second case was a 92-year-old woman in whom acute exacerbation of interstitial pneumonia was diagnosed. While the pulse therapy, CRP, LDH and blood-gas temporarily improved, K was continuously greater than 1.0 and the physical condition worsened, resulting in her death. These cases suggest that the measurement of super oxide generation in peripheral whole blood may play a useful role in assessing the prognosis of the elderly with acute exacerbation of interstitial pneumonia.

Acute Disease↗
PubMed1993

Impaired pulmonary oxygenation of diabetic origin in patients undergoing coronary artery bypass grafting.

The effect of a disposition to diabetes mellitus on pulmonary function was determined by dividing 70 consecutive patients who underwent coronary artery bypass grafting (CABG) into a group of 41 patients with such a disposition and a group of 29 without. Indices of pulmonary function studied were the ratio of the arterial partial pressure of oxygen to the inspired oxygen fraction (PaO2/FiO2), the alveolar-arterial oxygen gradient (A-aDO2) and the respiratory index (A-aDO2/PaO2). These were determined before CABG, at the maximum level of blood glucose and when FiO2 was in the range 0.4-0.7 within 6 h after CABG. Even before bypass, all indices were significantly worse in the group with a disposition to diabetes mellitus than in that without. After surgery, these dysfunctions were more severely exacerbated in the former group. FiO2 was the best predictor of the current state of pulmonary function in both groups. Variables that strongly affected pulmonary function were pulmonary arterial wedge pressure in the group with no diabetic disposition and central venous pressure in those with such a disposition. Thus, pulmonary dysfunction of diabetic origin exists not only before CABG, but also after the procedure. Attending physicians must be careful not to increase wedge pressure and central venous pressure.

Blood Glucose↗
PubMed1993

[A case of congenital atrial flutter associated with atrial septal defect].

We report the case of a 8-month-old boy with atrial septal defect associated with congenital atrial flutter. He was operated on for ASD successfully. Atrial flutter in infants has been reported to be uncommon and to have a poor prognosis when associated with underlying cardiac disease. Therefore, early surgical intervention may improve the prognosis.

Atrial Flutter↗
PubMed1993

[Comparison between antegrade and retrograde cardioplegia with warm blood].

Recently continuous warm blood cardioplegia (BCP) has been reported as a superior method of myocardial protection, but it is unknown which is more effective antegrade or retrograde cardioplegia. This study was performed to investigate the efficacy of antegrade infusion via aortic root and retrograde infusion via coronary sinus with continuous warm BCP in regard to metabolism, oxygen extraction ratio, serum enzyme release, cardiac function, and myocardial edema. Fourteen adult mongrel dogs were subjected to total cardiopulmonary bypass and cross-clamp of the aorta for 120 minutes, and followed by 60 minutes reperfusion. The dogs were divided into two groups according to the infusion type of continuous warm blood cardioplegia: Group A, antegrade warm BCP, and Group R, retrograde warm BCP. Changes in excess lactate (delta XL), redox potential (delta Eh), and myocardial lactate extraction ratio showed that aerobic metabolism could be maintained in group A and could not in group R. Myocardial oxygen extraction ratio during aortic cross-clamp was same in group A and in group R, but at 5 minutes after reperfusion it was significantly higher in group A than in group R (41 +/- 8% V.S. 22 +/- 9%). The incidence of ventricular fibrillation (V.F.) after reperfusion was significantly lower in group A than in group R (1/7 V.S. 7/7). CPK-MB and HBDH releases during aortic cross-clamp and 60 minutes reperfusion were lower in group A than in group R, but not significant. Generations of lipid peroxides (A-Cs difference) were lower in group R than in group A, but not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Perioperative insertion of peritoneal dialysis catheter].

Silicon rubber peritoneal dialysis catheter (Tenkoff) was inserted perioperatively in neonates undergoing cardiac surgery and also in those patients in whom right-sided heart failure may occur. This method is easy and safe even in neonates. Post operative excessive fluid retention could be avoided using this method.

Acute Kidney Injury↗
PubMed1993

[Urgent mitral valve replacement for acute mitral regurgitation due to ruptured chordae tendineae in systemic lupus erythematousus].

We reported a successful surgical treatment of mitral regurgitation (MR) due to ruptured chordae tendineae in a 44-year-old man with systemic lupus erythematosus (SLE) who had received the steroid therapy. He had signs of acute congestive heart failure with severe pulmonary hypertension due to MR, and underwent urgent mitral valve replacement. The postoperative course was uneventful. When replacing valve in SLE, a careful manipulation should be taken because of friability of cardiovascular tissue. Patients are usually administered steroid agents, and the agents ought to be discontinued in perioperative period, but it seems to be better to resume as soon as possible. We conclude that the surgical treatment for valvular diseases should be considered, even in the patient with SLE.

Acute Disease↗
PubMed1993

[Descending thoracic aorto-aortic bypass grafting for coarctation of the aorta in an adult combined with a cerebral arterial aneurysm--a case report].

Coarctation of the aorta (CoA) in adults is often accompanied by hypertension, but CoA combined with a cerebral arterial aneurysm is rare. We performed successfully descending thoracic aorto-aortic bypass grafting for CoA in an adult who had a cerebral bleeding and a cerebral arterial aneurysm. The patient was a 46-year-old female who had the history of hypertension. She suddenly suffered from left hemiparesis due to cerebral bleeding, then a left middle cerebral arterial aneurysm and CoA were detected at the same time. Aortography showed that the internal diameter of the portion of the coarctation was 2.8 mm and the poststenotic dilatation was prominent. The peak systolic pressure gradient across the coarctation was 60 mmHg. We took the precedence of the surgical repair for CoA over that for the cerebral arterial aneurysm, because her cerebral arterial aneurysm was judged to have less risk to rupture from the viewpoint of its size and shape by neurosurgeons. We performed proximal descending thoracic aorto-distal descending thoracic aortic bypass grafting with a woven double velour graft of 16 mm in internal diameter and 9.5 cm in length. Intraoperative cerebrovascular hypertension can be avoided by this procedure. Furthermore the peak systolic pressure gradient has disappeared immediately after grafting. In general, the coarctectomy with direct end-to-end anastomosis is prevalent for CoA in adults. On the other hand, the descending thoracic aorto-aortic bypass grafting for CoA in adults has rarely been reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Thoracic↗
PubMed1993

[A clinical study of resected adenoid cystic carcinoma of the tracheobronchial tree].

From 1973 to 1990, 7 patients presented with a adenoid cystic carcinoma of tracheobronchial tree that was treated surgically. The locations were larger airways; 4 in the trachea, 1 in the carina, 2 in the basal bronchus. Surgical treatments were performed in all cases. The following resections were done: trachea only 3; carina 1; trachea plus larynx 1; left lower lobe (sleeve lobectomy) 1; left lung (pneumonectomy) 1. Except for tracheolaryngectomy and left pneumonectomy, all cases were undergone primary anastomosis. Operative death was only one patient who died of anastomotic separation. Irradiation was performed in 6 patients before or after operation. Two patients were died due to lung metastases or leukemia. According to the Kaplan-Meier's method, the 5 years survival rate of all patients was 68.6%. Our experience suggests that surgical treatment and adjunctive radiotherapy is beneficial in patients with adenoid cystic carcinoma.

Adult↗
PubMed1993

[A case of idiopathic chylothorax].

A 29-year-old female was admitted to our hospital because of right pleural effusion. Chyle was obtained by thoracocentesis. She received conservative therapy, however, the pleural effusion did not decrease. Thoracic duct ligation was performed, and improvement of the chylothorax was observed. Because there was no underlying disease to cause chylothorax, the diagnosis of idiopathic chylothorax was made. Idiopathic chylothorax is a rare disease and only 24 cases have been reported in Japan.

Adolescent↗
PubMed1993

[Thoracoscopic treatment of bronchogenic cyst].

A central bronchogenic cyst was excised thoracoscopically from a 44-year-old woman in whom a tumor had been pointed out in the left upper posterior mediastinum at a screening examination. Since the tumor was diagnosed to be benign, only conservative follow-up was undertaken, but the patient consulted our department desiring active therapy. On the basis of the chest CT and MRI findings a bronchogenic cyst was diagnosed. Under general anesthesia and mechanical ventilation of one lung, the thoracoscope was inserted into the thoracic cavity revealing in the left upper posterior mediastinum a cyst which was excised thoracoscopically. While coagulation was performed gingerly with an electric scalpel, the tumor was detached sharply and bluntly with a pair of scissors. The postoperative course was uneventful with little wound pain or scar formation. Hitherto bronchogenic cysts have been treated by resection after thoracotomy. Although this is an easy procedure, a relatively large operative scar is left and considerable wound pain may develop. In contrast, thoracoscopic treatment is characterized by minimal surgical invasiveness, little postoperative wound pain, and small scars. These advantages suggest that this technique may be indicated for benign mediastinal tumors, particularly cysts.

Adult↗
PubMed1993

[Extirpation of intra-atrial tumor thrombus of renal cell carcinoma by means of extracorporeal circulation--report of a case].

We report a case of renal cell carcinoma with a tumor thrombus extending into the right atrium, which was successfully removed with the use of extracorporeal circulation. A 68-year-old male presented with a one month history of abdominal distension. CT-scanning, selective renal angiography, vena cavography and echocardiography revealed a left renal tumor with a tumor thrombus extending into the right atrium through the inferior vena cava. Left nephrectomy and removal of the intra-atrial tumor thrombus were performed using extracorporeal circulation. Preoperative laboratory results showed elevation of the total bilirubin (17.0 mg/dl) due to congestion of the liver which was caused by obstruction of hepatic vein with the tumor thrombus. Postoperatively, the total bilirubin gradually decreased to 11.9 mg/dl on the third day, but increased to 22.2 mg/dl on the 9th day. So plasma exchange was performed on the 10th, 11th and 12th days, and the total bilirubin decreased to the normal range. The patient was discharged on the 50th day. For renal cell carcinoma with a tumor thrombus extending into the right atrium, effectiveness of operation using extracorporeal circulation and subsequent prognosis are discussed.

Aged↗
PubMed1993

A case of cor triatriatum with end-stage renal disease: successful management of open heart surgery under hemodialysis, subsequent renal transplantation and pregnancy.

A female patient who had open heart surgery for cor triatriatum under hemodialysis, subsequent kidney transplantation and pregnancy is reported. We performed hemodialysis on the patient before, during and after heart surgery to control renal failure. Two years after heart surgery, she received a kidney graft from her mother. The kidney graft showed good function. She was treated with azathioprine and prednisone. Three years after renal transplantation she delivered a healthy male infant by elective Caesarean section at 37 weeks' gestation. Mother and infant did well following delivery. There was lack of hypertension, proteinuria, signs of graft rejection, and recurrence of heart failure during pregnancy. She showed serum creatinine level < 2 mg/dl, a prednisone of < 2 mg/kg/day. Elective Caesarean section has improved hydronephrosis due to the compression of the fetus. The aforementioned good criteria contributed to the successful pregnancy of the renal transplant patient in our experience. We believe early surgical intervention overcomes complicated heart disease even with endstage renal disease, and it gives a chance to receive renal transplantation and have a healthy child. To our knowledge, this is the first report that has described the successful management of open heart surgery under hemodialysis, subsequent renal transplantation and pregnancy in a female patient with chronic renal failure.

Adult↗
PubMed1992

Novel positive inotropic agents: synthesis and biological activities of 6-(3-amino-2-hydroxypropoxy)-2(1H)-quinolinone derivatives.

A series of 6-(3-amino-2-hydroxypropoxy)-2(1H)-quinolinones has been synthesized and evaluated for positive inotropic activity on the canine heart. Some of these derivatives have a potent activity with none or negative chronotropic effect in isolated, blood-perfused dog heart preparations. They also display a high selectivity for positive inotropic effect over chronotropic and vasodilatory effects in anesthetized dogs. (+/-)-6-[2-Hydroxy-3-[(3-methoxybenzyl)amino]propoxy]-2(1H)-quinolinone (39) and (+/-)-6-[3-(3,4-dimethoxybenzyl)amino]-2-hydroxypropoxy]-2 (1H)-quinolinone (40) were further investigated in conscious dogs. After iv administration, they did not affect heart rate or mean blood pressure at the dose producing a 50% increase in the peak of the first derivative of the left ventricular pressure. The compounds (39, OPC-18750, and 40, OPC-18790) are the most promising agents with desirable biological activities, and now are currently undergoing clinical evaluation.

Animals↗
PubMed1992

Outcome of patients with lung cancer detected via mass screening as compared to those presenting with symptoms.

We performed lung cancer resection in 721 patients between 1980 and 1989. Cancers were detected via mass screening programs by annual chest X-ray examination in the majority of cases. We evaluated the surgical results in patients with tumors detected by mass screening and compared them to those in whom the malignancy was detected by symptoms. Lesions in the mass screened group were T1 to T2 tumors in 90% of the cases, and NO in 73%. Stage I disease accounted for 65.3% in the mass screened group. The overall 5-year survival rate was 56.2% in the mass screened group, which was significantly better than the 25.3% for the symptom group (P less than 0.001). The surgical results in the lung cancer cases detected by the mass screening program had better results than the cases who presented with symptoms.

Aged↗
PubMed1992

Transsternal thoracotomy for bilateral pulmonary metastasis.

Advances in the surgical treatment of primary malignancies and the recent chemotherapy have led to an expansion of the surgical treatment of metastatic lung tumors. However, multiple pulmonary metastases are often found and may affect both lungs. It is difficult to reach tumors in the posterior parts of the lung when using a common midsternal approach, especially lesions located in the left lower lobe. We performed transsternal simultaneous bilateral thoracotomy on 10 patients with bilateral lung tumors (9 bilateral metastatic pulmonary tumors and 1 bilateral primary lung cancer). This procedure provides a wide operative field and is an effective method of thoracotomy for patients with bilateral lung tumors. In future, this method should be more actively performed for patients in whom it is indicated.

Adolescent↗
PubMed1992

The use of a biventricular assist device for postcardiotomy profound biventricular failure.

A 58-year-old woman who could not be weaned from cardiopulmonary bypass was treated with a biventricular assist device (BVAD) using a centrifugal pump for the left side and a pneumatic pulsatile pump for the right side. At the initiation of the BVAD support, predominant right ventricular failure was recognized and therefore weaning was begun from the left side. The left ventricular assist device was discontinued after 87 h and the patient was finally weaned from the right ventricular assist device after 205 h. Despite the complete recovery of cardiac function, the patient developed renal failure followed by an intractable infection and died of multiple organ failure on the 59th postoperative day (POD).

Aortic Valve↗