Biomedical subjects
Publications and source records attributed to T Asada.
A case of aqueduct stenosis in an adult with several depressive episodes and the clinical features of delusional depression is presented. The patient complained of a strange feeling in the throat. She also had had several falls with loss of consciousness. The relationship between aqueduct stenosis and diencephalic dysfunction is discussed.
We examined the morphological changes in gastric mucosa and the generation of ammonia after exposure of the rat stomach to urea in the presence of urease, in attempts to investigate a pathophysiological role of urea, urease, and ammonia system in gastric ulcer diseases. Exposure of the stomach for 20 min to 2 ml urea (0.025-0.2%) together with urease (100 IU) induced histological damages in a concentration-related manner. Either urea or urease alone did not induce any histological change in the mucosa. Instillation of urea into the stomach generated ammonia in the presence of urease; the amount of ammonia was increased depending on the concentration of urea, and was closely associated with the severity of histological damage. The exposure of the stomach to ammonia (NH4OH: 0.01-0.1%) also produced histological damages in the gastric mucosa in a concentration-related manner. The characteristics of injury induced by 0.5-1.0% ammonia were stasis of microcirculation, disruption of the surface epithelial cells, and necrosis of the mucosa. These results demonstrated that ammonia generated from the hydrolysis of urea by urease in the stomach causes damages in the gastric mucosa.
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Whether a giant left atrium in mitral valve disease itself prolongs postoperative respiratory care or does not is an important problem. We investigated it in 39 patients who underwent MVR without plication of the left atrium. A giant left atrium (GLA) was defined when CT-LA volume exceeded 300 ml by rapid sequential CT or left atrial diameter exceeded 60 mm by echocardiography. According to this criteria, the 39 patients were divided into two groups: 18 patients of GLA group and 21 of non-GLA group. Eight GLA (44%) and 11 non-GLA patients (52%) needed postoperative respiratory care with intratracheal intubation for more than 24 hours. Four GLA (22%) and 2 non-GLA patients (9.5%) needed reintubation. There was no significant difference between the two groups concerning the duration of postoperative respiratory care and the frequency of reintubation. The reintubated patients had three prominent preoperative clinical profiles, such as poor general condition, poor cardiac function and poor respiratory function. Consequently, it is concluded that in mitral valve disease with a GLA the prolongation of postoperative respiratory care is largely due to poor cardiac and respiratory function rather than to the compression to the bronchus by a GLA.
A 17-year-old male patient with Marfan syndrome was admitted due to recurrent bilateral pneumothorax which had recurred totally 11 times during the past 3 years. For the treatment of obstinately continuing right pneumothorax resection of bullae in combination with pleuropexy using OK 432 was effective. Two months thereafter Bentall operation with a composite graft consisting of a woven Dacron tube and a Björk-Shiley 27 mm aortic valve prosthesis was performed for his anuloartic ectasia. Left pneumothorax recurred 2 weeks after Bentall operation. But it was treated successfully with OK 432 injection into the left pleural cavity. Now, he is doing well as a student.
From September 1983 to February 1987, 45 consecutive aortic valve operations were performed using the retrograde continuous cold blood cardioplegia (RCCBC) via the coronary sinus. Except one patient died of stuck valve after aortic and mitral valve replacements, 44 patients were subjected for this study and all survived patients were symptomatically improved. They were divided into two groups according to the aortic cross clamps time (ACCT). Group 1; 23 patients, ACCT within 120 minutes, and Group 2; 21 patients, ACCT exceeding 120 minutes. After the operation blood was taken periodically to check creatine phosphokinase (CPK) and its iso-enzyme creatine-kinase (CK-MB) and GOT etc. Then their levels were compared between the two groups. Although there seemed to be a tendency that the highest levels of these enzymes increase according to the ACCT, there was no significant difference in CK-MB level between the two groups. Judging from the operative results and the postoperative study of enzymatic level, RCCBC is safe and useful for aortic valve surgery, especially when long ACCT is necessary for correcting complicated lesions or when the coronary orifice is not suitable for coronary perfusion in aortic dissection.
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Forty biological units of Kallikrein were administered intramuscularly to nine persons suffering from multi-infarct dementia. With automatic analysis equipment, the wave-form recognition method was used to analyze EEG before injection, immediately after injection, and 30, 60, 90, and 120 minutes after injection. The results of analysis done the five times after injection were then compared with the analysis results before injection. With the passage of time after injection, delta and theta waves showed a gradually decreasing tendency, while alpha and beta waves showed a gradual increase. It was inferred that these changes in the EEG were caused by an increase in the flow of cerebral blood, which in turn was the effect of the dilatation of cerebral blood vessels resulting from the action of the Kallikrein.
It has been postulated that an accumulation of a sulfhydryl-containing amino acid, homocysteine in plasma may induce arteriosclerosis. In order to explore a possible contribution of homocysteine to the development of cerebral infarction in middle-aged and elderly patients, plasma sulfhydryl-containing amino acid profiles of 45 patients with cerebral infarction (CI) were compared with those of 45 normotensive and 45 hypertensive controls, and 20 patients with cerebral bleeding (CB), of similar ages and sex. The concentrations of both free and total homocysteine in plasma were highest in patients with CI among the 4 groups, while plasma free and total cysteinylglycine levels were similar. Although both free and total cysteine levels were also higher in patients with CI than in normotensive controls, the total homocysteine/total cysteine ratio was highest in patients with CI among the four groups. The hypertensive controls had higher plasma free and total concentrations than normotensive controls, but the levels did not differ between the 21 normotensive and 24 hypertensive CI patients. Our results suggest that high levels of plasma homocysteine in conjunction with hypertension could be one of the risk factors for arteriosclerotic CI.
We studied the effect of body position on gastric emptying of solid food using a sulfamethizole capsule food method developed by us. Gastric emptying was significantly delayed in a supine position than in a sitting position kept for 120 minutes after ingestion of test food. These findings were observed in all of the young, middle and old aged groups. A longer sitting position after ingestion was associated with faster gastric emptying. Gastric emptying was significantly delayed in the old aged group than in the young aged group in both sitting and supine positions. Our results indicate that a postprandial sitting position is desirable for gastric digestion and emptying of solid food, especially in the old aged subjects.
A 75-year-old woman developed general fatigue and left chest pain in October 1986, and Chest CT showed DeBakey IIIb dissecting aneurysm. During the next 8 months, she repeated abdominal pain, tarry stool and subcutaneous hemorrhage for three times and after an angiography large hematoma at puncture site appeared. The laboratory data showed the decrease in platelet and fibrinogen and the increase in FDP every time when she developed the symptoms. Because this bleeding tendency was thought to be the "local DIC" caused by dissecting aneurysm, we performed thromboexclusion on July 27, 1987. Immediately after the operation, 60 packs of platelet and 3 g of fibrinogen was transfused, then laboratory data remarkably improved and bleeding tendency disappeared. The patient died 12 days after the operation of sudden ventricular tachycardia. At autopsy, precise cause of death was not determined, but the purpose of thromboexclusion seemed to be achieved, because good thrombus formation was observed in the descending aorta and the graft was patent.
From September 1987 to January 1989, we performed 7 consecutive Bentall operations using a modified technique for the coronary artery to graft anastomosis with a satisfactory result. Six patients with annuloaortic ectasia and one with type 1 aortic dissection underwent the operation. After suturing a composite graft to the aortic annulus, side-holes about 8 mm in diameter were made in the graft at points corresponding to the coronary ostia. Then the graft was cut longitudinally on the side of the non-coronary cusp so as to make operative procedure easier. Four buttressed mattress sutures of 4-0 polypropylene thread were placed in the aortic wall around the coronary ostia and connected to the corresponding part of the graft. These threads were tied and then used for running sutures from inside of the graft. Even in a case where the coronary ostium was close to the aortic annulus, this procedure permitted easy and secure accessibility. Additionally, retrograde continuous cold blood cardioplegia via the coronary sinus made Bentall procedure easier and safer. Postoperative angiography revealed no stenosis or deformity of the coronary artery and no leakage from the suture line. All patients are doing well in NYHA functional class I.
We studied the effect of press stimulation applied to the back skin on gastric emptying and serum gastrin response to solid food in healthy subjects. Although gastric emptying and serum gastrin response were significantly suppressed by press stimulation of T6-9 dermatomes corresponding to the spinal levels which sympathetic outflow to the stomach arise, they were not affected by press stimulation of T10-L1 dermatomes. Plasma levels of ACTH, epinephrine and norepinephrine, which usually increase by stresses acting on the brain, did not change by press stimulation of T6-10 dermatomes. These results suggest that press stimulation applied to the back skin of T6-9 dermatomes suppress gastric emptying and gastrin response to solid food mainly through the spinal cord.
We have developed a simple but reliable method for assessing gastric emptying, a sulfamethizole capsule food method. The capsule food contains egg albumin and sulfamethizole. In saline or hydrochloride solution only a small amount of sulfamethizole, in sodium bicarbonate solution, however, a large amount of the drug was released from the capsule food. In this method, sulfamethizole concentrations in blood were measured in subjects after ingestion of 15 pieces of capsule food containing 1.0 g of sulfamethizole, and area under the curve of the blood concentrations was calculated as an index of gastric emptying. Gastric emptying of capsule food had a lag phase of 15 minutes, which was already reported in gastric emptying of radioisotope labeled solid food. Bread combined with the capsule food caused a delay in gastric emptying and a larger volume of the bread was associated with a longer gastric emptying time. In conclusion, our sulfamethizole capsule food method is useful in clinical practice to assess gastric emptying of solid food.
We successfully performed a concomitant operation in a patient with severe valvular heart disease with a giant left atrium and a pulmonary cancer. The operation was done via a median sternotomy under cardiopulmonary bypass. The patient was a 62-year-old man with congestive heart failure, NYHA class III. The CT ratio was 76%, and the volume of the left atrium estimated by a CT scan was above 900 ml. An abnormal shadow was recognized in the left upper lung field. Mitral valve replacement with St. Jude Medical valve (31 mm), and tricuspid annuloplasty with a Bex Reducer were performed. After an autonomous cardiac rhythm and a decrease in the size of the left atrium were confirmed, we went on to remove the upper lobe of the left lung under cardiopulmonary bypass. Twelve months postoperatively, the patient was doing well. For a complex case such as the present one, we recommend lobectomy via a median sternotomy using cardiopulmonary bypass as the technique of choice. This method assures good hemodynamic control and provides improved visibility of the pulmonary hilus.
The distribution of cefuzonam (CZON) was studied in 20 adults undergoing open heart surgery. In groups I (n = 11) and II (n = 9). CZON (2g) was intravenously infused at the time of induction of anesthesia; and in group II an additional 2 g was administered at the time of commencement of extracorporeal circulation (ECC). Just prior to and following the ECC, samples of blood and right auricle were taken for examination. CZON concentrations in serum and myocardium were measured using the thin-layer cup method with Esherichia coli NIHJ as the test organism. CZON concentrations in myocardium prior to ECC were 48.9 micrograms/g and 39.0 micrograms/g for groups I and II, respectively. The ratios of intramyocardial to serum CZON concentration were 0.40 and 0.45 for groups I and II, respectively, revealing no significant difference between the 2 groups. Following ECC, intramyocardial CZON concentrations were 20.8 micrograms/g for group I and 33.2 micrograms/g for group II; while the ratios were 0.43 and 0.59 for groups I and II, respectively. Again, there were no significant differences. From the above findings it may be concluded that: 1. There was good distribution of CZON in myocardium, with a concentration well above MIC80. 2. Therapeutic concentrations of CZON were maintained in myocardium for 6 hours, suggesting that initial infusion of 2 g CZON is sufficient for prophylaxis in routine open heart surgery.
We report on an 18-year-old man with a right atrial myxoma complicated by widespread pulmonary infarction. Under cardiopulmonary bypass, a typical gelatin-like myxoma of 65 g in weight and the segments of pulmonary infarction were simultaneously removed. From the excised lung specimens, pulmonary tissue infarction caused by myxoma acting as a blocker was recognized. This was a very rare case of myxoma complicated by pulmonary infarction, and we report here the successful removal of the right myxoma and partial pneumonectomy.
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