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Biomedical subjects

T Hiranaka

Publications and source records attributed to T Hiranaka.

At least 37 records · Page 2Linked to original sources
PubMed1990

[A case report of traumatic transection of the aortic arch].

A 16-year-old male, who sustained a blunt chest trauma in a traffic accident, was brought into the emergency room in an unconscious state, with an initial systolic blood pressure of 80 mmHg. He was found to have multiple fractures and a flail chest. The initial roentgenogram of the chest showed widening of the mediastinum. An emergency aortogram demonstrated intimal flap and aneurysmal dilatation of the aortic arch. Because of a coexisting severe contusion of the lung, operation was postponed until 15 days after admission. He was successfully treated by direct repair under profound hypothermia and circulatory arrest, which was induced by surface cooling in combination with ECC. Postoperatively he did well and 23 days after the operation, surgical repair of femoral and humeral fractures was performed by orthopedists.

Adolescent↗
PubMed1989

[Acute massive mediastinal hemorrhage three weeks after mitral valve replacement in a patient with systemic lupus erythematosus].

Systemic lupus erythematosus (SLE) is one of the most common autoimmune diseases and patients suffering from this disease often died of massive hemorrhage. We report the case of a patient who died of acute massive hemorrhage three weeks after mitral valve replacement. The patient, a 42 year-old woman, had been diagnosed as having valvular heart disease at the age of 10. She underwent mitral commissurotomy at the ages of 18 and 32. SLE was diagnosed 8 years previously and corticosteroid therapy was initiated. The patient was experiencing exertional dyspnea again 1 year ago and mitral valve replacement was performed for recurrent stenosis. The postoperative course seemed to be uneventful, but on the 21st postoperative day, acute massive mediastinal hemorrhage occurred, and the patient eventually died of septicemia. Massive hemorrhage in SLE patients usually occur in the central nervous system or alimentary tract. However, bleeding can occur anywhere, so great care must be taken in regulating anticoagulant therapy.

Adult↗
PubMed1988

Assessment of warfarin therapy under full dose using indium-111 platelet scintigraphy in patients with intracardiac thrombi.

Twenty patients in whom intracardiac thrombi were detected by indium-111 platelet scintigraphy (the first platelet scintigraphy) were prospectively studied to examine the effect of warfarin therapy under full dose on the intracardiac thrombogenicity. Eleven patients (group I) who received 2-6 mg/day of warfarin and 9 patients (group II) who did not receive warfarin had the second platelet scintigraphies 14-71 days after the first platelet scintigraphies. In group I, 10 platelet scintigraphies became negative and one remained positive for intracardiac thrombi after administration of warfarin, while in group II 8 platelet scintigraphies remained positive and only one changed to negative. The incidence of negative image at the second platelet scintigraphy was significantly lower in group II than that in group I. In group I, the degree of accumulation of platelets onto the surface of the thrombus (%IE), showed significant reduction (0.69 +/- 0.48 to 0.11 +/- 0.21) after warfarin therapy, while in group II %IE at the second scintigraphy (1.07 +/- 1.03) were not significantly different from those at the first scintigraphy (1.13 +/- 0.79). These results indicated that warfarin therapy under full dose inhibited the deposition of platelets on the intracardiac thrombi and thrombogenicity in the patients with intracardiac thrombi which were detected by indium-111 platelet scintigraphy.

Adult↗
PubMed1987

[Behavior of left ventricular filling after left ventricular aneurysmectomy: evaluation by pulsed Doppler echocardiography].

The pattern of diastolic flow velocity was studied using pulsed Doppler echocardiography to evaluate postoperative left ventricular (LV) diastolic function in patients who underwent left ventricular aneurysmectomy. This study involved 16 patients who experienced ischemic heart disease from January 1985 to April 1986. The patients were categorized in two groups; the aneurysm group comprised by seven patients undergoing aneurysmectomy, and the bypass group which included nine patients undergoing only coronary artery bypass grafting. Pulsed Doppler studies were performed five to 22 days before, and at an average of 12 days after surgery. Preoperative cardiac catheterization and cineangiography were performed and, myocardial infarct size was estimated by the Wagner's method. Using pulsed Doppler echocardiography, LV filling dynamics were assessed by the peak velocity in the rapid filling phase (R), the peak velocity in the atrial contraction phase (A), and the ratio of A to R (A/R ratio) of the mitral flow velocity pattern. All data were average in five consecutive beats. 1. The estimated myocardial infarct size (%MI) in both groups before surgery was 38.5% in the aneurysm group and 32.5% in the bypass group, and there was no significant difference between these groups. 2. The preoperative cardiac index (2.9 in the aneurysm group vs 2.8 1/min/m2 in the bypass group), left ventricular end-diastolic pressure (16.1 vs 17.3 mmHg), and left ventricular ejection fraction (0.43 vs 0.36) were not significantly different between the two groups. 3. The preoperative A/R ratio was 1.5 in the aneurysm group and this was significantly higher than that of the bypass group (1.2).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Long-term results in surgical treatment of children 4 years old or younger with coronary involvement due to Kawasaki disease.

Problems in myocardial revascularization for coronary impairment due to Kawasaki disease were assessed in five patients 1 to 4 years old. Each patient had significant stenosis or complete obstruction with aneurysm formation. There were no operative or late deaths in the follow-up period of 1 to 10 years after operation. The coronary arteries, including the first diagonal branch and obtuse marginal branch, were 1 to 1.5 mm in diameter. Eight saphenous vein grafts used were 2.5 to 3.5 mm in diameter and the internal mammary arteries used in two patients, ages 2 and 4 years, were 1 mm in diameter. All nine grafts examined in the early postoperative period were patent. However, only three of eight saphenous vein grafts were patent in the late postoperative studies. One saphenous vein graft to the right coronary artery was found patent 7 years after surgery in a patient who had been operated on at the age of 3 years. Internal mammary artery grafts used in the last two patients in the series were both patent throughout the late postoperative period. This experience suggests that myocardial revascularization is surgically feasible and beneficial even in young children and that further study is warranted.

Child, Preschool↗