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Biomedical subjects

T Ichihara

Publications and source records attributed to T Ichihara.

At least 109 records · Page 6Linked to original sources
PubMed1994

[A successful surgical case of supravalvular aortic stenosis with Williams syndrome: the investigations of the procedures].

We experienced a successful surgical case in which a 3-year-old boy with a characteristic elfin face, heart murmur, and mental retardation, underwent extended patch aortoplasty using equine pericardium for congenital supravalvular aortic stenosis. The aortography performed before operation, and demonstrated diffuse stenosis just above the aortic valve, which was a typical hour-glass type. The preoperative peak systolic pressure gradient between the left ventricle and ascending aorta was 120 mmHg, and was improved postoperatively. In this procedure only one cusp was incised, resulting in no deformity of the aortic valve and no obstruction of coronary arteries. In conclusion this method was excellent for the diffuse type of supravalvular aortic stenosis.

Abnormalities, Multiple↗
PubMed1994

[Left thoracotomy for reoperative coronary artery bypass procedures].

We report a case of 50-year-old male underwent reoperative coronary artery bypass grafting (CABG) through the left thoracotomy. He had undergone primary CABG with a saphenous vein graft to the left anterior descending coronary artery (LAD) to revascularize the left main trunk lesion a year ago, which was occluded, and recurred angina. The second operation was performed through the left thoracotomy under the the hypothermic cardiopulmonary bypass. The left internal thoracic artery was anastomosed to LAD, and a new saphenous vein was anastomosed to the descending aorta proximally, and to the left circumflex artery distally, under a hypothermic circulatory arrest (9 minutes and 8 minutes for each anastomosis). He recovered well without any major complications, and postoperative angiogram showed two new grafts patent.

Anastomosis, Surgical↗
PubMed1994

Successful peritransplant therapy in children with active hepatosplenic candidiasis.

Two pediatric leukemic patients with hepatosplenic candidiasis during multidrug antileukemic chemotherapy successfully underwent bone marrow transplantation (BMT) after aggressive antifungal chemotherapy employing fluconazole and amphotericin B with or without splenectomy. One patient received allogeneic marrow graft and the other received an autologous graft. One patient has been disease-free for more than 21 months after BMT without any recurrence of Candida infection. The other patient showed tentative reactivation of hepatic lesions just after BMT by CT scanning, but these lesions disappeared again by continuous administration of the antifungal agents. The second patient died of leukemia relapse without recurrence of fungal infection. Our cases indicate the possibility of successful BMT once a fungal infection is well controlled by antifungal chemotherapy and surgical resection.

Amphotericin B↗
PubMed1994

[The effects of a leukocyte removal filter during cold blood cardioplegia].

During myocardial ischemia neutrophils and platelets exert negative effects on the myocardium. We used a leukocyte removal filter during cardioplegia and investigated it's effect on myocardial damage during reperfusion. Plasma levels of the granulocyte components, the platelet components, and cardiac enzyme (CK-MB) were evaluated in 14 patients undergoing cardiopulmonary bypass. Blood samples were drawn directly from the coronary sinus before aortic cross clamping and 1, 5, and 15 minutes after unclamping. The group which had the filter in the cardioplegic route to eliminate the neutrophils and platelets showed better results than the group without the filter on cardiac enzyme and lipid peroxidation (LPO). In conclusion the application of the filter during cold blood cardioplegia effectively on enzymatically reduces myocardial damage during reperfusion.

Aged↗
PubMed1994

[A case underwent separate operation for AAE, AR and TAA using elephant trunk method].

A 20-year-old man with Marfan syndrome was recommended emergency operation for impending rupture of TAA. Because he was in the state of acute heart failure due to coexisting AAE and AR, so the simultaneous operations for AAE, AR and TAA were needed. He underwent Bentall, arch replacement and elephant trunk operation utilizing separate extracorporeal circulation and circulatory arrest. Chest CT, taken after 5 months postoperatively, revealed only a small amount of thrombus in TAA. Anticoagulation therapy stood in the way of aneurysmal thrombo-exclusion. The second operation, grafting of descending thoracic aorta, was performed 6 months later and elephant trunk made the second operation easier. Now 12 months passed after the second operation, he is in good health.

Adult↗
PubMed1994

[Experimental study on the etiology of ischemic colitis].

A reliable experimental model for ischemic colitis in rat could be obtained by ligating the marginal vessels of the colon 3 days after attaching the ring to induce partial colon obstruction. This model has the advantage of enabling to observe the chronic progress and the organ of the sideration to clarify the cause of ischemic colitis. The decrease of blood flow within the colonic mucosa continued up to 7 days after ligation in rat with partial obstruction, while no apparent abnormal changes were observed, and the previous level for several hours in the rats with out attaching the ring. This fact proved that the RT group is in a state easily developing sideration due to the sustained partial colon obstruction. The reactant reacting with thiobarbituric acid (TBA) was found to increase, in particular, 6 or more hours after ligation of vessels. A superoxide scavenger, liposomal-encapsulated superoxide dismutase (1-SOD) suppressed development of the ischemic lesion. The change in free radicals is therefore, considered to be involved in the occurrence of ischemic colitis.

Animals↗
PubMed1994

[A case report of ruptured dissecting aneurysm with thrombosed false lumen].

A successful surgical repair was experienced for a 75 year old female patient with ruptured dissecting aneurysm at the descending aorta. She presented with severe chest pain and advancing anemia. CT scan showed haemorrhage from the descending aorta into the pleural cavity. Diffused and circumferrential thickening of the descending aorta was shown but those area was not enhanced by dye injection. An "ulcer like formation" was shown at the descending aorta by aortogram done before surgery. Surgical repair was done subsequently by left thoracotomy with cardiopulmonary bypass. Only a small intimal wall leakage at the bottom of the crater with size of 20 mm and organized (old) thrombi were seen by intraoperative observation. Other part of intima was thickened but had no damage. Replacement was done for the descending aorta by 8 cm length with woven dacron graft successfully. Microscopic finding of resected aortic tissue showed severe atherosclerotic change. In this case, dissection was initiated from the part of crater which had most severe degeneration by atherosclerotic change and oozing started there, too. Atherosclerotic change, dissection, and oozing rupture were occurred at the same part in this patient, which is quite instructive.

Aged↗
PubMed1993

Expression of blood group-related antigens in normal and malignant pancreatic tissue correlated with genotype of the patient defined by saliva glycoprotein.

BACKGROUND: Seven murine monoclonal antibodies (MoAb) detecting blood group antigens of the Lewis system and their sialylated derivatives were used to define their immunohistochemical distribution in normal and malignant pancreatic tissues. The specific blood group antigens studied included Lewis(a) (Le(a)), Lewisb (Leb), Lewisx (Le(x)), Lewis(y) (Le(y)), sialyl-Lewis(a) (s-Le(a)), sialyl-lacto-N-tetraose (s-LNT), and sialyl-Lewisx (s-Le(x)). METHODS: The expression of these antigens was analyzed by immunoperoxidase technique in pancreatic tissue of patients with (n = 27) and without (n = 19) pancreatic cancer. The genetic background of their secretor status and their Lewis phenotypes were determined by the enzyme-linked immunosorbent assay using purified salivary glycoprotein and MoAb against eight different blood group-related antigens (Le(a), Leb, Le(x), Le(y), H1, H2, A, B2), and the putative genotypes of the patients were classified as follows: SeLe, Sele, seLe, and sele. RESULTS: The following results were obtained: (1) In normal pancreas, Le(a), s-Le(a), s-LNT, and s-Le(x) were expressed in ducts, but their expression was restricted to the luminal side of the cytoplasm (cytoplasmic type with positive polarity). Leb and Le(y) showed similar patterns of expression in ducts and some parts of the acinus. In contrast, Le(x) was absent in most cases. (2) Expression of Leb was observed in normal pancreatic ducts in all 46 patients, regardless of their genotypes. Le(a) and s-Le(a) were not expressed in specimens from patients with the seLe and sele saliva phenotypes. (3) In pancreatic cancer, the following antigens were expressed cytoplasmically in the proportion of cases indicated: Le(a) (78%), Leb (85%), Le(x) (33%), Le(y) (44%), s-Le(a) (78%), s-LNT (89%), and s-Le(x) (85%). They also were detected in the surrounding stroma. This pattern of expression is distinct from that found in normal pancreatic tissue. Patients with Sele and sele genotypes did not express Le(a) or s-Le(a), except in one case. (4) Serum levels of carbohydrate antigen 19-9 (CA 19-9) were not elevated in patients with pancreatic cancer with the Sele and sele genotypes but were elevated in most patients with SeLe and seLe genotypes. CONCLUSION: The overall findings indicate that Lewis-related antigens act as pancreatic tissue-related antigens, depending in part on salivary phenotypes of the patient. With proper antigen selection and the determination of secretor status, these anti-blood group MoAb may be of clinical utility in the diagnosis of pancreatic cancer.

Antibodies, Monoclonal↗
PubMed1993

Compton scatter compensation using the triple-energy window method for single- and dual-isotope SPECT.

The spatial distribution of scattered photons varies depending on many factors such as object size and source distribution. We propose a triple-energy window (TEW) scatter compensation method for determining position-dependent Compton scatter. We estimated the count of primary photons at each pixel in the acquired image using the 24% main window centered at the photo peak energy and 3 keV scatter rejection windows on both sides of the main window. We conducted a physical evaluation of this method using phantoms and also applied this method to patients in a clinical trial. The TEW method performed Compton scatter compensation with good accuracy.

Gamma Cameras↗
PubMed1993

[Surgical results of postinfarction ventricular septal rupture].

Between 1981 and 1991, 17 consecutive patients underwent surgical repair of postinfarction ventricular septal rupture (VSR). 15 patients were operated upon during acute phase after the onset of VSR. Two patients were operated upon six weeks or more after the onset. Overall hospital mortality was 43% in the reviewed group. Our experience suggested that the number of the patients over 70 years of age increased and prevalence in VSR associated with the multivessel coronary artery disease was recognized. Despite improved surgical techniques and enhanced myocardial protection, our experience with surgical treatment of VSR was not as successful as we had hoped. Delay of operation is likely to produce hemodynamic instability and may increase operative mortality. In conclusion, the preoperative mechanical and pharmacological support should be performed, even if the patient is not so critically ill, and the earlier operation might lead to more favourable results in the surgery of the postmyocardial infarction ventricular septal rupture. In addition, preoperative coronary angiography for the precise evaluation of the coronary artery lesions might contribute to better results in the late phase of postoperative period.

Aged↗
PubMed1993

[An emergent surgical case of the traumatic mitral regurgitation due to complete rupture of the papillary muscles].

We present a case of an emergency operation on acute MR and cardiac rupture due to a blunt thoracic trauma. This 27-year-old male suffered a severe blow to the chest when his motorcycle crashed to a tree. He was brought to this hospital by ambulance. On admission, the patient was in shock due to hypotension. Echocardiogram revealed cardiac tamponade and MR of grade 3/4. Pericardial drainage was performed immediately and his condition improved. Systolic pressure of the pulmonary artery was high at 70 mmHg which measured by Swan Ganz catheter. Isolated cardiac injury was diagnosed based on the results of various tests. A sign of acute pulmonary edema progressively deteriolated, therefore, emergent operation was performed on the same day. As cardiac fissure lesions were confirmed under cardiopulmonary bypass, we repaired the inferior side of the left ventricle and then closely examined the mitral valve. Both anterior and posterior papillary muscles were completely torn, so we immediately commenced with procedures to, replace a prosthetic valve. No complication were encountered, and the postoperative course was good. Complete ruptures of the papillary muscles due to trauma is rarely reported. We believe this case is exceptionally uncommon and worthy of reporting.

Accidents, Traffic↗
PubMed1993

[Safe and accurate coronary artery bypass grafting: combined use with single aortic clamp and retrograde coronary perfusion].

Neurological injury following myocardial revascularization may result from embolization of atheromatous debris from clamping the diseased aorta. The hazards of manipulating and clamping the aorta has been reported in some literatures. The proximal anastomoses with partial occluding clamp is conventional technique, but it may cause neurological injury, aortic tear or traumatic laceration. We developed a technique for coronary bypass grafting with single aortic cross clamp and combined antegrade/retrograde infusion of cardioplegia. Our method allows accurate performance of the proximal anastomosis without partial clamping and adequate protection of myocardium.

Aorta↗
PubMed1993

[Two successful surgical cases of total left anomalous pulmonary venous connection with intact atrial septum--a report on their operative procedures and approaches].

Partial anomalous pulmonary venous connection (PAPVC) is often associated with other congenital heart diseases. Atrial septal defect, particularly, appears in about ninety percent of patients with PAPVC. Successful repairs were made in two patients of total left PAPVC with intact atrial septum. In one patient, left thoracotomy was made, and the vertical vein was anastomosed to the left atrial appendage. Cardiopulmonary bypass was not used in this case. In the other patient, median sternotomy was made, and the vertical vein was anastomosed to the posterior wall of the left atrium under cardiopulmonary bypass. Although postoperative prognosis are excellent sofar in both cases. We consider that the latter operative procedures are preferable for PAPVC not associated with atrial septal defect. In the present paper, the detailed operative procedures and approaches for these two cases are reported, and the concerning literatures are discussed.

Adult↗