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Biomedical subjects

T Misaki

Publications and source records attributed to T Misaki.

At least 91 records · Page 5Linked to original sources
PubMed1997

[Minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass: a case report].

A new coronary artery bypass grafting of the left anterior descending coronary arteries (LAD) with in situ internal thoracic artery (ITA) bypass grafts through a limited anterior thoracotomy was performed in a 70-year-old [correction of 60] patient. The left ITA-LAD anastomosis was completed without cardiopulmonary bypass and postoperative angiography showed a patent anastomosis. With this minimally invasive approach, the procedure should provide the benefits of ITA grafting with rapid recovery short hospital stay without complication associated with cardiopulmonary bypass in selected cases.

Aged↗
PubMed1997

[Thoracoscopic cutting needle biopsy].

We presented a new method of percutaneous cutting needle biopsy under the thoracoscope. Percutaneous cutting needles for lung tumor have been abandoned because the risk of hemorrhage, death, and pneumothorax is much greater with these instruments than the computed tomographic guided needle aspiration. On the other hand, thoracoscopic stapled lung wedge resection is easy to obtain a good sample for any lung disease, but should be needed two or three staples, and waste a time, in the case following lobectomy was needed for malignancy. This thoracoscopic cutting needle biopsy was easy to obtain a specimen for the frozened section diagnosis. Under the view of thoracoscope, percutaneous cutting needle biopsy is safety, saving the cost for staples and easy to control the bleeding from the lung. The indication of this thoracoscopic cutting needle biopsy is the case that could not obtain the precise diagnosis by the preoperative biopsy and imaging diagnosis might be suspicious a malignant tumor.

Biopsy, Needle↗
PubMed1997

[Composite arterial conduits with internal thoracic artery and radial artery for a myocardial revascularization].

From April 1996 to December 1996, 15 patients were submitted to myocardial revascularization using composite arterial conduit with internal thoracic artery (ITA) and radial artery (RA). The age ranged from 51 to 76 years (mean age, 65.7 years); Forty patients were male. All patients had double or triple vessel disease or LMT disease. We used 28 arterial conduits including 15 left ITAs, 15 RA, 9 right gastroepiploic artery and one inferior epigastric artery. 15 RAs were anastomosed to LITAs and 15 composite arterial conduits were constructed (branched in 15). There was no operative deaths. Early postoperative angiographic controls demonstrated 93.3% (14/15) patency of composite grafts in 14 of 15 patients. The composite arterial graft using ITA and RA is feasible and the anastomoses so performed are completely safe.

Aged↗
PubMed1997

[A surgical case of aorto-pulmonary septal defect in a low weight neonate].

We report a surgical case of aorto-pulmonary septal defect (APSD) in a neonate weighing 1693 gm. A male twin baby delivered after 39 weeks and 5 days of gestational period was diagnosed as APSD. RAA, PFO and PLSVC by a echocardiography and a MRI. Because of the progressive cardiac failure, operation was performed under cardiopulmonary bypass and profound hypothermic circulatory arrest at 30 days of age and weighing 1693 gm. APSD was closed completely by a Dacron patch. Postoperative course was almost uneventful except for pulmonary hypertension crisis. He recovered without brain damage.

Aorta↗
PubMed1997

[Changes in neutrophil counts and lymphocytes subpopulations of a ECLS instituted patient].

A 4-year-old girl with tetoralogy of Fallot developed acute heart failure after ASD semiclosure. As drugs had no effect, ECLS was instituted. She gradually recovered from acute heart failure. ECLS was detached at 5 days after institution. Neutrocytopenia and lymphocytopenia became apparent during ECLS institution. The Subpopulations of T cell and NK cell decreased, and B cell subpopulation increased on the contrary during ECLS institution. This lymphocytopenia was caused by a decrease in T cell, especially CD4(+) cell numbers. It is necessary to minimize the potential for infection during ELCS institution.

Child, Preschool↗
PubMed1997

[A case of huge abscess extended from anterior neck to left lung and lateral chest wall].

62-year-old woman admitted our hospital with pain of left upper extremity from the left chest and dysphasia. Chest X-ray showed the huge mass shadow in the left lung field. Diabetes mellitus and inflammatory reaction such as high fervor, leukocytosis, CRP and ESR accentuation were recognized. Conservative therapy was done at first, but mass shadow on X-ray increased, and swelling appeared from the neck to the left lateral chest wall. And the same site appeared like subcutaneous emphysema. Computed Tomography showed mass shadow which was enlarged and spread in lung parenchyma and left chest wall with bubble image. Incision and open drainage was performed for the left chest wall but origin bacteria was detected in neither anaerobic nor aerobic culture of pus. Inflammation and mass shadow of left upper lung field have decreased gradually. The patient discharged without bronchoalveolar fistula. Abscess extending from the neck or chest wall with diabetes mellitus is very rare.

Abscess↗
PubMed1997

[Pathological examination of radial artery--as a graft material for coronary artery bypass grafting].

To evaluate the usefulness of the radial artery (RA) as a graft material for coronary artery bypass grafting (CABG), the histologic studies of the RA were performed. Specimens were obtained from both sides of 10 RAs during the operations. The degree of arteriosclerosis was evaluated by two methods. The one was microscopic examination by a pathologist, while the other was used by NIH Image 1.57 system. Using this system, the pathological index of arteriosclerotic change was expressed as a ratio (Rx: internal luminal area/tunica media area) of the cross section. From the pathological view the tunica media of RA was rich in smooth muscle cells and poor in elastic fiber. And there was little arteriosclerosis in this artery. The mean Rx of the proximal side of RA was 0.177 +/- 0.033 and that of the distal side was 0.258 +/- 0.132. There was no significant difference between the two, but the proximal side of the RA was slightly larger than the distal. These results showed that RA has a low grade of arteriosclerosis. This was confirmed on microscopic examination. According to these results, the RA can be expected to be a suitable bypass material for CABG.

Aged↗
PubMed1997

Timing and side effects of flumazenil for dental outpatients receiving intravenous sedation with midazolam.

We studied the timing and side effects of flumazenil treatment for 10 healthy volunteers and 46 dental outpatients who received intravenous sedation with midazolam. For the volunteers, vital signs were monitored before and after intravenous injection of midazolam and flumazenil. In addition, grip strength, signs and symptoms, and performance on the Romberg's test and addition tests were evaluated 30 min and 60 min after midazolam injection as well as after flumazenil injection. There were no significant changes in vital signs before, immediately after, or 50 min after injection of flumazenil, the latter time corresponding to the half-life of the drug. Thus, awakening from sedation was associated with no effects on the cardiovascular or respiratory systems. Distinct effects of flumazenil were demonstrated by the Romberg's test and the assessment of sedation status. Flumazenil had no effect on the outcome of the addition test. For the outpatients, sedation status and signs and symptoms were studied in patients undergoing procedures lasting 30 min or less (group S) and those undergoing procedures lasting 31 to 60 min (group L). Three patients in group S and one in group L had signs and symptoms of resedation. After treatment with flumazenil, abnormalities such as excitability and nausea were reported by only two patients in group L. One patient in group S had drowsiness that did not resolve after injection of flumazenil and continued until the following day. Our results indicate that flumazenil should be given at least 60 min after intravenous sedation with midazolam in dental outpatients. Moreover, caution should be exercised with regard to the potential side effects of flumazenil.

Adult↗
PubMed1997

Comparison of lidocaine with and without bupivacaine for local dental anesthesia.

The purpose of this study was to investigate the effectiveness of a combination of bupivacaine and lidocaine and that of lidocaine alone for local dental anesthesia. First, on different days, healthy volunteers were given 2% lidocaine with 1/80,000 epinephrine or 2% lidocaine with 1/80,000 epinephrine + 0.5% bupivacaine, after which pain was produced with a pulp tester. No difference was found in the time until onset of anesthetic effect between the preparations. However, the duration of anesthetic effect was longer with both lidocaine and bupivacaine than with lidocaine alone. Next, patients undergoing dental surgery were given one of the anesthetic preparations, after which serum concentrations of the anesthetics and epinephrine were measured. The maximal serum concentration of lidocaine was higher and was reached sooner after injection in patients receiving lidocaine alone (1.74 microgram/ml after 5 min) than in patients receiving both anesthetics (0.85 microgram/ml after 3 min). The mean maximal serum concentration of lidocaine was higher in patients receiving lidocaine alone (1.77 +/- 0.03 microgram/ml) than in those receiving both anesthetics (0.99 +/- 0.45 microgram/ml). Furthermore, the mean plasma concentration of epinephrine 1 min after injection was significantly higher in patients receiving lidocaine alone (0.671 ng/ml) than in patients receiving both lidocaine and bupivacaine (0.323 ng/ml). The results of this study suggest that the combination of lidocaine with epinephrine and bupivacaine produces lower systemic levels of the anesthetic and epinephrine and a longer duration of activity than lidocaine with epinephrine alone for local dental anesthesia.

Adolescent↗
PubMed1996

Successful treatment of Wolff-Parkinson-White syndrome with concomitant mitral stenosis by simultaneous surgery.

We report the case of a 61-year-old man with type B Wolff-Parkinson-White (WPW) syndrome associated with a right atrioventricular (AV) accessory pathway and concomitant mitral stenosis, who underwent successful operative treatment by simultaneous surgery. His preoperative course had been characterized by cardiac failure and repeated episodes of atrial tachyarrhythmia, in the form of fibrillation and flutter, which were difficult to control by conventional medication. Preoperative electrocardiograms (ECGs) had suggested that the accessory pathway was located in the right posterior to posteroseptal wall; however, at the time of surgery, epicardial electrophysiological mapping with sock electrodes revealed a preexcitation area in the AV groove at the lateral right margin of the heart. This discrepancy was thought to have been due to the presence of mitral stenosis or multiple accessory pathways. Thus, division and cryoablation of the accessory pathway by an endocardial approach, in addition to mitral valve replacement, were performed under cardiopulmonary bypass. His postoperative course was uneventful, and subsequent ECGs revealed that the delta waves had disappeared. The successful outcome of this patient demonstrates the effectiveness of simultaneous surgery for WPW syndrome associated with valvular disease.

Atrial Fibrillation↗
PubMed1996

A new technique of reinforced sternal closure.

A technique of reinforced sternal closure with stainless steel Kirschner wires is described. This technique is useful for patients with a fractured or friable sternum, or pectus excavatum.

Bone Wires↗
PubMed1996

Surgical therapy for Wolff-Parkinson-White syndrome in patients with bronchial asthma.

The surgical therapy for Wolff-Parkinson-White syndrome in patients with bronchial asthma was studied. Between 1974 and 1992, 447 patients with Wolff-Parkinson-White syndrome were treated, seven of whom had associated severe bronchial asthma. Supraventricular tachyarrhythmias were induced on occasion by bronchodilating agents such as beta-receptor agonists or theophylline preparations. High-dose steroids were required for acute bronchospasm in three patients, despite possibly leading to cardiac dysfunction. Beta-blockers therapy for Wolff-Parkinson-White syndrome can induce bronchospasm; in patients with Wolff-Parkinson-White syndrome and bronchial asthma, pharmacological agents used to treat one condition may exacerbate the other. Therefore, a non-pharmacological therapy was performed, namely surgical division of the accessory conduction pathway via an endocardial approach, in all seven asthmatic patients with Wolff-Parkinson- White syndrome. In all cases, division of the accessory conduction pathway resulted in disappearance of the delta wave, and there were no further tachyarrhythmias either at rest or after administration of bronchodilators. Since surgery, bronchial asthma has been effectively controlled with standard drug therapy in all patients. Non-pharmacological therapy is recommended for patients with Wolff-Parkinson-White syndrome and bronchial asthma.

Adolescent↗
PubMed1996

Clinical significance of measurements of antithyroid antibodies in the diagnosis of Hashimoto's thyroiditis: comparison with histological findings.

Measurements of antithyroglobulin and antimicrosomal (antiperoxidase) antibodies have been performed widely for the clinical diagnosis of autoimmune thyroid diseases. The present study was designed to compare these antibody titers with histological findings of the thyroid in patients with diffuse goiter who were suspected of having Hashimoto's thyroiditis. One hundred and ten euthyroid or hypothyroid patients (10 males and 100 females; age 48 +/- 15 (SD) years old) with diffuse goiter were studied for the measurement of antithyroglobulin and antimicrosomal or antiperoxidase antibodies by a hemagglutination technique (TGHA and MCHA, respectively) and by a newly developed radioassay (TgAb and TPOAb, respectively). The antibody titers were compared with the histological findings obtained by needle biopsy. TgAb, TPOAb, TGHA, and MCHA were detected in 80 (96.4%), 61 (73.5%), 37 (44.6%), and 54 (65.1%) of 83 patients with histologically proven Hashimoto's thyroiditis, respectively, but in only one (3.7%) of 27 patients without any inflammatory changes in the biopsy specimen. In 55 patients with negative TGHA and MCHA, the TgAb positivity was more closely associated with the histological diagnosis of Hashimoto's thyroiditis than the TPOAb positivity was, the incidence of each antibody in Hashimoto's thyroiditis being 89.7% (26/29) and 27.6% (8/29), respectively. In conclusion, the histological diagnosis of Hashimoto's thyroiditis can most precisely be predicted by the newly developed radioassay for TgAb.

Adolescent↗
PubMed1996

Serial occurrence of two types of postpartum thyroid disorders. Usefulness of Tc-99m pertechnetate uptake.

A 32-year-old woman with a history of Graves' disease had an episode of thyrotoxicosis 2.5 months after her first childbirth. Because of low thyroidal uptake of Tc-99m pertechnetate, a diagnosis of postpartum painless thyroiditis was made and the patient was observed without medication. After the normalization of serum levels of thyroid hormones, a second wave of thyrotoxic symptoms emerged. This time, the Tc-99m uptake was slightly elevated and the patient was diagnosed to have a relapse of Graves' disease. This case underscores the previously reported notion that thyroidal uptake was indispensable to distinguish these two causes of postpartum thyrotoxicosis.

Adult↗
PubMed1996

A new contact probe for intraoperative laser ablation.

Several clinical factors decrease the accuracy of intraoperative laser ablation. The distance to the target, the irradiation angle, and the media are reported among these factors. We developed a new laser probe to resolve these problems. This probe has a hollow conical tube with a tip covered by a thin film. Zero-degree centigrade saline was fed into this probe. Results from using the new probe were compared with those from the conventional noncontact irradiation method with cooling by sprinkled cooling water. In beating canine hearts, ventricles were irradiated with neodymium:yttrium aluminum garnet (Nd:YAG) lasers at 50-200 J/mm2. There was no difference in the mean volume of irradiated tissue between the new and the noncontact method. However, the distribution of volume values in the new method was smaller than that in the noncontact method (P < 0.05). In conclusion, results obtained indicate that this new probe could perform more accurate intraoperative ablation than the conventional method. Problems of stabilizing the distance to the target, the irradiation angle, and the media were resolved.

Animals↗
PubMed1996

Tumoricidal cytokines enhance radioiodine uptake in cultured thyroid cancer cells.

UNLABELLED: We explored whether the stimulation of iodine uptake by interferons seen in rat thyroid cell line is reproducible in human thyroid cancer and thus applicable to enhance the efficacy of radioiodine therapy. METHODS: Surgical specimens from 12 papillary and 2 follicular adenocarcinomas were minced and seeded in culture trays. After 14-16 days in a medium supplemented with 5% calf serum, we measured cellular uptake of 125I during a 40-min incubation period. RESULTS: In 8 of 12 papillary and all 2 follicular carcinomas, interferon-gamma significantly stimulated iodine incorporation. The four nonresponder tumors had lower basal iodine uptake and relatively less differentiation of histologic features. The effect was dose dependent (0-100 U/ml), and the average maximum increase in responding cases was 35.1% over basal values. Tumor necrosis factor-alpha alone did not alter uptake, but at 300 U/ml it further enhanced the effect of interferon-gamma in the two follicular tumors. In addition to the pure cytokines, supernatant from lymphocyte culture conditioned with a bacterial immunostimulator also boosted radioiodine trapping in thyroid cancer cells. CONCLUSION: These in vitro results warrant animal experiments to test potential usefulness of tumoricidal cytokines in radioiodine therapy.

Adenocarcinoma, Follicular↗
PubMed1996

[Video-assisted right pneumonectomy for small cell carcinoma].

We presented a case of video-assisted right pneumonectomy for small cell carcinoma. A 54-year-old male was admitted because of an abnormal shadow on a chest rentogenogram occasionally. The bronchoscopic biopsy revealed squamous cell carcinoma at the right intermediate bronchus. His magnetic resonance imaging demonstrated a 5-cm right hilar mass involving with right pulmonary artery. The operation was carried out by video-assisted thoracotomy with small lateral thoracotomy. Pathological findings revealed oat cell carcinoma with a subcarinal node involvement postoperatively. His postoperative course was uneventful. He received adjuvant chemotherapy and 60 Gy radiation in the mediastinum. He is alive 12 months after surgery without any evidence of recurrence. The advantages of the video-assisted thoracotomy were reported less postoperative pain and discharged earlier than the standard thoracotomy. Video-assisted pneumonectomy had not disturbed him in the adjuvant therapy for oat cell carcinoma.

Carcinoma, Small Cell↗