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Biomedical subjects

T Ohtsuka

Publications and source records attributed to T Ohtsuka.

At least 73 records · Page 4Linked to original sources
PubMed2000

Hypertrophic obstructive cardiomyopathy associated with mitral regurgitation due to infective endocarditis.

A 25-year-old woman treated for hypertrophic obstructive cardiomyopathy and suffering from mitral regurgitation due to infective endocarditis was referred to our department for surgery. Preoperative examinations revealed asymmetric septal hypertrophy, a large left ventricular outflow gradient (100 mmHg), and perforation of the anterior mitral leaflet resulting in severe mitral regurgitation. The entire mitral complex was resected and septal myectomy conducted to dilate the left ventricle. A bioprosthetic valve was then implanted. Although postoperative heart failure was severe, cardiac function has gradually recovered. The left ventricular outflow gradient has decreased to 8 mmHg, the diastolic left ventricular diameter has increased from 26 to 30 mm, and her New York Heart Association classification has improved from IV to I.

Adult↗
PubMed2000

Predictive risk factors for delayed extubation in patients undergoing coronary artery bypass grafting.

Prolonged mechanical ventilation increases hospitalization costs, airway and lung trauma, and stress. The objective of this study was to elucidate patient characteristics and operative variables that predict delayed extubation in patients undergoing coronary artery bypass grafting (CABG). The records of 167 patients who underwent CABG between 1994 and 1998 were examined retrospectively. The patients were divided into early and delayed extubation groups. Putative factors affecting the duration of intubation were included in a univariate analysis using the t-test and chi-squared test. A logistic regression model was then developed to determine the factors associated with delayed extubation. Forty-four percent of the patients needed prolonged mechanical ventilation (more than 24h). Univariate predictors of delayed extubation (P < 0.05) were emergency surgery, preoperative use of an intra-aortic balloon pump (IABP), the duration of anesthesia, surgery, cardiopulmonary bypass and aortic cross-clamping, the total volume of fentanyl. lowest rectal temperature, glucose level, perioperative transfusion, bleeding, perioperative heart failure, perioperative insertion of IABP, postoperative transfusion, cardiac index, inspired oxygen fraction (FiO2), arterial oxygen tension (PaO2), the PaO2/FiO2 ratio, and the volume of catecholamine. In the delayed extubation group, the intensive care unit stay was significantly longer (P < 0.001) and re-exploration was required more frequently (P = 0.004). Excellent prediction was provided by a model consisting of six variables: age, duration of surgery, perioperative heart failure, glucose level, postoperative transfusion, and the PaO2/FiO2 ratio. These results suggest that decreasing the cardiopulmonary bypass time, maintaining a low glucose level during cardiopulmonary bypass, and ensuring adequate perioperative hemostasis may help to avoid pulmonary dysfunction and delayed extubation. Moreover, the PaO2/FiO2 ratio may be a useful predictor of delayed extubation in patients undergoing CABG.

Aged↗
PubMed2000

Right heart bypass for left circumflex coronary artery bypass grafting.

Displacement of the heart to expose the left circumflex artery (LCX) causes hemodynamic disturbance during off-pump coronary artery bypass grafting (CABG). We applied right heart bypass (RHB) using a heparin-coated centrifugal pump without an oxygenator in an attempt to stabilize the hemodynamics. Five mongrel dogs (15.5-20 kg) were used. Hemodynamic parameters were continuously monitored at a fixed rate of 80 beats/min. The LCX was exposed with the use of an Octopus Tissue Stabilizer. After baseline data were obtained, each dog was placed in the Trendelenburg position. Finally, RHB was established with different pump flows. LCX exposure caused a significant decrease in aortic flow (to 33.1% +/- 13.1% of the baseline value) and arterial mean pressure (to 68.3% +/- 8.5%) (P < 0.001). Trendelenburg positioning caused these values to recover to 57.1% +/- 6.7% and 72.5% +/- 7.7%, respectively. RHB with 50% flow significantly improved the hemodynamic values, although 100% flow significantly increased LAP by 134.8% +/- 19.7% (P < 0.01). Tilting of the canine heart to expose the LCX caused significant deterioration of the hemodynamic values. Trendelenburg positioning was moderately effective, and RHB very effective, in improving the hemodynamics. In a limited number of cases, an appropriate flow of RHB may provide safe hemodynamic assistance during off-pump CABG of the LCX.

Animals↗
PubMed2000

Simultaneous analysis of [3H]-thymidine uptake and alpha 1(I) procollagen mRNA expression in systemic sclerosis skin fibroblasts--an in situ hybridization study.

Heterogeneity of DNA synthesis and collagen synthesis has been reported in skin fibroblasts from systemic sclerosis (SSc) patients. The uptake of [3H]-thymidine and expression of alpha 1(I) procollagen mRNA by cultured skin fibroblasts from four normal controls and four SSc patients was analyzed simultaneously. The grains overlying the cytoplasm representing alpha 1(I) procollagen mRNA and overlying the nucleus representing [3H]-thymidine uptake were counted using computer-aided image analysis. The results were analyzed statistically. Procollagen mRNA expression by SSc fibroblasts was significantly greater than by control fibroblasts (P < 0.01). The distribution curve of [3H]-thymidine uptake showed two peaks representing low- and high-uptake cells. Significantly more SSc fibroblasts than control fibroblasts showed high [3H]-thymidine uptake (P < 0.05). The number of SSc fibroblasts expressing low amounts of alpha 1(I) procollagen mRNA was significantly lower than the number of control fibroblasts (P < 0.05). [3H]-thymidine uptake by SSc fibroblasts expressing high amounts of alpha 1(I) procollagen mRNA was significantly lower than by those expressing low amounts (P < 0.05). These results indicate that elevated DNA synthesis and elevated collagen mRNA synthesis in SSc skin fibroblasts are due to different clones with high DNA-synthesizing ability and high collagen-producing ability.

Aged↗
PubMed2000

New instrumentation for video-assisted anterior spine release.

Endoscopic surgery in the area of orthopedics has been evolving, particularly in spine surgery. We describe the clinical outcome of thoracoscopic anterior spine release using new instruments. A harmonic scalpel (HS) with a 5-mm hook dissector was used to dissect the spine and rib and to coagulate and transect the vascular bundles. A rib dissector and resector were used for excision of the rib to be implanted in the disk spaces. We treated scoliosis in four patients (three male, one female) with a mean age of 19.5 +/- 4.5 years and thoracolumbar kyphosis in a 16-year-old male patient. A mean number of 6.5 +/- 2.5 vertebrae with scoliosis and four vertebrae with kyphosis were released. In all cases, division of the vascular bundle and exposure of the spine were completed using only the HS, and excision of a rib segment was performed via a port incision using only the rib dissector and resector. The mean duration of thoracoscopic anterior release was 92 +/- 28 min. Blood loss was minimal during and after surgery. Thoracoscopic anterior spine release can be facilitated by the new instruments described above.

Adolescent↗
PubMed2000

Ultrasonic coagulator for video-assisted internal mammary artery harvest.

BACKGROUND: The Harmonic Scalpel (HS; Ethicon Endo-Surgery, Cincinnati, OH, USA) is an ultrasonic coagulator that generates less heat than electrocautery. We compared canine internal mammary arteries (IMAs) harvested using the HS or electrocautery and reviewed the early clinical outcome after thoracoscopic IMA takedown with the HS. METHODS: Using HS and bipolar electrocautery (BE), 51 and 49 IMA branches, respectively, in six mongrel dogs were divided. The divided branches were subjected to a pressure tolerance test. The impact of coagulation on the main trunk was investigated microscopically. Thoracoscopic IMA harvesting with the HS was performed in 41 patients. Seven human IMA segments including 10 branches were examined microscopically. Postoperative angiography of 40 IMA grafts (97.6%) was performed. RESULTS: All the IMA branches withstood intraluminal pressures up to 250 mmHg. With BE, coagulation reached the adventitia of the main trunk in six segments (12.2%), but the HS caused no injury. Thoracoscopic IMA harvesting with excellent hemostasis was achieved using only the HS in all 41 patients. The main trunks of the human IMA segments were microscopically intact, and postoperative angiography demonstrated that the IMA grafts were intact. CONCLUSION: The HS appears to be a reliable coagulator for thoracoscopic IMA harvesting with minimal damage.

Animals↗
PubMed2000

Minimal damage during endoscopic latissimus dorsi muscle mobilization with the harmonic scalpel.

BACKGROUND: To reduce wound-related complications, a video-assisted surgical technique has been adopted for the mobilization of the latissimus dorsi muscle. We postulated that thermal damage to the muscle might be minimized by using a Harmonic Scalpel instead of electrocautery during this procedure. METHODS: Canine latissimus dorsi muscles were mobilized through a small incision, assisted by a videoscope. In 6 dogs, dissection with electrocautery was used to mobilize the latissimus dorsi muscle. In 6 other dogs, the Harmonic Scalpel was used. We compared operation times, wound infection rates, histologic changes in the muscles, and ease of handling between these groups. RESULTS: The operation time was significantly shorter in the Harmonic Scalpel group than in the electrocautery group (61.5 versus 106.5 minutes, p = 0.00014). The Harmonic Scalpel caused less histologic damage to the mobilized muscles and produced less vision-obscuring smoke. CONCLUSIONS: The Harmonic Scalpel shortens the operation, minimizes muscle damage, and facilitates the performance of video-assisted latissimus dorsi muscle mobilization.

Animals↗
PubMed2000

Three-dimensional computed tomography for reoperative minimally invasive coronary artery bypass.

We have been using three-dimensional computed tomography (3-D CT) in reoperative coronary artery bypass grafting performed by using a minimally invasive approach. Preoperative 3-D CT scanning can provide beneficial anatomical information about old patent grafts as well as the internal thoracic artery. Thus a mini-thoracotomy can be created at an optimal site, leaving the old graft untouched, and the length of the harvested internal thoracic artery, necessary for the bypass, can be assessed using this new modality.

Coronary Artery Bypass↗
PubMed2000

Minimally invasive limited pericardiectomy: the hybrid approach.

This communication describes our clinical experience with the hybrid method, a video-assisted anterior minithoracotomy approach developed for minimally invasive limited pericardiectomy to treat 8 patients with massive pericardial effusion. The average operating time was 37.2 minutes, and there was no procedure-related morbidity or mortality. The mean follow-up period was 5.6 months, and there have been no recurrences. The hybrid approach can be accomplished irrespective of pleural adhesions. It eliminates the need for hemipulmonary collapse, making it more advantageous than the totally port-access thoracoscopic approach.

Aged↗
PubMed2000

Thoracoscopic direct clipping of the thoracic duct for chylopericardium and chylothorax.

BACKGROUND: Chylothorax is a challenging clinical problem. Untreated, it carries a high mortality and morbidity. Traditional surgical management for cases refractory to conservative treatment is thoracic duct ligation through a right open thoracotomy. METHODS: We describe 4 patients treated successfully by video-assisted thoracic surgery, using ports and no thoracotomy, and precise ligation and division of the thoracic duct just above the diaphragm. A pericardial window was made in the patient with chylopericardium, as in the patient with end-stage renal disease. Pleurodesis was used in the patient with esophageal carcinoma and the patient with jugular and subclavian vein thrombosis. RESULTS: There were 2 women aged 18 and 42 years and 2 men, aged 61 and 65 years. No procedure-related mortality or morbidity occurred. In patients 1, 2, 3, and 4, the postoperative duration of drainage was 5, 7, 7, and 5 days, respectively (mean duration, 6 days) and the hospital stay, 5, 9, 10, and 5 days, respectively (mean stay, 7 days). There was no recurrence of chylothorax or chylopericardium during follow-up (range, 2 to 24 months; mean follow-up, 9 months). One patient died of esophageal carcinoma 4 months after operation. CONCLUSIONS: Video-assisted thoracic surgery without a thoracotomy is an effective way of treating chylothorax and carries minimal morbidity.

Adolescent↗
PubMed2000

Right heart mini-pump bypass for coronary artery bypass grafting: experimental study.

BACKGROUND: Visualization of the left circumflex arteries during off-pump coronary artery bypass grafting (CABG) causes hemodynamic disturbance. We investigated whether right heart mini-pump bypass (RHB), using a centrifugal pump, improved the safety of this procedure by studying the influences of different heart displacement positions, the Trendelenburg maneuver and RHB on hemodynamics. METHOD: Hemodynamic parameters in eight mongrel dogs (15.5-20 kg) were continuously monitored at a fixed heart rate of 80 beats/min through a conventional median sternotomy. The posterior descending artery (PDA) and left circumflex artery (LCX) were exposed using an Octopus tissue stabilizer. After evaluating the influence of the Trendelenburg maneuver on hemodynamics, a heparin-coated centrifugal pump without an oxygenator was introduced and the impact of different pump flow volumes was investigated during RHB. RESULTS: LCX exposure caused significant decreases in aortic flow (to 35. 1+/-12.8%) and arterial mean pressure (to 66.1+/-9.3%) compared with baseline (P<0.001). In contrast to PDA exposure, values remained significantly decreased during the Trendelenburg maneuver. On the contrary, RHB significantly improved the hemodynamic impairments caused by both heart displacement procedures, especially LCX exposure, although 100% pump flow significantly increased left atrial pressure to 131.3+/-19.5% (P<0.01). CONCLUSION: Exposure of the LCX caused severe hemodynamic deterioration, which was not fully reversed by the Trendelenburg maneuver. In contrast, RHB significantly improved hemodynamics, and therefore this technique can be beneficial for CABG of LCX in the limited cases.

Animals↗
PubMed2000

Substrate specificities of microbial transglutaminase for primary amines.

Transglutaminase (epsilon-glutaminyl-peptide:amine gamma-glutaminyl-transferase, EC 2.3.2.13) (TGase) is an enzyme that catalyzes acyl transfer reactions between primary amines and Gln residues in proteins and peptides. The substrate specificity of TGase for primary amines was investigated to incorporate various functional groups into proteins and peptides. In this study, microbial transglutaminase and guinea pig liver transglutaminase were used. For the primary amines to be incorporated into benzyloxycarbonyl-L-Gln-Gly (Z-Gln-Gly), they were required to have more than four carbon chains without side chains between the functional groups. These results suggest that with appropriate primary amines as spacers, various functional groups, carboxyl groups, phosphate groups, saccharides, and so on, can be incorporated into proteins by using TGase.

Amines↗
PubMed2000

Digital ulcers and necroses: novel manifestations of angiocentric lymphoma.

We describe a patient with angiocentric lymphoma whose presenting features were multiple areas of digital ulceration and necrosis, including deep ulcers on both great toes. He lacked the lateral halves of both earlobes because of multiple ulcers. Skin biopsy revealed a patchy and diffuse infiltrate of lymphoid cells with nuclear atypia in the dermis and subcutaneous tissue. Angiocentric and angiodestructive features of the lymphoid cells, a prominent histiocytic infiltrate and some epithelioid cell granulomas were found. The results of immunohistochemical staining showed a T-cell phenotype, and showed positive staining for apoptosis. He died in July 1999. Peripheral vascular disturbances including Raynaud's phenomenon, digital skin ulcers and necroses are novel clinical symptoms in patients with angiocentric lymphoma, which should be added to the differential diagnosis in patients with peripheral vascular disturbances.

Adult↗
PubMed2000

Importance of spatial activation of Cdc42 and rac small G proteins by frabin for microspike formation in MDCK cells.

BACKGROUND: Frabin is an actin filament (F-actin)-binding protein that shows GDP/GTP exchange activity for Cdc42 small G protein (Cdc42). Frabin furthermore induces indirect activation of Rac small G protein (Rac) in intact cells. We have recently shown that in nonepithelial cells, frabin induces the formation of both filopodia- and lamellipodia-like processes through the activation of Cdc42 and Rac, respectively. In epithelial cells such as MDCK cells, Cdc42 and Rac regulate cell-cell adherens junctions (AJs) via the accumulation of F-actin and E-cadherin, although neither Cdc42 nor Rac induces the formation of filopodia or lamellipodia. In this study, we have examined the effects of frabin on the reorganization of the actin cytoskeleton in MDCK cells. RESULTS: Frabin induces the formation of microspikes at the basal area of the lateral membranes through the activation of Cdc42 and Rac in MDCK cells, although a dominant active mutant of Cdc42 or Rac alone, or both, did not induce the formation of microspikes. Furthermore, frabin weakly increased the accumulation of F-actin and E-cadherin at cell-cell AJs and the formation of stress fibres through the activation of Cdc42 and Rac, under conditions where the dominant active mutant of Cdc42 or Rac markedly showed these effects. The Cdc42- and Rac-induced formation of stress fibres was dependent on the activation of Rho small G protein. CONCLUSION: These results indicate that the frabin-dependent spatial activation of Cdc42 and Rac is important for the formation of microspikes.

Actins↗
PubMed2000

Membrane-associated guanylate kinase with inverted orientation (MAGI)-1/brain angiogenesis inhibitor 1-associated protein (BAP1) as a scaffolding molecule for Rap small G protein GDP/GTP exchange protein at tight junctions.

BACKGROUND: Membrane-associated guanylate kinase (MAGUK) with inverted orientation (MAGI)-1/brain angiogenesis inhibitor 1-associated protein (BAP1), is a member of the MAGUK family that has multiple PDZ domains and interacts with many transmembrane proteins, including receptors and channels, through these domains. MAGI-1/BAP1 is ubiquitously expressed and localized at tight junctions in epithelial cells. It is an isoform of the neurone-specific synaptic scaffolding molecule (S-SCAM), which is known to interact with NMDA receptors and neuroligins. We have recently found that S-SCAM also interacts with a signalling molecule, a GDP/GTP exchange protein (GEP) that is specific for Rap1 small G protein, Rap GEP, which has also recently been referred to as RA-GEF/PDZ-GEFI/CNras-GEF. In this study, we have examined whether MAGI-1/BAP1 also interacts with and serves as a scaffolding molecule for Rap GEP at tight junctions in epithelial cells. RESULTS: MAGI-1/BAP1 similarly interacted with Rap GEP in cell-free and intact cell systems. A Northern blot analysis revealed that Rap GEP was expressed in most tissues examined. However, neither postsynaptic density (PSD)-95/synapse-associated protein (SAP) 90 (another member of the MAGUK family) nor SAP97/human discs-large tumour suppressor gene product (another ubiquitously expressed MAGUK localizing to adherens junctions in epithelial cells and the isoform of PSD-95/SAP90) interacted with Rap GEP. CONCLUSION: These results indicate that MAGI-1/BAP1 serves as a scaffolding molecule for Rap GEP at tight junctions in epithelial cells.

Adaptor Proteins, Signal Transducing↗
PubMed2000

Use of tactile stiffness to detect fatigue in the latissimus dorsi muscle.

In clinical settings, no method has been established to examine the fatigue of a latissimus dorsi muscle (LDM) preconditioned for cardiomyoplasty. We examined the feasibility of measuring muscle stiffness (tactile stiffness) to evaluate muscle fatigue in situ using our tactile sensor. We stimulated canine LDM with burst pacing and monitored both stiffness and tension to determine their relationship. In both dissected LDM and LDM in situ, the decrements of these parameters during burst pacing were compared between preconditioned and unconditioned LDM. In measurement in situ, the sensor probe was placed on the LDM through a small incision. Strong statistical correlation was shown between stiffness and tension (r = 0.935). In decrements of stiffness in situ, there were statistically significant differences between preconditioned and unconditioned LDM. Our tactile sensor system can provide an efficient method for evaluating fatigue of muscles in situ without measuring muscle tension.

Analysis of Variance↗
PubMed2000

Focal ductal branch dilatation on magnetic resonance cholangiopancreatography: a hint for early diagnosis of pancreatic carcinoma.

A 63-year-old man with a combination of early pancreatic carcinoma and an intraductal papillary adenoma was reported. A pancreatic cyst was detected by chance at the head of the pancreas by computed tomography for a follow-up study of early rectal carcinoma previously operated. Detailed studies by endoscopic retrograde pancreatography (ERP) showed irregular narrowing of the main pancreatic duct at the pancreatic body and magnetic resonance cholangiopancreatography (MRCP) revealed dilatation of ductal branches draining there. Brushing cytology of the pancreatic duct demonstrated cancer cells and total pancreatectomy was performed. Stepwise histo-pathological examinations of the specimen showed two foci of invasive carcinoma in the neck and body and multiple foci of severe dysplasia, some of which contained carcinoma in situ, in the body of the pancreas. The cystic tumor in the head of the pancreas was an intraductal papillary adenoma. In this case, the scrutiny of a pancreatic cyst including MRCP and ERP led to an early diagnosis of pancreatic cancer. Dilatation of ductal branches depicted by MRCP might be a new hint for early diagnosis of pancreatic carcinoma.

Adenoma↗