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Biomedical subjects

T Sakurada

Publications and source records attributed to T Sakurada.

At least 73 records · Page 4Linked to original sources
PubMed1998

Long-term thrombosis after transvenous permanent pacemaker implantation.

To assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis after long-term transvenous permanent pacemaker implantation, venograms were performed in 100 consecutive patients at the elective replacement of the pacemaker. Mean follow-up period after initial transvenous permanent pacemaker implantation was 6.0 years. The venograms demonstrated normal in 77 patients. The remaining 23 venograms showed venous stenosis in 11 patients and total obstruction in 12 patients. Twenty-one of these 23 patients had venous collateral circulation. No difference was found in the incidence of venous abnormalities according to the route of entry, the lead insulation, the total number of the implanted leads, and anticoagulant and antiaggregant drugs. All these patients have remained asymptomatic. In conclusion, the incidence of venous thrombosis after long-term transvenous pacing is 23% and the causes of venous thrombosis may be endothelial trauma and underlying venous stenosis. As this article describes a retrospective limited study, we cannot find the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis formation after transvenous permanent pacemaker implantation. Further prospective study will be needed to assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs.

Aged↗
PubMed1998

Surgical treatment of the coronary artery to pulmonary artery fistulas in adults.

Coronary artery to pulmonary artery fistula (CA-PAF) is a rare congenital anomaly. The purpose of this retrospective study was to analyze 11 adult patients with CA-PAFs treated surgically, and to evaluate the surgical management and long-term results. There were no surgical deaths and all patients survived the follow-up periods (mean 7.2 years). All symptomatic patients improved their New York Heart Association functional class. As surgical correction is safe and effective, with good long-term results, all the patients with CA-PAF in adults can be candidates for surgery to prevent life-threatening complications.

Adult↗
PubMed1998

Comparison of opioid activity between a N-terminal tetrapeptide analogue of dermorphin, H-Tyr-D-Arg-Phe-beta-Ala-OH and morphine.

The antinociceptive properties of dermorphin tetrapeptide analog, H-Tyr-D-Arg-Phe-beta-Ala-OH (TDAPA) were compared with morphine in mice. In the tail-pressure test, subcutaneously (s.c.) injected TDAPA and morphine produced significant antinociceptive activity. Pretreatment with naloxonazine (35 mg/kg, s.c., 24 h before testing) significantly antagonized the activity induced by TDAPA, but not morphine. The ED50 values of TDAPA changed from 0.39 mg/kg to 1.7 mg/kg by naloxonazine pretreatment In the formalin test, both TDAPA and morphine exhibited dose-related antinociceptive activity with ED50 values of 0.49 mg/kg and 2.5 mg/kg, respectively. Both drug activities were significantly antagonized by naloxonazine. These results indicate different mechanisms of action for TDAPA and morphine, suggesting TDAPA is highly selective for the mu 1-opioid receptor and may be clinically useful.

Analgesics, Opioid↗
PubMed1998

[Total aortic arch replacement for distal aortic arch aneurysms].

Between January 1991 to April 1997, 13 consecutive patients underwent the total aortic arch replacement for distal aortic arch aneurysms. The operation was performed through the median sternotomy and the cardiopulmonary bypass was instituted with the cannulation of ascending aorta for arterial perfusion and of right atrium for venous return. Then the aortic arch was totally replaced with four limbed artificial graft with the aid of selective cerebral perfusion and open distal anastomosis of the distal end of the aneurysm. The mortality was 16% (2 patients) and these cases had ruptured aneurysm and had deep shock preoperatively. There were no severe cerebral complication. Total aortic arch replacement would be the acceptable procedure for the distal aortic arch aneurysm and antegrade ascending aortic perfusion was useful method to avoid the thromboembolic attack due to the retrograde femoral perfusion.

Aged↗
PubMed1998

[Minimally invasive direct coronary artery bypass grafting (MIDCAB) for multivessel disease in a 86 year-old patient].

An 86-year-old male underwent minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass, for severe triple-vessel coronary disease. Left descending coronary artery was anastomosed with the in situ left internal thoracic artery through a limited anterior thoracotomy, and right coronary artery was anastomosed with the in situ right gastroepiploic artery through a small upper laparotomy. The postoperative angiography showed patent grafts, and the patient has been doing well without any complications. MIDCAB is a useful technique even for multivessel coronary diseases in selected cases.

Aged↗
PubMed1998

Emergency coronary artery bypass grafting after acute myocardial infarction. What influences early postoperative mortality?

Although short- and long-term outcomes after elective coronary artery bypass grafting (CABG) has improved, emergency CABG after acute myocardial infarction (AMI) does not always bring satisfactory prognosis. In this report, early postoperative and follow-up results were studied. Furthermore, variables related to hospital mortality were explored. From among 186 patients who underwent CABG, 18 patients formed the basis of this research. This series included 16 males and 2 females, with a mean age of 65.3 years old. Hospital mortality of the patients was 38.9%, and actual survival rate of all the patients 5 years after CABG was 55.6%. Factors that predicted hospital mortality in those patients included increased age and preoperative cardiogenic shock. There was no difference in hospital mortality between the patients operated on with only saphenous vein (SV) and those operated on in combination with SV and internal thoracic artery (ITA). In emergency CABG, cardiogenic shock before surgery was most likely to influence hospital mortality. Therefore, an appropriate circulatory support system should be applied to improve hemodynamic status before bypass surgery.

Adolescent↗
PubMed1998

[A case of painless Standford type A acute aortic dissection complicating acute occlusion of the right subclavian artery].

We reported about a rare case of painless Stanford type A acute aortic dissection with the only complaints being numbness and paleness in the right arm. A 68-year-old male who hed been treated in another hospital under the diagnosis of acute occlusion of the right subclavian artery was referred to our hospital because of severe heart failure and shock. After being admitted to our hospital, the patient was diagnosed as Standford type A acute aortic dissection with transesophageal echocardiography and underwent an emergency graft replacement of the ascending aorta and total aortic arch. The postoperative course was uneventful and the patient was discharged without any complications.

Acute Disease↗
PubMed1998

[The early results of the minimally invasive direct coronary artery bypass (MIDCAB)].

The clinical experiences of 29 consecutive MIDCAB procedures performed at our institution between October, 1996, and October, 1997, were analyzed. Preoperative patient's characteristics were as follows; LAD single vessel disease: 25, double vessel disease: 1, triple vessel disease: 1, RC single vessel disease: 1, LMT lesion: 1, concomitant procedures: 2 (ASO: 1, AAA: 1). LITA harvesting was performed using the video-assisted thoracoscopy in initial 4 patients, and in last 10 patients we used the specially designed retractor THORALIFT (Autosuture Co., Ltd.) for harvesting LITA by direct vision. LAD was stabilized mechanically using the stabilizer when we performed the anastomosis in last 10 patients to enhance the quality of the anastomosis. The patency rate was 96%, but there were two patients (6%) who had the stenosis of the anastomosis site. Coronary artery occlusion time was 13.2 minutes in the mean. We also studied the hemodynamics of blood flow in LITA grafts with the aid of 7.5 MHz transthoracic duplex imaging in these MIDCAB patients and compared with the LITA grafts in conventional CABG performed in same periods. There were no statistical differences between the two groups about the graft flow and velocity. We conclude that MIDCAB would be an alternative procedure that can be performed with low risk and acceptable early results in selected patients.

Aged↗
PubMed1998

[A case of Poland's syndrome with giant bulla resected by using autologous fascia lata].

We reported a case of giant bulla with Poland's syndrome, only left pectoral major and minor muscles defect. A 58-year-old man was admitted to our hospital with shortness of breath on exertion. Computed tomographic scan revealed right giant bulla in emphysematous lung. The giant bulla was resected by linear stapler with autologous fascia lata. Though minor air leakage persisted for 5 postoperative days, the postoperative course was uneventful. It could be effective to reinforce staple line by using autologous fascia lata in emphysematous bulla without any infectious problem.

Fascia Lata↗
PubMed1998

Emergency coronary artery bypass grafting after left coronary artery rupture: a case report.

Coronary artery rupture has been known as one of the complications of coronary balloon angioplasty. In this report, we describe a case of coronary artery rupture, who underwent emergency surgery for hemostasis and coronary revascularization. A 67-year-old-male with frequent angina attacks was admitted to our institution for possible coronary angioplasty. Coronary angiogram showed diffuse disease of the mid left anterior descending artery (LAD), with two 90% stenosis. Conventional balloon angioplasty was performed, however, coronary artery rupture occurred while the stent was expanded with a 3.5 mm balloon catheter. Though pericardial drainage improved his hemodynamic state, subsequent coronary angiogram revealed leakage of contrast medium. Emergency surgery was determined at this point for hemostasis and revascularization of the LAD. The revascularization was completed with the left internal thoracic artery (LITA) to the LAD. On the contrary, since the epicardial hemorrhage around the proximal LAD did not spread any further after systemic heparinization, the epicardial surface was covered with a piece of oxidazed cellulose and fibrin glue. After the surgery, the hemodynamic state improved gradually. Postoperative coronary angiogram revealed an aneurysm of the LAD, as well as excellent LITA-LAD patency.

Aged↗
PubMed1998

Comparison of effect of [D-Arg2,Sar4]-dermorphin (1-4) and morphine on mouse small intestinal transit and electrically evoked contraction of guinea pig ileum.

[D-Arg2,Sar4]-dermorphin (1-4) [DAS-DER (1-4)] was compared with morphine for the capacity to affect mouse gastrointestinal transit and electrically evoked contractions of the guinea pig ileum (GPI). A single subcutaneous injection with DAS-DER (1-4) and morphine dose-dependently inhibited gastrointestinal transit of charcoal in mice. DAS-DER (1-4) with ID50 of 0.053 mg/kg was 26 times more potent than morphine with ID50 of 1.38 mg/kg. The inhibitory effects of DAS-DER (1-4) and morphine were completely inhibited by pretreatment with 1 mg/kg naloxone, an opioid receptor antagonist. The GPI contraction was inhibited by DAS-DER (1-4) with an IC50 of 6.9 +/- 0.7 nM and morphine with an IC50 of 295.0 +/- 11.8 nM, respectively. These effects were also inhibited by preincubation with naloxone. Repeated subcutaneous injections of DAS-DER (1-4) and morphine to guinea pigs produced tolerance to the inhibitory effect on electrically evoked contractions of GPI. Moreover, a marked cross tolerance was seen in guinea pigs made tolerant to DAS-DER (1-4) or morphine. The present study indicates that pharmacological profiles of DAS-DER (1-4) as assayed by the gastrointestinal transit and stimulated contractions of the GPI were almost similar to that of morphine.

Analgesics, Opioid↗
PubMed1998

[Minimally invasive direct coronary artery bypass grafting (MIDCAB) for re-operation in a 85 year-old patient].

An 85-year-old male, who had undergone aorto-coronary bypass grafting to left anterior descending coronary artery (LAD) using saphenous vein graft (SVG) seventeen years before, was operated with minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass. LAD was anastomosed with the in situ left internal thoracic artery through a limited anterior thoracotomy. The postoperative angiography showed patent graft, and the patient has been doing well without any complications. MIDCAB is a useful technique even for re-operation of coronary diseases in selected cases.

Aged↗
PubMed1998

[The long-term results of surgical treatment for acute type A aortic dissection].

Between 1992 and 1996, 31 patients with acute type A aortic dissection underwent the surgical treatment on an emergency basis. The overall early mortality rate was 12.3% (4 patients), and the overall 5-year survival rate (calculated by Kaplan-Meier method) was 76.9% respectively. Although there is controversy about the operative procedure whether the aortic arch should be replaced or not in aortic arch dissection in which the primary intimal tear is located at or extends into the arch, the resection of the aortic arch tear and simultaneous arch repair with graft replacement of the ascending aorta would be the acceptable procedure in the long term period with the recent improvement of adjunct technique for the prevention of cerebral ischemia and heart protection. The composite graft replacement of the aortic root is also indicated in patients with acute dissection associated with annuloaortic ectasia or Marfan's syndrome and severely destroyed aortic root with the extension of dissection to the aortic root with acceptable mortality and survival rate in the early and late period.

Aortic Dissection↗
PubMed1998

[Successful surgical treatment for severe mitral valve annulus enlargement and mitral regurgitation 5 years after aortic root replacement in Marfan syndrome: a case report].

Major cardiovascular lesions associated with Marfan syndrome include aortic diseases such as aortic root dilatation and mitral disease. If untreated, cardiovascular manifestations of the Marfan syndrome cause death in one half of patients during the first four decades of life. Although aortic diseases in the Marfan syndrome are responsible for most of serious morbidity and mortality, 60-80% of patients with Marfan syndrome have mitral valve dysfunction. The results of surgical treatment for aortic diseases in Marfan patients have recently shown significant improvement. However, there is no acceptable consensus about the timing and the technique of surgical intervention for mitral diseases. Especially mitral valve diseases is the most common cause of morbidity and mortality in infants with the Marfan syndrome. We report herein a case of Marfan syndrome (21-year-old female) who had undergone two operations for aortic root dilatation five years before she underwent the surgical treatment for progressive heart failure due to severe mitral annulus enlargement and mitral regurgitation.

Adult↗
PubMed1998

Cardiac surgery using only autologous blood for a patient with hereditary spherocytosis: a case report.

A 50-year-old man was admitted to our hospital for possible surgery. Echocardiogram showed severe calcification of the aortic valve, and cardiac catheter examination recorded a gradient greater than 150 mmHg across the valve. These results determined aortic valve replacement (AVR) to relieve the pressure-overloaded ventricle. Preoperative evaluations however, demonstrated anemia derived from hereditary spherocytosis (HS), an inherited hemolytic disorder. In order to avoid homologous blood transfusion, the following strategies were tried; 1) an iron supplement and an injection of recombinant human erythropoietin (rHuEPO); 2) pre- and perioperative autologous blood transfusion; and 3) an aggressive iron supplement just after the surgery. These raised the blood hemoglobin concentration to the criterion where autologous blood donation was started, and maintained the hemoglobin level stable, up to his discharge. In conclusion, bloodless cardiac surgery is possible for cases with anemia, and some strategies should be tried to raise and maintain the blood hemoglobin concentration well.

Aortic Valve↗
PubMed1997

Cancer cells isolated from malignant pleural and peritoneal effusions inhibit phospholipase A2 activity in human polymorphonuclear leukocytes.

We studied the influence of cancer cells on the LTB4 production by human polymorphonuclear leukocytes (PMN). The cancer cells were isolated from malignant pleural effusion specimens taken from two patients or from a peritoneal effusion specimen of one patient. While human PMN produced LTB4 following stimulation with A23187, the addition of cancer cells inhibited LTB4, 5-HETE and 12-HETE production by PMN in a cell number-dependent manner, while the cancer cell lines also showed a similar inhibition. The addition of lysate of the breast cancer cells also inhibited in a dose-dependent manner the production of LTB4 by PMN following stimulation with A23187. The addition of arachidonic acid completely reversed the inhibition of PMN-LTB4 production by the addition of the breast cancer cell lysates, thus suggesting inhibition at the phospholipase A2 level. The addition of this lysate to the partially purified human cytosolic PLA2 also inhibited the PLA2 activity. In contrast, the addition of lymphoma cells isolated from metastatic lymphnodes did not inhibit the LTB4 production from PMN. Since LTB4 is one of the important chemotactic factors for PMN and monocytes, these findings suggest that the inhibition of the PLA2 activity by the cancer cells thus results in a reduced production of LTB4 from PMN and contributes to a predisposition to develop severe infection in patients with advanced cancer.

Ascitic Fluid↗