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Biomedical subjects

Y Imai

Publications and source records attributed to Y Imai.

At least 919 records · Page 51Linked to original sources
PubMed1990

[Longterm result of standardized patch infundibuloplasty and its application to conotruncal repair in tetralogy of Fallot].

Longterm result more than 10 years of standardized patch infundibuloplasty which had started in 1974 was reviewed. Thirty four cases were categorized into three groups. Group A: patch infundibuloplasty less than 45% of RV length. Group B: patch infundibuloplasty more than 45%, Group C: non-cusped transannular patch. Group B had longer patch infundibulolasty than group A and C. RV/LV pressure ratio of group C was higher than that of group A and B. There was no significant difference in CTR. However, when the cases with CTR more than 55% were precisely compared, enlarged CTR was related to high RV pressure and pulmonary regurgitation in group C while it might result from residual shunt in group A and B. Although longterm result of standardized patch infundibuloplasty was good, even small pressure and volume load in RV should be avoided as much as possible. Based on this longterm result, the conotruncal repair has been introduced and its better longterm result would be expected.

Adolescent↗
PubMed1990

[Anaphylactic shock following topical use of thrombin for irrigation of urinary bladder].

A 55-yr-old male with carcinoma of bladder received transurethral coagulation (TUC) under epidural anesthesia. A few min after the operation, he went into anaphylactic shock during irrigation of urinary bladder with thrombin solution. The symptoms were epigastralgia, circulatory collapse, skin rashes over the whole body and dyspnea. Oxygen inhalation and iv administration of epinephrine and steroid were performed, and his general condition improved within several hours. On the 2nd day after recovery from the anaphylactic shock, the patient received prick test on several agents which he had been given during operation. Prick test and RAST (radioallergosorbent test) on thrombin were positive. Based on our experience, thrombin may act to produce anaphylactic reaction. Although anaphylactic shock following topical thrombin is rare, we feel that thrombin should not be used without prick test.

Anaphylaxis↗
PubMed1990

[Surgical treatment of hypoplastic left heart syndrome: a successful case report].

A successful case of Norwood operation for a 5-day-old infant with hypoplastic left heart syndrome is reported. Norwood procedure and central shunting with a 4 mm PTFE tube was performed. Cerebral and coronary artery were perfused independently during reconstruction of aorta in order to shorten the time of circulatory arrest. Post operative UCG documented un-obstructive systemic output from the right ventricle, well regulated pulmonary arterial blood flow and widely patent interatrial communication. This baby was discharged the hospital 66 days after surgery. He has been clinically well for six month after the operation.

Anastomosis, Surgical↗
PubMed1990

Congenitally corrected transposition with normally positioned atria, straddling mitral valve, and isolated posterior atrioventricular node and bundle.

A heart is described with congenitally corrected transposition of the great arteries, normally positioned atria, and a straddling mitral valve. Instead of an anteriorly positioned atrioventricular node, a regularly positioned posterior node and bundle were observed. This observation has important clinical and surgical implications and underlines that close inspection of the alignment of atrial and ventricular septa during operations is mandatory.

Atrioventricular Node↗
PubMed1990

Septation and Fontan repair of univentricular atrioventricular connection.

From April 1986 to September 1988, 12 patients with double- or common-inlet left ventricle and left anterior rudimentary right ventricle underwent septation while 17 patients with double- or common-inlet left or right ventricle underwent the Fontan operation. In the septation group, three patients who had pressure gradients ranging from 10 to 85 mm Hg between the left ventricle and the aorta underwent enlargement of the outlet foramen, and all survived. One of the 12 patients had a common atrioventricular valve that was repaired by separating the atrioventricular valve by the procedure used for atrioventricular septal defect. One had complete heart block before septation and the other one had it after separation. One 17-year-old woman, who had the smallest left ventricle (168% of normal), died in the hospital (mortality, 8.3%). In the Fontan group, one patient who died in the hospital (5.9%) had high pulmonary resistance of 4.4 U/m2, and one late death (5.9%) occurred in a patient who had complete heart block and a high mean pulmonary arterial pressure of 20 mm Hg. Because of suprasystemic pressure in the pulmonary ventricle, two patients had immediate takedown of the septation repair and substitution of the Fontan repair. Although right atrial pressure was almost equal in both groups after operation, the cardiac index was significantly higher in the septation group than in the Fontan repair group (p less than 0.01). These data suggest that patients who are candidates for either septation or Fontan repair might fare better with septation.

Adolescent↗
PubMed1990

[Left ventricular function after Konno procedure for congenital aortic stenosis].

From February, 1984 to September, 1988, eighteen patients with congenital aortic stenosis underwent Konno procedure. There was no operative death, but one late death (5.6%). The annular diameter ranged from 9 mm to 23 mm (mean 15 mm). Preoperative left ventricular ejection fraction (LVEF) measured by cineangiography ranged from 0.59 to 0.92 (mean 0.77) and half of the patients had more than 0.80 of LVEF. Left ventricular function after the operation was evaluated at rest or during exercise by radionuclide ventriculography. Postoperative LVEF ranged from 0.59 to 0.89 (mean 0.75). Although there were no statistically significant changes between preoperative and postoperative LVEF, there was a trend that preoperative supernormal LVEF improved to normal after surgery. The response to exercise also improved in some cases after surgery. We concluded that Konno procedure can be safely undertaken with improvement of left ventricular function.

Adolescent↗
PubMed1990

[Two cases of Konno's operation for aortic stenosis developing after repair of interruption of the aortic arch with ventricular septal defect].

Two patients, 8-year-old and 7-year-old boys, underwent Konno's operation for left ventricular outflow tract obstruction, which had developed after the repair of interrupted aortic arch and ventricular septal defect. Both cases had bicuspid aortic valve and severe subaortic stenosis. The annular diameters were 15 mm and 16 mm, and pressure gradients between the left ventricle and the ascending aorta were 110 mmHg and 105 mmHg, respectively. A SJM prosthetic valve (23 mm, 25 mm) was used. Postoperative courses were good. Left ventricular outflow anomalies are frequently found in cases of interrupted aortic arch complicated with ventricular septal defect. The stenosis not infrequently develops and becomes apparent several years after primary or staged repair for interrupted arch with VSD as in the present cases. Therefore, careful observation should be carried out following the repair. Konno's operation can be safely performed for this lesion with low mortality and morbidity for valvular and subvalvular aortic stenosis even with small aortic ring.

Aorta, Thoracic↗
PubMed1990

[Semicircular annuloplasty in regurgitation of the systemic atrioventricular valve].

Semicircular annuloplasty was applied to 16 patients with congenital heart diseases with systemic atrioventricular valve regurgitation (congenital MR 4, ECD 4, Fontan 7, BWG 1). This annuloplasty was performed additionally after the conventional valvulocommissuroplasty. Regurgitation disappeared or was reduced in most of the cases and typical improvement was recognized in the congenital MR group. This procedure was able to be performed rapidly and was applicable to the various heart diseases with systemic atrioventricular valve regurgitation.

Adolescent↗
PubMed1990

Ten-year follow-up after valve replacement with the St. Jude Medical prosthesis in children.

Since 1979, 50 children, 4 months to 15 years of age, have successfully undergone cardiac valve replacement with the St. Jude Medical prosthesis (St. Jude Medical, Inc., St. Paul, Minn.). There were 24 boys and 26 girls. The valve replaced was mitral in 28 children, aortic in 15, mitral and aortic in 1, and mitral and tricuspid in 1. A left-sided tricuspid valve was replaced in 3 children. Anticoagulant therapy was maintained in all children; 40 children were treated with warfarin, whereas 10 children who underwent aortic or mitral valve replacement were on a regimen of aspirin combined with dipyridamole. The follow-up period, comprising 224 patient-years, ranged from 1 to 10 years. There were four valve-related complications: one from thromboembolism, two from valve thrombosis, and the other one from prosthetic valve endocarditis. Actuarial rate free from all valve-related complications at 10 years was 84.7%. There were four late deaths: one from valve thrombosis and the others from non-valve-related complications. Actuarial survival rate at 10 years was 90.8%. All surviving children are in functional class I, and no child so far has needed replacement of a prosthesis because of somatic growth. These results indicate that the St. Jude Medical prosthesis is a cardiac valve substitute of choice for valve replacement in children.

Actuarial Analysis↗
PubMed1990

Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan.

A total of 267 infants and children who underwent the arterial switch operation for transposition of the great arteries in the 6 years before Jan. 1, 1988 in six main Japanese institutions were entered into this review. The current status of patients surviving more than 1 year after the operation were evaluated along with early operative results. One hundred forty-six patients had an intact ventricular septum, 103 had a significant ventricular septal defect, and 18 had so-called Taussig-Bing anomaly of the transposition type. Eighteen patients were less than 28 days of age, 73 were 1 to 5 months of age, and 176 were older than 6 months of age at the time of operation. The overall mortality rate was 35% in the first 3 years and 12% in the more recent 3 years. There was a significant difference between the overall mortality rate of primary and two-stage repair (22% versus 10%, p = 0.047) in patients with intact ventricular septum. The overall mortality rate in patients with type B or C coronary arteries of Yacoub, and Radley-Smith's classification was significantly higher than that of other types of arteries (86% versus 18%, p = 0.0001). A total of 156 patients survived more than 1 year after the operation, and 44 children (28%) were noted to have supravalvular pulmonary stenosis (greater than 20 mm Hg). This complication was more common in patients operated on in the newborn period. Trivial or mild aortic regurgitation was noted in 29 patients (19%) and was more common in patients with two-stage than with primary repair (24% versus 14%). Aortic regurgitation was significantly more prevalent in patients in whom coronary arteries were implanted into slits or U-shaped defects than in those whose arteries were implanted into punched-out holes made on the pulmonary root (28% versus 8%, p = 0.049). Normal sinus rhythm was present in 97% of 154 patients and left ventricular ejection fraction was within the normal range in 97% of 115 patients at catheterization 1 to 5 months after the operation.

Aortic Valve Insufficiency↗
PubMed1990

Heterogeneity in lectin-binding characteristics of human lymphokine-activated killer cells.

The binding of various lectins to human lymphokine-activated killer (LAK) cells was investigated. Human peripheral blood lymphocytes were cultured for 3 days with recombinant interleukin-2 (rIL-2), and then stained with 20 kinds of lectins. There were four types of lectin-binding patterns: (a) negative staining; (b) weakly positive staining; (c) strongly positive staining; and (d) two populations, one weakly and one strongly positive staining. Among the 20 kinds of lectins, both Lens culinaris agglutinin (LCA) and Pisum sativum agglutinin (PSA) showed two peaks in the staining patterns on LAK cells (type 4). We separated these two populations of LAK cells by using a cell sorter, and assayed them for cytotoxic activity against 51Cr-labeled Hela cells. The LAK cells that were strongly stained by LCA or PSA [LCA (or PSA)-bright LAK cells] showed stronger cytotoxic activity than the LAK cells that were weakly stained by LCA or PSA [LCA (or PSA)-dull LAK cells]. Furthermore, we separated lymphocytes with LCA or PSA before culturing them with rIL-2 (LAK precursor), and we found that both LCA-bright and PSA-bright lymphocytes can develop into LAK cells with higher cytolytic activity. LCA-bright lymphocytes kept their ability to be stained strongly with LCA even after culture with rIL-2 for 3 days. Similarly, LCA-dull lymphocytes were still stained weakly after culture with rIL-2. Two-color assay of LAK cells revealed that 78% of NK (CD16+)-LAK cells and 46% of T (CD3+)-LAK cells were LCA-bright cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, CD↗
PubMed1990

[Surgical problems in d-TGA with VSD and PS associated with insertion of tricuspid valve chordae to the infundibular septum--the Rastelli operation by translocation of the infundibular septum].

Twelve (37.5%) out of 32 patients who underwent surgical repair of complete transposition of the great arteries (d-TGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS) from 1978 to 1987 had insertion of tricuspid valve (TV) chordae to the infundibular septum, i.e. superior margin of the VSD, which precluded the ordinary Rastelli type operation. Of these 12 patients early 5 patients (ages: 2-11 mean 7 years) underwent atrial switch operations with VSD closure and pulmonary valvotomy with or without fibromyotomy, and recent 6 patients (age: 4-8, mean 6 years) underwent the Rastelli operation (3 cases) or REV (3) by translocating the infundibular septum with TV chordae to the right ventricular side of the internal conduit. None died in hospital in the former group and 1 in the latter. Pulmonary/systemic ventricular peak pressure ration (Ppv/sv) was 0.75 +/- 0.22 (mean +/- standard deviation) in the atrial switch group v. 0.49 +/- 0.08 in the Rastelli/REV group 1 month postoperatively. The higher Ppv/rv in the atrial switch group was attributed to the pressure gradient across the pulmonary outflow tract, which was 37.8 +/- 16.6 mmHg in the atrial switch v. 16.7 +/- 4.2 mmHg in the Rastelli/REV (p less than 0.05). No pressure gradient was demonstrated between left ventricle (LV) and aorta in the both groups. Pulmonary wedge pressure was higher in the atrial switch group (13.8 +/- 1.9 mmHg) than in the Rastelli/REV (10.0 +/- 2.7 mmHg) (p less than 0.05). Systemic atrioventricular (AV) valve regurgitation was noted in 2 of the atrial switch group but none in the Rastelli/REV.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1990

[Radical correction of paracardiac type IIb of total anomalous pulmonary venous connection using pedicled flaps of right atrium and atrial septum].

Surgical results of total anomalous pulmonary venous connection (TAPVC) has been improved in recent years, however, late development of pulmonary venous obstruction was our concern in its total correction in early infancy. In the cardiac type of TAPVC, in which the pulmonary veins were connected to the right lateral wall, prosthetic patch is conventionally used in diversion of pulmonary venous flow into left atrium. It seemed favorable to repair this subset without using prosthesis. A 3-month-old female with TAPVCIIb according to Darling's classification underwent total correction on September 22th, 1988. Two pedicled flaps were developed using the right atrial wall and the atrial septum to create a pulmonary venous channel to divert arterial blood into left atrium and absorbable sutures were used throughout. Right atrium was entered through a vertical incision in its body and all the pulmonary veins were found in a recess in the lateral wall of the right atrium. Atrial septal defect in the cranial aspect of the fossa ovalis was enlarged by cutting the primum tissue along the right limbus and its caudal margin so as to form a pedicled flap attached to the left limbic tissue. Then the flap was sutured along the limbus to create a roof of the fossa ovalis. The second flap was made in the middle of the lateral atrial wall and was used to create a tunnel from the recess to the atrial septal defect. The defect in the right atrial wall was closed directly and no prosthetic patch was used. Postoperative course was uneventful and echocardiogram showed wide pulmonary venous channel draining into the left atrium.

Female↗
PubMed1989

Synthesis and immunoadjuvant activity of 2,2'-O-[2,2'-diacetamido-2,3,2',3'-tetradeoxy-6,6'-di-O-(2-tetradecyl- hexadecanoyl)-alpha,alpha'-trehalose-3,3'-diyl]bis(N-D-lactoyl-L-alanyl -D-isoglutamine).

The disaccharide of 6-O-(2-tetradecylhexadecanoyl)muramoyl dipeptide coupled through an alpha-(1----1)-alpha linkage, named in the title, and an analog bearing a single peptide moiety, have been synthesized from 2,2'-diazido-2,2'-dideoxy-alpha,alpha'-trehalose. The immunoadjuvant activities of the products were examined.

Acetylmuramyl-Alanyl-Isoglutamine↗