Biomedical subjects
Publications and source records attributed to Y Sezai.
We employed a new procedure of the total aortic replacement in 2 cases which is made of composite graft and reimplantation of the coronary arteries by direct suture technique. These patients took good clinical course and were discharged after operation. We believe that this procedure is a very useful for annuloaortic ectasia or dissecting aortic aneurysm involved coronary artery with aortic regurgitation.
A case of Malignant Hemangioendothelioma (MHE) effectively treated with intra-arterial continuous infusion of recombinant interleukin-2 (rIL-2) was experienced. The Pt, a 82-year-old women, presented herself in our hospital with a complaint of the tumor in right-frontal region. Based on clinical and pathological findings, the Pt, was diagnosed as MHE. Increase of LAK (Lymphokine activated killer cell) activity was observed during treatment with intra-arterial continuous infusion of rIL-2. In addition, decrease of tumor was started when LAK activity showed high value. We mainly discussed about treatments for MHE and mechanism of these therapies by use of data of this case and other autho's papers.
We have experienced 67 operative cases of giant emphysematous bullae of the lung. For the bilateral lesions, two stage operation was performed in five cases and one stage operation under median-sternotomy in 12 cases. Twenty six cases were subjected to Naclerio-Langer's method, 25 cases to partial resection or plication and 15 cases to lobectomy. At the earlier period lobectomy was the treatment of choice, but, recently lobectomy was avoided for the conservation of pulmonary function. In terms of the improvement of pulmonary function, there was no difference between Naclerio-Langer's method and partial resection by Autosuture. In conclusion, for the treatment of giant bullae, partial resection by Autosuture is preferable because of improvement of pulmonary function and one stage median-sternotomy for bilateral lesions also are effective.
Hygroma is generally regarded as a benign tumor occurring favoritely in the cervical region of a child. Recently we have experienced a case of hygroma which was initially detected as a right chest wall tumor in a 16-year-old man, then was surgically diagnosed as cystic hygroma; chest roentgenography on a check up examination in his senior high school pointed out some anomaly, leading to his hospitalization. On admission, he had no subjective symptom, but chest roentgenography and CT confirmed an abnormal shadow in the right pulmonary area and a tumor with calcification on the right chest wall, respectively, so he was operated on for excisional biopsy. The tumor was extirpated together with the 7th intercostal muscle adhered to the tumor, and postoperative pathohistological examination led to diagnosis as cystic hygroma. Cystic hygroma of the chest wall is so rare that we would like to report this case, together with some addition consideration of related literature.
In 1986, a total of 18 430 open-heart procedures was performed in Japan. Whereas surgery of congenital heart disease amounted to 46% of all operations, cardiac tumors caused only 0.8% (148 cases). The results of an investigation based on data from 9 Japanese institutes over a period of 5 years show that myxomas are the most frequent tumors of the heart (74 out of 89 cases). Among 89 cardiac tumors there were 6 malignant neoplasms. More females were affected than male patients. Most of the myxomas were localized in the left atrium (66 out of 74). The majority of the myxomas originated from the atrial septum, two myxomas derived from atrio-ventricular valves. Inflow and outflow obstruction, valvular dysfunction and arrhythmias were the most common symptoms of cardiac tumors. In 88 patients resection of the tumor could be performed, in 4 cases combined with mitral valve replacement and in one case mitral valvuloplasty. In one patient, only a tumor biopsy was possible. Reoperation for recurrent myxoma had to be carried out in 4 patients after an interval of 1-6 years. In the case of a large left atrial tumor the circular incision of the biatrium is preferred by our group. This large approach facilitates the removal of the tumor, enables the repair of the left atrial posterior wall and atrial septum as well as the surgery of the mitral valve. If necessary, this surgical technique can easily be switched to cardiac autotransplantation. With regard to new operative procedures we are convinced that surgical intervention for cardiac tumors can be applied more widely in future.
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Thymolipoma is a very rare mediastinal tumor. We reported a case of 52-year-old female with thymolipoma which was located in the cervicomediastinal area. The chest X-ray film revealed an abnormal shadow in the superior mediastinum. Computed Tomography (CT) clearly showed the existence of a large mass in the left side of the trachea. The angiogram showed that there was a stenosis on the left brachiocephalic vein. On June 13, 1988, median sternotomy was performed. A large tumor, about 5.5 x 13 x 5.5 cm, was found arising from the left cervical area. This tumor was excised completely and thymolipoma was diagnosed histopathologically. The post-operative course was very satisfactory.
The effects of two different H2-receptor antagonists, cimetidine and famotidine, on the acute renal failure induced by 20 min of renal artery occlusion and gentamicin (240mg/kg BW, s. c., for 3 days) were investigated in Sprague-Dawley rats. The animals were treated with either cimetidine (80 or 160 mg/kg BW) or famotidine (4 or 8 mg/kg BW) mixed in the drinking water for 7 days. The low dose of cimetidine and famotidine did not alter the renal function in the absence of renal trauma. However, the high dose of cimetidine or famotidine decreased the GFR by 32% and 22%, whereas RPFR increased by 46% and 62%, and % FENa by 92% and 558%, respectively. The data for the renal function obtained 24 hrs after 20 min of renal ischemia demonstrated a decrease of 54% in GFR, a decrease of 47% in RPFR and an increase of 370% in %FENa over the non-ischemic control values (p less than 0.05). Cimetidine (80 mg/kg BW) or famotidine (4 mg/kg BW) did not modify the recovery of renal function following the ischemic insult, showing 55% and 539% decreases in GFR, 74% and 101% increases in RPFR, and 393% and 461% increases in %FENa over the non-ischemic control rats, respectively. Famotidine reduced the decrease in RPFR significantly during the recovery period following ischemia. In the gentamicin study, gentamicin treatment was found to lower the renal function significantly.(ABSTRACT TRUNCATED AT 250 WORDS)
IABP and well functioning left ventricular assist device for a failing left ventricle have potential for altering the loading condition of the right heart. Depending on the extent of myocardial damage and the pulmonary vascular resistance, IABP and LVAD can have different degree of hemodynamic effect on the right ventricle. We examined 20 clinical cases who required IABP support to wean from cardiopulmonary bypass. In 10 cases (group I), CVP rose up above 20 cmH2O within 12 hrs of post operative period. In another 10 cases (group II), CVP rose less than 20 cm H2O. Then we compared hemodynamic change (m-PAP, PVR, CVP, PAWP, CI and RVSWI) between two groups until 72 hrs of post operative period. No significant differences were noted in PVR and CI between two groups, but CVP, m-PAP, PAWP and RVSWI were markedly higher in I group. Reduction of RV afterload produced with an IABP may probably be due to degree of recovery of failing left ventricular function. It is though that IABP has less favorable effect on right ventricular in the cases whose CVP elevate above 20 mmH2O within 12 hrs after operation than in those with CVP below 20 cmH2O. Clinical studies were made on 4 cases with biventricular failure in our experiences of 8 LVAD cases (LV aneurysmectomy + VSP closure, MVR + AVR + CABG + LV aneurysmectomy, CABG + LV aneurysmectomy and MVR + CABG). LVAD seems to have more beneficial effect on RV afterload, than IABP right ventricular dysfunction, however, is likely to continue in the cases whose CVP elevates above 30 mmH2O even if LVAD is used.
The effects of famotidine on renal function were investigated. Eight healthy men (N) and 8 renal patients with varying degrees of renal failure (R.F.) participated in the trial. They were given either famotidine (40 mg) or cimetidine (800 mg) for 7 days. Cimetidine produced a significant decrease in creatinine clearance (from 131.6 +/- 12.9 to 107.7 +/- 3.4 ml/min (N), and 22.2 +/- 3.9 to 18.1 +/- 3.5 ml/min (R.F.], and increase in serum creatinine (from 0.96 +/- 0.05 to 1.09 +/- 0.04 mg/dl (N), and 3.46 +/- 0.62 to 3.86 +/- 0.51 mg/dl (R.F.], and a decrease in creatinine excretion (from 24.0 +/- 1.1 to 22.6 +/- 0.8 mg/kg/24 hr (N], respectively, although the reduction in creatinine excretion in the renal failure group was small. On the other hand, the famotidine treatment produced no significant changes in renal function in both subjects (creatinine clearance, 136.5 +/- 5.7 to 133.6 +/- 6.0 ml/min (N), and 21.9 +/- 3.6 to 20.9 +/- 4.1 ml/min (R.F.); serum creatinine, 0.98 +/- 0.02 to 0.99 +/- 0.02 mg/dl (N), and 3.24 +/- 0.43 to 3.46 +/- 0.55 mg/dl (R.F.); and urinary creatine, 25.1 +/- 1.0 to 25.3 +/- 1.0 mg/kg/24 hr (N), and 17.2 +/- 1.4 to 16.6 +/- 1.5 mg/kg/24 hr (R.F.]. There were no changes in the percent sodium excretion, or the serum and urinary beta 2-microglobulin in both groups.
The laboratory data from 136 patients suffering from a mass outbreak of rubella were serially examined. Alteration of thrombocytopenia (38.7%), leukopenia (26.4%), increased LDH (94.3%), and increased GOT (32.4%) were observed during the early days of disease. Slightly later, increased GPT was noted in 48.5%. LDH isozymes may be grouped into two specific patterns: 1) an LDH3 dominant pattern appeared (90.4%) during the beginning days of the disease. 2) an LDH3 dominant pattern with LDH5 greater than LDH4 was detected one week later. It was concluded that the increase of LDH3 may have been induced by thrombocytopenia due to viral infection. The increase of LDH5 appears to result from liver damage. In conclusion, LDH isozyme findings are significant in the early diagnosis of liver damage in rubella.
Surgical treatment and problems in patients required reoperation for malfunctioning prosthetic valves are reviewed in our institute. The cinefluoroscopy and pulse doppler echocardiography were helpful for diagnosis of artificial valve dysfunction. In recent two decades valve replacement were performed in 382 cases and number of re-implanted valve were 469. Among them the cases of reoperation were 21 and reimplanted valves were 25 (5.6%); 4.7% in aortic, 5.0% in mitral, 6.7% in tricuspid position. Three cases of those patients had three operations. Main causes of reoperation were primary tissue failure in Carpentier-Edwards porcine xenograft (6 cases, 23%) and cloth wear in Starr-Edwards ball valve (9 cases, 38%) and thrombosis in St. Jude Medical bi-leaflet valve (3 cases, 15%). In most cases St. Jude Medical valve were chosen for the alternative prosthetic valve in reoperation. We applied IABP support to seven patients for severe low cardiac output syndrome after the operation and overall mortality was 24% in reoperation. It concluded that St. Jude Medical valve may be most reliable because of low incidence of postoperative complication in our institute.
In an attempt to save patients with severe cardiac pump failure to which no emergency methods of treatment show effect even with various medications or machinery assisted circulation, the ventricular assisted device (VAD) has come more and more in need today as it provides patients with a temporary cardiac function and serves as a life-prolongation means, eventually aiming at patients' return to normal daily life. In Japan, basic researches for development of VAD have been proceeding since 1960. We have been pursuing researches in the related scientific field since 1980 with the theme of clinical application of VAD and have completed the total system of VAD in August, 1982. In October 1982, we succeeded for the first time in Japan in weaning a patient from the VAD. Until April, 1988 we had managed clinical applications of VAD in 121 cases. Based on this experience, I have presented here a result of our clinical analysis of these cases and have come up with the problems surrounding the clinical application of VAD.
88 cases of bacterial spontaneous pneumothorax, 20 cases, occurred same time and 68 cases, occurred different time, were treated in our Department of Thoracic Surgery from 1975 to July 1987, and represented 16.6% of all cases of spontaneous pneumothorax. The characteristics of bilateral spontaneous pneumothorax, occurred same time, were as follows; 1) frequent in teens, 2) often occurred with history of unilateral spontaneous pneumothorax, 3) slightly collapsed. For the treatment of bilateral spontaneous pneumothorax, occurred same time, bilateral thoracotomy was necessary. The characteristics of bilateral spontaneous pneumothorax, occurred different time, were as follows; 1) frequent in the twenties, 2) often occurred the other side after unilateral thoracotomy within a year. For the treatment of bilateral spontaneous pneumothorax, occurred different time, if the patient is under 20 thoracotomy must be carried out, but if the patient is over 20 at the side of pneumothorax must be operated.
The surgical results of post-infarction left ventricular aneurysmectomy have been evaluated in 24 patients approximately 1 year after operation. In 20 patients coronary artery bypass grafting (CABG) was also carried out. In 8 patients mechanical circulatory assist such as intra-aortic balloon pump (IABP) or left ventricular assist device (LVAD) was undertaken for the purpose of weaning from cardiopulmonary bypass. Postoperative left ventricular function, such as ejection fraction and cardiac index, and classification of the New York Heart Association were improved significantly after aneurysmectomy. However, postoperative improvement of these parameters was not remarkable in cases of poor preoperative left ventricular function. Preoperative left ventricular function revealed to be poor in multiple vessel disease, and concomitant coronary artery bypass grafting with aneurysmectomy can be performed with good long-term results and significant improvements of postoperative cardiac function. In patients that had showed the end-diastolic perimeter more than 40% and the shortening rate of transverse axis at the left ventricular base less than 20%, postoperative improvement of cardiac function revealed unsatisfactory. Mechanical circulatory assist showed lifesaving effect, but in cases that required IABP or LVAD postoperative cardiac function has not improved significantly.
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Results about comparison of new extracapillary blood flow type polypropylene hollow fiber oxygenator (PHO) with HF-4000, Capiox II and Silox for effects on blood components, hemolysis, immunoglobulin and high molecular weight proteins, such as complements: 1) Platelet protection was about equal. Silox was best in leucocyte protection. 2) PHO was superior to HF-4000. The extracapillary type was better for hemolysis. 3) Silox was best in immunoglobulin protection. Effect on C3 and C4 was equal, and Silox was best in protection of CH50. Slight differences were caused by silicone membrane, not caused by blood flow type. 4) PHO was superior to HF-4000 (commercial extracapillary type), and almost equal to Capiox II (intracapillary type).
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