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Biomedical subjects

Y Shimazaki

Publications and source records attributed to Y Shimazaki.

At least 145 records · Page 8Linked to original sources
PubMed1992

[A case report of tetralogy of Fallot associated with total occlusion of the right coronary artery and complicated with infective endocarditis].

A 31-year-old male with tetralogy of Fallot (TF) and total occlusion of the right coronary orifice complicated with infective endocarditis successfully underwent total repair of TF and coronary artery bypass graft (CABG). The patient had severely suffered from symptoms including breathlessness, palpitation (SVT) and chest pain. The coronary arteriography revealed occlusion of the right coronary orifice. The preoperative course was further complicated by endocarditis with vegetation of the aortic valve that did not respond to antibiotics. Concomitant surgical procedures consisting of TF repair, CABG to the right coronary artery with saphenous vein graft and vegetectomy of the aortic valve were carried out. The postoperative course was uneventful though he underwent cholecystectomy for symptomatic gall stones after TF repair. The patient is now in NYHA class II.

Adult↗
PubMed1992

The dimensions of the right ventricular outflow tract and pulmonary arteries in tetralogy of Fallot and pulmonary stenosis.

Studies were undertaken of the cineangiograms in 196 consecutive patients entering two institutions with tetralogy of Fallot and pulmonary stenosis, none of whom had previously undergone a surgical procedure. The median age of the patients at the time of the study was 5.9 months. The diameters of the right ventricular infundibulum, pulmonary trunk, and the entirety of the right and left pulmonary arteries were measured (in millimeters), corrected for magnification, and expressed in standard deviation units (Z-values). The median values of the cineangiographically determined diameters of the right ventricular infundibulum and pulmonary trunk were smaller than those of 95% of normal individuals. The median values throughout the right and left pulmonary arteries were within the range of normal. Those of the distal branches of both the right and left pulmonary arteries were similar to the mean values in normal individuals. However, great variability of the dimensions between individuals, and along the pathway in individuals, characterized patients with tetralogy of Fallot. Diffuse narrowing of the pathways both proximally and distally was uncommon. The relation between the diameters of the pulmonary "anulus" and of the distal pulmonary trunk and origin of the left pulmonary artery explained the difficulty of extending an enlarging patch into a wide area distally in some patients.

Cineangiography↗
PubMed1992

Morphologic and surgical determinants of outcome events after repair of tetralogy of Fallot and pulmonary stenosis. A two-institution study.

Survival after entry and survival after repair (94%, 91%, and 91% at 1 month, 1 year, and 5 years, respectively) were similar in two institutions treating 196 consecutive patients, and there was no advantage (and a possible disadvantage) of a protocol of preliminary shunting and later repair in very young patients. Size and configuration of the right and left pulmonary arteries had no demonstrable effect on survival, prevalence of transannular patching, or postrepair right ventricular-left ventricular pressure ratio. Small size of the pulmonary "anulus" and trunk were risk factors for death, transannular patching, and high postrepair pressure ratio. High postrepair pressure ratio was a risk factor for death after repair. Very young age (less than about 3 months) was a risk factor for death after repair, particularly when other risk factors coexisted. The prevalence of transannular patching in patients with mild infundibular and pulmonary anulus and trunk hypoplasia decreased across the time of the study, without ill effect. The usefulness of measuring postrepair right ventricular-left ventricular pressure ratio is emphasized by the data.

Female↗
PubMed1992

[Assessment of the size and distribution of the coronary artery selected for bypass grafting using myocardial contrast echocardiography during coronary artery bypass surgery].

We assessed the size and distribution of the native coronary artery selected for bypass grafting, using myocardial contrast echocardiography by injection of sonicated agents into a saphenous vein graft, during surgical revascularization. A total of 69 saphenous vein grafts (LAD, 16; D1, 10; OM, 13; PL, 13; RCA, 17) were performed in 36 patients with right dominant system at preoperative coronary angiogram. The size of the area of revascularized myocardium was quantified with the ratio of its circumference to a full circle depicted on the left ventricular short-axis view at the mid-papillary level. The extents of the revascularized area to LAD stenosing at the proximal portion was 28 +/- 6% and stenosing at the intermediate portion was 23 +/- 6%. D1, 10 +/- 2%; OM, 17 +/- 3%; PL, 22 +/- 6%, RCA, 17 +/- 5%. The extent of the areas perfused by the totally occluded coronary arteries with collateral vessels was similar to those perfused by the partially occluded coronary arteries. In conclusion, myocardial contrast echocardiography enabled the intraoperative assessment of the geometry of regional myocardial perfusion, and was very useful for the intraoperative evaluation of the effectiveness of the indicated surgical procedure.

Arteries↗
PubMed1992

[Open heart surgery without homologous blood transfusion in small children of body weight less than 20 kg].

In 28 children with congenital cardiac lesions, open heart surgery was attempted without homologous blood transfusion using extreme hemodilution for cardiopulmonary bypass (CPB) and moderate to profound hypothermia. The entry criteria for this study were preoperative hemoglobin value above 10 g/dl and expected CPB time of less than 120 minutes. Acyanotic heart diseases such as ventricular or atrial septal defect were the main lesion, but some cases of tetralogy of Fallot and single ventricle were also included in this study. Intraoperative saving of autologous blood and autotransfusion using cell saver were carried out in a part of the subjects. Acceptable lowest values for hemoglobin was 4-5 g/dl and 40% for mixed venous oxygen saturation. As the results, 18 patients tolerated CPB without transfusion and eventually 16 patients were discharged without transfusion at all. The body weight for those without transfusion was 13.9 kg in average and the lowest was 6.8 kg. The significant factor affecting the needs for homologous blood transfusion was prolonged CPB time over 120 minutes. Although there was a tendency that the patients with body weight less than 15 kg received transfusion more frequently than those with body weight more than 15 kg, the body weight was not necessarily a limiting factor. Pre-CPB blood saving and intraoperative autotransfusion were the positive factors for successful non-transfusion open heart surgery.

Blood Transfusion↗
PubMed1992

[Assessment of Blalock-Taussig shunts in children with complex cardiac anomalies associated with reduced pulmonary blood flow and total anomalous pulmonary venous drainage].

Eleven patients with syndromes of asplenia and polysplenia associated with total anomalous pulmonary venous drainage (TAPVD) were underwent Blalock-Taussig (B-T) shunt operation for reduction of pulmonary blood flow. The age of patients at operation were 6 days to 5 years (average 19.5 +/- 18.7 month). There were seven patients in supracardiac type and four in cardiac type of TAPVD. All patients didn't present obstruction to pulmonary venous return (PVO) before B-T shunt operation. There were one early (9%) and two late deaths (20%) after surgery. Although the hospital death was related to perioperative errors. Two late deaths were not due to the PVO. One of infants had moderately pulmonary congestion and cardiac failure after shunt procedure. Two patients were measured pressure gradient (3 to 4 mmHg) between common pulmonary vein to atrium chamber before shunt procedure. Repeated catheterization revealed that 6 of them could be measured pressure gradient, 3 to 7 mmHg, and no patients had clinical sign of the PVO. Our results demonstrated that B-T shunt operation could be satisfactory for syndromes of asplenia and polysplenia associated with reduced pulmonary blood flow and TAPVD.

Anastomosis, Surgical↗
PubMed1991

Pulmonary artery morphology and hemodynamics in pulmonic valve atresia with ventricular septal defect before and after repair.

Cardiac catheterization and angiography were performed in 22 patients with pulmonic valve atresia and ventricular septal defect to evaluate pulmonary morphology and hemodynamics before and after repair. In 12 of the 22, pulmonic valve atresia and ventricular septal defect were associated with major aortopulmonary collateral arteries, which were ligated in most. Mean postoperative pulmonary artery pressure (PAP) ranged from 9 to 92 mm Hg (mean 28 +/- 19) and pulmonary vascular resistance ranged from 1.1 to 35.2 U.m2 (mean 6.4 +/- 8.0). These data correlated (r = 0.89, p less than 0.001). The number of pulmonary artery subsegments connected to the central pulmonary arteries was 22 to 42 (mean 38 +/- 6). Univariate analysis revealed that the mean postoperative PAP correlated with the number of pulmonary artery subsegments connected to the central pulmonary arteries (r = -0.81, p less than 0.001), with mean postoperative PAP (r = 0.79, p less than 0.001), with the postoperative pulmonary artery area index of the right and left pulmonary arteries at prebranching (r = -0.76, p less than 0.001), and with the sum of the pulmonary artery areas after branching (r = -0.69, p less than 0.005). Pulmonary vascular resistance correlated with the number of pulmonary artery subsegments connected to the central pulmonary arteries (r = -0.85, p less than 0.001), with the mean preoperative PAP (r = 0.79, p less than 0.001), with the sum of the pulmonary artery areas after branching (r = -0.73, p less than 0.001), and with the postoperative pulmonary artery area index (r = -0.70, p less than 0.001). The incidence of pulmonary vascular resistance being less than 3 U.m2 was significantly higher in patients with greater than 36 pulmonary artery subsegments connected to the central pulmonary arteries and with a preoperative pulmonary artery area index greater than 0.5 (88%) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

4'-galactooligosaccharide affects sodium and potassium metabolism in rats.

The effect of different levels (0, 10 and 20%) of O-beta-D-galactopyranosyl-(1-4)-O-beta-D-galactopyranosyl-(1-4)-D- glucose (4'-GL) on the bioavailability of sodium and potassium was studied in 18 male rats. Three 3-d metabolic balance studies were conducted during the 62-d feeding trial. These were between d 30 and 32 (first period), 45 and 47 (second period) and 60 and 62 (third period). Growth and food intake were not significantly different (P less than 0.05) between the control group and the 4'-GL-fed groups. In rats fed 10 and 20% 4'-GL diet, the fecal sodium excretion was significantly greater (P less than 0.05) in all three balance periods. Fecal potassium excretion was significantly greater (P less than 0.05) in the 10% 4'-GL-fed group in the second balance period and the 20% 4'-GL-fed group in all balance periods relative to the control group. Although not statistically significant, rats in the 4'-GL-fed groups exhibited a tendency for lower sodium retention and higher potassium retention compared with the control group. The cecal weight of rats in both 4'-GL-fed groups was significantly heavier (P less than 0.05) than that of the control group at the end of study. Sodium concentration in the cecum was significantly lower (P less than 0.05) in the 20% 4'-GL-fed group relative to the other groups.

Animals↗
PubMed1991

[Immunohistochemical study of the distribution of collagens (type I, III, IV), fibronectin, factor XIIIa and factor VIII related antigen in alcoholic liver disease].

Histopathological changes in alcoholic liver disease are characterized by Mallory body, fatty liver, and peculiar fibrosis such as pericentral fibrosis, pericellular fibrosis, stellate fibrosis originating from Glisson's sheath, and swelling of the liver cells. However, the mechanism of fibrosis remains unknown. The author tried to demonstrate, by the immunohistochemical method, fibronectin (FN), collagen type I, III, IV (IC, IIIC, IVC), factor XIIIa, and factor VIII related antigen (VIII RAg), all of which are related to the process of wound healing, in order to clarify the mechanism of fibrosis in alcoholic liver disease. With the progress of fibrosis, FN was demonstrated in the sinusoidal wall, as well as the portal areas and around the central veins. IC and IIIC were positive in the fibrotic area extending into the lobules and pericellular fibrosis. IVC was similar to FN and was positive in the sinusoidal wall. Scattered XIIIa positivity was recognized in the fibrotic areas, especially in the foci of active fibrosis. VIII RAg was positive in the capillary vessels invading the lobules through the limiting plates. The distribution of these proteins in the fibrotic area in alcoholic liver disease closely resembled that in the wound healing process. It is concluded that fibrosis occurring in the periportal area is essentially the same as in the wound healing process and the mechanism of fibrosis in alcoholic liver disease is thought to be active fibroplasia.

Adult↗
PubMed1991

Echocardiographic comparison of postoperative left ventricular contractile state between one- and two-stage arterial switch operation for simple transposition of the great arteries.

Left ventricular contractile function was compared between primary and two-stage arterial switch operation (ASO) in neonates and infants with simple transposition of the great arteries (TGA). Eight patients (group 1) underwent primary ASO at 13-42 (23 +/- 10 [mean +/- SD]) days of age, and five patients (group 2) underwent two-stage ASO after pulmonary artery banding and Blalock-Taussig shunting at 11-26 (15 +/- 3) months of age. Postoperative echocardiographic studies were undertaken at 6-48 (22 +/- 16) months of age in group 1 and 25-45 (32 +/- 7) months of age in group 2. The results were compared with those obtained from nine age-matched normal children (group N). To compare left ventricular contractile state among the patients, the deviations from the mean normal values in relations of end-systolic wall stress to fractional shortening and to rate-adjusted mean velocity of circumferential shortening (the stress-shortening index and stress-velocity index, respectively) were obtained for each patient. The stress-shortening index was significantly lower in group 2 (-3.1 +/- 3.1) than in group 1 (1.3 +/- 1.7, p less than 0.05); the stress-velocity index was significantly lower in group 2 (-3.3 +/- 1.8) than in group 1 (1.5 +/- 1.6, p less than 0.01) or in group N (-0.4 +/- 0.5, p less than 0.05). These results suggest that postoperative left ventricular contractility can be well preserved in patients after primary ASO for simple TGA in neonates, but there is a possibility of depressed contractility in patients after two-stage ASO.

Cardiac Surgical Procedures↗
PubMed1991

[Effects of sodium chloride on destruction of microorganisms by microwave heating in potatoes].

To assess the destructive effect of different sodium chloride concentrations (0, 0.3, 1.5, and 3%) on microorganisms with microwave heating, strains of Vibrio parahaemolyticus, Staphylococcus aureus, Salmonella enteritidis, Escherichia coli and Bacillus cereus were used to inoculate a mashed potato preparation. After microwave heating for 1 min at 800 W, resulted in temperatures and rate of destruction of bacteria significantly higher (p less than 0.05) in the core than on the surface of mashed potato when no salt was added. Except for B. cereus, microorganisms inoculated into mashed potato, with no added salt, could be completely destroyed by 2 min of microwave heating. Core temperatures and rate of destruction of microorganisms in the mashed potato decreased significantly (p less than 0.05) with increase in concentration of added salt. The results also indicate that bacterial species differ in their susceptibility to microwave inactivation. In particular, S. aureus, which exhibited a level of survival that was greater than that of any other species tested here, seemed notably resistant to microwave treatment for 2 min while V. parahaemolyticus was highly susceptible.

Bacteria↗
PubMed1991

[The effect of 4'-galacto-oligosacchraide on sodium and potassium in growing rats].

The effect of 4'-galacto-oligosaccharide (4'-GL), fed at the 5% dietary level on sodium (Na) and potassium (K) absorption was investigated during four 3-day balance periods (days 15 and 17, 30 and 32, 45 and 47 and 60 and 62) of a 62-day feeding course in young male rats. The results obtained were as follows: 1) A decrease in urinary volume excretion and an increase in fecal weight were observed in the 4'-GL group, but growth rate was not affected by 4'-GL administration. 2) Fecal Na excretion, expressed either in milligrams or as a percent of intake, was significantly increased (p less than 0.05) in the 4'-GL group during the second (days 30 and 32) and third (days 45 and 47) balance periods. 3) Urinary K excretion, expressed either in milligrams or as a percent of intake, was significantly lower (p less than 0.05) in the 4'-GL group during the second and third balance periods. 4) While differences in Na and K retention between the two groups were not significant, a tendency for decreased Na retention and increased K retention was observed in 4'-GL group. 5) Rats fed the 4'-GL diet had heavier cecal weight, decreased Na concentration and increased K concentration in the cecum, than rats fed the control diet. 6) While no significant difference was found in Na or K concentration in plasma between the two groups, Na/K ratio in plasma was lower in the 4'-GL group.

Absorption↗
PubMed1991

[Late postoperative pulmonary vascular resistance in patients with tetralogy of Fallot and pulmonary atresia].

Twenty-two patients with tetralogy of Fallot and pulmonary atresia underwent cardiac catheterization and angiocardiography late after repair. In ten patients, the disease was not associated with the major aortopulmonary collateral artery (MAPCA), but in 12 patients, the disease was associated with it. Three patients died after restudy, two because of pulmonary hypertension and one because of pneumonia. Pulmonary artery mean pressure was 15-92 (28 +/- 21) mmHg, being higher in 75% of the patients with MAPCA than the normal range. The number of pulmonary artery subsegments connected to the central pulmonary arteries was determined from pulmonary arteriography, being 22-42 (38 +/- 6). Pulmonary artery mean pressure and pulmonary vasculature resistance (PVR), 0.8-35.2 (10 +/- 9), inversely correlated with the number of the centrally connected pulmonary artery subsegments (r = -0.81, p less than 0.001 vs PAP, r = -0.85, p less than 0.001 vs PVR). PVR per subsegment also inversely correlated with them (r = -0.81, p less than 0.001). These findings suggest that pulmonary vasculature resistance is abnormally high in this disease, and increase as the number of the centrally connected pulmonary artery subsegments decrease.

Adolescent↗
PubMed1991

Hemodynamic effects of bidirectional cavopulmonary shunt with pulsatile pulmonary flow.

The effects of "pulsatile" bidirectional cavopulmonary shunt (BCPS) produced by the flow from the ventricle or Blalock-Taussig (B-T) shunt on ventricular function and pulmonary circulation were evaluated in 10 patients with univentricular heart from 3 to 37 months (mean, 16.6 +/- 9.5 months) after surgery. Age at operation ranged from 7 months to 15 years (mean, 5.5 +/- 4.5 years). In addition to the BCPS, pulmonary flow was supplied from a B-T shunt on the contralateral side of the BCPS in five patients, from the ventricle through the stenotic pulmonary valve in four patients, and from both the ventricle and a B-T shunt in one patient. There were no operative deaths; however, there were two late deaths from acute respiratory infection 10 and 13 months after operation. Mean pulmonary arterial pressure measured the first day after operation ranged from 10 to 19 mm Hg (mean, 14 +/- 3 mm Hg). Mean pulmonary arterial pressure at postoperative cardiac catheterization was less than 15 mm Hg (mean, 12 +/- 4 mm Hg). Pulse pressure ranged from 3 to 12 mm Hg (mean, 7 +/- 4 mm Hg). Arterial oxygen saturation increased significantly from 77 +/- 5% before BCPS to 86 +/- 4% immediately after discharge from the intensive care unit (p less than 0.005) and 85 +/- 3% (p less than 0.025) at late cardiac catheterization. Pulmonary arteriovenous fistula was not detected in contrast echocardiography and pulmonary arteriography. Systemic ventricular end-diastolic volume index decreased significantly (p less than 0.01) from 141 +/- 54 ml/m2 before BCPS to 98 +/- 35 ml/m2 1 month after BCPS by echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1991

[Analysis of the intraoperative shunt flow and its effect on late prognosis after Blalock-Taussig shunt in single ventricle].

Single ventricle (SV) seems to likely to develop congestive heart failure after Blalock-Taussig shunt (BT), particularly when the regurgitation of atrioventricular valve (AVVR) is combined. Analysis of the relation between operative result and intraoperative BT shunt flow is made in order to draw a safety limit or shunt flow in SV. Twenty-six patients (pts) with SV who underwent BT had shunt flow measurement at surgery, 20 pts showed right ventricular (RV) type of SV, 5 had left ventricular (LV) type, and 1 undivided type. The common atrioventricular valve was associated in 19 patients. The age at operation ranged from 6 days to 14 years of mean 3.2 years and the flow ranged from 6 to 146 of mean 49 ml/min/kg. Seven developed congestive heart failure at late follow-up with 4 late deaths. The average flow in this group (poor result) was 68 +/- 40 (mean +/- SD) ml/min/kg, and the remaining pts with favorable results (n = 16) had a mean flow of 41 +/- 22 ml/min/kg (p less than 0.05). In the group of LV type (n = 5), there was one late death caused from apparently excessive shunt flow (146 ml/min/kg). In the group of RV type without AVVR (n = 10), three pts of poor result had flow over 50 ml/min/kg. In those with AVVR (n = 8), pts with poor result were found with flow below 50 ml/min/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Clinical efficacy of cefpirome against various infectious diseases in children].

The clinical efficacy and the pharmacokinetics of cefpirome (CPR, HR 810), a new semisynthetic cephalosporin derivative, were investigated in children with various infectious diseases. CPR showed high blood peak levels, relatively long half-life and high levels in urine. Excellent clinical efficacy was obtained in 2/3 cases with pneumonia, 3/4 cases with upper respiratory infection, 2/2 cases with cutaneous and soft tissue infection and 1/1 case with urinary tract infection. The overall efficacy rate was 80%. No clinical adverse effects were observed while slightly elevated GPT and GOT, decreased platelet were detected in 4 cases without clinical problems. CPR should be an useful and safe drug in treating infectious diseases in children.

Adolescent↗
PubMed1991

[Surgical treatment of tetralogy of Fallot with pulmonary atresia: early and late results].

From 1968 to 1987, 45 consecutive patients with tetralogy of Fallot and pulmonary atresia underwent corrective surgery. In the former 10 years, there were 8 operative deaths (40%) in the 20 patients and no late death. In the recent 10 years, there were 4 operative deaths and 4 late deaths in the 25 patients. In the 17 patients associated with large aorto pulmonary collateral artery (LAPCA) which was ligated in the most patients, there were 5 operative deaths (29%) and 3 late deaths. Nine patients (53%) survived long-term. There were 7 operative deaths (25%), one late death and 20 patients (71%) being long-term survivors in the 28 patients without LAPCA. Pulmonary hemodynamics were investigated in 10 patients without LAPCA and 11 with LAPCA after corrective surgery. Pulmonary arterial mean pressure (PAm) ranged from 9-24 (17 +/- 6) mmHg in patients without LAPCA and 15-92 (37 +/- 23) mmHg in those with LAPCA. Pulmonary arteriography showed arborization abnormality in 7 of the 11 patients with LAPCA. PAm inversely correlated well with number of pulmonary artery segments connected to the central pulmonary arteries. Postoperative pulmonary hypertension was found in patients with less than 16 bronchopulmonary segments connected to the central pulmonary arteries, and two of them died of pulmonary hypertension late after surgery. These results suggested that unifocalization to connect the central pulmonary artery more than 15 bronchopulmonary segments may be an important strategy for correction of this anomaly with LAPCA.

Child↗