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Biomedical subjects

Y Suda

Publications and source records attributed to Y Suda.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Inferior mini-sternotomy for off-pump CABG using bilateral internal thoracic arteries].

Case 1: A 72-year-old woman with effort angina underwent coronary artery bypass grafting. A preoperative coronary angiogram showed 90% stenosis in the proximal main RCA, and total occlusion in the proximal LAD, distal of which was an area well supplied by collaterals from the RCA. This patient had previously undergone right upper lobectomy due to lung cancer. With a skin incision of 8 cm, the LITA was inserted into the LAD and the RITA was inserted into the mid RCA through an inferior mini-sternotomy while the heart was beating. Case 2: A 69-year-old man with effort angina underwent CABG. A preoperative coronary angiogram showed 90% stenosis in the proximal main RCA, 75% stenosis in the PDA and total occlusion in the proximal LAD, distal of which was an area well supplied by collaterals from the RCA. With a skin incision of 11 cm, the LITA was inserted into the LAD, the RITA into the mid-RCA and the radial artery graft attached to the RITA was grafted to the PDA through an inferior mini-sternotomy while the heart was beating. In both cases, the sternum was not cut transversely in order to prevent injury to the ITAs and pseudo-joint formation. With the use of this technique, exposure of the LAD and RCA was excellent. Postoperative recovery in both patients was uneventful and postoperative angiograms revealed widely patent grafts. This technique was very useful when performing off-pump CABG using bilateral ITAs.

Aged↗
PubMed2001

[Lower-end sternal splitting (LESS) approach as a new strategy for minimally invasive off-pump CABG].

There are several ways to perform off-pump coronary artery bypass grafting (OPCAB) using a minimally invasive method. Currently, one of the most commonly used approaches is left anterior small thoracotomy (LAST). However, using this approach, only the LAD can be grafted. We have employed a partial sternotomy without a transverse cut, namely, the lower-end sternal splitting (LESS) approach for OPCAB. Through this approach, the LAD and RCA can be revascularized via a single small incision without the risk of damaging the tissue around the intercostal space when the sternum is transversely divided. Since November 1999 to September 2000, we have applied OPCAB through LESS approach in 17 patients. Mean age was 70.0 + 5.4 years (range 58-77), and 13 were men. Mean length of the skin incision was 8.6 + 1.2 cm (range 8-11). No hospital death or morbidity was observed. No patient required blood transfusion. All had arterial conduits: LITA-LAD, in 11; LITA-LAD, RITA-RCA, in 1; LITA-LAD, GEA-PDA, in 2; LITA-LAD, RITA-RCA, RITA-RA-PDA, in 1; and GEA-PDA, in 2. All underwent postoperative coronary angiography, and the patency rate was 95.5%. Our experience demonstrates that the LESS approach for OPCAB is technically feasible and can be used with excellent cosmetic results and safety. Although experience is limited, this less invasive surgical technique can be used as an alternative approach for MIDCAB in patients with LAD and/or RCA disease.

Aged↗
PubMed2001

Examining the effect of intervention to nutritional problems of the elderly living in an inner city area: a pilot project.

OBJECTIVE: To examine the effect of interventions provided to home-delivered meal service recipients living in an inner city neighborhood for the purpose of improving their nutritional conditions. DESIGN: Intervention study. SETTING AND PARTICIPANTS: Both the Study Group (42 seniors) and the Control Group (39 seniors), all of whom are over 60 years old, received home delivered meal services. In addition, only the Study Group received the following services through the trained neighborhood residents: 1) health education, 2) referrals to other community resources for unmet health needs, and 3) follow-up services to assure that the health problems were addressed appropriately. The nutritional condition, depression and cognitive status of the Study Group were assessed by medical staff before and after the six-month intervention. The same assessments were conducted to the Control Group with the same interval. Data was analyzed using ANOVA (repeated). MEASUREMENTS: MNA, GDS, and MMSE. RESULTS: Compared to the Control Group, the nutritional condition (p=0.052) and depression (p=0.02) of the Study Group were improved, while no significant difference was observed in their cognitive status. CONCLUSION: A combination of interventions by medical professionals and by trained neighborhood residents seemed to be an effective strategy to approach nutritional problems of seniors living in inner city areas.

Aged↗
PubMed2001

Chemical structure and biological activity of a lipid A component from Helicobacter pylori strain 206.

The chemical structure of a lipid A, which was obtained as a minor component from lipopolysaccharide of Helicobacter pylori strain 206-1, was determined to be a glucosamine beta-(1 -6) disaccharide 1-(2-aminoethyl)phosphate acylated by (R)-3-hydroxyoctadecanoic acid, (R)-3- hydroxyhexadecanoic acid, and (R)-3-(octadecanoyloxy)octadecanoic acid at the 2-, 3- and 2'-positions, respectively. Compared with the other major lipid A from the same strain, which was previously reported [Suda Y, Ogawa T, Kashihara W et al. Chemical structure of lipid A from Helicobacter pylori strain 206-1 lipopolysaccharide. J Biochem 1997; 121: 1129--1133], the structure was very similar with one exception. An (R)-3-hydroxyhexadecanoic acid was present at the 3-position of the novel lipid A component. The structure is apparently identical to one of the proposals by Moran et al. [Moran AP, Lindner B, Walsh EJ. Structural characterization of the lipid A component of Helicobacter pylori rough- and smooth-form lipopolysaccharides. J Bacteriol 1997; 179: 6453--6463], who concluded the same structure as the so-called major lipid A from the H. pylori strain NCTC 11637 but without isolating a homogeneous component. The endotoxic properties and pro-inflammatory cytokine-inducing activities of this novel tetra-acyl type lipid A were lower than those of previously reported major tri-acyl type lipid A.

Animals↗
PubMed2001

[Coronary artery bypass-grafting using interrupted anastomosis with the U-clip].

For coronary artery anastomosis, the continuous suture technique is generally used because it is easy to perform, there is less anastomotic leakage, and a shorter anastomotic time compared with the interrupted suture technique. However, with this technique there is a potential risk of anastomotic stenosis caused by the purse-string effect, which does not occur with the interrupted suture technique. The U-Clip device was designed to facilitate the interrupted suture technique in coronary anastomosis by eliminating the need for suture management, knot tying, and surgical assistance. The device employs the superelastic properties of nitinol and two components: 1. a needle/suture delivery system, and 2. a detachable nitinol self-closing wire. We used this device successfully for LITA-LAD anastomosis in MIDCAB. When this device is applied to small caliber conduits, such as the internal thoracic arteries and the gastroepiploic artery, the side-to-side anastomosis can reduce the anastomotic leakage more efficiently, since the coronary incision and graft incision can be perfectly matched. The U-Clip facilitates coronary anastomosis by simplifying and decreasing the amount of manipulation and complexity required in minimally invasive CABG procedures. Nitinol technology also has potential in robotic and endoscopic surgical applications.

Aged↗
PubMed2000

Cytokine-inducing macromolecular glycolipids from Enterococcus hirae: improved method for separation and analysis of its effects on cellular activation.

Previously, we showed that several minor macromolecular glycolipids accounting for less than 5% of the lipoteichoic acid (LTA) fraction from Enterococcus hirae ATCC 9790 possess cytokine-inducing activity, whereas the purified LTA does not. In other words, the immunobiological activity of the LTA fraction reported in the 1980s was not attributable to LTA itself, but to other glycolipids coexisting in the fraction. In the present study, we improved the procedure of separation of the active glycolipids and evaluated their effects on cellular activation. The immunobiologically active glycolipids were separated from the crude glycolipid fraction obtained by hot phenol-water extraction of the cells. The total yield of active glycolipids was about fivefold higher than that separated by the previous method. Interleukin-6-inducing activities of the active glycolipids from 1,25-dihydroxy vitamin D(3)-differentiated human monocytic leukemia cells, THP-1, were inhibited by anti-CD14 mAbs in a dose-dependent manner. Macrophages from Toll-like receptor (TLR)-2-deficient or -4-deficient mice completely lacked the ability to produce tumor necrosis factor-alpha on stimulation with active glycolipids. These observations indicated that the cellular activation by the active glycolipids from E. hirae is mediated by CD14 and by both TLR2 and TLR4.

Animals↗
PubMed2000

Tricuspid valve replacement after cardiac transplantation.

Tricuspid regurgitation, a fairly common finding after cardiac transplantation, is generally mild or moderate, and is not clinically significant. The etiology of tricuspid regurgitation is not entirely understood, and experience with valve replacement after cardiac transplantation is limited. We describe a case of progressively severe tricuspid regurgitation ultimately requiring tricuspid valve replacement. At operation, the ruptured chordae of the posterior part of anterior and septal leaflet with resulting partially flail leaflets were found. Examination of the papillary muscle showed origins of several of the ruptured chordae. Damage to the tricuspid subvalvular apparatus at endomyocardial biopsy appeared to be a possible cause. A 31-mm Carpentier-Edwards porcine valve was implanted. This was because replacement with a mechanical prosthesis would prevent future right-side heart catheterization and endomyocardial biopsy and in valve repair, the patient remains exposed to the risk of the recurrence of chordal rupture. We discuss proposed causes and choices in surgical technique.

Adult↗
PubMed2000

Twenty-two-year follow-up of saphenous vein grafts in pediatric Kawasaki disease.

We describe 2 Kawasaki disease patients with excellent long-term patency of saphenous vein grafts, who underwent coronary artery bypass at age 7 and 9 years, respectively, and demonstrated normal growth during 22 years of follow-up. The grafts showed no deterioration and played an important role in coronary blood supply.

Child↗
PubMed2000

Lower sternal splitting approach for off-pump coronary artery bypass grafting.

There are several ways to revascularize coronary arteries without cardiopulmonary bypass using a minimally invasive method. Currently, one of the most commonly used methods is minimally invasive direct coronary artery bypass (MIDCAB) through a left thoracotomy. Using this technique, however, only the left anterior descending and diagonal branch can be grafted. This article describes coronary revascularization of the left anterior descending artery or right coronary artery, or both, via a lower ministernotomy without a transverse cut, namely, the lower sternal splitting method. Through this approach, the left anterior descending, diagonal, and right coronary arteries can be revascularized using a single, minimally invasive approach without the risk of damaging the tissue around the intercostal space when the sternum is transversely divided.

Aged↗
PubMed2000

Axis location of tibial rotation and its change with flexion angle.

The magnitude and location of the axis of tibial rotation were measured at 15 degrees increments between 0 degree and 90 degrees flexion using 24 normal anatomic knee specimens, and their changes with flexion angle were investigated. The magnitude of tibial rotation was small (8.3 degrees) at 0 degree flexion, but increased rapidly as the flexion angle increased and reached a maximum rotation (31.7 degrees) at 30 degrees flexion. It then decreased again with additional flexion (24.8 degrees at 90 degrees flexion). The location of the axis was close to the tibial insertion of the anterior cruciate ligament at 0 degree flexion, gradually moving toward insertion of the posterior cruciate ligament (observed at 45 degrees and 60 degrees flexion), and then moved anteriorly again with additional flexion: the axis was approximately equidistant from the two cruciate insertions at 90 degrees flexion. The results showed that a relatively large degree of tibial rotation was possible in a normal knee and that the location of the axis remained approximately in the area between the two cruciate ligament insertions throughout the range of flexion. However, the location of the axis changed with the flexion angle within this area according to the changes in direction and tension of the cruciate ligaments and the surrounding soft tissues.

Adult↗
PubMed2000

Usefulness of HMG-CoA reductase inhibitor in Japanese hyperlipidemic women within seven years of menopause.

OBJECTIVE: To assess the therapeutic value of treatment with an HMG-CoA reductase inhibitor in women with hypoestrogenic hyperlipidemia caused by menopause. DESIGN: Fifty-six women with total cholesterol (TC) levels of 220 mg/dl or more who were within 7 years of menopause were randomly assigned to receive an HMG-CoA reductase inhibitor (pravastatin 10 mg/day; treated group, 26 patients) or no medical treatment (nontreated group, 30 patients) in this 6-month nonblinded prospective trial. RESULTS: In the treated group, the mean (SD) TC levels decreased significantly from 254.5+/-22.3 mg/dl at baseline to 204.7+/-22.2 mg/dl (19.6%), and the mean low-density lipoprotein cholesterol (LDL-C) level decreased significantly from 146.7+/-30.5 to 104.3+/-22.5 mg/dl (28.9%); the mean arteriosclerotic index decreased significantly from 2.98 to 2.08 (30.2%). There were no significant changes in either triglyceride levels or high-density lipoprotein cholesterol (HDL-C) levels. In the nontreated group, there were no significant changes in the TC, HDL-C, LDL-C, or triglyceride levels; there was also no change in the arteriosclerotic index. After 6 months, the TC level, LDL-C level, and arteriosclerotic index were significantly lower in the treated group compared with the nontreated group (p<0.01). CONCLUSIONS: The results indicate that the HMG-CoA reductase inhibitor lowered TC and LDL-C levels and was useful in the treatment of hypoestrogenic hyperlipidemia for periods of at least 6 months.

Arteriosclerosis↗
PubMed2000

[Persistent primitive trigeminal artery presenting with Weber's syndrome: report of a case with three-dimensional CT angiographic evaluations].

We report a rare case of persistent primitive trigeminal artery(PPTA) presenting with brain stem infarction known as Weber's syndrome, and document its unique findings of three-dimensional CT angiography(3 D-CTA). A 69-year-old woman was admitted to our hospital because of gait disturbance and blepharoptosis on the right eye. Neurological examination on admission revealed the right oculomotor nerve palsy, left hemiparesis and dysarthria, all of which indicated the signs and symptoms of Weber's syndrome. Initial CT scan revealed no abnormality, but a subsequent 3 D-CTA demonstrated the PPTA originating from the right internal carotid artery penetrate into the clivus directly to the distal basilar artery, on top of which a small saccular aneurysm was incidentally visualized. Right internal carotid angiograms showed the PPTA run between the cavernous segment of the internal carotid artery and the distal portion of the basilar artery with the filling of both the posterior cerebral and superior cerebellar arteries. However, the proximal portion of the basilar artery was visualized through the right vertebral artery and there was no blood flow to its distal portion. Evidence of infarction was finally confirmed at the right midbrain and thalamus by the MRI performed 5 days after the onset. With a conservative treatment including physical therapy, the patient recovered well from the deficits and could walk by herself with a cane. With regard to the pathogenesis of vertebrobasilar insufficiency in a patient with PPTA, it is generally considered that microembolus from an atherosclerotic carotid artery may be its cause because of the presence of direct communication between the anterior and posterior circulations. In the present case, however, this mechanism may not be applied since there was no evidence of atherosclerotic plaque or stenotic lesions on the carotid arteries. Alternatively, an embolic occlusion may have occurred in the paramedian branches of the posterior cerebral artery since a dilated PPTA itself, which resembled fusiform-aneurysm in appearance, may become the origin of microembolus.

Aged↗
PubMed2000

Reconstructive treatment of posterolateral rotatory instability of the knee: a biomechanical study.

Twelve cadaveric knees were tested to determine effective reconstructive treatment for severe chronic posterolateral rotatory knee instability accompanied by excessive varus and posterior laxity. Posterolateral, varus, and posterior laxity were measured, first with the ligaments intact, then after complete sectioning of the posterior cruciate ligament (PCL) and posterolateral structures, and finally after reconstruction of these structures in different orders. The increases in those laxities were produced following the sectioning of all of the structures and disappeared throughout the flexion range after combined reconstruction of the PCL, lateral collateral ligament (LCL), and popliteus tendon. However, some residual increase in the laxity was always observed if any of the three structures were excluded from reconstruction. Therefore, combined reconstruction of the PCL, LCL, and popliteus tendon is essential and adequate for treating severe chronic posterolateral rotatory instability.

Biomechanical Phenomena↗
PubMed1999

Synthesis of heparin partial structures and their binding activities to platelets.

A synthetic pentasaccharide corresponding to the antithrombin III-binding region in heparin was also found to bind to human platelets. To identify the platelet-binding site in the pentasaccharide which is expected to be a novel sequence in heparin responsible for its platelet-binding, five partial structures of this particular pentasaccharide were synthesized. In a competitive assay using [3H]-heparin, a trisaccharide, O-(2-deoxy-2-sulfamido-3,6-di-O-sulfo-alpha-D-glucopyranosyl)-1--> 4)-O-(2-O-sulfo-alpha-L-idopyranosyluronic acid)-(1-->4)-2-deoxy-2-sulfamido-6-O-sulfo-alpha-D-glucopyranose, was concluded to be a high-affinity site for heparin's binding to platelets.

Antithrombin III↗
PubMed1999

S-form lipopolysaccharide (LPS), but not lipid A or R-chemo-type LPS, induces interleukin-6 production in vitamin D3-differentiated THP-1 cells.

Bacterial lipopolysaccharide (LPS) induces the production of various inflammatory cytokines and the inducibility is considered attributable to the glycolipid part of LPS called lipid A. We report an in vitro model in which lipid A is not necessarily a minimal structure for the LPS activity. Vitamin D3-differentiated THP-1 cells, cultured human monocytic leukemia cells, produced a high level of interleukin-6 (IL-6) by stimulating LPS from Escherichia coli O111:B4, but not by stimulating synthetic E. coli-type lipid A (compound 506), E. coli Re mutant LPS (ReLPS), or alkali-treated LPS. The induction by LPS was inhibited by the anti-CD14 antibodies or by the synthetic lipid A precursor (compound 406). An alkali-treated LPS or compound 506 partially inhibited the LPS-induced IL-6 production. These facts suggest that lipid A alone is not sufficient for the IL-6-inducing activity, but the polysaccharide part in LPS contributes or acts as a co-factor for activation of differentiated THP-1 cells.

Alkalies↗
PubMed1999

Positive selection of NKT cells by CD1(+), CD11c(+) non-lymphoid cells residing in the extrathymic organs.

Previously, we found that NK1.1(+), TCRalpha beta(+) natural killer T (NKT) cells develop in cytokine-supplemented suspension cultures of fetal liver established from normal, but not from beta2 microglobulin-deficient [beta2m(- / -)] mice, and that recombination-deficient SCID fetal liver can reconstiute NKT cell development in beta2m(- / -) fetal liver cultures. We found here that cells of SCID adult liver, bone marrow, spleen and thymus were able to reconstitute NKT cell development in the former culture system with efficiency comparable to normal thymic cells. The reconstitution of NKT cells was also seen in the bone marrow chimeras that had been administered a combination of beta2m(- / -) and Rag-2(- / -) bone marrow cells. Development of NKT cells was hampered by depletion of CD11c(+) or CD11b(+) cells, but not by removal of B220(+) or Gr-1(+) cells from cultures of normal fetal liver cells. Furthermore CD11c(+), CD11b(+) and / or CD11c(+) CD11b(-) cells (both populations were CD1-dull positive) enriched from Rag-2-deficient fetal livers and pulsed with alpha-galactosylceramide, a possible antigen for NKT cells, were shown to reconstitute the NKT cell development in beta2m(- / -) fetal liver cultures. Collectively, our findings suggest that non-lymphoid cells, presumably CD11c(+), CD11b(+) and / or CD11c(+), CD11b(-) dendritic cells, are involved in the mechanism of positive selection of NKT cells in the thymus and extrathymic organs.

Animals↗
PubMed1999

Intraoperative irradiation after surgery for locally recurrent rectal cancer.

PURPOSE: This study retrospectively evaluated the effects of intraoperative electron beam irradiation on patients with locally recurrent (pelvic) rectal cancer. METHODS: From November 1, 1975, to December 31, 1997, 51 patients underwent surgery for locally recurrent rectal or rectosigmoid cancer, and 27 patients received intraoperative electron beam irradiation. The intraoperative electron beam irradiation dose was 15 to 30 Gy. Kaplan-Meier survival estimates at three and five years were analyzed for the 47 patients who recovered postoperatively. RESULTS: Statistically significant factors related to survival included intraoperative electron beam irradiation vs. no intraoperative electron beam irradiation (P=0.0007), amount of residual tumor (slight vs. gross; P=0.0022), and symptom status (P=0.0024). Factors not associated with survival included distant metastases at reoperation, type of surgery for the recurrent tumor, external beam irradiation, pathologic grade, age, and gender. Surgical resection without intraoperative electron beam irradiation resulted in three-year and five-year survival rates of 5 and 0 percent, respectively. For patients who received intraoperative electron beam irradiation, the three-year survival rate was 43 percent and five-year survival rate was 21 percent. Intraoperative electron beam irradiation was a statistically significant factor related to survival in patients with and without distant metastasis (P=0.04 and P=0.0035, respectively), with slight residual tumor (P=0.0003), or with palliative surgery (P=0.0276). CONCLUSION: The trends seen in resection with intraoperative electron beam irradiation are encouraging with regard to improvements in survival as compared with studies not using intraoperative electron beam irradiation treatment.

Adult↗