The importance of aortic compliance as a prognostic factor after aortic valve replacement

A variety of clinical variables and physiological parameters have been discussed in relation to postoperative survival and symptoms in aortic regurgitation (AR). Many of them have been derived from left ventricular morphology and functions, but there has been no parameter from aortic functions. As the heart is united with the aortic tree to form a circulatory system and both heart and aorta affect each other, aortic functions also have an important prognostic value after aortic valve replacement (AVR). This study was performed to clarify the participation of aortic functions in determining the prognosis after AVR. Fifteen consecutive patients undergoing isolated AVR for AR were evaluated. Twenty-one preoperative hemodynamic and dimensional variables of both heart and aorta were analyzed to determine the risk factors for early postoperative morbidity. These variables were obtained from chest X-ray film, electrocardiogram, echocardiogram, cine-aorto-ventriculogram and pressure manometries. All patients were divided in two groups according to the postoperative course. Group I composed of 10 patients took relatively smooth postoperative course, except two patients suffering from cardiac tamponade. Group II composed of 5 patients suffered from low cardiac output syndrome (LOS) and/or dangerous arrhythmias postoperatively. Two out of them died of uncontrollable ventricular arrhythmias. There were no statistic differences between two groups in the factors derived from preoperative examinations, i.e. CTR, LVDsI, PWT, R/Th, %FS, EDVI, EF, CI, LVEDP, etc. Mean aortic compliance of group II, (3.8 +/- 2.1) X 10(-4) mmHg-1, was, however, significantly lower than that of group I, (21.7 +/- 4.8) X 10(-4) mmHg-1, (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

A treatment of intractable sternal osteomyelitis--significant use of pedicle muscular flaps

In recent years, the greater omentum of pedicle muscular flap has been used to treat chest wall infection and Sternal Osteomyelitis following cardiac or respiratory surgery. In Japan, however, there has been an increasing number of cases in which neither the greater omentum Nor the rectus muscle can be used due to the comparatively young age of the patient. There are also many cases undergoing abdominal surgery for malignant tumor and bypass surgery of the coronary artery in which the internal thoracic artery (ITA) and gastroepiploic artery (GEA) are used. We studied three such cases; a case of coronary aortic bypass graft (CABG) where ITA from both the right and left sides were used following stomach resection; a case in which CABG and gallbladder resection were carried out simultaneously; and a case of sternal osteomyelitis is years following surgery for ventricular septal defect. All three cases had undergone reconstructive surgery using the pectoralis major muscle or a pedicle muscular flap from the latissimus dorsi muscle. It is estimated that cases of CABG using both the right and left sides of ITA and GEA, cases of the elderly as well as cases of children will continue to increase. Consequently, cases of sternal osteomyelitis in which neither the omentum nor rectus muscle can be used will also increase. Therefore, it is considered that treatment using pedicle muscular flaps from the breast or dorsal area may be very effective. Herein, we report on the choice of treatment and its results.     

Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1985). II. Background of patients

We have investigated relationships between patients' backgrounds and isolates from urinary tract infections in reference to various conditions, such as sexes, age distribution by sex, species of causative organisms by sex, age distribution according to species and types of infections, species and infections before and after treatment with antibacterial agents, and species and detected places. As for the relationship between sexes and types of infections, although simple urinary tract infections were consistently found at about 20% in men and at about 80% in women between 1981 and 1983, these infections were seen at 24.4% in men and at 75.6% in women in 1984, and at 26.6% and at 73.4% in 1985, indicating slight decreases in the ratio of women. By contrast, complex urinary tract infections were found in men at about 60-70% from 1981 up to 1985, regardless of the presence or absence of indwelling catheter. There were no noticeable changes according to age during this 5-year period in incidences of infections including simple urinary tract infection and complex urinary tract infection with or without indwelling catheter. Thus, backgrounds of patients with urinary tract infections, including sex, age and simple or complex infections, were fairly consistent throughout this period, while there were relatively large changes in species of isolates. Enterococcus faecalis was isolated at about 8% of both men and women in 1982 and 1983, but its isolation rates were increased to 22.5% of men and 17.9% of women in 1984. In 1985 this species was isolated in 14.9% of men and 7.6% of women, and in 11.2% of all patients. Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp. and Enterococcus spp. were detected at rates of 3.2%, 8.1%, 0.7% and 1.0%, respectively, and 24.2% of isolated strains were Gram-positive organisms. When species of isolates before treatment with antibacterial agents and their isolation rates were analyzed, it was found that the isolation rate of E. faecalis increased dramatically in 1983, and that this tendency was still seen in 1984. The isolation rate of Gram-positive organisms was 25% in 1984 and 24.3% in 1985. Escherichia coli was consistently isolated at about 40%, but, as far as simple urinary tract infections are concerned, its isolation rate decreased by about 10% in 1985, compared to 1982 and 1983. These results suggested that causative organisms for simple urinary tract infections became similar to those for complex urinary tract infections. In other words, isolates obtained from complex urinary tract infections before treatment were similar to those of simple infections.(ABSTRACT TRUNCATED AT 400 WORDS)     

A case of Swyer-James syndrome diagnosed at age 70

A male case of Swyer-James syndrome, who had been followed for bronchiectasis for a long time, detected at age 70 and diagnosed by radiological studies was reported. The movement of his left diaphragm was impaired. Arterial oxygen tension was 68 torr while breathing room air. Pulmonary function tests showed mixed ventilatory impairment, increase of residual volume, and uneven gas distribution, but diffusing capacity was normal with the single breath method. Chest radiograph revealed hyperlucency of the left lung and the right middle lung field. In these areas, pulmonary angiography showed marked hypovascularity and diffuse vascular atrophy, and perfusion and inhalation scans also showed marked decreased perfusion and ventilation. Pulmonary hypertension was not detected by right heart catheterization. Fiberoptic bronchoscopy was performed and showed no abnormality of the left bronchial tree, and bronchography demonstrated diffuse cylindrical bronchiectasis of the left lung with no alveolar filling. He had suffered from chronic sinusitis for a long time, which might suggest that he had sinobronchitis due to congenital abnormality of the airway and this caused continuous respiratory infection, which could cause this syndrome. Including our own case, about 80 cases of Swyer-James' syndrome have been reported in Japan. But only 4 cases were above 70 years of age and all of them were male, and there has been no female cases above age 50. Males predominate over females, and in both sexes the left lung was more commonly affected than the right.     

Evaluation of cerebral hemodynamics with perfusion CT]

We report on the evaluation of cerebral ischemic lesions with perfusion CT. Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) of 52 patients mostly with ischemic cerebrovascular disease were analysed using the box-modulation transfer function method with 30 ml of contrast medium intravenously injected at 5 ml/sec. CBF, CBV and MTT of the middle cerebral artery (MCA) territory were 43.5 +/- 4.6 ml/100 g/min, 1.9 +/- 0.2 ml/100 g and 2.9 +/- 0.6 seconds at the unaffected side, and 37.7 +/- 7.3 ml/100 g/min, 2.1 +/- 0.3 ml/100 g, 3.7 +/- 0.9 seconds at the lesion side with stenosis or occlusion in the main MCA trunks or internal carotid artery, respectively. A statistically significant difference was shown in CBF and MTT values. Furthermore, there was a close correlation in CBF values of MCA territories between Xe-CT and perfusion CT (r = 0.645, n = 76, p < 0.0001). MTT showed a positive correlation with CBV in those subjects when MTT was below 4.1 seconds (r = 0.526, p < 0.0001, n = 83). MTT also showed a negative correlation with CBF in those patients when MTT indicated more than 4.1 seconds (r = 0.818, p < 0.001, n = 21). These results suggest that the progression of cerebral ischemia may be classified in 4 stages using perfusion CT. The stages are as follows: stage 0; normal CBF without prolonged MTT and increased CBV, stage 1; relatively increased CBV, stage 2; significantly prolonged MTT, and stage 3; significantly decreased CBF with prolonged MTT.     

The effect of OP 2507, a stable analogue of prostacyclin, on Hep G2 exposed to hypoxia

We developed a model for screening drugs to reduce ischemic liver damage using Hep G2, a hepatoblastoma cell line, and examined the effect of OP 2507, a stable analogue of prostacyclin, on hypoxic cell damage. Hypoxic exposure of the cells was done for 16 hr in an air-tight chamber which was placed inside an incubator and was purged with 5% CO2/95% N2. Adding OP 2507 (0.01-10 ng/ml) to the incubation medium during hypoxic exposure reduced mitochondrial damage estimated by MTT-reducing activity, while it failed to inhibit lactate accumulation in the medium. OP 2507 seems to be a good candidate for improving the preservation of liver allografts.     

The Development of a New Setup for Video-assisted Thoracic Surgery

In order to accomplish video-assisted thoracic surgery (VATS) in a much easier and safer way, especially for assistant operators, we have developed a new display system for VATS. The original thoracoscope has been designed for this new system. The monitor is fixed at approximately 10 cm away from the surface of the chest wall just above the operative field. In using this procedure, the operator and assistants can see the patient and the monitor at the same time. According to this new idea, the previous problem in the area of hand-eye coordination and the three-dimensional understanding of this procedure can be improved compared to the image of the conventional thoracoscopy, because it is not necessary for the operator and assistants to look up at the monitors. When the thoracoscopy was placed in an adequate position to resect the target pathology, this new system led to good and easy handling of instruments, as it was with the standard thoracotomy.