1.Surgical Treatment of Partial Atrio-Ventricular Canal in Aged Patients: Report of Two Cases.
Yusuke UMEBAYASHI ; Kazuhiro ARIKAWA ; Toshiyuki YUDA ; Shinji SHIMOKAWA ; Shigeru FUKUDA ; Yukinori MORIYAMA ; Akira TAIRA
Japanese Journal of Cardiovascular Surgery 1992;21(2):207-211
Partial atrio-ventricular canal is usually symptomatic and treated surgically in a childhood. In the literature, only eight cases have been operated on over fifty years of age. We experienced two cases of partial atrio-ventricular canal; one was 63-year-old female and the other was 67-year-old male. The female patient showed rapid increase of the pulmonary pressure during the last three years. The male patient had moderate mitral regurgitation with mild pulmonary hypertention. Although the repair of the mitral valve was successful in the female patient, it was difficult in the male patient because of massive calcification along the edges of the mitral cleft. Blood biochemistry data revealed the liver cirrhosis due to congestion in the male patient. Because of poor tolerance of the viscera in aged patients, it is quite important not to raise the central venous pressure more than 15cmH2O at the cessation of the cardio-pulmonary bypass. Over-hydration may cause congestive heart failure easily, and take into vicious cycle. Of course early operation is better, these two cases, however, had uneventful course and resumed active life early in their postoperative days. Results of them encouraged us to treat aged patient of partial atrio-ventricular canal surgically.
2.Hypothermia for the Management of Low Cardiac Output Syndrome after Open Heart Surgery.
Yoshifumi IGURO ; Hitoshi TOYOHIRA ; Shinzi SHIMOKAWA ; Yuusuke UMEBAYASHI ; Shigeru FUKUDA ; Yukinori MORIYAMA ; Shunichi WATANABE ; Akira TAIRA
Japanese Journal of Cardiovascular Surgery 1993;22(2):118-122
Surface induced hypothermia was introduced in six cases with low cardiac output syndrome after open heart surgery to reduce oxgen consumption. The patients were consisted of two ACBG, two LV rupture after MVR, MVR with ACBG and AVR with poor LV function. Hemodynamic changes such as heart rate, mean arterial pressure, cardiac index, systemic vascular resistance, pulmonary artery wedge pressure, were measured every 3-4 hours throughout the course of hypothermia. Acid-base balance, mixed venous oxgen saturation and oxygen consumption were also monitored. Hypothermia was induced using a blanket and ice-beutels. Temperature in hypothermia was maintained at about 33°C. We are intended to increase SVO2 up to the level of 50% and to improve anerobic condition. Hypothermia was continued for 45 hours in the shortest and 148 hours in the longest case with a mean of 78 hours. Arrythmia was not seen. Hemodynamic and acid-base balance were in significantly changed in comparison of the control values. However, SVO2 and VO2 changed significantly after introduction of hypothermia. They increased from 47.8±7.5% to 58.7±7.9% and reduced from 231±29.7 to 188±31.3ml O2/min respectively. Hemodynamic condition was improved and IABP was successfully weaned in all cases. We suggest that the use of hypothermia is one of the effective modality in the management of low cardiac output syndrome after open heart surgery.
3.Vasculo-Behcet Disease with Multiple Surgery and Reconstructed by Extraanatomic Bypass.
Toshiyuki Yuda ; Shigeru Fukuda ; Masaaki Koga ; Syuniti Watanabe ; Riitirou Toda ; Yuusuke Umebayashi ; Tosiaki Miyazaki ; Kazuhiro Arikawa
Japanese Journal of Cardiovascular Surgery 1996;25(1):59-63
A 52-year-old man suffering from Behçet's disease had undergone 6 operations for recurrent aneurysms of the bilateral iliac and femoral arteries. Thereafter, the patient underwent graft replacement for abdominal aortic aneurysm. Six years later he complained of lower abdominal pain and back pain. Abdominal CT-scan revealed abnormality of the proximal anastomotic site. The proximal suture line was completely dehiscent. The distal edge of infra-renal abdominal aorta was closed with interrupted mattress sutures. A right axillo-iliac bypass using a Dacron graft was performed for arterial reconstruction of the lower extremity. The patient has been free of recurrence for 4 years after the operation.
4.LOVE49 Activity in Gunma: Report and Prospects for The Future
Kaori ONOSATO ; Satomi HOSHIKAWA ; Yasunori KURIBARA ; Toru YAMAGISHI ; Harumi KAMIYAMA ; Shigeru TSUCHIDA ; Toshio FUKUDA
An Official Journal of the Japan Primary Care Association 2020;43(2):73-76
INTRODUCTION: To eradicate uterine cervix cancer, we report LOVE49 activity in Gunma prefecture and considered activities to be focused on in the future.METHODS: Activities included the creation of original goods and "Gunma-chan" costume, broadcast by local FM radio, plans for distribution, and distribution among college students.RESULTS: Original goods were distributed more efficiently to young women than in previous years. These activities led to an increased number of goods distributed, shortening of the time for distribution and reducing the burden on members.CONCLUSION: It is important that women themselves obtain correct knowledge and information to continuously improve the check-up rate. Health education for young people in particular is important.
5.Analysis of 183 Adult Cases of Secundum Type Atrial Septal Defect.
Yusuke UMEBAYASHI ; Yukinori MORIYAMA ; Shigeru FUKUDA ; Ryohei ISHIBE ; Hideaki SAIGENZI ; Shinzi SHIMOKAWA ; Toshiyuki YUDA ; Hitoshi TOYOHIRA ; Akira TAIRA ; Kazuhiro ARIKAWA
Japanese Journal of Cardiovascular Surgery 1993;22(6):468-471
A total of 183 patients who underwent surgical repair of secundum type atrial septal defect (ASD), were divided into 5 age groups. Hemodynamic parameters, arrhythmia, and abnormality of the atrio-ventricular valve function were compared among the 5 groups. Although the pulmonary to systemic blood flow ratio was not different, the pulmonary to systemic pressure ratio was higher in the sixth decade than in the third (p<0.05) and fourth (p<0.01). Pulmonary to systemic vascular resistance ratio increased with age, although the difference was not statistically significant. The cardiothoracic ratio, atrial fibrillation and tricuspid regurgitation (TR) also increased with age. These data suggest that ASD progresses with age. There were 41 patients who showed more than grade II TR, 10 patients underwent tricuspid annuloplasty (TAP), 1 underwent tricuspid valve replacement, and the other 30 patients had no treatment of the tricuspid valve. TAP with DeVega's (6 cases) or Carpentier-ring (1) method was effective. In 30 untreated TR patients, 9 patients remained with grade II TR after closure of the defect. Because TAP is an easy and very effective procedure, TAP should have been applied to all patient with TR more severe than grade II. There were 10 patients with mitral regurgitation (MR) of more than grade II. Two patients in whom mitral valve prolapse had been detected on ultrasound cardiography (UCG) before operation underwent mitral valve plasty successfully. Although MR decreased in 6 patients after only ASD closure, two patients remained with grade II MR. We now recommend that the mitral valve should be assessed under direct vision, and intraoperative trans-esophageal echo cardiography, and also that the mitral regurgitation test as well as preoperative UCG should be performed. Because ASD is progressive with age, surgical repair should be performed before age 40.
6.Controlled Clinical Trials Using the Envelope Method for Urinary Dysfunction. The Effectiveness of the zhongji (cv-3).
Munenori MINAGAWA ; Tatsuyo ISHIGAMI ; Shigeru HORI ; Norikazu TANAKA ; Hironori NAKAMURA ; Yoshiyuki KAWASE ; Teruo HATTORI ; Akira KINUTA ; Hidetaka HIRAMATU ; Hisashi KOUDA ; Yoshikazu TANAKA ; Hiroyasu FUKUDA ; Ako NAKAMURA ; Tomoyuki IZAWA ; Haruhiko IJIMA ; Takayuki NAKAMURA ; Yasuzo KURONO
Journal of the Japan Society of Acupuncture and Moxibustion 1999;49(3):383-391
At the 45th Japanese National Acupuncture and Moxibustion Conference, Kitakoji et al. of the Research Committee's Urology Group reported the results of controlled clinical trials, using the envelope method, on the effectiveness of acupuncture for urinary dysfunction. This was presented as a case in which the “Guidelines and Recommendations for clinical Trials in Acupuncture” were applied in actual clinical research. A controlled investigation was carried out by the Information and Evaluation Group, Research Section, Aichi Regional Association, at multiple institutions (9 hospitals and clinics) on the effectiveness of the zhongji (cv-3) point for urinary dysfunction, using the envelope method of Kitakoji et al. Although the zhongji (cv-3) point was not found to be effective against urinary dysfunction, we were able to demonstrate that it is possible to conduct controlled clinical trials at multiple institutions based on soft data.