1.Antithrombotic Effect on Hemostasis during Water Immersion at Indifferent Temperature.
Hiroyuki SHIONO ; Junichi SAKAI ; Tadashi OKADA ; Isamu SUGIE
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine 1997;60(4):227-234
Studies on the effects of heating as well as the mineral components of hot spring water have been conducted to investigate the effects of balneotherapy. However, few studies have been conducted on the effects of hydrostatic pressure and buoyancy during water immersion. Therefore, we investigated the effect of water immersion up to the neck at thermoneutral temperature on hemostatic activity.
Nine healthy men aged 22 to 34 were immersed up to the neck in the standing position in thermoneutral water (34.0±0.5°C) for two hours. The heart rate decreased immediately after starting water immersion and remained low during the immersion. Hematocrit values (Ht) of the blood samples taken from the ante-cubital vein decreased by 3.4% in average. The decrease in Ht was more prominent in the blood samples taken from the earlobe (4.0%), suggesting that hemodilution due to fluid shift was stronger in the upper part of the body. The time until euglobulin clot lysis shortened immediately after starting the immersion. Although fibrinolytic activity was enhanced, the concentration of tissue plasminogen activator (t-PA) antigen in the blood decreased gradually during the immersion and tended to return to the original level 30 minutes after immersion. A larger decrease in the concentration of plasminogen activator inhibitor-1 (PAI-1) antigen in the blood was observed immediately after starting the immersion, and it remained low for 30 minutes after immersion. An increase in fibrinolytic activity due to the decrease in PAI-1, not in t-PA, was observed during water immersion at thermoneutral temperature and the activation of fibrinolytic system without activation of the coaguration system was also observed.
2.A Case of Aortitis Syndrome Complicated with Incomplete Marfan's Syndrome Operated by the Cabrol Method.
Kiyoshige Inui ; Hiroyuki Orita ; Tetsuro Uchida ; Satoshi Shiono ; Masahiko Washio ; Takao Shimanuki ; Chiharu Nakamura
Japanese Journal of Cardiovascular Surgery 1994;23(3):212-216
We report a very rare case of annuloaortic ectasia with an etiology of both aortitis syndrome and Marfan's syndrome. A 25-year-old woman showed AAE and AR. Her mother had died of SLE, but there was no Marfan's syndrome in her family. Her eyes were normal but her finger was long enough to show wrist sign and thumb sign. Urgent operation was performed because of her progressive heart failure. The ascending aorta was enlarged and Valsalva sinuses showed asymmetrical dilatation. The Cabrol operation was done with a composite graft of 23mm Medtronic Hall valve and 26mm Gelseal graft. The valve was sutured to the graft for 5mm from the end of graft to minimize the tension for annulus because of the high invidence of valve detachment and leakage in aortitis syndrome. Pathological study showed findings of both aortitis syndrome and Marfan's syndrome. Postoperative aortography showed good valvular function, and the patient is doing well now at 6 months after operation.
3.Endovascular Stent-Grafting in a Patient with Concomitant Descending Thoracic Aortic Aneurysm and Cancer of the Right Lung.
Tsutomu Sugimoto ; Toshiki Takahashi ; Takashi Minowa ; Satoshi Shiono ; Hiroyuki Oizumi ; Takao Watanabe ; Yasuhisa Shimazaki
Japanese Journal of Cardiovascular Surgery 2001;30(4):210-212
A 75-year-old woman underwent endovascular stent-grafting for a descending thoracic aortic aneurysm, followed by video-assisted thoracoscopic right upper lobectomy for concomitant lung cancer in a later procedure. Two custom-made endovascular spiral Z stents covered with woven Dacron (DuPont Co., Wilmington, DE, USA) were delivered via the femoral artery under local anesthesia using pull-through technique. Intraoperative angiograms showed successful exclusion of the aneurysm without any endoleakage. Conventional surgical treatments for both diseases in this patient would have required bilateral thoracotomy either in a simultaneous or staged fashion and entail risks of postoperative pulmonary dysfunction and progression of the cancer. Endovascular stent-grafting offered potential superior operative results and quality of postoperative life in this patient with concomitant descending thoracic aortic aneurysm and cancer of the right lung.
4.Effects of 38.DEG.C. Bathing for 30 min on Hemostatic Function and Autonomic Nervous Function in Patients with Cerebral Infarction.
Yumi KATOH ; Toshiaki YOSHIDA ; Mariko AIHARA ; Masakazu NITTA ; Hiroyuki SHIONO ; Junichi SAKAI ; Tadashi OKADA ; Isamu SUGIE ; Nariaki IIJIMA
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine 2001;64(2):93-102
Effects of 38°C 30-minute bathing on hemostatic function and autonomic nervous function were studied in 15 48-to-72-year-old patients with cerebral infarction. Blood samples were collected three times: immediately before the bathing, at the end of 30 minutes of bathing, and 30 minutes after the bathing. Hematocrit values and fibrinogen concentrations decreased during bathing and returned to the pre-bathing levels 30 minutes after bathing. This indicates that bathing caused hemodilution due to the fluid shift. During bathing, noradrenaline decreased at a rate significantly higher than that of hemodilution while the sympathetic nervous function, which was evaluated by spectral analysis of sequential variation in arterial blood pressure, was not suppressed. The autonomic nervous system seemed to be inactive in these patients. Coagulation time (PT and APTT) and platelet factor (β-TG and PF4) showed few changes. In the fibrinolytic system, however, tissue plasminogen activator (t-PA) antigen levels increased and plasminogen activator inhibitor type-1 (PAI-1) levels decreased after 30 minutes of bathing. This suggests that fibrinolytic activity was enhanced by 38°C bathing for 30 minutes. Thus, subthermal bathing with comfort may be useful in preventing cerebral infarction.
5.A Case of Aortic Valve Replacement in Patient with Chronic Idiopathic Thrombocytopenic Purpura.
Hiroyuki Hirose ; Motomi Shiono ; Yukihiko Orime ; Shinya Yagi ; Tomonori Yamamoto ; Haruhiko Okumura ; Mitsumasa Hata ; Nanao Negishi ; Yukiyasu Sezai ; Yoshihiro Matsukawa
Japanese Journal of Cardiovascular Surgery 2000;29(6):400-403
A 66-year-old woman with aortic stenosis and idiopathic thrombocytopenic purpura (ITP) underwent concomitant splenectomy and aortic valve replacement (AVR). High-dose trans-venous gamma-globulin therapy (400mg/kg/day) was performed for five days before surgery. The number of platelet, which was 6.0×104/mm3 on admission slighty increased to 7.0×104/mm3 before surgery. The aortic valve was replaced by an ATS 19mm prosthesis using cardiopulmonary bypass. Platelets were transfused postoperatively. Perioperative hemorrhage was moderate, and the postoperative course was uneventful. This was the second case we treated by concomitant cardiac surgery and splenectomy. It was safely performed after high-dose trans-venous gamma-globulin therapy.