1.Long Term Results with Tilting Disk and Bileallet Prostheses in Mitral Valve Replacement.
Tomohiro Ogawa ; Shunichi Hoshino
Japanese Journal of Cardiovascular Surgery 1996;25(6):364-370
A total of 35 patients who underwent mitral valve replacement were followed up for more than 5 years. Their hemodynamics and valve function were analyzed using transthoracic and esophageal Doppler ultrasound echocardiography and cineangiography. They were classified and evaluated according to valve function. The tilting disk valve replacement group (group I) consisted of 24 cases, the bileaflet valve replacement group (group II) consisted of 11 cases. There were 4 mechanical valve dysfunction cases in group I. The function of group II tended to be superior to group I, even excluding those with valve dysfunction. However, the hemodynamic recovery of the latter was as good as that of group II. The left cardiac function parameters of LVEF, %FS and CI were comparable in both groups, but in valve dysfunction cases LVEDVI decreased because of prosthetic stenosis and there was some right ventricular overload with severe tricuspid regurgitation.
2.A Case of Chest Pain as an Initial Symptom of Coronary-Pulmonary Arterial Fistula.
Kazunori Ishikawa ; Shunichi Hoshino ; Hirofumi Midorikawa ; Tomohiro Ogawa ; Kouichi Sato
Japanese Journal of Cardiovascular Surgery 2002;31(3):187-190
A 51-year-old woman suffered from a sudden onset of anterior chest pain and was referred to our hospital on the suspicion of an anginal attack. The exercise ECG showed findings of an anterior lesion and ischemia. Coronary angiography also revealed left anterior descending branch fistula and circumflex branch fistula connecting to the main pulmonary artery trunk. Direct closure was performed for both intra-pulmonary openings under cardiopulmonary bypass. The postoperative course was uneventful and the patient did not show any precordial pain. Coronary angiography showed no coronary organic narrowing, but contrast medium remained in the fistulae although there was no left to right shunt. Ligation of the fistulae had to be performed simultaneously to confirm complete obstruction of the coronary-pulmonary arterial fistulae. The antiplatlet agent is administered to the patient to prevent occurring myocardial infarction caused by thrombus which might be formed in fistulae.
3.Acute Stanford Type B Aortic Dissection after Endoluminal Grafting for the Treatment of Descending Thoracic Aortic Aneurysms
Hirofumi Midorikawa ; Tomohiro Ogawa ; Kouichi Satou ; Masayuki Koyama ; Shunichi Hoshino
Japanese Journal of Cardiovascular Surgery 2004;33(1):26-29
A 65-year-old patient underwent successful transluminally placed endoluminal prosthetic grafts (TPEGs) of a descending thoracic aortic aneurysm (dTAA). Two hours after TPEGs, the patient suddenly complained of chest, back pain and right leg pain. Angiography and computed tomography showed acute type B aortic dissection. Re-TPEGs was immediately performed, and the entry was successfully closed. This case suggests that TPEGs for the treatment of acute aortic dissection may be useful for selected patients.
4.Hemodynamics and Surgical Results of Chronic Venous Insufficiency with Skin Changes in the Lower Limbs.
Hirono Satokawa ; Shunichi Hoshino ; Fumio Iwaya ; Tsuguo Igari ; Hirohumi Midorikawa ; Shinya Takase ; Tomohiro Ogawa
Japanese Journal of Cardiovascular Surgery 1996;25(5):290-294
Preoperative hemodynamics in the lower limbs in 174 limbs of 103 patients were measured and investigated and the surgical results were evaluated. The subjects were divided into the C4-6-group, which included 51 limbs with skin changes, and the C2, 3-group, which consisted of 123 limbs without skin changes. Plethysmography showed that the maximum venous outflow was significantly higher, and the refilling time was shorter in the C4-6-group compared to the C2, 3-group. All C4-6-group patients had reflux of the long saphenous vein, and the reflux velocity and volume was significantly greater than in the C2, 3-group. Limbs with deep vein reflux accounted for 45% of the C4-6-group. We performed angioscopic deep vein external valvuloplasty in 23 of those limbs. There was no case of reccurence of skin changes at a mean follow-up of 22 months. However chronic venous insufficiency often was associated with multisegmental reflux lesions and in such cases it might be necessary to perform multiple surgical procedures to eliminate the reflux.
5.Photodynamic hyperthermal chemotherapy with indocyanine green: a novel cancer therapy for 16 cases of malignant soft tissue sarcoma.
Masaki ONOYAMA ; Takeshi TSUKA ; Tomohiro IMAGAWA ; Tomohiro OSAKI ; Saburo MINAMI ; Kazuo AZUMA ; Kazuhiko KAWASHIMA ; Hiroshi ISHI ; Takahiro TAKAYAMA ; Nobuhiko OGAWA ; Yoshiharu OKAMOTO
Journal of Veterinary Science 2014;15(1):117-123
Sixteen cases of malignant soft tissue sarcoma (STS; 10 canines and six felines) were treated with a novel triple therapy that combined photodynamic therapy, hyperthermia using indocyanine green with a broadband light source, and local chemotherapy after surgical tumor resection. This triple therapy was called photodynamic hyperthermal chemotherapy (PHCT). In all cases, the surgical margin was insufficient. In one feline case, PHCT was performed without surgical resection. PHCT was performed over an interval of 1 to 2 weeks and was repeated three to 21 times. No severe side effects, including severe skin burns, necrosis, or skin suture rupture, were observed in any of the animals. No disease recurrence was observed in seven out of 10 (70.0%) dogs and three out of six (50.0%) cats over the follow-up periods ranging from 238 to 1901 days. These results suggest that PHCT decreases the risk of STS recurrence. PHCT should therefore be considered an adjuvant therapy for treating companion animals with STS in veterinary medicine.
Animals
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Antineoplastic Agents/*therapeutic use
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Cat Diseases/drug therapy/surgery/*therapy
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Cats
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Combined Modality Therapy/veterinary
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Dog Diseases/drug therapy/surgery/*therapy
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Dogs
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Hyperthermia, Induced/veterinary
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Indocyanine Green/*therapeutic use
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Photochemotherapy/veterinary
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Photosensitizing Agents/*therapeutic use
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Sarcoma/drug therapy/surgery/therapy/*veterinary
6.Mechanism of hepatocyte apoptosis in rats with liver fibrosis induced by lipogenic methionine-choline-deficient diet.
Yong-ping MU ; Tomohiro OGAWA ; Norifumi KWADA
Chinese Journal of Pathology 2012;41(2):112-118
OBJECTIVETo clarify the effects of endoplasmic reticulum stress (ER stress) and mitogen-activated protein kinase (MAPK) on hepatocyte apoptosis in rats with non-alcoholic fatty liver fibrosis induced by methionine-choline-deficient diet (MCDD).
METHODSNonalcoholic steatohepatitis with advanced fibrosis was induced in rats by giving a MCDD for 10 weeks (group M). A methionine-choline-control diet (MCCD) instead of MCDD was given for the last 2 weeks to the experimental group (group R). Steatosis, fibrosis and inflammation were determined by tissue staining. The activation of hepatic stellate cells and oxidative stress were determined by immunostaining, immunoblotting or real time-PCR (RT-PCR), respectively. Hepatocyte apoptosis was determined by TUNEL staining. Expressions of glucose-regulated protein 78 (GRP78), caspase-12, caspase-7, cleaved caspase-7, caspase-3, cleaved caspase-3, and caspase-9 were evaluated to clarify the presence of ER stress. Expressions of c-Jun, ERK1/2, p-ERK1/2 were evaluated to clarify the states of MAPK signaling.
RESULTSChanging the diet from MCDD to MCCD triggered the reduction of fat in hepatocytes, a decrease in inflammatory response, oxidative stress, and fibrosis. The protein expressions of ERP78, caspase-12, caspase-7, and cleaved caspase-7 were increased significantly in group M compared with normal control group (group N, P < 0.05 or P < 0.01), the mRNA expressions of ERP78, caspase-12, and caspase-7 were also increased significantly in group M compared with group N (3.03 ± 0.41 vs 2.12 ± 0.37, 1.86 ± 0.36 vs 0.78 ± 0.20, and 2.38 ± 0.19 vs 1.84 ± 0.13, respectively, P < 0.05 or P < 0.01), while they recovered immediately in group R. In contrast, the protein levels of caspase-3, cleaved caspase-3 and mRNA expressions of caspase-3 and caspase-9 revealed no significant differences in three groups (P > 0.05). The mRNA expressions of c-Jun and protein levels of ERK1 and p-ERK1 were increased significantly in group M compared with group N (P < 0.01), while they recovered immediately after changing the diet from MCDD to MCCD.
CONCLUSIONSER stress plays a role in the development and regression of non-alcoholic fatty liver fibrosis induced by MCDD, however, ER stress-related caspase-12 pathway may not be the main mechanism of hepatic apoptosis, and MAPK signaling may play an important role in hepatic apoptosis in the model.
Animals ; Apoptosis ; Caspase 12 ; metabolism ; Caspase 3 ; metabolism ; Caspase 7 ; metabolism ; Caspase 9 ; metabolism ; Choline Deficiency ; Diet ; Endoplasmic Reticulum Stress ; physiology ; Fatty Liver ; etiology ; metabolism ; pathology ; Heat-Shock Proteins ; metabolism ; Hepatocytes ; pathology ; Liver Cirrhosis ; etiology ; metabolism ; pathology ; Male ; Methionine ; deficiency ; Mitogen-Activated Protein Kinases ; metabolism ; Non-alcoholic Fatty Liver Disease ; Proto-Oncogene Proteins c-jun ; metabolism ; RNA, Messenger ; metabolism ; Rats ; Rats, Wistar ; Signal Transduction
7.Involvement of endoplasmic reticulum stress in development of fatty liver fibrosis induced by methionine-choline-deficient diet in rats.
Yong-ping MU ; Norifumi KWADA ; Tomohiro OGAWA ; Xiu-hong XI ; Xiao-rong CHEN
Chinese Journal of Hepatology 2010;18(2):124-130
OBJECTIVETo study role of endoplasmic reticulum stress in the development of fatty liver fibrosis induced by methionine-choline-deficient diet in rats.
METHODSNon-alcoholic steatohepatitis was induced by 10 weeks- methionine-choline-deficient diet (MCDD), Markers of endoplasmic reticulum stress were determined by immunoblotting and real-time PCR.
RESULTSThe number of apoptotic hepatocytes, The expression levels of endoplasmic reticulum stress markers were increased significantly in MCDD group compared to control group (probability value less than 0.05 or probability value less than 0.01), while ratio of hepatocyte proliferation/apoptosis was decreased in MCDD group (probability value less than 0.01). The number of hepatocytes apoptosis, and the expression levels of endoplasmic reticulum stress markers were decreased significantly 2 weeks after the feeding with normal diet in MCDD group (probability value less than 0.05 or probability value less than 0.01).
CONCLUSIONMCDD induces endoplasmic reticulum stress and fibrosis in rats.
Animals ; Apoptosis ; Caspases ; genetics ; metabolism ; Cell Proliferation ; Choline ; administration & dosage ; metabolism ; Choline Deficiency ; Diet ; Disease Models, Animal ; Endoplasmic Reticulum ; physiology ; Fatty Liver ; complications ; Liver ; metabolism ; pathology ; Liver Cirrhosis ; diet therapy ; etiology ; physiopathology ; Male ; Methionine ; deficiency ; RNA, Messenger ; genetics ; metabolism ; Random Allocation ; Rats ; Rats, Wistar
8.A Randomized Double-blind Placebo-controlled Trial on the Effect of Magnesium Oxide in Patients With Chronic Constipation
Sumire MORI ; Toshihiko TOMITA ; Kazuki FUJIMURA ; Haruki ASANO ; Tomohiro OGAWA ; Takahisa YAMASAKI ; Takashi KONDO ; Tomoaki KONO ; Katsuyuki TOZAWA ; Tadayuki OSHIMA ; Hirokazu FUKUI ; Takeshi KIMURA ; Jiro WATARI ; Hiroto MIWA
Journal of Neurogastroenterology and Motility 2019;25(4):563-575
BACKGROUND/AIMS: Magnesium oxide (MgO) has been frequently used as a treatment for chronic constipation (CC) since the 1980s in Japan. The aim of this study is to evaluate its therapeutic effects of MgO in Japanese CC patients. METHODS: We conducted a randomized, double-blind placebo-controlled study. Thirty-four female patients with mild to moderate constipation were randomly assigned to either placebo (n = 17) or MgO group (n = 17) 0.5 g × 3/day for 28 days. Primary endpoint was overall improvement over the 4-week study period. Secondary endpoints were changes from baseline in spontaneous bowel movement (SBM), response rates of complete spontaneous bowel movement (CSBM), stool form, colonic transit time (CTT), abdominal symptom, and quality of life. RESULTS: One patient failed to complete the medication regimen and was omitted from analysis: data from 16 placebo and 17 MgO patients were analyzed. The primary endpoint was met by 25.0% of placebo vs 70.6% of MgO group (P = 0.015). MgO significantly improved SBM changes compared to placebo (P = 0.002). However, MgO did not significantly improved response rates of CSBM compared to placebo (P = 0.76). In addition, MgO significantly improved Bristol stool form scale changes (P < 0.001) and significantly improved CTT compared to the placebo group (P < 0.001). MgO significantly improved the Japanese version of the patient assessment of constipation quality of life (P = 0.003). CONCLUSION: Our placebo-controlled study demonstrated that MgO was effective treatment for improving defecation status and shortened CTT in Japanese CC patients with mild to moderate symptoms.
Asian Continental Ancestry Group
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Colon
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Constipation
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Defecation
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Double-Blind Method
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Female
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Humans
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Japan
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Magnesium Oxide
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Magnesium
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Quality of Life
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Therapeutic Uses
9.Repeated unconsciousness due to chronic carbon monoxide poisoning in an older patient: a case report
Syuichi TETSUKA ; Tomohiro SUZUKI ; Tomoko OGAWA ; Ritsuo HASHIMOTO ; Hiroyuki KATO
Journal of Rural Medicine 2021;16(4):289-292
Objective: Although much is known about acute carbon monoxide (CO) poisoning, little is known about chronic CO poisoning. Chronic CO poisoning is often diagnosed based on the patient’s living environment and medical history. Herein, we report the case of an older patient who presented with repeated unconsciousness due to chronic CO poisoning.Case presentation: A 90-year-old man was brought to the emergency department after being found at home with a disturbance of consciousness. Arterial blood gas measurements in room air revealed a carboxyhemoglobin level of 18.0%. Impaired consciousness was caused by chronic CO poisoning. The patient received high-flow oxygen therapy, which promptly improved his condition. According to his family, briquette kotatsu was the cause of chronic CO poisoning.Conclusion: Although high-flow oxygen therapy has been said to be less effective than hyperbaric oxygen therapy in CO poisoning treatment, recent studies have demonstrated that high-flow oxygen has similar effects and benefits. Thus, in institutions that do not have hyperbaric oxygen, high-flow oxygen may be sufficient to treat patients with CO poisoning, as seen in the present case. It should be noted that briquette kotatsu can lead to CO poisoning. This case highlights the need for clinicians to consider patients’ living conditions.
10.Safety and Recipient Satisfaction of Propofol Sedation in Outpatient Endoscopy: A 24-Hour Prospective Investigation Using a Questionnaire Survey
Yoshihide KANNO ; Tetsuya OHIRA ; Yoshihiro HARADA ; Shinsuke KOSHITA ; Takahisa OGAWA ; Hiroaki KUSUNOSE ; Yoshiki KOIKE ; Taku YAMAGATA ; Toshitaka SAKAI ; Kaori MASU ; Keisuke YONAMINE ; Kazuaki MIYAMOTO ; Megumi TANAKA ; Tomohiro SHIMADA ; Fumisato KOZAKAI ; Kazuki ENDO ; Haruka OKANO ; Daichi KOMABAYASHI ; Takeshi SHIMIZU ; Shohei SUZUKI ; Kei ITO
Clinical Endoscopy 2021;54(3):340-347
Background/Aims:
The aim of this study was to evaluate the safety of sedation with propofol as an alternative to benzodiazepine drugs in outpatient endoscopy.
Methods:
In this prospective study, examinees who underwent outpatient endoscopy under propofol sedation and submitted a nextday questionnaire with providing informed consent were evaluated. Periprocedural acute responses, late adverse events within 24 hours, and examinee satisfaction were evaluated.
Results:
Among the 4,122 patients who received propofol in the 17,978 outpatient-based endoscopic examinations performed between November 2016 and March 2018, 2,305 eligible examinees (esophagogastroduodenoscopy for 1,340, endoscopic ultrasonography for 945, and total colonoscopy for 20) were enrolled, and their responses to a questionnaire were analyzed. The mean propofol dose was 69.6±24.4 mg (range, 20–200 mg). Diazepam, midazolam, and/or pentazocine in combination with propofol was administered to 146 examinees. Mild oxygen desaturation was observed in 59 examinees (2.6%); and mild bradycardia, in 2 (0.09%). Other severe reactions or late events did not occur. After eliminating 181 invalid responses, 97.7% (2,065/2,124) of the patients desired propofol sedation in future examinations.
Conclusions
Propofol sedation was found to be safe—without severe adverse events or accidents—for outpatient endoscopy on the basis of the patients’ next-day self-evaluation. Given the high satisfaction level, propofol sedation might be an ideal tool for painless endoscopic screening.