Hitoshi Mohri

A Single Pericardial Patch Technique for Repair of Partial Anomalous Pulmonary Venous Drainage Associated with Sinus Venosus Atrial Septal Defect

A technique is described for repair of partial anomalous pulmonary venous drainage associated with sinus venosus atrial septal defect. The procedure, using a single autologous pericardial patch, is able to facilitate both reconstruction of the pulmonary venous channel and enlargement of the superior vena cava. This technique also reduces the incidence of arrhythmias.

Effects of Coenzyme Q10 Added to a Potassium Cardioplegic Solution for Myocardial Protection during Ischemic Cardiac Arrest

To evaluate effects of coenzyme Q10 added to a potassium cardioplegic solution for myocardial protection, 17 mongrel dogs underwent 60 minutes of ischemic cardiac arrest under cardiopulmonary bypass. Cardiac arrest was induced by infusing the cardioplegic solution into the aortic root every 20 minutes. Experimental animals were divided into three groups according to the cardioplegic solution used. In Group 1, we used our clinical potassium cardioplegic solution (K+, 22.31 mEq/L); in Group 2, potassium cardioplegic solution with coenzyme Q10 added (coenzyme Q10, 30 mg/500 ml of solution); and in Group 3, cardioplegic solution with coenzyme Q10 solvent. Exogenous coenzyme Q10 in the cardioplegic solution provided significantly high myocardial stores of adenosine triphosphate and creatine phosphate and a low level of lactate during induced ischemia and reperfusion. Furthermore, percent recovery of the aortic flow in Group 2 was significantly higher than that in the other two groups. Ultrastructures of the ischemic myocardium in Group 2 were better preserved than those in Group 1. Addition of coenzyme Q10 to potassium cardioplegia resulted in improved myocardial oxygen utilization and accelerated recovery of myocardial energy metabolism after reestablishment of circulation.

Mesenteric infarction in Takayasu's arteritis treated by thromboendarterectomy and intestinal resection

A 36-year-old woman with a history of left nephrectomy for renovascular hypertension secondary to arterial occlusive lesion of Takayasus arteritis was re-admitted to our hospital with complaints of postprandial abdominal pain in the sixth post-operative month. On the 14th hospital day, the developing abdominal distension and generalized tenderness suggested a mesenteric vascular occlusion. Following abdominal aortography, emergency surgery was performed. The entire small bowel was edematous and markedly cyanotic with spotted, dark colored areas and the mesentery was pulseless. The patient was sucessfully treated by thromboendarterectomy at the origin of the celiac and superior mesenteric arteries and the necrotic loop of intestine was then resected 7 days later. Takayasus arteritis was diagnosed by histological examination of the resected specimens. Although the occurrence of mesenteric infarction secondary to Takayasus arteritis is rare, the possibility of mesenteric vascular occlusion should be given consideration in the follow-up of patients with Takayasus arteritis.

Malignant duodenocolic fistula--a case report.

A 63 year-old woman with a malignant duodenocolic fistula of colonic origin was so diagnosed following radiological examination. She had symptoms of feculant vomitus, persistent diarrhea and emaciation. Following preoperative treatment of the nutritional and electrolyte disorders with intravenous hyperalimentation, a one-staged right hemicolectomy and pancreatoduodenectomy was performed successfully. We emphasized that an en-bloc removal of all the possibly involved structures is the most successful procedure for malignant duodenocolic fistula of colonic origin.

Depression of host-defence mechanisms following cardiac surgery

The purpose of the present study was to determine the effects of open-heart surgery on host-defence mechanisms, by studying serial changes in serum immunoglobulins, circulating lymphocyte function in patients undergoing open-heart surgery. Serum proteins and immunoglobulins were significantly depressed immediately after operation and these depressions were correlated to the degree of the durations of cardiopulmonary bypass and associated hypothermia. White cell counts in peripheral blood increased significantly after operation. In contrast, total circulating lymphocytes were depressed postoperatively. The depression of circulating lymphocytes was mainly due to a marked decrease in the number of T-cells. Mitogen responses of lymphocytes stimulated by phytohemagglutinin were also depressed postoperatively. The quantitative and qualitative depression of cell-mediated immunity following open-heart surgery was observed. However, these depressions returned to preoperative levels in one week and had no clinical significance.

Operative arteriography: An indicator for infrainguinal bypass

Preceding infrainguinal artery bypass surgery, a complete arteriographic delineation of the recipient artery is not always feasible. For 13 out of 63 patients with occlusion of the infrainguinal arteries, distinct delineation could not be accomplished with preoperative angiography. However, prebypass operative arteriography was successful in 8 of the 13. In 5, we performed bypass surgery on vessels not visualized on the preoperative angiography. In the other 3, bypass was performed on vessels in which the status of the distal circulation had not been well defined, although the popliteal and infrapopliteal arteries were partially visualized on the preoperative angiography. Intraoperative arteriograms—a technique requiring operative exploration of the target vessel—can significantly improve the visualization of the recipient artery and the distal circulation. Therefore, prebypass operative arteriography may become another indicator for arterial bypass surgery.

Aneurysms of the descending aorta: Surgical experience with three methods of adjunct procedures

Thirteen patients were surgically treated for the repair of aneurysms of the descending aorta, using three different types of adjunct procedures—an external temporary bypass with a vascular prosthesis, a tridodecylmethylammonium chloride (TDMAC) or a partial cardiopulmonary bypass. There was no operative death, though one patient died 73 days following surgery. Significant intraoperative morbidity occurred in 3 patients: one had ventricular fibrillation and the other two massive hemorrhages. There was no instance of paraplegia or renal failure. The only significant complication that developed was pulmonary insufficiency in two patients with a pump bypass. The mean operative time and the mean aortic occlusion time in patients with the TDMAC shunt were shorter than the times in patients with the vascular prosthetic shunt or the pump bypass. TDMAC shunt required no special equipment and cannulation was simpler and safer.

Gravimetric, histological and cytotoxic changes of lymphoreticular tissue after implantation of tumor cells in mice

In inbred C3H/He male mice, gravimetric, histologic and cytotoxic changes in the lymphoreticular tissue after implantation of the tumor cells were studied. Gravimetric changes found in the thymus and the spleen suggest that the thymus plays an essential role until death in a tumor-bearing host and that the thymus and the spleen have inverse functions in relation to tumor growth. In this study, no association was found between the large pyroninophilic cells in the deep cortex of the lymph nodes and the cytotoxicity against the tumor cells. However, enlargement of the deep cortex of lymph nodes may be associated with cytotoxicity against these tumor cells.

Serum concentrations of glycoproteins in lung cancer patients.

肺葉切除が行われた19例を対象とし, 6種の血清糖蛋白を術前および術後経時的に測定し, これら血清糖蛋白値およびその変動と, 肺癌進展度ならびに術後経過との関係について検討した.肺癌病期分類別による血清糖蛋白値の変動では, pn因子においてα1AG値がpn1群に比べpn2群で有意 (p<0.05) に低値を示した.又, α2HS値が術前に比べ術後高値となった症例に予後良好例を多く認めた.