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| 1.
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川筋, 道雄 ; Rosenthal, Arvo ; 沢, 重治 ; 竹村, 博文 ; 藤井, 奨 ; 岩, 喬 ; Kawasuji, Michio ; Sawa, Shigeharu ; Takemura, Hirofumi ; Fujii, Susumu ; Iwa, Takashi
概要:
Transesophageal two-dimensional echocardiography (TEE) was evaluated in 14 patients who underwent coronary bypass surgery. The TEE transducer was positioned to view the left ventricular short axis at the level of the papillary
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muscle. Global left ventricular function was assessed by measuring left ventricular end-diastolic and end-systolic area and computing the fractional area change (FAC). Regional left ventricular function was analyzed after dividing the short axis view of the left ventricle into four anatomic segments. The mean FAC was 48% after intubation, 48% after skin incision, 47% after sternotomy, and 51% after pericardiotomy. The mean FAC increased significantly to 55% 0 to 30 minutes after cardiopulmonary bypass, and was 53% at the end of the operation. In 5 patients, FAC decreased and regional wall motion abnormalities appeared around sternotomy. These abnormalities was considered due to transient myocardial ischemia. In 7 patients, a paradoxical motion of the ventricular septum occurred at closing of the sternum. TEE was performed without complication and found to be a good method for assessing global and regional left ventricular function.
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| 2.
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松本, 康 ; 川筋, 道雄 ; 渡辺, 剛 ; 岩, 喬 ; Matumoto, Yasushi ; Kawasuji, Michio ; Watanabe, Go ; Iwa, Takashi
概要:
A patient with complex cardiac anomalies who developed severe respiratory insufficiency due to high pulmonary blood flow from a giant PDA was treated successfully by PDA banding. PDA-dependent heart disease causes a reduction in
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pulmonary blood flow in many patients and is often treated by palliative shunt operation. Although the present patient had PDA-dependent heart disease, heart failure occurred due to increased pulmonary blood flow through PDA and required surgical treatment. We performed PDA banding, because it is technically simple and allows adjustment of the postoperative pulmonary blood flow according to the degree of constriction. The degree of constriction was determined according to the PaO2 value. SO2 levels of 60-70% have been used as an index of the extent of banding, but PaO2 is considered to be equally appropriate.
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| 3.
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竹村, 博文 ; 川筋, 道雄 ; 澤, 重治 ; 藤井, 奨 ; 岩, 喬 ; Takemura, Hirofumi ; Kawasuji, Michio ; Sawa, Shigeharu ; Fujii, Susumu ; Iwa, Takashi
概要:
Ten patients with solitary stenosis of the left main coronary artery underwent coronary artery bypass grafting. All patients suffered from unstable angina and were in NYHA class III or IV. Two of them required intravenous infusion of
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nitroglycerin preoperatively. The degree of stenosis of the left main coronary artery was 75% in 3 patients, 90% in 5, 95% in one and total obstruction in the other one. Five patients received saphenous vein grafts to the LAD and circumflex artery and the other 5 patients received IMA grafts to the LAD and saphenous vein grafts to the circumflex arteries. In 2 patients with 75% stenosis of the left main coronary artery we found narrow internal mammary artery grafts, the so called "string sign", on postoperative angiography. Although several causes of string sign were proposed previously, we supposed that the main cause of the "string sign" was the competition for flow between the IMA graft and the native coronary artery or grafted coronary artery. Postoperatively, all patients showed improvements in cardiac function and were in NYHA class I. No evidence of ischemic findings was found in postoperative exercise stress tests.
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| 4.
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手取屋, 岳夫 ; 川筋, 道雄 ; 沢, 重治 ; 榊原, 直樹 ; 岩, 喬 ; 滝, 淳一 ; Tedoriya, Takeo ; Kawasuji, Michio ; Sawa, Shigeharu ; Sakakibara, Naoki ; Iwa, Takashi ; Taki, Jun-ichi
概要:
The sequential change of left ventricular function during exercise and recovery after exercise was assessed in 50 patients who had undergone coronary bypass surgery before and after the operation by means of continuous ventricular
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function monitoring system (VEST). Cardiac response was divided into 4 types with respect to the profiles of the left ventricular ejection fraction during exercise. Type A continued to increase; type B initially increased but decreased in severe exercise stages; type C did not change during exercise; type D continued to decrease. Most patients showed type C or D before surgery but showed type A after surgery. 9 patients with occluded grafts or ungrafted coronary arteries showed type B, C or D. Two patients with extended infarction and poor left ventricular function showed type C after surgery. In recovery period after exercise, the ejection fraction showed an overshoot. The mean ratio of peak ejection fraction during recovery to ejection fraction at rest increased from +62 +/- 12% before operation to +68 +/- 16% after operation (p less than 0.05). The recovery time after exercise was decreased from 195 sec before operation to 98 sec after operation (p less than 0.01). VEST revealed response of left ventricular function during exercise and recovery after exercise as far as detail abnormalities.
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| 5.
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川筋, 道雄 ; 榊原, 直樹 ; 渡辺, 洋宇 ; 北村, 昭洋 ; Kawasuji, Michio ; Sakakibara, Naoki ; Watanabe, Yoh ; Kitamura, Akihiro
概要:
金沢大学医薬保健研究域医学系<br />A new vein holder for a side-to-side anastomosis between a vein graft and the coronary artery is des
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cribed. The holder is consisted of two nerve hooks, and those distance is adjusted. The technique for creating the diamond anastomosis is also described.
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| 6.
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大竹, 裕志 ; 渡辺, 剛 ; 向井, 恵一 ; 三崎, 拓郎 ; 松永, 康弘 ; 松本, 勲 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Ohtake, Hiroshi ; Watanabe, Go ; Mukai, Kei-ichi ; Misaki, Takuro ; Matsunaga, Yasuhiro ; Matsumoto, Isao ; Kawasuji, Michio ; Watanabe, Yoh
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金沢大学医薬保健研究域医学系<br />To investigate whether the efficacy of laser ablation therapy is affected by the color of the target
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organ, we irradiated 9 canine hearts through the epicardium with Nd-YAG laser (200 J, 400 J), and compared coagulated myocardial volume in the beating heart (reddish) with that in the stopped heart (whitish) infused with 0 degrees C saline (cardioplegic model) via a coronary artery. The coagulated myocardial volume of the beating heart was significantly larger than that of the arrested heart, indicating the YAG laser energy is absorbed by red myocardium to greater extent than it is by white myocardium. In conclusion, during intraoperative laser ablation, the presence or absence of blood in cardiac tissue is an important factor for safe irradiation.
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| 7.
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手取屋, 岳夫 ; 川筋, 道雄 ; 榊原, 直樹 ; 竹村, 博文 ; 渡辺, 洋宇 ; Tedoriya, Takeo ; Kawasuji, Michio ; Sakakibara, Naoki ; Takemura, Hirofumi ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />The pressure of in situ arterial graft was measured with Fiber Optic Transducer-Tipped Pressure Moni
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toring System (Camino). Internal thoracic artery (ITA) and gastroepiploic artery (GEA) were prepared as in situ grafts, and the pressure at the end of each graft was recorded with ascending aortic pressure (Ao) and electrocardiogram, simultaneously. Although the peak systolic pressures of these grafts were identical, the systolic pressure of ITA and GEA formed narrow contours. While the diastolic pressures of Ao was sustained and high, the diastolic pressures of ITA and GEA showed rapid falling. Therefore, ITA and GEA had the risk of inadequate blood supply. This pressure measurement of in situ arterial graft was an easy and effective method for presumption of the ability of blood supply.
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| 8.
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手取屋, 岳夫 ; 川筋, 道雄 ; 榊原, 直樹 ; 上山, 圭史 ; 渡辺, 洋宇 ; Tedoriya, Takeo ; Kawasuji, Michio ; Sakakibara, Naoki ; Ueyama, K. ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />Arterial grafts have been used widely for coronary artery bypass grafting (CABG) because of their ex
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cellent long patency. However, some clinical reports suggest that blood flow in arterial grafts may not be adequate compared with aorto-coronary bypass grafting. Pressure in arterial grafts was measured in patients undergoing CABG. The pressure tracing in the ascending aorta (AA) was maintained during diastole. The systolic pressure wave in ITA and GEA was narrow, while the diastolic pressures fell rapidly: the diastolic pressure in GEA was lower than in ITA. The area under the pressure wave was measured in diastole and in systole. Although there was no significant difference in systolic areas, the diastolic area were lower in ITA than in AA, and lower in GEA than in AA and in ITA. These results clarified that arterial grafts which belong to the systolic-dominant systemic circulation have disadvantages over aorto-coronary bypass grafts, in terms of physiological suitabilities to the diastolic-dominant coronary circulation.
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| 9.
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小林, 孝一郎 ; 清水, 淳三 ; 大村, 健二 ; 村上, 眞也 ; 小田, 誠 ; 林, 義信 ; 家持, 健一 ; 関戸, 伸明 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Kobayashi, Ko-ichi ; Shimizu, Junzo ; Omura, Kenji ; Murakami, Shinya ; Oda, Makoto ; Hayashi, Yoshinobu ; Ietsugu, Ken-ichi ; Sekido, Nobuaki ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />We present a series of 8 consecutive patients who underwent the omental pedicle flap method in the f
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ield of thoracic surgery. Four of them had empyema with bronchopleural fistula and four had mediastinal infection. A pedicle of omentum containing the right gastroepiploic artery was passed through a tunnel in the diaphragm into the empyema cavity or the mediastinal abscess cavity. All eight patients were cured successfully by single-stage procedures. We think this series demonstrates the value of omental pedicle flap method which lacks in symptoms due to defected organ and offers an excellent therapeutic effect with easy operative procedure. And, this method produce a quality of life. Further active application of this method can be expected in the management of chest problems.<br />4
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| 10.
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榊原, 直樹 ; 浦山, 博 ; 松永, 康弘 ; 竹村, 博文 ; 村上, 眞也 ; 上山, 圭史 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Sakakibara, Naoki ; Urayama, Hiroshi ; Matsunaga, Yasuhiro ; Takemura, Hirofumi ; Murakami, Shinya ; Ueyama, K. ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />We analyzed cerebral protection of twenty-five patients, 11 of whom underwent ascending-arch aortic
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replacement and 14 underwent aortic arch replacement, supported with cardiopulmonary bypass. Twenty of patients underwent selective cerebral perfusion (SCP) with moderate hypothermic circulatory support; 12 of single SCP, 8 of double SCPs. Major arch branch reconstruction were performed with 11 patients; 3 of triple branches, 2 of double branches and 6 of single branch reconstruction. Cerebral impairment was found in 7 patients (25%) with SCP; 3 of them died of low output syndrome and major bleeding during perioperative period. Four of 17 patients, who survived more than one month, showed cerebral infarction in 2 patients and temporary neurological deficit in 2 patients. Our strategies for cerebral protection are (1) careful cerebral four vessels study, (2) SCP with perfusion pressure more than 40 mmHg and flow rate of 7-10 ml/kg/min under moderate hypothermia, (3) bilaterally double branches perfusion minimally for arch replacement, (4) intensive cerebral monitoring from multiple aspect, (5) pharmacological support with barbiturate or aprotinin, (6) gentle maneuver and reliable major branch cannulation to prevent debris embolism.
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| 11.
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安田, 保 ; 川筋, 道雄 ; 榊原, 直樹 ; 上山, 圭史 ; 笠島, 史成 ; 渡辺, 洋宇 ; 伊藤, 正典 ; 清水, 賢巳 ; Yasuda, Tamotsu ; Kawasuji, Michio ; Sakakibara, Naoki ; Ueyama, K. ; Kasajima, H. ; Watanabe, Yoh ; Ito, Masanori ; Shimizu, Masami
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金沢大学医薬保健研究域医学系<br />We performed a left ventricular aneurysmectomy for a left ventricular aneurysm associated with acrom
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egaly in a 62-year-old man. Bromocriptine mesilate was administered to suppress high growth hormone (GH) levels, and there were no complications during or after the operation. The majority of patients with acromegaly die of cardiovascular diseases such as cardiomegaly, hypertension, arteriosclerosis of the coronary arteries, congestive heart failure, valvular disease, and arrhythmia. Ventricular aneurysm is a rare complication of acromegaly. In order to safely operate, it is important to control serum GH levels and pay special attention to the well-known complications of acromegaly such as diabetes mellitus and hypertension.
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| 12.
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安田, 保 ; 川筋, 道雄 ; 榊原, 直樹 ; 竹村, 博文 ; 松本, 康 ; 牛島, 輝明 ; 藤井, 奨 ; 渡辺, 洋宇 ; Yasuda, Tamotsu ; Kawasuji, Michio ; Sakakibara, Naoki ; Takemura, Hirofumi ; Matsumoto, Y. ; Ushijima, Teruaki ; Fujii, Sho ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />The effect of systemic temperature during cardiopulmonary bypass (CPB) surgery was evaluated in 100
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patients. The patients were divided into three groups, based on systemic temperature during CPB; 28 degrees C, 30 degrees C, or 32 degrees C (tepid). Multidose cold crystalloid cardioplegia was administered for myocardial protection. Pump flow was maintained at 75 ml/kg/min. Methoxamine hydrochloride and phenothiazine were used to maintain systemic perfusion pressures between 60 and 80 mmHg. Preoperatively, there were no differences between groups in left ventricular ejection fraction or extent of coronary artery disease. The time required for CPB and weaning from CPB were significantly shorter in the 32 degrees C group than in either the 28 degrees C or the 30 degrees C group. There were significant differences in the doses of methoxamine hydrochloride and phenothiazine required in each group. Postoperatively, there were no significant differences in the incidence of myocardial infarction, stroke, or 30-day mortality between groups. In conclusion, tepid systemic perfusion shortens the length of CPB and does not differ significantly from cold perfusion with respect to mortality and morbidity.
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| 13.
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安田, 保 ; 竹村, 博文 ; 榊原, 直樹 ; 松本, 康 ; 牛島, 輝明 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Yasuda, Tamotsu ; Takemura, Hirofumi ; Sakakibara, Naoki ; Matsumoto, Y. ; Ushijima, Teruaki ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />Coronary artery fistula is one of the most common coronary malformations and is being diagnosed with
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increasing frequency with widespread use of selective coronary arteriography. Twenty-one patients with coronary artery fistulas underwent surgical treatment at our institute between 1973 and 1994. The left coronary artery was most commonly involved, and the fistula communicated primarily with the pulmonary artery. Associated cardiovascular disease include: mitral stenosis (1), mitral insufficiency (1), partial anomalous pulmonary venous return (1), ventricular tachycardia (1), atrial septal defect (1), aortitis syndrome (1), and coronary arteriosclerotic narrowing (1). In five patients, the coronary artery fistulas were selectively ligated without CPB. In sixteen patients, in addition to selective ligation, the fistula ostia were closed from inside using CPB. There were no operative or late deaths in the patients who underwent operations. Thus, the risks of surgical correction appear to be considerably less than the potential development of serious and possibly fatal complications, even in asymptomatic patients.
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| 14.
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安田, 保 ; 牛島, 輝明 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Yasuda, Tamotsu ; Ushijima, Teruaki ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />Continuous infusion of warm blood cardioplegic solution is often interrupted during coronary artery
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bypass grafting to obtain a bloodless operating field. We measured myocardial oxygen saturation continuously using near-infrared spectroscopy to determine myocardial oxygen metabolism during intermittent warm blood cardioplegia (IWBC). In 7 adult mongrel dogs undergoing cardiopulmonary bypass IWBC was administered using the Buckberg-Shiley system. Cardiac arrest was induced by a warm blood cardioplegic infusion of 100 ml/min for 5 minutes followed by a maintenance infusion of 40 ml/min for 5 minutes. The infusion of warm blood cardioplegia was then stopped for 15 minutes. Measurement of myocardial oxygen saturation was performed continuously throughout cardiopulmonary bypass. IWBC produced an increase in myocardial oxygen saturation for the first 5 minutes and a slight decrease for the second 5 minutes. After the termination of IWBC, myocardial oxygen saturation showed a marked reduction for 3 minutes and plateaued after 5 minutes. Measurement of myocardial oxygen saturation revealed myocardial oxygen metabolism during IWBC. This procedure may be a useful way to monitor myocardial oxygen metabolism during open heart surgery.
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| 15.
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石田, 善敬 ; 川筋, 道雄 ; 榊原, 直樹 ; 藤井, 奨 ; 木下, 敬弘 ; 西田, 聡 ; 渡辺, 洋宇 ; Ishida, Yoshinori ; Kawasuji, Michio ; Sakakibara, Naoki ; Fujii, Sho ; Kinoshita, T. ; Nishida, Satoshi ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />A 71-year-old male is presented as ever the oldest patient of tetralogy of Fallot who underwent succ
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essful radical surgery. Heart murmur was pointed out at the age of 10 years. The patient consulted us because of dyspnea and cough, and was noted to have cyanosis and clubbing fingers. Polycythemia was also detected by hemoglobin of 20.8 g/dl and hematocrit of 58.4%, and a low PaO2 of 48.5 mmHg at room temperature was pointed out. Preoperative echocardiography and cardiac catheterization indicated a ventricular septal defect, overriding of the aorta, and right ventricular outflow tract stenosis with a pressure gradient of 115 mmHg between the right ventricle and the main pulmonary artery. Under cardiopulmonary bypass, the ventricular septal defect was closed with a dacron patch and the right ventricular outflow tract was enlarged by a patch of collagen-coated vascular graft with a commissurotomy of the pulmonary valve. Postoperatively, cyanosis disappeared and the pressure gradient was decreased to 26 mmHg.
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| 16.
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川筋, 道雄 ; 手取屋, 岳夫 ; 榊原, 直樹 ; 上山, 圭史 ; 高橋, 政夫 ; 渡辺, 洋宇 ; Kawasuji, Michio ; Tedoriya, Takeo ; Sakakibara, Naoki ; Ueyama, Keishi ; Takahashi, Masao ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系
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| 17.
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川筋, 道雄 ; 榊原, 直樹 ; 手取屋, 岳夫 ; 上山, 圭史 ; 竹村, 博文 ; 渡辺, 洋宇 ; Kawasuji, Michio ; Sakakibara, Naoki ; Tedoriya, Takeo ; Ueyama, Keishi ; Takemura, Hirofumi ; Watanabe, Yoh
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金沢大学医薬保健研究域医学系
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| 18.
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竹村, 博文 ; 川筋, 道雄 ; 高橋, 英雄 ; 岩, 喬 ; Takemura, Hirofumi ; Kawasuji, Michio ; Takahashi, Hideo ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 19.
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川筋, 道雄 ; 竹村, 博文 ; 辻口, 大 ; 岩, 喬 ; Kawasuji, Michio ; Takemura, Hirofumi ; Tsujiguchi, Hajime ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 20.
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川筋, 道雄 ; 竹村, 博文 ; 岩, 喬 ; Kawasuji, Michio ; Takemura, Hirofumi ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 21.
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川筋, 道雄 ; 岩, 喬 ; Kawasuji, Michio ; Iwa, Takashi
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金沢大学医薬保健研究域医学系
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| 22.
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川筋, 道雄 ; 辻口, 大 ; 岩, 喬 ; Kawasuji, Michio ; Tsujiguchi, Hajime ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 23.
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辻口, 大 ; 川筋, 道雄 ; 岩, 喬 ; Tsujiguchi, Hajime ; Kawasuji, Michio ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 24.
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金平, 永二 ; 岩, 喬 ; 三崎, 拓郎 ; 川筋, 道雄 ; 辻口, 大 ; 坪田, 誠 ; 高橋, 英雄 ; 遠藤, 将光 ; Kanahira, Eiji ; Iwa, Takashi ; Misaki, Takuro ; Kawasuji, Michio ; Tsujiguchi, Hajime ; Tsubota, Makoto ; Takahashi, Hideo ; Endo, Masamitsu
概要:
金沢大学医薬保健研究域医学系
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| 25.
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澤, 重治 ; 浦山, 博 ; 川筋, 道雄 ; 渡辺, 洋宇 ; 岩, 喬 ; Sawa, Shigeharu ; Urayama, Hiroshi ; Kawasuji, Michio ; Watanabe, Yoh ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 26.
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川筋, 道雄 ; 三崎, 拓郎 ; 岩, 喬 ; Kawasuji, Michio ; Misaki, Takuro ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 27.
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川尻, 文雄 ; 川筋, 道雄 ; 榊原, 直樹 ; 岩, 喬 ; Kawashiri, Fumio ; Kawasuji, Michio ; Sakakibara, Naoki ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 28.
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渡辺, 剛 ; 川筋, 道雄 ; 三崎, 拓郎 ; 向井, 恵一 ; 岩, 喬 ; Watanabe, Go ; Kawasuji, Michio ; Misaki, Takuro ; Mukai, Keiichi ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 29.
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川筋, 道雄 ; 浦山, 博 ; 岩, 喬 ; Kawasuji, Michio ; Urayama, Hiroshi ; Iwa, Takashi
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金沢大学医薬保健研究域医学系
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| 30.
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川尻, 文雄 ; 川筋, 道雄 ; 遠藤, 将光 ; 青山, 剛和 ; 榊原, 直樹 ; 向井, 恵一 ; 三崎, 拓郎 ; 岩, 喬 ; Kawashiri, Fumio ; Kawasuji, Michio ; Endo, Masamitsu ; Aoyama, Takekazu ; Sakakibara, Naoki ; Mukai, Keiichi ; Misaki, Takuro ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 31.
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三崎, 拓郎 ; 岩, 喬 ; 向井, 恵一 ; 鎌田, 栄一郎 ; 飯田, 茂穂 ; 斉藤, 裕 ; 川筋, 道雄 ; Misaki, Takuro ; Iwa, Takashi ; Mukai, Keiichi ; Kamata, Eiichiro ; Iida, Shigeho ; Saito, Yutaka ; Kawasuji, Michio
概要:
金沢大学医薬保健研究域医学系
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| 32.
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斉藤, 裕 ; 遠藤, 将光 ; 笠原, 善郎 ; 横井, 克己 ; 船木, 芳則 ; 川筋, 道雄 ; 三崎, 拓郎 ; 岩, 喬 ; Saito, Yutaka ; Endo, Masamitsu ; Kasahara, Yoshio ; Yokoi, Katsumi ; Funaki, Yoshinori ; Kawasuji, Michio ; Misaki, Takuro ; Iwa, Takashi
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金沢大学医薬保健研究域医学系
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| 33.
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麻柄, 達夫 ; 鎌田, 栄一郎 ; 遠藤, 将光 ; 藤野, 茂樹 ; 川筋, 道雄 ; 三崎, 拓郎 ; 岩, 喬 ; Magara, Tatsuo ; Kamata, Eiichiro ; Endo, Masamitsu ; Fujino, Shigeki ; Kawasuji, Michio ; Misaki, Takuro ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 34.
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麻柄, 達夫 ; 川筋, 道雄 ; 土屋, 和弘 ; 三崎, 拓郎 ; 岩瀬, 孝明 ; 小林, 弘明 ; 岩, 喬 ; Magara, Tatsuo ; Kawasuji, Michio ; Tsuchiya, Kazuhiro ; Misaki, Takuro ; Iwase, Takaaki ; Kobayashi, Hiroaki ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 35.
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浦山, 博 ; 川上, 健吾 ; 笠島, 史成 ; 川瀬, 裕志 ; 原田, 猛 ; 松本, 康 ; 竹村, 博文 ; 榊原, 直樹 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Urayama, Hiroshi ; Kawakami, Kengo ; Kasashima, Fuminori ; Kawase, Yuji ; Harada, Takeshi ; Matsumoto, Yasushi ; Takemura, Hirofumi ; Sakakibara, Naoki ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />Ischemic heart disease (IHD) poses a major complicating factor for abdominal aortic aneurysm (AAA) r
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epair. To identify patients with IHD, we evaluated patients scheduled to undergo AAA repair with dipyridamole-thallium scintigraphy (DTS) and coronary angiography (CAG). If indicated, coronary revascularization was performed. Finally, an assessment of the effectiveness of these preventive measures was made. One hundred and ten patients scheduled to undergo AAA repair were identified and treated accordingly over a 20-year period. As the pre-operative evaluation and prophylactic surgical revascularization strategies were instituted in 1983, the patients were divided into 2 groups: 25 patients between 1973-1982 (group A) and 85 patients between 1983-1992 (group B). The mean age of patients in group A was 65.3 years. The male/female ratio within this group was 21:4. One patient in the group had a history of IHD and 9 had hypertention. The mean age of patients in group B was 67.7 years. The male/female ratio within this group was 77:8. Fourteen patients in this group had a history of IHD and 27 had hypertension. Screening and treatment of IHD in group B was as follows. All patients with a history of IHD underwent CAG. Of the 32 patients with cardiac risk factors, including hypertension and hyperlipidemia, or ECG abnormalities who underwent DTS, 8 were referred for CAG. Thirty-nine patients with no risk factors and a normal ECG proceeded to AAA repair without further workup. Perioperative myocardial infarction occurred in 2 patients in grouzp A, leading to death in 1 patient. Coronary revascularization was performed in 5 patients in group B. No perioperative myocardial infarction occurred in this group. Pre-operative identification of high-risk cases with DTS, CAG, and coronary revascularization in patients with IHD may prevent cardiovascular complications in patients undergoing AAA repair.<br />心筋梗塞は腹部大動脈瘤の術中術後の合併症で最も重篤なものの一つである. ジピリダモール負荷心筋スキャン, 冠状動脈造影により評価を行い, 必要な症例には冠状動脈再建を行う方針を開始した1983年以降と, それ以前の腹部大動脈瘤の待機手術例を比較検討した. 1982年までの前半の10年間の症例は25例で術前併存症としての虚血性心疾患を1例に認めた. 1983年以降の後半の10年間の症例は85例で, 術前併存症としての虚血性心疾患を14例に認め, 全例冠状動脈造影にて評価した. 後半において高血圧や高脂血症などの危険因子もしくは心電図異常を認める32例にジピリグモール負荷心筋スキャン等を施行し, うち8例に冠状動脈造影を施行した. 前半の25例において術後心筋梗塞を2例に認め, うち1例が死亡した. 後半の85例中5例に冠状動脈バイパスを施行した. 後半の85例において術後心筋梗塞は認めなかった. 腹部大動脈瘤手術では積極的な虚血性心疾患対策が必要である.
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| 36.
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榊原, 直樹 ; 川筋, 道雄 ; 手取屋, 岳夫 ; 上山, 圭史 ; 高橋, 政夫 ; 安田, 保 ; 渡辺, 洋宇 ; Sakakibara, Naoki ; Kawasuji, Michio ; Tedoriya, Takeo ; Ueyama, Keishi ; Takahashi, Masao ; Yasuda, Tamotsu ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />積極的胸膜切開下での内胸動脈 (ITA) グラフト剥離が胸膜温存した場合と比べて胸部合併症が多いか検討した. 対象はITA剥離を積極的胸膜切開下で行った50例 (I群) と胸膜を可及的温存した50例
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(II群) とした. I群には左開胸例40例 (Ia群) と両側開胸例10例 (Ib群) があり, 胸膜は開窓のまま閉胸した. II群には胸膜を完全温存した22例 (IIa群) と胸膜穿孔を修復した28例 (IIb群) があった. I群はII群よりITA剥離時間が短く, 術後1週間以内の呼吸管理に関する因子では胸腔ドレーン排液量のみがIa群およびIb群でII群より有意に多かった. 術後1か月までの胸部合併症はIIa群以外で胸膜肥厚をわずかに認めたが, それ以外はIIb群に横隔膜神経麻痺に起因する胸水貯留を1例のみ認めた. 積極的胸膜切開法はITA剥離時間の短縮, ITA中枢側剥離の容易化, In-situ グラフト走行の最短化が得られる優れた術式で胸部合併症はほとんどなかった.<br />A recent study evaluated the effect of pleurotomy for harvesting internal thoracic arteries (ITAs) on pulmonary complications after coronary artery bypass grafting (CABG). Fifty consecutive patients with pleurotomy (group I) were studied retrospectively and compared with a control group of fifty patients undergoing CABG without pleurotomy during ITA harvest (group II). Group I was divided into two groups; forty patients using left ITAs with left open pleurotomy (group Ia), and ten patients using bilateral ITAs with bilateral open pleurotomy (group Ib). On the other hand, group II includes 22 patients without pleurotomy (group IIa) and 28 patients with closed pleurotomy (group IIb). In group I, ITAs were dissected from the chest wall with mediastinal pleura and then isolated from the pleura by pleurotomy. Before sternal closure, an L-shaped pleural tube was inserted into the deep costophrenic sinus and the pleurotomy remained open. In group II, ITAs were simultaneously dissected from the chest wall and mediastinal pleura, and if the pleura was damaged, the pleurotomy was approximated before sternal closure. There was no significance in the number of bypass grafts, aortic crossclamp time, cardiopulmonary bypass time and temperature. ITA harvest time with open pleurotomy was shorter than that of closed pleura (15min versus 25min). Postoperatively, the ventilation time and duration of chest drainage also showed no significance, however group Ia and Ib showed significantly more fluid accumulation removed by chest drainage (Ia, 288±193ml; Ib, 285±198ml, versus IIb, 169±98ml). On postoperative day 30 no pleural effusion was observed in group I but it was seen in one case in group IIb which had diaphragm paralysis. In conclusion, open pleurotomy results in minimal pulmonary complications with optimal chest drainage and offers significant advantages for harvesting ITAs.
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| 37.
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川筋, 道雄 ; 青山, 剛和 ; 清原, 薫 ; 桜井, 潤司 ; 三崎, 拓郎 ; 向井, 恵一 ; 塩谷, 謙二 ; 大平, 政人 ; 田中, 信行 ; 岩, 喬 ; Kawasuji, Michio ; Aoyama, Takekazu ; Kiyohara, Kaoru ; Sakurai, Junji ; Misaki, Takuro ; Mukai, Keiichi ; Shioya, Kenji ; Ohira, Masato ; Tanaka, Nobuyuki ; Iwa, Takashi
概要:
金沢大学医薬保健研究域医学系
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| 38.
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富田, 重之 ; 榊原, 直樹 ; 竹村, 博文 ; 手取屋, 岳夫 ; 川筋, 道雄 ; 渡邊, 洋宇 ; 滝, 淳一 ; 中嶋, 憲一
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| 39.
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安田, 保 ; 竹村, 博文 ; 榊原, 直樹 ; 松本, 康 ; 牛島, 輝明 ; 川筋, 道雄 ; 渡辺, 洋宇 ; 滝, 淳一 ; 中嶋, 憲一
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| 40.
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滝, 淳一 ; 中嶋, 憲一 ; 分校, 久志 ; 谷口, 充 ; 村守, 朗 ; 松成, 一朗 ; 秀毛, 範至 ; 利波, 紀久 ; 久田, 欣一 ; 川筋, 道雄
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| 41.
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松本, 康 ; 榊原, 直樹 ; 竹村, 博文 ; 亀水, 忠 ; 川筋, 道雄 ; 渡辺, 洋宇 ; 中嶋, 憲一 ; 久田, 欣一
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| 42.
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滝, 淳一 ; 中嶋, 憲一 ; 村守, 朗 ; 谷口, 充 ; 松成, 一朗 ; 久田, 欣一 ; 分校, 久志 ; 川筋, 道雄
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| 43.
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竹村, 博文 ; 榊原, 直樹 ; 松永, 康弘 ; 藤井, 奨 ; 高橋, 敦 ; 持木, 大 ; 川筋, 道雄 ; 渡辺, 洋宇 ; 滝, 淳一 ; 中嶋, 憲一 ; 久田, 欣一 ; 分校, 久志
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| 44.
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榊原, 直樹 ; 川筋, 道雄 ; 高橋, 政夫 ; 手取屋, 岳夫 ; 渡辺, 洋宇 ; 滝, 淳一 ; 中嶋, 憲一 ; 分校, 久志 ; 久田, 欣一
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| 45.
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手取屋, 岳夫 ; 川筋, 道雄 ; 榊原, 直樹 ; 上山, 圭史 ; 岩, 喬 ; 滝, 淳一 ; 村守, 朗 ; 久田, 欣一
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| 46.
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滝, 淳一 ; 村守, 朗 ; 中嶋, 憲一 ; 分校, 久志 ; 松成, 一朗 ; 川筋, 道雄 ; 岩, 喬
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| 47.
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手取屋, 岳夫 ; 川筋, 道雄 ; 沢, 重治 ; 竹村, 博文 ; 榊原, 直樹 ; 坪田, 誠 ; 岩, 喬 ; 滝, 淳一 ; 村守, 朗 ; 久田, 欣一
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| 48.
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竹村, 博文 ; 川筋, 道雄 ; 澤, 重治 ; 高橋, 政夫 ; 藤井, 奨 ; 川上, 健吾 ; 岩, 喬 ; 滝, 淳一 ; 村守, 朗 ; 久田, 欣一
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| 49.
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滝, 淳一 ; 村守, 朗 ; 中嶋, 憲一 ; 分校, 久志 ; 谷口, 充 ; 利波, 紀久 ; 久田, 欣一 ; 川筋, 道雄 ; 岩, 喬
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| 50.
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竹村, 博文 ; 川筋, 道雄 ; 高橋, 政夫 ; 澤, 重治 ; 藤井, 奨 ; 岩, 喬 ; 滝, 淳一 ; 村守, 朗 ; 久田, 欣一
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| 51.
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高橋, 英雄 ; 川筋, 道雄 ; 辻口, 大 ; 森田, 克哉 ; 岩, 喬 ; 谷口, 充 ; 滝, 淳一 ; 分校, 久志
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| 52.
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浅井, 徹 ; 川筋, 道雄 ; 辻口, 大 ; 沢, 重治 ; 小林, 孝一郎 ; 岩, 喬 ; 滝, 淳一 ; 分校, 久志 ; 久田, 欣一
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| 53.
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手取屋, 岳夫 ; 川筋, 道雄 ; 川尻, 文雄 ; 松永, 康弘 ; 土田, 敬 ; 岩, 喬 ; 中嶋, 憲一 ; 谷口, 充 ; 久田, 欣一
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| 54.
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沢, 重治 ; 川筋, 道雄 ; 橋本, 琢生 ; 川尻, 文雄 ; 三崎, 拓郎 ; 岩, 喬 ; 分校, 久志 ; 中嶋, 憲一 ; 久田, 欣一
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| 55.
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南部, 一郎 ; 分校, 久志 ; 中嶋, 憲一 ; 滝, 淳一 ; 四位例, 靖 ; 谷口, 充 ; 利波, 紀久 ; 久田, 欣一 ; 川筋, 道雄 ; 岩, 喬
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| 56.
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川尻, 文雄 ; 川筋, 道雄 ; 遠藤, 将光 ; 青山, 剛和 ; 榊原, 直樹 ; 広瀬, 宏一 ; 岩, 喬 ; 中嶋, 憲一 ; 分校, 久志 ; 久田, 欣一
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| 57.
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青山, 剛和 ; 川筋, 道雄 ; 遠藤, 将光 ; 榊原, 直樹 ; 渡辺, 剛 ; 岩, 喬 ; 中嶋, 憲一 ; 分校, 久志 ; 久田, 欣一
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| 58.
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渡辺, 剛 ; 川筋, 道雄 ; 青山, 剛和 ; 辻口, 大 ; 岩, 喬 ; 中嶋, 憲一 ; 分校, 久志 ; 久田, 欣一
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| 59.
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佐々木, 正寿 ; 川筋, 道雄 ; 森, 善裕 ; 遠藤, 将光 ; 榊原, 直樹 ; 渡辺, 剛 ; 岩, 喬 ; 中嶋, 憲一
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| 60.
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川筋, 道雄
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| 61.
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川筋, 道雄
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| 62.
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原, 拓央 ; 牛島, 輝明 ; 竹村, 博文 ; 榊原, 直樹 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Hara, Takuo ; ushijima, Teruaki ; Takemura, Hirofumi ; Sakakibara, Naoki ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />Cardiac hemangioma is a rare benign vascular tumor. A 44-year-old woman with hemangioma arising from
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the left atrium and transient atrial fibrillation is reported. Echocardiography, computed tomography and magnetic resonance imaging suggested a hypervascular tumor with clear borders in the pericardial cavity. Selective coronary angiography demonstrated feeding arteries arising from the right and left circumflex coronary arteries. Under cardiopulmonary bypass the tumor was successfully resected. Pathological examination showed a cavernous hemangioma. There is no evidence of recurrence and the patient is doing well three years after the operation.
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| 63.
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池田, 真浩 ; 永峰, 洋 ; 富田, 重之 ; 牛島, 輝明 ; 竹村, 博文 ; 榊原, 直樹 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Ikeda, M. ; Nagamine, Hiroshi ; Tomita, Shigeyuki ; Ushijima, Teruaki ; Takemura, Hirofumi ; Sakakibara, Naoki ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />Ischemic preconditioning (IP) protects the myocardium from subsequent sustained ischemic insults. Te
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mporary occlusion of the coronary artery is indispensable for anastomosing the graft vessel during coronary artery bypass operation without cardiopulmonary bypass. In the canine model of ischemia and reperfusion, we measured myocardial tissue oxygen saturation (SO2) continuously using near-infrared spectroscopy to determine the effect of IP on myocardial oxygen metabolism. Nine dogs underwent occlusion of the left descending coronary artery for three 5-minute periods, followed by three 5-minute periods of reperfusion. The dogs were then subjected to a 20-minutes periods of sustained coronary artery occlusion, followed by prolonged reperfusion. The myocardial SO2 was 82 +/- 2% at the baseline before coronary occlusion and was decreased to 74 +/- 2%, 76 +/- 2%, 77 +/- 3%, 77 +/- 3% at the first, second, third and sustained coronary occlusion, respectively. The increase in the minimum myocardial SO2 value at the second and third coronary occlusion suggested the effect of IP. Near-infrared spectroscopy is a useful method of continuously monitoring myocardial oxygenation and of evaluating the effect of IP during off-pump heart surgery.
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| 64.
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竹村, 博文 ; 川筋, 道雄 ; 榊原, 直樹 ; 牛島, 輝明 ; 石川, 智啓 ; 渡辺, 洋宇 ; Takemura, Hirofumi ; Kawasuji, Michio ; Sakakibara, Naoki ; Ushijima, Teruaki ; Ishikawa, T. ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />Six thoroughly selected patients underwent minimally invasive direct coronary artery bypass grafting
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(MIDCAB). While monitoring left ventricular function with transesophageal echocardiography, MIDCAB was done by performing small left thoracotomy through the fourth intercostal space, dissection of the left internal thoracic artery without thoracoscopy, ischemic preconditioning, and grafting of the internal thoracic artery to the left anterior descending coronary artery with 8-0 polypropylene continuous suture. A home-made cardiac stabilizer and Visuflow enabled us to perform precise suturing of the internal thoracic artery. The patency of all grafts was confirmed by early transthoracic Doppler echocardiography and selective angiography. A new stenosis of the coronary artery distal to the anastomosis was detected probably due to coronary snaring in one patient. The anastomosis sites were confined to the distal segments of the left anterior descending coronary artery in MIDCAB patients. The optimal anastomosis site may be missed in the patients with proximal left anterior descending artery disease. An experimental study of myocardial tissue oxygen saturation using near infrared spectroscopy showed that two times of coronary occlusion and reperfusion provided satisfactory effects of ischemic preconditioning. Measurement of the myocardial tissue oxygen saturation may be helpful for confirming effective ischemic preconditioning and a safe coronary occlusion during MIDCAB. Although MIDCAB is an attractive procedure, we should consider the accuracy of anastomosis, the risk of possible incomplete revascularization, the indications, and long-term results.
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| 65.
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川筋, 道雄 ; Kawasuji, Michio
概要:
金沢大学医学部<br />虚血性心疾患に対する細胞増殖因子を用いた冠血管新生療法の開発を目的として,急性心筋梗塞モデルを用いて,塩基性線維芽細胞増殖因子(bFGF)を心筋内に投与し,局所心筋血流量,心機能,梗塞後左室形態,血管新生,心筋細胞
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アポトーシスに及ぼす影響を検討した.成犬で左冠状動脈前下行枝を結紮し急性心筋梗塞モデルを作成し,bFGF100μgを心筋梗塞および梗塞境界領域の心筋内に分散注入した.対照群では生理食塩水を心筋内に注入した.冠状動脈結紮前,直後,1週、2週,4週後に左心耳からカラーマイクロスフェアーを注入し,4週後に心臓を摘出した.左室心筋層を輪状に切除し,梗塞領域,梗塞境界領域および正常領域に分け,局所心筋血流量を測定した.冠状動脈結紮前,3日,1週,2週,4週後に超音波法で心機能を計測した.摘出心で左室壁菲薄化率を計測し,梗塞後左室再構築を定量化した.血管内皮細胞をvon Willebrand因子の免疫組織化学染色を用い同定し,毛細血管と細動脈レベルで血管新生像を評価した.梗塞境界領域心筋のTunnel染色とp53染色を行いアポトーシスを検討した.対照群では2週まで血流は回復しなかったが,bFGF群では3日から血流が回復し始めた.対照群では2週まで心機能は回復しなかったが,bFGF群では1週で回復し始めた.梗塞境界領域ではbFGF群で毛細血管数ならびに細動脈数が多かった.bFGF群で心筋アポトーシスが少ない傾向を示した.心筋梗塞モデルにおいて,心筋内に投与したbFGFは左室再構築過程で壁菲薄化を抑制し,心機能の回復を促進した.その要因としてbFGFによる血管新生に基づく局所心筋血流量の増加と心筋アポトーシスの抑制が考えられた.bFGFを用いた血管新生療法は虚血性心疾患に対する新しい治療法として臨床応用が期待される.<br />This study was designed to evaluate the effects of intramyocardial administration of basic faibroblast growth factor (bFGF) on myocardial blood flow, angiogenesis, and ventricular function in a canine acute myocardial infarction model. Myocardial infarction was induced in dogs by ligation of the left anterior descending coronary artery. Within 5 minutes after coronary occlusion, 100μg of bFGF in 1 mL of saline was injected into the infarct and border zone in 6 dogs, whereas saline alone was used in 6 control dogs. Myocardial blood flow was determined with colored microsphere before and immediately after coronary ligation and again 3, 7, 14, and 28 days after treatment. Angiogenesis was evaluated by immunohistochemical studies 28 days later. Treatment with bFGF significantly increased the endocardial blood flow in the border zone as well as epicardial blood flow in the infarcted zone. Treatment with bFGF significantly increased the capillary density as well as arteriolar density in the border zone. Treatment with bFGF significantly reduced the change in ratio of thickness of the infarcted wall to the normal wall. It improved the left ventricular ejection fraction. Intramyocardial administration of bFGF increased the regional myocradial blood flow, reduced thinning of the infracted region, and improved ventricular function. Intramyocardial adminiastration of bFGF may be a new therapeutic approach for patients with acute myocardial infarction.<br />研究課題/領域番号:11671311, 研究期間(年度):1999 – 2000<br />出典：「細胞増殖因子の心筋内投与による心筋梗塞の血管新生療法の研究」研究成果報告書 課題番号11671311（KAKEN：科学研究費助成事業データベース（国立情報学研究所）） （ https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-11671311/ ）を加工して作成
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