Hirosaki Medical Journal
Online ISSN : 2434-4656
Print ISSN : 0439-1721
Volume 70 , Issue 2-4
Showing 1-18 articles out of 18 articles from the selected issue
Original Article
  • Zaiqiang Yu, Kazuyuki Daitoku, Wei Yang, Norihiro Kondo, Masahito Mina ...
    2020 Volume 70 Issue 2-4 Pages 99-108
    Published: 2020
    Released: March 27, 2020
    Background Combined aortic valve replacement(AVR)and coronary artery bypass grafting(CABG)is mostly performed for patients with aortic stenosis(AS)and coronary artery disease(CAD).
    Objectives We aim to clarify that combined operation of AVR and CABG with adequate perioperative cardiac protection does not increase operative and postoperative risk.
    Methods A total of 217 patients who underwent AVR for aortic stenosis alone or combined AVR and CABG from 1/2002 to 12/2015 were recruited. The aortic valve alone group(group A)had 164 patients, with an average age of 71.6± 8.1 years. The combined operation group(group C)consisted of 54 patients, with an average age of 73.5±8.5 years. Aortic valve area and pressure gradient showed no significant differences between the two groups. In group C, an average of 2 ±0.8 vessels had CAD. Cold crystalloid cardioplegia according to left ventricular mass ± a terminal hot shot was used for all patients. Distal graft anastomosis was done after cardiac arrest and cardioplegia(1.5-fold normal)was injected additionally from the graft with severe proximal obstruction of the right coronary artery.
    Results Group C included more patients with diabetes mellitus(DM, 43.4% vs. 26.8%)and low left ventricular ejection fraction(LVEF<50%, 33.96% vs. 16.46%)than group A. On the other hand, the incidence of atrial fibrillation(AF, 3.77% vs. 13.41%)was significantly less in group C than in group A. Although cardiac arrest time was longer in group C, postoperative CPK-MB was not significantly elevated, except in 4 patients. Postoperative data showed no significant differences between the two groups.
    Conclusions In our department, satisfactory clinical outcomes were obtained with combined operation AVR and CABG. Sufficient myocardial protection had an important effect on clinical outcomes.
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  • Atsumi Fukuda, Eiki Tsushima, Kanichiro Wada
    2020 Volume 70 Issue 2-4 Pages 109-118
    Published: 2020
    Released: March 27, 2020
    Objectives: To clarify the relationship between trunk range of motion(ROM)and back extensor strength(BES)for postural alignment in community-dwelling older adults.
    Methods: Postural alignment in the sagittal plane(thoracic kyphosis angle, lumbar lordosis angle, sacral inclination angle, overall inclination angle, knee flexion angle), trunk ROM, and BES were measured in 52 subjects. We analyzed the relationship between trunk ROM and BES for each of the postural alignment variables and the group of postural alignment variables.
    Results: After adjusting for age, body mass index(BMI), and 5-repetition sit-to-stand test(SS-5), all postural alignment variables except for the sacral inclination angle were affected by the thoracolumbar ROM. The postures with decreased lumbar lordosis, forward-tilted trunk, and knee flexion were influenced by lumbar ROM, age, BMI, and SS-5. The postures with increased thoracic kyphosis, lumbar lordosis, and sacral forward tilt were affected by only thoracolumbar ROM.
    Conclusions: Postural alignment was related to trunk ROM, but there was not enough evidence to say that it is related to BES. Depending on postural characteristics, there may be no relationship with BES.
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  • Masaya Kajino, Eiki Tsushima, Hideaki Somura
    2020 Volume 70 Issue 2-4 Pages 119-129
    Published: 2020
    Released: March 27, 2020
    [Objective] The association of changes in physical function at 1 and 2 weeks after gastrointestinal surgery with postoperative conditions and surgical factors was surveyed to investigate intervention methods and the need for postoperative rehabilitation.
    [Methods] The subjects were 28 patients who had undergone surgery for digestive cancer. Knee extensor muscle strength, grip strength, SPPB(balance test, 4-meter walking time, and 5-sit-to-stand time), and 6-minute walking distance were measured about 1 and 2 weeks after surgery for evaluation of physical function. Canonical correlation analysis was performed with physical function factors as dependent variables and preoperative and surgical data as independent variables.
    [Results] Physical function improved over 2 weeks. The 4-meter walking time and 5-sit-to-stand test were correlated with preoperative %FVC, days of postperative rehabilitation, and presence or absence of postoperative complications(p<0.01).
    [Conclusion] Preoperative physical condition may affect postoperative functional improvement.
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  • Yamato Niioka, Eiki Tsushima, Hirofumi Ogihara, Takaaki Sato, Kazuya H ...
    2020 Volume 70 Issue 2-4 Pages 130-138
    Published: 2020
    Released: March 27, 2020
    Aim: We aimed to clarify the physical, mental and social factors related to the quality of life of the elderly adults who require long-term care.
    Methods: The physical functions of 123 users of day care rehabilitation services were measured. Survey and measurement items were the physical and mental component summaries of the 8-item Short-Form Health Survey, Life Satisfaction Index K, 30-Second Chair-Stand Test, 5-meter walking time maximum, pain, Geriatric Depression Scale-15, K-I Scale, Japanese version of the abbreviated Lubben Social Network Scale, age, gender, nursing care level, living arrangements, residence history, educational level, and hobbies. Canonical correlation analysis was used to clarify factors related to quality of life.
    Results: The Geriatric Depression Scale-15 was found to be related to the Life Satisfaction Index K and mental component summary. The 30-Second Chair-Stand and pain were found to be related to the physical component summary.
    Conclusions: Depression, pain, and leg muscle strength are related to quality of life in elderly users of day care rehabilitation services when evaluating quality of life using health-related quality of life and subjective well-being as a single construct.
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  • Tomo Kato, Takashi Yokota, Kazutaka Kitayama, Naotake Miura, Masashi N ...
    2020 Volume 70 Issue 2-4 Pages 139-147
    Published: 2020
    Released: March 27, 2020
    Background: We previously reported that ST-segment elevation myocardial infarction( STEMI) patients with large residual thrombus burden after thrombectomy before stent implantation had more severe microvascular dysfunction, and greater myocardial damage compared with those with small residual thrombus. However, clinical significance of residual thrombus after stent implantation in STEMI patients is unclear.
    Aims: This study aimed to evaluate the incidence of thrombus by optical coherence tomography( OCT) after stent implantation, and to investigate its clinical impact in STEMI patients.
    Methods and Results: A total of 180 STEMI patients within 12 hours after onset of symptoms were studied. Patients were divided into two groups according to OCT findings after stent implantation: thrombus group( n = 73) and nonthrombus group( n = 107). Peak CPK levels were greater in thrombus group than in non-thrombus group with close to significance( 3649 {1752-7053} versus. 2563 {1201-4282} IU/L, p = 0.053). Thrombus after stent implantation was independently associated with peak CPK levels by a stepwise multivariate analysis.
    Conclusions: Residual thrombus on OCT after stent implantation was detected in 41% of STEMI patients. The residual thrombus was associated with greater myocardial damage assessed by peak CPK levels, indicating clinical impact of OCT-detected thrombus in STEMI patients.
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  • Natsumi Kudo, Kenji Hanada, Yosuke Kawamura, Masamichi Nakata, Masashi ...
    2020 Volume 70 Issue 2-4 Pages 148-155
    Published: 2020
    Released: March 27, 2020
    Coronary spastic angina(CSA)has become increasingly important for clinical practice. β-arrestin regulates a large network of cellular responses including inflammation and muscle contraction. However, little is known about its role in the pathogenesis of CSA. In this study, we performed mutational analysis of β-arrestin1 and β-arrestin2 genes in CSA patients. The study population included 20 CSA patients and 5 control subjects. Mutational analyses of the coding regions of β-arrestins were performed by direct sequencing. In β-arrestin1, single base heterozygous substitution at nucleotide position 176 in exon 5 was detected in 2 of 20 CSA patients, whereas no substitution was detected in control subjects. We subsequently performed an association study involving 50 CSA patients and 50 control subjects. No difference was found in the incidence of the mutation between the two groups (p=0.44). In β-arrestin2, single base substitution at nucleotide position 61 in exon 11 was detected. This substitution was homozygous in 13 and heterozygous in 7 of 20 CSA patients, whereas all homozygous in 5 control subjects. These substitutions were well-annotated SNPs(rs877711 and rs1045280, respectively)and did not cause amino acid replacement. No significant substitution of the coding regions of β-arrestins was detected in Japanese CSA patients.
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  • Anna Matsumoto, Tetsuya Kushikata, Kazuyoshi Hirota
    2020 Volume 70 Issue 2-4 Pages 156-162
    Published: 2020
    Released: March 27, 2020
    In kidney transplantation, stable hemodynamics is essential to preserve graft function. We used ketamine as an anesthetic because of its sympathomimetic properties. On the other hand, ketamine has several adverse effects, such as prolonged emergence from anesthesia or psychological reactions. Altered ketamine pharmacokinetics was previously reported in rabbits with renal insufficiency, but no study has examined human living kidney transplantation, which has the potential to cause renal insufficiency in the donor and recipient. Therefore, we evaluated ketamine pharmacokinetics in the donor and recipient of living kidney transplantation in various situation including ABO blood type-compatible and -incompatible transplantation.
    Materials and Methods: We examined the ketamine pharmacokinetics in donors(n=8), and ABO blood type -compatible(n=8)and -incompatible(n=8)recipients of living kidney transplantation. We also measured the estimated glomerular filtration ratio(eGFR), blood urea nitrogen(BUN), and serum creatinine in these patients.
    Results: The time course of changes in the ketamine level after stopping ketamine administration did not differ between the donors and recipients. We also found that the eGFR in recipients gradually improved 48 h after the kidney transplantation. No patient developed ketamine-related adverse effects or allograft rejection.
    Conclusion: We conclude that ketamine can be safely applied as an adjuvant with intravenous anesthesia during ABO blood type-compatible and -incompatible living kidney transplantation.
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  • Yuichi Toyama, Manabu Yonekura, Yoshiaki Arakawa, Shoki Higuchi, Hirof ...
    2020 Volume 70 Issue 2-4 Pages 163-171
    Published: 2020
    Released: March 27, 2020
    The cardiac action potential in the sinoatrial node is important, as it propagates throughout the heart and determines cardiac rhythm. Because of the anatomical complexity, pacemaker cells in the sinoatrial node can be difficult to identify for electrophysiological analysis. Also, analysis of pacemaker cells requires a specialized technique. In this study, we tried to analyze pacemaking in the sinoatrial node. First, we evaluated the expression of various factors that participate in pacemaking or modify cardiac rhythm. Next, we evaluated recordings of the action potential in the sinoatrial node by a conventional electrophysiological technique and using oxonol V, a fluorescent voltage-sensitive dye.
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Case Study
  • Hirotaka Kinoshita, Daiki Takekawa, Noriko Mikami, Junichi Saito, Kazu ...
    2020 Volume 70 Issue 2-4 Pages 172-176
    Published: 2020
    Released: March 27, 2020
     The treatment of esophageal achalasia using peroral endoscopic myotomy(POEM)is a standard technique that is less invasive than other techniques. There have been no previous reports of using transthoracic ultrasonography to detect complications with POEM.
     We report the case of a 29-year-old male patient with esophageal achalasia who underwent POEM. The procedure was repeatedly interrupted due to hypercapnia and hemodynamic instability. Even after a peritoneal puncture to release abdominal distention, improvement of his respiratory condition was limited. The patient emerged promptly from general anesthesia but developed tachypnea. Using transthoracic ultrasonography we diagnosed left pneumothorax. He was admitted to the intensive care unit, and the trachea was extubated without any invasive intervention 6 hours later.
     We treated a patient who required mechanical ventilation due to hypercapnic respiratory failure after undergoing POEM and found that transthoracic ultrasonography may be useful to detect pneumothorax in such cases.
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Abstracts of Meeting of Hirosaki Medical Society