RESUMEN
BACKGROUND: It has been reported that the toxins that Staphylococcus aureus produces are associated with the exacerbation of atopic dermatitis (AD). It has been shown in many studies that staphylococcal enterotoxin (SE) A and SEB contribute to AD by humoral immunity through IgE production as a superantigen. On the other hand, little attention has been paid to the relationship between AD and exfoliative toxin x (ETx). OBJECTIVE: We investigated the toxins that are frequently detected from the skin of patients and how these toxins affect AD. METHODS: S. aureus, isolated from the skin of 100 patients with mild to severe AD, were examined for the producibility of toxins by polymerase chain reaction. Serum samples were obtained from 21 patients with mild and moderate AD. The levels of SEB, ETA, total IgE, specific IgE, and specific IgG in sera were measured by ELISA. RESULTS: SEB was most frequently detected from S. aureus on the skin of these patients as previously reported. And ETx, to which little attention has been paid so far, was frequently detected next to SEB. Furthermore, ETA was detected from the sera of almost all the AD patients. SEB was not detected at all. Although the level of ETA in the AD group was significantly higher than that of controls, ETA-specific IgE was not detected from their sera. High levels of ETA tended to be detected from infantile patients. Although there were no significant differences in the levels of ETA-IgG between AD and the controls, its prevalence was more than twice as high as the controls in AD. CONCLUSION: These results suggest that many AD patients were exposed to ETx. We conclude that ETx may contribute to exacerbation of AD, particularly in infants, by a mechanism that is not through specific IgE production, unlike SEB.
Asunto(s)
Toxinas Bacterianas/sangre , Dermatitis Atópica/sangre , Dermatitis Atópica/microbiología , Exfoliatinas/sangre , Proteínas Hemolisinas/sangre , Piel/química , Infecciones Estafilocócicas/sangre , Adolescente , Adulto , Toxinas Bacterianas/biosíntesis , Western Blotting , Estudios de Casos y Controles , Niño , Preescolar , Dermatitis Atópica/inmunología , Ensayo de Inmunoadsorción Enzimática/métodos , Exfoliatinas/biosíntesis , Femenino , Proteínas Hemolisinas/biosíntesis , Humanos , Inmunoglobulina E/sangre , Inmunoglobulina G/sangre , Lactante , Recién Nacido , Masculino , Esfingomielina Fosfodiesterasa/biosíntesis , Esfingomielina Fosfodiesterasa/sangre , Estadísticas no ParamétricasRESUMEN
A 26-year-old man was diagnosed with mycotic aneurysm of the left hand associated with active infective endocarditis. Preoperative arteriography of the hand revealed aneurysm of the radial side of the deep arch of the palmar artery. We approached the aneurysm from the dorsal side of the hand in order to avoid damage to the collateral vascular supply of the superficial arch of the palmar artery and neurological structures. As a result, the aneurysm was excised simply by proximal and distal ligation of the vessel. During follow-up over 14 months, no evidence of recurrent aneurysm formation or ischemia of the fingers has been obtained.
Asunto(s)
Aneurisma Infectado/cirugía , Endocarditis Bacteriana/complicaciones , Mano/irrigación sanguínea , Infecciones Estreptocócicas/complicaciones , Streptococcus pyogenes , Adulto , Aneurisma Infectado/diagnóstico por imagen , Angiografía , Válvula Aórtica/cirugía , Ecocardiografía Doppler en Color , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/cirugía , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Válvula Mitral/cirugía , Infecciones Estreptocócicas/diagnóstico , Streptococcus pyogenes/aislamiento & purificación , Factores de TiempoRESUMEN
The patient was a 74-year-old man who was complained cyanosis and shortness of breath on exertion. He had undergone open mitral commissurotomy for mitral stenosis 19 years previously. He was diagnosed with mitral stenosis and regurgitation combined with pulmonary arteriovenous fistula (PAVF). Moderate pulmonary hypertension was also observed. It appeared that the PAVF was located where one-step operation with open heart surgery was anatomically feasible, and that his condition would be improved by resection of the fistula and decreasing overload of left atrium by mitral valve replacement. One-step operation including mitral valve replacement and tricuspid annuloplasty with enuculation of the PAVF was therefore performed. The patient has done well postoperatively, and postoperative cardiac catheterization revealed no increase in pulmonary arterial pressure.
Asunto(s)
Fístula Arteriovenosa/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Arteria Pulmonar , Venas Pulmonares , Anciano , Fístula Arteriovenosa/complicaciones , Humanos , Masculino , Insuficiencia de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/complicacionesRESUMEN
The purpose of this study was to review our experience with atrial synchronous ventricular pacing devices (THERA VDD pacing systems, Medtronic, Inc., U.S.A.) using single atrioventricular leads in Japanese patients with complete atrioventricular block and normal sinus function. Twenty patients with a mean age of 55 +/- 13 years underwent implantation of VDD pacemakers. At implantation the amplitude of atrial signals in the supine position during normal breathing, which was measured directly using an external pacing system analyzer, ranged from 1.8 to 5.8 mV with a mean amplitude of 3.4 +/- 1.4 mV. Atrial amplitudes did not change during deep breathing (3.3 +/- 1.1 mV) or in the semi-Fowler position (3.4 +/- 1.6 mV). Atrial oversensing or undersensing was not observed in any of the patients. During a follow-up period, the percentage of atrial synchronization was >95% in 19 patients, and none of the patients had pacemaker related tachycardia or pacemaker related complications. These results were promising enough to warrant the extension of the clinical use of the VDD pacemaker.
Asunto(s)
Estimulación Cardíaca Artificial , Bloqueo Cardíaco/terapia , Adulto , Anciano , Femenino , Estudios de Seguimiento , Atrios Cardíacos/fisiopatología , Bloqueo Cardíaco/fisiopatología , Humanos , Japón , Masculino , Persona de Mediana Edad , Marcapaso Artificial , Posición Supina , Resultado del TratamientoRESUMEN
The aim of the study was to assess the optimum timing of surgical treatment for the active phase of native valve endocarditis. A retrospective study was conducted of the records of patients who had undergone aortic and/or mitral valve replacement for active native valve endocarditis during 1979-94 at Kinki University Hospital. Thirty-three patients with active infective endocarditis of the native valves were treated surgically. Their mean age was 45.4 years (range 11-71). The infective organism was streptococcus in 9 cases, Staphylococcus aureus in 8, and enterococcus in 4 cases. Blood cultures were negative in 9 cases. Of the patients infected with Staphylococcus aureus, 3 died soon after the operation and 1 died later during hospitalization. These 4 patients had been treated medically more than 2 weeks before operation. Another patient who was also treated medically more than 2 weeks before surgery survived. In contrast, all 3 patients infected with Staphylococcus aureus who were operated on within 2 weeks after the onset survived. No early or in-hospital deaths were documented among patients infected with organisms other than Staphylococcus aureus. Among patients who had suffered preoperative embolic episodes, the time from the initial pyrexia to the embolic event was clearly shorter in those infected with Staphylococcus aureus than in those infected with other organisms. Among the former group, 5 out of 6 patients suffered an embolism within 2 weeks of the onset of pyrexia and the remaining 1 within 3 weeks. Thus, in patients presenting with active native valve endocarditis caused by Staphylococcus aureus, surgical treatment should be performed as soon as possible after the onset of pyrexia, preferably within 2 weeks or as soon as the infective organism is identified as Staphylococcus aureus.
Asunto(s)
Endocarditis/cirugía , Prótesis Valvulares Cardíacas , Infecciones Estafilocócicas/cirugía , Staphylococcus aureus , Adolescente , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos/métodos , Niño , Embolia/etiología , Endocarditis/microbiología , Femenino , Fiebre/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Factores de Tiempo , Resultado del TratamientoRESUMEN
The surgical treatment for psychotics remains unsatisfactory because of the potential risk of the sudden death after operation. The perioperative care with an advice from the psychiatrist has been called the liaison psychiatry and considered important to prevent the postoperative psychiatric complication. A 47-year-old male patient who was diagnosed as the schizophrenia underwent aortic valve replacement with an aortic annular enlargement. The cardiac procedure in this patient was accomplished safely without postoperative complications related to the schizophrenia. When the liaison psychiatry is done adequately in the psychiatric patient who needs surgery, an operative procedure can be performed more safely with the minimum risk of the psychiatric complication.
Asunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas , Complicaciones Posoperatorias/prevención & control , Esquizofrenia/complicaciones , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/psicología , Prótesis Valvulares Cardíacas/psicología , Humanos , Masculino , Persona de Mediana Edad , Válvula Tricúspide/cirugíaRESUMEN
A new prediction method of vancomycin (VCM) pharmacokinetics has been developed using the modified Bayesian forecasting method involved in time-dependent pharmacokinetics in clearance. We investigated to evaluate the usefulness of this new prediction method compared with that of the ordinary Bayesian forecasting method. Serum samples, obtained from 4 patients at least 3 different days during the period for the VCM treatment were assayed by fluorescence polarization immunoassay. VCM pharmacokinetic parameters and predicted serum VCM concentrations were calculated using this new method and the ordinary one according to the one-compartment model. The precision of the predicted serum VCM concentrations by these two methods at the third experimental day were evaluated with the mean prediction error (ME), mean absolute prediction error (MAE) and root mean squared error (RMSE). The most precise and least-bias prediction of serum VCM concentrations were observed using this new prediction method (ME: -0.36 +/- 1.40, MAE: 1.13 +/- 0.82 and RSME: 1.37). The time-dependent decrease of VCM clearance was observed in all patients. Therefore, the fitting of the actual serum VCM concentrations obtained using the ordinary method produced less precise results than that using this new method. These results suggest the usefulness of this new prediction method considering time-dependent changes in VCM clearance.
Asunto(s)
Antibacterianos/farmacocinética , Vancomicina/farmacocinética , Anciano , Anciano de 80 o más Años , Teorema de Bayes , Monitoreo de Drogas , Femenino , Humanos , Masculino , Resistencia a la Meticilina , Persona de Mediana Edad , Modelos Biológicos , Infecciones Estafilocócicas/metabolismo , Factores de TiempoRESUMEN
The patient who had had systemic atrio-ventricular valve replacement with Björk-Shiley 19 M at the age of 4 years was treated successfully with repeated re-replacement with St. Jude Medical 23M and St. Jude Medical 27M at the age of 8 years and 16 years respectively, because of his somatic growth. Two size larger valve was easily replaced at each operation. The original disease of this patient was corrected transposition of the great arteries with ventricular septal defect and regurgitation of the left atrio-ventricular valve caused by Ebstain anomaly and severe pulmonary hypertension. This case revealed that the annulus of the atrio-ventricular valve would grow even when fixed to the prosthetic valve sawing ring, thereby permitting the use of a larger-sized valve at the time of second and third prosthetic valve re-replacement.
Asunto(s)
Constitución Corporal , Crecimiento , Prótesis Valvulares Cardíacas , Adolescente , Adulto , Niño , Preescolar , Cardiopatías Congénitas/fisiopatología , Cardiopatías Congénitas/cirugía , Humanos , Masculino , ReoperaciónRESUMEN
A total of 267 infants and children who underwent the arterial switch operation for transposition of the great arteries in the 6 years before Jan. 1, 1988 in six main Japanese institutions were entered into this review. The current status of patients surviving more than 1 year after the operation were evaluated along with early operative results. One hundred forty-six patients had an intact ventricular septum, 103 had a significant ventricular septal defect, and 18 had so-called Taussig-Bing anomaly of the transposition type. Eighteen patients were less than 28 days of age, 73 were 1 to 5 months of age, and 176 were older than 6 months of age at the time of operation. The overall mortality rate was 35% in the first 3 years and 12% in the more recent 3 years. There was a significant difference between the overall mortality rate of primary and two-stage repair (22% versus 10%, p = 0.047) in patients with intact ventricular septum. The overall mortality rate in patients with type B or C coronary arteries of Yacoub, and Radley-Smith's classification was significantly higher than that of other types of arteries (86% versus 18%, p = 0.0001). A total of 156 patients survived more than 1 year after the operation, and 44 children (28%) were noted to have supravalvular pulmonary stenosis (greater than 20 mm Hg). This complication was more common in patients operated on in the newborn period. Trivial or mild aortic regurgitation was noted in 29 patients (19%) and was more common in patients with two-stage than with primary repair (24% versus 14%). Aortic regurgitation was significantly more prevalent in patients in whom coronary arteries were implanted into slits or U-shaped defects than in those whose arteries were implanted into punched-out holes made on the pulmonary root (28% versus 8%, p = 0.049). Normal sinus rhythm was present in 97% of 154 patients and left ventricular ejection fraction was within the normal range in 97% of 115 patients at catheterization 1 to 5 months after the operation.
Asunto(s)
Transposición de los Grandes Vasos/cirugía , Insuficiencia de la Válvula Aórtica/epidemiología , Niño , Estudios de Seguimiento , Defectos del Tabique Interventricular/mortalidad , Defectos del Tabique Interventricular/cirugía , Humanos , Lactante , Japón/epidemiología , Complicaciones Posoperatorias/epidemiología , Estenosis de la Válvula Pulmonar/epidemiología , Factores de Tiempo , Transposición de los Grandes Vasos/mortalidadRESUMEN
A five year and six month old boy, who had undergone Mustard operation for complete transposition of the great arteries with intact ventricular septum at two months of age, was reoperated on for pulmonary venous obstruction and pulmonary hypertension (PLV/RV = 0.96). The other complications which he had were moderate tricuspid regurgitation and various supra-ventricular arrhythmias. After the atrial baffle of the Mustard procedure was taken down, atrial septum was reconstructed and arterial switch operation was performed at the same time. One month after the operation, Pp/Ps was 0.41 and no tricuspid regurgitation and arrhythmias were found. He was discharged and his quality of life was ameliorated surprisingly.
Asunto(s)
Hipertensión Pulmonar/cirugía , Complicaciones Posoperatorias , Enfermedad Veno-Oclusiva Pulmonar/cirugía , Transposición de los Grandes Vasos/cirugía , Preescolar , Humanos , Hipertensión Pulmonar/etiología , Masculino , Enfermedad Veno-Oclusiva Pulmonar/etiologíaRESUMEN
A five months old infant with the transposition of the great arteries with posterior aorta undergoing arterial switch operation is reported. A pre-operative diagnosis of the transposition of the great arteries with posterior aorta, subarterial ventricular septal defect, anterior pulmonary artery, bilateral conus and fibrous continuity between aortic and mitral valve was made. This diagnosis was confirmed by the open heart surgery. The ventricular septal defect was subaortic from the transected aortic aspect, and the infundibular and trabecular septum was aligned. For these reasons, this subarterial ventricular septal defect was easily closed transaortically. The right coronary artery arose from the left sinus and the left coronary artery from the posterior sinus, so the coronary arterial pattern of this patient was a Shaher type 9. And in addition, another small ostium located in the left sinus gave rise to an additional small branch. Translocation of the coronary arteries was performed. The new pulmonary trunk was reconstructed to the right pulmonary artery so as not to compress the coronary artery and distort the great arteries. This patient was restudied three months after the repair. The right to left ventricular systolic pressure ratio was 0.42 and no pressure gradient was present between the right ventricle and the right pulmonary artery. But a moderate aortic regurgitation was detected. This was caused by deformity of the aortic sinus of valsalva. Only 28 patients with the transposition of the great arteries with posterior aorta were reported in the literature, but there were no reports on the successful surgical treatment for its rare anomaly, to our knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Aorta/anomalías , Transposición de los Grandes Vasos/cirugía , Humanos , Lactante , Masculino , MétodosRESUMEN
A 62-year-old man underwent operation for tension pneumopericardium and left hemothorax caused by multiple rib fractures. He sustained other multiple injuries, such as acute subdural hematoma, compound fractures of the left leg. At left thoracotomy, massive hemorrhage from the left apical lung disrupted by the first and second fractured ribs was encountered and pericardium was seen to be bulging and tensely inflated. Incision of the pericardial sac resulted in expulsion of air with a subsequent fall in central venous pressure and heart rate. And after repair of the tear of the laceration of the left lung, the chest was closed with underwater seal drainages of the left pleural cavity. He was successfully weaned off the ventilator after 12 days. After extubation, repeated bronchoscopy was done, but the tracheobronchial injury was not able to be found out.
Asunto(s)
Hemotórax/cirugía , Traumatismo Múltiple/complicaciones , Neumopericardio/cirugía , Fracturas de las Costillas/complicaciones , Hemotórax/etiología , Humanos , Masculino , Persona de Mediana Edad , Neumopericardio/etiologíaRESUMEN
Operative risk factors and postoperative late results were evaluated in 26 patients undergoing pulmonary artery reconstruction with a substitute valve. Seventeen extracardiac conduits bearing a valve were used in 16 patients and an in situ pulmonary valve insertion was carried out in the other 10. The surgical results were influenced by complexity of the underlying cardiac lesions and pulmonary vascular status, with a high mortality rate in patients with several cardiac defects including single ventricle, asplenia syndrome, complete atrioventricular canal etc. The mortality rate was 6% in patients with an immediate post-repair Ppv/sv of less than 0.75 and 77.8% in those with a Ppv/sv over 0.75. Postoperative Ppv/sv was mainly regulated by valve area index and a close correlation was obtained for the regression equation Ppv/sv = 0.41/(VAI)2 + 0.36 (r = -0.61, p less than 0.05). To obtain excellent hemodynamics with a Ppv/sv of less than 0.50, valve area index should be over 1.7 cm2/M2, and to eliminate re-implantation of the conduit after reaching adulthood, the diameter of the conduit should be 18 mm or more and the valve size 23 A, or more when a SJM valve is used.
Asunto(s)
Prótesis Vascular , Prótesis Valvulares Cardíacas , Arteria Pulmonar/cirugía , Adolescente , Adulto , Presión Sanguínea , Prótesis Vascular/mortalidad , Niño , Preescolar , Defectos del Tabique Interventricular/fisiopatología , Defectos del Tabique Interventricular/cirugía , Prótesis Valvulares Cardíacas/mortalidad , Humanos , Lactante , Persona de Mediana Edad , Estenosis de la Válvula Pulmonar/fisiopatología , Estenosis de la Válvula Pulmonar/cirugía , Tetralogía de Fallot/fisiopatología , Tetralogía de Fallot/cirugía , Transposición de los Grandes Vasos/fisiopatología , Transposición de los Grandes Vasos/cirugía , Resistencia VascularAsunto(s)
Cardiopatías Congénitas/cirugía , Niño , Preescolar , Femenino , Humanos , Masculino , MétodosRESUMEN
Factors affecting the surgical results of total anomalous pulmonary venous drainage were evaluated in 17 patients in an attempt to establish an appropriate plan of management. The mortality rate correlated with age, size of interatrial communication, arterial oxygen saturation and left heart volume but not with pulmonary to systemic systolic pressure ratio, vascular resistance ratio and right ventricular volume. In cases where the symptoms appeared early in life, left heart volume was small and clinical features were severe. Four children with a left ventricular end-diastolic volume of less than 65% of normal died of low cardiac output syndrome. In those with an unusually small left heart, enlargement of the left atrium and/or delayed ligation of the anomalous vertical vein were considered more favorable. Left atrial and ventricular volumes were restored to normal after the surgery.
Asunto(s)
Venas Pulmonares/anomalías , Factores de Edad , Presión Sanguínea , Volumen Cardíaco , Puente Cardiopulmonar , Niño , Preescolar , Conducto Arterioso Permeable/complicaciones , Conducto Arterioso Permeable/mortalidad , Conducto Arterioso Permeable/cirugía , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/mortalidad , Defectos del Tabique Interventricular/cirugía , Humanos , Lactante , Consumo de Oxígeno , Circulación Pulmonar , Venas Pulmonares/cirugía , Volumen Sistólico , Resistencia VascularRESUMEN
Anatomically corrected malposition of the great arteries (ACM) is an extremely uncommon cardiac disease in which the great arteries arise from their appropriate ventricles despite abnormal spatial interrelations. Two patients with this malformation underwent successful surgical intervention for their associated anomalies. One was of situs solitus, d-loop and l-malposition and the other of situs inversus, l-loop and d-malposition of the great arteries. Fifty-three cases with accurate anatomical description were collected from the literature, and anatomical characteristics and associated anomalies were investigated. From the standpoint of anatomy and hemodynamics, we considered that ACM should be classified into atrioventricular concordant ACM, atrioventricular discordant ACM and ACM with situs ambiguus. Heart position and conus were variable. Dextrocardia and mesocardia were frequent. Bilateral conus was characteristic in concordant ACM, and subpulmonary conus was prominent in discordant ACM. The hypoplasia of the right heart and juxtaposition of the atrial appendages were in high incidence in cases of ACM. Surgical intervention was also discussed.