K Kinoshita

Matsuyama Red Cross Hospital, Matuyama, Ehime, Japan

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Publications (87)113.7 Total impact


  • No preview · Article · Apr 1999 · Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
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    ABSTRACT: The aim was to investigate the effects of a calcium antagonist (diltiazem) and a catecholamine (noradrenaline) on extracellular potassium accumulation during global ischaemia. Extracellular potassium concentration ([K+]e) was measured during 30 min global ischaemia in the isolated rat heart using a valinomycin potassium sensitive electrode. Contracture development during ischaemia was measured throughout with an intraventricular balloon inserted into the left ventricle and myocardial adenine nucleotides were measured in separate series of hearts. In control hearts, [K+]e showed a characteristic triphasic change during 30 min global ischaemia. This consisted of an early rising phase followed by a transient falling phase after the initial peak of [K+]e, and then a late rising phase. Diltiazem suppressed the rate of rise of [K+]e during early ischaemia, but extended the time course of the early [K+]e rise with the higher dose, abolishing the transient falling phase of [K+]e. During late ischaemia, the rise in [K+]e was attenuated by diltiazem. Noradrenaline also suppressed the early extracellular potassium accumulation, but in contrast to diltiazem, hastened the time course of the late [K+]e rise. Although diltiazem suppresses the early potassium loss during ischaemia as previously described, the drug also decreases the [K+]e fall by some as yet unknown mechanism, so that the [K+]e level becomes higher than control during the falling phase.
    No preview · Article · Dec 1992 · Cardiovascular Research
  • Y Kawachi · J Tanaka · R Tominaga · K Kinoshita · K Tokunaga
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    ABSTRACT: From February 1975 through October 1981, 256 Hancock porcine bioprostheses (Johnson & Johnson Cardiovascular, King of Prussia, Pa.) (60 aortic, 169 mitral, and 27 pulmonary/tricuspid position) were implanted in 220 patients (104 male and 116 female, aged 9 to 67 years; mean 43.3) at Kyushu University Hospital in Japan. The procedures include 41 aortic valve replacements, 121 mitral valve replacements, 4 pulmonary valve replacements, 6 tricuspid valve replacements, and 48 combined valve replacements (31 aortic plus mitral, 13 mitral plus tricuspid, and 4 aortic plus mitral plus tricuspid). Hospital mortality was 6.4%. Follow-up was 98% during 8 to 14 (mean 10.5) years. Cumulative follow-up was 1836 patient-years and 2078 valve-years. At 10 years the overall actuarial survival rate, including hospital morality, was 70% +/- 3%, and freedom from valve-related mortality with sudden death was 87% +/- 3%. More than half of the current survivors required no anticoagulant therapy. Freedom from thromboembolism or anticoagulant-related hemorrhage (or both) and prosthetic valve endocarditis was common. Freedom from structural valve failure and reoperation declined more than 9 years after replacement of left-sided heart valves but not after replacement of right-sided heart valves. Sixty-seven patients underwent 68 repeat operations, and there were four deaths (5.9%). The rate of freedom from overall valve-related complications at 10 years was 62% +/- 8% for aortic valve replacement, 53% +/- 5% for mitral valve replacement, 80% +/- 13% for pulmonary/tricuspid valve replacement, and 42% +/- 9% for combined valve replacement. There was a significant difference between pulmonary/tricuspid valve replacement and combined valve replacement (p less than 0.05). The Hancock bioprosthesis is suitable for the replacement of valves in the right side of the heart but not for combined valve replacement.
    No preview · Article · Aug 1992 · Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: To assess the underlying mechanisms of ventricular fibrillation induced by myocardial reperfusion after cardioplegic arrest, 62 patients undergoing an open heart operation were divided into two groups based on the absence (group 1, n = 37) or the development (group 2, n = 25) of reperfusion-induced ventricular fibrillation. There was no close relationship between the incidence of reperfusion-induced ventricular fibrillation and aortic clamp time. On reperfusion, the time to onset of cardiac activity was similar in groups 1 (2.4 +/- 1.8 minutes) and 2 (1.9 +/- 1.1 minutes). At that time, there was no significant difference in values of arterial oxygen and bicarbonate contents, pH, or base excess between the two groups, but myocardial temperature was significantly higher in group 2 (25.6 degrees +/- 3.4 degrees versus 27.6 degrees +/- 2.4 degrees C; p less than 0.05). In addition, serum levels of sodium (123.9 +/- 4.2 versus 126.1 +/- 3.7 mmol/L; p less than 0.05) and calcium (0.80 +/- 0.07 versus 0.84 +/- 0.05 mmol/L; p less than 0.05) were significantly higher and serum potassium levels (3.98 +/- 0.58 versus 3.55 +/- 0.61 mmol/L; p less than 0.02) and the serum potassium to calcium ratio (4.94 +/- 0.90 versus 4.29 +/- 0.72; p less than 0.01) significantly lower in group 2. Postoperative serum levels of the myocardial-specific isoenzyme of creatine kinase and myoglobin were similar in both groups. By multivariate analysis, shorter ischemic time, higher myocardial temperature, higher serum sodium concentration, and lower serum potassium to calcium ratio were found to influence induction of reperfusion-induced ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)
    No preview · Article · Jul 1992 · The Annals of Thoracic Surgery
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    ABSTRACT: We examined influences of a blocker (glibenclamide) and an opener (nicorandil) of the ATP-sensitive potassium (KATP) channel on extracellular K concentration [( K+]e), as well as the myocardial function and metabolites during global ischemia and reperfusion in Langendorff-perfused rat heart preparation. In control hearts, [K+]e began to rise 20 s after the onset of ischemia up to an initial peak (8.3 +/- 0.3 mM) at 2.5 +/- 0.7 min, then fell to 6.0 +/- 0.8 mM after 8.2 +/- 0.7 min, and then rose progressively to 14.6 +/- 0.8 mM at the end of 30 min of ischemia. Glibenclamide (50 microM) reduced the initial peak of [K+]e to 7.2 +/- 0.3 mM (P less than 0.01), and nicorandil (200 microM) increased it to 9.4 +/- 0.6 mM (P less than 0.01). There were no significant differences in [K+]e values among all groups at the end of ischemia. During ischemia, nicorandil decreased the time to mechanical arrest from 1.9 +/- 0.1 min to 1.5 +/- 0.1 min, whereas it was increased by glibenclamide to 2.7 +/- 0.4 min. In control hearts, the time to onset of ischemic contracture was 14.7 +/- 1.8 min. Nicorandil delayed onset of contracture and glibenclamide accelerated it. Thus we have confirmed that some part of the early increase in [K+]e during ischemia is attributable to K+ efflux through the KATP channel in our model, and opening of the KATP channel may contribute to a rapid reduction of the contractility of the ischemic myocardium that subsequently protects the myocardium against further ischemic injury.
    No preview · Article · Jan 1992 · The American journal of physiology
  • H Mayumi · K Matsuzaki · Y Kawachi · K Kinoshita · R Tominaga · K Tokunaga
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    ABSTRACT: Newly devised protractor rings that can equally partition a prosthetic valve sewing ring into 10-20 acrs have been used on 46 patients who underwent 59 aortic, mitral, and/or tricuspid valve replacement. After an appropriate number of interrupted mattress sutures were placed along the host annulus, one of the 11 protractor rings was chosen and used to copy the partition onto the sewing ring with a tissue pen. The interrupted mattress sutures kept on a suture holder were then passed through the prosthetic sewing ring directly from one end to the other. Based on ex vivo experiments in simulating valve replacement, it was evident that time required for placing sutures around the sewing ring was significantly shortened by the use of such protractor rings. The use of these protractor rings may thus be useful in decreasing valve replacement time as well as in potentially simplifying operative procedures.
    No preview · Article · Jan 1992 · Artificial Organs

  • No preview · Article · Jan 1992
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    ABSTRACT: Postoperative complications of Bentall operation for the annuloaortic ectasia have frequently occurred, although the mortality has been reduced. To reduce complications after Bentall operation we have taken three major treatments since 1987. The first was reimplantation technique of coronary ostia in replacing the ascending aorta and the aortic valve with a tube graft. The second was the infusion technique of cardioplegic solution such as retrograde cardioplegia infusion. The third method was to save blood and reduce the blood transfusion by preserving autoblood preoperatively and using cell saving machine. The purpose of this study was to analyse 20 patients who underwent the Bentall procedure and to investigate the effect of our treatments in Bentall operation on the operative results. We divided our patients into two groups. Fourteen patients in the group 1 were operated before 1987, when our principles were not performed. Six patients in group II were operated under the principles mentioned above. There were no differences in cardiopulmonary bypass time and ischemic time between group I and II. Transfused blood volume in group II was remarkably less than that of group I. Postoperative complications occurred in all patients in group I (100%), while three patients in group II (50%) had complications (p less than 0.05). We, hence, conclude that our method could be useful for reducing postoperative complication rate in Bentall operation.
    No preview · Article · Jan 1992 · Kyobu geka. The Japanese journal of thoracic surgery
  • K Kinoshita · K Matsuzaki · H Mayumi · T Asou · M Masuda · Y Kawachi · K Tokunaga
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    ABSTRACT: Five patients developed coronary artery spasm during open heart surgery in our institute between 1984 and 1988. One patient was undergoing coronary artery bypass grafting and the other four valvular surgery or surgery for congenital heart disease. In one of the patients undergoing non-coronary surgery, the preoperative induction of right coronary artery spasm by ergonovine had been documented angiographically while the remaining three patients did not possess organic or functional coronary disease. All five patients exhibited a sudden onset of hemodynamic collapse with ventricular tachyarrhythmias or ST elevation during the early period of reperfusion, the time to onset being 89.2 +/- 84.8 minutes after unclamping of the aorta. In addition, contraction of the right ventricular free wall was severely impaired. Although one patient died due to left ventricular rupture caused by direct cardiac massage, the early mortality thus being 20 per cent, the other four were successfully treated with the intravenous administration of nitroglycerin and diltiazem. Three patients required the assistance of intraaortic balloon pumping for severe cardiac failure. Thus, during open heart surgery, coronary artery spasm can occur even in patients without organic coronary lesions and the possible mechanisms of this condition are discussed herein.
    No preview · Article · Aug 1991 · The Japanese Journal of Surgery
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    ABSTRACT: Recently, it has been recognized in Japan that informed consent is indispensable to make decisions for medical treatment, although it had been already confirmed in western countries for several decades of years. However, there may be some differences in the content of informed consent between Japan and western countries. We discussed the problems of informed consent in Japan concerning the choice of prosthetic valve, mechanical prosthesis or bioprosthesis, in patients to be undergone valve replacement. We conclude that informed consent should be the humane relationship between therapists and a patient.
    No preview · Article · Aug 1991 · Kyobu geka. The Japanese journal of thoracic surgery
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    ABSTRACT: We performed cytogenetic studies and breakpoint cluster region (bcr) rearrangement analysis in two cases of juvenile chronic myeloid leukemia (JCML) which is special type of chronic myeloid leukemia (CML). Case 1 (8-month-old male) and case 2 (3-month-old female) showed clinical and hematologic manifestations similar to CML. Each of case 1 and 2 had normal karyotype and no bcr rearrangement. These findings suggest that JCML is a different heterogeneous disorder from that of adult CML.
    No preview · Article · Jul 1991 · [Rinshō ketsueki] The Japanese journal of clinical hematology
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    K Kinoshita · Y Tsuruhara · K Tokunaga
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    ABSTRACT: Postoperative changes in serum myoglobin levels have been studied in 47 patients undergoing open heart surgery. The patients were retrospectively divided into two groups according to the time to peak myoglobin level during reperfusion. In 38 patients, myoglobin levels increased rapidly to a peak within 3 hours after reperfusion, after which it was cleared from the blood (group 1). Contrarily, a rise in myoglobin levels was persistent for 24 hours and its time to peak was greater than 3 hours after reperfusion in nine patients (group 2). There were no differences in preoperative and early reperfusion (within 1 hour of reperfusion) values of myoglobin between the two groups. At 3, 6, and 12 hours of reperfusion, myoglobin levels were significantly greater in group 2: 448 +/- 196 vs 1,149 +/- 900 ng/ml, 359 +/- 172 vs 2,653 +/- 3,179 ng/ml, 184 +/- 95 vs 1,896 +/- 1,387 ng/ml, respectively, p less than 0.0001 in each. The maximum activities of both myoglobin and CK-MB were significantly higher in group 2 (myoglobin-max: 771 +/- 257 vs 3,221 +/- 3,024 ng/ml, p less than 0.0001; CK-MBmax: 107 +/- 60 vs 227 +/- 219 IU/L, p less than 0.005). Five of nine patients in group 2 required post-operative assistance with intra-aortic balloon pumping (p less than 0.0005 compared with one of 38 in group 1) and perioperative myocardial infarction developed in three patients (33.3 percent) in this group (p less than 0.005 compared with 0 percent in group 1). Thus, patients with a delayed peak of serum myoglobin level exhibited detrimental cardiac failure postoperatively. These findings suggest that myocardial injury accelerated by reperfusion following ischemia might progress in these patients.
    Preview · Article · Jul 1991 · Chest
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    ABSTRACT: Five patients developed coronary artery spasm during open heart surgery in our institute between 1984 and 1988. One patient was undergoing coronary artery bypass grafting and the other four valvular surgery or surgery for congenital heart disease. In one of the patients undergoing non-coronary surgery, the preoperative induction of right coronary artery spasm by ergonovine had been documented angiographically while the remaining three patients did not possess organic or functional coronary disease. All five patients exhibited a sudden onset of hemodynamic collapse with ventricular tachyarrhythmias or ST elevation during the early period of reperfusion, the time to onset being 89.2±84.8 minutes after unclamping of the aorta. In addition, contraction of the right ventricular free wall was severely impaired. Although one patient died due to left ventricular rupture caused by direct cardiac massage, the early mortality thus being 20 per cent, the other four were successfully treated with the intravenous administration of nitroglycerin and diltiazem. Three patients required the assistance of intraaortic balloon pumping for severe cardiac failure. Thus, during open heart surgery, coronary artery spasm can occur even in patients without organic coronary lesions and the possible mechanisms of this condition are discussed herein.
    No preview · Article · Jul 1991 · Surgery Today
  • K Kinoshita · M Oe · K Tokunaga
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    ABSTRACT: The protective effect of low-calcium, magnesium-free potassium cardioplegic solution on ischemic myocardium has been assessed in adult patients undergoing heart operations. Postreperfusion recovery of cardiac function and electrical activity was evaluated in 34 patients; 16 received low-calcium, magnesium-free potassium cardioplegic solution (group I) and 18 received St. Thomas' Hospital solution, which is enriched with calcium and magnesium (group II). There were no significant differences between the two groups in age, sex, body weight, and New York Heart Association functional class. Aortic occlusion time (107.3 +/- 46.8 minutes versus 113.6 +/- 44.3 minutes), highest myocardial temperature during elective global ischemia (11.5 degrees C +/- 3.1 degrees C versus 9.3 degrees C +/- 3.2 degrees C), and total volume of cardioplegic solution (44.2 +/- 20.5 ml/kg versus 43.4 +/- 17.6 ml/kg) were also similar in the two groups. On reperfusion, electrical defibrillation was required in four cases (25.5%) in group I and in 15 cases (83.3%) in group II (p less than 0.005), and bradyarrhythmias were significantly more prevalent in group II (6.3% versus 44.4%; p less than 0.05). Serum creatine kinase MB activity at 15 minutes of reperfusion (12.3 +/- 17.0 IU/L versus 42.6 +/- 46.1 IU/L; p less than 0.05) and the dose of dopamine or dobutamine required during the early phase of reperfusion (1.8 +/- 2.5 micrograms/kg/min versus 6.1 +/- 3.3 micrograms/kg/min; p less than 0.0002) were both significantly greater in group II. Postischemic left ventricular function, as assessed by percent recovery of the left ventricular end-systolic pressure-volume relationship in patients who underwent aortic valve replacement alone, was significantly better in group I (160.4% +/- 45.5% versus 47.8% +/- 12.9%; p less than 0.05). Serum level of calcium and magnesium ions was significantly lower in group I. Thus low-calcium, magnesium-free potassium cardioplegic solution provided excellent protection of the ischemic heart, whereas St. Thomas' Hospital solution with calcium and magnesium enabled relatively poor functional and electrical recovery of the heart during the early reperfusion period. These results might be related to differing levels of extracellular calcium and magnesium on reperfusion.
    No preview · Article · May 1991 · Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: The patient was a 67-year-old female, complaining of cyanosis, clubbed finger and anoxic spell-like symptom. She was diagnosed as pulmonary arteriovenous fistula combined with mitral regurgitation. The fistula was giant and multiple, and was located in the right middle-lower lobe. Right to left shunt ratio was 27%, SO2 was 58.2%, %VC was 60%, mean pulmonary arterial pressure was 19 mmHg. Mitral regurgitation was mild (II). Ligation of the middle-lower branch of right pulmonary artery and the right lower pulmonary vein was performed through a median sternotomy. All of her symptom improved.
    No preview · Article · Mar 1991 · Kyobu geka. The Japanese journal of thoracic surgery
  • M Ichimaru · S Ikeda · K Kinoshita · S. and Hino · Y Tsuji
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    ABSTRACT: Transmission of HTLV-I via mother's milk has been confirmed by epidemiological studies and by animal experiments using carrier mother's milk and a marmoset. The prevalence rates of HTLV-I carriers in children born of carrier mothers in endemic areas and ATL families were higher than in three control groups of young people. Also, the prevalence rates of carrier mothers who were traced from previously identified carrier children in three groups (two endemic areas and ATL family members) were extremely high. When HTLV-I antigen-positive lymphocytes were detected in carrier mother's milk, the child infection rate was higher than in the cases where antigen-positive cells could not be detected in mother's milk. The number of infected cells present in carrier mother's milk was calculated and the volume of milk given to the baby from delivery to weaning was estimated. Then, an equivalent amount of carrier mother's milk was inoculated into a marmoset orally and this marmoset seroconverted 2.5 months after the inoculation. A campaign to stop carrier mothers from giving their breast milk to their babies has been started in Nagasaki. So far, this trial has been shown to be successful in the prevention of mother-to-child infection.
    No preview · Article · Feb 1991 · Cancer Detection and Prevention

  • No preview · Article · Jan 1991

  • No preview · Article · Jan 1991
  • R Tominaga · T Asou · E Nakano · M Masuda · K Kinoshita · Y Kawachi · J Tanaka · K Tokunaga
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    ABSTRACT: Since 1957, 30 patients with constrictive pericarditis have been treated surgically in Kyushu University Hospital. The surgical approaches were the left anterolateral thoracotomy in 17 patients (group I); the median sternotomy without cardiopulmonary bypass (CPB) in 6 patients (group II); and the median sternotomy with CPB in 7 patients (group III). The hospital mortality was 3.3 percent. The mean postoperative follow-up period was 11.7 years (longest 30 years). The actuarial survival rate at 5 years postoperatively was 88% in total cases (100% in group I, 82% in group II and 52% in group III), 88% at 10 years, 75% at 15 years and 67% at 20 years. Several patients in group III, who underwent complete pericardiectomy using CPB showed severe congestive heart failure and arrhythmia postoperatively. The comparative study between an poor result group (patients who died within 10 years post-operatively) and a good result group (patients who survived more than 10 years postoperatively revealed that preoperative hepatomegaly, atrial fibrillation and the interval between the onset of symptoms and the pericardiectomy influenced the survival rate significantly. These results suggested that pericardiectomy using CPB was a safe method for removing the calcified pericardium in the patient with severe constrictive pericarditis. However, a careful long term follow-up was necessary for the patient with severe myocardial damage even though the complete pericardiectomy was performed.
    No preview · Article · Aug 1990 · [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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    ABSTRACT: Hemoconcentration for the establishment of no-donor blood transfusion in open heart surgery was assessed in regard to both the saving of protein and platelets and the exclusion of free hemoglobin. Two different types of hemoconcentrator were compared: the ultrafilter (group I, 6 patients) and the Cell Saver (group II, 6 patients). The total serum protein level, expressed as the percent recovery of the preoperative value, after hemoconcentration was significantly higher in group I (group I versus group II: total serum protein, 118% versus 87% [p less than 0.05]; fibrinogen, 77% versus 50% [p less than 0.01]; immunoglobulin, 83% versus 60% [p less than 0.01]). The platelets also seemed to be well preserved after hemoconcentration in group I. Although the exclusion of free hemoglobin from plasma was inferior in group I compared with group II, the postoperative plasma free hemoglobin level did not increase in group I. We conclude that use of the Cell Saver in nontransfusion cardiopulmonary bypass might cause a severe depletion of various proteins and that the ultrafilter is both safer and more useful if employed routinely.
    No preview · Article · Jul 1990 · The Annals of Thoracic Surgery

Publication Stats

1k Citations
113.70 Total Impact Points

Institutions

  • 1992
    • Matsuyama Red Cross Hospital
      Matuyama, Ehime, Japan
  • 1991-1992
    • Kyushu University
      • Faculty of Medical Sciences
      Hukuoka, Fukuoka, Japan
  • 1983
    • National Cancer Center, Japan
      Edo, Tōkyō, Japan