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Biomedical subjects

A Ihaya

Publications and source records attributed to A Ihaya.

At least 19 recordsLinked to original sources
PubMed2006

[Surgical strategy for critical aoritc stenosis with small aortic annulus in the elderly patients].

BACKGROUND: There are an increasing number of elderly patients with critical aortic stenosis. This study was performed to evaluate the surgical outcome of aortic valve surgery for elderly patients with aortic stenosis. METHODS: Eleven patients aged over 75 years old (mean 79.7 +/- 4.4) underwent aortic valve replacement with stented bioprosthesis from May 2001 to August 2004. All of the patients had a history of congestive heart failure, syncope, or angina pectoris with multiple medical problems including renal dysfunction, diabetes mellitus, cerebral infarction, or coronary artery disease. The New York Heart Association (NYHA) classification ranged II to IV (mean 2.8 +/- 0.7). Their logistic Euro score ranged from 2.56 to 41.61 (mean 8.6 +/- 10.9). The concomitant procedures were annular enlargement in 2 and coronary artery bypass grafting (CABG) in 3 patients. RESULTS: All patients tolerated these procedures well and were discharged except 1 patient who died from arrhythmia on the postoperative day 14. Postoperative echocardiogram after 3 months showed satisfactory decrease in peak left ventricular-aortic pressure gradient as well as left ventricular mass regression. All surviving patients are in NYHA class I. CONCLUSIONS: Aortic valve replacement provided satisfactory results for elderly patients. Surgical treatment should be considered even for the elderly patients with critical aortic stenosis under meticulous perioperative management.

Aged↗
PubMed2005

[Yolk sac tumor of the anterior mediastinum and pulmonary metastases; report of a case].

A 31-year-old female was clinically diagnosed as having a anterior mediastinal yolk sac tumor because of the elevation of the AFP (17,500 ng/ml), a large mass lesion (9 x 5 cm) in the anterior mediastinum and bilateral lung metastases. After 4 courses of chemotherapy with cisplatin (CDDP), etoposide (VP-16) and bleomycin hydrochloride (BLM), the mediastinal mass reduced in size significantly and the serum AFP level reached within normal range. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed a weak uptake in the mediastinum, accordingly the operation was performed. The tumor was completely removed and there were no viable foci of the tumor in part of the tumor. After the operation, 4 courses of chemotherapy with carboplatin (CBDCA), VP-16 and ifosfamide (IFM) were performed. She is alive without evidence of recurrence in 5 months after operation. It was noticed that the serum AFP is a useful indicator for determing the chance of operation after chemotherapy.

Adult↗
PubMed2002

[Thoracic outlet syndrome with arterial complication treated by the subclavicular transsternal approach: report of a case].

A 42-year-old female was referred to our vascular service because of her right arm fatigue and cold sensitivity. On elevation of right arm, her radial pulse was absent with pallor of the hand. Angiography demonstrated a significant stenosis of the right subclavian artery, which was considered to be complication of thoracic outlet syndrome. We performed resection of the first rib using the standard subclavicular approach and the subclavian-subclavian artery bypass using a new transsternal extension approach to the subclavian artery. After follow-up 18 months, she was working and asymptomatic. This transsternal extension is effective to treat the arterial complication after decompression of the thoracic outlet.

Adult↗
PubMed2001

Hyperamylasemia and subclinical pancreatitis after cardiac surgery.

Hyperamylasemia after cardiac surgery is common but typically causes no clinical concern because it consists mainly of the salivary isoenzyme. In this study we evaluated the incidence, source, and time course of postoperative hyperamylasemia with special attention to the possibility of subclinical pancreatitis. In 88 patients prospectively tested for serum amylase and lipase concentrations, elastase 1 activity, and amylase isoenzyme characteristics, 57 (64%) showed hyperamylasemia during the early postoperative period. In most cases early hyperamylasemia was not of pancreatic origin, but two patients were diagnosed with subclinical pancreatitis. Among the last 23 patients, 5 of 10 patients with early hyperamylasemia exceeding 1000 IU/L showed late hyperamylasemia on the seventh postoperative day, when it represented mainly the pancreatic isoenzyme. Lipase concentrations and elastase 1 activities were elevated in these cases. Late hyperamylasemia following cardiac surgery may be of pancreatic origin and indicative of subclinical pancreatitis, even if early hyperamylasemia was of salivary origin.

Adult↗
PubMed2001

Surgical outcome of infectious aneurysm of the abdominal aorta with or without SIRS.

The surgical outcome of infectious abdominal aortic aneurysms was evaluated based on the preoperative presence or absence of systemic inflammatory response syndrome (SIRS). Nine patients were divided into two groups according to the criteria for SIRS such as body temperature, heart rate, respiratory rate, and white blood cell count. In the group with SIRS, rupture and impending rupture of aneurysms occurred in three of the four patients (75%). All aneurysms were resected with a small part as a remnant; two in situ and two extraanatomic reconstructions were performed. Three patients died after surgery: one after in situ (cerebral infarction) and two after extraanatomic reconstruction (sepsis and multiple organ failure). In the group without SIRS, closed en bloc resection in two patients and resection of the aneurysm with a small part as a remnant in three patients were performed. In situ reconstruction in all patients and omentum wrapping in two patients were performed. One of the five patients died of massive hematemesis 70 days after surgery. The overall mortality rate was 75% in the group with SIRS versus 20% in the group without SIRS. The surgical outcome of infectious abdominal aortic aneurysm depends upon the severity of underlying infection. A possibility exists that SIRS is a useful indicator for predicting the surgical outcome of patients.

Aged↗
PubMed2001

Transmyocardial laser revascularization induced angiogenesis correlated with the expression of matrix metalloproteinases and platelet-derived endothelial cell growth factor.

OBJECTIVE: Transmyocardial laser revascularization (TMLR) has been widely evaluated as a treatment for ischemic myocardium. However, its mechanism remains unclear. One mechanism is angiogenesis. This study examines the relationship between TMLR and angiogenesis from the viewpoint of matrix metalloproteinases and platelet-derived endothelial cell growth factor. METHODS: The left anterior descending coronary artery (LAD) was ligated permanently in 12 beagle dogs. TMLR was accomplished in six of the 12 dogs using a carbon dioxide laser. No laser treatment was done in the six control dogs. Two weeks after the initial operation, dogs were euthanized and transmural samples (each of approximately 0.5 g) were cut from the center of the infarcted LAD territory, right ventricular wall, left circumflex artery perfuse area and interventricular septum except the LAD perfuse area. They were snap-frozen in liquid nitrogen for matrix metalloproteinases and platelet-derived endothelial cell growth factor activity analysis. Hematoxylin and eosin staining, double immunohistologic staining with anti-proliferating cell nuclear antigen and von Willebrand factor antibody, and immunohistologic staining with antibody against platelet-derived endothelial cell growth factor were performed for histologic studies. The activities of matrix metalloproteinases were examined by gelatin zymography. The activity of platelet-derived endothelial cell growth factor was examined by a spectrophotometric method. RESULTS: The channels were found to be infiltrated with granulation tissue and fibrosis. In the laser group, the active matrix metalloproteinase-2 and platelet-derived endothelial cell growth factor activity in the area of the left anterior descending coronary artery was significantly higher than in the control group (P<0.0001 and P=0.037, respectively). Within the channel remnants or close to these areas, the number of von Willebrand factor positive microvessels and proliferating cell nuclear antigen with correlating von Willebrand factor positive microvessels were significantly higher than in the control group (P=0.001 and P=0.0006, respectively). These increases in microvessels significantly correlated with the expression of matrix metalloproteinases and platelet-derived endothelial cell growth factor. CONCLUSION: Based on these findings it was concluded that transmyocardial laser revascularization induced angiogenesis correlated with the expression of active matrix metalloproteinases-2 and platelet-derived endothelial cell growth factor.

Animals↗
PubMed2001

Subclavicular trans-sternal approach to treat subclavian artery aneurysm. Case report.

Subclavian artery aneurysms are relatively rare, and the surgical approach depends on the location (intrathoracic or extrathoracic) and size of the aneurysm. Right subclavian artery aneurysms are usually operated upon using a supraclavicular approach or median sternotomy incision with right supraclavicular extension. We treated a right intrathoracic subclavian artery aneurysm by subclavicular trans-sternal approach. This surgical approach is recommended for treatment of right intrathoracic subclavian artery aneurysms for its easy access and excellent cosmetic results.

Aneurysm↗
PubMed2001

[Aortic dissection in aged siblings without Marfan's syndrome].

Aortic dissection rarely occurs in 2 or more family members without Marfan's syndrome. This report describes two aged siblings who underwent emergency operations for aortic dissection. Case 1: A 71-year-old female (sister), who had Stanford type B aortic dissection, underwent replacement of the descending aorta with a Hemashield graft. Case 2: A 72-year-old male (brother of case 1), who had Stanford type A aortic dissection, underwent replacement of the ascending aorta with a UBE graft following the closure of the entry located in the proximal arch. Neither of 2 siblings nor other family members had any features of the Marfan's syndrome. It is proposed that two aortic dissections occurred coincidentally in one family without Marfan's syndrome.

Aged↗
PubMed2000

Primary aortosigmoid fistula treated by descending thoracic aortofemoral bypass.

Primary aortoenteric fistula is a rare disease with a fatal outcome unless it is diagnosed accurately and treated surgically. We present an elderly patient with primary aortosigmoid fistula confirmed by endoscopy. Descending thoracic aortofemoral bypass was performed and the aortoiliac aneurysm and sigmoid colon were then resected in continuity. The patient maintains a good quality of life 6 years after the operation with good graft patency and no sign of graft infection.

Aged↗
PubMed1999

Postoperative inflammatory reactions of impregnated Dacron grafts.

The clinical efficacy of Dacron grafts that are impregnated with collagen or gelatin has been well demonstrated, but inflammatory reactions during the first few postoperative weeks have been reported. We experienced two patients, an 87-year-old man with a reconstruction of an abdominal aorta and a 7-year-old boy with a reconstruction of aortic arch with a collagen-impregnated graft (Hemashield), who continued to demonstrate a high fever with a high serum level of C-reactive protein (CRP) and immunoglobin for more than 5 months. The body temperature, the white blood cell (WBC) counts, and the serum level of CRP were compared on the seventh and 14th postoperative day among the 37 patients who underwent a reconstruction of either a thoracic or abdominal aorta using the Hemashield graft (Hemashield group) and a nonimpregnated graft (control group) in our hospital. An elevation of body temperature above 38 degrees C was seen 29% of the patients in the Hemashield group and 0% in the control group. No significant differences were seen in the WBC counts, but the serum level of CRP was significantly higher on the 14th postoperative day in the Hemashield group. We should therefore pay careful attention to inflammatory reactions after the implantation of the impregnated grafts.

Aged↗
PubMed1999

Experimental determination of the safe minimum perfusion flow rate for low-flow hypothermic cardiopulmonary bypass.

This study investigated the safe minimum perfusion flow rate for low-flow hypothermic cardiopulmonary bypass in a canine model. The adequacy of cerebral oxygenation was determined from the adenosine concentration, the oxygen saturation of cerebral venous blood and brain oxyhemoglobin level. In experiment 1, nine beagles were cooled on bypass to a nasopharyngeal temperature of 18 degrees C and the perfusion flow rate was reduced in a stepwise fashion every 30 min from 100 to 50, 30, 20 and 10 ml/kg per min. In experiment 2, six beagles were cooled on bypass as in experiment 1, and flow was maintained at 30 ml/kg per min for 120 min. At a perfusion flow rate of 30 ml/kg per min, adequate cerebral oxygenation was maintained for 120 min. In contrast, perfusion flow rates of 20 and 10 ml/kg per min were associated with cerebral ischemia.

Adenosine Triphosphate↗
PubMed1999

Low-potassium University of Wisconsin solution for cardioplegia: improved protection of the isolated ischemic neonatal rabbit heart.

Recovery of cardiac function and high-energy phosphates following ischemia and reperfusion were determined for hearts perfused with low potassium University of Wisconsin solution, high potassium University of Wisconsin solution, St Thomas' solution, or subjected to hypothermia alone. Isolated hearts were arrested for either 3 h at 15 degrees C or 6 h at 20 degrees C (n = 7 for each group) with one of the four solutions and then reperfused. Aortic flow after ischemic arrest at 20 degrees C was 40.3 +/- 13.3%, 79.3 +/- 10.0%, 64.3 +/- 11.9% and 43.9 +/- 15.9% of control values for high potassium University of Wisconsin solution, low potassium University of Wisconsin solution, St Thomas' solution and hypothermia alone, respectively. Similar results were observed in hearts subjected to ischemic arrest at 15 degrees C. Myocardial adenosine triphosphate and creatine phosphate after reperfusion tended to be higher in the low potassium University of Wisconsin solution group. It is concluded that low potassium University of Wisconsin solution may provide reliable cardioplegia during surgery that requires prolonged cardiac arrest in neonates and infants.

Adenosine↗
PubMed1998

[Removal of retained transvenous pacemaker electrodes under cardiopulmonary bypass].

A case of breakage and removal of a retained transvenous pacemaker electrode is described. A 22-year-old woman with complete A-V block underwent implantation of a transvenous pacemaker system on the left anterior chest wall in 1989. Three years later, a new generator was implanted on the right chest wall because of local infection of the pacemaker pockets. The old electrodes could not be removed and were left in place. Beginning in 1995, the patient complained of anterior chest pain. A chest roentgenogram revealed that one of the pacemaker electrodes had broken at the right costoclavicular ligament and a fragment was floating in the superior vena vava. The retained electrodes were removed under tot cardiopulmonary bypass. These electrodes had become firmly encased with fibrous tissue within the right ventricle and atrium, but they were easily removed under direct vision duting complete cardiac arrest. The postoperative course was uneventful and the patients had no further complaint.

Adult↗
PubMed1998

Effects of depletion of leukocytes and platelets on cardiac dysfunction after cardiopulmonary bypass.

BACKGROUND: This study examined the effects of the depletion of leukocytes and platelets from circulated blood on cardiac function after cardiopulmonary bypass in 37 patients who underwent coronary artery bypass grafting or aortic valve replacement. METHODS: Leukocytes and platelets were removed continuously using a blood cell separator, beginning immediately after the start of the operation and ending 1 hour after the release of the aortic cross-clamp in 19 patients (LPD group), but not in the remaining 18 patients (control group). Blood cell counts and levels of thromboxane B2, 6-keto-prostaglandin F1alpha, leukocyte elastase, complements C3a and C4a, thrombin-antithrombin III complex, and D-dimer were determined periodically during and after the operation. The cardiac index, the difference between the central and peripheral core temperatures, and the doses of catecholamines and vasodilators required to support the circulation in the early postoperative period also were assessed. RESULTS: Leukocyte and platelet counts and levels of leukocyte elastase, thromboxane B2, thromboxane2/6-ketoprostaglandin F1alpha, thrombin-antithrombin III complex, and D-dimer were significantly lower in the LPD group than in the control group before and after the release of the aortic cross-clamp and during the perioperative period. There were no significant differences in the levels of 6-keto-prostaglandin F1alpha or complements C3a and C4a between the two groups. The catecholamine dose was significantly lower in the LPD group than in the control group (1.1 +/- 2.5 versus 5.0 +/- 5.2 mg/kg, respectively). Fewer patients required the use of nitroprusside as a vasodilator in the LPD group than in the control group (1/19 versus 12/18, respectively). CONCLUSIONS: The depletion of leukocytes and platelets using a blood cell separator prevents the deterioration of cardiac function after cardiac operations using cardiopulmonary bypass.

6-Ketoprostaglandin F1 alpha↗
PubMed1998

Prolongation of total permissible circulatory arrest duration by deep hypothermic intermittent circulatory arrest.

OBJECTIVE: We determined whether the duration of permissible circulatory arrest could be prolonged by deep hypothermic intermittent circulatory arrest. METHODS: Twenty-five beagles were cooled on bypass to 18 degrees C to initiate deep hypothermia that was maintained for 3 hours. Five protocols were then studied: group 1, uninterrupted bypass during hypothermia; group 2, arrest for 40 minutes during hypothermia; group 3, arrest for 60 minutes during hypothermia; group 4, arrest for 80 minutes during hypothermia; and group 5, intermittent circulatory arrest, consisting of six cycles of 20 minutes of arrest followed by 10 minutes of systemic recirculation during hypothermia (total, 120 minutes of arrest). The oxyhemoglobin concentration in the brain was measured with near infrared spectrophotometry. RESULTS: In groups 2, 3, and 4, the oxyhemoglobin concentration in the brain decreased continuously after arrest, finally reaching a plateau after 24.9 +/- 1.2 minutes. This finding suggested that the available cerebral oxyhemoglobin was depleted. In contrast, the available cerebral oxyhemoglobin was not depleted during hypothermic intermittent arrest in group 5. The mitochondrial respiratory control index was significantly lower in group 4 than in the other groups (p < 0.05). However, there were no significant differences in the respiratory control index for groups 1, 2, 3, and 5. Moreover, the formation of brain edema was significantly lower in group 5 than in the other groups (p < 0.05). CONCLUSIONS: These results indicate that deep hypothermic intermittent arrest can increase the duration of total permissible circulatory arrest and will be a useful modality when prolonged arrest is anticipated.

Animals↗