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Biomedical subjects

A Ohtaki

Publications and source records attributed to A Ohtaki.

At least 55 records · Page 3Linked to original sources
PubMed1996

Preoperative intra-arterial infusion chemotherapy for invasive thymoma: a case report.

A 24-year-old man was diagnosed as having mixed-type thymoma by preoperative percutaneous needle biopsy. A chest computed tomogram showed a tumor measuring 12x9 cm. Selective intra-arterial infusion chemotherapy was first selected because invasion to the superior vena cava was suspected. Bolus injection of 50 mg/m2 cisplatin and 20 mg/m2 adriamycin was performed once into the right internal thoracic artery. The resulting decrease in tumor size was 81%. Neither complications due to the infusion procedure nor side effects due to the anticancer drugs were encountered. An extended thymectomy with partial resection of the mediastinal pleura was safely performed. The histological diagnosis of the resected tumor was thymic hyperplasia. The patient was transferred to a radiologist for additional radiotherapy. Selective intra-arterial infusion chemotherapy for invasive thymoma is an effective therapy, producing no significant side effects and allowing safe resection.

Adult↗
PubMed1996

[Surgical repair of atrial septal defect and tricuspid regurgitation in a 79-year-old man: a case report].

A 79-year-old man with atrial septal defect (ASD) and tricuspid regurgitation was successfully operated upon. Preoperative examinations showed atrial fibrillation, moderate pulmonary hypertension and lung dysfunction. Direct closure of the ASD accompanying with tricuspid annuloplasty was performed. Postoperative administration of catecholamines continued for twenty-six days to maintain hemodynamics. An intratracheal tube was extubated two days after the operation. However, an additional respiratory support using a nasal continuous positive airway pressure method was required for six days. His postoperative physical activity has been improved with class I of the New York Heart Association classification. Surgical intervention may be the treatment of choice for aged patients over 70 years with an ASD.

Aged↗
PubMed1996

[Surgical repair of atrial septal defect in patients over 70 years of age].

Three patients over 70 years of age underwent surgical repair of secundum atrial septal defect (ASD). All patients had preoperative symptoms such as heart failure, atrial fibrillation and cardiomegaly. According to the New York Heart Association (NYHA) functional classification, two patients belonged to class II and one class III. Cardiac catheterization data revealed mild pulmonary hypertension and mild to moderate tricuspid regurgitation in all the patients. An ASD was directly closed in all the patients, and two of them required tricuspid anuloplasty. The use of catecholamine continued for two or three weeks in two patients because of postoperative cardiac dysfunction. Postoperative physical activity has improved in all the patients. Surgical repair of an ASD is recommended even for patients over 70 years of age unless they have major risks and severe pulmonary hypertension.

Aged↗
PubMed1996

Long-term heart preservation by the combined method of simple immersion and coronary perfusion.

BACKGROUND: The combined method of cold storage and coronary perfusion for prolonged preservation of donor hearts was evaluated through preservation and transplantation with the use of 10 pair of adult mongrel dogs. METHODS: In situ initial flush for cooling and coronary vascular washout was performed with a University of Wisconsin solution. The heart was then removed and immersed into a cold (4degrees C) University of Wisconsin solution. After 12-hour cold storage, 1-hour preservation was added by coronary perfusion using a 4degree C oxygenated University of Wisconsin solution. High-energy phosphate (phosphocreatine, beta-adenosine triphosphate) and phosphate were measured by 31P-nuclear magnetic resonance spectroscopy at 0-hour cold storage, 12-hour cold storage, and immediately after coronary perfusion. RESULTS: Phosphocreatine and beta-adenosine triphosphate decreased to 12.1 +/- 24.2% (mean +/ standard deviation), 37.4% +/- 25.0%, respectively, after 12-hour cold storage, and significantly increased to 94.0% +/- 48.7% (p < 0.001), 48.8% (p < 0.05), respectively after 1-hour coronary perfusion. Disorder of nuclear arrangement and edema of muscular cells, which were observed after cold storage, were histologically restored after 1-hour coronary perfusion. After transplantation of preserved grafts, left ventricular pressure and left ventricular rate of pressure rise were evaluated in the graft with 12-hour cold storage only (group A) and in the graft with 12-hour cold storage and 1-hour coronary perfusion (group B). Left ventricular pressure 2 hours after transplantation in group B recovered to 76.1% significantly (p < 0.01), compared with 51.9% in group A. Significantly higher values of left ventricular rate of pressure rise 2 hours after transplantation was observed in group B (83.0% +/ 12.7%) compared with group A (68.2% +/- 12.5%). CONCLUSIONS: These results indicate that the combined method of cold storage and coronary perfusion may be effective for myocardial protection during long-term preservation.

Adenosine↗
PubMed1996

[Surgical treatment for acute dissection associated with thoracic aneurysm--a case report and a review of Japanese literatures].

DeBakey IIIa acute dissection associated with thoracic aneurysm was successfully operated upon in 62-year-old man. The patient was referred to our hospital complaining of sudden severe back pain, and diagnosed as having acute dissection associated with thoracic aneurysm. An emergency operation was carried out, using partial cardiopulmonary bypass support with the cannulation into the right atrium via left femoral vein and left femoral artery. There was an entry in a true aneurysm of the descending aorta, which was replaced with a 22 mm Hemashield prosthetic graft. His postoperative course was uneventful. Acute dissection associated with a true thoracic aneurysm is rare and belongs to high risk groups for rupture. An urgent operation is often the treatment of choice.

Acute Disease↗
PubMed1995

Successful surgical management of emphysematous giant bullae accompanied by severe bronchial asthma: report of a case.

The surgical treatment of emphysematous lung bullae is usually contraindicated in patients with severe bronchial asthma. However, we recently encountered a patient who required surgery due to the development of respiratory distress despite treatment with bronchodilators and low-dose prednisolone (5 mg/day). During the first operation, bronchospasm occurred with anesthesia. After suppression of the asthmatic symptoms for 2 weeks with high-dose prednisolone (25 mg/day), the giant bullae could be resected safely. Thus, the preoperative resolution of asthma to decrease the probability of an attack is indispensable for such patients.

Adult↗
PubMed1995

Intratracheal stent intubation under extracorporeal lung assist.

An artificial stent was intubated using extracorporeal lung assist (ECLA) in two patients with inoperable tracheal stenosis. In a patient with an endotracheal tumor, an airway obstruction due to a partial stent collapse was overcome by an immediate ECLA perfusion. In another patient with chronic inflammatory tracheal stenosis, a repetitive balloon dilation of the trachea could be safely performed utilizing ECLA perfusion. Preventive femoral cannulation, employing the assistance of an ECLA circuit, is thus considered to be a safe and effective procedure for the treatment of inoperable tracheal stenosis.

Adult↗
PubMed1995

Valve replacement for children: report of two cases.

The authors report on two children who underwent valve replacement. Case 1: A 10-year-old boy with high fever and severe heart failure was diagnosed as having aortic regurgitation and left ventriculo-right atrial fistula caused by active infective endocarditis. An aortic annular defect was repaired by a pericardial patch to enlarge the aortic annulus followed by aortic valve replacement with a 17-mm Björk-Shiley prosthetic valve. He is doing well 2 years after surgery. Case 2: A 3-year-old girl was diagnosed as having congenital mitral stenosis with severe pulmonary hypertension. Mitral valve stenosis was a commissural fusion type according to the Carpentier's classification. An open mitral commissurotomy was attempted initially, resulting in severe mitral regurgitation. Then, the mitral valve was replaced with a 16-mm CarboMedicus bileaflet valve. Her postoperative course was uneventful and residual pulmonary hypertension decreased gradually. The selection of prosthetic valves is important in its type and size in order to obtain as large an orifice as possible. Careful postoperative follow-up is mandatory.

Adult↗
PubMed1995

Non-infective high fever after replacement of thoracic aorta using collagen-impregnated Dacron prosthesis.

We present three patients who were complained of a high fever without infective signs clinically and bacteriologically after the implantation of a woven Dacron prosthesis impregnated with collagen for thoracic aortic aneurysm. High fever appeared on the third on fourth day after surgery, and continued for three to seven days. The maximum fever ranged 39.1 to 39.9 degrees C. There was a close relationship between the value of C-reactive protein and the duration of a high fever. There were no differences between patients with and without a high fever in white blood cell counts, and other hematological and biochemical examinations. Non-infective high fever may be encountered in the postoperative acute phase following the implantation of a Hemashield prosthesis.

Aged↗
PubMed1995

[Myasthenia gravis: an analysis of patients with postoperative crisis after thymectomy].

Five patients with myasthenia gravis whose condition declined during the postoperative unstable period were studied. The Osserman's type, age at the time of onset, duration of illness, sex, age at the time of surgery, preoperative steroid therapy, thymoma and acetyl choline receptor antibody titers were compared with those of 21 patients (control) with myasthenia gravis who had an uneventful postoperative course. In comparison, the study group's Osserman's type was slight, age at the time of onset was older (p < 0.05) and duration of illness was shorter (p < 0.05). There was no significant difference between the groups in sex, age at the time of surgery, thymoma and acetyl choline receptor antibody titers. None of them had preoperative steroid therapy. Intensive postoperative management and careful follow-up at the postoperative unstable period are necessary particularly for patients who have slight Osserman's type, old age at the time of onset, short duration of illness and no preoperative steroid therapy.

Adolescent↗
PubMed1995

Pulmonary epithelioid hemangioendothelioma: a case report.

A 45-year-old woman whose x-ray film revealed multiple widespread bilateral small nodules was diagnosed as having pulmonary tuberculosis or metastatic pulmonary cancer. A conclusive histological diagnosis of pulmonary epithelioid hemangioendothelioma (PEH) was made following an open-lung biopsy. PEH is a progressive disease that probably originates from an endothelial cell. However, there is still no effective therapeutic modality for PEH. The postoperative course of our patient has been uneventful with no evidence of tumor growth for four and a half years after initial x-ray detection of the lesions.

Biopsy↗
PubMed1995

[Mediastinal schwannoma originating from the intrathoracic vagal nerve--a case report and review of the literature].

A 31-year-old woman was operated upon with the diagnosis of mediastinal tumor. The resected specimen revealed pathologically benign schwannoma originating from the right intrathoracic vagal nerve. The postoperative course was uneventful with no complication. Mediastinal schwannoma arising from the vagal nerve is rare. We discussed characteristics of this disease and reviewed the Japanese literature.

Adult↗
PubMed1995

A patch technique for reconstruction of stenotic pulmonary bifurcation in a Rastelli-type operation after palliations for cyanotic congenital heart disease. A report of two cases.

A Rastelli-type operation was successfully performed on two patients with cyanotic congenital heart disease with pulmonary artesia (PA) and severe stenosis or obstruction of the pulmonary bifurcation, following the improvement of a pulmonary artery index (PA index) after palliative systemic pulmonary shunts. It is a point that stenotic or obstructive pulmonary bifurcation was reconstructed by a patch technique. An extracardiac conduit was used a combination of a bicuspid valved pericardial roll and a prosthetic vessel graft. In a 5-year-old male with an extreme type of tetralogy of Fallot associated with PA and patent ductus arteriosus (PDA), the enlargement of stenotic pulmonary bifurcation was attempted using a brimshaped equine pericardial patch in order to get sufficient suture margin and be safely anastomosed with a conduit. In a 6-year-old female with complete transposition of the great arteries, PA, PDA and right aortic arch (RAA), an obstructive pulmonary bifurcation behind the RAA was enlarged using a brimshaped equine pericardial patch. The attachment of the conduit was shifted to the left pulmonary artery to avoid compression of an extracardiac conduit and pulmonary artery behind RAA. Reconstruction of the pulmonary bifurcation using an equine pericardial patch is useful to anastomose an extracardiac conduit and the stenotic or obstructive pulmonary bifurcation.

Cardiac Surgical Procedures↗
PubMed1994

[Surgical treatment of needles in intracardiac cavity and chest wall--a case report and the review of cases removed under open-heart surgery in Japan].

A 36-year-old woman under the treatment for neurosis stuck five sewing needles into her left anterior chest wall for the purpose of suicide. She was hospitalized with complaints of anterior chest pain and low-grade fever. Chest roentgenogram and computed tomogram showed two needles in the cardiac cavity and three needles in the chest wall. Following extraction of three needles in the chest wall, we removed two needles from the left and the right ventricular cavities under extracorporeal circulation. Preoperative and intraoperative two-dimensional echocardiography was useful for confirming the location of needles.

Adult↗
PubMed1994

[Lung cancer with pleural dissemination diagnosed by thoracofiberscopy: a case report].

Pleural dissemination was suspected in a 39-year-old woman with pulmonary adenocarcinoma. Thoracofiberscopy provided the preoperative exact diagnosis of pleural dissemination and the following prepare operative procedure. Thoracofiberscopy is effective for the diagnosis of pleural dissemination and the selection of operative methods in patients with pulmonary cancer.

Adenocarcinoma↗
PubMed1994

[A concomitant operation of coronary artery bypass grafting and thymectomy: a case report].

A 63-year-old man was successfully operated upon concomitantly for coronary artery disease and invasive thymoma. The chest roentogenogram showed a mass shadow in the anterior mediastinum, which was 6.0 x 4.0 cm in size and irregular. Coronary angiography revealed complete obstruction of the right coronary artery and 90% stenosis of the first diagonal branch (#9). Following thymectomy combined with the resection of the left phrenic nerve and the mediastinal pleura, coronary artery bypass grafting with the major saphenous vein was performed to #4 PD and #9. This is the first report of concomitant surgery for the ischemic heart disease and invasive thymoma in Japan.

Coronary Artery Bypass↗