Biomedical subjects

A Ohtaki

Publications and source records attributed to A Ohtaki.

64 records · Page 4Linked to original sources

PubMed1994

Surgery for tumor thrombi in the right atrium and inferior vena cava of patients with recurrent hepatocellular carcinoma.

This is a report on a 42-year-old woman with a tumor thrombus in the inferior vena cava and the right atrium caused by recurrent hepatocellular carcinoma. The tumor thrombus, which extended from the retrohepatic inferior vena cava into the right atrium close to the tricuspid valve was successfully resected using a cardiopulmonary bypass and total hepatic vascular exclusion. The cardiopulmonary bypass was established by cannulating the ascending aorta, the superior vena cava and the infrarenal vena cava, and was performed under moderate hypothermia and ventricular fibrillation. To reduce the duration of ventricular fibrillation, after the tumor thrombus had been removed from the right atrium into the suprahepatic inferior vena cava through the atriotomy, the atriotomy was closed. The intrapericardial or suprahepatic vena cava was then clamped. The caval tumor thrombus was removed using the total hepatic vascular exclusion technique through a vena cava incision. To reduce total hepatic vascular exclusion time the suprahepatic vena caval clamp was released after the caval tumor had been removed from the suprahepatic vena caval. The infrahepatic vena cava just below the hepatocaval junction was then clamped and the entire tumor thrombus was removed. The vena caval incision was closed without a prosthesis. The total hepatic vascular exclusion and vena caval exclusion times were 10 and 30 minutes, respectively. The ventricular fibrillation and total cardiopulmonary bypass times were 15 and 52 minutes, respectively. The operating time was 9 hours and 30 minutes and the total blood loss was 4,000 ml.

Adult↗

PubMed1994

[The Takeuchi procedure for anomalous origin of left coronary artery from pulmonary artery--report of an adult case].

The Takeuchi procedure was successfully performed in a 31-year-old female with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). The internal tunnel in the main pulmonary trunk was patient in coronary angiography and a marked improvement of coronary perfusion was demonstrated with a single photon emission CT four months after surgery. Cardiac catheterization at that time revealed mild supravalvular pulmonary stenosis with no clinical manifestation. The Takeuchi procedure may be the treatment of choice even for adults with ALCAPA if it is arising from the posterior wall of the pulmonary trunk, since a long-term patency is expected in this procedure than in coronary artery bypass grafting.

Adult↗

PubMed1994

[Long-term results after surgical repair for aged atrial septal defect].

Between 1980 and 1992, 84 patients over 30 years were underwent operative closure of atrial septal defect (ASD). Preoperative complaints and lower cardiac function were more frequent in the older than in the younger, but the clinical symptom of both generation improved significantly after surgery. Only a 67-year-old patient died after surgery due to low cardiac output syndrome. No long-term death occurred. The incidence of atrial fibrillation was increased postoperatively compared with preoperatively. Therefore, we recommend early surgical repair for aged ASD before thirties, if possible.

Adult↗

PubMed1994

[Thoracotomy for patients with bronchial asthma].

We discussed the perioperative management in three patients with bronchial asthma who underwent thoracotomy. The management was as follows: 1. theophylline and steroid agents were preoperatively given till wheezing disappeared, 2. just before surgery, theophylline or beta-stimulator and steroid agents were given, 3. during surgery, aminophylline and steroid agents were given and bronchodilative anesthetics were inhaled, 4. steroid agents were postoperatively applied sufficiently so that signs due to bronchial asthma don't appear. Preoperative respiratory conditions improved with disappearance or decrease of wheezing, and resection of giant bulla and lobectomies with radical mediastinal lymph node dissection were safely possible with no evidence of the side effects due to steroid administration. The perioperative sufficient suppression of airway-tract hyperactivity is very important for thoracotomy in patients with bronchial asthma.

Adult↗

PubMed1993

[Effect of extended thymectomy in myasthenia gravis of pure ocular type].

The effect of extended thymectomy in myasthenia gravis of pure ocular type was investigated in 13 patients, who were divided into the surgical group of nine and the conservative group of four. In the surgical group, the onset was at 47 +/- 20 years old. The preoperative duration of symptoms was 4 +/- 6 years. The age at the time of operation was 51 +/- 16 years old. Three patients had thymomas, including one malignant thymoma. Acetylcholine receptor antibody titer was over normal range with 34.0 +/- 49.7 nmol/l. No postoperative crisis occurred. The palliation rate of the surgical group was more higher through the whole period than that of the conservative group, and increased with progress of the course. The remission occurred in the surgical group, but did not in the conservative group. It took 7 months to improve the symptom in the surgical group, while 18 months in the conservative group. We conclude extended thymectomy is reasonable for patients with myasthenia gravis of pure ocular type.

Adult↗

PubMed1993

[Surgical treatment of elderly patients with primary lung cancer].

Fourteen patients with lung cancer over the age of 70 years had the standard operation with mediastinal lymph node dissection. Their postoperative complications and prognoses were compared with those of 47 patients under the age of 70 years with the same operation. The propriety of the standard operation with mediastinal lymph node dissection for lung cancer in elderly patients was studied. A program of respiratory training was arranged preoperatively for the patients. Preoperative complications was more common in elderly than in younger patients, but postoperative complications were less frequent. The prognosis in elderly patients was also satisfactory. We conclude that the standard operation with mediastinal lymph node dissection for lung cancer can be performed as well in elderly as in younger patients.

Adult↗

PubMed1992

[Bicuspid aortic valve with sudden onset of aortic insufficiency due to rare causes: report of two cases].

This report describes two cases of aortic valve replacement which was warranted by the suddenly developed aortic regurgitation due to a congenitally bicuspid aortic valve. Aortic insufficiency was caused by the rupture of the strand which lifted a larger cusp to the aortic wall in one, and by the perforation of valvular aneurysm in another. Reviewing the literature these types of aortic insufficiency are rarely reported.

Acute Disease↗

PubMedDate not supplied

Noninvasive nasal mask BiPAP management for prolonged respiratory failure following cardiovascular surgery.

The purpose of this study was to assess the efficacy of nasal mas bi-level positive airway pressure (BiPAP) support in managing respiratory failure following cardiovascular surgery. A total of 20 patients requiring postoperative prolonged respiratory support of 72 hours or longer were studied. BiPAP support was used for eight patients (BiPAP group); the other 12 patients were managed using ordinary oxygen mask treatment (control group). The mean age of the BiPAP group and control group was 65 and 58 years of age, respectively. The mean period of postoperative endotracheal intubation of the BiPAP group and control group was 12 +/- 5 days and 7 +/- 1 days, respectively. Reintubation was necessary in two patients of the control group. The BiPAP group patients required no reintubation. BiPAP support was discontinued within 48 hours in 6 out of 8 patients. The respiratory rates of control group increased (p < 0.1) 24 hours after extubation, however, the respiratory rates of the BiPAP group remained unchanged. The values of the respiratory index of the BiPAP group improved significantly (p < 0.01) after BiPAP management (from 1.5 +/- 0.2 to 0.9 +/- 0.2). The values of the control group, however, remained unchanged. A-aDO2 and Qs/Qt decreased (p < 0.1) in the BiPAP group. There were no significant differences in central venous pressure or circulatory status between the two groups. In conclusion, BiPAP support is a noninvasive management technique for postoperative respiratory failure and may also prevent prolonged endotracheal intubation.

Aged↗

PubMedDate not supplied

PEEP therapy for patients with pleurotomy during coronary artery bypass grafting.

Severe pulmonary oxygenation impairment resulting from peripheral lung atelectasis occurred in some patients with pleurotomy during the harvest of the internal mammary artery graft followed by coronary artery bypass grafting (CABG). We studied the efficacy of intraoperative positive end-expiratory airway pressure (PEEP) therapy for the prevention of postoperative pulmonary oxygenation impairment. A total of 66 patients with solitary CABG procedure were included in this study. The pleural cavity was intraoperatively opened in 44 patients and not opened in 22. PEEP therapy was not used in any patient before May 1996 (referred to herein as the former period) and was used more recently in eight patients with pleurotopmy (referred to herein as the latter period). PEEP was initiated immediately after pleurotomy during the harvest of the internal mammary artery graft. Without PEEP therapy, values of PaO2, A-aDO2, and respiratory index (RI) were worse in patients with pleurotomy than in those without pleurotomy. Meanwhile, there were no major differences in these values between patients with or without pleurotomy after the induction of PEEP therapy. Respiratory insufficiency (A-aDO2 > 400 mmHg and RI > 1.5) was detected in six patients with pleurotomy in the former period. Three of these six patients required over 1 week of long-term mechanical respiratory support. No respiratory insufficiency occurred in patients of the latter period. In conclusion, PEEP therapy, which is initiated just after pleurotomy, may prevent oxygen impairment and pulmonary atelectasis after extracorporeal circulation (ECC) and is recommended for patients with pleurotomy, especially for patients with preoperative low respiratory function.

Aged↗

PubMedDate not supplied

Successful resection of renal cell carcinoma with tumor thrombi extending into the right atrium: a case report.

Renal cell carcinoma (RCC) is often associated with an extension of tumor thrombi into the inferior vena cava (IVC) and occasionally up to the right atrium. RCC with IVC involvement has a relatively favorable prognosis when it is completely resected. We present a successfully resected case of RCC with tumor thrombi extending into the right atrium. We performed radical right nephrectomy with lymph node dissection and removed the tumor thrombi en bloc under total hepatic vascular exclusion with the veno-venous bypass between the IVC and the right atrium using an active centrifugal force pump. The patient has been in good condition for 3 years since surgery with no evidence of recurrence.

Carcinoma, Renal Cell↗