Biomedical subjects

E Suenaga

Publications and source records attributed to E Suenaga.

At least 19 recordsLinked to original sources

PubMed2002

[Blood conservation in thoracic aortic surgery with total cardiopulmonary bypass].

BACKGROUND: In thoracic aortic surgery, a large number of homologous transfusions sometimes cause systemic inflammatory response, which may lead to pulmonary dysfunction, renal dysfunction and brain edema. To predict the need for homologous blood transfusion in aortic surgery, we use blood transfusion index (preoperative Ht x body weight) to predict the magnitude of homologous transfusion. PATIENTS AND METHODS: From Dec 1997 to May 2000, 59 consecutive patients were underwent thoracic aortic graft replacement with total cardiopulmonary bypass. These patients were divided in 2 groups, who were underwent graft replacement without blood transfusions, and who needed blood transfusions. Each group was compared in age, sex, emergency, Ht, CPB time, blood transfusion index and operative mortality. RESULTS: Forty patients (67.7%) did not required blood transfusion. In elective cases (32 cases), 84.3% were underwent operation without blood transfusion. There was no significant difference between 2 groups in terms of age and mean bypass duration. Blood transfusion index was significantly higher in transfusion group (2,320 +/- 784) compared with that in not transfusion group (1,445 +/- 706). CONCLUSION: Blood transfusion index was useful preoperative parameter to predict the need for homologous transfusion.

Aged↗

PubMed2002

[Combined carotid endarterectomy and off-pump coronary artery bypass grafting].

Patients with angina undergoing carotid endarterectomy have a high mortality. A 74-yaer-old man who has severe carotid stenosis was performed combined carotid endarterectomy and off-pump coronary artery bypass grafting successfully. At first, carotid endarterectomy was performed with Jamieson's specially designed dissector, which allow simultaneous dissection and removal blood from the surgical field. Secondly, then off-pump CABG was performed. Skeletonized internal mammary artery was harvested with ultrasound dissector. The advantage of that the dissected artery is not only long and greater blood flow, but also less damage to sternal blood flow which prevent infection and complications. Then internal mammary artery was anastomosed to left anterior discending artery with Octopus II stabilizer. After the operation, he recovered uneventfully without neurological complication. Combined single staged carotid endarterectomy and off-pump CABG appears to be a safe method.

Aged↗

PubMed2001

Coronary endothelial damage during off-pump CABG related to coronary-clamping and gas insufflation.

OBJECTIVE: Although off-pump coronary artery bypass grafting (CABG) has been recognized less invasive than conventional CABG on cardiopulmonary bypass, off-pump CABG may be partly invasive especially to the coronary endothelium. The present study was designed to evaluate the adverse effects of coronary snaring with looped sutures and gas insufflation on the coronary endothelium. The protective efficacies on the coronary endothelium of coronary snaring with elastic sutures or humidified gas insufflation with/without heparin and dipyridamole-added were also tested. METHODS: Thirty-six mongrel dogs were used. After systemic heparinization (150 U/kg), a 5 mm longitudinal coronary incision was made with looped non-elastic monofilament sutures or elastic sutures applied proximally and distally. The incised coronary artery was exposed to non-humidified carbon dioxide, humidified carbon dioxide with lactated Ringer solution, or humidified carbon dioxide with heparin and dipyridamole-added lactated Ringer solution for 10 or 20 min in each group. After gas insufflation, the incised coronary artery was repaired, then, the coronary was reperfused. Perfusion-fixation was done for observation of the coronary endothelium by scanning electron microscopy. The adverse effect on the endothelium was graded as follows: grade 1, appeared normal; grade 2, few blood cells deposited; grade 3, many blood cells deposited; grade 4, few endothelial cells delaminated with blood cells deposited; grade 5, many endothelial cells delaminated with blood cells deposited. RESULTS: Non-elastic looping caused much more endothelial tears than elastic looping (P<0.00001). Non-humidified gas blowing for 20 min caused more endothelial cell damage than humidified gas blowing (P=0.00005). Non-humidified gas blowing for 10 min caused less damage than for 20 min (P=0.00326), but still caused more damage than humidified gas blowing (P=0.00253). Heparin and dipyridamole-added humidification reduced coronary endothelial area mottled by the deposited cells when compared with simple humidification (P=0.00120). CONCLUSIONS: Coronary snaring resulted in coronary endothelial injury, which was ameliorated by using elastic sutures instead of non-elastic sutures. Non-humidified gas insufflation made blood cells deposited and endothelial cells delaminated with time. Humidified gas insufflation attenuated these adverse effects. Heparin and dipyridamole-added humidification had potential advantage in terms of reducing deposited blood cells on the endothelium over simple humidification.

Animals↗

PubMed2001

[Early operation for acute type a closing dissection].

From March 1997 to January 2000, we operated eleven cases of Stanford type A acute closing dissection. The patients consisted of 4 men and 7 women with a mean age of 71 +/- 9 years. There were 9 cases (81%) of cardiac tamponade and 5 cases (45%) was in the shock state. There were no malperfusion and end organ ischemia. All cases were operated with deep hypothermia and circulatory arrest. Ascending aortic replacement were performed in 9 cases and 2 cases were performed total arch replacement. 6 cases (63%) were not required blood transfusion. There was one operative death and one hospital death. These result suggest that we had better to perform immediate graft replacement for Stanford type A acute closing dissection as soon as possible, even if there were no serious complications.

Acute Disease↗

PubMed2001

[A case of minimal invasive aortic valve replacement for quadricuspid aortic valve with aortic regurgitation].

Congenital quadricuspid aortic valve is rare, which may be a cause of sever aortic regurgitation. We report a case of a 55-year-old man who had severe aortic regurgitation with congenital quadricuspid aortic valve. Preoperative aortography showed severe aortic regurgitation. Preoperative trans-esophageal echocardiography revealed abnormal quadricuspid aortic valve. We performed minimal invasive aortic valve replacement with SJM # 21 mm HP prosthetic valve through the limited upper sternotomy. Skin incision was 9 cm. Aortic cross-clamping time was 92 min, cardiopulmonary bypass time was 108 min. At the operation, a quadricuspid valve with three equal cusps and one small cusp was noted. The postoperative course was excellent and he discharged 8 days after the operation.

Aortic Valve↗

PubMed2001

[A successful case report of emergency coronary artery bypass grafting for left main trunk obstruction with profound cardiogenic shock: bridge use of balloon pumping and percutaneous cardiopulmonary support system to surgical intervention].

A 73-year-old man was admitted for sudden onset of dyspnea with cardiogenic shock. Chest X-P showed bilateral severe pulmonary edema. Echocardiogram demonstrated diffuse severe hypokinesis of left ventricle. Emergency coronary angiography showed 99% stenosis of left main trunk with delay. After insertion of intraaortic balloon pump (IABP) and percutaneous cardiopulmonary support system (PCPS), vital signs and consciousness were improved. Emergency coronary artery bypass grafting (CABG) was performed, LIMA to left anterior descending artery, saphenous vein grafts to circumflex and right coronary artery. Left ventricular wall motion was improved after bypass grafting and cardiopulmonary bypass was weaned with catecholamine and IABP support. The patient was discharged from hospital 60 days after the operation with good cardiac function. We emphasized a usefulness of combined use of IABP and PCPS to provide systemic organ perfusion and reduce myocardial infarct size and ischemic damages after re-vascularization for coronary insufficiency with profound shock.

Aged↗

PubMed2001

[A case of emergency surgery for acute mitral regurgitation due to complete papillary muscle rupture as a severe form of reperfusion injury: report of a case].

Complete rupture of a papillary muscle following acute myocardial infarction is a severe complication associate with acute left ventricular failure and pulmonary edema. Since the introduction of acute percutaneous transluminal coronary angioplasty (PTCA) in the management of acute myocardial infarction, the frequency of this complication has further decreased. We described a patient who had acute mitral regurgitation due to complete rupture of papillary muscle rupture after successful coronary intervention. Transesophageal echocardiography demonstrated severe mitral regurgitation and the ruptured papillary muscle. At operation, posteriol papillary muscle was found to be totally ruptured. Mitral valve replacement was performed. Postoperative course was uneventful, with 2 days of IABP and 5 days of ventilator support.

Acute Disease↗

PubMed2000

Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head.

We have studied the correlation between the prevention of progressive collapse and the ratio of the intact articular surface of the femoral head, after transtrochanteric rotational osteotomy for osteonecrosis. We used probit analysis on 125 hips in order to assess the ratio necessary to prevent progressive radiological collapse over a ten-year period. The results show that a minimum postoperative intact ratio of 34% was required. This critical ratio may be useful for surgical planning and in assessing the natural history of the condition.

Adult↗

PubMed2000

[Limited upper sternotomy for minimally invasive aortic valve replacement].

The practice of minimally invasive valve surgery remains controversial. From May 1998, we began minimal invasive aortic valve replacement through the limited upper sternotomy. This technique is simple and provides and easy approach for the aortic valve. From May 1998 to Jan 2000, we performed 15 cases of aortic valve replacement with the limited upper sternotomy approach. All patients received valve replacement with prosthetic valve. We also described a simple and easy air evacuation system to avoid air embolism, a serious problem with a limited operative field. Mean aortic cross clamping time was 79 min, mean cardiopulmonary bypass time was 106 min, and mean operation time was 207 min. It did not take too much time compared with the conventional approach. Mean extubation time was 62 min and mean bleeding 12 hours after the operation was 96 ml. No patient required blood transfusions. All patients but one walked the very next day after the operation. We believe this new method brings not only cosmetic benefits, but also results in excellent post-operative course.

Adult↗

PubMed2000

Experimental use of a compact centrifugal pump and membrane oxygenator as a cardiopulmonary support system.

Compactness and high performance are the most important requirements for a cardiopulmonary support system. The Nikkiso (HPM-15) centrifugal pump is the smallest (priming volume; 25 ml, impeller diameter; 50 mm) in clinically available centrifugal pumps. The Kuraray Menox (AL-2000) membrane oxygenator, made of double-layer polyolefin hollow fiber, has a minimum priming volume (80 ml) and a low pressure loss (65 mm Hg at 2.0 L/min of blood flow) compared with other oxygenators. The aim of this study was to evaluate the performance of the most compact cardiopulmonary support system (total priming volume: 125 ml) in animal experiments. The cardiopulmonary bypass was constructed in a canine model with the Nikkiso pump and Menox oxygenator in comparison with a conventional cardiopulmonary support system. The partial cardiopulmonary bypass was performed for 4 h to evaluate the gas exchange ability, blood trauma, serum leakage, hemodynamics, and blood coagulative parameters. The postoperative plasma free hemoglobin level of the compact cardiopulmonary system was 29.5 +/- 10.21 mg/dl (mean +/- SD), which was lower than that of the conventional cardiopulmonary system, 48.75 +/- 27.39 mg/dl (mean +/- SD). This compact cardiopulmonary system provided the advantage in terms of reduction of the priming volume and less blood damage. These results suggested the possibility of miniaturization for the cardiopulmonary bypass support system in open-heart surgery in the near future.

Animals↗

PubMed1999

Hip arthroscopy.

Explore the source record for details and available documents.

Arthroscopes↗

PubMed1998

[A case report of mycotic aneurysms of descending thoracic aorta].

A rare case of mycotic aneurysms of descending thoracic aorta is presented. A 63-year-old man was admitted with history of persistent high fever and loss of consciousness to our hospital. On admission, there were elevated WBC and CRP. Blood and spinal fluid cultures revealed growth of Streptococcus pneumonia. Despite of antibiotic therapy for meningitis and bacteremia, inflammatory sign continued, and new abnormal shadow appeared on chest X-ray. Chest CT and aortography showed two aneurysms of descending thoracic aorta. In an emergency operation, there was no abscess formation around the aneurysms. Aneurysms were excised en bloc without opening aneurysms followed by in situ Dacron tube graft replacement. The patient has been doing well without infection.

Aneurysm, Infected↗

PubMed1997

[An approach to lobectomy under a thoracoscopic surgery].

Lobectomy under a thoracoscope is a minimally invasive surgery and full consideration must also be given to the length of access thoracotomy and the number of access ports inserted. On the other hand, securing a full visual field within a limited access and treating the pulmonary artery/vein and bronchus safely and for sure are needed. However, it would not be too much to say that the easiness of lobectomy under a thoracoscope depends on the length of access thoracotomy and the number of access ports inserted. In the experiment this time we discussed an approach to the access area in lobectomy under a thoracoscope in our cases.

Aged↗

PubMed1996

Increased mast cell infiltration in varicose veins of the lower limbs: a possible role in the development of varices.

BACKGROUND: This study shows increased infiltration of mast cells in the walls of varicose veins in the lower limbs as an explanation of the pathogenesis of varix formation. METHODS: Great saphenous veins exhibiting varicosity were histologically examined after vein stripping surgery, and the numbers of mast cells in the varicose lesions were estimated in 20 high-power fields (x400). Normal-looking regions of the veins were referred to as controls, and normal saphenous veins were prepared during coronary artery bypass grafting and designated baseline controls. RESULTS: The varicose lesions showed a greater extent of mast cell infiltration (15.0 +/- 8.4 cells; mean +/- standard deviation), whereas control veins (5.9 +/- 4.0) and baseline control veins (4.4 +/-2.9) had a smaller number of mast cells. CONCLUSIONS: The study suggests that increased mast cell infiltration contributes to the development of varicose veins.

Adult↗

PubMed1996

[Surgery for acute type A aortic dissection associated with Marfan syndrome].

Recently, extended operation has been recommended for aortic dissection associated with Marfan syndrome. However, the operation for acute type A aortic dissection associated with Marfan syndrome is controversial. Between May 1985 and July 1994, 5 patients associated with acute type A aortic dissection and Marfan syndrome underwent surgical repair. CT examination on all patients, the survivors of the initial operation, revealed a gradually enlarged residual pseudolumen. 2 patients who underwent aortic root reconstruction and ascending aortic replacement for the initial operation eventually had to undergo aortic arch repair. From the results of this study and the improvements of intraoperative cerebral protection, we recommend aortic arch repair with aortic root reconstruction and ascending aortic replacement on initial emergency operation for acute type A aortic dissection associated with Marfan syndrome.

Acute Disease↗

PubMed1996

Comparative hemolysis study of clinically available centrifugal pumps.

Centrifugal pumps have become important devices for cardiopulmonary bypass and circulatory assistance. Five types of centrifugal pumps are clinically available in Japan. To evaluate the blood trauma caused by centrifugal pumps, a comparative hemolysis study was performed under identical conditions. In vitro hemolysis test circuits were constructed to operate the BioMedicus BP-80 (Medtronic, BioMedicus), Sarns Delphin (Sarns/3M Healthcare), Isoflow (St. Jude Medical [SJM]), HPM-15 (Nikkiso), and Capiox CX-SP45 (Terumo). The hemolysis test loop consisted of two 1.5 m lengths of polyvinyl chloride tubing with a 3/8-inch internal diameter, a reservoir with a sampling port, and a pump head. All pumps were set to flow at 6 L/min against the total pressure head of 120 mm Hg. Experiments were conducted simultaneously for 6 h at room temperature (21 degrees C) with fresh bovine blood. Blood samples for plasma-free hemoglobin testing were taken, and the change in temperature at the pump outlet port was measured during the experiment. The mean pump rotational speeds were 1,570, 1,374, 1,438, 1,944, and 1,296 rpm, and the normalized indexes of hemolysis were 0.00070, 0.00745, 0.00096, 0.00066, 0.00090 g/100 L for the BP-80, Sarns, SJM, Nikkiso, and Terumo pumps, respectively. The change in temperature at the pump outlet port was the least for the Nikkiso pump (1.8 degrees C) and the most with the SJM pump (3.8 degrees C). This study showed that there is no relationship between the pump rotational speed (rpm) and the normalized index of hemolysis in 5 types of centrifugal pumps. The pump design and number of impellers could be more notable factors in blood damage.

Blood Flow Velocity↗

PubMed1994

[Total aortic arch graft replacement: strategy for shortening the duration of cardiac ischemic arrest].

Between August 1991 and November 1993, five patients underwent total aortic arch graft replacement in a manner which placed emphasis on myocardial protection. All operations were performed with the use of extracorporeal circulation and selective cerebral perfusion. Oxygenated warm blood was infused at a flow rate of 300 ml/min. via a catheter inserted proximal to the site of occlusion of the ascending aorta or replaced graft of the ascending aorta. After the beating of the heart was resumed under left venting, aortic arch was replaced using a prosthetic graft with three branches. Concomitant operations were reconstructions of the aortic root with composite graft (Bentall's technique) in two patients of Marfan's syndrome and type A aortic dissection. All patients were easily taken off cardiopulmonary bypass and postoperative course was uneventful. We believe that shortening of the duration of ischemic cardiac arrest is important if surgical results of total aortic arch replacement are to be further improved, above all in patients at high risk for surgery, such as elderly subjects whose organ function is often compromised.

Adult↗

PubMed1994

[Traumatic transection of the descending thoracic aorta--2 successful case reports].

We report two cases of acute traumatic transection of the descending thoracic aorta that were successfully treated. Case 1 (a 24-year-old male) was admitted to our hospital because of unconsciousness with multiple severe injuries including pelvic fracture, hepatic laceration, brain contusion, and multiple fractures in the extremities. An emergency operation was performed to control the active bleeding from the hepatic laceration and the transluminal arterial embolisation of the internal iliac arteries for the pelvic fractures. Since the condition of the patient was very serious, we had to wait the repairment of the thoracic aorta for 3 weeks. The operation was successful using extracorporeal circulation. Case 2 (a 22-year-old female) suffered traumatic transection of the descending thoracic aorta without other injuries and received an emergency operation, which was successful. The strategy for the treatment of an aortic transection is difficult, especially when involving multiple injuries. However provided the decision to operate takes careful account of the general condition of the patient, then a successful result might be obtained even in a very severe case.

Adult↗