Biomedical subjects

Hitoshi Ogino

Publications and source records attributed to Hitoshi Ogino.

30 records · Page 2Linked to original sources

PubMed2005

Detection of aortic graft infection by fluorodeoxyglucose positron emission tomography: comparison with computed tomographic findings.

OBJECTIVE: Radionuclide imaging with fluorodeoxyglucose (FDG) and positron emission tomography (PET) has been proposed for the identification of vascular graft infection; however, its accuracy has not been determined. We performed this prospective study to compare the usefulness of FDG-PET in the assessment of vascular graft infection relative to computed tomography (CT). METHODS: FDG-PET was performed for 33 consecutive patients with a suspected arterial prosthetic graft infection. The PET images were then assessed visually in terms of the density of uptake. In cases with positive uptake, the pattern of accumulation was also defined, such as focal or diffuse uptake. We compared the diagnostic efficiency of PET with contemporaneous CT in detection of infection of the arterial prosthetic graft. RESULTS: On the basis of the surgical, microbiological, and clinical follow-up findings, the aortic grafts were considered infected in 11 patients and not infected in 22 patients. Although the sensitivity of PET (91%) was higher than that of CT (64%), its specificity (64%) was lower than that of CT (86%). When focal uptake was set as the positive criterion in FDG, the specificity and positive predictive value of PET for the diagnosis of aortic graft infection improved significantly to 95% (P < .05 for both). CONCLUSIONS: Although both techniques are useful in evaluation of patients with suspected aortic graft infection, using the characteristic FDG uptake pattern described previously as a diagnostic criterion made the efficacy of FDG superior to that of CT in the diagnostic assessment of patients with suspected aortic graft infection.

Adult↗

PubMed2005

Recruitment maneuver and high positive end-expiratory pressure improve hypoxemia in patients after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism.

OBJECTIVES: To investigate the effects of a recruitment maneuver and high positive end-expiratory pressure (PEEP) on oxygenation and hemodynamics in hypoxemic patients with pulmonary hypertension after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism. DESIGN: Prospective, observational, clinical study. SETTING: A surgical intensive care unit in a national heart institute. PATIENTS: Fourteen consecutively admitted patients who developed acute lung injury (Pa(O2) <300 torr at F(IO2) 1.0) and pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg) after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism. INTERVENTIONS: The recruitment maneuver was an increase of PEEP to 30 cm H2O in one step for 1 min at F(IO2) 1.0. The level of pressure control ventilation during the recruitment maneuver was the same as before the maneuver. Subsequently, PEEP was decreased in 15-min intervals from 15 to 10, 5, and 0 cm H2O. MEASUREMENTS AND MAIN RESULTS: Hemodynamics and respiratory variables were analyzed before and during the recruitment maneuver and at each PEEP level. At F(IO2) 1.0, Pa(O2) increased from 240 +/- 62 torr to 470 +/- 83 torr at 15 cm H2O of PEEP and 469 +/- 75 torr at 10 cm H2O of PEEP after the recruitment maneuver (p < .001). At 15 cm H2O of PEEP, cardiac index decreased (from 2.7 +/- 0.6 at baseline to 2.2 +/- 0.3 L.min(-1).m(-2), p < .01) and mean blood pressure decreased (from 86 +/- 8 at baseline to 74 +/- 11 mm Hg, p < .05), but they returned to the baseline levels at 10 cm H2O of PEEP (2.5 +/- 0.4 L.min(-1).m(-2) and 83 +/- 9 mm Hg). There were no differences in mean pulmonary artery pressure at different levels of PEEP. CONCLUSIONS: In hypoxemic patients with pulmonary hypertension after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism, oxygenation was improved by the recruitment maneuver followed by high PEEP. However, hemodynamics were transiently suppressed and overall oxygen delivery did not change.

Adult↗

PubMed2005

Sustained upregulation of inflammatory chemokine and its receptor in aneurysmal and occlusive atherosclerotic disease: results form tissue analysis with cDNA macroarray and real-time reverse transcriptional polymerase chain reaction methods.

BACKGROUND: Although cytokines are known to be pivotal in the development of atherosclerotic diseases, few data exist regarding their expressions in the established stages such as aneurysmal or occlusive lesions. Therefore, in the present study the gene expression levels of cytokine-related substances in abdominal aortic aneurysm (AAA) and carotid artery stenosis (CAS) were determined using cDNA macroarray and real-time reverse transcriptase polymerase chain reaction (RT-PCR) methods. METHODS AND RESULTS: Tissue samples were obtained from 31 patients with AAA and 24 with CAS. The array-specific [33P]-labeled cDNA probe mixture synthesized from 2.5 microg total RNA with gene-specific primers was hybridized with nylon membranes containing 375 cDNA clones. Densitometric analysis confirmed differences in expression (>5-fold) for 97 of the cytokine-related gene products between AAA and adjacent control tissue. Among these, simultaneous upregulation was found in the expression of interleukin (IL)-8 (9-fold) and its receptor, CXCR-2 (11-fold). Thus, the expressions of IL-8 and CXCR-2 were further quantified by real-time RT-PCR. The expression of both the genes was significantly upregulated in both AAA and CAS compared with control regions as followed: IL-8=0.53+/-0.16 vs 0.11+/-0.04 (p<0.01); CXCR-2=2.04+/-0.75 vs 0.29+/-0.10 (p<0.01) in AAA, and IL-8=1.35 +/-0.25 vs 0.60+/-0.16; CXCR-2=2.00 +/-0.51 vs 0.58+/-0.21 (p<0.05) in CAS. Under these conditions, the gene expressions of monocyte chemotactic protein-1 and its receptor, CCR-2, were not significantly different in the control and diseased regions of both AAA and CAS. CONCLUSIONS: Sustained upregulation of IL-8 and CXCR-2 was observed in both AAA and CAS, suggesting the inflammatory process is still active in established dilated and occlusive atherosclerotic diseases. Whether upregulation of this system could be protective or not protective for disease development requires further study.

Aged↗

PubMed2005

[Influence of DPC on cardiovascular surgery].

After a new medical expense system "DPC (Diagnosis Procedure Combination)" had been introduced in 2003, the change in the medical treatment fee was evaluated according to each cardiovascular surgical field. Application of the DPC is limited to hospitalization fee in the general ward by a fixed daily amount The former payment system remains for operation, anesthesia, and some invasive examinations such as cardiac catheterization, therefore, the influence of the DPC introduction on cardiovascular surgery was minimum. A lot of problems are still left, however, for the classification of diagnosis, especially in a congenital heart disease, and the fee setting of intensive care. It is required also to reconsider serious cases, advanced complications and methods of life support. In the field of cardiovacular surgery, the treatment is so risky and so expensive, that more detailed analysis should be necessary by establishment of data base system.

Cardiovascular Surgical Procedures↗

PubMed2005

Successful surgical treatment for aneurysm of splenic artery with anomalous origin.

The splenic artery is the third common site of an infrarenal abdominal arterial aneurysm after the abdominal aorta and iliac arteries, and the most common site of a visceral artery aneurysm. It is a rare, but clinically important form of vascular disease with the potential for life-threatening rupture. We report a 64-year-old woman with a splenic artery aneurysm. Though she was asymptomatic, calcification around the left upper quadrant was incidentally detected. A saccular aneurysm with calcification located in the proximal portion of the splenic artery was detected by computed tomography (CT). Anomalous origin of the splenic artery, from the superior mesenteric artery (SMA), was also detected. Aneurysmal resection without splenectomy was carried out successfully. A suitable approach to aneurysms must be selected in each case, because the splenic artery exhibits congenital anomaly in 10% of all the people.

Aneurysm↗

PubMed2004

Successful thromboendarterectomy for severe chronic thromboembolic pulmonary hypertension caused by primary antiphospholipid syndrome.

Pulmonary hypertension is one of the lethal complications in the antiphospholipid syndrome due to chronic recurrence of embolism or thrombosis. We experienced a 19-year-old man suffering from severe chronic thromboembolic pulmonary hypertension (CTEPH) caused by primary antiphospholipid syndrome. According to the guideline, pulmonary thromboendarterectomy was decided on after combined therapy with warfarin, beraprost and oxygen inhalation had not been effective enough to improve severe CTEPH. By an operation, the mean pressure of the pulmonary artery was decreased from 50 mmHg to 16 mmHg, while his New York Heart Association (NYHA) functional class classification significantly improved from class III to class I. We concluded that pulmonary thromboendarterectomy could dramatically improve hemodynamic indices, NYHA functional status and quality of life in patients with CTEPH.

Adult↗

PubMed2004

Application of real-time RT-PCR to quantifying gene expression of matrix metalloproteinases and tissue inhibitors of metalloproteinases in human abdominal aortic aneurysm.

BACKGROUND: The relative expression levels of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), key regulators in remodeling of extracellular matrix, are considered to play a pivotal role in the development of abdominal aortic aneurysm (AAA). However, few data exist regarding quantitative assessment of their expression in clinical settings. METHODS: In 22 patients with AAA who underwent graft replacement, tissue samples of the AAA and non-dilated aorta were obtained. Using a real-time RT-PCR method that enabled quantitative measurement of mRNA levels in small tissue samples, we determined gene expression levels of MMPs and TIMPs relative to that of glutaraldehyde 3-phosphate dehydrogenase in each sample. RESULTS: The expression levels of the MMP-1 and -3 genes were significantly augmented in AAA compared with non-dilated regions (4.48 +/- 2.01 versus 0.26 +/- 0.12, P < 0.01 and 1.89 +/- 1.00 versus 5.01 +/- 0.97, P < 0.05, respectively). Although genes for TIMP-1, -2 and -3 tended to be upregulated in AAA, relative expression levels of MMP-1 to TIMP-1, MMP-1 to TIMP-2, MMP-1 to TIMP-3, and MMP-3 to TIMP-2 were still higher in AAA than in non-dilated regions (1.12 +/- 0.63 versus 0.10 +/- 0.03, 4.13 +/- 1.12 versus 0.43 +/- 0.11, 1.61 +/- 0.59 versus 0.14 +/- 0.03, and 7.81 +/- 1.60 versus 2.56 +/- 0.76, respectively, P < 0.05). CONCLUSION: These results demonstrate that the present real-time RT-PCR method is reliable for the determination of mRNA levels in small samples of vascular tissue and that disproportional expression of both MMP-1 and MMP-3 relative to TIMPs relates pathologically to the evolution of AAA.

Aged↗

PubMed2004

Should the transverse aortic arch be replaced simultaneously with aortic root replacement for annuloaortic ectasia in Marfan syndrome?

OBJECTIVE: The purpose of this study was to determine, on the basis of the late fate of the intact aortic arch with abnormal tissue after aortic root replacement, whether the intact aortic arch should be replaced prophylactically at the time of aortic root replacement for annuloaortic ectasia in Marfan syndrome. METHODS: A retrospective review was performed in 85 patients with Marfan syndrome who underwent aortic root replacement for annuloaortic ectasia with or without aortic dissection (mean age 37 years, range 19-61 years). These 85 patients were divided into four groups according to the postoperative condition of the residual aorta. In group I (n = 47), the patients underwent aortic root replacement for annuloaortic ectasia with or without localized dissection in the ascending aorta. In these patients the residual aorta, including the aortic arch, was therefore intact. In group II (n = 10), the aortic arch was intact, although the descending thoracic aorta was dissected because of the preoperative type B dissection. In groups III and IV, the patients had type A dissection involving the transverse arch associated with annuloaortic ectasia. In group III (n = 13), residual dissection existed in the descending thoracic aorta after concomitant total arch replacement. In group IV (n = 15), the aortic arch and the descending thoracic aorta were dissected. RESULTS: There were 5 early deaths (3 in group I, 1 in group II, and 1 in group III). Subsequent operations were required in 10, 5, 6, and 7 cases in groups I, II, III, and IV, respectively. Regarding the aortic arch, only 2 of 53 survivors of the initial hospitalization with an intact aortic arch (groups I and II) underwent subsequent total arch replacement for the onset of dissection in the aortic arch, and 4 of 14 survivors of the initial hospitalization with a residual dissecting arch (group III) needed subsequent total arch replacement. Actuarial freedom from arch repair among patients with an intact aortic arch (91% at 15 years) was significantly higher than that among patients with a residual dissecting arch (49% at 15 years, P =.0078). CONCLUSIONS: The incidence of new dissection in the residual intact arch after aortic root replacement was extremely low. Therefore prophylactic replacement of the intact arch does not appear to be necessary at aortic root replacement for annuloaortic ectasia in Marfan syndrome.

Actuarial Analysis↗

PubMed2003

Total arch replacement using antegrade selective cerebral perfusion with right axillary artery perfusion.

OBJECTIVE: Right axillary artery (AxA) perfusion, which can prevent cerebral embolism caused by retrograde perfusion via the femoral artery (FA), was used for selective cerebral perfusion (SCP) as well as cardiopulmonary bypass (CPB) in aortic arch repair. We review the outcome of aortic arch surgery using SCP with right AxA perfusion to clarify its efficacy. METHOD: Between 1998 and 2002, 120 patients underwent aortic arch repair using SCP with right AxA perfusion. The mean age was 69+/-10 years. Aneurysms were atherosclerotic in 79, dissecting in 32, and others in nine patients. Twenty of them (16.7%) required emergency surgery. CPB was initiated with right AxA and FA perfusion, and following SCP was established using right AxA and left common carotid artery perfusion. RESULTS: With right AxA perfusion, hospital mortality was 5.8%. Multivariate analysis showed only ruptured aneurysm was an independent determinant for hospital mortality. Permanent neurological dysfunction developed in one patient (0.8%), while seven (5.8%) suffered from temporary one. In univariate analysis, SCP time, stenosis of the carotid arteries, past history of cerebrovascular events, and atherosclerotic aneurysm were not related to temporary neurological deficits CONCLUSION: Right AxA perfusion in conjunction with SCP is a safe and useful alternative for brain protection in total arch replacement.

Adolescent↗

PubMed2003

Prostacyclin therapy before pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension.

OBJECTIVES: The continuous IV administration of prostacyclin improves pulmonary hemodynamics and prognosis in patients with primary pulmonary hypertension. We investigated whether the administration of prostacyclin therapy to patients before they undergo pulmonary thromboendarterectomy ameliorates pulmonary hypertension in patients with the most severe form of chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Of the 33 patients with CTEPH who were candidates for pulmonary thromboendarterectomy, 12 patients with severe pulmonary hypertension (pulmonary vascular resistance, > 1,200 dyne. s. cm(-5)) received IV prostacyclin prior to undergoing pulmonary thromboendarterectomy. Right heart catheterization and plasma brain natriuretic peptide (BNP) measurements were repeated at baseline, immediately before surgery, and 1 month after surgery. RESULTS: During a mean (+/- SEM) follow-up period of 46 +/- 12 days, the IV administration of prostacyclin resulted in a 28% decrease in pulmonary vascular resistance (1,510 +/- 53 to 1,088 +/- 58 dyne. s. cm(-5); p < 0.001) before surgery. Prostacyclin therapy markedly decreased plasma BNP level (547 +/- 112 to 188 +/- 30 pg/mL; p < 0.01), suggesting improvement in right heart failure. Pulmonary thromboendarterectomy caused a further reduction of pulmonary vascular resistance (302 +/- 47 dyne. s. cm(-5)) and plasma BNP levels (60 +/- 11 pg/mL) compared to each preoperative value (p < 0.05). Operative mortality rates were relatively low (8.3%) in patients with the most severe form of CTEPH. CONCLUSION: The IV administration of prostacyclin caused beneficial hemodynamic effects in patients with severe CTEPH and may serve as pretreatment for patients undergoing pulmonary thromboendarterectomy.

Adult↗

PubMed2003

[Recruitment maneuver and high PEEP in a patient with severe reperfusion pulmonary edema after pulmonary thromboendarterectomy].

Recently open lung approach such as recruitment maneuver and high PEEP has been applied in patients with acute respiratory distress syndrome. We report here a 29-year-old man with chronic pulmonary thromboembolism (CPTE). In this case, recruitment maneuver and high PEEP relieved postoperative respiratory failure. The major complications after pulmonary thromboendarterectomy (PTE) for CPTE are: reperfusion pulmonary edema (RPE), pulmonary hypertension (PH), hypoxia and bronchial bleeding, all of which the patient has demonstrated. Preoperative examination showed high pulmonary artery pressure (85/41, mean 50 mmHg), and high pulmonary vascular resistance predicted poor postoperative course. After PTE, he developed severe RPE, PH, hypoxia and bronchial bleeding, resulting in failed weaning from cardiopulmonary bypass. Therefore he required mechanical support of percutaneous cardiopulmonary support (PCPS). In ICU we repeated recruitment maneuver (PEEP: 30 cmH2O, peak inspiratory pressure: 42 cmH2O, respiratory rate; 15 breaths.min-1, for 1 min) and kept high PEEP (15 cmH2O). After initiating this ventilatory strategy, RPE was gradually relieved, followed by improvement of oxygenation and PH. We successfully weaned him from PCPS 38 hr after surgery and he was discharged alive on the 90 post-operative day. We conclude that recruitment maneuver and high PEEP may be useful for RPE developed after PTE.

Adult↗

PubMed2002

Total arch replacement with elephant trunk procedure for retrograde dissection.

BACKGROUND: The surgical management of type A dissection with the intimal tear in the descending aorta--retrograde dissection--has some challenging aspects because the standard approach through a median sternotomy for ascending aortic dissection is difficult in these cases in which the intimal tear is located in the descending aorta. METHODS: From January 1995 to December 2001, 12 (8.6%) consecutive patients aged 40 to 71 years underwent total arch replacement with an elephant trunk procedure through a median sternotomy for retrograde dissection of the ascending aorta (acute: 10, chronic: 2) among 139 patients with type A dissection. The intimal tear was located in the descending aorta in all patients. Dissection extended proximally to the aortic root in 7 patients and to the ascending aorta in 5, and extended distally to the abdominal aorta in 4 and to the common iliac artery in 8. RESULTS: Hospital mortality occurred in 1 patient (8%) owing to multiple organ failure after malperfusion of the renal arteries. Postoperatively the false lumen in the descending aorta was closed in all patients who survived but the false lumen in the abdominal aorta was patent in 9. The thoracic and abdominal aorta had slight dilatation in 2 patients. CONCLUSIONS: These data suggest that total arch replacement with an elephant trunk procedure through a median sternomy should be recommended in patients with type A dissection and the intimal tear in the descending aorta. This procedure induces thrombosis of the remaining false lumen in the distal aorta postoperatively.

Adult↗