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Biomedical subjects

K Ataka

Publications and source records attributed to K Ataka.

At least 55 records · Page 3Linked to original sources
PubMed1997

Open distal anastomosis in retrograde cerebral perfusion for repair of ascending aortic dissection.

BACKGROUND: In patients with aortic dissection, a patent distal false lumen at long-term follow-up leads to complications. We investigated the feasibility of performing an open distal anastomosis using retrograde cerebral perfusion. METHODS: Over a 10-year period, 41 patients with acute type A aortic dissection underwent 43 surgical repairs. In 1991, an open distal anastomosis using retrograde cerebral perfusion (group 2) was introduced to replace the standard aortic cross-clamp method (group 1). The mean retrograde cerebral perfusion time was 47.3 minutes (range, 22 to 67 minutes), and there were no neurologic sequelae in surviving patients. RESULTS: The operative mortality rate was 18.5% in group 1 and 18.7% in group 2. At long-term follow-up, dilatation of the false lumen (more than 50 mm in diameter) occurred in 9 of 18 patients (50%) in group 1, and 2 patients died of aortic rupture. There were no deaths in group 2, and dilatation of the distal false lumen occurred in only 15.4% of patients (p < 0.05). CONCLUSIONS: The use of retrograde cerebral perfusion in patients with acute aortic dissection provides adequate time to perform a safe, open, distal anastomosis, and could decrease significantly the rate of enlarged, patent, false lumina.

Acute Disease↗
PubMed1997

[Successful surgical treatment for giant non-specific cyst in the anterior mediastinum].

A 46-year-old woman was admitted to our hospital with giant cyst in the anterior mediastinum. We strongly suspected the cyst would be cystic teratoma from preoperative examinations. Cystectomy was undergone through a right thoracotomy in the 6th intercostal space. The cyst, 15 x 14 x 13 cm in size, had a fibrous wall and contained yellowish serous fluid with hair-ball which revealed aseptic bacteriologically. In the pathological study, the cyst had no recognizable specific epithelium or mesothelium, and this finding was incompatible with cystic teratoma. Due to lack of teratoid elements, the final diagnosis was "non-specific mediastinal cyst". The cyst was considered to be the result of inflammation or intracystic auto-digestion by enzymes from the alimentary tissue of the cystic teratoma.

Diagnosis, Differential↗
PubMed1997

Retrograde cerebral perfusion with pharmacological cerebral protection in the repair of aortic arch aneurysm.

Twenty-six patients underwent resection and graft replacement of an aortic arch aneurysm (proximal arch,5; transverse arch:2, distal arch,8; and type A dissecting aneurysm. Retrograde cerebral perfusion with pharmacological cerebral protection was carried out during aortic arch aneurysm surgery. Prostaglandin E1, thiopental methylpredonisolone were administered for cerebral protection during core cooling. D-Mannitol and deferoxamine mesylate (radical scavengers) were administered for prevention of reperfusion injury. retrograde cerebral perfusion time was 48 +/- 16 minutes (range 20-80 minutes). Perfusion flow was 288 +/- 93 mL/min (range 150-500 mL/min). Since retrograde cerebral perfusion requires no arterial cannulation or aortic cross clamp, the operative field is simplified, and the risks of air and debris emboli to the brain were minimized. Reconstruction was designed to minimize the circulatory arrest time. Eleven cases underwent emergency surgery due to rupture and acute dissection. Five patients (19.2%) died (three from bleeding from the distal anastomosis, one from postoperative DIC and, one from intraoperative dissection). The remaining 21 patients survived neurologically intact. Retrograde cerebral perfusion with pharmacological cerebral protection is a very simple method to prevent air embolism or thromboembolism in aortic arch aneurysm surgery and allows aortic arch replacement in a bloodless field. In spite of the extended circulatory arrest time, recovery of consciousness was complete.

Adult↗
PubMed1997

[Surgical treatment of aortic dissection (Stanford type A) using hypothermic retrograde cerebral perfusion in patients older than 70 years of age].

Since 1991, 27 consecutive patients with aortic dissection (Stanford A) have been operated on using deep hypothermic retrograde cerebral perfusion (RCP). There were no differences in ECC time (247 +/- 15 vs 307 +/- 22 min), and RCP time (47 +/- 2 vs 47 +/- 3 min) between the aged (> or = 70 y.o., n = 11) and non-aged (< 70 y.o., n = 16) group. Although the aged group showed the higher incidences of postoperative neurological complications of prolonged emergence (2 cases) and delirium (3 cases), respiratory disorder (3 cases), and renal dysfunction (3 cases), there was no significant difference in hospital mortality (18% in the aged vs 13% in the non-aged). We concluded that RCP is well acceptable procedure for surgical treatment of the aged patients with aortic dissection.

Age Factors↗
PubMed1997

[A case of hemodialysis-associated innominate vein stenosis inducing superior vena cava syndrome].

Twenty years after making an arteriovenous shunt in the left arm, a 45-year-old man on hemodialysis developed progressive swelling in the face to left arm and venous dilatation on the left anterior chest. Venogram disclosed severe stenosis of the left innominate vein at the junction of the superior vena cava, which was considered to be a primary lesion because he had no history of subclavian vein cannulation or mediastinal disease. Surgical resection of the stenotic lesion and direct anastomosis of the innominate vein resulted in a rapid recovery of the symptom of venous hypertension. This is a rare case of hemodialysis-associated large vein complication leading to superior vena cava syndrome.

Arteriovenous Shunt, Surgical↗
PubMed1997

Cerebral complications and distal false lumen in the repair of aortic dissection with retrograde cerebral perfusion.

BACKGROUND: In aortic dissection, patent distal false lumen at long-term follow-up leads to complications. We investigated the feasibility of an open distal anastomosis under retrograde cerebral perfusion. METHODS: During a 15-year period (1981-1995), 51 patients with type A dissection underwent 59 surgical repairs. In 1990, a distal open anastomosis with retrograde cerebral perfusion (group II) was introduced to replace the aortic cross clamp method (group I). Mean retrograde cerebral perfusion time was 50 minutes (range 22 to 65 minutes) with no neurologic sequelae in surviving patients. RESULTS: Operative mortality was 28.6% in group I, and 16.1% in group II. At long-term follow-up, dilatation of the false lumen (more than 50 mm in diameter) occurred in 56.2% (9/16) in group I, and 4 patients died of aortic rupture. There was no mortality in group II, and dilatation of the distal false lumen occurred in only 15.3% (p<0.05). CONCLUSIONS: Use of retrograde cerebral perfusion in aortic dissection allowed for adequate time to perform a safe, open, distal anastomosis. Intraoperative cerebral complications and enlarged patent false lumens decreased significantly.

Acute Disease↗
PubMed1996

Profile of chest injuries arising from the 1995 southern Hyogo Prefecture earthquake.

STUDY OBJECTIVE: To better understand the types of chest injuries that are likely to occur following a major earthquake in the urban environment, we analyzed the pattern of chest injuries arising from the earthquake that struck the southern part of Hyogo Prefecture in Japan at 5:46 AM on January 17, 1995 and registered 7.2 on the Richter scale. DESIGN AND SETTING: The medical records of 487 patients with injuries who were referred to Kobe University Hospital from January 17 to January 23 were reviewed. RESULTS: Of the 487 patients, 63 (12.9%) were found to have chest injuries. Of these 63, eight patients with severe chest compression were dead on arrival at the hospital. Eight patients were admitted to our hospital, two of whom developed crush syndrome. The remaining 47 (74.6%) patients had light to moderate injuries and were treated in the emergency department on an outpatient basis. CONCLUSIONS: Minor trauma was the most common type of chest injury. However, there were severely injured patients who were trapped in collapsed buildings.

Adolescent↗
PubMed1996

Successful surgical treatment of cardiac cirrhosis. Tricuspid surgery and plasma exchange.

A patient with cardiac cirrhosis due to severe tricuspid regurgitation associated with a mitral valve lesion successfully underwent mitral and tricuspid valve replacement. Preoperative rest cure with liver supporting therapy for 5 months was used to maximize hepatic and cardiac function. Postoperatively, jaundice developed despite improvements in cardiac function. Plasma exchange was performed nine times over a period of 10 days with the liver function improved. He was discharged with New York Heart Association class I symptoms and normal liver function 2 months following surgery.

Heart Valve Prosthesis↗
PubMed1996

[Surgical-treatment for active infective endocarditis].

The results of surgical treatment of active native infective endocarditis in 24 patients were analyzed. Fifteen of 24 (63%) patients were successfully cured by operation. Three of the 8 patients with severe cardiac failure who underwent emergency operation died of low cardiac output syndrome and bleeding early postoperatively. One of the 6 patients with late death had preoperative cerebral embolism and died of multiple organ failure. Five of them had annular infection. Among 6 patients with annular infection, 3 patients who had Staphylococcus epidermidis and Gram negative bacterium as a causative microorganism had a short duration within 4 weeks from the onset to operation. Two died suddenly in the long-term period after surgery because of prosthetic valve detachment. The second operation were required for other 4 patients because of prosthetic valve endocarditis or perivalvular leakage. Three of them were lost from low cardiac output syndrome. These findings suggested that delayed surgical intervention may be a major causative factor resulting in high surgical mortality. For patients with active native infective endocarditis, an early aggressive operation should be considered prior to congestive heart failure and the destruction of the annulus.

Adult↗
PubMed1996

Suppression of enterotoxin-induced intestinal fluid secretion by wood creosote.

Wood creosote suppresses intestinal fluid secretion induced by heat-labile enterotoxin (LT) of enterotoxigenic Escherichia coli (ETEC). When rabbit jejunum is ligated into a 5-cm segment and LT is administered locally, it actively induces intestinal fluid secretion in a dose-dependent manner. Local administration of wood creosote together with a fixed dose of LT suppressed the LT-induced fluid secretion in a dose-dependent manner. At a 50-ng/segment dose of LT, 7.4 +/- 1.1 ml (n = 5) of fluid is secreted into an intestinal segment; coadministration of wood creosote (150 micrograms/segment) significantly (p < 0.01) suppressed the fluid secretion to 2.4 +/- 2.3 ml. Based on these results, we conclude that the antidiarrheal activity of wood creosote is attributable to its antisecretory or proabsorptive effect (or both) on the intestine.

Animals↗
PubMed1996

[A case report of closing aortic dissection with cardiac tamponade].

A 64-year-old man was hospitalized with severe chest and back pain. A computed tomography (CT) demonstrated an acute type A aortic dissection with cardiac tamponade. Emergency pericardial drainage was performed. Then he was referred to our hospital. An enhanced CT showed an acute type A aortic dissection with thrombosed false lumen. A digital subtraction angiography (DSA) showed no intimal tear and false lumen. He received the medical treatment. Marked elevation of fibrinogen, thrombin-antithrombin III complex (TAT), plasmin-alpha(2) plasmin inhibitor complex (PIC), fibrin degradation products (FDP), and D-Dimer indicated the activation of both coagulation and fibrinolysis in the false lumen. These thrombotic and fibrinolytic parameters were completely normalized 6 weeks after admission. He was discharged in good health 7 weeks after admission.

Aortic Dissection↗
PubMed1996

[Successful surgical treatment for distal arch aneurysm involving an aberrant right subclavian artery].

A 68-year-old woman with an aneurysm of the distal arch involving an aberrant right subclavin artery was surgically treated successfully. Computed tomography suggested distal arch aneurysm with the abnormal branching of the arch vessels, which was confirmed as an aberrant right subclavian artery (ARSA) by angiogram. ARSA originated from Kommerell's aortic diverticulum and its orifice developed an aneurysmal change, which severely compressed esophagus and was thought to be the cause of preoperative dysphagia. Distal arch reconstruction was performed with woven Dacron graft using retrograde cerebral perfusion technique under deep hypothermia. Esophageal compression was satisfactorily released by resection of the aneurysm of ARSA which was reconstructed with the same material. Dysphagia disappeared postoperatively. Esophagogram showed no stenosis, and angiogram indicated successful distal arch and ARSA reconstructions.

Aged↗
PubMed1996

[A case of intrathoracic goiter].

Intrathoracic goiter is an uncommon conditional lesion. A case of intrathoracic goiter in a 66-year-old woman is herein described. Her chief complaint was anterior chest opplession. A computed tomographic scan and magnetic resonance imaging (MRI) revealed intrathoracic goiter pressed the trachea to the right side. The tumor was safety and completely took by collar incision without thoracotomy. Histologically, the mass was diagnosed the adenomatous goiter. In this case, MRI was very useful to be determined the surgical approach.

Aged↗
PubMed1996

Directly visualized cerebral circulation during retrograde cerebral perfusion.

BACKGROUND: Retrograde cerebral perfusion (RCP) was clinically introduced as a supportive technique to protect the brain during operations on the thoracic aorta. However, it remains unclear whether this procedure provides adequate blood supply for the brain. METHODS: We have observed the optic fundus of patients undergoing operation on the thoracic aorta to evaluate the cerebral circulation during RCP. There were 1 male and 3 female patients, ages ranged from 34 to 78 years. RCP time ranged from 39 to 70 minutes, and blood flow via the superior vena cava cannula ranged from 200 to 400 ml/min. RESULTS: The arteries of the retina showed marked constrictions soon after the initiation of RCP. The veins showed almost normal diameter. The large arteries were reduced to thin threads, while the smaller arteries were invisible at 30 minutes after the initiation of retrograde cerebral perfusion. CONCLUSION: Ophthalmoscopic findings demonstrate the reduction of cerebral blood flow, especially in arteries, during RCP. Although RCP is a useful technique for cerebral protection, it could be mentioned that the blood supply to the brain by RCP is not enough to maintain good cerebral metabolism.

Adult↗
PubMed1996

A simple technique for the prevention of lower limb ischemia during femoral veno-arterial cardiopulmonary support.

OBJECTIVE: We describe a simple technique to prevent the lower limb ischemia during femoral veno-arterial cardiopulmonary support (CPS). PATIENTS: Between July 1994 and September 1995, five patients underwent the insertion of femoral veno-arterial CPS with distal limb perfusion for the treatment of circulatory collapse after cardiac surgery. METHODS: After CPS is established, the ipsilateral superficial femoral artery (SFA) is punctured downward with a 14-gauge Teflon catheter and connected to the side port of the membrane oxygenator. RESULTS: None of the patients were complicated by lower limb ischemia for up to 77 hrs on CPS with distal limb perfusion. CONCLUSIONS: Active perfusion through a 14-gauge Teflon catheter downstream to the ipsilateral SFA is effective in preventing lower limb ischemia during prolonged femoral veno-arterial CPS after cardiac surgery.

Adult↗
PubMed1996

Non clamping anastomosis of the ascending and arch aneurysm using retrograde cerebral perfusion.

Twelve consecutive patients requiring surgery for replacement of ascending aortic aneurysms (n = 3), ascending arch aortic aneurysms (n = 2), or type A aortic dissections (n = 7) were treated without aortic cross clamping. Retrograde cerebral perfusion (RCP) with circulatory arrest (mean RCP time: 46.0 +/- 15.9 minutes, range 20 to 65 minutes) and continuous retrograde cardioplegia (mean cardiac ischemic time: 134.4 +/- 39.7 minutes, range: 40 to 180 minutes) were employed. In the patients with aortic dissection, the intimal tear at the origin of the brachiocephalic artery (BCA) was resected completely, the aortic wall was trimmed and closed with Teflon felt. The distal anastomosis was created using an open technique. Air and debris were completely evacuated by returning blood from the cerebral vessels and femoral artery. Then the artificial graft was clamped, and cardiopulmonary bypass resumed. The proximal anastomosis was performed during rewarming. The operations were elective in seven cases, and emergent in five cases. Graft replacement of the ascending aorta was performed in ten patients (including two BCA reconstructions). The remaining two patients were treated by patch repair (n = 1), primary anastomosis (n = 1). There were no perioperative deaths. One patient had a transient neurological deficit. The distal false lumen was occluded completely in five of seven patients with aortic dissections. The other two patients had a secondary tears in the descending aorta. Thus retrograde cerebral perfusion and continuous retrograde cardioplegia without aortic cross clamping is an effective technique in the replacement of the ascending and arch aorta.

Adult↗
PubMed1995

Differential cloning using in-gel competitive reassociation.

We describe the principle and actual processes of a differential cloning procedure designed for cloning of anonymous restriction DNA fragments whose molecular sizes differ between two genomic DNA preparations from higher organisms as a result of DNA rearrangement, polymorphism, etc. The procedure, which was extensively modified from the original one and still employs in-gel competitive reassociation (IGCR) as the basic principle, aims for cloning of DNA fragments which exist in one copy or less per mammalian genome. The modified procedure consists of dissociation and reassociation of biotinylated restriction digests of target DNA fragments (from which clones are to be isolated) in the presence of a large excess of reference (competitor) DNA in gel after electrophoresis, which is followed by absorption of the target DNA fragments to streptavidin-coated tubes and solid-phase polymerase chain reaction. After repeating these steps we attained substantial enrichment of altered DNA fragments which were originally present in one copy or less per complex mammalian genome.

Animals↗