Biomedical subjects

K Koja

Publications and source records attributed to K Koja.

At least 19 recordsLinked to original sources

PubMed2000

Surgical treatment of multiple inflammatory aortic aneurysms of the aortic arch and thoracoabdominal aorta.

A 67-year-old woman hospitalized with pleuritis was treated with antibiotics. Although the inflammation was resolved, saccular aneurysms in the aortic arch and thoracoabdominal aorta enlarged rapidly. We conducted graft replacement of the aortic arch, but despite careful blood pressure control, the thoracoabdominal aneurysm rapidly enlarged even further. We conducted graft replacement of the thoracoabdominal aorta on day 25 after the first operation. The postoperative course was uneventful and no exacerbation was found 18 months after the second operation. These multiple aortic aneurysms were diagnosed as inflammatory because bacterial tests of blood and aneurysmal walls were all negative and cells infiltrating aneurysmal walls were pathologically plasma cells.

Aged↗

PubMed2000

Suppression of manganese superoxide dismutase augments sensitivity to radiation, hyperthermia and doxorubicin in colon cancer cell lines by inducing apoptosis.

Increased expression of manganese superoxide dismutase (Mn-SOD), one of the mitochondrial enzymes involved in the redox system, has been shown to diminish the cytotoxic effects of several anti-cancer modalities, including tumour necrosis factor-alpha, ionizing radiation, certain chemotherapeutic agents and hyperthermia. We asked if Mn-SOD is a potential target to augment the sensitivity of cancer cells to various anti-cancer treatments and for this we established stable Mn-SOD antisense RNA expressing cell clones from two human colon cancer cell lines, HCT116 (p53 wild-type) and DLD1 (p53 mutant-type). Suppression of Mn-SOD in HCT116 was accompanied by an increased sensitivity to radiation, hyperthermia and doxorubicin, as compared with findings in controls. The mitochondrial permeability transition, as measured by a decrease of the mitochondrial transmembrane potential was more intensely induced by radiation in HCT116 antisense clones than in the control, an event followed by a greater extent of DNA fragmentation. Apoptosis was also induced by hyperthermia more intensely in HCT116 antisense clones than in the control. On the other hand, DLD1 antisense clones did not exhibit any enhancement of sensitivity to any of these treatments. These data support the possibility that inhibition of Mn-SOD activity renders colon cancer cells with wild-type p53 susceptible to apoptosis induced by radiation, hyperthermia and selected anti-cancer drugs. Therefore, we suggest that Mn-SOD could be a target molecule to overcome the resistance to anti-cancer treatments in some colon cancer cells carrying wild-type p53.

Adenocarcinoma↗

PubMed1999

Distribution and localization of cells and collagens in the proliferated intima of arterially implanted autovein grafts.

We examined the microscopic features and distribution of collagens in the hyperplastic intima of arterially implanted autovein bypass grafts under conditions of a reduced blood flow with a poor distal outflow. Vascular anastomosis was made using 7-0 nonabsorbable polypropylene sutures (PP group), or absorbable polydioxanone sutures (PDS group). On the contralateral limb, an autovein bypass graft was performed under normal flow conditions (NF group). The thickness of the intima in the NF group was approximately 50 microm throughout the duration of the study, while in the PP and PDS groups, intimal hyperplasia progressed to 290+/-112 microm and 267+/-123 microm, respectively, at 13 months after grafting. Collagen accumulated significantly in both the PP and PDS groups; types IV and V collagen in particular increased considerably in the deep layer. Regardless of the suture materials, the progression of intimal hyperplasia was considered to be closely related to the poor distal outflow to be and caused by the proliferation of myofibroblasts and active production of collagen. The increase in types IV and V collagen, particularly in the deep layer of the hyperplastic intima, was due to development of numerous vasa vasora in this region.

Anastomosis, Surgical↗

PubMed1999

Surgical treatment of traumatic aneurysm of the ascending aorta.

Traumatic aneurysm of the ascending aorta is a rare event. This case describes a patient with such an aneurysm, resulting from injuries received in a motorcycle accident. The patient was admitted to the emergency room of a local hospital complaining of chest pain, and was subsequently referred to our institution. On admission, a chest x-ray showed mediastinal widening. Computed tomography and aortography revealed an ascending aortic aneurysm and contusion of the upper lobe of the right lung. Due to concerns about bleeding from the lung contusion, surgery was delayed for one week. During surgery, intimal tears were detected at two sites in the ascending aorta. The wall of the ascending aorta was subsequently resected and a prosthetic graft inserted. The postoperative period was uneventful and a postoperative aortogram showed that the graft had molded well.

Accidents, Traffic↗

PubMed1999

Successful surgical treatment of impending rupture of thoracoabdominal aortic aneurysm in an elderly patient with severe pulmonary emphysema.

In a case of successful surgery for impending thoracoabdominal aortic aneurysmic rupture, an 83-year-old man with severe pulmonary emphysema was transferred to our hospital diagnosed with impending aneurysmic rupture. The aneurysm had been pointed out 2.5 years ago but surgical repair was not undertaken due to the patient's severe pulmonary emphysema. After admission, computed tomography showed an enlarging saccular thoracoabdominal aortic aneurysm. Emergency surgery was conducted because of severe pain below the left costal margin. We resected the wall of the saccular aortic aneurysm and reconstructed the aorta with an on-lay patch under femoro-femoral bypass and selective visceral organ perfusion. Tracheostomy provided respiratory care on the day following surgery. The patient was weaned from respiratory support 6 days after surgery. Postoperative aortography showed that the reconstructed thoracoabdominal aorta functioned satisfactorily. The patient remains in good health 18 months after surgery.

Aged↗

PubMed1999

Postoperative radiation therapy for completely resected invasive thymoma: prognostic value of pleural invasion for intrathoracic control.

BACKGROUND: Optimal management of postoperative radiation therapy for completely resected invasive thymoma remains controversial. This study was conducted to assess the efficacy of postoperative mediastinal irradiation in patients with completely resected invasive thymoma. METHODS: Between 1981 and 1996, 21 patients with completely resected invasive thymoma were referred for postoperative mediastinal irradiation. The distribution of Masaoka stages was stage II in 14 patients and stage III in seven patients. Nine patients had pleural invasion by the tumor. Thirteen patients were treated with a localized field and eight were treated with the whole mediastinal field with boost. The total dose to the primary tumor was 40-61 Gy (median: 52 Gy). The median follow-up time of the 16 living patients was 67 months (range: 29-202 months). RESULTS: The 5- and 10-year actuarial overall survival rates in all patients were both 77%. Relapses were observed in five patients, in all of whom the sites of the first relapse involved pleural dissemination. There were no relapses within the irradiated field in any of the 21 cases. Five of nine (56%) patients with pleural invasion had relapse of pleural dissemination, while 0 of 12 (0%) patients without pleural invasion had relapse. In univariate analysis, pleural invasion had a statistically significant impact on intrathoracic control (P = 0.01). CONCLUSIONS: The results indicated that pleural invasion might be predictive of pleural-based relapse for completely resected invasive thymoma. In patients with pleural invasion, mediastinal irradiation alone might be insufficient to avoid pleural-based relapse even after complete resection.

Adult↗

PubMed1999

A new devised skirted elephant trunk technique.

A simple and effective new elephant trunk technique was devised and applied to two patients with a successful result. In advance before the operation, an arch graft with a skirted elephant trunk was made. This was done by inserting a smaller, 22 mm diameter sized graft into the arch graft at the distal end and suturing it so as to leave a skirt extending over the smaller graft. This configuration facilitates the distal anastomosis and effectively shortens anastomotic time.

Adult↗

PubMed1999

Two-stage operation for multiple aneurysms of the thoracic aorta, abdominal aorta, and left common iliac artery in an octogenarian.

Multiple aortic aneurysms are well described in the surgical literature. However, there are many problems related to surgical treatment of elderly patients with such aneurysms. This report presents the case, an octogenarian with multiple aortic aneurysms that were successfully treated by graft replacement. An 82-year-old man with a descending aortic aneurysm was referred to our institution for surgery. In addition to the previously diagnosed aneurysm, computed tomography and aortography showed an abdominal aortic aneurysm and a left common iliac aneurysm. Since the patient was an elderly man with chronic obstructive pulmonary disease, a two-stage operation was performed. The abdominal aortic aneurysm and left common iliac aneurysm were resected first due to the risk of thromboembolism from the abdominal aortic aneurysm during surgery involving replacement of the descending aorta under femoro-femoral (F-F) bypass. Fifty-two days after the first operation, a second operation was performed to repair the descending aortic aneurysm. The postoperative course was uneventful. Angiography after the operation showed satisfactory replacement of the multiple aortic aneurysms. The patient was discharged 25 days after the second operation.

Aged↗

PubMed1999

Sutureless technique for subacute left ventricular free wall rupture: A case report of an 85-year-old.

This case was an 85-year-old female who developed left ventricular free wall rupture (LVFWR) of the anterior wall 13 days after an acute myocardial infarction. She was further complicated with an ascending aortic aneurysm and severe aortic regurgitation. The wall was repaired using a sutureless technique with an autologous pericardial patch and GRF glue without cardiopulmonary bypass. Although the complication of a left ventricular aneurysm was seen, the postoperative course was uneventful. Nevertheless, she is doing well 9 months after surgery.

Aged↗

PubMed1998

[Thoracoscopic surgery for diagnosis of interstitial pneumonia special reference to medicoeconomical effect].

We compared thoracoscopic surgery (TS) and open thoracotomy for the diagnosis of interstitial pneumonia. Intraoperative blood loss and duration of postoperative chest drainage were significantly less with TS than with thoracotomy. The length of postoperative hospital stay and social insurance costs with TS was significantly less than with thoracotomy. These results show that TS for the diagnosis of interstitial pneumonia is superior to open thoracotomy in terms of surgical stress and cost.

Adult↗

PubMed1998

[A case of traumatic aneurysm of the brachiocephalic artery].

Traumatic aneurysm of the brachiocephalic artery is rate. We presented a case of traumatic aneurysm of the brachiocephalic artery caused by traffic accident. A 28-year-old woman suffered a blunt chest trauma. A chest X-ray revealed a widening of the superior mediastinum and multiple rib fractures. CT scanning demonstrated left hemothorax with lung contusion and upper mediastinal hematoma. An aortography was performed which showed aneurysmal dilatation at the origin of the brachiocephalic artery. The patient underwent an operation 24 hours after chest injury. An aorto-right common carotid artery and right subclavian artery bypass with bifurcated Dacron graft was performed while monitoring temporary artery pressure. After resection of aneurysm, We found that about 3 cm longitudinal laceration of intima on the posterior wall of brachiocephalic artery. Her post operative condition was good and no neurological defect was noted.

Accidents, Traffic↗

PubMed1998

Successful treatment of bilateral deep femoral aneurysms and multiple iliac aneurysms associated with severe aortic valve disease: report of a case.

We report herein the case of a patient in whom aneurysms of the bilateral deep femoral arteries (DFA) and multiple iliac aneurysms associated with severe aortic valve disease were successfully treated by a two-staged operation. The patient was a 74-year-old man who had dense calcification of the ascending aorta and aortic arch. Prior to aortic valve replacement (AVR), the aneurysms of the DFA and internal iliac arteries were resected. The terminal end of the abdominal aorta and bilateral common iliac arteries were then reconstructed with a Y graft to be used as a possible alternative arterial input route in place of the ascending aorta for extracorporeal circulation during the AVR. The inferior mesenteric artery (IMA) was well developed, and the external iliac arteries and their branches were preserved at aneurysmectomy. Postoperatively, there was no ischemia of the pelvic organs or the hip muscles. The AVR was subsequently performed 5 weeks after the first operation, and the patient was discharged after an uneventful postoperative course.

Aged↗

PubMed1998

Improvement in esophageal varices and liver histology postoperatively in Budd-Chiari syndrome.

BACKGROUND: In the past 17 years, 32 patients with Budd-Chiari syndrome were treated by reconstruction of the occluded inferior vena cava and reopening of the hepatic veins under femoro-femoral normothermic extracorporeal partial bypass. The mean follow-up was 8 years (range, 1.5 to 17 years). METHODS: To evaluate the benefits of our operative procedure, we compared the preoperative, early postoperative, and late postoperative endoscopic appearance of the esophageal varices and the histologic findings of the liver tissue obtained intraoperatively and at a later date. RESULTS: The esophageal varices found preoperatively in 29 patients (90.6%) had disappeared in 7 patients by the time of discharge, and in 2 patients they disappeared 4 to 7 years after surgery. In the remaining 20 patients, the grade of the esophageal varices was reduced markedly. Histologic examination of the liver showed cirrhosis in 22 patients, fibrosis in 9 patients, and severe congestion in 1 patient. Inspection of the liver in the late postoperative period (in 10 patients) showed improvement in centrilobular congestion and no increase in interlobular fibrosis. CONCLUSIONS: Gradual and steady improvement of esophageal varices and hepatic fibrosis can be achieved after our operative procedure.

Adult↗

PubMed1998

A ruptured syphilitic descending thoracic aortic aneurysm. The characteristic findings on computed tomography for the etiological diagnosis of aneurysm.

We report the case of a 72-year-old man with a ruptured syphilitic descending thoracic aneurysm who underwent an emergency operation and successful graft replacement. Preoperative physical examination showed a pulsative mass on the left back. Preoperative computed tomography showed bone destruction in the TH6 to TH10 thoracic vertebrae and ribs and penetration (or rupture) of the aneurysm into the subcutaneous tissue. During the period of preoperative evaluations, free wall rupture of the aneurysm occurred and emergency operation for graft replacement was performed. The microscopical examination of the aneurysmal wall revealed the syphilitic changes. In literature, the vertebral destruction by atherosclerotic aneurysm is usually located at the TH12 to L3 of vertebral bodies. From the findings of this patient and a study of existing literature, we concluded that the finding of vertebral bone beyond TH12 to L3 region on CT examination of the aneurysm could be a etiological characteristic finding for syphilitic aortic aneurysm.

Aged↗

PubMed1997

[A case report of surgical treatment of constrictive pericarditis with coronary artery disease].

We performed the concomitant operation for constrictive pericarditis and coronary artery disease in an octogenarian. A 82-year-old male was hospitalized with dyspnea, edema of the lower extremities and pleural effusion on chest X-ray film. Cardiac catheterization revealed constrictive pericarditis and 75% stenosis of left anterior descending artery. Extensive pericardiectomy was performed including posterior wall of left ventricle and left atrium under the beating heart by using femoro-femoral partial bypass. Single CABG with a saphenous vein graft was performed following pericardiectomy. Postoperative cardiac catheterization showed good recovery of hemodynamics and patency of the bypass graft. Postoperative course was uneventful. The patient was discharged on twenty fifth postoperative day.

Aged↗

PubMed1996

Radical open endvenectomy with autologous pericardial patch graft for correction of Budd-Chiari syndrome.

A surgical technique for the treatment of Budd-Chiari syndrome associated with vena caval obstruction has been devised. The occluded hepatic vena cava and hepatic veins were reconstructed by open endvenectomy, using an autologous pericardial patch graft and a femorofemoral bypass technique. The hepatic artery and portal vein were not controlled with vascular clamps during the surgery. Between 1979 and 1994, 29 patients were treated using this technique and achieved good results. All the patients did well with good function of the reconstructed vena cava and of the hepatic veins, and showed acceptable reduction of symptoms caused by portal hypertension and caval stagnation.

Adult↗

PubMed1996

[Clinical experience with normothermic selective cerebral perfusion during graft replacement of ascending-arch-descending aortic aneurysms with annuloaortic ectasia].

We treated three cases of ascending-arch-descending aortic aneurysm with annuloaortic ectasia by performing graft replacement. The patients included a 34 year old female, a 34 year old male and a 42 year old male. In one case the aneurysm was atherosclerotic and of type I and II + IIIb dissection in the other two cases. During the operation we were able to utilize normothermic selective cerebral perfusion during construction of the left common carotid artery. Specially, normothermic partial F-F bypass and normothermic selective cerebral perfusion to the left common carotid artery were used during graft replacement from the descending aorta to the left common carotid artery. This was followed by regular hypothermic total ECC and hypothermic cerebral selective perfusion during subsequent graft replacement of the innominate artery and a modified Bentall's operation. This new protocol in which normothermic cerebral perfusion is utilized during the procedure on the left common carotid artery and hypothermic perfusion is utilized only during the subsequent procedure on the innominate artery permits significant shortening of the cardiac arrest time and cerebral perfusion time compared with when only hypothermic perfusion is used. This significant shortening contains obvious benefits in the areas of cardiac and brain protection.

Adult↗

PubMed1995

High proportion of false positive reactions among donors with anti-HCV antibodies in a low prevalence area.

Among 39,656 voluntary blood donors in Okinawa Prefecture, Japan, 115 (0.29%) were repeatedly reactive for antibody to hepatitis C virus (anti-HCV) by second generation (2nd-gen) passive hemagglutination assay (PHA). Positive serum samples were tested for anti-HCV using three different enzyme immunosorbent assays (ELISAs; Abbott 2nd EIA, UBI-HCV-EIA, JCC-2) and for HCV-RNA by the polymerase chain reaction (PCR). The 115 2nd-gen PHA-positive sera were divided into three groups according to the agglutination titers; > 2(10) (high titer group), 2(7)-2(9) (median), 2(5)-2(6) (low). All but one serum (44/45) in the high PHA titer group reacted in each of the three second screening ELISAs. Furthermore, 43 (97.7%) of the 44 sera contained HCV-RNA by PCR. In the median titer group, 11 of the 13 samples tested were positive by each of the three ELISAs, and 4 (36.4%) of the 11 showed reaction by PCR. On the other hand, all of the 38 sera tested in the low titer group were negative for HCV-RNA by PCR, and 24 of the 38 were also negative by each of the three ELISAs. Most of the low titer positive reactions in the 2nd-gen agglutination assay seemed to be false positive. In Okinawa Prefecture, the prevalence of anti-HCV among blood donors is much lower than in the rest of Japan (0.29% vs. 1.11%). Moreover, a significant proportion of these sera were low titer by the PHA assay.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Donors↗