Biomedical subjects

K Makihara

Publications and source records attributed to K Makihara.

At least 19 recordsLinked to original sources

PubMed2001

Ultrasonic pleural debridement of empyema.

Thoracic decortication is a common procedure for empyema. However, effective dissection without injuring the lung parenchyma is sometimes difficult. We introduce a new technique using an ultrasonic surgical unit (USUTM) to search the dissection plane and simultaneously perform pleural debridement and irrigation with minimal injury of the lung parenchyma. USUTM was used on 5 patients with acute empyema with fibrino-purulent phase and good clinical course was achieved. This procedure facilitates effective pleural debridement under either thoracoscopy or conventional thoracotomy.

Adolescent↗

PubMed2001

[A case with lung metastasis of osteosarcoma occurred 21 years after the operation of osteosarcoma on left tibia].

The patient was a 38-years-old woman. A chest X-ray film demonstrated the presence of an abnormal lesion. Her past history included osteosarcoma on the left tibia for which she received amputation of the left inferior limb at 17 years of age without any relapse thereafter. Considering that the patient might have lung metastasis of osteosarcoma on the basis of lung biopsy performed under CT guide, and then a tumor was removed under the thoracoscope. The tumor, 2.8 x 2.2 x 2.1 cm in size, was located right under the pleura at left S10 with its inside being filled up with fragile necrotic tissues. When compared pathohistologically with the primary lesion of osteosarcoma which had occurred 21 years before, the lung tumor was almost identical in terms of the tumor cell morphology but had a higher cell density without evidence of osteoid formation. The diagnosis of lung metastasis of osteosarcoma was established on the basis of the clinical course and the immunohistochemical staining. It is extremely rare case that osteosarcoma recurs in the form of lung metastasis 21 years after the operation of primary lesion. We report this case as a valuable one to identify the prognosis of osteosarcoma and the development mechanism of lung metastasis.

Adult↗

PubMed2000

A case of primary squamous cell carcinoma of the breast with rapid progression.

Primary squamous cell carcinoma of the breast is a rare disease for which no definite treatment or prognosis has been established. This report describes our experience with one case of primary squamous cell carcinoma of the breast that ended in death after rapid progression. The patient was a 58 year old woman who visited our hospital complaining of a growing tumor and pain in the right breast. Ultrasonographically the tumor consisted of solid tumor and a large cyst. Squamous cell carcinoma was diagnosed by fine-needle aspiration cytology. Neoadjuvant CEF was given, but the tumor continued to grow, so CEF was discontinued after one course and modified radical mastectomy was performed subsequently. There was no evidence of metastasis to lymph nodes. About 5 months post operatively CT of the head and chest X-ray demonstrated metastatic lesions in the brain and lungs. Resection of the cerebral tumor was performed. About 1 month after the operation, however, a new metastatic brain tumor was found and the patient later died.

Breast Neoplasms↗

PubMed2000

[Video-assisted thoracic surgery (VATS) for metastatic lung tumor: comparison with thoracotomy].

Effectiveness and present problems of video-assisted thoracic surgery (VATS) for metastatic lung tumor were investigated by comparing 14 cases (16 operations) of VATS with 16 cases (19 operations) of conventional thoracotomy during the same period. VATS was favorably selected in the solitary metastasis. The cases who had small tumor diameter less than 3 cm and shorter distance from viseral pluera to the tumor surface than tumor diameter were advantageous for only thoracoscopic procedure to do the safe and sure resection. Regarding to the tumor number, we detected another tumor intraoperatively in 2 of 16 cases (12.5%) of VATS and 6 of 19 cases (31.6%) of thoracotomy. Multiple metastases had the tendency to have the differences of the tumor number between preoperation and intraoperation. Prognosis is very good until now, but the recurrence rate was high (64.5%) and one case had the recurrence at the surgical margin. VATS for metastatic tumor is very effective, but it is important not to hesitate to do the mini-thoracotomy and convert to conventional thoracotomy for safe and sure resection.

Adult↗

PubMed2000

[A new method of reconstruction for chest wall resection].

Sixteen patients who involved in chest wall disease underwent major chest wall resection between April 1995 and January 1999. The underlying diseases were 6 recurrence of breast cancers, 4 direct invasion by primary lung cancer, 2 metastatic chest wall tumor, one direct invasion by metastatic lung tumor, one direct invasion by metastatic mediastinal tumor, one radio-induced-necrosis of the chest wall, and one chest wall infection. In 9 patients, the thoracic cage reconstruction was performed using double sheets of absorbable mesh (Dexon mesh), cross string sutures and autologous ribs grafts. None of the patients had major respiratory failure and chest wall unstability. No late complications including infections, pains, recurrence and others related to reconstruction materials have been observed.

Aged↗

PubMed2000

[Thoracoscopic surgery for pulmonary nodules in patients with previous malignant tumor].

We evaluated the clinico-pathological characteristics of thirty-four cases with previous malignant tumor who was operated under thoracoscopy for pulmonary nodules. In twenty-three cases (67.6%), including 20 cases suspected metastatic pulmonary tumor before operation, thoracoscopic surgery was performed without doing the preoperative examinations for the definite diagnosis. The mean diameter of resected tumors was 13.5 mm and the definite diagnosis was determined in all cases by the intraoperative pathological diagnosis. There were 26(76.5%) cases of malignancy, including 20 cases(58.8%) of metastatic pulmonary tumor and 6 cases (17.7%) of primary lung cancer. Accuracy rate of predictive diagnosis before operation was 67.6%. From the analysis of difference between pre- and post-operative diagnoses, inflammatory nodules or tuberculoma in the solitary nodule and intrapulmonary lymph nodes or silicotic nodules in the multiple nodules should have been considered with more carefully attention. Univariate and multivariate analysis showed that patients with metastatic tumor previously was only a predictive factor for metastatic tumor. Age, gender, CT findings, the number of nodules, disease free interval and tumor markers were unreliable factors in this study. In conclusion, there were a lot of cases with previous malignant tumor in which thoracoscopic surgery could become a first choice of modalities for the diagnosis of pulmonary nodules. Early thoracoscopic procedure will be recommended for such patients to perform the immediate treatment.

Adolescent↗

PubMed2000

Thoracoscopic debridement for acute pediatric empyema: efficacy of ultrasonic surgical device.

Few studies have examined thoracoscopic treatment for pediatric empyema. We encountered three children with thoracic empyema successfully treated by thoracoscopic debridement. Patients were a 3-year-old girl, a 17 month-old boy and a 13-year-old girl who developed thoracic empyema during therapy for pneumonia. We performed dissection and debridement under thoracoscopy and resolved fibrinopurulent collections using an ultrasonic surgical device in two cases to search the dissection plane while minimizing injury to the lung parenchyma. Ultrasonic surgical device (USUTM) is very useful for performing effective debridement and irrigation with minimal pleural damage. Thoracoscopic debridement performed early in the course of therapy is recommended even for acute pediatric empyema and could prevent the unnecessary open surgical intervention or decortication.

Acute Disease↗

PubMed1999

Thoracoscopic surgery for intralobar pulmonary sequestration.

A 47-year-old male with intralobar pulmonary sequestration successfully treated by thoracoscopic surgery was reported. Preoperative selective angiography revealed two aberrant arteries originating from the left infraphrenic artery. Under thoracoscopy, adhesive tissues around the sequestered lung were dissected, aberrant arteries were divided and the sequestered lung was resected. We considered that preoperative detailed analysis of the aberrant artery was very important to safely perform thoracoscopic procedures for pulmonary sequestration.

Angiography, Digital Subtraction↗

PubMed1998

[Primary clear cell carcinoma of the lung: report of an operative case].

The patient was a 75-year-old man complaining of cough in July 1996. Chest X-ray demonstrated a tumor in the left S6. Percutaneous lung biopsy specimen revealed lung cancer. On September 4, 1996, left lobectomy (R 2 a) was performed. The tumor was 3.8 x 3.2 x 2.1 cm in size and showed a white yellow solid mass (pT2N0M0, pStage I, p1d0e0pm0). The pathological examination was confirmed no differentiation in adenocarcinoma and squamous cell carcinoma. More than 90% of the tumor cells were characterized as having large clear cytoplasm. On immunohistochemical study, the tumor cells expressed positive with EMA, CEA, cytokeratin and negative with vimentin. The postoperative findings showed no presence of renal cell carcinoma. As the result, a diagnosis of primary clear cell carcinoma of the lung was made. The postoperative course is uneventful.

Adenocarcinoma, Clear Cell↗

PubMed1997

Assessment of embryonic anatomy at 6-8 weeks of gestation by intrauterine and transvaginal sonography.

Our purpose was to compare the ultrasound visualization of the early first-trimester embryo using transvaginal and intrauterine sonography. In all, 32 women about to undergo therapeutic abortion at 6-8.9 weeks gestation were studied using a specially developed catheter-based, high-resolution, real-time miniature (2.4 mm outer diameter) ultrasonography transducer (20 MHz). Before the intrauterine sonographic procedure was performed, transvaginal sonographic assessment of the embryo was conducted. The parameters evaluated included the ability to visualize anatomical structures and a subjective assessment of the overall image clarity. The ability to view most organs was better with intrauterine sonography compared to transvaginal sonography, and this was especially true for the brain, spine, heart, liver, midgut herniation, extremities, and sacral tail. Moreover, it was possible to obtain finer image quality of very small embryonic structures with intrauterine sonography than with transvaginal sonography. Stomach, spleen, kidney, and bladder could not be depicted with both techniques. One cystic hygroma was diagnosed at 7 weeks 6 days using intrauterine sonography, but not with transvaginal sonography. Intrauterine sonography may provide additional information on the visualization of anatomical structures of the embryo in the early first trimester of pregnancy. In this limited series, one case of cystic hygroma was demonstrated and, thus, there is a potential for its use in the early detection of embryonic malformation. These results suggest that intrauterine sonography may be a valuable tool in imaging the early first-trimester embryo, complementing and not replacing transvaginal sonography in high-risk pregnancies.

Congenital Abnormalities↗

PubMed1997

Plasma catecholamines and Doppler-derived cardiac time intervals in vaginally and cesarean delivered neonates.

OBJECTIVE: Our purpose was to compare Doppler-derived cardiac time intervals and cord plasma levels of catecholamines in vaginally and cesarean delivered neonates. METHODS: Doppler echocardiographic assessments of fetal and neonatal cardiac time intervals were made to determine differences in circulatory changes in 8 neonates delivered vaginally and 12 delivered by elective cesarean section. Aortic and pulmonary acceleration time (AT), ejection time (ET), and the AT/ET ratio in systole were assessed at various time points from antenatal to 72 h after delivery. Umbilical artery blood gas and acid-base values, and cord blood concentrations of epinephrine and norepinephrine were also measured. RESULTS: Umbilical artery blood pH in the cesarean section group was significantly lower than that in the vaginal delivery group (p < 0.05). Base deficit in umbilical artery blood and cord blood norepinephrine in cesarean delivered neonates were significantly higher than those in vaginally delivered neonates, respectively (p < 0.05). There were no significant changes in aortic cardiac time intervals between the 2 groups at any of the various time points. However, pulmonary AT and the AT/ET ratio were significantly lower in the normal vaginal delivery group than those in the cesarean section group 6 h after delivery (p < 0.05). CONCLUSIONS: The lower AT and AT/ET ratio of the pulmonary artery in vaginally delivered neonates may reflect an increase in pulmonary vascular resistance, indicating transient pulmonary hypertension. The findings were the reverse of what might be expected from an elevated pulmonary vascular resistance and transient pulmonary hypertension in cesarean delivered neonates.

Adult↗

PubMed1997

Antenatal diagnosis of aberrant umbilical vessels.

OBJECTIVE: To evaluate the antenatal screening of aberrant umbilical vessels and assess the association of fetal abnormality with these entities. STUDY DESIGN: 444 pregnant women were studied with routine obstetric ultrasound and Doppler color flow imaging in late second trimester or early third trimester. Fetal growth and anomaly, and the number of umbilical cord vessels were screened. RESULTS: Out of 444 subjects, 3 cases with discordant umbilical artery, 2 with four vessels in the umbilical cord, and 1 with single umbilical artery were detected (1.4%). Fetal anomaly was noted in 2 of 6 cases with aberrant umbilical vessels (33.3%). CONCLUSION: These results suggest that antenatal screening of umbilical cord vessels is necessary for detection of fetal anomalies.

Congenital Abnormalities↗

PubMed1996

Fetal ophthalmic artery blood flow velocity waveforms.

OBJECTIVE: To evaluate alterations in vascular impedance of the fetal ophthalmic artery (OA) with advancing gestation. STUDY DESIGN: Color Doppler flow imaging and pulsed Doppler ultrasonographic assessment were performed on 28 normal fetuses, at gestational ages ranging from 21 to 40 weeks. The pulsatility index (PI) was calculated for the OA and the middle cerebral artery (MCA). Optimal models for these PI values were determined by regression analysis. A normal range of PI values for both arteries was generated. RESULTS: In the OA, the model showed a parabolic pattern during pregnancy, as was the case for MCA. The predicted PI values for the OA were always lower than those for the MCA. CONCLUSION: Our study is the first to demonstrate alterations in regional vascular impedance of the fetal OA with advancing gestation. These data provide a foundation for the evaluation of fetal ocular circulation in normal and abnormal pregnancies.

Blood Flow Velocity↗

PubMed1995

[Analysis of 4 cases of intralobar pulmonary sequestration].

Four cases with pulmonary sequestration treated in Tottori university hospital between January 1993 and December 1994 were reported. Case 1 was a 63-year-old male who had lung tumor without inflammatory findings. Differential diagnosis from lung cancer was needed, and aortography showed a aberrant artery from descending aorta. Pulmonary partial resection and division of aberrant artery were performed. Case 2 was a 71-year-old female who diagnosed pulmonary sequestration in other hospital 10 years ago. Tumor shadow did not progress compared with the old X-ray film. Because tumor size was remarkably diminished by aspiration of cystic tumor, conservative follow up was continued. Both case 3 and 4 were a 20-year-old man and 16-year-old female who had typical findings of pulmonary sequestration with inflammation and easily detection of aberrant artery by CT or aortography. Resection of sequestrated lung and division of aberrant arteries were performed in both cases. Pulmonary sequestration was the disease which should be always kept in our mind in differential diagnosis from various lung disease.

Adolescent↗

PubMed1993

Quantitative characterization of arcuate artery hemodynamic change in normal pregnancy with Doppler ultrasonography.

Using color and pulsed Doppler ultrasonography, arcuate arterial velocimetry was carried out in 91 normal women, at 16-40 weeks, menstrual age. The arcuate arterial hemodynamics was assessed by the calculation of the resistance index (RI). A curvilinear relationship was found between the RI value of the arcuate artery obtained from the placental site in the uterus and menstrual age (R2 = 0.328). The relationships between the RI value of the arcuate artery obtained from the nonplacental site (R2 = 0.268) or the averaged RI value between the placental and nonplacental sites (R2 = 0.321) and menstrual age were both linear. Normal ranges of RI values of arcuate arteries during pregnancy for the placental site, nonplacental site, and their average values were generated. These results provide a foundation for evaluating uteroplacental velocimetry in normal pregnancy using Doppler ultrasonography.

Arteries↗

PubMed1993

Mathematical modeling of fetal organ growth using the Rossavik growth model: II. Adrenal gland.

Growth of the fetal adrenal gland has been monitored by measurements of the circumference (AGC) and area (AGA) of the adrenal gland from 16 to 40 weeks menstrual age. Growth curves for these parameters have been determined using a Rossavik growth curve models [P = c(t)k + s(t)]. R2 values of 86.2 and 91.1% were obtained for AGC and AGA, respectively. Variability analysis indicated a progressive increase in variability with menstrual age for these two parameters. Variability data were used with the growth curve models to determine standard curves for AGC and AGA. These standard curves provide a superior means for evaluating the adrenal growth in the fetus and the fetal status in utero in high-risk pregnancies.

Adrenal Glands↗

PubMed1993

Echocardiographic assessment of systolic time intervals in vaginal and cesarean delivered neonates.

Echocardiographic assessments of fetal and neonatal systolic time intervals were made to determine differences in circulatory changes in 40 neonates delivered vaginally and 30 delivered by elective cesarean section. Left preejection period (LPEP), left ventricular ejection time (LVET), LPEP/LVET, right preejection period (RPEP), right ventricular ejection time (RVET), RPEP/RVET, and heart rate were determined at various time points from antenatal to 120 hours after delivery. There were no significant changes in left systolic time intervals between the two groups at any various time points. However, RPEP and RPEP/RVET values were significantly higher in the cesarean section group than in those in normal vaginal delivery group within 12 hours after delivery. These results suggest that the transient pulmonary hypertension after delivery is prolonged in babies delivered by elective cesarean section.

Cesarean Section↗

PubMed1992

Mathematical modeling of fetal splenic growth: use of the Rossavik growth model.

Growth of the fetal spleen has been monitored by measurements of the maximal length (SL), profile circumference (SC), and profile area (SA) of the spleen, from 20 weeks to 41 weeks, menstrual age. Growth curves for these parameters have been determined using a specially developed growth curve model [P = c(t)k + s (t)]. R2 values of 94.3%, 94.9%, and 96.3% were obtained for SL, SC, and SA, respectively. Variability analysis indicated some progressive increase in variability with menstrual age for these three parameters. Variability data were used with the growth curve models to determine standard curves for SL, SC, and SA. These standard curves provide a superior means for evaluating the normal splenic growth in the fetus and for identifying splenic abnormalities in utero.

Embryonic and Fetal Development↗