Biomedical subjects

Keiichi Ishida

Publications and source records attributed to Keiichi Ishida.

7 recordsLinked to original sources

PubMed2006

Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting.

OBJECTIVE: It has been observed that a systemic inflammatory response after on-pump coronary artery bypass grafting (CABG) participates in the pathogenesis of postoperative atrial fibrillation (AF). In patients undergoing off-pump CABG, it is plausible that inflammation is associated with the development of postoperative AF. The present study examined relation of proinflammatory cytokines, which play an important role in the upstream of inflammatory cascade, to the development of AF after off-pump CABG. METHODS: The present study included 39 patients undergoing off-pump CABG. Tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, and IL-8, were measured by enzyme-linked immunosorbent assay, on anesthetic induction, after sternotomy before anastomoses, at the completion of anastomoses, 3 and 6h thereafter, and on postoperative days (POD) 1-4. C-reactive protein (CRP) was also measured by turbidimetric immunoassay, preoperatively, and on POD 1, 2, 3, 6, 9, and 13. RESULTS: Eleven patients (28%) developed postoperative AF. Patients with postoperative AF were older (70+/-6.4 years vs 60+/-8.8 years, P=0.001); however, there was no difference in other pre- and perioperative variables. TNF-alpha level did not change during the study period. However, IL-8 and CRP levels significantly increased after the surgery, although there was no significant difference between the two groups. IL-6 level also increased after the surgery with its peak at 6h after the completion of anastomoses. IL-6 levels of 3 and 6h after anastomoses were significantly higher in patients with postoperative AF (360+/-143 pg/ml vs 230+/-94 pg/ml, P=0.0047, 435+/-175 pg/ml vs 247+/-102 pg/ml, P=0.0005, respectively). Logistic regression analysis indicated that the highest quartile of IL-6 level immediately after the surgery (odds ratio 7.63; 95% CI, 1.06-54.9; P=0.04) and age (odds ratio 1.18; 95% CI, 1.01-1.39; P=0.04) independently predict postoperative AF. Furthermore, the maximum level of IL-6 immediately after the surgery significantly correlated to age and intraoperative blood loss (r=0.04, P=0.01, and r=0.47, P=0.04, respectively). CONCLUSIONS: Advanced age was a major risk factor for postoperative AF. Furthermore, inflammatory response induced by surgical trauma was also associated with the development of AF after off-pump CABG.

Age Factors↗

PubMed2006

A case complicated with Horner's syndrome after off-pump coronary artery bypass.

In the present report, a case complicated with Horner's syndrome after off-pump coronary artery bypass (OPCAB) was presented. This case showed ptosis and miosis in the left eye promptly after OPCAB. No abnormal neurological findings other than Horner's syndrome were observed in postoperative examinations including head magnetic resonance imaging (MRI), and this case was thought to have Horner's syndrome as a complication after cardiac surgery through median sternotomy.

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PubMed2005

Early results of off-pump coronary artery bypass: retrospective consecutive comparative study.

OBJECTIVE: The purpose of this study is to compare the operative results of off-pump coronary artery bypass (OPCAB) and on-pump (conventional) coronary artery bypass (CCAB), to clarify qualitative problems and whether OPCAB is less invasive or not. METHODS: OPCAB was consecutively performed in 63 patients and CCAB in 63 patients between July 1998 and December 2003. RESULTS: The mean number of bypass grafts was 2.43 +/- 0.82 in the OPCAB group and 2.70 +/- 0.71 in the CCAB group (p = 0.096). In-hospital mortality was 0% in the OPCAB group and 3.2% in the CCAB group. The incidence of perioperative myocardial infarction was 0% in the OPCAB group and 3.2% in the CCAB group. The incidence of postoperative major complications was significantly lower in the OPCAB group than in the CCAB group (OPCAB group=4 complications, CCAB group=13 complications). Cerebrovascular accidents occurred in 1.6% of patients in both groups. The incidence of sternal infection or mediastinitis was 0% in the OPCAB group and 3.2% in the CCAB group. The early patency rate of graft was 94.0% in the OPCAB group and 92.8% in the CCAB group, and was not significantly different (p = 0.822). CONCLUSION: Operative mortality and major complications after surgery in OPCAB were lower than that in CCAB. The early patency rate in OPCAB was as good as that in CCAB. It is considered that OPCAB is less invasive and the quality of bypass in OPCAB is as good as that in CCAB.

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PubMed2005

A ruptured aneurysm in persistent sciatic artery: a case report.

Persistent sciatic artery (PSA) is a rare congenital anomaly, but in many cases it is a clinically important condition. PSA is susceptible to atherosclerotic degeneration, resulting in aneurysmal dilatation, occlusive thrombosis, or thromboembolization. PSA aneurysm is associated with distal embolization, sciatic neuropathy, or rupture. We describe a case of a patient with a ruptured PSA aneurysm treated by exclusion of the aneurysm and bypass between the common iliac artery and the PSA distal to the aneurysm, and discuss treatment of PSA aneurysm.

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PubMed2004

Heparin-induced thrombocytopenia after coronary artery bypass grafting with cardiopulmonary bypass: report of a case.

A 79-year-old man was transferred to our hospital with severe chest pain and a suspected diagnosis of acute myocardial infarction. Emergency cardiac catheterization showed triple-vessel coronary artery disease, and we performed coronary artery bypass grafting under cardiopulmonary bypass (CPB). Continuous hemodiafiltration was started for acute renal failure postoperatively, and heparin was given as an anticoagulanting agent. By 9 days after the initiation of heparin therapy, his platelet count had fallen and a deep vein thrombosis had formed in his left leg. We suspected heparin-induced thrombocytopenia (HIT), and immediately discontinued the heparin, implementing danaparoid (Orgaran) instead, following which the platelet count recovered. Heparin-induced thrombocytopenia, which causes thrombosis, is a serious side effect of heparin therapy and few cases of HIT associated with CPB surgery have been reported in Japan.

Acute Kidney Injury↗

PubMed2004

Omental transfer for mediastinitis in a patient with early gastric cancer.

We encountered a patient with mediastinitis after coronary artery bypass grafting and early gastric cancer requiring surgical resection. We treated the patient's mediastinitis by omental transfer since complete resection of the malignancy did not require omentectomy. However, in the procedure for harvesting an omental flap, lymph nodes along the gastroepiploic artery (GEA) were left in the stomach for dissection after recovery from mediastinitis; the greater omentum was divided along the outside of the GEA, and was used as a flap based on the left GEA. After mediastinitis was successfully treated, the patient underwent distal gastrectomy and resection of lymph nodes, including those along the GEA. Although indication for omental transfer must be carefully considered when selecting this procedure for mediastinitis patients with malignancies of the abdomen, this technique of harvesting the greater omentum was useful in the present case of a mediastinitis patient with surgical indications of early gastric cancer.

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PubMed2002

A case of fistula of the right common iliac aneurysm to the appendix.

We report a very rare case of spontaneous ilioappendicial fistula with right common iliac aneurysm. After the aneurysm was opened, afferent and efferent vessels were closed following extraanatomical femorofemoral bypass, and the appendectomy was performed. The wall of the aneurysm showed the atherosclerotic change and histologic study of the appendix confirmed the diagnosis of acute appendicitis. Enhanced computed tomography was useful for the diagnosis and the extraanatomical bypass was deemed the most effective operative strategy. The pathogenesis of the fistula was surmised to be related to the appendicitis.

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