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Biomedical subjects

M Funami

Publications and source records attributed to M Funami.

At least 19 recordsLinked to original sources
PubMed1996

The retroperitoneal approach to aortoiliac surgery associated with a horseshoe kidney: report of a case.

The presence of a horseshoe kidney associated with aortoiliac vascular disease poses technical difficulties in terms of vascular reconstruction. The renal isthmus, position of the renal pelvis and ureters, and variable blood supply to the horseshoe kidney can complicate aortoiliac reconstruction. The left retroperitoneal approach provides excellent exposure of the abdominal aorta in patients with a horseshoe kidney without dividing the renal isthmus and avoids the risk of injury to a ureter in an anomalous position. We herein report the case of a patient with a horseshoe kidney who underwent a successful reconstruction of aortoiliac vascular disease using the left retroperitoneal approach.

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PubMed1995

Spontaneous rupture of the iliac vein: report of a case.

We report a rare case of a spontaneous rupture of the iliac vein which was then surgically treated with good results. A 66-year-old woman was admitted complaining of leg swelling and lower abdominal pain. On the 3rd day after admission, an operation was performed because of a gradually increasing hematoma in the retroperitoneal space. Laparotomy revealed a 17 mm longitudinal tear on the anterior surface of the left external iliac vein with a thrombus inside the lumen. Most of the previously reported 14 cases of this nature have required emergency operations.

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PubMed1995

[Coronary artery disease in patients with abdominal aortic aneurysm].

To evaluate the influence of coronary artery disease (CAD), we reviewed 102 patients who underwent elective repair of abdominal aortic aneurysm (AAA) between 1982 and 1992. Prior to surgery, all patients underwent clinical evaluation for the presence of CAD including dipyridamole thallium scintigraphy. They were classified into the following groups: Group I (n = 66), no clinical evidence of CAD; Group II (n = 26), clinical evidence of stable CAD; Group III (n = 10), unstable CAD. Coronary angiography (CAG) was performed in group II and group III patients only. All patients in group I and group II underwent elective repair of their AAA without coronary revascularization. Eight patients in group III underwent CABG followed by elective AAA repair within two months. One of two patients who had impending ruptured AAA underwent combined CABG and AAA repair as a single operation and the other underwent AAA repair followed by CABG. One case of perioperative myocardial infarction occurred in group II, but there was no early postoperative death related to cardiac disease in group I and II. In group III, however one patient who underwent combined surgery died of low-output syndrome in the early postoperative period, no death or myocardial infarction occurred following staged operation in the other nine patients. This present results support the contention that CAG is not necessary in all AAA patients, and that they can be managed according to appropriate risk by a selective approach based upon clinical assessment of their CAD. It is also apparent that a staged operation can be performed very safely in patients with unstable CAD.

Adult↗
PubMed1994

[Dissecting aortic aneurysms that occurred in aged brothers without Marfan syndrome].

The occurrence of familial dissecting aortic aneurysms without Marfan syndrome is rare. This report describes two aged siblings who underwent successful surgery for this disease. Neither patient had the clinical features of Marfan syndrome, and both had histories of systemic hypertension. Case 1: A 76-year-old man had dissecting aortic aneurysm, DeBakey type IIIa, which was localized and had multiple lumina with thrombi. Case 2: A 71-year-old man (younger brother of case 1) had retrograde dissecting aortic aneurysm, DeBakey type IIIa. Histological examinations of the aortae showed cystic medial necrosis in both cases, and also showed atherosclerotic changes in case 1. These two siblings had no familial history of cardiovascular incidents and were much older than previously reported cases. Therefore it may be possible that the dissecting aortic aneurysms of these two cases occurred coincidently rather than due to hereditary factors.

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PubMed1994

[A case of mediastinal malignant lymphoma; 16 years follow up after surgery].

A 32-year-old female was admitted to our hospital on September 1976 because of left mediastinal mass shadows on chest roentgenogram. Needle biopsy studies provided no definitive diagnosis, and exploratory operation was carried out through left postero-lateral thoracotomy. Two large masses were seen in the mediastinum and five small tumors were seen on the diaphragm. All of these masses were removed. Histopathological examination of the tumors indicated non-Hodgkin's lymphoma, diffuse small cell type. Radiation therapy was carried out postoperatively, but chemotherapy could not continue because of side effect. Eight years after surgical therapy, recurrence was seen at left parietal pleura, ten years at peritoneum, twelve years at left parietal pleura, thirteen years at upper mediastinal lymph node, 16 years at post-peritoneal space. These tumors disappeared after radiation therapy. She is doing well seventeen years after the surgery.

Adult↗
PubMed1993

[Single selective cerebral perfusion for aortic arch replacement].

The patients underwent aortic arch replacement for aneurysmal disease from 1988 to 1993 using a simplified cardiopulmonary bypass (CPB) technique with single selective cerebral perfusion (single SCP). Recently cold cerebral perfusion technique was also used. In order to study the effect of this technique, we monitored bilateral carotid artery pressure, blood oxygen saturation of jugular vein and brain oxygenation by near infrared spectroscopy during CPB. Of the ten patients with arch aneurysm, five had urgent operation for ruptured aneurysm. The cold single SCP was accomplished by perfusion to the right axillary artery using separate pump and separate heat exchanger (flow 10-15 ml/kg/min, pressure 40-60 mmHg, perfusion temperature under 12 degrees C) under the low CPB flow (1,000-1,500 ml/min), moderate systemic cooling (23-25 degrees C) and retro-grade cardioplegia. There were no strokes caused by this technique. This simplified technique of cold single SCP was simple and attractive method, provide satisfactory cerebral protection.

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PubMed1991

[Mitral valve replacement in idiopathic hypereosinophilic syndrome].

Idiopathic hypereosinophilic syndrome (IHES) is a rare systemic manifestation of eosinophilia that may cause endocardial fibrosis and thrombus formation. We presented a 48-year-old man with rapid onset of intractable congestive heart failure during the course of chemotherapy for IHES. After the urgent operation, which included left ventricular thrombectomy and mitral valve replacement the patient was asymptomatic, but died 1 month after operation because of development of IHES. Atrioventricular valve replacement may be beneficial to selected patients with congestive heart failure associated with the cardiac process of the IHES and review of the literature led us to prefer porcine heterograft prostheses in patients with IHES.

Eosinophilia↗
PubMed1991

[Combined valvular and coronary artery surgery].

We report 14 consecutive patients who have undergone myocardial revascularization combined with valve surgery during 7 years (1983-1989). There were 7 males and 7 females with a mean age of 53.8 years. All patients had congestive heart failure and 7 had angina pectoris. Coronary angiography revealed single-vessel disease in 6 patients, double-vessel disease in 5, triple-vessel disease in 3. Mitral regurgitation was predominant in 5, aortic regurgitation in 5, mitral stenosis in 3 and aortic stenosis in 1. The indicated operations were: valve replacement in 12 and mitral anuloplasty in 2 with coronary artery bypass grafting (mean 1.6). One operative and 1 late death were seen in our series, however, NYHA functional class was improved from 3.4 to 1.7 postoperative. Postoperative evaluation by UCG showed good recovery of cardiac function (EF, MVcf, LVEDV, CI). No angina pectoris was evident in surviving patients, the quality of life was significantly improved.

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PubMed1991

[A study of glomerular damage due to extracorporeal circulation--meaning and usefulness of measuring of urinary microalbumin].

An increase of excretion of urinary microalbumin (U-Alb) is thought to demonstrate earlier glomerular damage than deterioration of Glomerular Filtration Rate (GFR). In this study, the meaning and usefulness of measuring U-Alb before, during and after Extracorporeal Circulation (ECC) was estimated. In 25 cases of adult cardiac surgery, we measured U-Alb, and simultaneously as current indices of glomerular function, serum and urinary creatinine, blood urea nitrogen, serum beta 2-microglobulin, urine volume, and cardiac output were measured. Albumin Excretion Rate (AER) [U-Alb X urine volume] and Albumin Index (AlbI) [U-Alb/U-Cr] were calculated as indices of U-Alb, and Creatinine clearance (Ccr) was calculated as GFR. The changes of each parameter, the correlation AER and AlbI during and after ECC with parameters that relate to ECC, and the assessment of the prolongation of glomerular damage after operation that possibly progress to acute renal failure were investigated. Our results showed AER and AlbI to increase following ECC with high values maintained during and after ECC, in spite of recovery of Ccr, from 24 hours to 4 days postoperatively. AER and AlbI recovered at 7 days and 14 days after surgery, respectively. The existence of glomerular damage, not indicated by a change in Ccr, was indicated by increases of AER and AlbI. The damage was thought to be temporary glomerular dysfunction. In correlation of AER and AlbI with ECC parameters, ECC of long duration influenced the glomerular damage as indicated by an increase of AER and AlbI.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Nonsurgical retrieval of intra-cardiovascular catheter fragments].

Migrated intra-cardiovascular fragments from broken catheters were retrieved transvenously in 6 cases. In all of these cases, the catheters had been used for total parenteral nutrition. The catheter fragments were lodged in the pulmonary artery in 3 cases and in the right atrium in the others. A basket-type grasping forceps modified for this retrieval technique was inserted via the subclavian vein, femoral vein or basilic vein percutaneously. The migrated catheter fragments were removed successfully without any clinical complications in all 6 cases. Appropriate evaluation of the lodging site and length of the fragment, and careful examination of general condition should be carried out prior to this procedure. This noninvasive maneuver is simple, safe and reliable, and can be promptly. It is considered to be a reliable method of choice in cases of migrated catheter fragment.

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PubMed1988

[Treatment of renal vein thrombosis associated with nephrotic syndrome].

Renal vein thrombosis is a rare entity in which true incidence is unknown. The disease occurs most frequently in patients with nephrotic syndrome, but it also can occur in the presence of other hypercoagulable state. Two cases of renal vein thrombosis with nephrotic syndrome which were treated by thrombectomy are reported here. One patient was successfully treated by renal vein and inferior vena cava thrombectomy before developing severe pulmonary embolism. The other was treated by renal vein thrombectomy by which fatal shock was able to be prevented. In those cases, immediate operation was indicated, primarily to prevent additional, possibly fatal, pulmonary embolism and also to improve perfusion of the kidney. In the hope of salvaging the kidney, thrombectomy may be the treatment of choice for acute renal vein thrombosis, complication of pulmonary embolism and inferior vena cava thrombosis, right renal vein thrombosis without collateral flow and acute renal vein thrombosis with shock.

Adult↗