PubMed Health⌕ Search

Biomedical subjects

M Sawazaki

Publications and source records attributed to M Sawazaki.

At least 19 recordsLinked to original sources
PubMed2003

[Usefulness of semi-skeletonized right gastroepiploic artery].

The right gastroepiploic artery (RGEA) could be harvested easily and safely by using an ultrasonic scalpel. It is easier and faster not to remove a satellite vein from RGEA than to skeletonize it fully. And blood flow of the vein is important, because it is the flow of vasa vasorum of RGEA. Among 70 patients who have bypassed to right coronary arteries (RCA), 25 patients were treated with semi-skeletonized RGEA (SSK-RGEA), the other 45 patients were operated with pedicled RGEA or (if pedicled RGEA was short and small) with the other grafts. An availability of SSK-RGEA for RCA was 100%. And that of pedicled RGEA was 47% (p < 0.001). Twenty-eight patients were operated without a pump. Twenty-three of them (82%) were bypassed with RGEA. In the on-pump cases (42 patients), RGEA were used for 13 (31%) cases (p < 0.05). Early post-operative angiographies revealed 1 occlusion. But the site of occlusion was the origin of RGEA branch from a gastro-duodenal artery, and the anastomotic site was patent. This graft was supposed to be occluded post-operatively by arteriosclerosis. Flow competition occurred in two grafts. In conclusion, the SSK-RGEA was useful for RCA bypass grafting. The reliability of RGEA should increase the indication of off-pump coronary artery bypass grafting.

Cardiopulmonary Bypass↗
PubMed2001

[Pitfall in the choice of the in situ arterial grafts in OPCAB].

Flow capacity with arterial grafts which have been used in off-pump CABG has been discussed. To analyze the hypoperfusion syndrome when in situ arterial grafts are selected, we made the simple mathematical model which consisted of two vessels with in parallel. We speculated the flow capacity of the various grafts, and flow distribution in the distal coronary artery, based on Poiseuille's law. This theoretical model clearly demonstrated that hypoperfusion syndrome occurred in reoperative coronary bypass grafting had a close relation with the diameters and lengths of bypass grafts.

Blood Viscosity↗
PubMed2000

Management of suspected nosocomial infection: an audit of 19 hospitalized patients with septicemia caused by Bacillus species.

From April to August of 2000, Bacillus spp. were detected in the blood culture of 29 patients in a hospital in Japan. Of these patients, 19 had clinical signs of septicemia; positive culture in the remaining 10 patients was attributed to contamination with skin flora at the site of puncture. Of the 18 strains evaluated, 15 were Bacillus cereus, 2 were Bacillus subtilis, and one was Bacillus licheniformis. The only hospital death observed was that of a patient who had no clinical signs of septicemia at the time of blood sampling. That death is now considered attributable to the underlying neoplasm. The hospital committee for prevention of nosocomial infection concluded after a critical review of the patient records that the cause of septicemia in most cases had been contaminated intravenous lines. To control the situation, the committee recommended the use of a new skin disinfectant, and medical personnel were advised to avoid infusion pauses with interruption of intravenous lines and to replace the caps for the stopcocks with new ones each time the caps were removed. These measures were rigorously observed in addition to the conventional measures for preventing catheter sepsis, and the incidence of septicemia due to the Bacillus spp. declined dramatically thereafter.

Adult↗
PubMed1998

Results of omental flap transposition for deep sternal wound infection after cardiovascular surgery.

OBJECTIVE: Our experience with omental flap transposition in the treatment of deep sternal wound infections is reviewed here with an emphasis on efficacy, risk factors for in-hospital mortality rates, and long-term results. SUMMARY BACKGROUND DATA: Even with improvements in muscle and omental flap transposition, the timing of closure and the surgical strategy are controversial. METHODS: Forty-four consecutive patients with deep sternal wound infections were treated using the omental flap transposition from 1985 through 1994. The strategies included debridement with delayed omental flap transposition or single-stage management, which consisted of debridement of the sternal wound and omental flap transposition. Methicillin-resistant Staphylococcus aureus was cultured from more than 50% of the wounds. A logistic regression analysis was used to identify the predictors of in-hospital death after omental flap transposition. RESULTS: There were seven (16%) in-hospital deaths. Univariate analysis demonstrated that hemodialysis and ventilatory support at the time of omental flap transposition were significantly associated with in-hospital mortality rates (p = 0.0023 and p = 0.0075, respectively). Thirty-seven patients whose wounds healed well were discharged from the hospital. Two patients with cultures positive for methicillin-resistant Staphylococcus aureus had recurrent sternal infections. Patients without positive methicillin-resistant Staphylococcus aureus cultures had good long-term results after reconstructive surgery. CONCLUSIONS: Transposition of an omental flap is a reliable option in the treatment of deep sternal wound infections, unless the patients require ventilatory support or hemodialysis at the time of transposition.

Adult↗
PubMed1996

[Valve replacement concomitant with anulus reconstruction].

It is important that surgical treatment of infective endocarditis involves complete debridement of the affected tissue. In case of abscess formation in the mitral anulus and/or aortic root, disruption of the anulus occurs because of radical resection of the abscess. David et al. reported a new technique for mitral and aortic anulus reconstruction. The novel part of the technique was the endocardial repair, i.e., suturing of a pericardial patch to the endocardium of the left ventricle. We were surprised to learn that the left ventricular endocardium and muscle are capable of tolerating the stress induced by the prosthetic ring, especially in the mitral position. Since 1992, we treated eight cases of anulus disruption using this technique ; 5 cases involved the mitral anulus, 1 involved the aortic, and 2 involved both. We used a slightly different technique involving suturing of a patch not only to the left ventricular endocardium but also to left atrial wall for reinforcement. Two patients died in the perioperative period. One had a brain abscess ; the other had methicillin-resistant Staphylococcus aureus sepsis and mediastinitis. There was 1 late (sudden, unknown) death 3 years after the operation. No perivalvular leakage, dehiscence of the patch, hemolysis, prosthetic valve endocarditis, or thromboembolism have been observed in the other 5 patients.

Abscess↗
PubMed1995

Left atrial function after Cox's maze operation concomitant with mitral valve operation.

BACKGROUND: This study examined whether the atrial fibrillation that commonly occurs in patients with a mitral valve operation could be eliminated by a concomitant maze operation. METHODS: Left atrial function after Cox's maze operation performed concomitantly with a mitral valve operation was evaluated in 10 patients ranging in age from 38 to 67 years (mean age, 54 years). Seven patients who had had coronary artery bypass grafting served as the control group. Using transthoracic echocardiography, the ratio between the peak speed of the early filling wave and that of the atrial contraction wave (A/E ratio) and the atrial filling fraction (AFF) were determined from transmitral flow measurements. These two indices have been considered to represent the contribution of left atrial active contraction to ventricular filling. RESULTS: The A/E ratio and the AFF were significantly lower in the maze group (0.35 +/- 0.17 versus 0.97 +/- 0.28 [p < 0.01] and 17.6% +/- 8.8% versus 36.8% +/- 6.4% [p < 0.01], respectively). The A/E ratio and the AFF correlated inversely with age (r = -0.72, p < 0.05 and r = 0.76, p < 0.05, respectively) in the maze group. In an angiographic study, the mean left atrial maximal volume index in the maze group was approximately three times larger than that in the control group (117.5 +/- 24.3 mL/m2 versus 35.3 +/- 6.6 mL/m2 [p < 0.01]). The left atrial active emptying volume index was significantly smaller in patients in the maze group (7.2 +/- 2.5 mL/m2 versus 13.1 +/- 4.6 mL/m2 [p < 0.01]). CONCLUSIONS: After the maze procedure performed concomitantly with a mitral valve operation in patients with a dilated left atrium, left atrial contraction is detectable but incomplete in the elderly.

Adult↗
PubMed1995

[Repair of mitral valve prolapse by resection and sliding plasty].

There have been many techniques applied to the repair of mitral valve prolapse, and the method used in a particular case is usually selected according to the position and extent of the lesion. To simplify and standardize the technique of mitral valve repair, we have adopted the resection, sliding plasty and ring annuloplasty methods since December 1992. Of 10 consecutive surgical cases, 2 involved prolapse of the anterior leaflet, 1 the posteromedial commissural, and 7 the posterior leaflet. One patient with posterior leaflet prolapse required valve replacement due to dehiscence of the plastied site on the 3rd postoperative day, and one died because of sepsis. However, the remaining patients were doing well without mitral regurgitation at a mean of 20 months (range: 8-32) after the operation. The advantages of these techniques include easy adjustment of the height of the leaflet and a good chance of long-term durability, since the affected lesion is resected.

Adult↗
PubMed1995

[Surgical repair of post-infarction ventricular septal defects--reconstruction with pericardial patch].

Despite improvements in the pre- and postoperative management of patients with post-infarction ventricular septal defects, the results after surgery have been variable. This is in part due to advanced patient age, multi-vessel coronary disease. In addition, resection of the infarcted ventricular septum results in significant compromise in left ventricular function. Since January of 1993, we have used a new technique for the reconstruction of the left ventricle using a single pericardial patch. In this method, which was introduced by Komeda and David in 1990, a single patch is sutured to the interventricular septum and the lateral ventricular wall, excluding the infarcted muscle from the left ventricular cavity. This method was used in the treatment of four patients. There was no bleeding along the suture lines at operation, all of the patients survived. Postoperatively, all four were functional New York Heart Association Class 1. One patient underwent re-operation on the 12th day using the same technique because of a residual shunt. Another two patients had small residual shunts, which spontaneously resolved in 2 to 7 months. Left ventricular function evaluated 1 month after the operation utilizing cardiac catheterization revealed a mean stroke volume index of 40 (range: 32-45 ml/m2, and a mean left ventricular ejection fraction of 71 (range: 70-73%). An excellent functional outcome has thus been achieved with the reconstruction of post-infarction ventricular septal defects using a single pericardial patch.

Aged↗
PubMed1994

New modification of a mammary artery retractor.

A new accessory instrument to the self-retaining internal mammary artery retractor was developed. This instrument presses the chest wall inward, relieves the concavity of the inner surface of the chest wall, and provides good exposure of the internal mammary artery.

Equipment Design↗
PubMed1994

[Reoperation for complications of mitral valve surgery].

Among the early postoperative complications of mitral valve surgery. Mitral Regurgitation (MR) is one of the most dangerous complications, which has to be diagnosed and to be treated as early as possible. Four reoperations-two of which are of paraprosthetic regurgitation, and two of recurrent MR after mitral valve plasty-are reported. Their clinical courses and transesophageal echocardiographic findings are shown. And the differences their MR has when it is compared with the physiologic MR of the prosthetic valve and with the acceptable MR after mitral valve plasty are described.

Aged↗
PubMed1994

Resection of aortic aneurysms without aortic clamp technique with the aid of hypothermic total body retrograde perfusion.

Aneurysms involving either the aortic arch or the proximal descending thoracic aorta in five patients were resected with the aid of profound hypothermic total body retrograde perfusion. Traditional surgical management of the aortic arch and the descending thoracic aorta necessitates clamping of the aorta. However, this technique may be associated with rupture or atheroembolism. Rupture occurring at the clamping site may be difficult to repair. Atheroembolism to the brain compromises the neurologic system, and multiple organ embolism is associated with disseminated intravascular coagulopathy. Atheroembolism in cardiovascular surgery has become increasingly prevalent. It is necessary to prevent clamp injuries and to preserve the function of the vital organs, such as the brain, heart, and liver, during aortic reconstruction. We applied a total body retrograde perfusion technique to operations for aortic aneurysms. Total body retrograde perfusion consists of cerebral protection by continuous perfusion through the superior vena cava, intermittent retrograde coronary perfusion through the coronary sinus, and continuous abdominal visceral perfusion through the inferior vena cava. It can yield a relatively bloodless operating field without the need for aortic clamping. We believe this new adjunct offers excellent results in the surgical treatment of aneurysms of the aortic arch or adjacent structures.

Adult↗
PubMed1993

[Safe and accurate coronary artery bypass grafting: combined use with single aortic clamp and retrograde coronary perfusion].

Neurological injury following myocardial revascularization may result from embolization of atheromatous debris from clamping the diseased aorta. The hazards of manipulating and clamping the aorta has been reported in some literatures. The proximal anastomoses with partial occluding clamp is conventional technique, but it may cause neurological injury, aortic tear or traumatic laceration. We developed a technique for coronary bypass grafting with single aortic cross clamp and combined antegrade/retrograde infusion of cardioplegia. Our method allows accurate performance of the proximal anastomosis without partial clamping and adequate protection of myocardium.

Aorta↗
PubMed1993

[Surgical results in diabetics undergoing coronary artery bypass grafting].

Diabetes mellitus is a well-known risk factor in the patients undergoing coronary artery bypass grafting (CABG) and with increasing frequency diabetic patients are referred for CABG. From the fact that the arteriosclerosis is more diffuse and advanced in patients with diabetes, the presence of the diabetic state might be expected to be at risk for CABG. We retrospectively evaluated the surgical results in 91 patients with diabetes mellitus operated on from January, 1985, to June, 1991, compared with a control group of 339 patients during the same period. Compared with nondiabetic patients, diabetic patients had more extensive coronary artery disease and, therefore, received the more number of grafts per patient. However, no difference was noted in the incidence of operative mortality, morbidity and postoperative complication. The incidence of postoperative sternotomy infection was slightly higher, if not statistically significant, in the diabetic patients. Our study demonstrates that patients with diabetes mellitus can be operated on relatively safely.

Aged↗
PubMed1992

Clinical application of total body retrograde perfusion to operation for aortic dissection.

The use of profound hypothermia and total circulatory arrest in the surgical treatment of aortic dissection has previously been reported. However, the safe period of prolonged circulatory arrest with hypothermia remains controversial. We have developed a technique of hypothermic total body retrograde perfusion to achieve systemic organ protection: cerebral protection by continuous retrograde perfusion through the superior vena cava, myocardial protection by coronary sinus infusion, and abdominal visceral organ perfusion by continuous retrograde perfusion through the inferior vena cava. Our technique yields a relatively bloodless operating field and avoids hypoperfusion of vital organs through a false lumen.

Adolescent↗
PubMed1992

Successful resection of a distal aortic arch aneurysm in a patient with Behçet's disease using an "aortic no-touch" technique and hypothermic total-body retrograde perfusion.

Resection of a false aneurysm of the aortic arch in a patient with Behçet's disease was safely performed using an "aortic no-touch" technique. This consisted of: (1) femoral artery and bicaval cannulation, (2) profound hypothermia (below 20 degrees C) by core cooling, (3) retrograde cardioplegia through the coronary sinus, and (4) total body retrograde perfusion via both venae cavae without aortic cross-clamping. The patient showed no evidence of neurological damage and the postoperative course was uneventful.

Adult↗
PubMed1992

[Analysis of preoperative predictors influencing early patency of coronary artery grafts].

Under the recent trend of popular use of arterial grafts, we investigated the predictors of coronary artery bypass graft patency using modified scoring system of Greenlane hospital. A total of 127 grafts including 58 arterial grafts (53 in situ ITA, 3 free ITA, and 3 GEA) and 69 saphenous vein grafts were placed in 43 patients for average of 2.95 grafts per patient during the period from April 1990 to December 1991. Early patency of arterial grafts (98.3%) were significantly better than that of saphenous vein grafts (91.3%) (p less than 0.01). With regard to recipient vessels, both coronary flow-demand score (= score of the size of perfused myocardium x viability index x index of proximal stenotic lesion/3) and distal run-off score influenced early graft patency significantly. It seems that better patency of arterial grafts were reflected on the bias that these grafts were preferentially placed on larger coronary arteries such as the left anterior descending artery, not on the advantage of arterial grafts.

Adult↗
PubMed1992

[Problems and prevention in using arterial grafts for coronary artery bypass grafting].

The arterial graft has proved to be superior to the saphenous vein graft for coronary bypass grafting (CABG), because of its excellent long-term patency. However, there mains controversial on the choice of the arterial grafts. Six hundreds and twenty seven patients who had CABG using both arterial grafts and saphenous vein grafts, operated upon over 11-years period between 1980 and 1991, have been analysed. Some disadvantages and complications associated with the use of arterial grafts were demonstrated in our series. We discussed, the flow capacity, myocardial protection and postoperative complications in using arterial grafts for CABG.

Aged↗