PubMed Health⌕ Search

Biomedical subjects

M Tago

Publications and source records attributed to M Tago.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Two cases of coronary artery bypass grafting associated with antiphospholipid syndrome in systemic lupus erythematosus].

We report two cases of coronary artery bypass grafting (CABG) associated with antiphospholipid syndrome (APS) in systemic lupus erythematosus (SLE). Patient 1, 65-year-old female, who had been treated for SLE with prednisolone for 11 years was transferred to our hospital due to unstable angina caused by stenosis of the left main trunk (LMT) and the left anterior descending artery (LAD). She underwent emergency CABG of the LAD using left internal thoracic artery (LITA). Post operative doppler study demonstrated patent LITA to the LAD. Patient 2, 67-year-old female who had been treated for SLE with prednisolone for 8 years was transferred to our hospital due to acute myocardial infarction caused by stenosis of the LMT and the left circumflex artery (LCX). She underwent emergency CABG of the LAD and the LCX using saphenous vein grafts (SVGs). Post operative angiography confirmed a patent SVG to the LAD and an occuluded SVG to the LCX. In cases of SLE, the frequency of occurrences of ischemic heart diseases is high. Until now, however, there are few instances reported on performing CABG for patients with SLE. We are reporting here our particular cases of APS with SLE, discussing the involvement of APS as causative factor of ischemic heart diseases and related issue of surgical and post surgical antithrombotic treatments.

Aged↗
PubMed1998

High-dose conformal radiotherapy influenced the pattern of failure but did not improve survival in glioblastoma multiforme.

BACKGROUND AND PURPOSE: Although glioblastoma multiforme is clearly radiation-resistant, there is evidence of a dose-dependent response relationship. The purpose of the study was to evaluate the impact of higher dose by rotational multileaf collimator (MLC) conformal radiation therapy. MATERIALS AND METHODS: From 1984 to 1995, 38 consecutive cases with intracranial glioblastoma multiforme were treated using the rotational MLC conformal therapy. There were 25 men and 13 women with a median age of 47 years (12-73 years, mean 46.5 years). Median Karnofsky performance score was 80 (30-100, mean 78.2). Median tumor volume was 64 cc (8-800 cc, mean 110.3 cc). All underwent surgical intervention (only biopsy in 1, partial resection in 13, subtotal resection in 21, and gross total resection in 3). Radiation dose to was 60 to 80 Gy (median 68.5 Gy, mean 68.3 Gy) in 21 patients treated before 1990 and 90 Gy in the 17 patients thereafter. Biweekly i.v. chemotherapy was also administered for both arms. RESULTS: The 1-year, 2-year, 5-year, and 10-year overall survival rates were 75%, 42%, 20%, and 15%, respectively. Univariate analysis showed the initial tumor volume, residual tumor volume, and Karnofsky performance score were statistically significant factors for survival. Only the residual tumor volume was statistically significant by multivariate analysis. The 5-year survival rate of patients with residual tumors of 5 cc or less in volume was as good as 37%. Survival of the 90-Gy Group appeared inferior to that of the Low-Dose Group, though no statistical difference was seen (the 3-year survival was 40% vs. 22%). Local failure was observed in 16 of the 19 recurrences in the Low-Dose Group, whereas it was observed in only 4 of the 13 recurrences in the 90-Gy Group. The difference in pattern of failure was statistically significant. Two patients of the High-Dose Group developed radiation necrosis and one died of it. CONCLUSIONS: The high-dose conformal radiotherapy did not improve survival in the disease, but did change the pattern of failure.

Adolescent↗
PubMed1998

Radiotherapy of bone metastases of a spinal meningeal hemangiopericytoma.

Hemangiopericytoma is a rare tumor arising from pericapillary cells or pericytes of Zimmerman, and can occur anywhere capillaries are found. We describe a patient with a meningeal hemangiopericytoma who was treated with primary surgical resection and experienced multiple bone metastases 20 years after the first treatment. This patient with multiple bone metastases was treated with multiple courses of irradiation and good palliation was achieved.

Adult↗
PubMed1998

Control of epilepsy associated with cerebral arteriovenous malformations after radiosurgery.

OBJECTIVE: To investigate the effect of radiosurgery for symptomatic epilepsy associated with cerebral arteriovenous malformations (AVMs). METHODS: Thirty five patients with unruptured epileptogenic AVMs were studied with a mean follow up of 43.0 months. The duration of epilepsy before radiosurgery ranged from 2 months to 21 years (mean 2.8 years). Fifteen patients showed partial seizures; eight of these had associated secondary generalisation. The remaining 20 patients showed only generalised seizures without preceding focal seizures. RESULTS: At the final follow up examination, 28 patients remained seizure free, whereas seizures continued in seven. Variables significantly associated with continuity of seizures after radiosurgery were the number of seizures before therapy (p<0.01) and duration of epilepsy (p<0.05). According to Engel's classification, the 10 patients with intractable seizures before treatment included five with grade I, four with grade III, and one with grade IV. The frequency of seizures began to decrease several months after radiosurgery; much shorter than the time required for morphological change in the AVMs. CONCLUSIONS: Radiosurgery seems to be beneficial for seizure control in patients with unruptured epileptogenic AVM.

Adolescent↗
PubMed1997

Role of radiosurgery in the management of cavernous sinus meningiomas.

OBJECTIVE: To provide our early experience and philosophy in the utility of radiosurgery in the management of cavernous sinus meningiomas. METHODS: Twenty-five consecutive cases with cavernous sinus meningiomas treated between 1990 and 1995 were reviewed. Three cases were treated with gamma-knife radiosurgery, 15 with preceding surgery and gamma knife, 7 with surgery. Mean follow-up following radiosurgery and surgery were 34.8 and 25.4 months, respectively. RESULTS: The 5-year actuarial tumor control rate following radiosurgery was 85.7% and tumor remission rate was 61.4%. Permanent neurological deterioration after radiosurgery was seen in 1 case (5.9%), whereas newly developed or worsened neurological deficits permanently persisted in 59.1% of patients after surgery. There was a clear correlation between surgical radicality and postoperative morbidity rate. CONCLUSIONS: Gamma-knife radiosurgery is a valuable addition to surgical removal in the treatment of cavernous sinus meningiomas. Combination of non-radical resection and subsequent radiosurgery is recommended to improve treatment-associated morbidity.

Adult↗
PubMed1997

[Gamma knife radiosurgery for metastatic brain tumors: neuropathological report of two autopsy cases and review of literatures].

More than 40,000 cases have been treated with gamma knife radiosurgery, but few neuropathological reports are available. This paper describes two autopsy cases in which the patients had been treated with gamma knife. As these patients died 67 and 24 days after therapy, early neuropathological changes are reported. The first case was a 58-year-old woman diagnosed with multiple brain metastases from breast cancer. One of these lesions, in the medullaoblongata, was irradiated with a gamma knife. Sixty-seven days later, she died from heart failure. The second case was a 69-year-old man diagnosed with multiple brain metastases from lung cancer. One of these lesions, in the pons, was irradiated with a gamma knife. Twenty-four days later, he died from acute renal failure caused by hepatorenal syndrome. In both cases, the irradiated lesions were well demarcated from the undamaged surrounding tissues on light microscopy. Histologically, the tumor cells showed a variety of degenerative changes, such as pyknosis, multinuclear cells, and vacuolar degeneration in the cytoplasm. Fibrosis, more prominent in the first case, was observed spreading in the irradiation field, adhering to the hyalinized and thickened vessel walls. Demyelination was also observed in the first case. As far as we know, this report is the first published description of fibrosis in the radiosurgical irradiation field.

Aged↗
PubMed1997

[Thymic carcinoid: a case report of complete surgical resection using internal mammary artery (IMA) retractor].

Carcinoid tumor of the thymus is a rare tumor and discovered not infrequently at advanced stage. A 56-year-old male was admitted to our hospital with severe chest pain. Chest X-ray film and CT scan, revealed a tumor mass in the anterior mediastinum. The patient underwent extended thymectomy including tumor completely through median sternotomy in combination with partial resection of pericardium, mediastinal pleura and left upper lobectomy using internal mammary artery (IMA) retractor. The microscopic findings of the tumor revealed carcinoid Invasion to pericardium and lung was found microscopically. After the operation he has been treated by radiotherapy and any regrowth of the tumor has never been detected for 32 months. This case who had been undergone complete resection using IMA retractor followed by radiotherapy seemed to have better prognosis. Accordingly, extended thymectomy including tumor should be carried out for thymic carcinoid, and the IMA retractor is useful for complete surgical resection through median sternotomy.

Carcinoid Tumor↗
PubMed1997

[High-dose conformal radiotherapy for glioblastoma multiforme].

The purpose of this study was to evaluate the impact of administering high doses by rotational multi-leaf collimator (MLC) conformal radiation therapy. From 1984 to 1995, thirty-five consecutive cases with glioblastoma multiforme were treated using rotational MLC conformal therapy. There were 23 men and 12 women, with an average age of 45 years (12-73 years). Median Karnofsky performance score was 80(30-100). Median tumor volume was 56 cc (8-800 cc). All patients underwent surgical intervention (only biopsy in one, partial resection in 13, subtotal resection in 18, and gross total resection in three). Radiation dose ranged from 60 to 80 Gy (mean 68.5 Gy) in 21 patients treated before 1991, and was 90 Gy in the 14 patients treated thereafter. Biweekly intravenous chemotherapy was also administered in both arms. The 1-year, 2-year, and 5-year survival rates were 72%, 43%, and 21%, respectively. Residual tumor volume was the only statistically significant factor for survival by multivariable analysis. The five-year survival rate of patients with residual tumors 2 cm or less in diameter was as high as 44%. Local failure was observed in 15 of the 18 patients in the lower dose group, whereas it was observed in only 4 of the 10 patients in the higher dose group. The difference was statistically significant. Rotational conformal therapy in combination with intensive surgical resection showed a favorable outcome. However, increased dose did not lead to higher survival rate.

Adult↗
PubMed1997

[Management of sternal dehiscence following median sternotomy: modified Robicsek technique for sternal dehiscence].

Median sternotomy is the standard incision for surgery of the heart and great vessels. But patients who undergo median sternotomy continue to suffer morbidity and death from sternal wound complications. Recently we have experienced 4 cases of patients with postoperative sternal dehiscence following median sternotomy. We have used a technique of sternal approximation that is a modification of the technique described by Robicsek and associates. We believe this technique should not be used routinely but seems to be useful in the stabilization of complicated sternal dehiscence especially in the presence of multiple cutting through the sternum. The described technique is easy to perform, and its advantage is that it provides good stability in perioperative respiratory management of patient with sternal dehiscence following median sternotomy.

Aged↗
PubMed1996

Gamma Knife radiosurgery for brain stem metastases: two autopsy cases.

Early neuropathological findings were obtained at autopsy in two cases of brain stem metastasis treated with the Gamma Knife. In both cases, light microscopy radiation changes were strictly localized. Residual tumor tissue in the irradiation field showed marked degenerative changes including multinuclear cells, atypical nuclei and vacuolar degeneration. A characteristic finding in the irradiation field was fibrosis associated with hyalinized and thickened vessels. In more peripheral regions, demyelination and vacuolar degeneration were seen. This is the first report demonstrating extravascular fibrosis in the irradiated field following radiosurgery.

Aged↗
PubMed1995

[Two case reports of Stanford type A acute aortic dissection complicated with thrombosed false lumen and saccular aneurysm formation].

We report two cases of successful surgical treatment for Stanford type A aortic dissection with thrombosed false lumen and saccular aneurysm formation. They were admitted to our clinic for severe anterior chest and back pain. Diagnosis was made as a Stanford type A dissection with thrombosed false lumen by chest CT, aortography and cardiac ultrasonography. Aortography showed ulcer like projection (ulp) in the ascending aorta, although flow in false lumen was not visualized. They were initially treated with antihypertensive drugs. Six and eight weeks later, although medical therapy was continued, a saccular aneurysm of the ascending aorta was found to be increased in size rapidly in both cases. Operation performed was the ascending aorta replacement with resection of the saccular aneurysm. The location of the ulp was found to be corresponded with the intimal tear at surgery. The postoperative courses were uneventful. Thus, careful medical follow up and surgical treatment were necessary in these cases. We believe that the ulp represents defect in the intima leading to the clotted false lumen and provides a possible sign of rupture in clinical course of aortic dissection.

Acute Disease↗
PubMed1995

[A case of infective endocarditis with subtotal rupture of the posterior papillary muscle].

We recently experienced a case of infective endocarditis with multiple embolic complications. The patient was a 21-year-old male who was admitted to our hospital with high fever and dyspnea. Echocardiography showed vegetation on the aortic valve, severe aortic regurgitation and mild mitral regurgitation. Abdominal echography revealed large splenic infarction. First we performed aortic valve replacement and splenectomy. But infective endocarditis developed after surgery, and echocardiography revealed severe mitral regurgitation, which has been a change for the worse. After treatment with antibiotics, mitral valve replacement (the second surgery) was performed. Intraoperative findings were confirmative of subtotal rupture of the posterior papillary muscle. Histological examination of the subtotal ruptured muscle revealed presence of coagulation necrosis. The patient is healthy without recurrence of infective endocarditis after the second surgery. It is exceedingly rare to experience a case of surgically treated subtotal papillary muscle rupture due to infective endocarditis.

Adult↗
PubMed1994

[Surgical treatment of atherosclerotic vascular diseases associated with coronary artery disease].

Selective coronary angiography to determine the incidence of coronary artery disease (CAD) has been performed in the 38 patients with atherosclerotic vascular disease. significant CAD was demonstrated in 17 of 23 (73.8%) patients with angina pectoris or previous myocardial infarction, in 4/15 (26.7%) patients who had no clinical evidence of CAD. There were no early and late postoperative death in the 9 patients who underwent simultaneous coronary artery bypass graft and vascular operations or percutaneous coronary angioplasty, on the other hand, there were one early and four late death in the 11 patients who underwent only vascular procedure.

Aged↗
PubMed1990

[Extended hypothermic heart-lung preservation system for cardiopulmonary preservation with retrograde coronary sinus perfusion and lung immersion].

One major restriction of clinical heart-lung transplantation has been the inability to provide extended hypothermic organ preservation. We examined whether core-cooling, retrograde heart perfusion and lung immersion could provide adequate cardiopulmonary preservation. Hence, donor dogs were placed on cardiopulmonary bypass, and rapidly cooled to 15 degrees C. Then heterotopic heart unilateral left lung transplantations were performed. In control group I (n = 5), hearts and lungs were harvested following core-cooling and cardioplegic arrest, and transplanted immediately. In experimental group II (n = 5), heart-lung blocks were similarly excised but stored at 4 degrees C for 12 hours and then transplanted. During preservation, the lungs were immersed in the extracellular solution. For the heart, non-recirculating retrograde coronary sinus perfusion was performed with oxygenated intracellular solution containing perfluorochemicals. Myocardial function determined by the ratio of end-systolic pressure to end-systolic dimension in the experimental group was similar to that in controls. Although pulmonary vascular resistance and extravascular lung water of the experimental group was higher than those in control group, arterial oxygenation was similar in both groups. Thus, extended heart-lung preservation with core-cooling, retrograde heart perfusion and lung immersion technique could be achieved for heart-lung transplantation.

Animals↗
PubMed1990

[A case of primary mediastinal liposarcoma which presents a singular appearance].

An operated case of primary mediastinal liposarcoma is reported. A 71-year-old male who was asymptomatic was unexpectedly pointed out a huge abnormal mass shadow in the mediastinum on the chest roentgenogram, when he caught a common cold. The CT scan showed the singular horseshoe-shaped tumor in the posterior mediastinum which was adjacent to the antero-lateral phase of the vertebrae. MRI was useful to our recognition of its whole shape and localization. Extirpation of the tumor via right postero-lateral thoracotomy was performed successfully. The pathological diagnosis was liposarcoma; well differentiated, lipoma-like type. Primary mediastinal liposarcoma is a very rare mediastinal tumor (0.2%). Thirty-six cases of primary mediastinal liposarcoma including our case have been reported at present in Japan, so far as we surveyed. It is generally known that liposarcoma has the low sensitivity to the radiotherapy and chemotherapy and has high incidence of recurrence. We think that this case needs the strict postoperative follow-up.

Aged↗
PubMed1989

Successful extended hypothermic cardiopulmonary preservation for heart-lung transplantation.

The inability to obtain sufficiently extended hypothermic organ preservation is a major restriction on clinical heart-lung transplantation. We used core cooling, nonrecirculating retrograde heart perfusion, and lung immersion with liposomal recombinant human superoxide dismutase in an attempt to provide effective 12-hour cardiopulmonary preservation. Donor dogs supported by cardiopulmonary bypass were rapidly cooled to 15 degrees C with cardioplegic arrest, and heterotopic heart and unilateral left lung transplantations were performed. In control dogs (n = 7), hearts and lungs, harvested after core cooling and cardioplegic arrest, were transplanted with a total mean ischemic time of 88 +/- 5 minutes. In group II (n = 7), heart-lung blocks were similarly excised but preserved at 4 degrees C for 12 hours (756 +/- 30 minutes) and then transplanted. During preservation, the lungs were immersed in hyperosmolar extracellular solution. For the heart, retrograde coronary sinus perfusion was performed with intracellular solution containing perfluorochemicals at a temperature of 4 degrees C and a rate of 30 ml/hr for 12 hours. In group III (n = 7), donor organs were similarly excised and preserved for 12 hours (726 +/- 39 minutes), except that liposomal recombinant human superoxide dismutase was administered during harvest, preservation, and reperfusion. Myocardial function, assessed by the ratio of end-systolic pressure to end-systolic dimension, after the 12-hour preservation period in both experimental groups was similar to that of the control group 4 and 6 hours after transplantation. The mean arterial oxygen capacity of the transplanted left lung during ventilation with an inspired oxygen concentration of 40% was also similar in each group. In contrast, the 12-hour preservation of pulmonary function assessed by pulmonary vascular resistance, the accumulation of extravascular lung water, and histologic evidence of alveolar wall injury, interstitial edema, and perivascular hemorrhage were significantly impaired in the absence of liposal recombinant human superoxide dismutase. These findings suggest that successful extended cardiopulmonary preservation for heart-lung transplantation is possible with core cooling, nonrecirculating retrograde heart perfusion, and hypothermic lung immersion incorporating liposomal recombinant human superoxide dismutase.

Animals↗
PubMed1989

[High energy phosphates and mitochondrial respiratory function after 24 hours cardiac preservation--comparison between simple hypothermic immersion and continuous hypothermic perfusion].

Cardiac preservation is one of the most important step during heart transplantation. Prolonged preservation period is necessary to get the greater donor pool. To get safe prolonged preservation two methods, simple hypothermic immersion method (group A) and continuous hypothermic perfusion method (group B), were compared in this report by evaluating the myocardiac high energy phosphate level and mitochondrial respiratory function. The values of ATP, TAN and Energy charge were significantly higher in group B than group A (p less than 0.001). Mitochondrial respiratory function such as state 3 QO2, state 4 QO2, RCI and ADP/O also showed significantly higher values in group B than group A (p less than 0.001). These date indicate that continuous hypothermic perfusion method provides better preservation than simple hypothermic immersion method for 24 hours cardiac preservation.

Adenosine Triphosphate↗