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Biomedical subjects

N Kutsukata

Publications and source records attributed to N Kutsukata.

6 recordsLinked to original sources
PubMed1999

Combined non-cardiac operations with minimally invasive direct coronary artery bypass grafting.

We report two cases in which Minimally invasive direct coronary artery bypass grafting was followed by other non-cardiac operations in the same operative setting. A left internal thoracic artery-to-left anterior descending artery anastomosis was constructed through a left anterior thoracotomy in both patients. Immediately after Minimally invasive direct coronary artery bypass grafting, one patient underwent a pancreatoduodenectomy for a biliary duct carcinoma and the other patient received a prosthetic graft replacement for an abdominal aortic aneurysm. Minimally invasive direct coronary artery bypass grafting is advantageous in patients with significant coronary artery disease who have to undergo other non-cardiac surgeries.

Aged↗
PubMed1997

[A case of far-advanced gastric cancer treated with neoadjuvant combination chemotherapy of UFT, low-dose CDDP and leucovorin, followed by subtotal gastrectomy with curative intent].

We herein present a case of a 70-year-old man with the tentative diagnosis of far-advanced gastric cancer supposed to be beyond surgical intervention. Neoadjuvant chemotherapy enabled us to perform subtotal gastrectomy with curative intent. The man was admitted to our hospital with the chief complaint of poor appetite. Because preoperative examinations revealed a mass adjacent to the portal vein and common bile duct, which was suspected to be lymphnode metastasis or gastric cancer directly invading those vital structures, 4 weeks of neoadjuvant combination chemotherapy (NACC) (CDDP 10 mg/body, day 1 through day 5/week, UFT 600 mg/body, every day, Leucovorin 15 mg/body, every day) was given with resultant curative resection of the tumor one month after completion of NACC.

Aged↗
PubMed1996

Aortic dissection extending from the left coronary artery during percutaneous coronary angioplasty.

A 72-year-old woman with acute aortic dissection as a complication of percutaneous coronary angioplasty was successfully treated. She received a graft replacement of the ascending aorta as well as triple coronary artery bypass grafts. The dissection had extended from the left coronary artery. Although acute aortic dissection is a rare complication of percutaneous coronary angioplasty, physicians and cardiac surgeons should keep its potential occurrence in mind.

Acute Disease↗
PubMed1995

[Long-term results in valve replacement with Björk-Shiley prosthesis. Analysis of life expectancy by relative survival rate].

Using the U.S. STS guidelines, I analyzed the results of 389 patients who underwent Björk-Shiley valve (BS valve) replacement at Nippon Medical School over the past 15 years. In addition, I calculated their relative survival rates using the Japanese Abridged Life Table and objectively determined the treatment effects by taking into account the patients' postoperative life expectancy. There were 201 male and 188 female patients, whose mean age at the time of surgery was 52 +/- 12 years. Of these, 151 patients underwent aortic valve replacement (AVR); 185 had mitral valve replacement (MVR); and 53, aortic and mitral valve replacement (DVR). Convexo-Concave models (CC models) were used in 94 patients, and Monosrut models (MS models) in 295. Their cumulative follow-up was 2006 patient-years and their average observation period was 5.2 +/- 3.6 years (complete follow-up in 98% of cases). A total of 32 patients suffered an early death, while 36 suffered a late death. At 10 years after surgery, the actual survival rates were 80.3% for patients who underwent AVR; 81.9% for MVR; and 70.7% for DVR, indicating no significant differences among the three groups (NS). Meanwhile, the relative survival rates at 10 years after surgery were 88.6% for patients who underwent AVR; 88.2% for MVR; and 75.4% for DVR, indicating that AVR was superior to DVR (p < 0.001), with MVR rated between the two. No significant differences were seen among the three groups with respect to the occurrence rate of valve-related complications. The most frequent complications' thromboembolism occurred at a rate of 2.29%/patient-years overall. Strut fractures occurred in two patients using the CC models (0.25%/patient-years), but there were no strut fractures among those using the MS models. While the effect of atrial fibrillation on the subjects' life prognoses was unclear (NS), patients often developed complications related to artificial valves (p < 0.025), and their life prognoses were inferior to those of patients with sinus rhythm. Survivors reported marked improvements in their quality of life, and their late survival rates were satisfactory. However, their life expectancy was inferior to that of the normal population.

Female↗
PubMed1995

[Sequential coronary artery bypass grafting utilizing the internal thoracic and gastroepiploic artery as in situ grafts].

36 consecutive patients (male:female = 33:3, mean age 57.3) underwent sequential coronary artery bypass grafting (CABG) utilizing the left internal thoracic artery (LITA, n = 30), right gastroepiploic artery (RGEA, n = 8) as in situ grafts. Two patients received sequential bypass grafting with both grafts simultaneously. No right internal thoracic arteries were used except for one as a free nonsequential graft. Taking into account the adjunctive venous anastomoses and the arterial nonsequential anastomoses, there were 3.5 anastomoses per patients. Proxymal side-to-side anastomosis of LITAs were all constructed on the diagonal branches except for one on the proxymal Left Anterior Descending Coronary Artery (LAD), whereas that of the RGEAs were on the proxymal Right Coronary Artery (RCA) (2), distal RCA (6) or distal circumflex (1). Distal end-to-side anastomoses of LITAs were all on the LAD, and those of the RGEAs were on the distal RCA (3) or distal circumflex artery (5). Proxymal side-to-side anastomoses were always performed first, allowing us to assess the distal flow through the graft before we anastomose it to the distal branch. We routinely obtain a preoperative angiogram of the arterial grafts, which enable us to fully assess the suitability of the arteries as in situ grafts. There were no perioperative deaths, nor perioperative myocardial infarctions, however, two patients died of extracardiac causes at 42 and 68 days after operation respectively. For the thirty four survivors, followup was complete (4-49 months, average 12.3 months). One still had angina of Canadian Cardiovascular Society Classification (CCSC) class 2, and 33 were free of angina.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗