Paraneoplastic striatal encephalitis.
Explore the source record for details and available documents.
Brain↗
Biomedical subjects
S Katada
Publications and source records attributed to S Katada.
Plasminogen activators, matrix metalloproteinases and their inhibitors in implanted vascular prostheses.
OBJECTIVES: To examine the role of plasminogen activators (PAs) and matrix metalloproteinases (MMPs) in the healing of prosthetic grafts. METHODS: Thirty explanted grafts (16 Dacron and 14 PTFE) were studied immunohistochemically using antibodies to PAs, MMPs, and their inhibitors. The percentages of immunostain-positive multinucleated giant cells (MGC) were related to duration of implantation (early vs late), type of lesion (stenosis vs false aneurysm), graft material (Dacron vs PTFE), and graft status (occluded vs patent). RESULTS: All specimens were positive for PAs and MMPs. There were no significant differences in the percentages of MGCs positive for PAs, MMPs, or tissue inhibitor type 2 of MMP (TIMP-2) between the groups. The percentage of TIMP-1 in the aneurysm group (mean, 26%) was significantly lower than that of the stenosis group (mean, 46%) (p<0.05). CONCLUSION: After the implantation of a vascular prosthesis, PAs and MMPs are expressed in cell migration, proliferation and matrix construction. Under-expression of TIMP-1 may be related to the formation of an anastomotic aneurysm.
Anastomosis, Surgical↗
Rupture of pseudointima in an implanted vascular prosthesis: immunohistological study of plasminogen activators and matrix metalloproteinases.
We investigated late-onset anastomotic stenosis in an implanted prosthetic graft. Rupture of the pseudointima and hemorrhaging from the vasa vasorum were observed at the border of the collagenous tissue and fibrin layer. An immunohistological study showed that the fibrin layer was positive for tPA, but weakly positive for PAI-1. Some neutrophils and monocyte/macrophages in the fibrin layer were immunostained for tPA, uPA, uPAR, and MMP-1, -2 and -3. Some spindle-shaped cells surrounding the graft were immunostained for uPA, uPAR, MMP-1, -2, -3, -7 and -9, and TIMP-1 and -2. The endothelial cells of some microvessels were positive for MMP-1 and -2, and tPA. Some multi-nucleated giant cells were immunostained for MMP-7 and-9, tPA, PAI-1, uPA, and uPAR. Overexpressed MMPs and PAs possibly caused instability of the pseudointima.
Aged↗
Exclusion of internal iliac arterial aneurysm concomitant with abdominal aortic aneurysm repair.
BACKGROUND: To study the long-term outcomes after exclusion of internal iliac arterial aneurysm performed concomitantly with abdominal aortic aneurysm repair in patients with ruptured aortic aneurysm or other high-risk conditions. METHODS: The 31 patients who participated in this study underwent emergency (N = 9) or elective surgery (N = 22). The abdominal aortic aneurysm and the common iliac artery were excluded together with the internal iliac aneurysm in 7 patients. Forty-three (12 bilateral and 19 unilateral) internal iliac aneurysms were excluded: 35 by proximal ligation only, 5 by proximal and distal ligation, and 3 by partial resection of the proximal part of the aneurysm. The platelet count and fibrinogen level were evaluated pre- and postoperatively. Pelvic organ ischemia, classed as ischemic colitis, buttock claudication and sexual dysfunction, was examined. RESULTS: The inferior mesenteric artery was reimplanted in 21 patients. The platelet count dropped significantly postoperatively, but the fibrinogen level increased and no bleeding tendency was noted. Ischemic colitis occurred in 7 patients, resulting in colonic infarction in 2 patients. The operative mortality was 16%, and the postoperative observation periods ranged from 4 days to 217 months (mean, 60 months). The incidence of buttock claudication and sexual dysfunction was 12% and 39%, respectively. The excluded aneurysms were all thrombosed at discharge, and no late rupture was noted. The 5- and 10-year survival rate after surgery was 56% and 51%, respectively. CONCLUSIONS: Exclusion of the internal iliac aneurysm concomitant with abdominal aortic aneurysm repair shows acceptable outcome when performed in patients with high-risk conditions.
Aged↗
Prevention of spinal cord ischemia by selective intercostal arterial infusion of prostaglandin E1.
PURPOSE: A new protective method against the spinal cord ischemia that occurs during aortic clamping was investigated in dogs. Oxygenated blood containing prostaglandin E1 (PGE1) was administered at the clamped aortic segment, and the effect was evaluated by measurement of the sensory evoked spinal potential (SESP). METHODS: In 30 dogs, a thoracotomy was made with dissection of the thoracic aorta. After intravenous heparin (100 units/kg) was administered, the proximal and distal descending thoracic aortas were cross-clamped for 60 minutes. Group A (n=10) received oxygenated blood at the rate of 1.0 ml/kg/min. Groups B (n=10) and C (n=10) received oxygenated blood at the same rate, with PGE1 at the dosage of 25 and 50 ng/kg/min, respectively. The infusion was continuously administered throughout the entire period of ischemia. SESP was measured with epidural electrodes before clamping, 10 and 60 minutes after clamping, and 10 and 60 minutes after declamping. Neurologic outcome was assessed at 24 hours after the operation and graded according to the method of Tarlov. RESULTS: There was no significant hemodynamic change in any group. At 60 minutes after damping and at 10 and 60 minutes after declamping, the amplitude of SESP was lower than that at preclamping in groups A and B (p < 0.05). At 60 minutes after damping and at 10 and 60 minutes after declamping, the SESP was more markedly decreased in group A compared with groups B and C. Regarding postoperative neurologic outcome, the dogs with SESP amplitude of more than 50% of the preclamping control value at 60 minutes after clamping showed neither paralysis nor paraplegia. Seven of nine dogs with less than 50% SESP amplitude showed neurogenic deficit. In a comparison of groups A, B, and C, the Tarlov score for group A dogs was significantly lower than that for group C dogs (p < 0.05). CONCLUSION: In this model, PGE1 administration at the rate of 50 ng/kg/min showed sufficient spinal cord protection against ischemia without a decrease in the blood pressure. Further studies are needed to determine the dose that will provide the maximal protective effect and to determine the maximum duration of ischemia against which PGE1 shows protective effects.
Alprostadil↗
Branched graft technique for middle aortic syndrome. Three case reports.
BACKGROUND: Middle aortic syndrome is a rare disease caused by stenosis of the distal thoracic and abdominal aorta involving the visceral and renal arteries. METHODS: We performed reconstructive bypass surgery for three middle aortic syndrome patients. We used magnetic resonance angiography as well as conventional angiography to assess the stenotic vessels. According to these data, branched graft was fabricated preoperatively. We selected Dacron for aortic bypass graft, and ePTFE for the branch graft. In previous reports, branched graft was not applied for the surgery for middle aortic syndrome. RESULTS: Using this branched graft, the clamping time and ischemic time of the organs were shortened. CONCLUSIONS: Using branched graft prefabricated according to accurate preoperative angiographic findings, the reconstructive surgery is thought to proceed more safely.
Adult↗
Thyroid nodules: evaluation with US-guided core biopsy with an automated biopsy gun.
To evaluate the efficacy of ultrasound (US)-guided automated core biopsy of thyroid nodules, 74 biopsies were performed in 61 consecutive patients with an 18-gauge short-throw (1.1-cm excursion) biopsy gun. Results were correlated with diagnoses made at surgery (n = 38) or at sonographic follow-up of at least 6 months (n = 36). Sensitivity, specificity, and accuracy of diagnoses made with automated core biopsy were 84%, 95%, and 91%, respectively. US-guided biopsy with an automated biopsy gun allowed accurate assessment of thyroid nodules.
Adult↗
[A case of completion pneumonectomy with carinal wedge resection after sleeve upper lobectomy for right lung cancer].
A 58-year-old man underwent sleeve upper lobectomy for squamous cell carcinoma of the right lung in April 1993. Eleven months after the operation, local recurrence at the bronchial suture line was detected by bronchoscopy. As the patient declined our proposal for performing reoperation, the recurrent tumor was treated with concurrent radiotherapy and chemotherapy, which resulted in only minimal response. After these treatment, the tumor was still localized at the right pulmonary hilus with no distant metastasis, and patient's pulmonary function was preserved good enough to undergo reoperation. Therefore, with a patient's consent to reoperation, we performed completion pneumonectomy with carinal wedge resection in September 1994. Pedicled serratus anterior muscle flap was applied to the suture line in order to prevent anastomotic complications. Postoperative course was uneventful except for pneumonia, and the anastomosis had healed well. As of March 1997 the patient is alive with no evidence of tumor recurrence. Completion pneumonectomy with carinal resection carries a high risk of operative morbidity and is seldom indicated. We reported a patient underwent this procedure for recurrent lung cancer and discussed about its indication and procedure.
Carcinoma, Squamous Cell↗
[A case of groove pancreatitis with duodenal stenosis].
Explore the source record for details and available documents.
Chronic Disease↗
Cavernous lymphangioma of the spleen in a patient with Klippel-Trenaunay-Weber syndrome.
A 31-year-old woman presented with hypertrophy of the left upper extremity and thrombocytopenia. Physical examination revealed splenomegaly, and laboratory investigation revealed thrombocytopenia, elevation of cross-linked fibrin degradation products (XDP), and thrombin-antithrombin III complex (TAT). A diagnosis of Klippel-Trenaunay-Weber (K-T-W) syndrome was established by the dermatologic findings and angiography of the extremities. A splenic cavernous lymphangioma was diagnosed by ultrasonography and angiography, and was confirmed by pathology following splenectomy. Post-operatively, the platelet count increased, and hemostatic parameters normalized. Cavernous lymphangioma is a rare complication of Klippel-Trenaunay-Weber syndrome. Splenectomy proved to be an effective therapy for both cavernous lymphangioma and consumptive coagulopathy in Klippel-Trenaunay-Weber syndrome.
Adult↗
[Granular cell tumor].
Explore the source record for details and available documents.
Granular Cell Tumor↗
[Granular cell tumor].
Explore the source record for details and available documents.
Granular Cell Tumor↗
Reconstruction of jugular and portal blood flows using remodeled great saphenous vein grafts.
Remodeled great saphenous vein grafts were used to reconstruct both jugular and portal veins. The great saphenous vein was split longitudinally and sutured side-to-side to construct a vessel twice the diameter and one half the length of the original vessel. This graft was used with good results for reconstruction of the jugular veins in a patient after a bilateral neck dissection for tongue cancer and for a portal vein in a patient after resection for cancer in the head of the pancreas.
Adult↗
[Combined resection of the aortic wall in T4 lung cancer under the assistant devices].
Radical operation for T4 lung cancer is technically difficult. We report here 3 cases of T4N0M0 lung cancer involving aorta or left subclavian artery which was successfully operated on. We could carry out combined aortic resection more safely and speedy under the assistant devices, such as Anthrontube and Biomedicus Centrifugal Pump. Even T4 lung cancer having aortic invasion with N0 disease can be operated on and be expected long-term survival using these assistant devices.
Adenocarcinoma↗
[Brain dysfunction after operation of aortic arch aneurysm].
Postoperative brain dysfunction was studied for 18 patients who survived more than 30 days after operations of aortic arch aneurysms. The operative procedures were graft replacement in 12 patients, resection with direct or patch closure in 3, and thromboexclusion in 3. Except for thromboexclusion, adjuncts were used: temporary bypass in 1, partial EPC (extracorporeal circulation) in 2, and selective cerebral perfusion during EPC in 12. As for intra-operative monitoring, the temporal artery blood pressures were more than 50 mmHg in all, but the electroencephalogram changed to flat wave just after clamping the aorta in one patient. Postoperative brain dysfunction occurred in 5 patients, including temporary loss of consciousness in 2, lasting loss of consciousness in 1, and paralysis with loss of consciousness in 2. Postoperative brain dysfunction occurred more often in old aged men with atherosclerotic aneurysms. Patients with temporary brain dysfunction had no remarkable change in CT scan, but patients with lasting brain dysfunction had low density areas. It is recommended to prevent this complication as follows: 1) pre-operative evaluation of cerebral vascular disorders, 2) gentle maneuver of atherosclerotic lesions, 3) bilateral cerebral perfusions and intra-operative monitorings, 4) intensive perioperative care of circulation and respiration.
Adult↗
[Hyperbaric oxygenation therapy for chronic occlusive arterial diseases of the extremities].
Therapeutic effects of hyperbaric oxygen therapy (HBO) in 50 patients with chronic occlusive arterial diseases were studied with determination of the transcutaneous oxygen pressure (TcPO2), plasma lipid peroxide level, and plasma superoxide dismutase (SOD) level. Necrosis or ulceration was present in 30 patients, rest pain without tissue loss in 6, infection and necrosis in 2, infection of the amputated stump in 2, delayed healing of the amputated stump wound in 8, and delayed union of bone fractures in 2. HBOs were carried out in 2-3 absolute atmospheres for 60 min for 3-40 times (mean, 12.7 times). In combination with HBO, sympathetic denervation was performed in 41 patients, and PGE1 infusions were administered in 46. Of patients with necrosis or ulceration, 16 were healed, 13 were improved, and one was unchanged. Of patients with rest pain, 5 had relief and one was unchanged. All patients with infection were cured. Of patients with delayed healing of amputation wounds, 7 were healed and one required reamputation. All patients with bone fractures obtained bone union. The TcPO2 markedly increased during HBO and remained at a high level for some time after HBO. The lipid peroxide and SOD levels were not changed significantly by HBO.
Adult↗
[A case of successful surgical treatment of DeBakey IIIb dissecting aortic aneurysm with the true lumen obstruction of the thoracic descending aorta].
A case of successful surgical treatment of DeBakey IIIb dissecting aortic aneurysm with the true lumen obstruction of the thoracic descending aorta is presented. A 64-year-old male was admitted to our hospital with a complaint of severe chest and back pain. Immediately antihypertension therapy was carried out. But, after 14 days, acute renal failure was occurred by the true lumen obstruction of the thoracic descending aorta. On the 78 days after hospitalization, the flow reversal thromboexclusion by ascending aorta-abdominal aorta bypass and permanent aortic clamping was done. The reasons why this procedure was selected are as follows: 1) widely extended dissection, 2) renal failure, 3) poor pulmonary function, 4) left hemiparesis due to apoplexy. The post-operative course was excellent, paraplegia did not occur and renal function improved very well. The post-operative CT revealed thrombi formation within the thoracic descending aorta.
Aortic Dissection↗
[Revascularization with the branched graft in middle aortic syndrome].
A case of middle aortic syndrome which was thought to be the thoracoabdominal type of Takayasu's disease was successfully treated with the branched graft bypass. Patient was a 23 year-old woman with hypertension and abdominal pain. The preoperative angiography revealed aortic stenosis from the celiac axis to the left renal artery. The operative procedures were as follows; patient was positioned in supine with her left shoulder and arm raised. Eighth intercostal thoracotomy and midline laparotomy was performed with the thoracoabdominal incision. The branched graft was made previously with woven Dacron (phi 18 mm) and three EPTFEs (phi 8mm). The woven Dacron of the graft was used for the bypass from the descending thoracic aorta to the infrarenal abdominal aorta, and the branched EPTFEs of the graft were used for the bypasses to the common hepatic artery, the superior mesenteric artery and the right renal artery in this order. The bypasses were placed along the anatomical courses in the retroperitoneal space. Postoperatively, the blood pressure dropped and the abdominal pain disappeared. The plasma renin activity decreased and the renal function improved. Two months after operation the bypasses were patent by the angiography and now six months after operation she has returned to her social life healthily. The approach to the aorta and its abdominal branches by thoracotomy and laparotomy and bypass with the three branched graft was useful for middle aortic syndrome.
Adult↗