PubMed Health⌕ Search

Biomedical subjects

Shigeyuki Sasaki

Publications and source records attributed to Shigeyuki Sasaki.

At least 19 recordsLinked to original sources
PubMed2007

Occluding the junction of the middle cardiac vein in retrograde cardioplegia: a new retrograde cannula for optimizing retrograde cardioplegic delivery.

Retrograde cardioplegia often fails to provide adequate perfusion of the right ventricle and the posterior wall of the left ventricle because of the shunt through the thebesian vein. However, much of the retrograde cardioplegic solution may leak into the right atrium after veno-venous anastomoses at the apex of the heart, especially when a retrograde balloon cannula is inserted too deeply in the great cardiac vein, although this is not widely recognized. We designed a new retrograde cardioplegic cannula with three self-inflating balloons, which reduced the shunt flow by occluding the junction of the middle cardiac vein and improving in cardioplegic delivery. We describe the myocardial dye distribution achieved by using this new cannula in pig hearts and report the results of its clinical application.

Animals↗
PubMed2006

Head and neck cancer associated with esophageal cancer.

BACKGROUND: Multiple squamous cell carcinomas (SCCs) frequently arise in the aerodigestive tract. This study aims to clarify the incidence of squamous cell carcinoma of the head and neck (SCCHN) in esophageal cancer (EC) and clinical features of SCCHN. METHOD: We reviewed the records of 1118 EC patients treated from May 1995 to December 2001 in our institution. All patients with EC underwent otolaryngological examination and pharyngolaryngoscopy screening before and after its treatment periodically during their follow-up periods. The incidence, site and stage of SCCHNs were analyzed. RESULT: A total of 127 patients had associated SCCHNs among all patients with EC (11.4%). Of these, the index antecedent tumor was SCCHN in 49 and EC in 78 patients. One hundred and fifteen patients developed double cancers (SCCHN and EC), 9 patients developed triple cancers (2 SCCHNs and EC) and 3 patients developed fourth cancers (3 SCCHNs and EC). Of 49 patients with the index SCCHN, 30 ECs were detected metachronously after its treatment (Group A) and 20 were synchronously (Group B). Of 78 patients with index EC, 38 SCCHNs were detected synchronously (Group C) and 54 SCCHNs were metachronously (Group D). The stages of 54 SCCHNs in the Group D were 33, 14, 4, 3 (Stages I-IV, respectively), which was significantly earlier than that of 50 SCCHNs in the Groups A and B (p<0.001). CONCLUSION: The incidence of SCCHN in our EC patients was 11.4%. Periodic otolaryngological examination and pharyngoscopy screening can detect SCCHNs early in patients with primary EC.

Aged↗
PubMed2006

Identification of a novel blue pigment as a melanoidin intermediate in the D-xylose-glycine reaction system.

Some blue pigments were formed in the D-xylose (1 M)-glycine (0.1 M) reaction system. A novel blue pigment, designated as Blue-M2 (blue Maillard intermediate-2), was identified as 5-[1,4-dicarboxymethyl-5-(2,3-dihydroxypropyl)-1,4-dihydropyrrolo[3,2-b]pyrrole-2-ylmethylene]-1,4-dicarboxymethyl-2-{5-[N-carboxymethyl(2,3,4-trihydroxytetrahydrofuran-2-yl)methylamino]-2-hydroxymethyl-4-(1,2,3-trihydroxypropyl)tetrahydrofuran-3-yl}-4,5-dihydropyrrolo-[3,2-b]pyrrole-1-ium. Blue-M2 is presumed to have been generated by the reaction between Blue-M1, which was identified as the major blue pigment in a previous paper (Hayase et al., Biosci. Biotechnol. Biochem., 63, 1512-1514 (1999)), and di-D-xyluloseglycine. Blue pigments are important Maillard reaction intermediates through the formation of melanoidins.

Color↗
PubMed2006

Impact of endoscopic screening on early detection of hypopharyngeal cancer.

BACKGROUND: The aim was to investigate whether periodic pharyngolaryngoscopy screening in high-risk patients with preceding carcinoma of the upper aerodigestive tract can detect early hypopharyngeal cancer and preserve the larynx. METHODS: The records of 122 patients with hypopharyngeal cancer were retrospectively reviewed. Patients were divided into the following two groups: (1) the screening (SCR) group (n = 65), patients whose hypopharyngeal cancer was detected by pharyngolaryngoscopy screening; and (2) the symptom (SYMP) group (n = 57), patients whose cancer was discovered by any symptoms. Patients' demographics and larynx preservation were compared. RESULTS: The number of patients with clinical stage I to IV disease at diagnosis was 44, 14, three, four for the SCR group, respectively, and six, six, 15, 30 for the SYMP group, which was significantly different (p < .0001). The rate of larynx preservation after radical treatment was 79.4% for the SCR group and 45.4% for the SYMP group (p < .001). CONCLUSIONS: Periodic pharyngolaryngoscopy screening in high-risk patients may contribute to detecting early hypopharyngeal cancer. Early detection of hypopharyngeal cancer may enhance the rate of larynx preservation and improve the quality of life.

Aged↗
PubMed2006

Phase I/II study of S-1 combined with carboplatin in recurrent and/or metastatic head and neck cancer as outpatient chemotherapy.

BACKGROUND: The aims of this study were to determine the recommended dose (RD) in combination chemotherapy of S-1 and carboplatin in recurrent and/or metastatic head and neck cancer (phase I) and to examine response rate and toxicities at RD (phase II). METHODS: S-1 was given orally at a fixed dose of 40, 50, or 60 mg twice daily based on the patient's body surface area for 21 days followed by a 14-day rest. In phase I, carboplatin was given intravenously to a cohort of three patients on day 8 at a dose of 2.5, 3.0, 3.5, or 4.0 area under the curve (AUC) values, depending on the dose-limiting toxicities (DLTs). RESULTS: In phase I, the RD was estimated as 2.5 AUC. In phase II, thrombocytopenia and leukopenia were most commonly found as hematologic DLTs, which were manageable without hospitalization. The response rate was 40.9%. CONCLUSIONS: This regimen is considered to be active against recurrent and/or metastatic head and neck cancer in an outpatient setting.

Adult↗
PubMed2006

Laryngoscopic detection of pharyngeal carcinoma in situ with narrowband imaging.

OBJECTIVES: Narrowband imaging (NBI) is a novel optical technique that enhances the diagnostic capability of endoscopes in characterizing tissues by using narrow-bandwidth filters in a video endoscope system. The purposes of this study were to verify the effectiveness of the NBI system in conducting endoscopic screening at the oropharynx and the hypopharynx. METHODS: This study was conducted between July 2005 and August 2005. During this period, 217 consecutive patients with esophageal cancer underwent endoscopic screening of the oropharynx and the hypopharynx with the NBI system at the Department of Otolaryngology, Keiyukai Sapporo Hospital. RESULTS: Among 217 patients, 6 superficial lesions, at the oropharynx (n = 1) and at the hypopharynx (n = 5), were discovered with the NBI system. On conventional electroendoscopic view, four of six lesions could be hardly recognized because of its small diameter measuring 5 mm or less. The NBI view was more beneficial in recognizing the superficial lesions than conventional electroendoscopic view. Endoscopic mucosal resection was performed for all six patients under general anesthesia in the operation room. The histologic examination exhibited a histologically proven squamous cell carcinoma (SCC) in situ. In our series, the NBI system might improve the sensitivity by about twofold over the conventional method. CONCLUSION: NBI may play an important role in the diagnosis of SCCs of the oropharynx and hypopharynx.

Aged↗
PubMed2006

A novel femoral arterial cannula to prevent limb ischemia during cardiopulmonary support: preliminary report of experimental and clinical experiences.

Distal limb ischemia may occur as a serious complication related to the use of femoral cannulation during veno-arterial cardiopulmonary support (CPS). We developed a simple cannula for femoral arterial cannulation with two holes in the side wall, which could provide the distal limb blood flow without additional cannulation or surgical procedure. This cannula can be inserted into the femoral artery by routine Seldinger technique. The distal blood flow from the side holes can be confirmed by Doppler detector without specialized techniques. In porcine experimental model, the distance between the position where the blood flow was first detected and those where the blood leakage took place was at least more than 10 mm. When this cannula and its side holes were adequately positioned, the mean distal limb flow ranged from 75 to 90 mL/min under CPS at a flow of 1.5 L/min. We employed this cannula for six patients in clinical settings. Three patients showed a good distal limb blood flow at the introduction position without its adjustment. The other three patients showed distal limb ischemia at the introduction position, but the limb ischemia was soon recovered after a slight adjustment of its position. There was no blood leakage from the percutaneous entry into the artery in all cases. We currently use this cannula as the first choice for patients undergoing a prolonged CPS.

Animals↗
PubMed2005

A new device for ensuring the correct length of artificial chordae in mitral valvuloplasty.

Mitral valvuloplasty using Gore-Tex as artificial chordae, especially for patients with anterior leaflet prolapse, is often associated with difficulties in determining the length of artificial chordae as well as in preventing knot slipping. We describe a simple technique of using a new device that enables surgeons to easily determine the accurate length of the artificial chordae and to tie the slippery knot without sliding and damaging it.

Cardiac Surgical Procedures↗
PubMed2005

Chemistry and biological effects of melanoidins and glyceraldehyde-derived pyridinium as advanced glycation end products.

Blue pigments (blue-M1 and blue-M2) and red pigments (red-M1 and red-M2) were generated in a xylose-glycine reaction system. Blue-M2 was identified as an addition compound of di-xylulose-glycine to blue-M1 that involved two pyrrolopyrrole structures. We identified red pigments as isomers of addition compounds of xylulose-glycine to the condensed compound between pyrrolopyrrole-2-carbaldehyde and pyrrole-2-carbaldehyde. These pigments have polymerizing activity, suggesting that they are important Maillard reaction intermediates through the formation of melanoidins. Melanoidins induced IFN-gamma and IL-12 expression in spleen cells exposed to allergen and in macrophages, respectively. These findings suggest that melanoidins have a suppressive effect on allergic reaction as a novel physiological effect. On the other hand, we identified a glyceraldehyde-derived advanced glycation end product (AGE) formed from glyceraldehyde and N-acetylarginine as well as glyceraldehyde-derived pyridinium (GLAP) in physiological conditions. The AGE was identified as 5-methylimidazoline-4-one (MG-H1), which has been reported to be formed from arginine and methylglyoxal. GLAP, which induced reactive oxygen species (ROS) production in HL-60 cells, is supposed to be a toxic AGE, while MG-H1 is a nontoxic AGE.

Glycation End Products, Advanced↗
PubMed2005

Impact of papillary muscles approximation on the adequacy of mitral coaptation in functional mitral regurgitation due to dilated cardiomyopathy.

PURPOSE: We report early outcome of our modified papillary muscles approximation (PMA) as an adjunct to mitral annuloplasty (MAP) by analyzing the mitral coaptation zone echocardiographically and clinical outcome in three different procedures. METHODS: Mitral valve coaptation depth (MVCD) and tenting area were measured in patients with ischemic (n=8) or non-ischemic (n=22) dilated cardiomyopathy (ICM or non-ICM) undergoing either of following: Group I: isolated left ventricular volume reduction (LVVR) (n=11), Group II: PMA plus LVVR (n=14), Group III: isolated PMA (n=5). Clinical outcome including cardiac function were also investigated. RESULTS: Thirty-day mortality was 6.7%. Postoperative data in overall survivors showed significant improvement of ejection fraction (EF) (from 19+/-7 to 32+/-9%), left ventricular end-diastolic volume index (LVEDVI) (from 189+/-74 to 132+/-41 mL/m2), and left ventricular diastolic dimension (LVDd) (from 73+/-8 to 65+/-6 mm) (p<0.001). The overall preoperative MVCD (mm) and tenting area (cm2) was 10.4+/-2.8 and 2.4+/-0.6, respectively, which were both significantly reduced to 5.6+/-2.5 and 0.8+/-2.4 postoperatively (p<0.001). In comparison of the degree (%change) of improvement, Group II and III showed favorable effects on tethering force, compared with Group I. CONCLUSION: Our modified PMA is a relatively safe method to have the potential for improving tethering of the mitral valve and clinical outcome in evaluating mitral coaptation zone.

Cardiomyopathy, Dilated↗
PubMed2005

A case of mitral valve replacement with a collar-reinforced prosthetic valve for heavily calcified mitral annulus.

Mitral valve replacement in the presence of extensive calcification of the mitral annulus is a technical challenge. Dense calcification of the annulus can cause a great difficulty in the insertion of a prosthetic valve and later periprosthetic leakage. A radical calcium debridement may cause left circumflex coronary artery injury, atrioventricular rupture, and thromboembolic events. We report a case of a 65-year-old woman suffering from mitral regurgitation with a severely calcified mitral annulus. She underwent mitral valve replacement using a collar-reinforced prosthetic valve, which allowed the surgeon to safely insert a prosthetic valve, avoiding the calcification completely without any major complications. We recommend this method as a feasible technique for mitral valve replacement in the presence of heavily calcified or disrupted fragile mitral annulus.

Aged↗
PubMed2004

Adenocarcinoma arising from ectopic gastric mucosa in the cervical esophagus.

Ectopic (heterotopic) gastric mucosa (EGM) of the upper esophagus, referred as inlet patch, is an asymptomatic benign lesion that is often detected during endoscopic examination. Although it is considered a source of adenocarcinoma in the upper esophagus, only 17 cases of adenocarcinoma have been reported previously. We report a rare case of adenocarcinoma arising in EGM of the cervical esophagus.

Adenocarcinoma↗
PubMed2004

Outcome of the perioperative use of percutaneous cardiopulmonary support for adult cardiac surgery: factors affecting hospital mortality.

Percutaneous cardiopulmonary bypass support (PCPS) has become a widespread standard modality for the treatment of circulatory collapse; however, its clinical use for postcardiotomy low cardiac output syndrome (LOS) has been reported to be unsatisfactory. We reviewed the clinical outcomes of twenty-three patients undergoing cardiac surgery and treated with PCPS. Solitary coronary artery grafting was undertaken for nine patients, while three had concomitant procedures. The remaining patients underwent valvular surgery. The indications for PCPS were preoperative shock in two patients and postcardiotomy LOS or shock in twenty-one patients. All patients except one underwent an intraaortic balloon pump. Sixteen of the twenty-three patients (69.6%) were weaned from PCPS and twelve patients (52.2%) reached hospital discharge. A univariate analysis revealed that risk factors for hospital mortality were age older than seventy years (P = 0.05), PCPS running time (P = 0.017), low cardiac function at the institution of PCPS (P = 0.004), and urine output within the initial 24 h (P = 0.041). The cardiac index (CI) in survivors was improved within 24 h, and eleven of the twelve survivors were weaned off PCPS within 48 h, whereas ten of the twelve nonsurvivors required PCPS for more than 48 h (P = 0.0006). There is little possibility of weaning patients from PCPS who do not show any signs of hemodynamic recovery within 48 h after its institution. Limited use of PCPS within 48 h may be applicable for postcardiotomy patients, but other cardiopulmonary support, such as a left ventricular assist device, may be required when hemodynamic recovery is not obtained within 48 h.

Adolescent↗
PubMed2003

Experimental study of a new operative procedure for nonischemic dilated cardiomyopathy: overlapping cardiac volume reduction operation.

PURPOSE: To assess a newly devised procedure for cardiac volume reduction without resecting any cardiac muscle and evaluate its effectiveness in an experimental settings. METHODS: Ten beagle dogs underwent a rapid pacing leading to heart failure for 3 weeks and then underwent left ventricular reduction by a procedure called the overlapping cardiac volume reduction operation (OLCVR), which consisted of a longitudinal incision in the left ventricular (LV) free wall, sutures from the left margin to the septal wall, and the right margin to the LV free wall. A slope of the linear preload recruitable stroke work relationship ( M(w)), with an X-intercept ( V(o)) were calculated as precise indicators of the LV systolic function. The constant of isovolumic pressure decay (Tau) and the peak filling rate (PFR) were also calculated as indicators of the LV diastolic function. RESULTS: The LV end-diastolic dimensions significantly decreased by OLCVR (43 +/- 2 to 25 +/- 1 mm). Fractional shortening significantly improved by OLCVR (11% +/- 2% to 30% +/- 4%). M(w) (erg. cm(-3). 10(3)) also significantly improved (21 +/- 2 to 33 +/- 3 ( P < 0.001)), whereas V(o), Tau, and PFR did not show any significant changes. CONCLUSION: The OLCVR significantly increased the early LV systolic function without any detrimental effects on the diastolic function. This procedure may therefore be a useful therapeutic option for end-stage cardiomyopathy.

Animals↗
PubMed2003

Periodic pharyngolaryngoscopy detects early head and neck cancer and improves survival in esophageal cancer.

BACKGROUND: Multiple squamous cell carcinomas (SCCs) frequently arise in the upper aerodigestive tract. The purposes of this study were to identify risk factors for SCC of the head and neck in patients with esophageal cancer (EC) and to investigate the value of periodic pharyngolaryngoscopic screening in detecting early SCCs of the head and neck and improving survival. METHODS: We reviewed the cases of 754 patients with EC treated surgically (n = 545) or nonsurgically (n = 209) from May 1995 to December 1999 in our institution. Of these patients, 541 underwent periodic pharyngolaryngoscopic screening after treatment of EC, whereas 213 did not because of hospital death, dropout from the program, and distance from the hospital. Data were compared between patients in whom SCCs of the head and neck developed synchronously or metachronously (EC + SCC group, n = 70) and patients without SCCs (EC group, n = 684). Survival rates were compared between patients receiving periodic pharyngolaryngoscopy and those followed without endoscopic screening. RESULTS: In the EC + SCC group, younger patients (p < 0.05), male patients (p < 0.05), and patients with a higher alcohol intake (p < 0.01) were more common than in the EC group. The 5-year survival rate was 40.9% in the EC group and 44.8% in the EC + SCC group (p = not significant). The survival rate of patients receiving periodic pharyngolaryngoscopy was significantly higher than that of patients followed without endoscopic screening (p < 0.001). Periodic pharyngolaryngoscopy was effective in detecting early SCCs of the head and neck and was beneficial for patients with EC in stages I to IV. CONCLUSIONS: Periodic pharyngolaryngoscopy can provide early detection of SCCs of the head and neck, which arose in 9.3% of patients with EC. Such screening particularly benefits male patients and heavy drinkers, who are at high risk for multiple SCCs. Periodic pharyngolaryngoscopy may prevent reduced survival resulting from associated SCCs of the head and neck and improve overall survival in patients with EC.

Age Distribution↗
PubMed2003

Induction chemotherapy with docetaxel, cisplatin, fluorouracil and l-leucovorin for locally advanced head and neck cancers: a modified regimen for Japanese patients.

Combination chemotherapy with docetaxel (T), cisplatin (P), fluorouracil (5-FU) and leucovorin has been reported to have major activity against squamous cell carcinoma of the head and neck (SCCHN) administered as a 4-day (TPFL4) or 5-day (TPFL5) regimen. The purpose of this study was to evaluate the efficacy and toxicity of a modified TPFL regimen (m-TPFL) for locally advanced SCCHN, consisting of a modified dosage with docetaxel, cisplatin, 5-FU and l-leucovorin (l-LV) designed for Japanese patients. Organ preservation of the primary tumor site was also assessed. Thirty-four Japanese patients with locally advanced SCCHN were eligible. Docetaxel was administered as a 1-h i.v. infusion at 48 mg/m2 on day 1; cisplatin, 24 mg/m2/day; 5-FU, 560 mg/m2/day and l-LV, 125 mg/body/day were delivered on days 1-4 by continuous i.v. infusion. This regimen was administered every 28 days. Patients who achieved a complete response (CR) after induction chemotherapy underwent radiation therapy alone. Ninety-one cycles were administered. The main hematological toxicity was neutropenia, classified as grade III or IV in 18.7% of cycles. The most common non-hematologic toxicities included anorexia, stomatitis and alopecia. The clinical overall response rate to m-TPFL was 88.2%, with 58.8% CRs and 29.4% partial responses. After definitive locoregional therapy, 25 of 34 patients were disease-free with preserved primary tumor site anatomy. Overall and progression-free survival rates at the 2-year follow-up are 92.8 and 75.3%, respectively. Our m-TPFL regimen designed for Japanese patients yielded excellent response rates with an acceptable toxicity profile in good-performance-status patients.

Adult↗
PubMed2003

Emergency surgical treatment for acute occlusion of the left main coronary artery-report of a case-.

We report a case of acute occlusion of the left main coronary artery (LMCA) successfully treated with percutaneous transluminal coronary angioplasty (PTCA) under the use of percutaneous cardiopulmonary bypass support (PCPS) and subsequent coronary artery bypass grafting (CABG). CABG was started only two hours after admission, and subsequent reperfusion of left anterior descending artery (LAD) after completing distal and proximal anastomosis was achieved 60 minutes later. Although postoperative CK levels were elevated to 10,900 IU/l, akinesis of the left ventricular (LV) wall was limited to segment #1 and #2, and hypokinesis in segment #3 and #6 documented by postoperative left ventriculogram (LVG). The patient was discharged from the hospital on foot without neurologic sequelae and is doing well and in New York Heart Association (NYHA) functional class I in 20 months of follow-up. Simultaneous efforts to maintain systemic circulation and to achieve reperfusion of the occluded LMCA as soon as possible are essential for survival. Prompt introduction of mechanical circulatory support and early revascularization to minimize the infarct area are both necessary.

Angioplasty, Balloon, Coronary↗