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Biomedical subjects

T Jikuya

Publications and source records attributed to T Jikuya.

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

[A case of cor triatriatum with atrial septal defect in an adult].

A surgical treatment of a 54 year-old female with cor triatriatum was reported. Two dimensional echocardiography had demonstrated an abnormal septum in the left atrium. The abnormal septum had a 2 x 1 cm fenestration and existed between the left and right pulmonary veins. Preoperatively, we had misjudged the septum as ASD and misdiagnosed this case as PAPVC. During surgery we found that there was the accessory atrial chamber posterior to the true ASD. The accessory chamber received right pulmonary veins and connected to the left atrium. The left pulmonary veins connected to the left atrium normally behind the abnormal septum. We diagnosed this case as Lucas-Shmidt IIIA1 type cor triatriatum with ASD. The abnormal septum was resected, and the ASD was closed with a bovine pericardium. The postoperative course was uneventful and she was discharged 19 days after the operation.

Cor Triatriatum↗
PubMed1999

[A case of lateral femoral circumflex artery as a free graft for coronary artery bypass surgery].

A 46-year-old man had a three-vessel coronary disease. We performed quadruple coronary artery bypass grafting (CABG) with the left internal thoracic artery (LITA), right gastroepiploic artery (RGEA), saphenous vein and lateral femoral circumflex artery (LFCA). Postoperative coronary angiogram showed that the LFCA bypass graft was patent and supplied sufficient blood to the anastomosed vessel. There was no stenosis at the anastomotic site. However, the LFCA graft showed a string sign. Long-term follow-up and angiographic studies is necessary to establish the use of LFCA as an arterial free graft for coronary revascularization.

Cardiac Surgical Procedures↗
PubMed1998

Mitral reoperation via right thoracotomy in a patient with pulmonary hypertension.

A 62-year-old woman with pulmonary hypertension underwent mitral valve re-replacement through right thoracotomy. Severe adhesion occurred to the right lung. During pleural dissection the lung collapsed under single-lung ventilation, rapidly elevated pulmonary vascular resistance caused hemodynamic instability. When pulmonary hypertension is preoperatively present, this approach under single-lung ventilation is not recommended.

Female↗
PubMed1998

Aortic dissection extending from ductus diverticulum aneurysm.

We report the case of a 28-year-old woman with type B chronic aortic dissection extending from a ductus diverticulum aneurysm. The patient was successfully treated by interposition of a Hemashield 26-mm woven Dacron graft with a left posterolateral thoracotomy approach. Circulatory arrest through profound hypothermia and short retrograde cerebral circulation were employed during proximal anastomosis of the graft.

Adult↗
PubMed1998

Prevention of pulmonary embolization during excision of an infected venous thrombus.

We describe the case of a 64-year-old woman with an iatrogenic pseudoaneurysm, arteriovenous fistula, and thrombotic occlusion of the right femoral vein with Staphylococcus aureus infection resistant to methicillin as complications of femoral catheterization for hemodialysis access. A temporary caval filter was introduced just prior to operation and kept in place for 4 days. An infected thrombus was captured and removed with a filter-catheter device. The placement of a temporary caval filter should be considered for prevention of pulmonary embolism in patients with infected venous thrombosis which requires surgical thrombectomy.

Catheterization, Peripheral↗
PubMed1998

An approach for acute disruption of large arteries in patients with advanced cervical cancer: endoluminal balloon occlusion technique.

OBJECTIVE: To test the feasibility of an intraluminal balloon occlusion technique for the control of sudden arterial disruption from cervical branches in patients with advanced malignancy. BACKGROUND: A sudden disruption of large cervical arteries is a devastating complication of advanced cervical malignancy and local infection. METHODS: Three patients with this complication underwent endoluminal balloon occlusion before surgical management. A double-lumen balloon catheter was introduced from the femoral artery to the bleeding point. Angiographic examination of the intracranial cross-filling could be performed by the injection of contrast medium from the opposite carotid artery, and consciousness levels could be directly confirmed under unilateral carotid occlusion. RESULTS: Resection of the carotid or innominate artery was safely performed in all the patients. No neurologic complications occurred. Bleeding did not recur during follow-up (range 5-32 months). CONCLUSIONS: This experience, although limited, suggests that surgical intervention to control cervical arterial bleeding with intraluminal balloon occlusion prevents excessive bleeding, decreases the risk of damage to the central nervous system, and improves the outcome in these critically ill patients.

Acute Disease↗
PubMed1998

Right thoracotomy as an alternative for redo mitral valve replacement and concomitant repair of the tricuspid valve.

BACKGROUND: We report the results of a right thoracotomy for reoperation on the mitral plus concomitant procedures. Access to aorta or repair of other lesions by this approach is controversial. EXPERIMENTAL DESIGN AND SETTING: Retrospective study. Institutional practice (University of Tsukuba Hospital, Tsukuba Japan). METHODS: Until 1995, 9 patients underwent right thoracotomy for mitral reoperation. The indication for this approach was no retrosternal space with the pericardium left open. Seven patients had deteriorated bioprosthesis, 1 periprosthetic valve leakage, and 1 re-stenosis. Four were associated with moderate tricuspid regurgitation. Operations were performed under fibrillation. Cardioplegia was used in 1. RESULTS: Through thoracotomy, 4 underwent mitral valve re-replacement, and 4 mitral valve re-replacement plus tricuspid annuloplasty. One was abandoned because of severe pleural adhesion. No neurological injury, or perioperative myocardial infarction occurred. CONCLUSIONS: The right thoracotomy was an effective alternative to repeat sternotomy for redo mitral valve operation. Also, concomitant repair of the tricuspid valve could be safely done by this approach.

Aged↗
PubMed1998

[Simultaneous cholecystectomy and CABG for acute cholecystitis and post-infarction angina].

A 71-year-old man was admitted to our hospital with massive GI bleeding and followed by acute myocardial infarction. Severe three vessel coronary artery disease with poor left ventricular performance (EF: 40%) was demonstrated by coronary angiography. He was referred for CABG. He had also cholecystitis, which needed surgical treatment simultaneously. Combined CABG and cholecystectomy were performed without using gastroepiploic artery as a bypass graft, and through separate median sternotomy and through right upper transrectal laparotomy. Postoperative course was uneventful. This combined procedure is beneficial for the patients with acute cholecystitis and unstable angina.

Acute Disease↗
PubMed1997

Aprotinin inhibits plasmin-induced platelet activation during cardiopulmonary bypass.

BACKGROUND: In the past few years, aprotinin has been used in cardiac surgery with impressive results of reducing blood loss, but several adverse effects of aprotinin also have been reported. One of the most likely mechanisms is the inhibition of plasmin by aprotinin, although this indirect effect has not been reproduced in all experimental studies. METHODS AND RESULTS: We evaluated the platelet function and fibrinolytic activity during human cardiac surgery, with or without aprotinin. During cardiopulmonary bypass (CPB) in humans without aprotinin (n=16), decrease of platelet aggregation induced by thrombin, increase of alpha-granule secretion of platelet and microparticle formation, and increase of plasmin/alpha2-antiplasmin complex (PIC) were observed. In contrast, low-dose aprotinin (1.0 x 10(6) KIU), which was administered only into the priming fluid of extracorporeal circuits (n=10), maintained platelet aggregation induced by thrombin and reduced alpha-granule secretion and microparticle formation of platelets during CPB. In vitro, plasmin (0.8 CU/mL) released alpha-granules of washed platelets, and this activation was completely inhibited by aprotinin (10 KIU/mL). CONCLUSIONS: Aprotinin has indirect effects to inhibit platelet activation, and this may partly explain the reduction of blood loss during cardiac surgery. To prevent the adverse effects, a single and minimal use of aprotinin is important. The results of in vivo and in vitro studies suggest that platelet preservation was demonstrated by the lower concentration of aprotinin (1.0 x 10(6) KIU per patient or 10 KIU/mL) compared with the concentration that inhibits plasma fibrinolysis.

Aged↗
PubMed1997

Does laser Doppler flowmetry aid the prevention of ischemic colitis in abdominal aortic aneurysm surgery?

Acute ischemic colitis is noted as a rare but lethal complication of abdominal aortic aneurysm (AAA) surgery. Because of its high mortality a reliable method of monitoring colonic blood perfusion to predict the possible occurrence of ischemic colitis is highly desirable for AAA surgery. We have tested the use of a laser Doppler flowmeter placed on the surface of the sigmoid colon for intraoperative monitoring in 31 patients with AAA. Although most of the patients showed the same flow levels after aorto-iliac or aorto-femoral grafting (at least unilaterally the internal iliac artery was perfused), in 6 cases poor colonic perfusion (below 50% of the basal flow) was observed and inferior mesentric arterial reconstruction was performed. In these 6 patients, sigmoid colonic blood perfusion returned from 37% to 82% of preoperative value after the reconstructions. No ischemic colitis was noted in this series of patients. We suggest that monitoring of serosal blood flow in the sigmoid colon using a laser Doppler flowmeter is useful for the management of patients during abdominal aortic aneurysm surgery.

Acute Disease↗
PubMed1997

Application of lipid microspheres containing prostaglandin E1 ointment to peripheral ischemic ulcers.

BACKGROUND: The systemic use of prostaglandin E1 (PGE1) in the treatment of peripheral vascular disease is well documented. It is known that the liposomal formulation of some drugs enhances their transdermal absorption. OBJECTIVE: The potential of topical application of lipid microspheres containing PGE1 (lipo-PGE1) to treat ischemic ulcers was evaluated. METHODS: Lipo-PGE1 ointment (1 microgram/g) was applied topically to peripheral ischemic ulcers in 10 patients for 5.8 weeks (range 4-9 weeks). The patients were followed up for 6 months, and response was assessed comparing photographs of the lesions. RESULTS: Nine of 10 patients responded to treatment, but in 3 patients, the ulcers recurred after cessation of treatment. CONCLUSION: It is concluded that lipo-PGE1 ointment provides an alternative to the management of patients with incurable peripheral ischemic ulcers.

Administration, Topical↗
PubMed1997

[Aortic valve regurgitation due to quadricuspid valve: a report of complicated case].

A 66-year-old male with the congestive heart failure was diagnosed grade 4 aortic valve regurgitation due to quadricuspid valve associated with bacterial endocarditis, widely patent left coronary artery ostium, chronic renal failure, and secondary hyperparathyroidism. Coronary arteriography showed that the size of left coronary ostium was widely patent 10 mm in diameter, and trans-esophageal echo cardiogram revealed perforation and vegetations on the coronary cusps of the aortic valve.

Aged↗
PubMed1997

[NO inhalation therapy for post-operative pulmonary hypertensive crisis of the case of truncus arteriosus].

Two-months-old baby underwent complete correction by Barbero-Marcial's procedure for type I truncus arteriosus. Postoperative hemo-dynamics was fairly stable immediately after the operation. However, the acute rise in pulmonary pressure occurred on the 2nd postoperative day. The pulmonary vasodilation therapy with prostaglandin E1 and amrinone had failed. Thirty ppm of inhaled nitric oxide (NO) was started and it resulted in an immediate decrease in pulmonary arterial pressure. Complete weaning from NO was achieved 9 days after surgery by simultaneous administration of PGE1 and amrinone. Although inhalation of NO reduced pulmonary arterial pressure, combination of PGE1 and amrinone with NO inhalation exerted a pulmonary vasodilation and brought the patient to full recovery in this case with pulmonary hypertensive crisis.

Administration, Inhalation↗
PubMed1996

[Inhaled nitric oxide for postoperative pulmonary hypertensive crisis in a patient with complete atrioventricular canal associated with Down's syndrome: a case report].

Two-year-old boy with Down's syndrome was treated with inhaled nitric oxide for pulmonary hypertensive crisis after correction of complete atrioventricular canal and persistent ductus arteriosus. The acute rise in pulmonary pressure and hemodynamic instability occurred on 3rd, 4th and 6th post operative days and pulmonary vasodilation with prostaglandin E1 and amrinone had failed. Twenty ppm of inhaled nitric oxide effectively reduced the pulmonary pressure and the patient was subsequently weaned from ventilation. Inhaled nitric oxide exerted a pulmonary vasodilation without decreasing systemic pressure in this patient with postoperative pulmonary hypertensive crisis.

Acute Disease↗
PubMed1996

[Management of postoperative pulmonary hypertensive crisis in children--indication and usefulness of inhaled nitric oxide therapy as a pulmonary vasodilator].

Among 176 pediatric patients who underwent open heart surgery from 1990 to 1996, 7 developed severe pulmonary hypertensive crisis (PHC) postoperatively. All patients were treated with conventional medical therapy consisting of hyperventilation and deep sedation. Prostaglandin E1 and/or amrinone were administered initially as a pulmonary vasodilator, and in 3 of the 7 patients this resulted in immediate improvement in hemodynamics. These patients subsequently weaned off ventilatory support and they were discharged from the hospital. In 4 other patients, pulmonary vasodilator therapy with prostaglandin E1 and amrinone had failed and they were treated with inhaled nitric oxide (NO). In all patients, inhalation of NO resulted in immediate decrease in pulmonary pressure without significant change in systemic arterial pressure. Two patients successfully weaned from the ventilator, whereas in 2 patients decrease in pulmonary pressure was transient. They developed airway bleeding and died as a result of respiratory insufficiency. Although inhaled NO effectively reduced pulmonary pressure in patients with PHC, this effect was not maintained over 12 hours in patients associated with bronchopulmonary dysplasia. In patients at risk for severe PHC, rapid treatment with NO inhalation after initial event as well as the prevention of lung injury caused by mechanical ventilation were found to be important in the postoperative management.

Administration, Inhalation↗
PubMed1995

Influence of bypass grafting to the infarct artery on late potentials in coronary operations.

BACKGROUND: Late potentials (LPs) after myocardial infarction identify the risk of arrhythmic events and sudden death, and the absence of anterograde flow in the infarct-causing occluded coronary artery frequently is associated with LPs on signal-averaged electrocardiography. The present study was designed to clarify the influence of revascularization of the infarct artery on the LPs in the late course after myocardial infarction. METHODS: We studied 21 patients after myocardial infarction with positive LPs who had at least one occluded infarct coronary artery. We investigated the LPs on signal-averaged electrocardiograms on the day of elective coronary artery bypass grafting (CABG) and 1 week after CABG. RESULTS: There were 25 infarct arteries in the study patients, 13 of which were grafted. The positive LPs disappeared soon after CABG in 13 patients, 10 of whom had grafts to all of the infarct arteries. The LPs persisted in 8, who received no graft to the infarct artery. One week after CABG, the LPs were still present in 4, all of whom had no graft to the infarct right coronary artery. CONCLUSIONS: In patients with positive LPs late after myocardial infarction, grafting to the infarct artery eliminated the LPs soon after CABG.

Aged↗