PubMed Health⌕ Search

Biomedical subjects

T Kazui

Publications and source records attributed to T Kazui.

At least 91 records · Page 5Linked to original sources
PubMed1998

Comparison of clinical outcome between histidine-triptophan-ketoglutalate solution and cold blood cardioplegic solution in mitral valve replacement.

BACKGROUND: This study was conducted to compare the effect of histidine-triptophan-ketoglutalate solution (HTK) with that of cold blood cardioplegic solution (CBC) in mitral valve surgery. METHOD: Forty-six patients who underwent mitral valve replacement between January 1994 and December 1996 were enrolled in this study. Twenty patients received HTK (HTK group), while 27 patients had CBC (CBC group) as myocardial protection. HTK was given as a single high dose, whereas CBC was used in the usual multidose format. RESULT: The doses of inotropic agent at the end of extracorporeal circulation did not differ between the HTK group and the CBC group. Creatine kinase values (units) on day 1 and day 2 were 1140+/-412, 921+/-436 for the HTK group and 904+/-335, 816+/-420 for the CBC group, respectively (p = NS). Spontaneous defibrillation occurred in 26% of the CBC group and 90% of the HTK group (p < 0.05). Pacing was temporarily used in 20% of the HTK group and 44% of the CBC group after extracorporeal circulation (p < 0.05). CONCLUSIONS: These results suggest that HTK provided more adequate myocardial protection in mitral valve surgery.

Blood↗
PubMed1998

[A case report of ruptured pseudoaneurysm into the left lung after graft replacement of the descending thoracic aorta].

We report a successful case of total aortic arch replacement using selective cerebral perfusion for ruptured pseudoaneurysm into the left lung after graft replacement of the descending thoracic aorta. A 74-year-old female who had graft replacement of the descending thoracic aorta for ruptured acute type B dissecting aneurysm into the left pleural cavity was admitted with a complaint of severe hemoptysis. Preoperative enhanced computed tomography revealed a large pseudoaneurysm of the aortic arch and massive hematoma around it. She was diagnosed as having a ruptured pseudoaneurysm into the left lung. A graft replacement of the total aortic arch with the aid of selective cerebral perfusion was performed. At the time of operation, a pseudoaneurysm which was from an intimal defect in the aortic wall 2 cm proximal to the suture line was found. It was suspected that the cause of the pseudoaneurysm was due to clamp injury during the initial operation. Postoperatively, she had no cerebral complications, and digital subtraction angiography showed excellent reconstruction of the aortic arch. One month after the operation, she had recovered sufficiently to be discharged from our hospital.

Aged↗
PubMed1998

[A case report of aortic valve replacement and ascending + hemi aortic arch replacement for congenital bicuspid aortic stenosis with poststenotic dilatation of ascending aorta].

The patient of 21-year-old female, who had undergone VSD closures at the age 5 and had been pointed out to have aortic valve stenosis at that time, was admitted to our hospital with complaints of palpitation and easy fatigability. Pressure gradient of 140 mmHg between left ventricle and ascending aorta, and poststenotic dilatation of max 55 mm in diameter from ascending aorta to hemi aortic arch was recognized by cardiac catheterization and aortogram. For fear of aortic dissection in late phase caused by dilatation of ascending aorta left over, graft replacement from ascending aorta to hemi aortic arch was carried out simultaneously adding to aortic valve replacement (AVR). We are of the opinion that not only AVR but also simultaneous graft replacement should be performed actively on the case with dilatation of ascending aorta of over 55 mm in diameter in order to prevent aortic dissection.

Adult↗
PubMed1998

Laparoscopic inguinal hernia repair using fine-caliber instruments and polyester mesh.

Laparoscopic inguinal hernia repair (LH) requires similar scar size to traditional open repair. To perform LH with minimal access, finer instruments were used. A 5-mm laparoscope was inserted from the umbilicus, and surgical instruments were inserted through 5- and 3-mm trocars to perform LH by the transabdominal preperitoneal approach. Polyester mesh was placed over the hernia orifice and the peritoneum was closed with 3-0 silk sutures. Sixteen patients underwent smaller access LH and 24 had standard LH. Although smaller access LH took longer (105.7 versus 83.9 min), significantly fewer patients required analgesia after smaller access LH than after standard LH (12.5 versus 70.8%), and the postoperative hospital stay was shorter (4.6 versus 5.6 days). In addition, a better cosmetic outcome was obtained with smaller access LH. In conclusion, access was minimized by using fine-caliber instruments and polyester mesh, making LH less invasive and improving the cosmetic outcome.

Adult↗
PubMed1998

[Operative results and long-term prognosis of type A acute aortic dissection].

Between 1983 and 1997, we operated upon 91 patients with type A acute aortic dissection. The dissection was localized in 22 patients and extensive in 69 patients. All patients underwent graft replacement and 61 (67%) patients underwent simultaneous replacement of ascending aorta and total aortic arch. The hospital mortality rate were 9% for the localized dissection and 21% for the extensive dissection. The actuarial survival rates in patients with localized dissection at 5 and at 10 years was 91% and 76%, whereas those in patients with extensive dissection at 5 and at 10 years was 68% and 62%. The freedom from dissection related death or reoperation in operative survivors with localized dissection at 5 and at 10 years was 100% and 83%, whereas those in patients with extensive dissection at 5 and at 10 years was 78% and 56%. The simultaneous replacement of ascending aorta and total aortic arch in patients with extensive dissection was effective to obliteration of the distal false channel, although this extended procedure has to be carefully adopted in high risk patients with associated complications such as acute dissection organ ischemia.

Acute Disease↗
PubMed1997

The pharmacokinetics of water-in-oil-in-water-type multiple emulsion of a new tacrolimus formulation.

We developed a water-in-oil-in-water-type (W/O/W)-type multiple emulsion of a new tacrolimus formulation. A potential approach to avoid the complications of systemic immunosuppression and simultaneously enhance immunosuppressive efficacy is to deliver immunosuppressive agents locally to the site of the target organs. The W/O/W emulsion is dispersed oil drops containing smaller water droplets that allow the delivery of drugs preferentially to the reticuloendothelial systems (RES). Since the liver and the spleen are primary components of the RES, and the brain and the kidney have a poor RES, we hypothesized that a W/O/W emulsion of tacrolimus would possess the pharmacokinetic benefits of local immunosuppression. We evaluated this hypothesis in a rat model. The tacrolimus levels of whole blood, the liver, spleen, brain, and kidney in rats given intravenous emulsions of tacrolimus (W/O/W group) were compared with a group administered tacrolimus alone (T group). There were no significant differences between the pharmacokinetic parameters of W/O/W group and T group based on whole blood data. However, the W/O/W group had significantly decreased tacrolimus levels in the brain and kidney, and significantly increased levels in the liver and spleen compared with the T group. These data suggest that the W/O/W emulsion is applicable as an intravenous drug carrier for local immunosuppression.

Animals↗
PubMed1997

Experimental studies on three types of heparin-coated cardiopulmonary bypass circuits.

In cardiovascular operations, we have usually used heparin-coated cardiopulmonary bypass circuits with low systemic heparinization. Three types of heparin-coated cardiopulmonary bypass circuits are available in Japan: 2 of the 3 have covalent heparin bonding, and the other has ionic heparin bonding. We studied these circuits in ex vivo experiments to explore which were the best in terms of biocompatibility. In this study we compared the Carmeda system (Medtronic) and the Capiox system (Terumo) with covalent heparin bonding, and the Duraflo-II (Baxter) with ionic heparin bonding, evaluating them in ex vivo experiments. They were primed with fresh human blood, and we studied and compared the platelet counts, fibrinogen, D-dimmer, beta-thioguanine (TG), thrombin-antithrombin complex (TAT), and C3a and C4a of each of them. Additional research will be presented in the future.

Anticoagulants↗
PubMed1997

Our distal aortic perfusion system in descending thoracic and thoracoabdominal aortic aneurysm repairs.

We have used heparin-bonded partial cardiopulmonary bypass to support distal aortic circulation during aortic cross-clamping. However, there were no cardiotomy reservoirs with fully reliable thromboresistance. To resolve this problem, a short-acting anticoagulant (nafamostat mesilate) was added into a cardiotomy reservoir. The present study was designed to evaluate the efficacy of our distal perfusion system. From May 1995 through the end of May 1996, 27 patients underwent descending thoracic and thoracoabdominal aortic aneurysm repairs with this adjunct, 4 being excluded from the experiment. Twenty patients who had undergone conventional partial cardiopulmonary bypass were defined as the control group. There were no significant differences between the 2 groups in the morbidity, mortality, gas transfer, or transfusion requirements despite the fact that more complicated surgical procedures (shown by a two-fold increase in the prevalence of reoperation) were required in the group that had received the current distal perfusion adjunct the heparin-bonded group. In conclusion, our perfusion system is very effective for descending thoracic and thoracoabdominal aortic aneurysm repairs.

Analysis of Variance↗
PubMed1997

[A case report of ruptured distal aortic arch aneurysm into pericardial space].

We report a case of successful total aortic arch replacement using selected cerebral perfusion for ruptured distal aortic arch aneurysm (DAAA) into the pericardial space. A 75 year-old man who had preoperative episode of severe chest pain and tachycardia was transferred to our hospital. Computed tomography showed saccular DAAA and pericardial effusion, so the patient was diagnosed as ruptured DAAA into pericardial space. Immediately after CT-scanning, urgent operation of a graft replacement of aortic arch with selective cerebral perfusion was carried out. Postoperatively, he had no cerebral complication, but develop transient respiratory failure and renal dysfunction. Three months after the operation he was discharged from the hospital. The patient is now leading a normal life.

Aged↗
PubMed1997

[Extended total aortic arch replacement involving the proximal descending aorta through a median sternotomy].

From January 1986 to September 1995, total aortic arch replacement (TAR) for aortic dissection was performed using selective cerebral perfusion in 151 patients. In 18 patients, the surgical procedures of extended aortic arch replacement (EAR) involving the proximal descending aorta through a median sternotomy were applied. To evaluate the outcome of EAR, the early and late results were compared with those of non-extended aortic arch replacements (NAR) through a median sternotomy (n = 66). The early mortality rates for EAR and NAR were 5.6% and 16.7%, respectively (NS); the lower rate for EAR may be due to the fact that EAR were performed more recently than NAR. The differences between EAR and NAR with respect to the amount of blood transfused intraoperatively and the respiratory index at 12 hours after surgery were not statistically significant. In addition, the extracorporeal bypass time in EAR was no longer than that in NAR. Thus, as compared with the NAR procedure, the EAR procedure did not have a negative effect on early outcome. Regarding late results, the actuarial survival rates after EAR and NAR, respectively were 87% and 72% at 1 year, 87% and 69% at 3 years (NS). The early thrombo-occlusion rates of the remaining false lumens after TAR in broad aortic dissections were 56% after EAR and 33% after NAR (p = 0.21). These results suggest that EAR may be a more useful procedure in some patients requiring TAR.

Aged↗
PubMed1997

[Surgical strategy for Stanford type A aortic dissection with Marfan syndrome].

Between January 1979 and May 1996, 23 Marfan patients underwent surgeries for type A aortic dissection; 8 patients with localized type dissection and 15 with extensive type. All of the 23 patients suffered from annuloaortic ectasia (AAE) which was treated by composite graft replacement, 10 of these patients had a concomitant replacement of the aortic arch. The operative mortality rate was 8.7%, and the causes were associated with the methods of coronary artery reattachment to the graft. Of the 15 patients with the extensive type dissection, there were 11 patients who had a non-thrombotic communicating false lumen in the untreated segments of the distal dissected aorta after the first operation and from this group there were seven patients who had anastomotic leakage around the distal suture line of the graft replacement that was demonstrated by aortography. Extensive graft replacement ranging from the entire thoracic aorta to the total aorta were performed in 10 (43.5%). Late deaths occurred in three patients (13.0%) and these causes were LOS and graft infection after the second operation and prosthetic valve endcarditis 6 months after the first operation. The present data indicate that Stanford type A aortic dissection with Marfan syndrome should be undertaken on the basis of a prior achievable plan to perform an entire aortic replacement. The dissection should also be performed using a procedure which doesn't leave distal anastomotic leakage.

Adolescent↗
PubMed1997

[A successful surgical treatment of dissecting thoracoabdominal aortic aneurysm using a heparin coated percutaneous cardiopulmonary support system].

A 52-year-old man with dissecting thoracoabdominal aortic aneurysm (impending rupture) involving the celiac, superior mesenteric and renal arteries underwent graft replacement of the thoracoabdominal aorta with reconstruction of all visceral branches and intercostal arteries (Th11,12) with the aid of femoro-femoral bypass. The bypass was performed using a heparin coated percutaneous cardiopulmonary support system with low doses of heparin, maintaining activated coagulation time at about 300 seconds. During the reconstruction of the major visceral branches, the branches were separately cannulated from inside the aorta, and perfused selectively via partial extracorporeal circulation. The intercostal arteries were reconstructed segmentally to minimize the duration of ischemia. During the repair of the intercostal arteries, Fogarty balloon catheters were inserted into the intercostal arteries to prevent back bleeding and ischemia. The patient had a satisfactory postoperative course.

Aortic Dissection↗