Biomedical subjects

T Kazui

Publications and source records attributed to T Kazui.

At least 109 records · Page 6Linked to original sources

PubMed1997

[A case of two stage operation of thoracic and thoracoabdominal aortic aneurysm of a patient in late phase with Behçet's disease].

Patient was a 70-year-old female diagnosed as Behçet's disease 1973. She underwent descending thoracic aortic aneurysm operation 1980. She had graft replacement for a residual thoracoabdominal aortic aneurysm on April 28, 1994. She didn't accept steroid therapy although she had a slight inflammatory reaction on admission. The graft replacement of thoracoabdominal aortic aneurysm was done with an aid of Carmeda closed chest support system bypass and segmental aortic cross clamping. Reattachment of the intercostal and lumbar arteries to the graft was used with button technique or interposition technique. Visceral branches including celiac axis, superior mesenteric and right renal arteries were reconstructed to an opening made in the graft with button technique and reattachment of left renal artery was used with graft interposition during selective perfusion of visceral arteries. She started steroid therapy with 5 mg of predonine to prevent inflammatory reaction postoperatively. The thoracoabdominal aortic aneurysm accompanied with Behçet's disease was relatively rare and this is a long survival case.

Aged↗

PubMed1997

[An elderly case of pneumothorax treated with omentopexy].

A 74-year-old male was admitted to our hospital because of left pneumothorax with persistent air leakage. He had undergone negative pressure drainage, chemical pleurodesis and transbronchial embolization in another hospital. Chest X-ray and CT scan showed collapse of the left lung and a defect of the pleura in the left lung S9. Patch closure was performed for the round pleurobronchial fistula (35 x 35 mm in size) using polyglycol acid felt and fibrin glue. But as severe air leakage was observed again about 24 hours after surgery, omentopexy was performed. The postoperative course was uneventful, and he was discharged 17 days after the second surgery.

Aged↗

PubMed1996

Comparative experimental study of cerebral protection during aortic arch reconstruction.

BACKGROUND: The optimal adjunctive method for cerebral protection during aortic arch repair remains controversial. METHODS: Retrograde cerebral perfusion, selective cerebral perfusion, and hypothermic circulatory arrest were compared in terms of their effect on cerebral function of mongrel dogs using somatosensory evoked potentials. Brain temperatures were held at 20 degrees C for 90 minutes during cerebral perfusion or circulatory arrest and then rewarmed gradually to normal temperature. RESULTS: Somatosensory evoked potentials completely disappeared as soon as retrograde cerebral perfusion or hypothermic circulatory arrest started and did not recover completely. In the selective cerebral perfusion group, it recovered in all cases. Only 2% of cerebral blood flow and about 3% of the cerebral metabolic rate for oxygen were obtained during retrograde cerebral perfusion compared with the preoperative value. The analysis of adenosine triphosphate and water content of the brain supported these results. CONCLUSIONS: Retrograde cerebral perfusion had some advantage for cerebral protection compared with hypothermic circulatory arrest, but could not supply sufficient cerebral blood flow to maintain brain function. Selective cerebral perfusion was the safest method for arch reconstruction that requires cerebral protection for 90 minutes.

Animals↗

PubMed1996

Extended aortic replacement for acute type A dissection with the tear in the descending aorta.

OBJECTIVE: There has been controversy as to the selection of surgical treatments for acute type A dissection with the tear in the descending thoracic aorta, a subtype of acute aortic dissection in which the limited tear is located distal to the left subclavian artery but the dissection extends retrogradely to the ascending aorta. METHODS: Total replacement of the ascending aorta and aortic arch was performed in 12 patients with acute type A dissection with the tear in the descending thoracic aorta between March 1991 and the end of September 1995. The indications for total replacement of the ascending aorta and aortic arch were cardiac tamponade, acute aortic regurgitation, cerebral ischemia, and dilatation of the ascending aorta. The operation was performed with the aid of extracorporeal circulation, blood cardioplegia, selective cerebral perfusion, and open distal anastomosis. The surgical procedure used was total replacement of the ascending aorta and aortic arch with a graft provided with three limbs accompanied by resection of the intimal tear in the descending thoracic aorta. RESULTS: Hospital death occurred in two patients (16.7%). In both, death was due to dissection/related complications of renal/mesenteric ischemia. The other 10 patients have had uneventful postoperative courses over a mean period of 24 months. CONCLUSIONS: Total replacement of the ascending aorta and aortic arch accompanied by resection of an intimal tear distal to the left subclavian artery seems to be justified in selected patients with acute type A dissection with the tear in the descending thoracic aorta.

Acute Disease↗

PubMed1996

[Depression of cellular immunity after aortic arch replacement].

Multiple organ failure due to infection is now one of the most serious postoperative complications following aortic arch replacement. We therefore evaluated the postoperative changes of cellular immunity using four parameters, 1) peripheral lymphocyte subsets 2) mitogen responsiveness 3) the activity of natural killer (NK) cells 4) interleukin-2 (IL-2) production. Patients were divided into two groups: group A (n = 5) with aortic arch replacement and group B (n = 10) with coronary artery bypass grafting. All variables were measured the day before, the day after, 3 days after, 7 days after, and 14 days after surgery. CD3 positive cells in group A were significantly lower than in group B throughout the postoperative course. CD4 positive cells in group A were significantly lower than in group B on the day after 3 days after the operation. IL-2 production in group A was markedly depressed the day after (all patients 0.8 U) and 3 days after (1.5 +/- 1.6 U) as compared to the preoperative level (7.7 +/- 4.4 U) and the levels on the same days in group B. The activity of NK cells in group A was significantly impaired the day after (10.6 +/- 6.7%) and 3 days after (10.0 +/- 6.7%) as compared to the preoperative level (28.6 +/- 16.7%) and the levels on the same days in group B. IL-2 production in group A was significantly correlated to CD3 and CD4 positive lymphocyte levels. These results clearly showed that patients who underwent aortic arch surgery suffered functional depression of cellular immunity, in particular IL-2 production and the activity of NK cells. These depressions may be a result of massive blood transfusion, tissue trauma under hypothermic cardiopulmonary bypass.

Aged↗

PubMed1996

[A successful case report of composite graft and total aortic arch replacement in a patient with chronic idiopathic thrombocytopenic purpura (ITP)].

A successful composite graft and total aortic arch replacement for aortic valvular disease and thoracic aneurysm from the ascending aorta to the distal aortic arch with ITP is reported in a 68-year-old male. For seven years the ITP was treated with corticosteroids, the platelet count was 5.6 x 10(4)/mm3 on admission. At operation a low dose of aprotinin was administered before cardiopulmonary bypass and two packs of platelet were transfused after that. The platelet count was dramatically increased to 13 x 10(4)/mm3 after surgery from 1.8 x 10(4)/mm3 at the end of cardiopulmonary bypass without preoperative treatment of high-dose gamma-globulin. Perioperative bleeding was moderate and postoperative course was uneventful. This is first case of extended graft replacement for thoracic aneurysm associated with ITP.

Aged↗

PubMed1996

[Experimental study of safe limits of retrograde cerebral perfusion].

Safe limits of retrograde cerebral perfusion (RCP) which is now used as an adjunctive method in the surgical treatment of the aortic arch aneurysm were examined experimentally using adult mongrel dogs. After the brain was cooled to 20 degrees C by extracorporeal circulation, RCP was performed from the bilateral maxillary veins, and later, the brain was warmed up to the initial temperature. Experimental groups were divided into two groups; Group I (n = 5) were subjected to cerebral perfusion for 60 minutes, and Group II (n = 8) for 90 minutes. Cerebral function was evaluated using somatosensory evoked potentials (SEP). Cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2) were measured, and histopathological examination was conducted SEP disappeared immediately after the initiation of RCP. In Group I, all the wave forms were recovered by rewarming in every animals, but the amplitude was only 35.0 +/- 16.6% of the preoperational value. In Group II, wave forms were not recovered in 3 animals of 8. CBF during RCP was minimal and about 2% of CBF observed before operation in either group. CMRO2 after being rewarmed up in Group II was lower than that in Group I, but this difference was statistically insignificant. In the histopathological examination, no ischemic change was found in Group I, while many cells indicating ischemic change were found in Group II. These findings indicate that RCP at 20 degrees C could not supply sufficient blood to brain tissues, and the brain can be injured irreversibly when the RCP exceeds more than 60 minutes.

Animals↗

PubMed1996

[Case report of a thoracoabdominal aneurysm operation using profound hypothermia and circulatory arrest].

A 55-year-old male was diagnosed by CT scan as having a Crawford type I thoracoabdominal aneurysm. An angiogram revealed an aortic aneurysm located from the Th 7 to the visceral vessels of the abdominal aorta and its maximum diameter was 10 cm. Resection and replacement of the aneurysm was performed, but due to the large diameter of the aneurysm, cross-clamping of the descending aorta was impossible. Therefore, the operation was carried out under profound hypothermia and circulatory arrest (HCA). The postoperative course was excellent without any adverse neurological symptoms or complications of any kind. Although HCA has some disadvantages such as coagulation disorders and lung complication, it seems to be a very useful method in cases of reoperation or in cases such as presented here where the aneurysm was of large diameter.

Aortic Aneurysm, Abdominal↗

PubMed1996

[Resection of congenital aneurysm in the posterior wall of left ventricle communicated to the right atrium].

An echocardiography detected a large aneurysm, 10 x 15 cm in size, in the posterior wall of left ventricle in a 21-year-old male. This aneurysm could not be detected by either left or right ventriculogram. The aneurysm was opened during cardiac arrest with extracorporeal circulation, and red and white thrombi were found in it. Also the anurysm was communicated to the right atrium through a 1 x 1 cm hole, not to the left ventricle. For the complete resection of the anurysm, it was necessary to resect the left circumflex coronary artery running along the surface. The posterior wall movement in angiogram one month after surgery showed no change. Morphologically and histologically this case was similar to "Submitral annual left vetricular aneurysm" reported by Abrahams et al. 1962. It was a rare case because the anurysm was communicated to the right atrium.

Adult↗

PubMed1995

Experimental study on the optimum flow rate and pressure for selective cerebral perfusion.

The optimum flow rate and pressure for selective cerebral perfusion during moderate hypothermia (25 degrees C) were investigated in 36 mongrel dogs. Cerebral perfusion was performed for 90 minutes at a flow rate of 100% (the physiologic flow rate), 50%, 25%, and 0%, or no flow (cerebrocirculatory arrest). Somatosensory evoked potentials were monitored to assess brain function. An excess lactate level was considered an index of anaerobic cerebral metabolism, and histopathologic evaluation was performed. Somatosensory evoked potentials showed no abnormalities at flow rates of 100% and 50%, but became abnormal in some dogs at 25% and in all dogs under no-flow conditions. The excess lactate level only increased at a no-flow rate, but not significantly. Histopathologic evaluation showed no ischemic changes at flow rates of 100% and 50%, but there were slight ischemic changes at 25% and severe ischemic damage at no flow. The mean carotid arterial pressure was 63.1 +/- 5.9, 39.8 +/- 6.2, 24.9 +/- 6.0, and 11.3 +/- 3.5 mm Hg at a flow rate of 100%, 50%, 25%, and no flow, respectively. These results suggest that the safe range of flow rates for cerebral perfusion during moderate hypothermia is more than 50% of the physiologic level with a carotid arterial pressure of about 30 mm Hg or more.

Animals↗

PubMed1995

[Aortic arch aneurysm: new modification of aortic arch reconstruction and selective cerebral perfusion].

Selective cerebral perfusion (SCP) has been widely used as the method for cerebral protection during aortic arch repair in the treatment of aortic arch aneurysms in our institution. Recently, we modified our technique of aortic arch reconstruction and SCP in order to reduce the neurological complication. Following institution of SCP into both innominate and left common carotid arteries at 22 degrees C, the distal graft anastomosis and left subclavian reconstruction were performed while the descending aorta was left opened. Then the antegrade perfusion with rewarming was started via the fourth limbs attached to the main graft instead of the femoral artery. The aortic arch was completely replaced with the graft with three limbs for arch vessels. During one-year period from December 1993 to November 1994, 30 patients were operated on for aortic arch aneurysms using this technique. The etiology of aneurysms was true aneurysms in 16 patients, and aortic dissection in 14 including 8 cases of acute dissection. The concomitant procedures included descending graft replacement in 11 patients, composite graft replacement in 5, CABG in 3, and AVR in 1. The hospital mortality was 3.3% (1 of the 30 patients). There was no neurological complication. We conclude that the present techniques are useful methods for preventing the neurological complication in the treatment of aortic arch aneurysms.

Adult↗

PubMed1995

Surgical treatment of aortic arch aneurysms using selective cerebral perfusion. Experience with 100 patients.

Hundred consecutive patients were operated on for aortic arch aneurysms between January 1986 and October 1993. All operations were performed with the aid of extracorporeal circulation, blood cardioplegia for myocardial protection, and selective cerebral perfusion (SCP) for protection of cerebral ischemia during aortic arch repair. Forty-four patients (44%) had an emergency operation because of frank or impending rupture of aneurysms or acute aortic dissection. Eighty-three patients (83%) underwent total arch replacement, and 54 had concomitant procedures including aortic valve resuspension, aortic valve replacement (AVR), composite graft replacement and coronary artery bypass grafting (CABG). The overall early (30-day) mortality rate was 16%. Multivariate analysis revealed, as significant risk factors, preoperative cardiopulmonary resuscitation, renal-mesenteric ischemia due to acute dissection, previous ascending aorta/arch operation and preoperative stroke. Of the 71 (71%) patients who were free of these risk factors, only one (1.4%) died. One patient (1%), who was preoperatively in shock state, had a distinct stroke. The present data suggest that SCP is a useful method for aortic arch aneurysm operation requiring complex repair of the aortic arch.

Adult↗

PubMed1995

[Surgical treatment of the true aortic arch aneurysm combined with coronary artery disease].

Between January 1989 and August 1994, 6 patients with true transverse aortic arch aneurysm combined with coronary artery disease (CAD) were operated in our institute. They had the simultaneous revascularization for both lesions. There were no cardiac deaths at early and late result. The present data suggested that the patient who underwent successful coronary artery bypass grafting have the same risk for transverse aortic arch aneurysm operations as the patients without CAD.

Aged↗

PubMed1995

[Replacement of the total thoracic aorta in a single stage using selective cerebral perfusion].

A 73-year-old male was admitted with complaints of a sense of back compression and diagnosed as impending rupture of chronic type B dissection and arch aneurysm by CT and angiogram. With the aid of extracorporeal circulation, selective cerebral perfusion and open distal anastomosis, the total graft replacement of the ascending aorta, aortic arch and descending aorta was performed in a single stage via median sternotomy. The angiogram two months after surgery showed that false lumen in the thoracic aorta was obliterated and the patient had recovered well without any cerebral complications. The approach to replace the total thoracic aorta via median sternotomy without left thoracotomy may contribute to reduce respiratory complications after surgery.

Aged↗

PubMed1995

[Tricuspid valve replacement for infective endocarditis in drug addict--a case report].

For right-sided endocarditis associated with drug abuse a successful treatment by tricuspid valve replacement was reported. A 34-year-old female who had a history of intravenous drug use for 14 years was admitted with complaints of chest pain, fever and dyspnea. A large vegetation about 47 mm in size attached to the tricuspid valve with tricuspid regurgitation was detected by echocardiography. Methicillin-resistant staphylococcus aureus was isolated in a blood culture. Because infection was persistent and uncontrollable in spite of sensitive multiple antibiotic regimens, tricuspid valve replacement using a St. Jude Medical valve was successfully performed with excision of markedly destroyed leaflets and debridement of the infectious lesions. After surgery the patient has been free from infection for 3 years.

Adult↗

PubMed1995

[A case report of active prosthetic valve endocarditis caused by MRSA].

A 53-year-old woman, who had undergone MVR and TAP 2 months ago at other hospital, was referred because of PVE caused by MRSA, mediastinitis and remaining AR. Emergency operation was performed, and it was found that mitral mechanical valve was detached and massive vegetation was present around prosthetic valve suture ring. MRSA was cultured from mechanical valve. Thorough debridement for mediastinitis and mitral annulus were performed. Diagnosis and timing of surgical intervention for mechanical PVE were discussed.

Endocarditis↗

PubMed1994

Surgical outcome of aortic arch aneurysms using selective cerebral perfusion.

The surgical results observed in 80 patients with aneurysms of the aortic arch who underwent an operation between January 1986 and the end of August 1992 were analyzed by multivariate analysis to identify predictors of high operative risk. All operations were performed using a cardiopulmonary bypass technique, blood cardioplegia for myocardial protection, and selective cerebral perfusion to prevent cerebral ischemia during aortic arch repair. The overall early (30-day) mortality rate was 16.3%. A severe stroke occurred postoperatively in 1 patient (1.3%). The 5-year survival rate was 73% +/- 5%, as determined by the Kaplan-Meier method. Multivariate analysis revealed that the presence of critical cardiopulmonary dysfunction preoperatively and the need for reoperation were significant independent predictors. Of the 63 (79%) patients who were free of these risks, only 3 (4.8%) died. The findings from the present study indicate that, currently, early mortality is relatively low for all patients who undergo operations for aneurysm of the aortic arch, unless they are in a critical condition preoperatively or unless they are undergoing a reoperation.

Actuarial Analysis↗

PubMed1994

Total arch graft replacement in patients with acute type A aortic dissection.

Treatment of acute type A aortic dissection with emergency total aortic arch graft replacement remains controversial. Between December 1988 and July 1993, 30 patients with this fatal disease underwent graft replacement of both the ascending aorta and total aortic arch on an emergency basis. All operations were performed with the aid of extracorporeal circulation, blood cardioplegia, selective cerebral perfusion, and open distal anastomosis. The overall early mortality rate was 23.3% (7 patients), but that in patients with complications with shock and renal/mesenteric ischemia was 57% and 66.7%, respectively. On the other hand, the mortality rate in the 23 patients (77%) in whom neither of these two risk factors was present was low (8.7%). The overall 4-year survival rate was 66.5% +/- 8.7%, and that for patients without these two risk factors was 87.0% +/- 7.0%. The present data suggest that simultaneous total arch replacement may be justified in selected patients with acute type A aortic dissection.

Adult↗