Biomedical subjects

Tsuyoshi Itoh

Publications and source records attributed to Tsuyoshi Itoh.

46 records · Page 3Linked to original sources

PubMed2002

Lymph node metastasis, recurrence, and prognosis in small peripheral lung adenocarcinoma. Analysis based on replacement.

OBJECTIVE: We studied clinical and pathological features of small peripheral adenocarcinoma of the lung, focusing on tumor typing based on Noguchi's classification of small adenocarcinoma and determining whether these tumors grew by replacing alveolar lining cells. METHODS: Subjects were 51 patients with small peripheral adenocarcinoma 2 cm or less in diameter resected between 1994 and 2001. Mediastinal and hilar lymph node dissection was done in 37 (72.5%). Patients were divided into 2 groups by replacement or nonreplacement tumors. We compared patient profiles, lymph node involvement, and recurrence and survival patterns. RESULTS: No significant difference was seen between groups in mean age, surgical procedure, or primary tumor location. Women predominated in replacement tumors at 71% vs 41%, p = 0.04. The incidence of lymph node metastasis at 40% vs 4.5%, p = 0.007 and distant metastasis at 47% vs 2.9%, p < 0.001 was significantly higher in nonreplacement than replacement tumors. Replacements tumor thus showed significantly better disease-free survival at 95% vs 53%, p < 0.001, and overall 3-year survival at 95.4% vs 62.7% than did nonreplacement tumors. CONCLUSION: We found distant metastasis and lymph node involvement to be more frequent in nonreplacement than replacement small peripheral adenocarcinoma, on suggesting that pretreatment tumor typing and accurate nodal status determination are essential to improve disease staging.

Adenocarcinoma↗

PubMed2002

Arterial embolization to preoperatively manage pulmonary disease associated with inflammation.

Preoperative arterial embolization is used in pulmonary disease to reduce intraoperative blood loss resulting from exposure of extensive adherent pleura due to repeated inflammation. Between January 1996 and February 2001, 5 patients underwent surgery with this procedure. Underlying diseases were 3 cases of aspergilloma and 1 each of chronic expanding hematoma and lung cancer. All embolization was permanent, involving coil insertion. Surgical treatment was successful in all 5 patients without mortality. Such preoperative management proved useful in reducing intraoperative blood loss in hypervascular collateral feeding vessels in the area of resection or decortication.

Aged↗

PubMed2002

Geometrical difference between an ascending aneurysm and a root aneurysm in valve-sparing operations.

OBJECTIVE: The aortic root geometry of the leaflet size and coaptation in an ascending aortic aneurysm, and in a root aneurysm, may predict the early and late outcomes from valve-sparing surgery. METHODS: The aortic root was investigated using intraoperative endoscopy before and after valve-sparing root reconstruction. The definition of 'root aneurysm' was marked sinus dilatation proximal to the sinotubular junction. 'Ascending aneurysm' was defined as dominant dilatation distal from the sinotubular junction. Fifteen cases were examined and classified into two groups; Group A with an ascending aneurysm (four patients), and Group R with a root aneurysm (eleven patients). RESULTS: Cusp prolapse was seen in 10 (90.9%) patients of Group R, and in only one (25%) patient of Group A. The length of the free margin of all cusps in Group R was significantly longer than those in Group A. In Group R, the lengths of the free margin of an individual cusp were significantly different, indicating asymmetric cusps. In Group A, the length of the free margin were similar, indicating symmetric cusps. There was no significant difference in the degree of immediate postoperative aortic insufficiency, between the two groups. At the most recent follow-up, progressive aortic insufficiency was present in two patients of Group R. CONCLUSIONS: A root aneurysm had asymmetric, elongated and prolapsed aortic cusps, while an ascending aneurysm had symmetric cusps without prolapse. The mechanism of aortic insufficiency in a root aneurysm was more complex, suggesting a difficulty in achieving long-term valve competence. Such geometrical difference should be considered in the indication for the surgical technique of valve-sparing operations.

Aorta↗

PubMed2002

Surgical results of hemiarch replacement for acute type A dissection.

BACKGROUND: The appropriate surgical strategy for patients with an arch tear in acute type A dissection remains controversial. We retrospectively compared surgical results after hemiarch as compared with transverse aortic arch replacement in patients with an arch tear in acute type A dissection. METHODS: The records of 88 patients who consecutively underwent graft replacement for acute type A dissection between 1989 and 2001 were reviewed. The patients were divided into three groups: patients with ascending aortic replacement (group AS, n = 41), those with hemiarch replacement (group HA, n = 23), and those with transverse arch replacement (group AR, n = 24). Operative mortality and morbidity and late outcome were compared among the three groups. RESULTS: The overall early (30 day) mortality was 11.3% (10/88), and in-hospital mortality was 14.7% (13/88). In-hospital mortality in groups AS, HA, and AR were 7.3%, 8.6%, and 33.3%, respectively (p = 0.011). Cardiopulmonary bypass, circulatory arrest, and operation times were significantly shorter in group HA than in group AR (p < 0.001). A smaller amount of intraoperative transfusion of red blood cells (p = 0.0006) and fresh-frozen plasma (p = 0.0003) was needed in group HA than in group AR, and postoperative bleeding during the first 24 hours postoperatively was significantly less in group HA than in group AR (p = 0.0028). The incidence of postoperative coma did not differ among the three groups (p = 0.89), nor did the incidence of postoperative patent false channel in the descending thoracic aorta (p = 0.57). Actuarial survival rates after 5 years were significantly better in group HA (91.3% +/- 5.9%) than in group AR (44.4% +/- 14.3%, p = 0.018). Freedom from reoperation on the distal aorta within 5 years did not differ among the groups (p = 0.46). CONCLUSIONS: Hemiarch replacement for acute type A dissection demonstrated favorable early and late outcome. The extent of graft replacement influenced surgical mortality and morbidity. Whenever the intimal tear is located in the lesser curvature of the transverse arch, hemiarch replacement is recommended to improve overall operative mortality and morbidity.

Acute Disease↗

PubMed2002

Complete resection of recurrent thymic carcinoid using cardiopulmonary bypass.

We report a case of recurrent thymic carcinoid (multiple episodes of recurrence over a 14-year period) invading the right atrium and superior vena cava, which was resected using cardiopulmonary bypass. In our case with dense adhesion between the great vessels and the sternum as a result of repeated operations and therapeutic irradiation, the innominate artery was injured while re-sternotomy, which was successfully repaired under deep hypothermic circulatory arrest. Repeated aggressive surgical resection might improve prognosis of the recurrent thymic carcinoid even in patients with extended lesions, which could be completely resected only on cardiopulmonary bypass.

Brachiocephalic Trunk↗

PubMed2002

Influence of St. Jude medical valve in patients with aortic stenosis and small aortic annulus on cardiac function and late survival result.

This clinical study analyzes our experience of postoperative cardiac function and long-term survival rate in patients with aortic stenosis and small-size St. Jude Medical (SJM) valve. Sixty-eight patients who underwent aortic valve replacement by SJM valve were divided into two groups by preoperative aortic annulus diameter. Group 1 consisted of 44 patients with small aortic annulus and small-size SJM valve (19 mm or 21 mm). In Group 1, small SJM standard valves were implanted in 16 patients, and small SJM Hemodynamic Plus (HP) valves were implanted in 28 patients. Group 2 consisted of 24 patients with large-size SJM standard valve (23 mm or larger). Preoperative left ventricular mass index, left ventricular dimension, the dimension of ascending aorta, and body surface area were significantly smaller in Group 1 than in Group 2. Average age at surgery was older in Group 1 than in Group 2. Effective orifice area index of the SJM valve measured by the manufacturer's data was smaller in Group 1 than in Group 2. Postoperative left ventricular mass indexes of Group 1 (standard valve or HP valve) and Group 2 significantly decreased in comparison with the preoperative mass indexes. Postoperative left ventricular ejection fraction and the peak ejection rate of Group 1 were not different from those of Group 2. The 10 year survival rate of Group 1 was 79%, and the rate of Group 2 was 77%. At 10 years after surgery, freedom from valve-related complication of Group 1 was 80%, and freedom from complication of Group 2 was 81%. Our results demonstrated that small-size SJM valve afforded satisfactory long-term survival rate and valve-related event-free rate for elderly patients with small body surface area and small aortic annulus.

Adult↗

PubMed2002

Morphological changes of the arterial systems in the kidney under prolonged continuous flow left heart bypass.

We investigated morphological changes of the arterial systems in the kidneys under prolonged continuous flow left heart bypass. Twelve goats were subjected to 2 weeks of pulsatile left heart bypass followed by 4 weeks of continuous flow left heart bypass (group CF). After autopsy, the kidneys underwent pathological evaluation. Six normal healthy goats were used as controls. The media of the afferent arterioles of group CF were frequently thickened by an increase in the number of the mature smooth muscle cells (SMCs). The juxtaglomerular areas (JGA) were expanded because of an increase in the number and size of SMCs and/or SMC-like cells. Furthermore, the percentage of anti-proliferating cell nuclear antigen antibody-positive cells in the JGA of group CF (9.9 +/- 1.9%) was significantly higher (p = 0.025) than that of the control group (4.6 +/- 3.4%), indicating active proliferation in group CF. We concluded that prolonged continuous flow left heart bypass causes proliferation of SMCs and/or SMC-like cells in the afferent arterioles and their perivascular tissue.

Animals↗

PubMed2002

Perforation of the descending aorta by the tip of an intra-aortic balloon pump catheter.

Perforation of the proximal descending aorta occurred in a patient on intra-aortic balloon pump (IABP) support after emergency coronary intervention for acute myocardial infarction. The IABP catheter was inserted under fluoroscopic guidance into the right femoral artery without difficulty, but after 8 h on IABP support the patient went into shock with a left hemothorax. Emergency surgery was performed with cardiopulmonary bypass and a perforation of the proximal descending aorta with active bleeding was found and successfully repaired. A distorted descending aorta in which the IABP catheter was kinked, as in the aortic arch, was discovered during surgery and confirmed postoperatively with 3-dimensional computed tomography scans, particularly in the lateral view. Not only the antero-posterior but also the lateral fluoroscopic view is recommended to prevent aortic perforation by a kinked IABP catheter.

Angioplasty, Balloon, Coronary↗

PubMed2002

Distensibility of the pulmonary autograft under systemic pressure.

BACKGROUND AND AIMS OF THE STUDY: Although the Ross procedure has recently been recognized as one of the best replacements of the aortic valve, regurgitation has occasionally been observed with dilatation of the sinotubular junction (STJ) and/or basal ring (BR). This study was designed to evaluate the native distensibility of the free pulmonary root under systemic pressure. METHODS: Pulmonary arterial grafts (n = 7) were taken from pig hearts and pressurized (20-100 cmH2O) with crystal sensors attached around the STJ and BR. Dimensions of the STJ and BR were measured using a digital 3-D ultrasonic sonomicrometer at different pressures (20-100 cmH2O) with and without the STJ and/or BR plicated with felt-strip to prevent overdistension. Valve insufficiency was evaluated macroscopically and endoscopically. RESULTS: All grafts showed no obvious valve insufficiency at 20 cmH2O. Grafts pressurized at 100 cmH2O showed 125+/-6% and 113+/-5% enlargement of dimensions compared with baseline (20 cmH2O) data at the STJ and BR respectively, with recognizable insufficiency. When the STJ was plicated to prevent overdistension at 100 cmH2O with less dilated BR (106%), mild excentric insufficiency was observed. In case of the BR plicated at 100 cmH2O with a less dilated STJ (112%), central slight regurgitation was observed. Both the STJ and BR plications resulted in no recognizable regurgitation. CONCLUSION: Free pulmonary arterial grafts were remarkably enlarged under systemic pressure with recognizable valve insufficiency; this could be prevented by maintaining the original dimensions of the graft STJ and BR.

Animals↗

PubMedDate not supplied

Transcutaneous immunization with cytotoxic T-cell peptide epitopes provides effective antitumor immunity in mice.

Much attention has been focused on transcutaneous immunization strategies to stimulate systemic cytotoxic T lymphocyte responses leading to anti-tumor or anti-microbial immunity. Here we report that topical application of vaccines consisting of synthetic peptides formulated with imiquimod, a Toll-like receptor agonist that functions as a potent adjuvant generates strong T cell responses that exhibit effective anti-tumor effects in a murine melanoma model system. These results support the use of peptide-based transcutaneous vaccines as a noninvasive and effective strategy for anti-tumor immunotherapy.

Administration, Cutaneous↗