Strangulation of internal hemorrhoids complicating sclerosing therapy with injection of OC-108 (Zione).
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Alum Compounds↗
Biomedical subjects
Yoshikazu Hachiro
Publications and source records attributed to Yoshikazu Hachiro.
Treatment methods for spinal cord injury caused by acute type B aortic dissection.
Acute distal aortic dissection rarely causes spinal cord ischemia presenting with paraplegia or paraparesis. Spinal cord involvement has poor outcomes, and there is no established effective treatment for this disorder. In this report we describe the acute conservative treatment of two cases of paraplegia/paraparesis due to acute type B aortic dissection. Early reversal of lower-limb dysmobility was achieved.
Aged↗
Initial experiences in management of blunt aortic injury taking associated brain injury into consideration.
BACKGROUND: Although endovascular stent-grafting (SG) has become acceptable for blunt aortic injury (BAI), open surgical repair (OR) does provide reliable, good long-term results. A current surgical strategy for BAI, taking account of associated brain injury, is presented and preferable initial management for BAI is proposed. METHODS AND RESULTS: The surgical strategy for BAI was established in 2001: SG is performed for patients with obvious brain injuries, but OR is performed for patients without brain injury, and conservative treatment should be used initially for patients with critical non-aortic injuries. Between 2001 and 2004 20 patients with BAI were admitted to hospital: 16 blunt aortic ruptures and 4 blunt aortic dissections. Of them 15 patients underwent surgery (SG, 9; OR, 6) and 5 patients were treated conservatively. One patient died from associated lung injury after SG, all patients treated conservatively died because of associated brain injuries or another rupture of BAI, and 2 elderly patients treated by OR died within 1 year from postoperative respiratory failure. CONCLUSION: This brain-injury conscious surgical strategy for BAI provided acceptable early results. OR should be chosen for young patients without brain injury, but endovascular SG seems to be a better initial treatment for elderly patients or patients with other comorbidities.
Adult↗
Endovascular stent grafting for thoracic aneurysms in Jehovah's Witnesses: report of three cases.
There are few published reports on endovascular stent grafting for thoracic aneurysms in Jehovah's Witnesses. Between 2001 and 2003, we performed endovascular stent grafting for a thoracic aneurysm in three patients of the Jehovah's Witness faith. Two patients had a thoracic aortic aneurysm and one had a chronic type-B dissection. The stent graft was constructed from a self-expanding Z-stent and thin-walled woven polyester fabric. None of the patients required perioperative blood transfusion, there was no postoperative endoleak, and all recovered uneventfully and were discharged from hospital. Thus, stent-graft repair of thoracic aneurysms in Jehovah's Witnesses is feasible and can be achieved without the need for blood transfusion.
Aged↗
Celiac artery compression syndrome due to acute type B aortic dissection.
Acute distal aortic dissection sometimes causes one or more visceral vessels to be stenosed by the thrombosed false lumen. Although stenosis of the only celiac artery (CA) usually does not cause ischemic symptoms because of the extensive collateral pathways of the mesenteric circulation, we experienced a rare case of CA compression syndrome which was caused by acute type B aortic dissection. The principal symptom was severe epigastric pain that was refractory to medicinal treatment. The angiogram showed absence of the anatomically well-developed collateral pathways between the CA and the superior mesenteric artery. We treated the patient with percutaneous transluminal angioplasty in the CA. This report indicates that attention should be given to the possibility of CA compression syndrome in the case of acute distal aortic dissection and that endovascular management can be successfully applied to control symptoms caused by the syndrome, which is otherwise extremely difficult to repair directly by surgery.
Aortic Dissection↗
Descending thoracic aortic aneurysm repair with the aid of partial cardiopulmonary bypass: heparin-coated circuits versus nonheparin-coated circuits.
BACKGROUND: We have performed descending thoracic aortic aneurysm repairs with partial cardiopulmonary bypass, including heparin-coated circuits. The aim of this study was to evaluate (i) the impact of partial cardiopulmonary bypass on distal organ function and surgical outcomes; and (ii) the effectiveness of using heparin-coated circuits for preventing bleeding complications. METHODS: From July 1980 to June 2004, 309 patients underwent descending thoracic aortic aneurysm repairs using partial cardiopulmonary bypass. Their mean age was 61 years (range 19-81 years). One hundred of the 309 patients underwent repair of descending thoracic aortic aneurysm with heparin-coated circuits. Blood data for renal and hepatic function were collected on the day before the operation and postoperative days. RESULTS: The in-hospital mortality was 15%. Distal organ dysfunction included spinal cord dysfunction in 2 patients (0.7%) and renal failure necessitating hemodialysis in 15 patients (5%, 15/297: excluded 12 dialysis patients). Multivariate analyses showed that preoperative hemodialysis and emergency operation were risk factors for operative mortality and that emergency operation was a risk factor for requiring hemodialysis. Renal and hepatic function normalized by 2 weeks after surgery. There were no significant differences between the heparin-coated group and nonheparin-coated group in amounts of packed red cells, fresh frozen plasma, and platelets transfused during the procedures. CONCLUSIONS: Our data showed that partial cardiopulmonary bypass is a safe and effective method for distal perfusion. Using this technique, descending thoracic aortic aneurysm repair can be performed with acceptable mortality and morbidity. However, the superiority of heparin-coated circuits over nonheparin-coated ones was not proved.
Adult↗
Endovascular stent-grafting for thoracoabdominal aortic aneurysm following bypass grafting to superior mesenteric and celiac arteries: report of two cases.
Two high-risk patients underwent an endovascular stent-grafting for thoracoabdominal aortic aneurysms (TAAA) following bypass-grafting to the visceral arteries. The first patient was a 73-year-old woman with severe ischemic heart disease (IHD) and chronic respiratory failure. The second patient was a 59-year-old woman with myelodysplastic syndromes (MDSs) and hepatic cell carcinoma (HCC). In general, TAAA is not considered to be indicated for endovascular stent-grafting because of the need to revascularize the visceral vessels. However, in some selected cases, such as the two cases presented herein, endovascular stent-grafting combined with bypass-grafting of the visceral arteries can be a feasible and a less-invasive alternative to conventional surgery.
Aortic Aneurysm, Abdominal↗
Stroke in surgery of the arteriosclerotic descending thoracic aortic aneurysms: influence of cross-clamping technique of the aorta.
OBJECTIVE: The risk of stroke caused by dislodgment of loose atheromatous plaque or mural emboli is increased by cross-clamping of the aorta. Some patients undergo descending thoracic aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. The objective of this study was to determine the influence of proximal aortic cross-clamping in arteriosclerotic aneurysm or dissecting aneurysm repair. METHODS: Between May 1984 and May 2003, 81 patients underwent elective surgery for distal arch or descending aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. To evaluate the influence of the proximal aortic cross-clamping, patients were divided into two groups: patients who had undergone arteriosclerotic aneurysm repair (group I, n=25) and patients who had undergone dissecting aneurysm repair (group II, n=56). RESULTS: Eight (9.9%) of the 81 patients had a stroke. Six strokes occurred in operations for arteriosclerotic aneurysm repair group I and two strokes occurred in operations for dissecting aneurysm repair group II (24 vs 3.6%; p=0.009). In-hospital mortality rates were 12% in group I and 8.9% in group II (p=0.70). Major postoperative complications included renal failure requiring hemodialysis (in 4.2% of the patients in group I and in 8.3% of the patients in group II, p=0.99) and pulmonary complication (in 20% of the patients in group I and in 16% of the patients in group II, p=0.67). CONCLUSION: Cross-clamping between head vessels should be avoided if at all possible when operating on patients who have arteriosclerotic descending thoracic aneurysms.
Adult↗
Concomitant mitral and tricuspid valve infective endocarditis: report of a case.
A rare case of native valve endocarditis affecting both the normal mitral and tricuspid valves is presented. A 25-year-old woman with an acute ischemic stroke was found to have vegetation secondary to infective endocarditis as the embolic source. One month after the onset of embolic cerebrovascular intervention, a valve repair with the implantation of artificial chordae, sliding commissuroplasty, and ring annuloplasty resulted in a complete recovery.
Adult↗
Minilaparotomy abdominal aortic aneurysm repair versus the retroperitoneal approach and standard open surgery.
PURPOSE: We evaluated the surgical results of minilaparotomy abdominal aortic aneurysm (AAA) repair in comparison with those of standard open repair and retroperitoneal approach repair. METHODS: Between February 2000 and January 2003, 30 patients with AAA underwent minimal incision laparotomy repair (MINI) through an abdominal incision 7-12 cm long. Their clinical characteristics and in-hospital outcome were then compared with those of patients who had undergone repair of AAA by a standard open technique (OPEN) or retroperitoneal approach technique (RETRO). RESULTS: There were significant differences between the MINI, OPEN, and RETRO groups in the time until the patient was able to resume eating (2.4 +/- 1.0 vs 4.4 +/- 2.4* vs 2.8 +/- 1.9 postoperative days [PODs], respectively; *P < 0.05), the time until ambulation outside the room (2.1 +/- 0.7 vs 3.5 +/- 1.3* vs 2.5 +/- 1.9 PODs, respectively; *P < 0.05), and the operation times (188 +/- 43* vs 256 +/- 77 vs 238 +/- 59 min, respectively; *P < 0.05). CONCLUSION: Minilaparotomy repair is a feasible technique, which combines the benefits of a small incision with those of conventional open repair. With the exception of patients with an iliac artery aneurysm extending to the external or internal iliac artery, MINI repair should be considered for the elective treatment of patients with aortic disease.
Aged↗
Thoracoabdominal aortic aneurysm repair through redo left-sided thoracotomy.
BACKGROUND: The outcome of thoracoabdominal aortic aneurysm repair through redo-left thoracotomy after operations for descending thoracic aortic aneurysms was investigated. METHODS: Between May 1982 and March 2003, 100 patients underwent thoracoabdominal aortic aneurysm repair in elective surgery without profound hypothermic circulatory arrest. Thirty of these patients had previously undergone operations for descending thoracic aortic aneurysms. To evaluate the influence of previous descending thoracic aortic aneurysm repairs on the results of thoracoabdominal aortic aneurysm replacements, patients were divided into two groups: (1) patients who had previously undergone descending thoracic aortic aneurysm repair (group I; n = 30), and (2) patients who had not previously undergone descending thoracic aortic aneurysm repair (group II; n = 70). RESULTS: The distal aortic perfusion time and operation time were both longer in group I than in group II, but there was no significant difference between the two groups in total selective visceral and renal perfusion time or aortic clamp time. In-hospital mortality rates were 13% in group I and 19% in group II (p = 0.52). Major postoperative complications included paraplegia (10% of patients in group I and 4.3% of patients in group II; p = 0.36), renal failure requiring hemodialysis (20% of patients in group I and 11% of patients in group II; p = 0.35), respiratory failure (30% of patients in group I and 19% of patients in group II; p = 0.22). CONCLUSIONS: Previously descending thoracic aortic aneurysm and redo-left thoracotomy do not adversely affect the outcome of thoracoabdominal aortic aneurysm repair.
Adult↗
Magnetic resonance angiographic localization of the artery of Adamkiewicz for spinal cord blood supply.
BACKGROUND: The purpose of this study was to determine whether the artery of Adamkiewicz (ARM) can be detected by magnetic resonance angiography and to determine the usefulness of preoperative magnetic resonance angiography evaluation of the ARM. METHODS: Between April 2000 and December 2003, 120 patients underwent magnetic resonance angiography for detection of the ARM. The morphology of the anterior spinal artery at the ARM junction, as revealed by magnetic resonance angiography, in 99 patients in whom ARM was preoperatively detected was classified into the following three types: noncontinuation of the anterior spinal artery above the ARM junction (type A), continuation of the anterior spinal artery above and below the ARM junction (type B), and noncontinuation of the anterior spinal artery below the ARM junction (type C). RESULTS: The ARMs were detected in 99 (83%) of 120 patients, and from a total of 110 ARMs 105 (95%) originated from intercostal arteries branching from the left side and 94 (86%) originated between Th9 and Th11. Two ARMs were found in 11 (11%) of 99 patients in whom ARMs were detected. In 107 patients, who underwent magnetic resonance angiography to reveal the morphology of the anterior spinal artery at the ARM junction, the patterns of the anterior spinal artery were type A in 59 patients (55%), type B in 21 patients (20%), type C in 3 patients (3%) and not classified in 24 patients (22%). No spinal cord injury occurred in patients in whom the ARM had been preoperatively detected. CONCLUSIONS: Preoperative detection of the ARM is possible by magnetic resonance angiography and is very useful for reducing the incidence of ischemic injury of the spinal cord.
Adult↗
Descending thoracic aortic rupture: role of endovascular stent-grafting.
BACKGROUND: The mortality of patients with descending thoracic aortic rupture who are treated by conventional surgery is high. Our current strategy for the management of descending thoracic aortic rupture is to treat seriously ill patients with endovascular stent-grafting using handmade grafts, and to treat other patients with traditional open repair. The aim of this study was to assess the early results of our strategy. METHODS: Twenty-nine consecutive patients with descending thoracic aortic rupture were referred to Sapporo Medical University Hospital from June 2001 to January 2004. Eighteen of these 29 patients were selected for endovascular stent-grafting because of polytrauma (n = 7), comorbidities (n = 6), advanced age (n = 2), past history of left thoracotomy (n = 2), and patient's preference (n = 1). The remaining 11 patients underwent traditional graft replacement of the diseased aorta. Their outcomes and follow-up data were collected and analyzed retrospectively. RESULTS: The in-hospital mortality rate was 14% (4/29). The mortality rate for surgical patients and stent-grafting patients was 9% (1/11) and 17% (3/18), respectively. The survival rate of patients at 2 years was 63% +/- 10%. In the follow-up period, 2 of the 18 patients who underwent endovascular stent-grafting required open repair, and 1 patient underwent a redo endovascular stent-grafting procedure because of stent failure. One of these 3 patients died of an intraoperative retrograde type A aortic dissection. CONCLUSIONS: The early results of endovascular stent-grafting for the treatment of high-risk patients with descending thoracic aortic rupture are promising. Early results of open repair can also be improved by the selection of stabilized patients. However, the requirement of reintervention indicates that detailed follow-up examinations in patients who have undergone endovascular stent-grafting with handmade stent-grafts should be performed.
Adult↗
Endovascular stent grafting for rupture of a thoracoabdominal aortic aneurysm after replacement of the entire aorta.
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Adult↗
Batista operation with aortic valve replacement for valvular cardiomyopathy.
We performed a successful Batista operation with aortic valve replacement (AVR), graft replacement of the ascending aorta, and tricuspid annuloplasty for a patient with valvular cardiomyopathy with severe aortic stenosis, an ascending aortic aneurysm, and grade 3 tricuspid regurgitation.
Aortic Aneurysm, Thoracic↗
Large bronchial cyst causing compression of the left atrium.
We describe here a case with a large bronchogenic cyst treated by surgical resection, who presented with evidence of left atrial overload on electrocardiogram (ECG). The 50-year-old male patient presented with the chief complaint of heaviness in the chest on exertion. An ECG revealed evidence of left atrial overload, and echocardiography and imaging revealed a mass having a maximum diameter of 9 cm on the cranial aspect of the left atrium, caudal to the tracheal bifurcation. The patient was treated by surgical resection of the cystic mass via right anterolateral thoracotomy. His postoperative course was satisfactory and the patient was relieved of his main symptom.
Bronchogenic Cyst↗
Composite graft replacement after aortic valvuloplasty in Takayasu arteritis.
A 24-year-old woman had undergone valvuloplasty of the aortic valve and external reinforcement of an aneurysm of the ascending aorta during the active phase of Takayasu arteritis 1 year prior to admission to our hospital. On examination, she was diagnosed as having a large false aneurysm of the ascending aorta with annuloaortic ectasia and severe aortic regurgitation, bilateral common carotid artery aneurysms with a left internal carotid artery saccular aneurysm, and bilateral subclavian artery and right vertebral artery obstructions due to Takayasu arteritis. Because of the risk of rupture, surgical intervention was carried out in spite of the fact that aortitis was in the active phase.
Adult↗
Traumatic coronary artery dissection.
A 14-year-old boy sustained blunt chest trauma resulting in dissection of the left main coronary artery, postinfarction left ventricular aneurysm, mitral regurgitation, and tricuspid regurgitation. He underwent pericardial patch angioplasty of the left main coronary artery, left ventricular aneurysmectomy, mitral valvuloplasty, and tricuspid annuloplasty. The patient continues to do well 4 years after operation.
Accidents, Traffic↗