-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Immunoglobulin (Ig) G4-related disease has recently been recognized to occur in the cardiovascular system in the aorta and main branching arteries, often manifesting as aneurysms and arteritis/periarteritis. Peripheral arteries (the femoral and popliteal arteries) are frequent sites of arteriosclerosis obliterans (ASO) and occasionally show aneurysms or arteritis. This study re-examined peripheral arterial lesions from the standpoint of IgG4-related disease. METHODS: The study comprised 104 patients who underwent surgical treatment of peripheral arterial lesions, including 30 patients with peripheral arterial aneurysms (PAAs) and 74 with ASO. IgG4-related disease was identified on the basis of diffuse infiltration of numerous IgG4-positive plasmacytes as revealed by immunohistochemical examination. Clinicopathologic features were compared between IgG4-related and IgG4-unrelated lesions. RESULTS: IgG4-related disease was found in four of the 30 patients with PAAs (13.3%; two in the deep femoral artery, two in the popliteal artery) but not in any patients with ASO. IgG4-related PAA displayed clinicopathologic features resembling those of other IgG4-related diseases and a characteristic saccular appearance (P = .002). CONCLUSIONS: IgG4-related disease was detected in PAA patients but not in ASO patients. IgG4-related disease thus represents one potential etiology of aneurysm in the peripheral arteries.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 11/2012; · 3.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Objectives: We reviewed early and midterm outcome of 11 multivessel-disease acute coronary syndrome patients treated by hybrid revascularization,
i.e., initial coronary angioplasty followed by minimally invasive direct coronary artery bypass grafting. We evaluated procedural
efficacy and applicability.Methods: Beginning in August 1997, hybrid revascularization was conducted in 11 multivessel-disease acute coronary syndrome patients—9
men and 2 women with a mean age of 70.3±9.3 years. Occlusion or stenosis of the target coronary artery was treated by interventional
cardiologic techniques and minimally invasive direct coronary artery bypass grafting, and the early and midterm outcome evaluated.
Coronary angiography was conducted in all cases at 2 weeks, 6 months, 1 and 3 years postoperatively to evaluate anastomosis
and restenosis in treated coronary vessels.Results: Initial intervention succeeded in patients with minimal residual stenosis. Subsequent minimally invasive direct coronary
artery bypass grafting involved no complications. Coronary angiography early postoperatively, 6 months, 1 and 3 years later
showed grafts patent without stenosis. Percutaneous transluminal coronary angioplasty was reconducted on restenotic lesions
in 3 patients, 1 of whom required 3 procedures.Conclusions: Hybrid revascularization appears safe and effective in coronary revascularization, at least over the short term. Several
patients underwent angioplasty for restenosis within 3 years after initial procedure. Overall acceptance of this hybrid method
depends on longterm functional success of the 2 procedures. Its major limitation is restenosis of angioplasty sites and the
need for repeat procedures.
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 49(12):700-705.
-
[show abstract]
[hide abstract]
ABSTRACT: Immunoglobulin G4-related sclerosing disease (IgG4-SD) has recently been reported to occur in the cardiovascular system and manifest as inflammatory abdominal aortic aneurysm. Thoracic aortic lesions are often associated with aortitis in several divergent etiologies. Thus, this study was performed to review thoracic aortic lesions from the aspect of IgG4-SD and to elucidate the clinicopathologic characteristics of this subgroup in the thoracic aorta.
The study comprised 125 patients, including 71 with thoracic aortic aneurysm (TAA), 44 with aortic dissection, 7 with Takayasu aortitis, and 3 with infectious aortitis. IgG4-SD was identified by diffuse infiltration of numerous IgG4-positive plasmacytes by immunohistochemical examinations. Clinicopathologic features were compared between IgG4-related and IgG4-unrelated lesions.
Among the 125 patients, IgG4-SD was found in 5 patients with TAA but was not detected in the other subgroups of thoracic aortic lesion. IgG4-related TAA included one case of lymphoplasmacytic aortitis, 1 case of inflammatory aneurysm, and three cases of atherosclerotic aneurysms. Patients with IgG4-related TAA showed clinicopathologic features similar to patients with IgG4-SD: male gender, old age, history of bronchial asthma and allergies, elevation of white blood cell counts, C-reactive protein levels, and IgG4 and IgE concentrations (in one patient); eosinophilic infiltration, obliterative phlebitis, lymph follicle formation, and perineural inflammation. In addition, compared with IgG4-unrelated TAA, IgG4-related TAA was characterized by clinically more frequency of involvement of the aortic arch (P = .002), saccular formation (P = .003), and fibrous adhesion to surrounding tissue (P < .001), and histopathologically thicker entire aortic wall and adventitia (P < .001 each).
IgG4-SD is involved in 4% of all thoracic aortic lesions and uniformly presents in the form of an aneurysm with distinct histologic and clinicopathologic features. IgG4-SD represents one, albeit rare, etiology of TAA, especially those originating in the aortic arch.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 12/2010; 52(6):1587-95. · 3.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Recently, the relationship between immunoglobulin (Ig)G4 and idiopathic sclerosing lesions has attracted much attention. IgG4-related disease was first described with regard to the pancreas (autoimmune pancreatitis), and has been expanded to various organ systems. We previously reported that inflammatory abdominal aortic aneurysm (IAAA) could be one of the manifestations of IgG4-related disease. In this study, we tried to elucidate the clinical characteristics of IgG4-related IAAA.
This study consisted of 23 cases of IAAA and 40 cases of atherosclerotic abdominal aortic aneurysm (AAA). Clinical presentation, laboratory findings, and pathological features were examined. Aneurysms of 13 cases histologically corresponded to IgG4-related IAAA.
Those cases accounted for 5% of all surgical AAAs, and 57% of IAAAs. Compared to non-IgG4-related IAAA, IgG4-related cases were characterized by less frequent association with abdominal or back pain. Serum IgG4 concentrations were significantly elevated in IgG4-related cases. Interestingly, patients with IgG4-related IAAA frequently showed an allergic constitution, such as drug allergy, autoimmune diseases, high serum IgE concentrations, and a high titer of antinuclear antibody. Pathologically, IgG4-related cases were characterized by more significant thickening of the adventitia and more numerous IgG4-positive plasma cell infiltrations. Three non-IgG4-related cases showed aneurysmal rupture at the time of first presentation, whereas no IgG4-related cases showed rupture.
Recognizing a new disease entity of IgG4-related IAAA seems important because this was clinically and pathologically different from conventional aAAA and non-IgG4-related IAAA.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 03/2009; 49(5):1264-71; discussion 1271. · 3.52 Impact Factor
-
Satomi Kasashima,
Yoh Zen,
Atsuhiro Kawashima,
Keiko Konishi,
Hisao Sasaki,
Masamitsu Endo,
Yasushi Matsumoto,
Kengo Kawakami, Fuminori Kasashima,
Makio Moriya,
Keiichi Kimura,
Hiroshi Ohtake,
Yasuni Nakanuma
[show abstract]
[hide abstract]
ABSTRACT: Inflammatory abdominal aortic aneurysm (AAA) is a member of a family of disorders referred to as "chronic periaortitis" together with retroperitoneal fibrosis. Retroperitoneal fibrosis is included in IgG4-related disease, which is characterized by numerous infiltrating IgG4-positive plasma cells and high serum IgG4 concentrations. However, the relationship between IgG4-related disease and inflammatory AAA has not been documented. In this study, we examined the clinicopathologic characteristics of inflammatory (10 cases) and atherosclerotic (22 cases) AAAs, based on the hypothesis that inflammatory AAA might be related to IgG4-related disease. Cases of inflammatory AAA could be classified into 2 groups based on immunostaining of IgG4. Four patients showed diffuse infiltration of abundant IgG4-positive plasma cells (IgG4-related cases), whereas the remaining 6 cases of inflammatory AAA and all cases of atherosclerotic AAA had only a few IgG4-positive plasma cells (non-IgG4-related cases). IgG4-related inflammatory AAA was pathologically characterized by the frequent infiltration of eosinophils, lymph follicle formation, perineural inflammatory extension, and inconspicuous infiltration of neutrophils compared with non-IgG4-related inflammatory AAA. Obliterative phlebitis, which is venous occlusion with inflammatory cell infiltration, is observed in all IgG4-related cases. In addition, serum IgG4 concentrations were significantly higher in IgG4-related inflammatory AAA (109 to 559 mg/dL, normal range: 4 to 110 mg/dL) than non-IgG4-related inflammatory AAA (32 to 59 mg/dL) and all atherosclerotic AAA (12 to 83 mg/dL). In conclusion, inflammatory AAAs might be classified into 2 groups: IgG4-related or nonrelated. The former might be one of the IgG4-related diseases, and could be included in IgG4-related periaortitis together with retroperitoneal fibrosis.
American Journal of Surgical Pathology 03/2008; 32(2):197-204. · 4.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We described the diagnosis and treatment for limb edema due to venous disease in this paper. Venous limb edema is caused by vein pressure elevation, which is induced by venous reflux, flow disturbance and overflow. Valve incompetence causes varicose vein and deep venous insufficiency of lower extremities. Deep vein thrombosis is the most popular disease among the venous obstruction morbidity. Arterio-venous fistula for hemodialysis sometimes induces venous arm edema due to overflow. Arm edema due to venous hypertension appears more clearly when it is associated by subclavian vein stenosis or occlusion. There are several causes for venous edema. So, we have to make an appropriate treatment based on the clear diagnosis.
Nippon rinsho. Japanese journal of clinical medicine 02/2005; 63(1):127-33.
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to evaluate the roles of matrix metalloproteinases (MMPs) and urokinase-type plasminogen activator (uPA) with regard to varicose veins (VVs). Immunohistochemical staining and ELISA were performed on samples from 73 patients with the following leg VVs: 82 greater saphenous veins (GSV) from the groin (GSV groin), 28 GSV from the ankle (GSV ankle), 85 VVs, and 13 normal GSV groin (control [CR]) obtained during coronary artery bypass surgery. Immunohistochemically, MMP-9 was localized in the smooth muscle cells (SMCs) in the tunica media. The ratio of immunopositive cells of MMP-9 in the GSV groin, VVs, and GSV ankle were significantly higher than that of CR. The ratios of immunopositive cells of uPA and uPA receptor (uPAR) were not significantly different among the groups. uPA and uPAR were found to be positive in a different set of SMCs of the MMP-9-positive cells. An ELISA showed that the amount of uPA in the culture of the GSV groin was significantly higher than that in CR. For the remodeling process, MMP-9 may be produced in the VV wall and degrade elastic lamellae and other extracellular components of the venous wall. uPA may be produced by groin tissue of the GSV and flow downward because of valvular incompetence, activating MMP-9 at VV tissues.
Annals of Vascular Surgery 06/2003; 17(3):234-8. · 1.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To report a rare case of mediastinal bronchial artery aneurysm successfully treated with an endovascular stent-graft.
A 79-year-old man with a history of tuberculosis was admitted to our hospital complaining of worsening hoarseness. Examination revealed a large mediastinal bronchial artery aneurysm located near the origin of the artery. Since neither surgical intervention nor transcatheter embolization was feasible, an endovascular stent-graft repair was performed using a newly developed stent-graft constructed from a nitinol stent and a thin membrane of polyester. Postprocedural angiography showed satisfactory exclusion of the aneurysm. The patient made an uneventful recovery. The 18-month computed tomographic scan documented continued exclusion of the aneurysm, with no evidence of endoleak, graft thrombosis, or migration.
When conventional procedures are too complicated for bronchial artery aneurysms, endovascular stent-graft repair can be a useful approach.
Journal of Endovascular Therapy 05/2003; 10(2):381-5. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study was conducted to assess the efficacy and applicability of on-pump beating heart valvular operations using retrograde coronary sinus perfusion.
A prospective, randomized study was conducted. A total of 50 patients participated in this study after having been allocated to one of two groups. On-pump beating heart valvular operations using retrograde coronary sinus perfusion as myocardial protection were performed in 25 patients (beating heart procedure group: aortic = 8 patients, mitral = 15 patients, double = 2 patients). Twenty-five patients underwent conventional valvular operation using retrograde continuous warm blood cardioplegia (conventional procedure group: aortic = 9 patients; mitral = 13 patients; double = 3 patients). The remaining operative variables and early outcomes of these procedures were compared. In the beating heart procedure group, myocardial tissue oxygen was measured by near infrared spectroscopy, and partial oxygen pressure of coronary sinus perfusion was also measured.
The visual field of the on-pump beating heart was equal to that of conventional valvular operation, and technical accuracy was not compromised. In the beating heart procedure group, tissue oxygen saturation was maintained at 79% +/- 2%, and partial oxygen pressure of coronary sinus perfusion blood and returned blood were maintained at 383 +/- 29 mm Hg and 38 +/- 2 mm Hg, respectively. Postoperative peak creatine kinase-MB (measured every 3 hours postoperatively) and peak troponin T concentrations were significantly lower than those of conventional procedures (17.5 +/- 7.8 vs 32.1 +/- 9.3 IU/L and 0.12 +/- 0.04 vs 0.21 +/- 0.06 ng/mL, respectively; p < 0.05). There was no operative mortality and no major complications.
On-pump beating heart valvular operation is a good surgical option, and has advantages because conditions for the heart are more physiologic with beating tonus than with cardioplegia.
The Annals of Thoracic Surgery 10/2002; 74(3):678-83. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We present the case of an 80-year-old man with chronic atrial fibrillation associated with mitral regurgitation. The atrial fibrillation was successfully treated with the maze procedure combined with mitral valve replacement. The electrophysiological data are also reported. Recordings of sinus rhythm and intraatrial activity demonstrated the coexistence of sinus rhythm and fibrillation of both atria. This finding indicates that the sinus node was protected from segmental atrial fibrillation by entrance block, and this, in turn, is evidence of the efficacy of the maze procedure.
The Annals of Thoracic Surgery 08/2002; 74(1):249-51. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: For many years, thoracic sympathectomy via open surgery was not used to treat Raynaud's phenomenon because of the invasiveness of this procedure and the poor long-term outcomes associated with it. However, with the introduction of endoscopic surgery, thoracic sympathectomy (or sympathicotomy) has been performed by some surgeons as a less invasive surgical option for patients with Raynaud's phenomenon. The less invasive procedure has the possibility of emphasizing merits of sympathectomy. The purpose of this study was to reevaluate the efficacy of sympathicotomy for Raynaud's phenomenon with endoscopic technique and its range of applicability.
Between December 1992 and August 2001, endoscopic thoracic sympathicotomy (ETS) was performed in 28 patients with Raynaud's phenomenon (of a total of 502 patients with autonomic disorders who underwent ETS) at National Kanazawa Hospital. We considered indications for surgical treatment of Raynaud's phenomenon to include severe chronic symptoms or nonhealing digital ulceration refractory to intensive medical therapy. All patients were mailed a self-assessment questionnaire after surgery to determine the immediate and long-term results of the procedure. Data from both initial and long-term follow-up examinations were obtained.
Fifty-four ETS procedures were performed in 28 patients. No operative mortality was seen, and no occurrence of major complications necessitated open surgery. Initial resolution or improvement of symptoms was achieved in 26 of 28 patients (92.9%). However, later in the postoperative period, symptoms recurred in 23 of 28 patients (82.1%), although no recurrence of digital ulceration was seen throughout our observation. At the final follow-up examination (median follow-up period, 62.5 months), 25 patients (89.3%) reported overall improvement of the frequency and severity of their symptoms.
Despite the high rate of recurrence, ETS clearly produced a high rate of initial relief. ETS did indeed promote healing of digital ulcers, and the procedure shows potential for reducing the severity of refractory symptoms. We consider ETS to be the method of choice for treatment of severe or refractory Raynaud's phenomenon, and especially for Raynaud's involving digital ulcer, because of its safety and efficacy.
Journal of Vascular Surgery 08/2002; 36(1):57-61. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Internal jugular venous thrombosis is an unusual entity with the potential to develop into pulmonary embolism (PE). A 28-year-old woman at 15 weeks gestational age of pregnancy was referred to our hospital for pain and swelling on the left side of her neck. Magnetic resonance imaging and computed tomography of her neck revealed an occlusion of the left internal jugular vein. Left internal jugular venous thrombosis was thus diagnosed. She was successfully treated by placement of a Greenfield filter in the superior vena cava and delivered a full-term healthy infant. This procedure could be an effective and safe method to prevent PE in patients of internal jugular venous thrombosis in whom anticoagulation therapy has either failed or is contraindicated.
Surgery Today 02/2002; 32(7):635-7. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aneurysms of the innominate and subclavian arteries are uncommon but associated with high mortality rates. We report herein
the case of a 45-year-old man who presented with facial anhidrosis that developed several years after blunt thoracic trauma,
in whom an aneurysm involving the innominate and subclavian arteries was revealed by preoperative examinations. Resection
of the aneurysm and reconstruction from the ascending aorta to both the subclavian and common carotid arteries using a bifurcated
graft was successfully performed without brain perfusion. Although the left posterior cerebral artery, which was not manipulated
during surgery, became occluded, it was recanalized by thrombolysis. The patient was discharged in good health and has remained
well since.
Surgery Today 12/2000; 31(1):51-54. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Primary cardiac neurofibroma is a rare occurrence. We describe a case of left ventricular neurofibroma in a 56-year-old woman with Von Recklinghausen disease. Resection of the tumor with concomitant mitral valve replacement yielded a satisfactory clinical result, and histological examination of the resected tissue confirmed benign neurofibroma. The anatomic distribution of the vagus nerve plexus, which penetrates the epicardium and myocardium and courses over the left ventricular subendocardial surface, provides a tissue source from which this neurogenic tumor may arise.
Journal of Cardiac Surgery 21(3):278-80. · 0.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The authors treated a 70-year-old woman with persistent atrial fibrillation associated with mitral valve stenosis. Restoration of sinus rhythm was achieved with encircling isolation of pulmonary vein orifices concomitant with mitral valve replacement. A vertical incision in the right side of left atrium was extended to the margin of the upper and lower left pulmonary vein orifices. Supplemental cryo-coagulation was applied to the remnant of the circular incision, avoiding the entire encircling incision. Consequently, all pulmonary veins were electrically isolated. Encircling pulmonary vein orifice isolation is less invasive than the MAZE procedure because of reductions in surgical time and cardiopulmonary bypass time, minimization of atrial incisions, and prevention of injury to the coronary artery. It is thus an effective option for selected patients with atrial fibrillation.
Journal of Cardiac Surgery 18(5):415-8. · 0.87 Impact Factor
