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ABSTRACT: From January 1995 to May 2003, 36 patients with dialysis-dependent renal failure underwent coronary artery bypass grafting. We performed the operation with cardiopulmonary bypass (group On) in 17 cases and without cardiopulmonary bypass (group Off) in 19 patients [off-pump coronary artery bypass grafting (OPCAB) 15, minimally invasive direct coronary artery bypass (MIDCAB) 4]. There were no statistical differences regarding mean age, sex, duration of dialysis, preoperative hypertension, diabetes and peripheral and cerebral vascular diseases. Mean operation time and the number of bypass grafts were 315 +/- 53 minutes, 2.8 +/- 0.8 grafts in group On and 284 +/- 78 minutes, 2.4 +/- 1.1 grafts in group Off, respectively (not significant). Seventeen patients (100%) of group On and 12 patients (63%) needed blood transfusion. Hospital stay after operation was significantly longer in group On (40 days) of group Off than that in group Off (26 days). After the operation, continuous hemodiafiltration (CHDF) was used in 10 cases (59%) in group On and 3 cases (16%) in group Off. In coronary artery bypass grafting (CABG) on dialysis patient, it is very effective to have various operation techniques, such as off-pump bypass and on-pump beating bypass. Also control of water-electrolyte balance using early postoperative CHDF is useful. However, off-pump cases could be controlled by conventional hemodialysis.
Kyobu geka. The Japanese journal of thoracic surgery 09/2007; 60(9):785-9; discussion 790-3.
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ABSTRACT: A 68-year-old man was admitted to our hospital because of ischemia in the upper and lower extremities with rest pain. Aortography revealed complete bilateral subclavian artery occlusion and left femoral artery occlusion. We planned simultaneous revascularization of upper and lower extremities. Ascending aorta to biaxillar and left femoral artery bypass was performed. The postoperative course was uneventful and he was discharged on the 18th day after operation. This procedure was useful for patient with upper and lower limb ischemia.
Kyobu geka. The Japanese journal of thoracic surgery 12/2006; 59(12):1079-81.
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ABSTRACT: A 60-year-old woman was admitted to our hospital because of syncope attack due to sustained ventricular tachycardia (VT). She was treated medically after cardiopulmonary resuscitation. Coronary arteriography revealed a 99% stenosis of right coronary artery (posterior descending artery: # 4 PD), a 90% stenosis of left descending artery (# 6) and left akinetic aneurysm was demonstrated. The patient successfully underwent Dor operation with endocardial cryoablation. The postoperative course was uneventful and the recurrence of VT was never recognized clinically.
Kyobu geka. The Japanese journal of thoracic surgery 05/2005; 58(4):313-5.
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ABSTRACT: We assessed the clinical efficacy and determined the effective dose of erythropoietin (EPO) in 48 children scheduled for open heart surgery without blood transfusion. The children were divided into three groups: group 1 (n=21) was treated with 300 U/kg of EPO; group 2 (n=11) was treated with 150 U/kg of EPO; and group 3 (n=16) was not treated with EPO. EPO was administered on the day of hospital admission (6 to 7 days prior to surgery), on the following day, immediately after surgery, and on the following day. Immediately after surgery, the hemoglobin concentration in groups 1 and 2 was significantly higher than that in group 3. The reticulocyte count in groups 1 and 2 was significantly higher than that in group 3. Open heart surgery was completed without transfusion in all 21 patients in group 1 (100%), 10 of 11 in group 2 (90.9%), and 11 of 16 in group 3 (68.8%). EPO caused no adverse reactions. In conclusion, EPO was effective as an adjuvant therapy for open heart surgery without blood transfusion in children. Administration of a relatively high dose of EPO (300 U/kg) seems to be effective for pediatric patients.
Chest 07/1997; 111(6):1565-70. · 5.25 Impact Factor
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ABSTRACT: Postoperative pulmonary hypertensive crisis is a major problem that may account for a substantial part of the postoperative mortality and morbidity. We, therefore, evaluated the effect of inhalation of low-dose nitric oxide (NO) on postoperative care in pediatric patients with pulmonary hypertension. We studied 10 infants and children ages 1-108 months (median age, 11 months) with congenital heart disease associated with pulmonary hypertension. The NO and N2 gas mixture was then mixed with varied quantities of air and oxygen and delivered into a respirator instead of an inspiratory tube. Patients were treated with inhaled NO for 38.6 +/- 19.6 h (range 1-200 h). All patients were eventually weaned from high level sedation and respirator. The NO concentration ranged from 2 to 5 parts per million. During NO inhalation patients demonstrated a statistically significant reduction in systolic pulmonary arterial pressure by approximately 26%; from 55 +/- 10 to 41 +/- 20 mm Hg. Inhalation of NO resulted in a significant increase of Pao2 from 110 +/- 16 to 149 +/- 29 mm Hg. A-aDo2 significantly decreased from 284 +/- 27 to 247 +/- 31 mm Hg. In conclusion, we have shown that a low-dose NO inhalation acted as pulmonary vasodilator in patients with preexisting pulmonary hypertension.
Artificial Organs 02/1997; 21(1):10-3. · 2.00 Impact Factor
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Y Shomura,
T Shimono,
K Onoda,
I Hioki,
H Tenpaku,
Y Maze, T Mizumoto,
K Tani,
K Tanaka,
H Shimpo,
H Yuasa,
I Yada
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ABSTRACT: The Nikkiso HPM-15 is a minimally sized centrifugal pump. Preliminary results regarding clinical use of this pump for cardiopulmonary bypass (CPB) procedures have been reported previously. Recently, we have managed some additional cases using a newly developed controller. This article reports our clinical experiences with the use of this pump. We have managed 23 cases with a Nikkiso centrifugal pump. Twenty-two patients underwent CPB and 1 patient with fulminant viral myocarditis underwent percutaneous cardiopulmonary support (PCPS). With this pump, the circuit was extremely easy to prepare and deaeration was achieved readily. Hemodynamics during CPB and PCPS were stable in all cases. The increase in serum-free hemoglobin levels during CPB with this pump was as low as that seen in preliminary tests. A decrease in the platelet count was observed after the initiation of CPB with this pump; however, platelet counts returned to preoperative values 7 days after surgery. Moreover, urine output during CPB with this pump was as high as that seen in preliminary tests. No abnormalities in renal or liver function occurred during CPB. It appears that this new centrifugal pump is safe and easy to operate, and we conclude that it is useful for CPB and PCPS.
Artificial Organs 07/1996; 20(6):711-4. · 2.00 Impact Factor
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ABSTRACT: The prognoses of T4 lung cancer patients treated surgically were investigated in 76 patients. Extended resection was performed in 21 patients, palliative resection in 21 and exploratory thoracotomy in 34. Although the five-year survival of the extended resection group did not differ significantly from that obtained in the exploratory thoracotomy group, the mean survival time of the extended resection group was 3.1 months longer than that of the exploratory thoracotomy group. Two patients who had undergone resection for left atrial involvement, survived for two years or more, and a T4N0 patient with squamous cell carcinoma, in whom resection for aortic involvement was carried out, died from an unrelated disease after 15 months. Two patients with pleural dissemination, who underwent panpleuropneumonectomy, survived for two years. Surgical intervention did not improve the prognosis of patients with N2-squamous cell carcinoma, those with malignant effusion or those with multiple organ involvement.
Japanese Journal of Clinical Oncology 01/1995; 24(6):316-21. · 1.78 Impact Factor
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ABSTRACT: Chordal replacement with expanded polytetrafluorethylene suture has become a procedure of choice for repairing anterior leaflet prolapse among certain surgeons. However, most surgeons believe that the chordal replacement is too complicated and not reproducible. This report introduces a new method of chordal replacement using intraoperative epicardial and transesophageal echocardiography. Three dogs underwent the following procedures. One major marginal chorda of an anterior mitral leaflet was resected during cardiopulmonary bypass. A specially designed 3-0 polytetrafluoroethylene suture, having straight needles, was attached to the anterior leaflet by a mattress suture. Then the needles were brought from the root of the anterior papillary muscle to the outside of the left ventricle. After the bypass flow was reduced, both ends of the polytetrafluoroethylene suture were pulled under echocardiographic guidance until valve competence was achieved. At that point, the suture was temporarily tied. When cardiopulmonary bypass was discontinued, competence was again confirmed and the suture was tied permanently. When the procedures were completed, echocardiography showed trivial regurgitation and good pliability of the anterior leaflets in all animals. Left atrial pressures were sufficiently decreased. It appears that this new technique is reproducible for all surgeons because the optimal length of polytetrafluoroethylene chordae is determined with the valve functioning.
Journal of Thoracic and Cardiovascular Surgery 11/1994; 108(4):719-26. · 3.41 Impact Factor
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ABSTRACT: A comparative study of a newly developed impeller-type centrifugal pump, Nikkiso HMS-15, was made to assess the effects on hemolysis, platelet function, and renal function for extracorporeal circulation (ECC) during open heart surgery. The Bio-pump (cone-type, Medtronic) and the roller pump were used as controls. The increase of serum hemoglobin level in the Nikkiso pump was significantly lower than that in the other pumps. The decrease of platelet counts was recognized after the initiation of ECC in the three pumps whereas the levels of platelet factor 4 and beta-thromboglobulin in the Nikkiso pump group increased by far less than in the other two groups. Moreover, renal function was better maintained in the Nikkiso pump group; in particular, a significantly higher urine output was recorded during ECC and for 1 h after the termination of ECC. The results of our clinical studies suggest that the Nikkiso centrifugal pump is suitable for ECC during open heart surgery.
Artificial Organs 10/1994; 18(9):706-10. · 2.00 Impact Factor
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ABSTRACT: We have developed the protocol for selective cerebral perfusion (SCP) and pharmacological cerebral protection, and used it successfully in cases of aortic arch aneurysm. The subjects of the present study were 34 patients (28 males, 6 females) whose aortic arch aneurysm were surgically treated. Preoperative brain CT and brain scintigram showed high incidence of brain ischemia. However only 4 patients experienced a neurological episode. We conclude that our SCP technique and pharmacological cerebral protection are useful component to surgery of the aortic arch.
Kyobu geka. The Japanese journal of thoracic surgery 08/1993; 46(8 Suppl):660-3.
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ABSTRACT: A bipolar Nd-YAG laser dissector was developed to quickly dissect or resect organs, and the possibility of laser pulmonary dissection without scissors and ligation threads was studied experimentally. Pulmonary tissue was completely and easily divided using a bipolar laser handpiece, and the dissected edge was perfectly sealed. Leakage of air and blood from the edge was not induced and no additional stitching was required. Histological examination of the dissected edge revealed tissue remodeling after laser irradiation. The formation of amorphous layers, including vacuoles, was peculiar to the fusion-coagulation area, and alveolar atelectasis and capillary obstructions were characteristic of the degenerative area. When tissue dissection was performed by laser vaporazation, tissue remodeling seemed to be the most important factor in the prevention of leakage. In conclusion, we can effectively and quickly resect pulmonary tissue using the bipolar Nd-YAG laser dissector without scissors and without ligation threads.
Journal of Clinical Laser Medicine & Surgery 07/1992; 10(3):223-8.
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ABSTRACT: We analyzed the outcome for 18 patients with prosthetic valve endocarditis (PVE) treated between 1965 and 1990, 17 of whom had undergone valve replacement with mechanical prosthetic valves and one of whom had a bioprosthesis. Two patients developed infection within 60 days after surgery, and 16 thereafter. Fifteen patients received combined medical and surgical therapy and three medical therapy. In 14 patients, surgery had been performed during active infection. Mortality rate of those who had received combined medical and surgical therapy was 27%, and that of those who had received medical therapy was 67%. At operation, para-annular abscess was around the mitral prosthesis was found in three patients and around the aortic prosthesis in eight. Seven patients required reoperation for postoperative paravalvular leakage, in six, para-annular abscess had been found at the operation for PVE, and in one para-annular abscess had been noted. One patient who had undergone reoperation had developed reinfection after the first surgery and died due to multiple organ failure after the second operation (Danielson's translocation technique). In one patient who had complete loss of supporting tissue because of severe para-annular abscess, we had performed aortic valve replacement by implanting the aortic valve prosthesis into the left ventricle with Dacron felt-supported sutures placed in the mitral annulus and the muscles of the left ventricular outflow tract. This patient showed no postoperative infection or no paravalvular leakage.(ABSTRACT TRUNCATED AT 250 WORDS)
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 03/1992; 40(2):177-83.
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ABSTRACT: The nuclear DNA content was determined by flow cytometry (FCM) in 155 resected specimens (122 paraffin-embedded and 33 fresh frozen specimens) of primary adenocarcinoma of the lung obtained at our department during the 8 years from 1982 to July, 1990. Aneuploid patterns were observed in 106 specimens (68.4%), and the diploid patterns in 49 (31.6%). No difference was observed in the age, sex, or clinical stage between the two groups. As for the relationship of the presence or absence of vascular infiltration with the DNA index (DI) and the heterogeneity index score (HIS), the percent positivity of vascular infiltration was 38.1% in the group with 1 less than or equal to DI less than 1.5 but nearly twice higher at 63.6% in the group with 1.5 less than or equal to DI. The percent positivity of vascular infiltration was 29.4% in the group with HIS less than 100 but 62.5% in the group with 100 less than or equal to HIS. Concerning the relationship between the ploidy pattern and outcome, the 5-year survival rate was 28.0% in the aneuploidy group and 65.1% in the diploid group, the outcome being significantly poorer in the first group. Concerning the relationship between DI and outcome, the 5-year survival rate was 14.9% in the group with 1.5 less than or equal to DI as compared with 55.4% in the group with 1.0 less than or equal to DI less than 1.5. DNA analysis was made also in bronchoscopic brushing specimens to examine the possibility of preoperative evaluation of the prognosis of lung cancer.(ABSTRACT TRUNCATED AT 250 WORDS)
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 11/1991; 39(10):1870-5.
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ABSTRACT: We experienced twelve cases of non-small cell carcinoma of the lung of the so-called "galloping type" small size carcinoma (less than or equal to 2 cm). Ten cases presented with mediastinal lymph node metastasis and two cases with distant metastasis. Solitary lymph node metastasis observed in almost half of the cases and lymph node metastasis in peculiar lymphatic regions (#3 a) seen in two cases, were the prominent characteristics of the lymphatic pathway dissemination showed by this type of cancer in advanced clinical stage. The prognosis was good, with 3 years and 5 years survival rate of 72.2% and 54.1% respectively. According to these results, we consider that, if the clinical stage is favorable, the surgical treatment must be indicated in all cases of these advanced small size carcinoma of the lung.
Kyobu geka. The Japanese journal of thoracic surgery 02/1991; 44(1):12-7.
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ABSTRACT: "Postoperative erythroderma", the pathogenesis of this disease have solved as graft-versus-host disease (GVHD) due to blood transfusion, is fatal and impossible to cure for the time being. Therefore the prevention against the disease is very important. One woman and three men who underwent an operation and blood transfusion at our department died of this disease. They fell into high fever on 11-13 days, erythroderma on 12-16 days, liver dysfunction on 14 days, and leukocytopenia on 17-19 days, after surgery and transfusion. Eventually, they all suffered from thrombocytopenia, diarrhea, renal dysfunction, and sepsis which led to death. The clinical course, macroscopic and microscopic findings of them coincided with those of GVHD. Since 1989, we have tried following methods for prevention of postoperative erythroderma: Reducing blood transfusion, especially fresh blood and fresh thrombocyte plasma, by using predeposited autologous blood, autologous washed erythrocytes collected from the operative area before and after extracorporeal circulation (ECC), concentrated residual blood from the ECC using a hemoconcentrater, and 1,500 rad of cobalt-irradiation of fresh blood, fresh thrombocyte plasma, and blood collected within 7 days prior to the transfusion. Postoperative erythroderma has not been experienced by introduction of these methods since 1989.
Kyobu geka. The Japanese journal of thoracic surgery 10/1990; 43(10):783-8.
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ABSTRACT: Two cases of left atrial ball thrombus associated with severe mitral stenosis in which echocardiography provided the clue to the diagnosis preoperatively were reported. First case was a 58 years old man who was admitted because of dyspnea and frequent syncopal attacks. An echocardiographic examination revealed a tight mitral stenosis and a floating ball thrombus in the left atrium. Under the extracorporeal circulation, the ball thrombus, 30 X 40 mm in size, weight 20 g was taken out. The other case was a 51 years old woman who had undergone surgery for closed mitral commissurotomy 14 years ago. She had a episode of syncope attack and a sudden loss of consciousness. The removed thrombus was 20 X 26 mm in size and weighed 5 g. Their cut surfaces showed an laminated structure in both cases. These mitral valves were replaced by Björk-Shiley prosthetic valves.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 05/1989; 37(4):723-8.
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ABSTRACT: The authors developed a percutaneous endoprosthesis for treatment of aortic dissections. The device is a Gianturco stent wrapped with Dacron or nylon mesh. Effectiveness of the covered stent versus a bare stent was compared in the treatment of acute aortic dissection.
Experimental aortic dissections were created in 10 mongrel dogs. Occlusion of intimal tears was attempted with covered stents in five dogs (group 1) and with bare stents in the remaining five dogs (group 2).
In group 1, entry tears were obliterated within 1 day (n = 3) or 1 week (n = 2) after stent placement and false lumina were thrombosed within 1 week (n = 3) or 1 month (n = 2). In group 2, entry tears and false lumina remained patent. Histologic specimens showed that the covered stents were entirely covered with smooth neointima.
This endoprosthesis offers an alternative to surgical treatment for dissections of the descending aorta.
Journal of Vascular and Interventional Radiology 5(6):805-12. · 2.08 Impact Factor
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ABSTRACT: This experimental study was designed to evaluate the effectiveness of metallic stents for the treatment of acute aortic dissection.
Thoracic aortic dissections were created in 14 mongrel dogs. Aortography performed immediately after creation of dissections showed two types of aortic dissections: rapid flow in the false lumen (group 1) and slow flow in the false lumen (group 2). Each group consisted of seven dogs. For each group, expandable metallic Gianturco stents were placed in five dogs and two dogs were used as controls.
A week later, false lumina were patent in all dogs in group 1 and thrombosed in all dogs in group 2. In group 1, the mean diameter of the true lumina was considerably enlarged from 5.9 mm +/- 1.6 to 9.9 mm +/- 2.8 and that of the false lumina significantly diminished from 9.1 mm +/- 1.3 to 5.2 mm +/- 2.3 (P < .05) after stent placement. In group 2, the true lumina were significantly dilated (5.2 mm +/- 2.3 vs 12.3 mm +/- 3.1, P < .05) and the false lumina disappeared completely (9.2 mm +/- 3.3 vs 0.0 mm, P < .01). Furthermore, the two control dogs in group 2 died of visceral ischemia due to the compression of the true lumen by the thrombosed false lumina, but the dogs with stents showed no symptoms of the visceral ischemia.
Expandable metallic stents are not effective in obliterating the false lumen in acute aortic dissection but may be useful in maintaining the blood flow in the true lumen and avoiding visceral ischemia.
Journal of Vascular and Interventional Radiology 5(3):417-23. · 2.08 Impact Factor
