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Biomedical subjects

A Ihaya

Publications and source records attributed to A Ihaya.

At least 37 records · Page 2Linked to original sources
PubMed1998

Deep hypothermic intermittent circulatory arrest--an adjunct technique for operations on aneurysms involving the aortic arch.

Aneurysms involving the aortic arch were repaired in 12 patients using a technique known as deep hypothermic intermittent circulatory arrest (DHICA). This technique consists of repeated cycles of 20 min of circulatory arrest and 10 min of cerebral and systemic reperfusion. Aneurysms were of the following types: 2 true atherosclerotic aneurysm, 8 aortic dissections, and 2 traumatic aneurysm. There were 2 operative deaths caused by coagulopathy as a result of hepatic failure and difficulty with left ventricular venting. The frequency of circulatory arrest ranged from 2 to 5 cycles, and total circulatory arrest ranged from 20 to 71 min (mean 43.6 min). The lowest tympanic temperature ranged from 17.7 to 19.2 degrees C. No permanent cerebral complications occurred in 10 patients. We believe that this adjunct technique offers excellent results in the surgical treatment of aneurysms involving the aortic arch.

Adult↗
PubMed1998

[A case of type A dissecting aneurysm who are complicated by paraplegia at the 4th day after emergent operation].

The 62-year-old man was admitted to our hospital with chief complaints of chest and back pain. He was diagnosed type A acute dissecting aneurysm by chest computed tomography, and underwent urgent operation, replacement of the ascending aorta and resuspension of the aortic valve. He was recovered without any neurologic complications. However, he was complicated by paraplegia at the 4th postoperative day. We suspect that is due to early thrombotic occlusion of the false lumen where the anterior spinal arteries branch by the operation.

Aortic Dissection↗
PubMed1998

Abdominal aortic aneurysmectomy in the octogenarian.

The risks, results, and postoperative quality of life were evaluated in 11 patients aged 80 years or older who underwent resection of an abdominal aortic aneurysm (AAA). The operative mortality was 9% (1/11). Three patients underwent urgent operation, 1 for impending rupture, 1 for contained rupture, and 1 for rupture into the sigmoid colon. Preoperative risk factors such as hypertension, electrocardiographic abnormalities, and respiratory dysfunction were found in about half of the patients. Neither operative mortality nor long-term survival were influenced by the preoperative risk factors. The quality of life enjoyed by these patients was not adversely affected by AAA resection. Surgical treatment of AAA should be undertaken in selected octogenarians to prevent rupture. Physiologic status rather than chronologic age should determine which patients undergo aneurysm resection.

Aged↗
PubMed1997

Effect of spinal cord preconditioning on paraplegia during cross-clamping of the thoracic aorta.

BACKGROUND: Paraplegia is a devastating complication of operations for thoracic or thoracoabdominal aneurysms. Preconditioning the brain with sublethal ischemia induces resistance to subsequent ordinarily lethal ischemia (ischemic tolerance). We investigated whether ischemic tolerance could be induced by preconditioning canine spinal cord. The role of heat-shock proteins (HSP) in this process was investigated. METHODS: In experiment 1, the preconditioning group (n = 6) had aortic cross-clamping for 20 minutes, whereas controls (n = 6) had no cross-clamping. After 48 hours the aorta was cross-clamped for 60 minutes in both groups. Neurologic examination was performed 24 hours later and the spinal cord was studied for immunohistochemically. In experiment 2, either 48 hours after 20 minutes of clamping or after sham operation (n = 4), HSP were investigated immunohistochemically. RESULTS: In experiment 1, 3 of 6 controls became paraplegic but none of the 6 preconditioning group dogs became paraplegic. The HSP appeared on sections from all 6 PC dogs and 3 control dogs that did not exhibit paraplegia. In experiment 2, HSP were present in clamped animals but could not be detected after sham operation. CONCLUSIONS: Ischemic tolerance was induced by preconditioning the canine spinal cord, in which HSP are believed to be involved.

Animals↗
PubMed1997

[A simple device of chest wall reconstruction].

We devised a simple method of chest wall reconstruction in two cases of malignant tumor of the chest. We strained a suture (adsorbable or monofilament) to the intact ribs above and below the defect and fixed the sheets of Marlex mesh in double layers and closed the skin without any myocutaneous flap. The postoperative course was uneventful. This device is simple and effective method to maintain the stability of the chest wall defect.

Aged↗
PubMed1996

Surgical treatment of infected thoracic and abdominal aortic aneurysms.

Twelve patients with infected aneurysms of the thoracic and abdominal aorta were evaluated. Aneurysmal location, aetiology, bacteriology and treatment modality were analysed to determine the relationship between these factors and outcome. Patients were divided into two groups based on the preoperative states of their infections. Group 1 patients (n = 7) underwent resection after resolution of their active infection. The causative organisms included Staphylococcus epidermidis (two cases). Salmonella spp. (one). Acinetobacter (one), Mycobacterium tuberculosis (one) and unknown organisms (two). Group 2 patients (n = 5) required urgent surgery because of uncontrolled sepsis despite intensive treatment with antibiotics. The causative organisms included Staphylococcus aureus (two cases). Pseudomonas aeruginosa (two) and Salmonella spp. (one). In group 1, three patients underwent closed en bloc excision of the aneurysm with in-situ graft replacement, and four underwent partial resection with in-situ graft replacement. In group 2, three patients underwent resection of the aneurysm with ligation of aorta and extra-anatomic bypass, and two underwent in-situ graft replacement after débridement of infected tissue. Overall, patients in group 1 had a mortality rate of 14% compared with 80% in group 2. These results suggest that the operative approach and method chosen to restore arterial continuity have less of an impact on outcome. The primary determinants of outcome are virulence of the infecting organism and the preoperative state of the infection.

Acinetobacter Infections↗
PubMed1996

Leukocyte and platelet depletion with a blood cell separator: effects on lung injury after cardiac surgery with cardiopulmonary bypass.

This study was undertaken to assess the effects of leukocyte and platelet depletion on postoperative lung injury in 42 patients who underwent heart operations. Blood was serially sampled before, during, and after cardiopulmonary bypass, and leukocyte count, platelet count, and thromboxane B2 6-keto-PGF1 alpha, leukocyte elastase, thrombin-antithrombin III complex, and D-dimer levels were determined. Postoperative respiratory function was assessed based on analyses of oxygenation and carbon dioxide elimination. Leukocyte and platelet depletion was performed in 21 patients (experimental group) but not in another (control group). In the experimental group, leukocytes and platelets were removed continuously by means of the blood cell separator CS-3000, beginning immediately after the start of the operation and ending 1 hour after the release of aortic occlusion. Leukocyte elastase, thromboxane B2, ratio of thromboxane B2 to 6-keto-PGF1 alpha, thrombin-antithrombin III complex, and D-dimer were significantly lower in the experimental group than in the control group. Of the various indexes of oxygenation, arterial oxygen tension was significantly higher in the experimental group and the alveolar-arterial oxygen pressure difference and respiratory index were significantly lower in the experimental group. The positive end-expiratory pressure needed to achieve an appropriate arterial oxygen tension was significantly lower in the experimental group. The elimination of carbon dioxide was lower in the experimental group. Depletion of leukocytes and platelets reduced respiratory dysfunction after heart operations with cardiopulmonary bypass. It was particularly effective in patients with a low preoperative oxygenation capacity and in those for whom an extended period of cardiopulmonary bypass was required.

6-Ketoprostaglandin F1 alpha↗
PubMed1995

The successful repair of annuloaortic ectasia using Cabrol's operation in a 5-year-old child with Marfan's syndrome of the forme fruste type.

This report describes our experience of treating a 5-year-old boy with annuloaortic ectasia and a presumptive diagnosis of Marfan's syndrome. He had elongation of the distal aortic arch and dilatation of the abdominal aorta. Surgical repair of annuloaortic ectasia was successfully carried out using Cabrol's operation, following which no significant perioperative complications developed. To our knowledge, this is the first reported case of Cabrol's operation being successfully performed on a child aged 5 years or less.

Aortic Diseases↗
PubMed1995

[A case of simultaneous treatment with mitral valve replacement and aorto-coronary bypass grafting of hypertrophic obstructive cardiomyopathy and coronary artery disease].

A case of surgical treatment of coexistent hypertrophic obstructive cardiomyopathy (HOCM) and coronary artery disease (CAD) in a 65-year-old male patient is reported. He had been diagnosed as HOCM and treated conservatively with beta-blocker and Ca-antagonist, but his complaints of chest oppression and palpitation had increased. Echocardiography revealed a systolic anterior motion of the mitral valve and mitral regurgitation. Cardiac catheterization showed a severe mitral regurgitation and peak systolic pressure gradient of 35 mmHg between the left ventricular and systemic artery. In addition, selective coronary angiography demonstrated a 99% stenosis in segment 7. He underwent aortocoronary bypass grafting and concomitant mitral valve replacement, and marked symptomatic and hemodynamic benefit could be achieved. This case shows the coexistence of HOCM and CAD in the same patient and suggest not only HOCM but also CAD should be routinely examined in the patient with angina, particularly when operative management is contempted. This case further suggests that simultaneous treatment of both diseases is more beneficial than single treatment of CAD or HOCM.

Aged↗
PubMed1995

[Clinical study of the reliability of monitoring ESP during descending thoracic aortic surgery].

We studied the reliability of monitoring ESP to detect paraplegia due to spinal cord ischemia during thoracic aortic cross-clamping. In eleven patients with descending thoracic aortic aneurysm, we observed the relationship between the ESP change and postoperative paraplegia. Two patients with loss of ESP had normal postoperative neurological function but one of seven patients with low ESP amplitudes (47% of the control value) showed postoperative paraplegia with anterior spinal artery syndrome. Monitoring ESP dose not appear to be reliable to detect paraplegia during cross-clamping of the descending thoracic aorta.

Aged↗
PubMed1995

[Surgical treatment of aortic rupture by blunt chest trauma].

During a ten-year period, seven patients with traumatic rupture of the thoracic aorta were operated upon. Four patients of them were operated within one week. Chest X-rays and chest computed tomography could not always reveal the exact diagnosis of aortic rupture. Intravenous digital subtraction angiography was useful to confirm the diagnosis. The repair of the rupture was accomplished with the adjunct of left heart bypass using Bio-pump, which was useful to reduce the bloodloss with a limited systemic heparinization. Another three patients were diagnosed to have chronic post-traumatic aneurysm of the thoracic aorta and underwent aortic replacement with prosthetic graft. One of seven patients died at seventh postoperative day because of cerebral contusion, the associated lesion of an automobile accident. It is stated that the aortic rupture is immediately fatal in approximately 80% of individuals, and most of remaining 20% die within 2 weeks unless the lesion is repaired. Therefore immediate operative intervention is recommended when the aortic rupture is strongly suspected. Chronic post-traumatic aneurysms should be resected because it has become apparent that the majority of patients with this lesion will develop complication, such as sudden rupture.

Adolescent↗
PubMed1995

[A case report of chronic sternal osteomyelitis after thoracic aortic aneurysmectomy].

A 76-year-old man, who was complicated with chronic sternal osteomyelitis after thoracic aortic aneurysmectomy was reported. He was treated with local wound care and antibiotics for about 3 months, but cutaneous fistula with persistent discharge required sternal bone debridement and omental pedicle grafting. After this treatment the patient was uneventful. 67Ga scintigram and 67Ga-SPECT may be more useful in the diagnosis of this serious complication.

Aged↗
PubMed1994

The significance of glutathione peroxidase on myocardial protection in the rat hearts: the key of clarify the cause of vulnerability to reperfusion injury in infantile cardiac operations.

Selenium (Se) is an integral component of glutathione poeroxidase (GSHPx), and the serum selenium concentration is age-depend. We speculated that myocardial GSHPx had relation to reperfusion injury in open heart operations, especially in infants in whom GSHPx activity is low. This study correlated GSHPx activity with the serum and myocardial selenium concentrations in Wistar rats, which were divided into three groups, infants, Se-deficient rats, and control rats. Serum GSHPx activity in infant and Se-deficient rats (22.7 +/- 3.5 U/g protein, 24.6 +/- 22.2 U/g protein) was lower than that in controls (179 +/- 12.0 U/g protein). The serum selenium concentration in infant and Se-deficient rats (3.81 +/- 0.81 micrograms/g protein, 2.06 +/- 1.69 micrograms/g protein) was also lower than that in controls (7.32 +/- 2.96 micrograms/g protein). The myocardial GSHPx activity was significantly lower in infants and Se-deficient rats (4.76 +/- 1.05 x 10(-1) U/mg protein, 3.38 +/- 0.32 x 10(-1) U/mg protein) than that in controls (8.03 +/- 0.57 x 10(-1) U/mg protein). However, the myocardial selenium concentration in infants (1.42 +/- 0.24 x 10(-1) micrograms/mg protein) was significantly higher than that in the other groups (0.31 +/- 0.06 x 10(-1) micrograms/mg protein, 0.28 +/- 0.04 x 10(-1) micrograms/mg protein). Next, in Se-deficient and control rats, isolated hearts were perfused for aerobically with Krebs-Henseleit solution in the Langendorff mode for 15 minutes, followed by 60 minutes of global ischemia at 4 degrees C and then reperfused for 30 minutes in a working mode. The hemodynamic parameters were measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Effect of intermittent deep hypothermic circulatory arrest on brain metabolism.

The effect of intermittent systemic reperfusion during deep hypothermic circulatory arrest was investigated in dogs to learn how the total arrest period may be prolonged. The animals were cooled on cardiopulmonary bypass to 18 degrees C and divided into the following three experimental groups: group I (n = 7), 60 minutes of uninterrupted circulatory arrest; group II (n = 7), 120 minutes of circulatory arrest with 10 minutes of intermittent systemic perfusion every 30 minutes during the arrest period; group III (n = 7), 120 minutes of circulatory arrest with 10 minutes of intermittent systemic perfusion every 20 minutes during the arrest period. Cerebral oxygen extraction rate increased significantly during the arrest periods (p < 0.05) and returned to normal after each 10-minute period of systemic reperfusion in every group. During circulatory arrest, cerebral excess lactate increased in a time-dependent manner after 20 minutes (r = 0.78; p < 0.001). Anaerobic metabolism did not increase throughout the circulatory arrest period in group III, although it increased significantly in groups I and II (p < 0.05). The present data demonstrate that cerebral energy metabolism becomes predominantly anaerobic within the first 20 minutes of deep hypothermic circulatory arrest. The present findings suggest that intermittent systemic recirculation for brief 10-minute periods every 20 minutes during circulatory arrest should prevent cerebral anaerobic metabolism during long periods of arrest that are required to complete complicated surgical repairs.

Animals↗
PubMed1993

A new method for coronary artery reconstruction in patients with recurrent aortic prosthetic valve endocarditis and an inaccessible coronary arterial system.

A new approach to the problem of recurrent infection of an aortic valve prosthesis in a patient with an inaccessible coronary arterial system is presented. The coronary arteries were reconstructed by anastomosing a looped ringed-PTFE graft to the left and right coronary ostia within the aorta, and the graft was withdrawn from the aorta just above the ostia. Then the top of the looped graft was anastomosed to the aorta above a translocated aortic prosthesis. This procedure is most likely to be useful in the treatment of recurrent aortic prosthetic valve endocarditis which has dense pericardial adhesion secondary to multiple cardiac operations. Aortic prosthetic valve endocarditis frequently is associated with a paravalvular ring abscess which may destroy the normal annulus. In these cases, translocating the aortic valve to the ascending aorta, and placing saphenous vein bypass grafts to the right and the left anterior descending coronary artery may be required. However, the coronary arteries may not be accessible following multiple operations. The following case illustrates a new solution to the problem how to translocated the aortic valve and reconstruct the coronary arteries in a patient with an infected aortic root and inaccessible coronary arteries.

Adult↗
PubMed1993

En bloc resection for cancer of the gastric cardia without thoracotomy.

Thirty-five consecutive patients underwent en bloc resection of cardia cancer without thoracotomy. All tumors were adenocarcinoma. The operative procedure involved wide resection of the peri-hiatal diaphragm, dissection of the upper abdominal and lower mediastinal lymph nodes, and resection of the stomach including a portion of the lower thoracic esophagus without thoracotomy. The resection area of the diaphragm included not only the crural muscle as in other methods, but also the diaphragmatic tissue surrounding the esophageal hiatus. Through the enlarged hiatus, dissection of the mediastinum was possible up to the carina from the abdominal cavity. The mediastinal node stations were affected in 25% of patients whose tumor invaded to the serosa. Hypotension with or without atrial arrhythmias and pleural tears occurred during surgery in 20 patients (57%) and in 18 patients (51%), respectively. Postoperatively, hypoxia requiring reintubation developed in 7 patients (19%), pleural effusions needed tube drainage in 16 patients (46%), atelectasis in 5 patients (14%), and anastomotic leaks in 3 patients (9%). They were all successfully treated. The cumulative 5-year survival rate for 21 patients with stages I (2 patients), II (9), and III (10) diseases was 62%, whereas none of the patients with stage IV disease lived for more than 2 years after surgery. Because thoracotomy is avoided, the procedure is better tolerated by debilitated patients. We believe this technique is a reasonable and safe alternative to the left thoracotomy approach for resection of cancer of the gastric cardia.

Adenocarcinoma↗
PubMed1993

Leucocyte depletion and prevention of reperfusion injury during cardiopulmonary bypass: a clinical study.

This study evaluated the effects of leucocyte depletion on reperfusion injury during cardiopulmonary bypass in 26 patients who underwent coronary artery bypass graft. In 10 patients leucocytes were continuously separated from the circulating blood; in 16 leucocytes were undepleted. Leucocyte count and serum creatine phosphokinase activity (and that of its isoenzymes) were measured before and after aortic cross-clamping; in addition the cardiac index and required catecholamine dosage during the early postoperative period in the two patient groups were compared. Mean(s.d.) leucocyte counts immediately after surgery were 8622(2887) microliters-1 in patients who were leucocyte depleted and 12,175(5303) microliters-1 in controls (P < 0.05). Mean(s.d.) creatine phosphokinase activity in patients with leucocyte depletion was significantly lower than in controls (334(121) versus 821 (356) units l-1; P < 0.05) immediately after surgery. Moreover, mean(s.d.) catecholamine dosage was significantly less in the leucocyte-depleted group than in controls (1.1(1.9) versus 4.9(2.2) micrograms kg-1 min-1; P < 0.05), whereas the cardiac index was significantly higher (3.3(0.5) versus 2.3(0.4) l min-1 m-2; P < 0.05). These results suggest that, in the clinical setting, leucocyte depletion during cardiopulmonary bypass provides effective protection against reperfusion injury.

Aged↗