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Biomedical subjects

A Taira

Publications and source records attributed to A Taira.

At least 127 records · Page 7Linked to original sources
PubMed1996

[A case of ASD with SLE treated with Carmeda BioActive surface circuit in cardiopulmonary bypass system].

A 61-year-old woman of ASD complicated with SLE was operated on. We used a heparin coating Carmeda BioActive Surface (CBS) in cardiopulmonary bypass circuit for the purpose to prevent the postoperative complications due to the reduced complement activation by SLE. This system could prevent the decline of the reduced complement activation during cardiopulmonary bypass and after operation. The management of steroid therapy for SLE patient, usefulness of heparin coating CBS system for hypocomplement disease were discussed.

Anti-Inflammatory Agents↗
PubMed1995

Echocardiographic diagnosis of partial anomalous pulmonary venous connection from right upper lobe to the coronary sinus.

A 36-year-old woman was admitted because of an enlarged right heart. Echocardiographic examination revealed an abnormal vessel connecting to the dilated coronary sinus. The abnormal vessel traveled in the direction from the right axillary to the left epigastric region. Partial anomalous pulmonary venous connection (PAPVC) from the right upper lobe to the coronary sinus was initially considered as a possible diagnosis by echocardiography. At surgery, diagnosis of an isolated PAPVC of the right upper pulmonary vein to the coronary sinus was confirmed.

Adult↗
PubMed1995

Late massive hemorrhage following cystogastrostomy for pancreatic pseudocyst: report of a case.

We report the case of a man who developed life-threatening massive gastric hemorrhage 3 months after undergoing cystogastrostomy for a pancreatic pseudocyst. After cystogastrostomy, the pancreatic pseudocyst became remarkably reduced in size, having the appearance of a shallow ulcer by barium study. However, tarry stools and hematemesis developed 3 months later, 6 days after which sudden massive hematemesis and melena occurred with severe hypotension. At emergency operation, a large artery at the bottom of the reduced cyst wall was found to have ruptured and hemostasis was achieved by suture ligation. The splenic artery was suspected as the bleeding point because a 95% abrupt stenosis was seen on angiography-performed the next day. Thus, the risk of hemorrhage occurring after internal drainage of a pancreatic pseudocyst even in the late postoperative period should always be borne in mind.

Adult↗
PubMed1995

Simultaneous repair of an abdominal aortic aneurysm and resection of bronchogenic carcinoma: report of a case.

A 69-year-old man successfully underwent simultaneous repair of an abdominal aortic aneurysm and resection of bronchogenic carcinoma during the same operation. Pulmonary lobectomy was performed following complete closure of the abdomen after aneurysmectomy to prevent any contamination. If the patients are carefully selected, an operation for abdominal aortic aneurysm and bronchogenic carcinoma can be safely performed with the advantage of treating both lesions simultaneously and thus sparing the patients from having to undergo the physical and psychosomatic pain, as well as the risk, of a second operation.

Aged↗
PubMed1995

Ruptured bronchial artery aneurysm associated with pleural telangiectasis and tortuous portal obstruction: report of a case.

A 25-year-old woman presenting with an emergent condition of massive hemothorax due to a ruptured bronchial artery aneurysm was successfully treated by transcatheter arterial embolization. She had previously undergone portosystemic shunt splenopneumopexy for hepatic portal hypertension at 6 years of age. When undergoing right thoracotomy for the removal of a clot, a prominent telangiectasis on the pleural surface was noted. The lesion appeared to be a rare systemic vascular abnormality although this could not be confirmed.

Adult↗
PubMed1995

Cardiac dystrophin abnormalities in Becker muscular dystrophy assessed by endomyocardial biopsy.

Duchenne and Becker muscular dystrophy (DMD/BMD) are allelic variants caused by mutations in gene-encoding dystrophin. Abnormal expression of dystrophin in skeletal muscle has been shown to correlate with severity of disease. However, in BMD the severity of skeletal and cardiac involvement are not well correlated. We studied the immunostaining pattern of cardiac dystrophin in endomyocardial biopsy specimens from 83 patients with heart disease. Immunohistochemical assessment of dystrophin in four patients with BMD and cardiomyopathy showed a variable distributions of myocytes with continuous, discontinuous, or absent membrane immunostaining patterns. These patterns were obviously different from patterns of other heart diseases. We conclude that the discontinuous immunostaining pattern of cardiac dystrophin is characteristic of BMD and that an absent pattern may be associated with more severe cardiac dysfunction. Because genetic analysis cannot determine the correct diagnosis in 35% of DMD/BMD cases, we recommend routine examination of immunostaining patterns of dystrophin in endomyocardial biopsy specimens in patients with cardiomyopathy suspected to be the result of BMD.

Adult↗
PubMed1995

Acute aortic dissection in a patient with osteogenesis imperfecta.

A case of osteogenesis imperfecta complicated with acute type A aortic dissection is presented. Emergency graft replacement of the ascending aorta was performed successfully despite the anticipated difficulties with tissue friability. Therefore, such an operation is suggested to be worthy of consideration and feasible in patients with osteogenesis imperfecta.

Acute Disease↗
PubMed1995

Infective mitral valve endocarditis after percutaneous transvenous mitral commissurotomy.

Infective mitral valve endocarditis developed in a 40-year-old female patient after a percutaneous transvenous mitral commissurotomy (PTMC). The echocardiogram demonstrated a vegetation in the anterior leadflet of the mitral valve and moderate aortic insufficiency. The patient underwent replacement of the infected mitral and incompetent aortic valves. Infective mitral valve endocarditis should be recognized as a potentially lethal complication after PTMC. The important measures to prevent bacteremia during PTMC and the appropriate role of operation are discussed.

Adult↗
PubMed1995

[Lung cancer manifested as cardiac tamponade: a case report].

A case of lung cancer manifested as cardiac tamponade was reported. A 64-year-old male had anterior chest pain and dyspnea. A chest X-ray films showed an enlarged heart with a solitary round shadow in the left lung hilus. Echocardiogram disclosed a large amount of pericardial effusion. Emergency pericardiectomy with drainage was accomplished. The patient lived for 8 months without effusion accumulation. Histologically adenocarcinoma of the lung with prominent lymph nodes metastases was disclosed. Surgical decompression such as pericardiectomy or pericardial fenestration is a valuable selection in the treatment of pericardial effusion and tamponade.

Adenocarcinoma↗
PubMed1995

[Isolated aortic valve regurgitation due to degeneration of the valve leaflet--a clinical study].

From 1989 through 1993 thirty-eight patients underwent aortic valve replacement at our institution for isolated aortic regurgitation (AR) caused by idiopathic degeneration of the valve. There were 32 male and 6 female patients aged between 33 and 74 years with a mean of 59 years. Preoperative New York Heart Association functional class, cardiothoracic ratio, cardiac index, and left ventricular end-diastolic pressure were 2.6, 57%, 3.1 L/min/m2, and 18 mmHg, respectively. Cross-sectional echocardiography clarified aortic valve prolapse in seven patients. Excised valvular cusps were thin, redundant and translucent in association with cuspal fenestration in 9 cases and idiopathic commissural disruption in 2 cases. Histological study revealed significant disruption of the fibrosa and cystic degeneration of the spongiosa layer filled with mucopolysaccharide. Actuarial survival rate, including 3 operative deaths, was 89% at 3 years after AVR with no apparent valve related complications. Idiopathic degeneration of the aortic valve is a common cause of AR, occurring in half of the surgically treated patients. We emphasize the importance of this lesion as a cause of AR.

Adult↗
PubMed1995

[Significance of combined use of anticoagulants and antiplatelet agents in the early stage after prosthetic valve replacement].

Patients who had undergone prosthetic valve replacement were treated with warfarin (anticoagulant) alone or in combination of ticlopidine (200 mg/day) or aspirin (81 mg/day) (anti-platelet agents). The study of blood coagulation factors and platelet aggregation were carried out with these cases. 1) The patients (n = 24) receiving warfarin for 21 days after prosthetic valve replacement revealed marked increases in PIVKA-II and vitamin K1-epoxide. The protein C activity was significantly lower than that before the operation. High levels of more than 5 ng/ml of TAT were found before operation and after warfarin administration for 21 days. 2) Warfarin did not affect platelet aggregation, whereas ticlopidine inhibited ADP-induced platelet aggregation and aspirin inhibited both collagen-induced and arachidonic acid-induced aggregation. In conclusion, combined use of anticoagulants and antiplatelet agents after prosthetic valve replacement will suppress not only the blood coagulation but also the platelet aggregation systems.

Adult↗
PubMed1995

Clinical abnormalities in adults with pancreaticobiliary maljunction with and without bile-duct dilatation.

OBJECTIVE: To study clinical diseases associated with pancreaticobiliary maljunction with or without bile-duct dilatation. DESIGN: A retrospective study over 16 years. SETTING: A single university surgical service in Japan. PATIENTS: Thirty-three patients with pancreaticobiliary maljunction. MAIN OUTCOME MEASURES: Gallstones and cancer in patients with and without bile-duct dilatation. RESULTS: Twenty-five patients had dilatation of the bile duct, 8 did not. Seven (28%) of the 25 patients with bile-duct dilatation had gallstones compared with 1 (12%) of the 8 patients with no dilatation. Seven (88%) of the 8 patients with no dilatation had carcinoma (all of the gallbladder), but only 3 (12%) of the 25 patients with bile-duct dilatation had carcinoma (1 of the gallbladder, 2 of the bile duct). CONCLUSION: Prophylactic cholecystectomy is recommended for patients with pancreaticobiliary maljunction and no dilatation of the bile duct because of the high incidence of gallbladder cancer.

Adolescent↗
PubMed1995

[Yolk sac tumor resected by transverse sternotomy: a case report].

Transverse sternotomy was performed in a 39-year-old man having bilateral lung metastatic lesions of yolk sac tumor. This approach provided an excellent operative field. Bilateral partial lobes including parietal pleura and diaphragma were readily resected. As described in this paper, transverse sternotomy is one of the beneficial method in the thorough surgical treatment for metastatic bilateral lung lesion.

Adult↗
PubMed1995

[Pulmonary embolectomy for massive pulmonary embolism].

Surgical cases of massive pulmonary embolism remain rare in Japan. To discuss the surgical problems, clinical courses of 4 patients who underwent pulmonary embolectomy under cardiopulmonary bypass at our hospital for the last six years were reviewed. There were 2 men and 2 women; ranging from 41 to 72 years (mean age, 63 years), 1 of whom had deep venous thrombosis of the lower extremity as a predisposing factor. The initial disease recurred in 2 patients. Shock occurred in 3 patients preoperatively, 2 of whom had sudden syncope. Cardiac arrest occurred before and during pulmonary arteriography (PAG) in 1 patient. The systolic pulmonary arterial pressure rose to between 60 and 80 mmHg in all patients except for 1 of whom it was not measured. The diagnosis was established in 3 patients by PAG and clinically in the remaining recurrent patient. Thrombolysis was not effective in all patients, then pulmonary embolectomy was performed between four hours and five days after the onset of the disease. One patient with preoperative cardiac arrest died of low output syndrome and severe respiratory failure, but 3 survived with clinical improvement. Development of the prompt and noninvasive diagnostic procedure, rapid cardiopulmonary support in severe cases and an early decision to operate are required to improve the operative results. Partial resection of the lung was obliged due to massive endobronchial hemorrhage after embolectomy in 1 recurred patient. Compression of the lungs and embolectomy using a balloon catheter should be performed carefully to prevent injuring pulmonary arteries. Implantation of an inferior vena cava filter may be beneficial for the selected patient to prevent recurrence of the disease.

Adult↗
PubMed1995

[Postoperative infections in cardiovascular surgery: what is an appropriate prophylactic administration of antibiotics?].

Between June 1990 and March 1993, postoperative infections developed in 19 (7.6%) of 250 consecutive patients. All patients studied underwent cardiac or major vascular operations and survived more than four postoperative days. Respiratory and wound infections were the most common infections after operation. Organisms detected were Staphylococci in 11 of which 4 were methicillin resistant, gram negative rods in 6. Factors significantly associated with an increased risk of postoperative infections by univariate analysis included age (> or = 70 years), NYHA (Grade IV), diabetes mellitus, long operating time (> or = 320 min), long perfusion time (150 min), using of IABP. The ratio of postoperative infections in patients who were given broad spectrum penicillin was higher than others. The percentage of postoperative infections was 4.4% in single antibiotic group and 13.2% in double antibiotics group, the former was significantly lower than the later. It is concluded that single dose of first or second or fourth generation cephem was strongly recommended as prophylactic antibiotics after cardiovascular surgery. Twenty adult patients received 2 g of flomoxef (FMOX) in the priming solution of cardiopulmonary bypass just before operation. Serum FMOX levels in patients developed slowly and remained at high levels, showing 49.8 micrograms/ml after five hours. It seemed that no addition of drugs were necessary during cardiopulmonary bypass within five hours.

Aged↗
PubMed1995

[Surgical treatment for complete rupture of anterior papillary muscle after acute myocardial infarction].

A 64-year-old male patient with postinfarction complete anterior papillary muscle rupture and massive mitral regurgitation is presented. The diagnosis was suspected clinically and confirmed by transesophageal echocardiography. One week after the episode of acute myocardial infarction (AMI) the patient had a sudden onset of severe congestive heart failure with pulmonary edema and was transferred to our hospital. The patient underwent an emergency mitral valve replacement with a SJM29M prosthetic valve. Histological examination revealed an acute coagulation necrosis of the anterior papillary muscle without specific inflammatory change. To our knowledge this is the second case with successful surgery for a complete rupture of the anterior papillary muscle following AMI in Japan.

Echocardiography, Transesophageal↗
PubMed1995

[Valvular surgery for the patients 70 years old or older].

From January 1986 to June 1993, twenty one patients aged 70 years or older with valvular heart disease underwent open heart surgery. There were 12 males and 9 females with a mean age of 71.2 years (range 70 to 76). Eight patients were in NYHA class III, and 4 in class IV preoperatively. AVR was performed in 10 patients, MVR, MVR with TAP, OMC, AVR with MAP, DVR with TAP in 4, 4, 1, 1, and 1, respectively. Mechanical and bioprosthetic valves were replaced in 11, and 9 patients respectively. There were 6 early death (4 operative, 2 hospital). Longer duration of cardiopulmonary bypass (p < 0.05) and aortic crossclamp time (p < 0.05) were the risk factors independently for early mortality. Follow-up of 15 hospital survivors was 100% (8 months-7.7 years, mean: 3.2 years) and cumulative follow-up was 47.6 patients years (PY). There was one late death, and one prosthetic valve endocarditis (2.1%/PY). No other valve-related complications was occurred. Actuarial survival rate and freedom from valve-related morbidity at seven years were 83.3%, and 93.3%, respectively. These results show that operative mortality of valvular disease in elderly patients remains high, but the late results is acceptable one. Valve surgery for these elderly patients is reasonably acceptable.

Aged↗