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Biomedical subjects

A Taira

Publications and source records attributed to A Taira.

At least 163 records · Page 9Linked to original sources
PubMed1994

[Simultaneous operation for thoracic and abdominal lesions].

Successful simultaneous operation for thoracic and abdominal lesions was performed in three cases. A 70-year-old man with bronchogenic cyst and a 73-year-old woman with thymoma, who had also cholecystolithiasis respectively, underwent a cholecystectomy following resection of the intrathoracic tumors. A 69-year-old man with bronchogenic carcinoma and abdominal aortic aneurysm underwent a left upper lobectomy following aneurysmectomy and grafting using vascular prosthesis. Their postoperative courses were uneventful. One stage operation has the advantage of treating both lesions simultaneously and saving the patient from the physical and psychosomatic pain and the risk of a second procedure. If patients are properly selected, simultaneous operation for thoracic and abdominal lesions can be safely performed with a short hospitalization and less expense.

Aged↗
PubMed1994

[Pulmonary sequestration diagnosed by combined computed tomography without contrast enhancement and magnetic resonance imaging: a case report].

A 71-year-old woman with pulmonary sequestration had iodine hypersensitivity. Diagnosis was made using computed tomography without contrast enhancement and magnetic resonance imaging. An anomalous artery arising from the descending thoracic aorta was clearly defined. Thus the diagnosis of pulmonary sequestration was confirmed before successful operation without angiography. This diagnostic procedure is safe, noninvasive and useful to detect the anomalous artery, especially in the patient with iodine hypersensitivity.

Aged↗
PubMed1994

[Multi-organ ischemia due to traumatic lesion of the descending thoracic aorta--a case-report].

This is a case of severe ischemic and reperfusion multi-organ failure due to descending thoracic aortic rupture. A 25 year-old man received a hard blow on his chest in a traffic accident. Chest X-ray, CT scans and aortogram elucidated descending thoracic aortic rupture. Emergency operation was performed 18 hours after the injury. The aortic rupture, 4/5 of the aortic circumference with intact adventitia was seen. The descending aorta 22 distal to the left subclavian artery was repaired under cardio-pulmonary bypass with selective cerebral perfusion. Ischemia due to aortic occlusion with thrombus and reperfusion injury after reconstruction of the aorta connected with rhabdmyolysis and severe multi-organ failure. Intestinal necrosis required laparotomy on the 9th and 15th post operative day. The patient died on 15th postoperative day of multi-organ failure.

Accidents, Traffic↗
PubMed1993

Cancer of the gallbladder associated with anomalous junction of the pancreatobiliary duct system without bile duct dilatation.

The aim of this study was to delineate clinical features and prognosis of cancer of the gallbladder associated with anomalous junction of the pancreatobiliary duct system without bile duct dilatation, and to determine methods for managing the disease. A retrospective study of seven patients is presented. A further 27 cases from the Japanese literature were reviewed retrospectively with regard to method of treatment and prognosis. In 11 of 18 patients in whom staging was known the tumour was stage V, representing advanced disease. In seven of 34 cases curative operation was performed; only two patients survived for > 3 years. This poor outcome was due largely to delayed diagnosis of cancer of the gallbladder. Prophylactic cholecystectomy is recommended in patients with this anomalous junction without bile duct dilatation or a malignant lesion in the gallbladder, because of the high incidence of cancer of the biliary tract.

Adenocarcinoma↗
PubMed1993

A new animal model for split liver transplantation using an infrahepatic IVC graft.

An animal model of split liver transplantation using pigs is described herein. The donor liver was divided into two grafts, the right graft consisting of the right medial and lateral segments with the caudate lobe, and the left graft consisting of the left lateral and medial segments. To make implantation easier, a distal part of the donor's inferior vena cava (IVC) was isolated and attached to the left graft with an anastomosis between the orifice of the renal vein and the graft's hepatic vein. The left graft thereby contained a newly constructed retrohepatic IVC for anastomosis to the recipient. During the anhepatic phase, no conventional bypass procedure was used, but an abdominal aortic clamp in combination with general hypothermia was employed. Ten pigs were used as donors and a total 20 liver transplantations performed. No immunosuppressive drugs were given in this series. Ten of the 20 recipients survived for more than 2 days, the mean survival time being 4.7 days, with a range of 2-14 days. The mean survival time of the left grafts was much longer than that of the right grafts, although no technical problems such as kinking of the graft or occlusion of the hepatic vein were encountered in either. This model is the first report of split liver transplantation in animals. The advantages of using the infrahepatic IVC graft include stability of the graft and safe hepatectomy. This model will therefore be useful for the experimental study of split liver transplantation and may also be employed for clinical use in the future.

Animals↗
PubMed1993

Aortic stenosis associated with Scheie's syndrome. Report of successful valve replacement.

A 62-year-old man who had aortic stenosis associated with Scheie's syndrome (mucopolysaccharidosis [MPS], type I-S) successfully underwent aortic valve replacement. The composition of acidic glycosaminoglycans (acid mucopolysaccharides) of the excised aortic valve analyzed by high-performance liquid chromatography (HPLC) supported the diagnosis of Scheie's syndrome. This article reviews the literature on aortic stenosis in MPS, a rare inherited metabolic disorder, and discusses biochemical features and surgical repair.

Aortic Valve↗
PubMed1993

[Laboratory diagnosis of left atrial thrombi in patients with mitral stenosis].

Left atrial (LA) thrombi sometimes occur in patients with mitral stenosis (MS) and may cause systemic embolization resulting in serious and fatal complications. Several clinical techniques are used to detect the presence of LA thrombi, but even echocardiography, the most widely used, has some drawbacks depending on the sizes and locations of the thrombi. This study evaluated D-dimer, fibrinopeptide A(FPA), and thrombin-antithrombin III complex (TAT) as molecular markers for diagnosing the presence of LA thrombi in 26 patients with MS who underwent cardiac surgery. Atrial fibrillation was detected in all patients. Patients with episodes of obvious thromboembolic diseases were excluded. Blood was obtained from the brachial vein before the surgery (3 +/- 1 days; mean +/- SD). The presence or absence of thrombi was confirmed at surgery in all patients. Levels of both D-dimer and TAT were significantly higher in patients with thrombi than in those without thrombi or in normal subjects. FPA levels did not differ significantly between the three groups. The levels of D-dimer and TAT correlated significantly with the weights of the LA thrombi. LA thrombi (ca > or = 2 g) were always confirmed at surgery in patients with levels of D-dimer higher than 200 ng/ml and/or levels of TAT higher than 4 ng/ml. These results indicate that D-dimer and TAT are simple and useful diagnostic markers for determining LA thrombi in patients with MS.

Antithrombin III↗
PubMed1993

[Surgery for ventricular septal defect with aortic regurgitation].

Twenty-two patients (mean age of 12.9 years) with ventricular septal defect (VSD) associated with aortic regurgitation (AR) were treated surgically. Sixteen patients had subpulmonic VSD and six had infracristal VSD. Fourteen patients with subpulmonic VSD underwent VSD closure alone. VSD was closed by pulling up the inferior rim to the pulmonary valve thus support the prolapse aortic cusp. AR improved in two and has remained stable in eleven for 0.5 to 12.7 years (mean 4.4 years). Aortic valve replacement (AVR) was necessary in an adult patient later. Plication of the aortic valve was effective in a young patient but ineffective in an adult patient. In infracristal VSD, AVR was necessary in two adult patients. In a young patient, AR improved by plication. Direct VSD closure ceased progression of AR in three patients. The long-term follow-up shows that VSD closure with our technique has been sufficient to arrest progression of AR in subpulmonic VSD. Early closure of VSD should be emphasized to prevent aortic valve prolapse and regurgitation.

Adolescent↗
PubMed1993

[Gastrointestinal complication after open cardiac operation].

Seven cases of abdominal complications necessitated laparotomies within 30 days after open heart surgery are presented. They consist of five cases of mesenteric infarction, one acalculous cholecystitis and one hemorrhagic ulcer of the rectum. The incidence is 0.9 percent at our institute. They also had a very complex course after their cardiac surgery such as cardiogenic shock, respiratory failure and renal failure prior to the development of their acute surgical abdomen. It is proposed that the cause of acute abdomen is attributed basically to the low cardiac output state. Surgery must be performed without delay because unnecessary passage of time is accompanied by unacceptable mortality rate.

Abdomen, Acute↗
PubMed1993

[An operative case of empyema necessitatis].

A case of empyema necessitatis presenting a mass in the retroperitoneal space is reported. Computer tomography preoperatively revealed the transdiaphragmatic abscess with calcified capsule. The operation was performed by means of resection of the abscess together with overlying ribs. Dead space after resection of the lesion was filled up with intercostal muscles. Empyema necessitatis is rare after introduction of antituberculous drugs. However, recognition of this disease is necessary for an appropriate surgical management. Total resection of the abscess followed by filling of the dead space with the intercostal muscles should be considered as a useful alternative method.

Aged↗
PubMed1993

[Surgical treatment of primary cardiac tumors].

Thirty-four cases of primary cardiac tumors, consisted of 11 men and 23 women, aged between 26 and 80 years have been operated on in our institution. A total of 30 myxomas and four malignant tumors were resected. The clinical presentations included congestive heart failure in 25 patients, tachyarrhythmia in 6, chest pain in 4, and embolism in 10. All 30 myxoma lesions were completely resected, although none of the malignant tumors could be resected completely because of invasion of the tumor to the surrounding tissues. Four patients with malignant tumors died of tumor recurrence within 9 months after operation. Histological diagnosis was rhabdomyosarcoma in two patients, round cell sarcoma in one and malignant fibrous histiocytoma in one. All patients with myxoma survived operation. Follow-up was completed in 28 patients (range 1 month to 15 years, mean 5.5 years): Twenty-four were in New York Heart Association Class I, and the remaining two in Class II. Actuarial survival rate was 89% at 15 years after operation. No recurrent myxoma have been identified clinically or by echocardiography. For malignant primary tumors, more effective adjuvant therapy with aggressive resection will be inevitable to improve long-term prognosis.

Adult↗
PubMed1993

[Ogilvie's syndrome in pregnancy--a case report].

A 23-year-old female in the 28th week of pregnancy was admitted with an acute abdominal distension. The plain X-ray films showed a marked gaseous dilatation of the colon from the cecum to the splenic flexure. A tube colostomy was performed. Her postoperative course was uneventful and she improved progressively. Her pregnancy and delivery elapsed uneventfully there after. After the delivery she again complained of marked abdominal distension. The colonoscopic decompression in combination with the administration of Cisapride was successfully accomplished. Ogilvie's syndrome is characterized by an unobstructed colon which progresses to marked dilatation. When the colonic diameter becomes 12cm or more, surgical decompression should be recommended to avoid the hazard of spontaneous rupture. This is the first reported case of Ogilvie's syndrome in pregnancy in Japan.

Adult↗
PubMed1993

[Surgical repair of total anomalous pulmonary venous drainage--four adult cases of successful operation].

We have experienced four adult cases of total anomalous pulmonary venous drainage (TAPVD). They were three females and one male, age between 18-51 with a mean of 33.8. In Darling's classification, they constituted of three cases of type Ia and one type IV. Cardiac catheterization revealed 1.71-5.93 with a mean of 3.92 in Qp/Qs and 0.34-0.49 with a mean of 0.38 in Pp/Ps. The pulmonary to systemic resistance ratio (Rp/Rs) was then calculated as 0.02-0.15 with a mean of 0.09. All cases showed short route type of drainage vein in pulmonary arteriography. None of them had stenosis or obstruction in the drainage veins. The operation was composed of anastomosis between the left atrium and the common pulmonary vein, closure of the atrial septal defect (ASD), and ligation of the drainage vein. Gersony-Malm's method was adopted in two cases and the posterior approach in two cases in anastomoses between the left atrium and the common pulmonary vein. Intraatrial approach combined with posterior approach was tried in a case with small left atrium. The mean size of ASD was 43 mm (35-55 mm) in diameter. Patch closure was performed in three cases. Important factors in survival for adult TAPVD are large ASD and short route type drainage vein without stenosis. All of four cases had good results. The operation method is variable and an easier approach must be adopted.

Adolescent↗
PubMed1993

[Simultaneous cesarean section and mitral valve replacement for infective endocarditis during pregnancy--a case report].

Infective endocarditis (IE) during pregnancy is uncommon. A 31-week-pregnant, 21-year-old woman suffered from severe mitral regurgitation caused by IE. She fell into heart failure and threatened abortion. Following to cesarean section, an emergent mitral valve replacement with a bioprosthetic valve was successfully performed. Her postoperative recovery was uneventful and she was discharged home 30 days after the operation. Her baby, however, died of intracranial hemorrhage caused by hypoxia 171 days after delivery. A strategy of simultaneous open heart surgery and cesarean section is recommended when emergent open heart surgery is inevitable for the treatment of cardiac diseases in cases with 24 and/or more weeks' gestation.

Adult↗
PubMed1992

Postnephrectomy arteriovenous fistula: a case report.

We report a 57-yr-old woman with severe cardiac failure secondary to postnephrectomy arteriovenous fistula which was successfully removed. A review of the literature shows the rarity of this complication; only 72 cases have been reported in the world literature including 6 cases (including the present case) from Japan. Surgical intervention is generally the treatment of choice from a fistula and provides satisfactory results for cardiac failure which is the major complication of this fistula. A characteristic bruit was observed in all reported cases. Therefore, nonsurgical closure by percutaneous embolization for a small sized shunt may be possible if early diagnosis is obtained by careful auscultation of the loin.

Arteriovenous Fistula↗
PubMed1992

[Left-sided gallbladder with accessory liver accompanied by intrahepatic cholangiocarcinoma].

A 66-year-old female of left-sided gallbladder with accessory liver was reported. These anomalies were recognized during an operation of intrahepatic cholangiocarcinoma. The gallbladder was located with its liver bed at the lateral segment of the liver. The cystic duct branched from the right side of the common bile duct, and turned in hairpin form in the left direction. The cystic artery branched from the right hepatic artery. There was the accessory liver on the wall of the gallbladder. A careful identification of the cystic duct and the portal vein was advocated in surgery of the left-sided gallbladder.

Adenoma, Bile Duct↗