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Biomedical subjects

A Yamaguchi

Publications and source records attributed to A Yamaguchi.

At least 415 records · Page 23Linked to original sources
PubMed1993

[Post-sternotomy mediastinitis treated by omental transposition].

Mediastinitis after cardiac surgery is a serious complication with high morbidity and mortality rates. Between December 1989 and April 1992, of 264 patients who underwent cardiac or aortic surgery with median sternotomy, seven (2.6%) developed deep sternal infections with mediastinitis. Six of these patients were treated with debridement, irrigation and delayed wound closure with mediastinal transposition of the greater omentum. Most of the infections were associated with several predisposing factors: cardiac cachexia in the preoperative state, prolonged perfusion time, and respiratory insufficiency in the postoperative period. One of the six patients died of adult respiratory distress syndrome in the postoperative course, but the remaining five patients were discharged with their wounds well healed. Acute and deep mediastinal infection occurred in one patient on the fifth day after cardiac surgery. The infection was successfully treated with radical debridement, two days of intermittent mediastinal irrigation and staged wound closure with omental transposition into the mediastinum. The omental transfer was achieved as follows: after the greater omentum was divided into two pedicles one pedicle was used to fill in the pericardial space and the other was placed between the sternum and the undermined skin. We conclude that early debridement and omental flap transposition are effective in the management of mediastinitis after cardiac surgery.

Aged↗
PubMed1993

[Preoperative evaluation of a distal aortic arch aneurysm by spiral CT with three-dimensional reconstruction].

Sixty-seven-year-old male with a distal aortic arch aneurysm was evaluated by spiral CT with three-dimensional reconstruction. Spiral CT allows rapid data acquisition through an entire anatomic region during a single breath hold. The helically acquired data undergo interpolation. Transverse images are reconstructed with slice intervals 1-4 mm apart. Three-dimensional images were generated by these data with the transverse images. The entire anatomical correlation with the aneurysm and the aortic arch branches was clearly recognized by these three-dimensional images. Preoperative evaluation of the distal aortic arch aneurysm by spiral CT with three-dimensional reconstruction was useful for the surgical treatment.

Aged↗
PubMed1993

[Basic study of CA125 measurement using a newly developed "SD-8729" IRMA kit].

"SD-8729" is a one-step IRMA kit employing OC125 antibody as 125I-labeled tracer and M-11 antibody as an immunoadsorbent. Higher bound-radioactivity to beads was observed with shorter incubation time than that of a currently used CA125 IRMA kit which employed OC125 antibody both as 125I-labeled ligand and immunoadsorbent attached to beads. Almost identical CA125 values were obtained by using two kits. The antigenic nature recognized by the M-11 antibody seems substantially different from those of 130-22 or 145-9 antibodies recognizing CA130 antigen.

Antibodies, Monoclonal↗
PubMed1993

[Basic and clinical studies of serum CA195 antigen assay with "BL-CA195" kit].

We performed basic and clinical studies of IRMA "BL-CA195" kit in which monoclonal antibody CC3C195 was used as 125I-labeled tracer and solid phase antibody. The reproducibility of the assay results and dilution curves were satisfactory. There was a close correlation between serum CA195 and CA19-9 values, and many patients with pancreatic and colorectal cancer had elevated serum CA195 concentrations. Unlabeled CC3C195 antibody dose-dependently and completely inhibited the binding of 125I-labeled anti-CA19-9 antibody to its corresponding antigen. These findings suggest that CA195 and CA19-9 share common antigenic determinants.

Adult↗
PubMed1993

[Surgical treatment of adult secundum ASD with severe pulmonary hypertension--two case reports].

Indication and treatment of adult secundum ASD with severe PH was discussed in two surgical cases. Case 1: 32-year-old woman with dyspnea on exercise. After 100% O2 inhalation, PA systolic pressure changed from 103 to 104 mmHg, left to right shunt ratio changed from 18.2% to 52.2%, Qp/Qs changed from 1.07 to 2.08, Rp/Rs changed from 0.58 to 0.28, PVR changed from 1606 to 805 dyne.sec.cm-5 respectively. Because the reversibility of pulmonary obstructive disease was recognized, ASD closure was performed. Her activity became well, and PVR was decreased to 758 after the operation. Case 2: 63-year-old man with dyspnea on exercise. After 100% O2 inhalation, PA systolic pressure changed from 102 to 95 mmHg, Left to right shunt ratio changed 31.9 to 51.0%, Qp/Qs changed from 1.30 to 2.0, Rp/Rs changed from 0.65 to 0.39, PVR changed from 1257 to 806 dyne.sec.cm-5. After the operation, he got well, and PA systolic pressure was decreased to 85 mmHg, PVR was 620. 100% O2 inhalation test was valuable to evaluate the reversibility of pulmonary obstructive state and to decide the surgical indication.

Adult↗
PubMed1993

[Selective cerebral perfusion with cold blood for the surgical treatment of aortic arch aneurysm].

To determine whether the selective cerebral perfusion with cold blood is useful for repair of aortic arch aneurysm, 7 consecutive patients with aneurysms were examined (October, 1991-July, 1992). Four of 7 patients (57%) required emergency surgery due to the aortic rupture. Surgical repair was performed under the moderate core hypothermia (20-25 degrees C) to avoid prolonged cardio-pulmonary bypass (CPB), and the selective cerebral perfusion with oxygenated cold blood (16 degrees C, 350-450 ml/min) was employed for cerebral protection. The selective cerebral perfusion system was easily added to the ordinary CPB system with low priming volume (150 ml). The mean cerebral perfusion time, the mean cardiac arrest time, and the mean CPB time in this series were 93 min, 93 min, and 201 min, respectively. One of 7 surgical cases (14%) died due to the postoperative complication (multiple organ failure). Other 6 patients recovered and discharged. Successful cerebral protection and avoidance of prolonged CPB may be achieved by this unique method. The selective cerebral perfusion with cold blood may be one of the useful and reliable methods for repair of aortic arch aneurysm.

Adult↗
PubMed1993

[Replacement of ascending and transverse aorta using zero-porocity gelatin impregnated graft].

Gelatin impregnated Dacron graft was used without preclotting for the replacement of ascending and transverse aorta in 11 cases. The replacement of transverse aorta was performed in six patients with atherosclerotic aortic arch aneurysms and two patients with aortic dissections. The replacement of ascending aorta was performed in two patients with annlo-aortic ectasia and one patient with aortic dissection. Five of 11 patients (45%) needed emergency surgery due to the aortic rupture. Bleeding from the graft was not recognized clinically in all cases during the full heparinized cardiopulmonary bypass ranged from 153 min to 260 min. One patient (9%) with the rupture of transverse aorta died at the 7 th post operative day due to the multiple organ failure. No complication related to the graft was observed in all cases. Zero-porocity gelatin impregnated graft was useful for the replacement of aorta, especially for the replacement of ruptured ascending and transverse aorta in emergency situation.

Adult↗
PubMed1993

[Comparative study in graft patency of individual and sequential grafting as coronary bypass].

We analyzed the graft patency rates of the individual saphenous vein graft (SVG) group and those of the sequential SVG group. In the individual SVG group, 184 SVGs were anastomosed to 184 coronary arteries. Twenty-six SVGs were used sequentially to 52 coronary arteries in the sequential group. The patency rates of all the SVGs in both groups showed no significant differences. The patency of left anterior descending (LAD), left circumflex (LCX), right coronary artery (RCA) and diagonal branch (Dx) was 96%, 67%, 90% and 63% respectively in the individual SVG group. In the sequential SVG group, the patency rates of LCX (95%) were much higher than those (67%) of the individual SVG group (p < 0.05). The patency rates of side-to-side anastomoses (SSAs) were 92% and those of the distal end-to-side anastomoses (ESAs) were 96% in the sequential SVG group. There were no significant differences between SSAs and ESAs. While, the patency rates of SSAs-Dx, ESAs-Dx, SSAs-LCX and ESAs-LCX were 89%, 100%, 100%, and 93% respectively in the sequential SVG group. There were no significant differences between two groups. These results showed that the sequential grafting is useful and effective for LCX coronary arteries in coronary artery bypass surgery. In conclusion, it seems that in LCX coronary arteries, the patency rates obtained by the sequential SVG technique are better than those obtained by using the individual SVG technique.

Coronary Artery Bypass↗
PubMed1993

[Parapsoriasis en plaque suspected of progression to mycosis fungoides associated with extranodal malignant B cell lymphoma of the cheek].

A 59-year-old female, clinically diagnosed as having parapsoriasis en plaque for ten years, was referred on June 1991 to the Department of Oral Surgery in the Dental School of showa University with a complaint of painless swelling of the left malar area. The swelling was found to have been caused by a tumor. Since the excised tumor was suspected to be a malignant lymphoma, she was admitted to our hospital. The specimen was subsequently confirmed to be a malignant lymphoma of the diffuse large cell type according to the LSG classification, and was immunologically confirmed to be a B cell lymphoma. In addition, the excised skin was suspected of incipient mycosis fungoides. She was classified as having stage IE disease according to her bone marrow biopsy and other examinations. she was treated with combination of chemotherapy (CHOP) and radiation therapy. This subject was interesting because her tumor probably resulted from a parapsoriasis en plaque skin lesion.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

[Selective cerebral perfusion with cold blood for the aortic arch surgery].

In seventeen patients with aortic arch aneurysms including seven emergency cases, the selective cerebral perfusion with cold blood (16 degrees C) was applied for the cerebral protection during the surgical procedure. Fifteen of them (88%) including the patient with the long cerebral perfusion (236 min) recovered perfectly and discharged. The selective cerebral perfusion with cold blood may be one of the safe and reliable methods for the repair of aortic arch aneurysm.

Adult↗
PubMed1993

[Clinical preeminence of single aortic cross-clamping for proximal anastomoses in coronary artery bypass surgery].

We evaluated the preeminence of the construction of proximal anastomoses during single aortic cross-clamping periods in coronary artery bypass surgery. Twenty-six patients were divided into two groups; single aortic cross-clamping (SAX) group: 13 patients, partial aortic clamping (PAC) group: 13 patients. In this study, these two groups were compared in terms of aortic cross-clamping time (AXT), total extracorporeal circulation (ECC) time (TECCT), ECC weaning time (WT), amount of cardioplegic solution, total levels of serum CPK and CPK-MB, and graft patency. The results were analyzed by ANOVA and chi-square test. AXT was longer in the SAX group compared with the PAC group (78.2 +/- 5 versus 63.2 +/- 4 min; p < 0.05). TECCT (120.4 +/- 6 versus 109 +/- 5 min) and WT (37.4 +/- 2 versus 41 +/- 2 min) were not significant between the two groups. The total amount of cardioplegic solution was greater in the SAX group compared with the PAC group (1100 +/- 60 versus 927 +/- 43 ml; p < 0.05). The levels of serum CPK and CPK-MB were a little lower in the SAX group, but there were no significant differences between the SAX group and the PCA group. The graft patency of both two groups were excellent. From these results, SAX is not critical in the routine of coronary artery bypass surgery. Clinically, the SAX technique allows us to select more suitable areas of the ascending aorta for placement of all the proximal grafts if the ascending aorta is short.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1993

Hepatic resection guided by needles inserted under ultrasonographic guidance.

BACKGROUND: Operative ultrasonography for orienting the direction of transection of the liver is often useful in obtaining an adequate disease-free surgical margin. We have devised a new technique for hepatectomy guided by needles inserted under ultrasonographic guidance. METHODS: One hundred two hepatectomies were performed between January 1987 and September 1991, and the hepatectomy with this technique was begun in January 1989. RESULTS: In 10 of 29 limited hepatectomies performed in the first phase of the period in which this technique was not available, disease-free surgical margin of less than 1 cm was left because of inadequately directed division. Disease-free surgical margin of more than 1 cm was left in 18 of 23 limited hepatectomies in the second phase of the period in which this technique was available. In the other five operations where disease-free surgical margin of less than 1 cm was left, carcinomas were located too close to the major hepatic vessels. The average blood loss during the limited hepatectomies was reduced by this technique. Two-year and 3-year survival of patients undergoing hepatectomy for hepatocellular carcinoma were more favorable in the second phase than in the first phase. CONCLUSIONS: Although the difference between the two groups was not significant, this technique is useful in performing adequate transection of the liver.

Adenoma, Bile Duct↗
PubMed1993

[Preoperative diagnosis of the thoracic aortic aneurysm by three-dimensional CT angiography].

Serial eight patients with thoracic aortic aneurysms were evaluated by a newly developed three-dimensional CT angiography (3D-CT) from December 1992 to January 1993. The patients include 3 aortic dissections, 3 aortic arch aneurysms, one descending aortic aneurysm and one thoracoabdominal aortic aneurysm. The surgical treatment was performed after the evaluation of 3D-CT, and the operative findings were compared to the three-dimensional images reconstructed by 3D-CT in all patients. Three-dimensional displays were achieved using the unique method of data collection of the helical (spiral) scanner with continuous tube rotation and continuous table feed. A intravenous contrast material was used to image the thoracic aorta and major aortic branches with the single-breath-hold technique. Two and three-dimensional images reconstructed by 3D-CT were displayed within 10-20 minutes after the scanning. These three-dimensional images of the aortic lesions could be displayed in any angle we chose. Three-dimensional structures of the thoracic aorta and major aortic branches were clearly visualized and easily recognized by 3D-CT. These images were similar to the intraoperative findings and were quite useful to determine the operative procedure. The successful repair of thoracic aortic aneurysm was achieved in all cases. 3D-CT is a new and attractive modality to assess the vascular system. Although our experience is limited, 3D-CT may be a useful and powerful diagnostic method for the surgical treatment of thoracic aortic aneurysm.

Adult↗
PubMed1993

[Surgical treatment of cardiac cachexia with mitral valve disease: the effect of preoperative IVH and left atrial plication on postoperative respiratory condition].

Twenty-four patients with cardiac cachexia associated with mitral valve disease were evaluated from the point of postoperative respiratory management. Our previous study suggested that preoperative intravenous hyperalimentation (IVH) had just a effect on postoperative respiratory management, but another study suggested that left atrial plication (LAP) for giant left atrium might improve the postoperative respiratory function. Therefore, four groups could be identified: (1) IVH group (17 patients), (2) No-IVH group (7 patients), (3) LAP group (6 patients), (4) No-LAP group (18 patients). The hospital mortality was 18% in IVH group and was not related to the postoperative respiratory distress. On the contrary, the mortality in No-IVH group was 57%, related to the postoperative respiratory distress. The mortality of LAP group was 67%, and was related to the respiratory distress except one patient. In No-LAP group which had undertaken preoperative IVH, the mortality was 17%. As a result, preoperative IVH therapy may consider to be a favorite procedure in order to get the good postoperative respiratory condition, but LAP itself would be suspicious for this purpose.

Adult↗
PubMed1993

[Surgical treatment of aberrant right subclavian artery aneurysm].

A 77-year-old female was admitted with dysphagia and back pain. Angiography revealed an aberrant origin of the right subclavian artery from the posterior aspect of the proximal descending thoracic aorta just distal to the origin of the left subclavian artery. The origin of the right subclavian artery was aneurysmal (maximum transverse diameter was 8 cm), and this aneurysm was causing compression of the esophagus. The patient was treated by Teflon patch graft aortoplasty and right subclavian artery reconstruction with the aid of cardiopulmonary bypass and hypothermic selective cerebral perfusion. Postoperative course was uneventful and there were no major complications.

Aged↗
PubMed1993

[Primary chondrosarcoma of the pulmonary artery].

A 69-year-old woman who had progressive dyspnea, edema and oliguria was diagnosed as primary sarcoma arising in the pulmonary trunk by preoperative examination. She received thoracotomy and total resection of the tumor in the pulmonary trunk utilizing cardiopulmonary bypass. A microscopical examination revealed that the tumor had the features of the chondrosarcoma originating in the pulmonary artery. There have been very few reports on chondrosarcoma in the pulmonary artery. It is reported that the prognosis of the sarcoma in the pulmonary artery is less favorable, however, this case had uneventfully postoperative course and no signs of recurrence one year after operation.

Aged↗