Search PubMed⌕ Search

Biomedical subjects

H Urayama

Publications and source records attributed to H Urayama.

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

Acute mesenteric vascular occlusion: analysis of 39 patients.

OBJECTIVE: To study the factors that influence mortality and long term outcome of patients with acute mesenteric vascular occlusion. DESIGN: Retrospective study. SETTING: University hospital, Kanazawa, Japan. PATIENTS: Thirty-nine patients treated between 1978 and 1995 for acute mesenteric vascular occlusion. INTERVENTIONS: 34 patients underwent laparotomy. Bowel was resected in 29 patients, and primary anastomosis was done in 20. The occluded vessel was revascularised in 5 patients. MAIN OUTCOME MEASURES: mortality, short bowel syndrome and long term survival. RESULTS: 25 patients had arterial occlusions, and 8 venous. In the remaining 6, the occluded vessel was not identified. 11 Patients developed renal failure, 11 respiratory failure, and 10 disseminated intravascular coagulation (DIC). Twelve patients died within 30 days. The factors associated with early death were acidosis and high serum amylase activity. 9 Patients developed the short bowel syndrome. Survival was 49% at 1 year, and 34% at 5 years. CONCLUSION: Mortality was higher in patients with advanced peritonitis. Mesenteric revascularisation should be attempted to avoid the short bowel syndrome.

Adult↗
PubMed1998

A solitary iliac artery aneurysm caused by Candida infection. Report of a case.

We report a very rare case of an infected aneurysm of solitary common iliac artery by Candida albicans. The patient, a 70 year-old male, had a history of systemic Candidemia infected through intravenous hyperlimentation (i.v.H) catheter 2 years ago. By physical examinations and laboratory data, infectious disease was suspected. Computed tomography showed right hydronephrosis and right solitary common iliac artery aneurysm, and operation was performed with diagnosis of infected aneurysm. The aneurysm was removed with the end of the abdominal aorta, and the arterial blood flow was restored by axillo-bifemoral bypass. Histopathological findings revealed abscess formation around the aneurysm with phlogocytes infiltration in both outer media of aneurysmal wall and vasa vasorum. Candida albicans was found as causative pathogen from resected specimens. This aneurysm is considered to be resulted from surviving candida in vasa vasorum after previous candidemia.

Aged↗
PubMed1998

Branched graft technique for middle aortic syndrome. Three case reports.

BACKGROUND: Middle aortic syndrome is a rare disease caused by stenosis of the distal thoracic and abdominal aorta involving the visceral and renal arteries. METHODS: We performed reconstructive bypass surgery for three middle aortic syndrome patients. We used magnetic resonance angiography as well as conventional angiography to assess the stenotic vessels. According to these data, branched graft was fabricated preoperatively. We selected Dacron for aortic bypass graft, and ePTFE for the branch graft. In previous reports, branched graft was not applied for the surgery for middle aortic syndrome. RESULTS: Using this branched graft, the clamping time and ischemic time of the organs were shortened. CONCLUSIONS: Using branched graft prefabricated according to accurate preoperative angiographic findings, the reconstructive surgery is thought to proceed more safely.

Adult↗
PubMed1997

Long-term results of flow reversal and thromboexclusion method for thoracic aortic aneurysm.

BACKGROUND: The long-term results of flow reversal and thromboexclusion for the elimination of a thoracic aortic aneurysm were studied. METHODS: We monitored the posttreatment course in 10 patients with a thoracic aortic aneurysm who underwent thromboexclusion between 1981 and 1990. All patients had comorbid factors, such as renal failure, myocardial infarction, or respiratory dysfunction, and the entire descending thoracic aorta was involved in all. One patient with impending rupture underwent permanent occlusion of both the proximal and distal aortas, and the remaining 9 patients underwent proximal aortic occlusion only. RESULTS: Two patients died within 30 days of operation. Postoperative cerebral infarction occurred in 1 patient, possibly as the result of the release of atheroma emboli at the time of permanent clamping. Incomplete paraplegia occurred in 1 patient 15 months postoperatively. Two patients died as the result of comorbid conditions 3 and 39 months after operation; 1 patient died as the result of penetration of the lung by the permanent clamp 12 months after operation. An aortic aneurysm recurred in 4 patients, and 3 of them died of aneurysmal rupture 50,55, and 63 months after operation, respectively. The fourth patient with aneurysmal recurrence underwent reoperation and is alive 124 months postoperatively. Another patient is alive without recurrence 140 months postoperatively. CONCLUSIONS: Because of the postoperative complications and the risk of aneurysm recurrence, the thromboexclusion method should be used only in patients with an infected aneurysm or in those with a severely morbid condition.

Aortic Dissection↗
PubMed1997

Pharyngoesophageal reconstruction with the use of vascular anastomoses: operative modifications and long-term prognosis.

OBJECTIVE: Vascular surgical techniques have contributed to the success of pharyngoesophageal reconstruction. We report our methods and analysis of postoperative complications, quality of life, and long-term prognosis. METHODS: Sixty-seven patients who underwent pharyngoesophageal reconstruction with use of vascular anastomoses comprised the study population. The operative procedures performed were free jejunal autograft transplantation in 54 patients, gastric pedicle placement with vascular anastomoses in 2, jejunal pedicle with vascular anastomoses in 4, colonic pedicle with vascular anastomoses in 4, free jejunal graft and gastric pedicle in 2, and free jejunal graft and jejunal pedicle in 1. The common carotid artery and internal jugular vein were primarily used as the recipient vessels. The period of postoperative observation ranged from 3 days to 145 months. RESULTS: The postoperative complications noted were dehiscence in 7 patients, graft failure in 1, wound infection in 2, small bowel intussusception in 4, pneumonia in 2, disseminated intravascular coagulation in 1, and pancytopenia in 1. Revascularization was successful in all but 1 patient, and oral intake was achieved in 58. Persistent swallowing dysfunction was recognized in 4%. Speech restoration was achieved in 57% of the patients with esophageal speech in 7% and with an artificial larynx in 50%. In the long-term follow-up, 36% of our patients died of the primary disease, 9% died of other diseases, and 55% are alive. CONCLUSIONS: Esophageal reconstruction with the use of vascular anastomoses affords low morbidity and mortality. Postoperative swallowing and speech are satisfactory, and the function of the reconstructed esophagus is well preserved for as long as 10 years.

Adult↗
PubMed1997

Exclusion of a sciatic artery aneurysm and an obturator bypass.

This case report describes surgical treatment in a sciatic artery aneurysm with hypoplastic external iliac and femoral arteries. An obturator bypass grafting procedure from the internal iliac artery to the distal sciatic artery was performed after aneurysmal exclusion was achieved by proximal and distal ligation. This method offers an acceptable option for surgery in some types of sciatic artery aneurysms.

Aneurysm↗
PubMed1997

Physiological changes during acute obstruction of the superior vena cava, azygos, and internal thoracic veins in dogs.

PURPOSE: In the surgery for superior vena cava (SVC) reconstruction, the cross-clamping of the SVC may cause brain damage. Experimental study was performed to clarify the safe limit of the clamping time and the appropriate monitoring method during the surgery. METHODS: In anesthetized dogs, the internal thoracic and azygos veins were ligated, and the SVC was clamped for 120 min. Arterial blood pressure, intracranial venous pressure, regional cerebral blood flow, and electroencephalogram were monitored in six dogs. Somatosensory evoked potentials were recorded in one other dog, and in another dog postoperative neurological changes were evaluated for 3 weeks. The brains of the dogs were subjected to the histological examination including tetrazolium stain. RESULTS: The arterial blood pressure decreased and the intracranial venous pressure increased during the clamping. Oscillation of the pressure was noted at 45 to 74 min after clamping. The regional cerebral blood flow was 57.4 ml/100 g/min on average before clamping, and decreased to 15.5 ml/100 g/min at 105 min after clamping. The electroencephalogram demonstrated no pronounced change during clamping, but the amplitude of the somatosensory evoked potentials decreased and the latency was prolonged during clamping. No neurological defect was noted in the dog observed for 3 weeks. All areas of the brain showed staining with the tetrazolium, indicating intact mitochondria. The microscopic findings for the brains included no marked changes. CONCLUSION: The SVC clamping for 120 min was tolerated by the dogs, and the most reliable monitoring method was concluded to be the recording of somatosensory evoked potentials.

Animals↗
PubMed1997

Bypass grafting for a right proximal subclavian artery pseudoaneurysm patient using a long temporary bypass.

We report an 80-year-old woman, with pseudoaneurysm of the right proximal subclavian artery despite the absence of a history of trauma. On preoperative examinations, the aneurysm involved to the common carotid arteries. A long temporary bypass using a heparin-coated tube from the right femoral artery to the right common carotid artery was created under low dose systemic heparinization. A Dacron bifurcation graft bypassing was then performed successfully. At surgery for right proximal subclavian artery aneurysm, which often involves the right common carotid artery, intraoperative accident or bleeding can induce brain ischemia. A temporary bypass should be prepared. Although the short temporary bypass from the aorta to the right common carotid artery was reported, this carries the risk of complications due to microemboli. The heparin-coated tube provided excellent anti-thrombosis. Inflow cannulation should be placed at the peripheral artery not the aorta.

Aged↗
PubMed1997

Comparison of cilostazol with warfarin as antithrombotic therapy after femoro-popliteal bypass surgery using an ePTFE graft.

BACKGROUND: Cilostazol (6-[4-(1-cyclohexyl-1H-tetrazol-5-yl)butoxy]-3,4- dihydro-2(1H)-quinolinone) is a new antiplatelet agent with a vasodilating action. The purpose of this study was comparison of cilostazol with warfarin as antithrombotic therapy after femoro-popliteal bypass surgery using an expanded polytetrafluorethylene (ePTFE) graft. EXPERIMENTAL DESIGN: This report is a retrospective study and the patients were followed up for five years. SETTING: Outpatients of university hospital. METHODS: Sixteen arteriosclerosis obliterans patients, who were diagnosed as having only superficial femoral artery stenosis or occlusion, underwent femoro-popliteal (above the knee) bypass using an ePTFE graft 6 mm in diameter. Cilostazol (150-200 mg/day) was administered to 6 cases (9 bypasses), and warfarin (prothrombin time was controlled to 15-25%.) was administered to 10 cases (14 bypasses). RESULTS: No clinically characteristic differences were found between the two groups. The cumulative 1-, 3-, and 5-year primary and secondary graft patency rates were 69% and 80%, 69% and 80%, and, 69% and 80% in the cilostazol group, vs 61% and 91%, 51% and 91%, and, 51% and 91% in the warfarin group, respectively. These differences were not significant (p < 0.05). No hemorrhage complications were observed in the cilostazol group. The management of cilostazol administration was safe and simple. CONCLUSIONS: Although the number of cases was small in this study, cilostazol was considered to be as effective as warfarin and suitable for the postoperative antithrombotic therapy after the ePTFE bypass surgery.

Aged↗
PubMed1996

Thromboxane A2 analogue contracts predominantly the hepatic veins in isolated canine liver.

Thromboxane A2 (TxA2) is a potent vasoconstrictor and has been implicated as a mediator of liver diseases such as ischemic-reperfusion injury. We determined the effects of TxA2 and the well-known hepatic venoconstrictor histamine, on the vascular resistance distribution and liver weight in isolated canine livers perfused with blood via the portal vein. The stable TxA2 (STA2; 20 micrograms, n = 5) and histamine (5 micrograms, n = 6) similarly increased the hepatic total vascular resistance, 2.5- and 2.4-fold, respectively. The increase in the hepatic venous resistance was significantly greater than that of the portal resistance (threefold vs. 1.9-fold for STA2; threefold vs. 1.8-fold for histamine). Predominant hepatic venoconstriction induced by both agents was confirmed in livers perfused in a reverse direction from the hepatic vein to the portal vein, as shown by marked precapillary vasoconstriction. STA2 transiently increased liver weight loss (-3.6 g/100 g liver weight), followed by a gradual weight gain (9.0 g/100 g). Histamine caused a progressive weight gain (9.1 g/100 g). In conclusion, similar to histamine, TxA2 constricts predominantly the hepatic vein in isolated canine livers.

Animals↗
PubMed1996

An immunohistochemical analysis of implanted woven Dacron and expanded polytetrafluoroethylene grafts in humans.

An immunohistochemical analysis was performed to clarify the healing process in implanted vascular grafts in human. Eight woven Dacron grafts and 6 expanded polytetrafluoroethylene grafts were obtained following redo surgery, limb amputation, and autopsy. The implantation periods ranged from 5 days to 148 months. The antibodies used for the analysis were specific to alpha-actin (smooth muscle cells), macrophages, von Willebrand factor (endothelial cells), fibrin, elastin, collagen types 1-5, CD3 (T cells), and CD20 (B cells). At 5 and 24 days after implantation, thrombi containing red blood cells and fibrin covered the anastomotic lines and some of the luminal surfaces of the grafts. Macrophages were scattered throughout the thrombi. At 11-148 months after implantation, either a single layer of endothelial cells or a thin layer of fibrin covered the anastomotic segments of the grafts, and smooth muscle cells and collagen fiber were seen forming anastomotic intimal hyperplasia (AIH). The AIH in the grafts at 94 and 148 months after implantation was almost the same thickness and length a that in the grafts at 11-36 months after implantation Apart from the anastomotic segments, a connective tissue matrix containing collagen fibers covered the luminal surfaces, and some thrombi were noted. Most of the collagen present was type 3, in addition to some type 1, 4, and 5 collagen. No type 2 collagen was noted. Some elastin was also detected in the AIH but not in the midportion of the grafts. Some macrophages and T cells were noted in the perigraft tissues.

Actins↗
PubMed1996

[Treatment and prognosis of renal cell carcinoma extending into the inferior vena cava].

Out of 173 patients with renal cell carcinoma diagnosed at our department between January 1984 and December 1994, 9 (5.2%) had an inferior vena caval tumor thrombus. They consisted of 6 men and 3 women between 43 and 74 years old with a mean age of 59.8 years. The tumors were on the right and left sides in 5 and 4 patients, respectively. According to the Novick's classification, 2, 1, 4 and 2 patients had level 1 (perirenal), level 2 (infrahepatic), level 3 (intrahepatic) and level 4 (suprahepatic) tumors, respectively. Five patients without distant metastases underwent nephrectomy and removal of the vena caval tumor thrombus. Although renal tumors and vena caval tumor thrombi were completely resected in all of the 5, 4 died of disease within 3 years. Only 1 patient without tumor invasion into the inferior vena caval wall survived over 5 years without disease. Since surgical treatment is the sole radical method for renal cell carcinoma, surgery is recommended for the patients even with a vena caval tumor thrombus unless there are metastases.

Adult↗
PubMed1996

[Gallstone ileus].

Explore the source record for details and available documents.

Cholelithiasis↗
PubMed1996

Graft replacement of the dissecting aneurysm originating in the suprarenal abdominal aorta. A case report.

Spontaneous dissection originating in the suprarenal aorta is very rare. We successfully treated a patient with this type of aneurysm by a safe and reliable operative method. During aortic clamping, the visceral organs were perfused with oxygenated blood. And for reconstruction of visceral arteries, a graft with multiple branches was used. In spite of renal dysfunction before surgery and aortic clamping time extending for 40 minutes, the patient recovered almost uneventfully, and postoperative angiography confirmed good patency of the graft.

Aortic Dissection↗
PubMed1995

[A case of renal cell carcinoma extending into the inferior vena cava in a long-term hemodialysis patient].

We report a case of left renal cell carcinoma extending into the inferior vena cava associated with the acquired cystic disease of the kidney (ACDK). The patient was a 46-year-old man, who had been treated with hemodialysis for 12 years. In November 1992, ACDK was observed on computed tomography (CT) for routine check up, but no tumorous lesions were detected. He noticed bleeding from the urethra in May 1994. CT and magnetic resonance imaging (MRI) revealed left renal tumor with intrahepatic vena caval tumor thrombus. There were no findings of distant metastasis. Left radical nephrectomy and partial removal of vena cava were performed. Histopathologically, renal cell carcinoma, pT3b, pN0, stage III was diagnosed.

Carcinoma, Renal Cell↗
PubMed1994

Reconstruction with free jejunal autograft after pharyngolaryngoesophagectomy.

Twenty-four patients with hypopharyngeal or cervical esophageal carcinoma were treated surgically. All had squamous cell carcinoma, and none had intrathoracic lymph node involvement by preoperative computed tomography. Endoscopy in 18 patients confirmed there was no intramural spread into the thoracic esophagus. The patients underwent pharyngolaryngoesophagectomy and bilateral modified radical neck dissection. Reconstruction of the cervical esophagus was performed with transplantation of a free jejunal autograft. Postoperative complications included anastomotic leak in 2 patients (8.3%), wound infection in 3 (12.5%), and intussusception in 4 (16.7%). Reconstruction of the cervical esophagus was successful in 23 (95.8%) of the 24 patients. The operative mortality rate was 4.2%, and the 5-year survival rate was 39.7%. We emphasize that pharyngolaryngoesophagectomy followed by transplantation of a free jejunal graft is suitable for cervical esophageal carcinoma or hypopharyngeal carcinoma when the disease is limited to the cervical region.

Adult↗
PubMed1994

Treatment of postoperative chylothorax by pleurodesis with the streptococcal preparation OK-432.

Of the 2877 patients who underwent chest surgery at our department during the 20-year period between 1973 and 1992, 9 (0.3%) developed postoperative chylothorax. The underlying disease included primary lung cancer in 5 patients, pulmonary metastasis in 1, invasive thymoma in 2, and neuroblastoma of the posterior mediastinum in 1. For the treatment of chylothorax, the thoracic duct was ligated in 2 patients with a high volume of chylous leakage. In 6 patients treated conservatively, early pleurodesis was attained by injecting 1 to 5 doses (mean: 2.2 doses) of the streptoccal preparation OK-432 intrathoracically; favorable results were achieved. In 1 patient, the diagnosis of chylothorax was delayed because of postoperative pyothorax. This patient developed nutritional deficiency, compromised immunity, and disseminated intravascular coagulation (DIC), which led to death before the chylothorax could be treated. In principle, postoperative chylothorax should be treated conservatively. Favorable results can be expected with the intrathoracic injection of OK-432 beginning at the early postoperative period to achieve pleurodesis, combined with the prevention of nutritional deficiency, electrolyte imbalance, and infection.

Adult↗