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Biomedical subjects

H Urayama

Publications and source records attributed to H Urayama.

At least 55 records · Page 3Linked to original sources
PubMed1994

Immediate haemodialysis and staged fasciotomy in the treatment of reperfusion injury.

A 67-year-old man was admitted with traumatic arterial occlusion in his leg 24 h after an accident. A double-lumen catheter was inserted into the left iliac vein, after revascularization, and haemodialysis started using a new membrane dialyser to remove myoglobin effectively. Intramuscular pressure of the limb was measured and, when it was 35 mmHg, staged fasciotomy was performed. A modification of the procedure used to prevent myonephropathic metabolic syndrome and compartment syndrome is described.

Aged↗
PubMed1994

[Combined resection and replacement of the superior vena cava with an expanded polytetrafluoroethylene graft in surgery of pulmonary-mediastinal malignant tumor].

Combined resection and replacement of the superior vena cava with an expanded polytetrafluoroethylene graft was performed in 7 patients. Five patients had lung cancer, and 2 had malignant thymoma. During operation, total clamping of the superior vena cava was required in 2 patients, and partial clamping of the superior vena cava or clamping of the innominate vein in 5. The reconstruction procedures were as follows; the superior vena cava or bilateral innominate veins with a graft in 4 patients, bilateral innominate veins with 2 grafts in 1, and one of the innominate veins with a graft in 2. There was no operative death. Edema of face, neck and arms appeared in 6 patients postoperatively, but it disappeared in 3-10 days. Phlebogram which was obtained in 5 patients demonstrated patency of the grafts in 4 and well-developed collateral drainage in 1. Postoperative survival time was 1-27 months, and 3 patients are alive. No superior vena cava syndrome was recognized in long term observation of any patient.

Aged↗
PubMed1993

Composite reconstruction of the esophagus.

Composite reconstruction of the esophagus using both the mobilized stomach and free jejunal graft is described. Tension at the anastomotic site can be minimized with interposition of a jejunal autograft between the pharyngeal stump and the mobilized stomach, even when the mobilized stomach is not long enough. Furthermore, problems derived from differing calibers of the pharyngeal stump and the mobilized stomach can be resolved by creating an end-to-side pharyngojejunal anastomosis. Our method is proposed as one procedure for reconstruction of the esophagus when the pull-up organ is too short.

Anastomosis, Surgical↗
PubMed1993

Reconstruction of jugular and portal blood flows using remodeled great saphenous vein grafts.

Remodeled great saphenous vein grafts were used to reconstruct both jugular and portal veins. The great saphenous vein was split longitudinally and sutured side-to-side to construct a vessel twice the diameter and one half the length of the original vessel. This graft was used with good results for reconstruction of the jugular veins in a patient after a bilateral neck dissection for tongue cancer and for a portal vein in a patient after resection for cancer in the head of the pancreas.

Adult↗
PubMed1993

Saphenous neuralgia and limb edema after femoropopliteal artery by-pass.

One hundred thirty-one limbs of 109 patients who underwent femoropopliteal artery by-pass were studied for postoperative saphenous neuralgia and limb edema. The following factors were analyzed: age, sex, underlying disease (arteriosclerosis obliterans or Buerger's disease), grade of symptoms (Fontaine's classification), presence of diabetes mellitus, the site of distal anastomosis (above or below the knee), vascular graft material (reversed saphenous vein, expanded polytetrafluoroethylene or composite), presence of postoperative hematoma, and levels of serum creatinine and albumin 3 weeks after surgery. To examine limb edema, radioisotope (RI) venography and RI lymphography were performed. Saphenous neuralgia occurred in 22 limbs (16.8%) and limb edema in 27 limbs (20.6%). None of the factors examined was found to be significantly associated with saphenous neuralgia. The risk of developing limb edema was higher in diabetic patients and in patients in whom the distal anastomosis was performed below the knee. Although no case of limb edema was associated with signs of obstruction on RI venogram, 80% of the cases showed lymphatic obstruction on RI lymphograms.

Adult↗
PubMed1993

[Strategy for cerebral protection during aortic arch replacement].

We analyzed cerebral protection of twenty-five patients, 11 of whom underwent ascending-arch aortic replacement and 14 underwent aortic arch replacement, supported with cardiopulmonary bypass. Twenty of patients underwent selective cerebral perfusion (SCP) with moderate hypothermic circulatory support; 12 of single SCP, 8 of double SCPs. Major arch branch reconstruction were performed with 11 patients; 3 of triple branches, 2 of double branches and 6 of single branch reconstruction. Cerebral impairment was found in 7 patients (25%) with SCP; 3 of them died of low output syndrome and major bleeding during perioperative period. Four of 17 patients, who survived more than one month, showed cerebral infarction in 2 patients and temporary neurological deficit in 2 patients. Our strategies for cerebral protection are (1) careful cerebral four vessels study, (2) SCP with perfusion pressure more than 40 mmHg and flow rate of 7-10 ml/kg/min under moderate hypothermia, (3) bilaterally double branches perfusion minimally for arch replacement, (4) intensive cerebral monitoring from multiple aspect, (5) pharmacological support with barbiturate or aprotinin, (6) gentle maneuver and reliable major branch cannulation to prevent debris embolism.

Aortic Dissection↗
PubMed1992

[Coarctation of aorta with right aortic arch and anomalous left subclavian artery].

The occurrence of coarctation in patients with right aortic arch is extremely rare. We have encountered a 21-year-old man with anomalous left subclavian artery. He was diagnosed when he was 13. On angiography he exhibited a right aortic arch. The left common carotid artery, right common carotid artery and the right subclavian artery diverged from the proximal side of the coarctation. The left subclavian artery diverged from the distal side. The right brachial arterial pressures measured 158-72 mmHg, while the left brachial arterial pressures measured 98-80 mmHg. Clinical studies revealed no vascular ring and no other anomalies were found in this patient. An attempt at treatment was made with extra anatomical bypass grafting from the ascending aorta to the descending aorta. No pressure difference due to coarctation remained after operation.

Adult↗
PubMed1992

[Brain dysfunction after operation of aortic arch aneurysm].

Postoperative brain dysfunction was studied for 18 patients who survived more than 30 days after operations of aortic arch aneurysms. The operative procedures were graft replacement in 12 patients, resection with direct or patch closure in 3, and thromboexclusion in 3. Except for thromboexclusion, adjuncts were used: temporary bypass in 1, partial EPC (extracorporeal circulation) in 2, and selective cerebral perfusion during EPC in 12. As for intra-operative monitoring, the temporal artery blood pressures were more than 50 mmHg in all, but the electroencephalogram changed to flat wave just after clamping the aorta in one patient. Postoperative brain dysfunction occurred in 5 patients, including temporary loss of consciousness in 2, lasting loss of consciousness in 1, and paralysis with loss of consciousness in 2. Postoperative brain dysfunction occurred more often in old aged men with atherosclerotic aneurysms. Patients with temporary brain dysfunction had no remarkable change in CT scan, but patients with lasting brain dysfunction had low density areas. It is recommended to prevent this complication as follows: 1) pre-operative evaluation of cerebral vascular disorders, 2) gentle maneuver of atherosclerotic lesions, 3) bilateral cerebral perfusions and intra-operative monitorings, 4) intensive perioperative care of circulation and respiration.

Adult↗
PubMed1992

[Hyperbaric oxygenation therapy for chronic occlusive arterial diseases of the extremities].

Therapeutic effects of hyperbaric oxygen therapy (HBO) in 50 patients with chronic occlusive arterial diseases were studied with determination of the transcutaneous oxygen pressure (TcPO2), plasma lipid peroxide level, and plasma superoxide dismutase (SOD) level. Necrosis or ulceration was present in 30 patients, rest pain without tissue loss in 6, infection and necrosis in 2, infection of the amputated stump in 2, delayed healing of the amputated stump wound in 8, and delayed union of bone fractures in 2. HBOs were carried out in 2-3 absolute atmospheres for 60 min for 3-40 times (mean, 12.7 times). In combination with HBO, sympathetic denervation was performed in 41 patients, and PGE1 infusions were administered in 46. Of patients with necrosis or ulceration, 16 were healed, 13 were improved, and one was unchanged. Of patients with rest pain, 5 had relief and one was unchanged. All patients with infection were cured. Of patients with delayed healing of amputation wounds, 7 were healed and one required reamputation. All patients with bone fractures obtained bone union. The TcPO2 markedly increased during HBO and remained at a high level for some time after HBO. The lipid peroxide and SOD levels were not changed significantly by HBO.

Adult↗
PubMed1991

Results of surgical treatment in patients with stage IIIB non-small-cell lung cancer.

From 1973 to March 1989, surgical resection was performed in 83 stage IIIB non-small-cell lung cancer patients (81% of all admitted stage IIIB patients). There were 2 operative deaths (2.3%), and complete resection was accomplished in 33 patients. The five-year survival rate of the patients undergoing complete resection was 25%, whereas that of the incomplete resection group was nil (p less than 0.05). Among the 26 patients with invasion of mediastinal structures who underwent complete resection, 3 patients survived for over five years. Two had squamous-cell carcinoma and one had adenocarcinoma, and their tumors involved the left atrium, pulmonary arterial trunk, and superior vena cava, respectively. Among the 6 patients with T4 lesions due to carinal invasion, two patients (one with mucoepidermoid carcinoma and one with squamous-cell carcinoma) have survived for over 8 and 4 years, respectively, after complete resection. There were no long-term survivors among the patients with malignant pleural effusion. Pleuropneumonectomy did not improve survival. Extended lymph-node dissection for N3 disease was only commenced in recent years, so it is not yet clear whether it will affect the survival rate or not. However, 6 out of 19 patients who underwent extended lymph-node dissection including the contralateral lymph-node compartments are still alive, with 23 months being the longest survival. To date, there are 6 three-year survivors among our present series of stage IIIB patients who underwent operative treatment. From these results, it can be concluded that stage IIIB patients should not be uniformly excluded from consideration for surgery, but rather should be evaluated with regard to the possibility of performing complete resection.

Carcinoma, Non-Small-Cell Lung↗
PubMed1991

[Effect of surgery for combined abdominal aortic and internal iliac artery aneurysm on postoperative intestinal ischemia and sexual dysfunction].

The effect of surgery for combined abdominal aortic aneurysm (AAA) and internal iliac artery aneurysm (IIAA) on postoperative intestinal ischemia and sexual dysfunction was studied. Nineteen men and three women, aged 51 to 79 years, were included in this study. The IIAA was unilateral in 13 cases and bilateral in 9. The maximum diameter of the IIAAs ranged from 3.0 to 7.5 cm. Seven cases underwent emergent surgery for aneurysmal rupture. A bifurcated graft was implanted in all cases. Among cases with unilateral IIAA, aneurysmectomy and IIA reconstruction was performed in 2 cases, and ligation of the IIA was performed in the remaining 11. Among cases with bilateral IIAAs, IIA reconstruction was performed on one side and IIA ligation on the another side in 1 case. Bilateral ligation was performed in 4 and exclusion of the AAA and both IIAAs were performed in 4. The inferior mesenteric artery was reconstructed in 10 cases. The average postoperative follow-up period was 6.2 years. Postoperatively 2 cases experienced bowel necrosis and 4 had diarrhea and/or mucous stool. An erectile disturbance occurred postoperatively in 33.3% of cases which had undergone unilateral and 50% of cases which had undergone bilateral IIA ligation.

Adult↗
PubMed1991

[Serum monitoring of methotrexate (MTX) and 7-hydroxymethotrexate concentrations in patients treated with MTX using high-pressure liquid chromatography (HPLC) and comparison of serum MTX levels between HPLC method and fluorescence polarization immunoassay (FPIA)].

In order to measure simultaneously the serum levels of methotrexate (MTX) and its major metabolite, 7-hydroxymethotrexate (7-OH-MTX), in samples obtained from patients treated with MTX, we have investigated the reversed-phase high-pressure liquid chromatographic assay using ion-pairing reagents. The mobile phase consisted of 77.5% solution of 0.005M tetrabutylammonium and 22.5% acetonitrile. SEP-PAK C18 Cartridges were used for the precolumn. The detectable range of MTX and 7-OH-MTX were 0.02-0.03 and 1.0 mumol/l respectively. A significant positive correlation was observed (r = 0.983) between FPIA and HPLC methods. Serum MTX levels with FPIA were significantly (p less than 0.05) higher than those of HPLC method. The serum 7-OH-MTX levels at 24 hr and 48 hr were 4.857 +/- 1.383 (n = 10) and 1.835 +/- 0.286 (n = 6) mumol/l respectively with the dosage of 400 mg/m2. The serum 7-OH-MTX levels at 48 hr were 6.254 +/- 3.053 mumol/l (n = 5) with the dosage of 3,000 mg. The serum half lives of MTX and 7-OH-MTX were 8.05 +/- 1.03 (n = 4) and 14.8 +/- 1.35 (n = 6) hours respectively between 24 hr and 48 hr after administration. The T1/2 7-OH-MTX/MTX ratio was 1.8. Percent cross-reactivity of 7-OH-MTX with concentrations ranging from 1-10 mumol/l were 0.6-2.0% by FPIA. However, patients' serum levels of 7-OH-MTX were 15-85 times (n = 21) higher than those of MTX. MTX levels of containing both MTX and 7-OH-MTX (7-OH-MTX/MTX ratio was 50/1) were significantly higher than those of containing MTX alone by FPIA.

Adult↗
PubMed1990

The role of neostigmine in development of acute gastric mucosal lesion in dogs with live bacterial flora-induced shock.

The factors that frequently cause the development of acute gastric mucosal lesions (AGML) were studied in 37 mongrel dogs. Bacterial shock was induced by bolus injection of E. coli live bacterial flora (10(10) cells/kg body weight) under parietal cell-stimulated condition by intravenous administration of 0.008 mg/kg per hour of pentagastrin. In addition, 0.01 mg/kg per hour of neostigmine sulfate was administered intravenously during the experiment. Frequent development of AGML was observed in the neostigmine-administered canines without significant changes in the gastric corporal and antral tissue blood flow. In the neostigmine-administered group, AGML was observed in the antrum, although in the other group AGML was mostly observed in the corpus. These results suggest that a neostigmine-induced systemic vagostimulated condition by intravenous administration of neostigmine plays an important role in the development of AGML in dogs subjected to bacterial shock.

Animals↗
PubMed1990

[A new method of preparation of doxorubicin-in-oil suspension using ultrasonificator attached with Cuphorn].

The property of selective deposition of oily contrast medium, Lipiodol (LPD), in tumor tissue was utilized for targetting intraarterial infusion chemotherapy for hepatic cancers. For this therapy anti-cancer agents need to be suspended in LPD. In this report the new suspension device using ultrasonificator attached with Cuphorn was studied. Doxorubicin (Dx) was stable to ultrasonification for 1 hour. Ten mg/ml of Dx was mixed with LPD and this mixture was treated 2 times for 5 minutes with the ultrasonification method. This procedure was simple and sterile, as the commercially used Dx vials into which LPD was injected were set in the Cuphorn and ultrasonificated just as sealed. Microscopic examination of the suspension showed uniform dispersion of Dx particles without formation of aggregates. Dx particles were finely and regularly fragmented. In vitro the suspensions showed a gradual release of Dx from LPD to water phase. In one case with hepatocellular carcinoma received intraarterial infusion of this suspension, the size of the tumor and serum level of alpha-fetoprotein was prominently decreased. This ultrasonification method was simple and convenient to prepare Dx-in-oil suspension.

Carcinoma, Hepatocellular↗
PubMed1990

[A case of successful surgical treatment of DeBakey IIIb dissecting aortic aneurysm with the true lumen obstruction of the thoracic descending aorta].

A case of successful surgical treatment of DeBakey IIIb dissecting aortic aneurysm with the true lumen obstruction of the thoracic descending aorta is presented. A 64-year-old male was admitted to our hospital with a complaint of severe chest and back pain. Immediately antihypertension therapy was carried out. But, after 14 days, acute renal failure was occurred by the true lumen obstruction of the thoracic descending aorta. On the 78 days after hospitalization, the flow reversal thromboexclusion by ascending aorta-abdominal aorta bypass and permanent aortic clamping was done. The reasons why this procedure was selected are as follows: 1) widely extended dissection, 2) renal failure, 3) poor pulmonary function, 4) left hemiparesis due to apoplexy. The post-operative course was excellent, paraplegia did not occur and renal function improved very well. The post-operative CT revealed thrombi formation within the thoracic descending aorta.

Aortic Dissection↗
PubMed1990

[The surgery of pharyngoesophageal carcinoma with vascular anastomosis].

Reestablishment of gastrointestinal continuity following resection of pharyngoesophageal carcinoma can be a challenging problem. Recent developments in vascular surgery have made microvascular anastomosis possible and practical. At present free intestinal interposition grafts and revascularization of the proximal end of pedicle grafts offer the surgeon new options. From 1983 through 1989, reconstruction with vascular anastomosis was performed in 18 cases with pharyngoesophageal carcinoma. Patients were 47 to 88 years old, mean 62.1 years. Reconstructive methods included; free jejunal graft in 14, revascularization of proximal end of a pedicled gastric tube in 1, revascularization of proximal end of a pedicled jejunum in 1, interposition of free jejunal graft between a pedicled gastric tube and the pharynx in 1 and interposition of free ileal graft between a pedicled jejunum and the cervical esophagus in 1 case. Modified radical neck dissection was performed in all cases and superior mediastinal lymph node dissection with median sternotomy was added in 5. The internal jugular vein and common carotid artery were the donor vessels of choice, but in the case of severe sclerosis of the carotid artery, another cervical artery was chosen. The vascular anastomosis was performed using interrupted 7-0 Prolene sutures in the anterior wall and running 7-0 Prolene sutures in the posterior wall under 2.25 magnification. The patency of the anastomosed vessels was confirmed by Doppler flowmeter. The postoperative following-up periods ranged from 1 to 73 months with a mean of 16.5 months, and the survival rate was 66.2% at 1 year and 42.6% after 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Revascularization with the branched graft in middle aortic syndrome].

A case of middle aortic syndrome which was thought to be the thoracoabdominal type of Takayasu's disease was successfully treated with the branched graft bypass. Patient was a 23 year-old woman with hypertension and abdominal pain. The preoperative angiography revealed aortic stenosis from the celiac axis to the left renal artery. The operative procedures were as follows; patient was positioned in supine with her left shoulder and arm raised. Eighth intercostal thoracotomy and midline laparotomy was performed with the thoracoabdominal incision. The branched graft was made previously with woven Dacron (phi 18 mm) and three EPTFEs (phi 8mm). The woven Dacron of the graft was used for the bypass from the descending thoracic aorta to the infrarenal abdominal aorta, and the branched EPTFEs of the graft were used for the bypasses to the common hepatic artery, the superior mesenteric artery and the right renal artery in this order. The bypasses were placed along the anatomical courses in the retroperitoneal space. Postoperatively, the blood pressure dropped and the abdominal pain disappeared. The plasma renin activity decreased and the renal function improved. Two months after operation the bypasses were patent by the angiography and now six months after operation she has returned to her social life healthily. The approach to the aorta and its abdominal branches by thoracotomy and laparotomy and bypass with the three branched graft was useful for middle aortic syndrome.

Adult↗