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Biomedical subjects

Hajime Hirose

Publications and source records attributed to Hajime Hirose.

At least 37 records · Page 2Linked to original sources
PubMed2003

Surgical outcome of abdominal aortic aneurysm repair in patients undergoing chronic hemodialysis.

Abdominal aortic aneurysm repair in patients undergoing chronic hemodialysis presents several surgical difficulties due to tissue fragility, accelerated atherosclerosis, and calcification of the aorta. In addition to these surgical procedure-related problems, anemia, electrolyte abnormalities, bleeding tendency, and susceptibility to infection were also critical issues in perioperative management. The aim of this study was to examine the surgical outcome of abdominal aortic aneurysm repair in patients undergoing chronic hemodialysis. Between January 1988 and August 2001, six patients undergoing chronic hemodialysis underwent repair of an abdominal aortic aneurysm. There were five males and one female, and the mean age was 65 years. Two of the six patients had bilateral common iliac artery aneurysms in addition to the abdominal aortic aneurysm. At the time of abdominal aortic aneurysm repair, the duration of hemodialysis had ranged from 3 to 109 months, with a mean of 34 months. All patients underwent hemodialysis on the day prior to the abdominal aortic aneurysm repair operation. The first postoperative hemodialysis was scheduled to be performed on the day after operation or later. The mean duration of operation was 291 min. Blood transfusion was required in all patients. The first postoperative hemodialysis was performed between the first and third postoperative days. Postoperative complications were: ileus in one, and atrial fibrillation and blue toe syndrome just after operation in one. There was no hospital death. The follow-up period was 56 months. One patient died of lingual cancer at 102 months after operation. Five patients are alive. Abdominal aortic aneurysm repair can be done in patients on chronic hemodialysis with an acceptable early and long-term outcome.

Aged↗
PubMed2003

A study of the early stage of Dysphagia in amyotrophic lateral sclerosis.

In amyotrophic lateral sclerosis (ALS) patients, dysphagia eventually occurs independent of time of onset. We studied dysphagia conditions in the early stage of ALS, principally at the oral phase. Videofluoroscopic and manometric studies were conducted on 11 patients (5 males and 6 females, age range = 47-82 years) who were diagnosed at our Neurology Clinic as having ALS. All patients were able to ingest orally. Swallowing scores on the ALS severity scale were from 10 to 5. In the oral phase of swallowing, abnormal movements of the anterior and/or posterior tongue were recognized in 8 cases. Dysphagia severity tended to be particularly influenced by dysfunction of the posterior tongue. Manometric studies were almost normal in all cases except one. These results suggested that the early stage of dysphagia in ALS was mainly caused by oral dysfunction, and the oral phase disorders began in some cases with a decreased function of bolus transport at the anterior part of the tongue, and in other cases with a deteriorated function of holding the bolus at the posterior part of the tongue. In conclusion, the tongue function of holding the bolus in the oral cavity mainly affects the severity of the early stage of dysphagia in ALS.

Aged↗
PubMed2003

Simultaneous operations for abdominal aortic aneurysm and liver cancer complicated by severe ischemic heart disease: report of a case.

We performed successful simultaneous operations for an abdominal aortic aneurysm (AAA) and liver cancer in a patient complicated by severe ischemic heart disease. A 59-year-old man with a history of liver dysfunction presented with acute epigastric pain. Abdominal computed tomography findings of ascites and a liver tumor indicated a diagnosis of ruptured hepatocellular carcinoma. He had a concomitant 65-mm AAA and a 48-mm right common iliac aneurysm. Elective surgery was scheduled because of his good general condition. Although triple-vessel disease was detected preoperatively, there were no graftable coronary arteries. The aneurysms were repaired first to utilize intra-aortic balloon pumping (IABP) during resection of the liver cancer, followed by left lateral segmentectomy. Perioperative hemodynamics were maintained by administering catecholamines and vasodilators, without the need for IABP. The patient was discharged on the 21st postoperative day without any complications, and no recurrence of liver cancer has been found in the 5 months since his operation.

Aortic Aneurysm, Abdominal↗
PubMed2003

Simultaneous operations for combined thoracic and abdominal aortic aneurysms.

PURPOSE: To assess whether simultaneous operations are appropriate for combined thoracic and abdominal aortic aneurysms. METHOD: Simultaneous operations were performed for combined thoracic and abdominal aortic aneurysms in nine patients. The thoracic aortic aneurysm (TAA) was repaired first, followed by repair of the abdominal aortic aneurysm (AAA). Selective cerebral perfusion was used in eight patients, after the exception of one who underwent replacement of the ascending aorta under hypothermic circulatory arrest. The abdominal organs were perfused during distal anastomosis in surgery for Stanford type A aortic dissection or aortic arch aneurysm; via the femoral artery with an aortic balloon occlusion catheter in one patient, and via an occlusion catheter with a perfusion lumen in two patients. RESULTS: All patients underwent planned simultaneous repair of the AAA. One of the patients who underwent simultaneous replacement of both the descending thoracic and abdominal aorta was left with paraplegia, and one patient died suddenly of massive hemoptysis and melena on the 29th postoperative day. Autopsy revealed that the bleeding had been caused by aorto-broncho-esophageal fistulae. The overall operative mortality was 11%. CONCLUSIONS: Simultaneous repair of combined TAA and AAA can be safely performed; however, the risk of paraplegia should be considered, especially with simultaneous repair of concomitant aneurysms of the descending thoracic and abdominal aorta.

Aged↗
PubMed2003

Proximal left subclavian artery aneurysm presenting hemoptysis, hoarseness, and diplopia: repair through partial cardiopulmonary bypass and perfusion of the left common carotid artery.

Isolated true aneurysm of the subclavian artery is rare and can rupture, thrombose, embolize, or cause symptoms by local compression. We describe a case of a 67-year-old man with proximal left subclavian artery aneurysm presenting with hemoptysis, hoarseness, and diplopia. These symptoms suggested that the aneurysm ruptured, that the left recurrent laryngeal nerve was compressed by it, and that its mural thrombus caused cerebral embolism. It was incidentally confirmed that the aneurysm grew at the rate of 1.31 cm/year, from 3.0 to 4.2 cm in diameter for 11 months, preciously measured in a computed tomography scan. The aneurysm was successfully repaired via partial cardiopulmonary bypass and separate perfusion of the left common carotid artery through cross-clamping the descending thoracic aorta and the aortic arch between the origins of the brachiocephalic artery and the left common carotid artery. Neither partial clamping of the aortic arch at the portion branching the left subclavian artery nor taping the aortic arch between the origins of the left common carotid artery and the left subclavian artery could be achieved.

Aged↗
PubMed2003

Antegradely insertable aortic balloon occlusion catheter for aortic arch repair.

We have developed an antegradely insertable aortic balloon occlusion catheter for aortic arch repair, and review our experiences of using it. The purpose of the present study was to examine the usefulness of the balloon for surgical treatment of aortic arch aneurysm. In 30 patients with aortic arch aneurysm, including 22 with a non-ruptured and 8 with a ruptured aneurysm, the catheter was antegradely inserted into the descending thoracic aorta through the aortic arch or the aneurysm without opening the pleural space after establishing antegrade selective cerebral perfusion and obtaining cardiac arrest. During distal anastomosis, the catheter occluded the aorta with continuous perfusion of the lower half of the body through an arterial cannula inserted into the femoral artery. Among the patients with a nonruptured aneurysm, two deaths (9.1%) occurred because of aorto-broncho-esophageal fistulae or cardiac arrest due to severe asthma attack within 30 days, and the other three hospital deaths were due to aspiration pneumonia, multiple organ failure with preoperative renal dysfunction, or low cardiac output syndrome due to perioperative myocardial infarction. Among the patients with a ruptured aneurysm, three deaths (37.5%) were due to acute myocardial infarction, respiratory failure, or intractable arrhythmia within 30 days, and another hospital death was caused by mediastinitis. No paraplegia was caused in any patient excluding one of the patients with a ruptured aneurysm who could not be weaned from the extracorporeal circulation due to perioperative myocardial infarction. There was no early postoperative serious visceral organ dysfunction except for two patients with postoperative low cardiac output syndrome or preoperative severe renal dysfunction. This catheter was effective in protecting the visceral organs and the spinal cord in the repair of an aortic arch aneurysm.

Aged↗
PubMed2003

Preoperative construction of an extracranial arterial shunt for resection of an aortic arch aneurysm with occluded left carotid artery.

A 68-year-old man with aortic arch aneurysm was referred to our department. Preoperative carotid echography and magnetic resonance angiography revealed occlusion of the left internal carotid artery. Single-photon emission computed tomography scanning indicated that cerebral blood flow was decreased and reactivity to acetazolamide was reduced in the left temporal lobe. A successful superficial temporal artery-middle cerebral artery anastomosis was first made by neurosurgeons. A postoperative single-photon emission computed tomography scan showed that cerebral blood flow and reactivity to acetazolamide were remarkably improved. Two months after the anastomosis, the aortic arch aneurysm was successfully repaired.

Acetazolamide↗
PubMed2003

Aortic arch repair for Stanford type A aortic dissection with distal anastomosis to the proximal level of the distal aortic arch.

BACKGROUND: In acute type A dissection, replacing the ascending aorta with the transverse aortic arch recently has been recommended for event-free long-term survival. Since 1994, we have performed our new transverse aortic arch replacement, in which the distal end of the graft is anastomosed between the left common carotid artery and the left subclavian artery to reduce the risk by obtaining a good surgical view, resulting in good hemostasis. The "elephant trunk technique" was used in anticipation of a staged descending aortic operation for residual dissecting aorta. We analyzed the surgical survival of patients with Stanford type A aortic dissection undergoing our operative procedure using hypothermic selective antegrade cerebral perfusion. METHODS: We performed our new technique in 27 patients (aged 61 +/- 11 years, 15 male and 12 female patients, 22 patients with acute type A dissection, and 5 patients with chronic dissection). RESULTS: One in-hospital death (3.7% in total: 4.5% in acute dissection, 0% in chronic dissection) occurred in patients undergoing our new technique. Actuarial survival (including early death) was 91% at 5 years after the operation. One late death occurred as the result of a malignant tumor. Four patients underwent a staged reoperation for aneurysmal dilatation of the residual descending aorta or renal and splenic embolism as the result of thrombus from the false lumen 2 to 11 months (mean interval 6 months) after the initial operation. They have been doing well since the reoperation. CONCLUSIONS: Our "distal anastomosis to the proximal level of the distal aortic arch" technique made aortic arch replacement easier and improved the survival of the arch replacement for aortic dissection, especially for acute type A dissection, by securing hemostasis in the suture line. Combining the elephant trunk technique with our new procedure is useful to perform a staged aortic replacement for dilatation and complication of the false lumen in the descending aorta.

Acute Disease↗
PubMed2003

Surgical treatment of thoracoabdominal aortic mural and floating thrombi extending to infrarenal aorta.

The case of a 49-year-old man with thoracoabdominal aortic mural and floating thrombi extending to the infrarenal aorta and occlusion of the common iliac artery is described. He had no factors promoting thrombosis, with a history of thrombectomy of the femoral artery. The thoracoabdominal aortic thrombi were successfully removed with a Forgaty catheter through a thoracotomy under simple aortic clamping and subsequent femoro-femoral cardiopulmonary bypass. Intravascular ultrasound performed through the femoral artery after thrombectomy revealed that little mural thrombi remained and that the celiac, superior mesenteric, and bilateral renal arteries were all patent.

Aorta, Abdominal↗
PubMed2003

Graft-preserving treatment for vascular graft infected with Staphylococcus aureus with antibiotic-releasing porous apatite ceramic in the rabbit.

OBJECTIVE: This study was undertaken to investigate whether infection of a vascular graft with Staphylococcus aureus can be treated in situ by applying antibiotic-loaded porous apatite ceramic, in a rabbit model. METHODS: Teicoplanin (TEIC) was loaded onto a beta-tricalcium phosphate (TCP) block, a type of porous apatite ceramic. The activity of TEIC released from the antibiotic-loaded TCP block was examined in vivo. A vascular graft was patched onto the abdominal aorta in 24 rabbits, and S aureus was applied directly on it. Seven days postoperatively, each rabbit underwent repeat laparotomy, and retroperitoneal abscess around the prosthetic vascular patch was debrided. Animals were divided into four groups of 6 rabbits each. In group 1 only debridement was carried out. In groups 2 and 3, solution containing 40 or 60 mg of TEIC, respectively, was applied to the prosthetic vascular patch. In group 4, an antibiotic-loaded TCP block (63 +/- 6.6 mg of TEIC) was placed around the graft. Three weeks after the second operation, the graft, the tissue around it, and arterial blood were collected and cultured. RESULTS: TEIC activity was maintained for 28 days in vivo. In group 1, bacterial cultures of the prosthetic vascular graft and the tissue around it were positive in 5 animals and negative in 1 animal (infection rate, 83%). In both groups 2 and 3, cultures were positive in 3 animals and negative in 3 animals (infection rate, 50%). In group 4, cultures were negative in all animals (infection rate, 0%). Blood cultures were negative in all animals. Infection rate in group 4 was significantly lower than that in group 1 (P =.03), and was also lower than that in groups 2 and 3, but the difference was not significant. CONCLUSIONS: Use of slow-release antibiotic loaded onto a TCP block, along with debridement, may control infection in vascular grafts in situ, averting the necessity to remove the graft.

Administration, Topical↗
PubMed2003

Abdominal aortic aneurysm with arteritis in ankylosing spondylitis.

Abdominal aortic aneurysm with arteritis in ankylosing spondylitis is described. An abdominal aortic aneurysm, 48-mm in diameter, in a 68-year-old woman with HLA-B27-associated ankylosing spondylitis was successfully replaced with a tube graft. The suture lines of the aortic wall were reinforced with Teflon felt strips. Pathologic examination of the aneurysmal wall revealed hyalinization of the connective tissue, with numerous lymphocytic infiltrates, remarkable calcification, and no elastic fibers. The original structure of the arterial wall was not recognized. These findings are compatible with aortitis reported in ankylosing spondylitis.

Aged↗
PubMed2003

Specific CTL activity of CD8+ TCR Vbeta14+ T cell in mouse 2, 4, 6-trinitrobenzene sulfonic acid-induced colitis.

We analyzed the functional role of CD8+ T-cell receptor (TCR) Vbeta14+ T cells, which increased specifically in the lamina propria in 2,4,6-trinitrobenzene sulfonic acid (TNBS) -induced colitis. Cytotoxic activity and cytokine production in CD8+ TCR Vbeta14+ T-cell clones were analyzed by 51Cr release assay and enzyme-linked immunosorbent assay, respectively. Cell transfer studies using these clones were performed. Established T-cell clones showed specific cytotoxic activity against TNBS-conjugated self spleen cells, and this cytotoxicity was completely inhibited by anti-TCR Vbeta14 monoclonal antibody. These clones produced interferon (IFN) - gamma in their culture supernatant, but neither interleukin (IL) - 2 nor IL-4. Histological findings of the colon in mice, which received clone transfer after enema with suboptimal doses of TNBS, showed massive colitis. Our results indicate that CD8+ TCR Vbeta14+ T cells had a cytotoxic T-lymphocyte function induced by Th-1 T-cell response and played a pathogenic role in the development of TNBS-induced colitis.

Adoptive Transfer↗
PubMed2003

Experimental studies on morphological changes of microcirculation of DMN-induced liver cirrhosis after normothermic ischemia with charge-coupled device microscope.

AIM: The purpose of the present experiment was to find indices for intraoperative ischemic-reperfusion injury in the cirrhotic liver. METHODS: One percent dimethylnitrosamine (DMN) was administered intraperitoneally to liver cirrhosis (LC) groups of Wister rats on three consecutive days of each week for a period of four weeks. The rats were divided into a N60 group with 60 minute ischemia in normal livers, a LC60 group with 60 minute ischemia in cirrhotic livers, and a LC30 group with 30 minute ischemia in cirrhotic livers. Digital videotapes recorded with a pencil lens-probe charge-coupled device (CCD) microscope were analyzed with NIH Image software. In zone 3, the sinusoid diameter (SD) was measured and the volume fraction (Vv) of zone 3 was calculated in preischemia and after 10, 20, 30, and 60 min of reperfusion. At the same time, bile flow was measured. RESULTS: The SD was significantly shorter in the cirrhotic liver groups than in the normal liver group at each point. The Vv after 60 min of reperfusion was significantly smaller in the LC60 group, with a survival rate of 0%, than in the LC30 group which had a survival rate of 67%. However, there was no significant difference in bile flow after 60 min of reperfusion in the LC30 and LC60 groups. Therefore, the Vv is suggested to be the better index for viability after ischemic-reperfusion. CONCLUSION: SD and Vv indicate microcirculatory differences and indices in the normal and cirrhotic livers in preischemia during reperfusion.

Animals↗
PubMed2003

Protective effect of prostaglandin E1 against ischemia of spinal cord during aortic cross clamping.

PURPOSE: The purpose of this study was to investigate whether or not 5-minute segmental intraaortic perfusion of prostaglandin E1 (PGE1) in the preischemic period has a protective effect against spinal cord ischemia during aortic cross clamping. METHODS: The rabbits were divided into two groups. In group A (n = 6), the infrarenal aorta was segmentally cross clamped and the segment was perfused for 5 minutes with blood and saline solution at first. The aorta was kept cross clamped without perfusion for a subsequent 20 minutes. In group B (n = 6), the infrarenal aorta was segmentally cross clamped and the segment was perfused for 5 minutes with blood and saline solution containing PGE1 of 100 ng/kg/min at first. The aorta was kept cross clamped without perfusion for a subsequent 20 minutes. After the aorta was declamped, the experimental animals recovered from the anesthesia. Twenty-four and 48 hours after the operation, the hind limb function was estimated with Tarlov's grade. Then, the animals were killed for pathologic study. RESULTS: The systolic arterial pressures measured at the left common carotid artery through the experiment were not significantly different between the two groups. The perfusion of the aortic segment between the proximal and distal clamp was nonpulsatile. The perfusion pressures of the aortic segments at 5 minutes after aortic cross clamping were 29 +/- 6 mm Hg and 33 +/- 6 mm Hg in groups A and B, respectively. No significant differences were seen between the two groups. In group A, the hind limb functions evaluated with Tarlov's grade after 24 hours and 48 hours were 0 to 3 (1.5 +/- 1.4) and 0 to 3 (1.3 +/- 1.4), respectively. In group B, these were 3 to 4 (3.5 +/- 0.5) and 3 to 4 (3.7 +/- 0.5), respectively. A significant difference was seen between the two groups (P <.05). In the ventral horn of the L5, L6, and L7 segments, large motor neurons that seemed viable were more preserved in group B than in group A. CONCLUSION: Segmental intraaortic perfusion of PGE1 in the preischemic period reduced neurologic damage of spinal cord ischemia.

Alprostadil↗
PubMed2003

Local treatment of Dacron patch graft contaminated with Staphylococcus aureus with antibiotic-releasing porous apatite ceramic: an experimental study in the rabbit.

OBJECTIVE: The purpose of this study was to investigate whether or not infection of prosthetic vascular graft could be prevented with the placement of antibiotic-loaded porous apatite ceramic on the graft with bacterial contamination. METHODS: Teicoplanin as an antibiotic was loaded into a beta-tricalcium phosphate (TCP) block of porous apatite ceramic. The activity of teicoplanin released from teicoplanin-loaded TCP was examined for 40 days at 2-day intervals. In an in vivo study, the graft was patched in the abdominal aorta of a rabbit. Two different doses of Staphylococcus aureus were applied (n = 13). Teicoplanin-loaded TCP was placed around the graft infected with S aureus (n = 6). The graft, the tissue around it, and the arterial blood were collected and cultivated 4 weeks after operation. RESULTS: The activity of teicoplanin in the replaced saline solution was maintained for at least 40 days. Because graft infection was established in all rabbits with a dose of 2 x 10(7) colony forming units, this dose was used as the dose of S aureus in this study. Fifty-seven percent of the subjects died from the infection. When teicoplanin-loaded TCP was placed around the graft contaminated with S aureus, no rabbits died. Bacterial cultures of the graft and of tissues around it were negative in all rabbits killed 4 weeks after operation. This infection was prevented with teicoplanin-loaded TCP in all rabbits. CONCLUSION: Teicoplanin-loaded TCP may be useful in avoiding Dacron graft infection with S aureus in rabbits.

Animals↗
PubMed2003

Analysis of the T cell receptor V beta repertoire in 2,4,6-trinitrobenzenesulfonic acid induced colitis in mice.

The aim of this study was to analyze which types of T cells are at work and the specific nature of their response, using a mouse 2,4,6-trinitrobenzenesulfonic acid (TNBS) induced colitis model. The response of T cells to TNBS was analyzed by anti-TNBS mixed-lymphocyte reaction. T cell clones were established by limiting dilution. Phenotypes and T cell receptor (TCR) V beta of T cells were analyzed by flow cytometry. Colitis was induced by administration of TNBS enemas, and lamina propria lymphocytes were isolated and analyzed. The proliferative responses to TNBS of spleen T cells were partially inhibited by the addition of antimouse CD4 or CD8 antibodies to the mixed-lymphocyte culture. Conversely, these were inhibited by the addition of both antibodies. Flow cytometric analysis showed that TCR V beta 14 T cells specifically increased in the CD8+ T cell population. We established CD8+ TCR V beta 14 T cell clones which were TNBS reactive and self-restricted. Investigation using lamina propria lymphocytes in TNBS-induced colitis revealed that the rate of CD8+ TCR V beta 14 T cells changed with histological inflammatory activity which also attained a peak on day 5 following enema administration. Both CD4+ and CD8+ T cell subsets responded to TNBS, and the rate of CD8+ TCR V beta 14 T cells changed with histological inflammatory activity in TNBS-induced colitis.

Animals↗