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Biomedical subjects

Hisato Takagi

Publications and source records attributed to Hisato Takagi.

At least 19 recordsLinked to original sources
PubMed2006

High-pressure irrigation and gentian-violet application for mediastinitis following replacement of ascending aorta and aortic valve.

Mediastinitis following ascending aortic replacement is intractable and potentially fatal, and the feature is characterized as having both high mortality and morbidity when its causation pathology is methicillin-resistant Staphylococcus aureus (MRSA). Possible treatments for the condition, which include debridement, irrigation, and healthy tissue transposition, often result in failure. We report a case of MRSA mediastinitis after replacement of the ascending aorta and the aortic valve successfully treated by continuous saline lavage and drainage, debridement, high-pressure irrigation, and gentian-violet application, and delayed omental-flap transposition. The application of gentian violet and high-pressure irrigation may provide an additional option to the standard therapy for intractable mediastinitis after ascending aortic replacement.

Aged↗
PubMed2006

Abdominal aortic aneurysm in situs inversus totalis.

Situs inversus totalis refers to a mirror-image reversal of the normal position of the internal organs. The recognition of concomitant anomalies, such as in the cardiac, venous, gastrointestinal, and urinary systems, is extremely important because these anomalies may disturb the surgical procedure for the concurrent disease in situs inversus totalis. The authors describe a case of successfully repaired abdominal aortic aneurysm with a false aneurysm of the right external iliac artery in situs inversus totalis. The coexistence of abdominal aortic aneurysm has been seldom encountered. The presence of anatomical anomalies significantly increases operative risk. The surgical management of patients with abdominal aortic aneurysm in situs inversus totalis is discussed.

Aged↗
PubMed2006

Revisiting evidence on lung cancer and passive smoking: adjustment for publication bias by means of "trim and fill" algorithm.

Meta-analyses are subject to bias because smaller or non-significant studies are less likely to be published, and most meta-analyses do not consider the effect of publication bias on their results. To assess the true risk, we revisited a famous meta-analysis including 37 studies on lung cancer and passive smoking, and adjusted for publication bias by means of the "trim and fill" algorithm. The adjusted relative risk of lung cancer in non-smokers who lived with a smoker from the 44 studies including the 7 filled ones was 1.19 (95% confidence interval 1.08-1.31, p = 0.0004), and the estimate of excess risk fell from 24 to 19%.

Algorithms↗
PubMed2006

Giant renal aneurysm with arteriovenous fistula.

A hypertensive 78-year-old woman was admitted with continuous abdominal pain and nausea and was diagnosed with right giant renal artery aneurysm (RAA; 70 mm in diameter) by means of abdominal computed tomography. Aortography demonstrated huge RAA with arteriovenous fistula visualizing the inferior vena cava at arterial phase. Nephrectomy was performed and the patient has had an uneventful postoperative course.

Aged↗
PubMed2005

Simultaneous operation of ischemic heart disease, abdominal aortic aneurysm, and rectal cancer.

A 68-year-old man with ischemic heart disease, abdominal aortic aneurysm, and rectal cancer was referred. Coronary angiography indicated triple-vessel disease with jeopardized collaterals, and dipyridamole myocardial scintigraphy disclosed no viability in the inferior, posterior, and lateral walls. Abdominal computed tomography scanning revealed an infrarenal abdominal aortic aneurysm, 65 mm in diameter, with an expanding rate of 8 mm/year. Barium enema revealed stenosis 4 cm in length 5 cm inward from the anal verge, and an endoscopic finding was ulcerated type tumor with a clear margin and circumferential stenosis. Histological examination of a biopsy specimen revealed adenocarcinoma, and the clinical stage in the Japanese classification of colorectal carcinoma was II according to other examinations. Simultaneous operations were scheduled because of the jeopardized collaterals of the coronary arteries, rapid expansion of the aneurysm, and subileus due to the cancer. The patient underwent simultaneous off-pump coronary artery bypass grafting to the left anterior descending artery with the in situ internal thoracic artery through a median sternotomy, abdominal aortic aneurysm repair with a tube graft through a median laparotomy, and the Miles' operation with total mesorectal excision. Although infection of the perineal wound was postoperatively recognized, it remained local and was healed with irrigation only. The patient is doing well 12 months after the operation, without myocardial ischemic symptoms or recurrence of the cancer.

Adenocarcinoma↗
PubMed2005

Chronic contained rupture of the descending thoracic aorta due to infection by Escherichia coli.

A 71-year-old man presented with hemoptysis due to chronic contained rupture of the descending thoracic aorta after sepsis by Escherichia coli complicated with transrectal biopsy of the prostate, and underwent urgent graft replacement. The aorta had an almost normal caliber and ruptured into the left lung without abscess. The perforated site of the lung was filled with gelatin-resorcinol-formaldehyde glue, and the defect of the aortic wall was closed. Without graft infection, lung abscess, or sepsis, the patient was discharged followed by 1 month's intravenous administration of cefazolin and piperacillin sensitive to Escherichia coli after the surgery.

Aged↗
PubMed2005

Surgical outcome of elephant-trunk anastomosis between the left carotid and subclavian arteries in aortic arch repair including the postoperative physical status of the left arm.

We studied the outcome of our modified aortic arch replacement procedure in which the distal end of the graft is anastomosed between the left common carotid artery and the left subclavian artery including the postoperative physical status of the left arm in comparison with the conventional technique. We assessed the surgical outcome of 26 patients who underwent our new technique and 11 patients who underwent the conventional one. Postoperative clinical symptoms and physical status of the left arm were also evaluated. No operative deaths were observed in the new technique group and one operative death was observed in the conventional group (9.1%). No significant differences between the two groups in postoperative clinical symptoms and the physical status of the left arm were observed. Our "distal anastomosis to the proximal level of the left subclavian artery" technique made aortic arch replacement easier and steadier with a satisfactory surgical outcome in comparison with the conventional method. The postoperative clinical symptoms and physical status of the left arm in the new technique group were identical to those in the conventional group.

Aged↗
PubMed2005

Intrathrombotic pressure of a thrombosed abdominal aortic aneurysm.

In a case of thrombosed abdominal aortic aneurysm, intraluminal and intrathrombotic pressures were simultaneously measured 3 cm distal to the left renal vein level (#1), at the inferior mesenteric artery level (#2) (3 cm distal to #1), 3 cm distal to #2 (#3), and at the aortic bifurcation level (#4) (3 cm distal to #3). The intraluminal pressure (at #1) was 154/72 (101) mmHg, and the intrathrombotic pressures at #2, #3, and #4 were 138/77 (100), 137/74 (97), and 135/68 (96) mmHg, respectively. The percentages of the systolic and mean intrathrombotic pressures to the intraluminal pressure were 90% and 99% at #2, 89% and 96% at #3, and 88% and 95% at #4, respectively. The mural thrombus of an aneurysm does not significantly decrease the pressure on the aneurysmal wall, even in a thrombosed aneurysm.

Aged↗
PubMed2005

Limited dissection of abdominal aortic aneurysm in a patient with multiple myeloma.

Dissection limited to the abdominal aorta contributes 4% of all aortic dissections, and inflammatory injury of the aortic media is one of factors associated with dissection. In multiple myeloma, leukocytoclastic vasculitis of the skin has been known. We describe limited dissection of an abdominal aortic aneurysm with dense lymphocyte infiltration in a 62-year-old man with multiple myeloma. Although it is unclear whether the lymphocyte infiltration in the aortic wall, which was denser than that of atherosclerotic aneurysm, was associated with multiple myeloma, the excessive aortic wall inflammation may have somewhat influenced aneurysm formation or aortic dissection.

Aortic Dissection↗