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K Goh

Publications and source records attributed to K Goh.

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

[Ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade: report a case].

The ruptured thoracic aortic aneurysm has had severely high mortality. A 71-year-old male who suddenly fainted away was admitted to our hospital. He was in shock on arrival. Computed tomography and echo cardiogram demonstrated ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade. Aortic arch replacement was performed using the selective cerebral perfusion under deep hypothermia. The recovery of his consciousness was delayed, and he had right hemiplegia postoperatively, but his state was improved gradually. Finally he complained only slight degree of aphasia, paralysis. An immediate and aggressive emergency operation is a only method to salvage the patient who has ruptured aneurysm of the thoracic aorta.

Aged↗
PubMed1997

Role of infrainguinal bypass in Buerger's disease: an eighteen-year experience.

OBJECTIVES: The role of bypass to the distal arteries for patients with Buerger's disease (thromboangiitis or TAO) remains controversial because of the high incidence of graft failure. We retrospectively reviewed the results of 71 bypasses to evaluate their efficacy. MATERIALS AND METHODS: We performed 71 autogenous vein bypasses in 61 patients with TAO. Of the patients, 97% were heavy smokers. The indications for surgery were claudication in 41%, and ischaemic ulcer or gangrene in 59%. Of the bypasses 85% were to the crural arteries or to the arteries below the ankle. The grafts used were 53 single saphenous veins, and 18 venovenous composite grafts. RESULTS: There were 38 graft failures, the main causes including anastomosis to a diseased artery, disease progression (which occurred in smokers after surgery), and vein graft stenosis. Of 38, 10 were restored to patency by revision surgery. Primary and secondary patency rates were 48.8% and 62.5% at 5 years, and 43.0% and 56.3% at 10 years, respectively. The patency rates of the postoperative non-smoking group was significantly higher than that of the smoking group (66.8% vs. 34.7%, p < 0.05). Thirty-six patients (59%) had successful revascularisation and returned to full-time work. However, of 28 with secondary failure, 11 underwent amputation, while 14 had persistent disabling claudication. CONCLUSION: Bypass to the distal arteries is an effective treatment for TAO patients, and the long-term patency is quite satisfactory as long as patients stop smoking.

Adult↗
PubMed1997

Myristoyl gelatin as a sealant for Dacron vascular prostheses.

Myristoyl gelatin (MG) retains its gel structure at temperatures above body temperature without any crosslinking. As a coating material, MG adheres well to polyester fibers, and the outermost layers of the sealant that are in contact with blood or surrounding tissue become hydrophilic. We produced MG-impregnated knitted Dacron vascular prostheses (MG graft [MGG]) and investigated the usefulness of MG as a sealant by replacing the thoracic aorta of dogs. MGGs (5 cm long with an inner diameter of 10 mm) were implanted in 5 mongrel dogs (10-20 kg), and the grafts were retrieved at intervals of 4 h and 2, 4, 8, and 15 weeks after grafting. There was no thrombus formation on the flow surface of the MGGs, indicating adequate antithrombogenic properties. No resorption of MG occurred until after 2 weeks, and neither immune reaction nor excessive foreign body reaction was noted. Fragmentation of the sealant induced by cell infiltration began to occur at 4 weeks, yet the sealing effect persisted. The organization of MGG was almost complete at 8 weeks. Because of its pliability and effective adhesion to polyester fibers, its antithrombogenicity, and the persistent sealing effect due to delayed biodegradation and resorption, we conclude that MG is an extremely useful sealant for polyester vascular prostheses.

Animals↗
PubMed1997

[A case of ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade].

The ruptured thoracic aortic aneurysm is still a dramatic even with very poor outcome, whereby its survival depends largely on early diagnosis and operation. We report a successful case of aortic arch replacement for ruptured aortic arch aneurysm with cardiac tamponade. Lethal hemopericardium causing cardiac tamponade is most commonly seen as a complication of acute myocardial infarction or acute aortic dissection, and subsequent rupture of the heart or ascending aorta leads to the rapid accumulation of blood within the poorly distensible pericardial sac. Our case was operated upon emergency basis due to hemopericardium. On operative findings, the aortic aneurysm located the minor curvature of aortic arch and was a huge saccular shape. In surgical procedure, the total arch replacement was completed using selective cerebral antegrade perfusion with deep hypothermia. Postoperative course was uneventful and no cerebral complication was observed after surgery.

Aortic Aneurysm, Thoracic↗
PubMed1997

Coronary artery bypass grafting of Takayasu's disease with calcified aorta and subclavian artery obstruction.

The lesions of Takayasu's disease, which may involve the aorta and major arterial branches, may pose technical difficulties during coronary artery bypass grafting (CABG). Because the aorta is often thick and calcified, the coronary arterial lesion is often located near the coronary orifice, and the internal thoracic arteries may not be suitable for grafting due to the lesions in the subclavian arteries. A 63-year-old man with a known history of Takayasu's disease was referred to our department with chest pain complaint. Coronary angiography revealed obstruction of the left main coronary artery. CT scan showed that he had a thickened and calcified aorta. Aortography showed that both subclavian arteries had obstructive disease. Instead of using ordinary arterial grafts or vein grafts, a piece of prosthetic patch carrying saphenous vein grafts was sewn to the ascending aorta to construct the proximal anastomosis of CABG. Distal anastomosis was made on the left anterior descending artery and the obtuse marginal branch in the usual fashion. The patient showed uneventful recovery, and a postoperative coronary angiogram showed patent grafts and uncomplicated ventricular performance. This technique is useful when the aorta is not suitable for vein graft anastomosis and arterial grafts are not available as in this case with aortitis reported in the paper.

Aorta↗
PubMed1996

Early results of a reinforced biosynthetic ovine collagen vascular prosthesis for small arterial reconstruction.

The efficacy of a reinforced biosynthetic ovine collagen (RBOC) vascular prosthesis developed for small arterial reconstruction was assessed by examining 30 grafts in 29 patients with arteriosclerosis obliterans. The operative procedures performed were femorofemoral bypass in 2 patients, above-knee femoropopliteal bypass in 28 patients, and below-knee femoropopliteal bypass in 1 patient. Femoropopliteal bypass was simultaneously performed in two patients undergoing femorofemoral bypass using one or two grafts. The indications for surgery were intermittent claudication in 27 patients and to salvage the limb in 2 patients. The longest follow-up period was 49 months, and there were six graft failures, occurring 1, 1, 9, 17, 17, and 23 months after implantation, respectively; caused by compression of the graft from outside in two, infection in one, anastomotic intimal hyperplasia in one, and unknown factors in two. Thus, the primary cumulative patency rate for above-knee femoropopliteal bypass at 3 years was 83.7%, and the secondary patency rate was 91.2%. No aneurysmal change was observed. Moreover, the RBOC was able to be used without preclotting, and its handling and suturing characteristics were satisfactory. Our findings suggest that this vascular prosthesis may be an acceptable alternative for above-knee femoropopliteal bypass.

Aged↗
PubMed1996

Histopathology of post-embolized meningiomas.

Although embolization of meningiomas has been performed for many years as a preoperative adjunct to reduce tumor vascularity and facilitate surgical excision, little has been written about the features of the histological artefacts introduced by the process. In particular, the fact that it may produce tumor necrosis may potentially cause confusion with atypical or malignant meningiomas. In this study, 25 meningeal tumors of different histological subtypes, all of which had been previously embolized, were reviewed histologically as well as with immunostaining for the MIBI antigen and proliferating cell nuclear antigen (PCNA). Necrosis, in the form of confluent necrosis as well as micronecrosis, was the most common feature (48%). Other characteristic features included florid ischemic changes (16%), intravascular Ivalon particles (24%), and fibrinoid necrosis of vascular walls (12%). Histological changes showed no obvious relationship with the interval between embolization and surgery. There was an increase in MIB1 and PCNA labelling indices in those tumor exhibiting necrotic foci, but it did not seem to have any prognostic significance. We believe pathologists should be familiar with the histological changes induced by embolization in meningiomas so that an erroneous diagnosis of a high-grade lesion will not be made.

Adult↗
PubMed1996

[Repair of diaphragmatic hernia through the thoracoabdominal spiral incision].

Traumatic diaphragmatic hernia requires urgent surgical treatment. A 51-year-old female was injured in a speeding car. She had dyspnea, and resistance on the abdominal wall on physical examination. Intra-thoracic and abdominal visceral injury was suspected. A chest roentogenogram and CT scan revealed an obvious diaphragmatic herniation on the left which necessitated emergency operation. On the right semi-lateral position, left thoracoabdominal spiral incision was made through the 7th intercostal space. Good exposure of the chest and abdomen was easily obtained. Herniated organs and the abdominal cavity were thoroughly examined with ease. The diaphragm was repaired directly. She had an uneventful postoperative recovery, and was discharged in 17 days. Thoracoabdominal spiral incision offered an excellent operative exposure for the patient with a possible combined thoracic and abdominal visceral injury.

Female↗
PubMed1995

[Emergency CABG and mitral valve replacement for anterolateral papillary muscle rupture after acute myocardial infarction].

A 74-year-old man developed sudden cardiogenic shock 5 days after the onset of acute myocardial infarction. Echocardiographic diagnosis was severe mitral regurgitation due to papillary muscle rupture. Despite the effort to support the hemodynamics with catecholamines and IABP, the patient's condition deteriorated rapidly, which necessitated emergency operation. Anterolateral papillary muscle was found to be totally ruptured. Coronary artery revascularization and mitral valve replacement were performed. Postoperative course was uneventful, with two days of IABP and three days of ventilatory support. The patient could start rehabilitation program on the 7th postoperative day. He was discharged in 2 months in NYHA class I. Reports of successful emergency operation for total papillary muscle rupture following acute myocardial infarction are rare. Involvement of anterolateral papillary muscle is rarer. Early diagnosis and surgical treatment are mandatory to save this group of patients.

Aged↗
PubMed1994

Plantar or dorsalis pedis artery bypass in Buerger's disease.

The peripheral type of Buerger's disease is unresponsive to conservative therapy when accompanied by multisegmental occlusion at the level of the ankle. Between November 1983 and April 1993, we performed 15 bypasses below the ankle for this type of thromboangiitis obliterans in 13 patients (mean age 45.7 years), including four females. Ten patients had intractable toe ulcers with severe pain, and five had foot-threatening ischemia or disabling foot claudication. Eleven patients were heavy smokers, two were passive smokers, and six had a history of sympathectomy. All patients had occlusion of the three main crural arteries or both of the tibial arteries at the ankle. Of the 15 bypasses, 10 were to the medial or lateral plantar arteries, two were to the common plantar artery, and three were to the dorsalis pedis artery. There were three early and three late graft failures. The causes of early graft failure were thrombosis at the site of cross-clamping, anastomosis to a diseased segment, and arterial spasm. The three late failures (> 3 months) were due to disease progression in patients who continued to smoke, whereas all grafts remained patent and functioned well in patients who stopped smoking. Because patients with thromboangiitis obliterans are relatively young and active, early healing of ulcers and restoration of normal limb function are important objectives in their treatment. Bypass to the foot arteries can provide an excellent outcome, although special techniques and postoperative cessation of smoking are essential for success.

Adult↗
PubMed1994

[Congenital coronary arterial fistula drained to the coronary sinus--a case report].

We report a very rare case of an infant with coronary arterial fistula in whom the communication between a dilated right coronary artery and the coronary sinus was found. The patient was 1-year-old. She had pulmonary congestion and cardiomegaly due to the left-to-right shunt through the fistula, and underwent ligations of the fistula. Ligations of the fistula was indicated because the patient was too small to undergo a fistula resection and coronary arterial bypass grafting. Although the patient had a successful post-operative course, we are paying attention to the aneurysmal change of the dilated right coronary artery proximal to the site of ligations.

Arteriovenous Fistula↗
PubMed1994

[Recent advances and problems in peripheral arterial reconstruction].

Recent advances in the field of peripheral arterial reconstruction have been remarkable. These advances are mainly derived from the development of diagnostic technology such as Doppler ultrasound analysis, further refinement of surgical technique including surgical instruments and materials, and naturally improvement of patient care in the pre-, peri- and postoperative period. During the past 14 years we have performed peripheral arterial reconstruction in 1,200 cases (1,660 limbs) mainly with occlusive lesion due to arteriosclerosis obliterans. In our hand, aorto-iliac occlusive lesion has been routinely bypassed with Dacron prostheses and the secondary patency rate at eleven years reached 96.5%. The main problems encountered in this region were anastomotic aneurysm in the femoral artery (3.9%) and graft infection (1.2%). In the infrainguinal region there are still problems to be solved, although the primary (secondary) 5 year patency rates of reversed vein graft as well as in situ vein graft including femoro-popliteal below knee and femoro-crural bypasses have exceeded 70% (85%). First, there is no graft material comparable to the autogenous vein (AVG). Secondly, many of the AVG should suffer occlusive pathological changes from the environment in the long term following surgery. At the present time, we have no effective method to solve these problems, therefore we should follow up the patients heedfully to maintain the graft patency as well as to improve their quality of life and prognosis.

Anastomosis, Surgical↗
PubMed1994

[A case report of innominate and carotid artery aneurysms causing cerebral embolism].

Brachiocephalic aneurysms are relatively rare in Japan. A case with tandem aneurysms of innominate and right carotid artery was experienced and its successful surgical treatment was reported. A 54-year-old female patient had an attack of cerebral infarction with left hemiparesis. Computed tomography and angiogram revealed aneurysms of innominate and right carotid artery causing cerebral embolisms. Aneurysmectomy and replacement with Dacron prosthesis was performed. A temporary shunt was utilized between ascending aorta and common carotid artery during clamping carotid artery. She had no problems after operation, and her postoperative course was uneventful.

Anastomosis, Surgical↗
PubMed1994

[Myocardial protection and the sarcoplasmic reticulum--the effect of ryanodine treatment prior to cardioplegic arrest on post-ischemic functional recovery].

Sarcoplasmic reticular (SR) calcium depletion may contribute to the myocardial protection against ischemia and reperfusion-induced injury. We have, therefore, investigated the effect of ryanodine-induced SR calcium depletion on the myocardial protection when given during Langendorff perfusion before ischemia in the isolated working rat heart. Hearts (n = 6/group) from male Wistar rats were aerobically (37 degrees C) perfused (20 min) with bicarbonate buffer (the first working perfusion), and then aerobically (37 degrees C) perfused with bicarbonate buffer containing 0, 1.75 or 7.00 nmol/L of ryanodine (a Langendorff perfusion). Hearts were then aerobically (37 degrees C) perfused (20 min) with ryanodine-free bicarbonate buffer (the second working perfusion). This was followed by a 3 min infusion of St. Thomas' Hospital cardioplegic solution, and then subjected to 38 min of normothermic (37 degrees C) global ischemia and 35 min of reperfusion (15 min Langendorff, 20 min working). After the ryanodine treatment, the percent reduction in aortic flow was significantly greater in the 7.00 nmol/L ryanodine group than in the control group. The post-ischemic recoveries of aortic flow were 39.1 +/- 3.3, 32.8 +/- 5.3 and 37.3 +/- 4.4% in the 0, 1.75 and 7.00 nmol/L ryanodine groups, respectively. There was no difference in the creatine kinase leakage during Langendorff reperfusion between the ryanodine-treated groups and the control group. Thus, ryanodine decreased the cardiac function after the ryanodine treatment, indicating a reduction in SR calcium content. Ryanodine, however, failed to improve the post-ischemic functional recoveries.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

["Extended aortic arch anastomosis" in Shone's anomaly--a case report].

We report a case of a newborn with Shone's anomaly in whom the parachute mitral valve, mild subaortic stenosis, hypoplastic aortic arch, and severe coarctation of the aorta were found. The patient was 10 days old, who had symptoms of low output syndrome due to the progressive obstruction of patent ductus arteriosus, underwent "extended aortic arch anastomosis" to repair the hypoplastic aortic arch and severe coarctation of the aorta. This surgical procedure, resulting in a successful post-operative course of the patient, might be effective in such anomalies.

Anastomosis, Surgical↗