Biomedical subjects

K Koja

Publications and source records attributed to K Koja.

At least 37 records · Page 2Linked to original sources

PubMed1999

Sutureless technique for subacute left ventricular free wall rupture: A case report of an 85-year-old.

This case was an 85-year-old female who developed left ventricular free wall rupture (LVFWR) of the anterior wall 13 days after an acute myocardial infarction. She was further complicated with an ascending aortic aneurysm and severe aortic regurgitation. The wall was repaired using a sutureless technique with an autologous pericardial patch and GRF glue without cardiopulmonary bypass. Although the complication of a left ventricular aneurysm was seen, the postoperative course was uneventful. Nevertheless, she is doing well 9 months after surgery.

Aged↗

PubMed1998

[Thoracoscopic surgery for diagnosis of interstitial pneumonia special reference to medicoeconomical effect].

We compared thoracoscopic surgery (TS) and open thoracotomy for the diagnosis of interstitial pneumonia. Intraoperative blood loss and duration of postoperative chest drainage were significantly less with TS than with thoracotomy. The length of postoperative hospital stay and social insurance costs with TS was significantly less than with thoracotomy. These results show that TS for the diagnosis of interstitial pneumonia is superior to open thoracotomy in terms of surgical stress and cost.

Adult↗

PubMed1998

[A case of traumatic aneurysm of the brachiocephalic artery].

Traumatic aneurysm of the brachiocephalic artery is rate. We presented a case of traumatic aneurysm of the brachiocephalic artery caused by traffic accident. A 28-year-old woman suffered a blunt chest trauma. A chest X-ray revealed a widening of the superior mediastinum and multiple rib fractures. CT scanning demonstrated left hemothorax with lung contusion and upper mediastinal hematoma. An aortography was performed which showed aneurysmal dilatation at the origin of the brachiocephalic artery. The patient underwent an operation 24 hours after chest injury. An aorto-right common carotid artery and right subclavian artery bypass with bifurcated Dacron graft was performed while monitoring temporary artery pressure. After resection of aneurysm, We found that about 3 cm longitudinal laceration of intima on the posterior wall of brachiocephalic artery. Her post operative condition was good and no neurological defect was noted.

Accidents, Traffic↗

PubMed1998

Successful treatment of bilateral deep femoral aneurysms and multiple iliac aneurysms associated with severe aortic valve disease: report of a case.

We report herein the case of a patient in whom aneurysms of the bilateral deep femoral arteries (DFA) and multiple iliac aneurysms associated with severe aortic valve disease were successfully treated by a two-staged operation. The patient was a 74-year-old man who had dense calcification of the ascending aorta and aortic arch. Prior to aortic valve replacement (AVR), the aneurysms of the DFA and internal iliac arteries were resected. The terminal end of the abdominal aorta and bilateral common iliac arteries were then reconstructed with a Y graft to be used as a possible alternative arterial input route in place of the ascending aorta for extracorporeal circulation during the AVR. The inferior mesenteric artery (IMA) was well developed, and the external iliac arteries and their branches were preserved at aneurysmectomy. Postoperatively, there was no ischemia of the pelvic organs or the hip muscles. The AVR was subsequently performed 5 weeks after the first operation, and the patient was discharged after an uneventful postoperative course.

Aged↗

PubMed1998

Improvement in esophageal varices and liver histology postoperatively in Budd-Chiari syndrome.

BACKGROUND: In the past 17 years, 32 patients with Budd-Chiari syndrome were treated by reconstruction of the occluded inferior vena cava and reopening of the hepatic veins under femoro-femoral normothermic extracorporeal partial bypass. The mean follow-up was 8 years (range, 1.5 to 17 years). METHODS: To evaluate the benefits of our operative procedure, we compared the preoperative, early postoperative, and late postoperative endoscopic appearance of the esophageal varices and the histologic findings of the liver tissue obtained intraoperatively and at a later date. RESULTS: The esophageal varices found preoperatively in 29 patients (90.6%) had disappeared in 7 patients by the time of discharge, and in 2 patients they disappeared 4 to 7 years after surgery. In the remaining 20 patients, the grade of the esophageal varices was reduced markedly. Histologic examination of the liver showed cirrhosis in 22 patients, fibrosis in 9 patients, and severe congestion in 1 patient. Inspection of the liver in the late postoperative period (in 10 patients) showed improvement in centrilobular congestion and no increase in interlobular fibrosis. CONCLUSIONS: Gradual and steady improvement of esophageal varices and hepatic fibrosis can be achieved after our operative procedure.

Adult↗

PubMed1998

A ruptured syphilitic descending thoracic aortic aneurysm. The characteristic findings on computed tomography for the etiological diagnosis of aneurysm.

We report the case of a 72-year-old man with a ruptured syphilitic descending thoracic aneurysm who underwent an emergency operation and successful graft replacement. Preoperative physical examination showed a pulsative mass on the left back. Preoperative computed tomography showed bone destruction in the TH6 to TH10 thoracic vertebrae and ribs and penetration (or rupture) of the aneurysm into the subcutaneous tissue. During the period of preoperative evaluations, free wall rupture of the aneurysm occurred and emergency operation for graft replacement was performed. The microscopical examination of the aneurysmal wall revealed the syphilitic changes. In literature, the vertebral destruction by atherosclerotic aneurysm is usually located at the TH12 to L3 of vertebral bodies. From the findings of this patient and a study of existing literature, we concluded that the finding of vertebral bone beyond TH12 to L3 region on CT examination of the aneurysm could be a etiological characteristic finding for syphilitic aortic aneurysm.

Aged↗

PubMed1997

[A case report of surgical treatment of constrictive pericarditis with coronary artery disease].

We performed the concomitant operation for constrictive pericarditis and coronary artery disease in an octogenarian. A 82-year-old male was hospitalized with dyspnea, edema of the lower extremities and pleural effusion on chest X-ray film. Cardiac catheterization revealed constrictive pericarditis and 75% stenosis of left anterior descending artery. Extensive pericardiectomy was performed including posterior wall of left ventricle and left atrium under the beating heart by using femoro-femoral partial bypass. Single CABG with a saphenous vein graft was performed following pericardiectomy. Postoperative cardiac catheterization showed good recovery of hemodynamics and patency of the bypass graft. Postoperative course was uneventful. The patient was discharged on twenty fifth postoperative day.

Aged↗

PubMed1996

Radical open endvenectomy with autologous pericardial patch graft for correction of Budd-Chiari syndrome.

A surgical technique for the treatment of Budd-Chiari syndrome associated with vena caval obstruction has been devised. The occluded hepatic vena cava and hepatic veins were reconstructed by open endvenectomy, using an autologous pericardial patch graft and a femorofemoral bypass technique. The hepatic artery and portal vein were not controlled with vascular clamps during the surgery. Between 1979 and 1994, 29 patients were treated using this technique and achieved good results. All the patients did well with good function of the reconstructed vena cava and of the hepatic veins, and showed acceptable reduction of symptoms caused by portal hypertension and caval stagnation.

Adult↗

PubMed1996

[Clinical experience with normothermic selective cerebral perfusion during graft replacement of ascending-arch-descending aortic aneurysms with annuloaortic ectasia].

We treated three cases of ascending-arch-descending aortic aneurysm with annuloaortic ectasia by performing graft replacement. The patients included a 34 year old female, a 34 year old male and a 42 year old male. In one case the aneurysm was atherosclerotic and of type I and II + IIIb dissection in the other two cases. During the operation we were able to utilize normothermic selective cerebral perfusion during construction of the left common carotid artery. Specially, normothermic partial F-F bypass and normothermic selective cerebral perfusion to the left common carotid artery were used during graft replacement from the descending aorta to the left common carotid artery. This was followed by regular hypothermic total ECC and hypothermic cerebral selective perfusion during subsequent graft replacement of the innominate artery and a modified Bentall's operation. This new protocol in which normothermic cerebral perfusion is utilized during the procedure on the left common carotid artery and hypothermic perfusion is utilized only during the subsequent procedure on the innominate artery permits significant shortening of the cardiac arrest time and cerebral perfusion time compared with when only hypothermic perfusion is used. This significant shortening contains obvious benefits in the areas of cardiac and brain protection.

Adult↗

PubMed1995

High proportion of false positive reactions among donors with anti-HCV antibodies in a low prevalence area.

Among 39,656 voluntary blood donors in Okinawa Prefecture, Japan, 115 (0.29%) were repeatedly reactive for antibody to hepatitis C virus (anti-HCV) by second generation (2nd-gen) passive hemagglutination assay (PHA). Positive serum samples were tested for anti-HCV using three different enzyme immunosorbent assays (ELISAs; Abbott 2nd EIA, UBI-HCV-EIA, JCC-2) and for HCV-RNA by the polymerase chain reaction (PCR). The 115 2nd-gen PHA-positive sera were divided into three groups according to the agglutination titers; > 2(10) (high titer group), 2(7)-2(9) (median), 2(5)-2(6) (low). All but one serum (44/45) in the high PHA titer group reacted in each of the three second screening ELISAs. Furthermore, 43 (97.7%) of the 44 sera contained HCV-RNA by PCR. In the median titer group, 11 of the 13 samples tested were positive by each of the three ELISAs, and 4 (36.4%) of the 11 showed reaction by PCR. On the other hand, all of the 38 sera tested in the low titer group were negative for HCV-RNA by PCR, and 24 of the 38 were also negative by each of the three ELISAs. Most of the low titer positive reactions in the 2nd-gen agglutination assay seemed to be false positive. In Okinawa Prefecture, the prevalence of anti-HCV among blood donors is much lower than in the rest of Japan (0.29% vs. 1.11%). Moreover, a significant proportion of these sera were low titer by the PHA assay.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Donors↗

PubMed1995

An in vitro evaluation of venous cannula in a simulated partial (femoro-femoral) cardiopulmonary bypass circuit.

We designed a study to evaluate three factors (siphon gradient [PH], the right atrial pressure [RAP], and the inferior vena caval flow [IVCF]) to be optimized to maximize the venous drainage flow (DF) during partial cardiopulmonary bypass using eight venous cannulas of three different types and an original model circuit. The relationship between venous DF and the three factors is indicated by the multiple regression equation DF2 = alpha PH + beta RAP + gamma IVCF2 + C, where alpha, beta, and gamma are regression estimates and C is a constant. Multiple regression analysis results showed that DF was positively correlated with PH and RAP and negatively correlated with IVCF. A long cannula with 12 side holes and 60 cm long was considered to be useful to yield the optimal venous drainage flow under the condition of maintenance of the flow balance (DF and ICVF) and the pressure balance (RAP and IVCP) at the zero point. Moreover, this model may allow extensive research in flow dynamics of venous cannula without involving human subjects.

Atrial Function↗

PubMed1995

[Staged operation of multiple aortic aneurysms with myocardial infarction and stenosis of three coronary arteries].

A 69-year-old man with multiple aortic aneurysms was admitted to the university hospital because of increasing the size of aneurysms. A coronary angiogram revealed three vessel disease (LAD at seg 7: 90%, D1: 75%, LCX at seg 13: 95%, RCA at seg 3: recanalization) and left ventriculography showed hypokinesis of the inferior wall. Staged extending operation was performed. Graft replacement of ascending and arch aortic aneurysms associated with coronary artery bypass grafting was done in the first operation. Two months after the 1st operation, thoracoabdominal and infrarenal aortic aneurysms were replaced by synthetic graft and the intercostal arteries (Th10, 11, 12) and the lumbar arteries (L1, 4) were reconstructed with synthetic bypass from the implanted graft. Postoperative course was uneventful and he has been well without any symptoms of paraplegia 26 months after the first operation.

Aged↗

PubMed1994

Morphological, immunohistological and fibrinolytic features of patch grafts for reconstruction of the inferior vena cava.

Morphological and immunohistological features and fibrinolytic activity of the neointima of various grafts implanted in the thoracic inferior vena cava (IVC) in dogs were examined. Autologous pericardium (group 1), treated porcine pericardium (group 2), treated bovine pericardium (group 3), treated horse pericardium (group 4) and expanded polytetrafluorethylene (e-PTFE) (group 5) were used as patch grafts. Grafts harvested 12-30 (mean 15.2) months after implantation were all patent in each group. The luminal surface of the grafts was completely covered with endothelial cells, which were positive for immunohistological staining of factor VIII and had active fibrinolytic activity. The gross appearance of the neointima of the grafts in group 1 was smooth; however, the grafts in groups 2-5 were severely deformed with retraction. The concavity of the retracted grafts in groups 2-5 was filled with thick neointima, which consisted of a superficial layer with mature smooth muscle cells and the deeper layer with fibroblast-like cells and extracellular collagen fibres. Fibroblast-like cells were thought to be a synthetic form of fibroblasts. The deeper layer of the neointima of the implanted biografts and e-PTFE graft was considered to be in the active phase in cell proliferation, even at > or = 12 months after implantation. It is concluded that autologous pericardium is the material of choice for patch grafts in reconstruction of the IVC and that biografts and synthetic grafts are less than satisfactory.

Animals↗

PubMed1994

[Use of the inferior epigastric artery in redo coronary artery bypass grafting--a case report].

A 71-year-old man who had undergone coronary artery bypass grafting (CABG) 9 years ago, was admitted for chest compression on exertion. A severe stenotic lesion (75%) of the main trunk of the left coronary artery and occlusion of the bypass graft previously implanted to the right coronary artery were showed by coronary angiography. Redo-CABG using the left inferior epigastric artery (LIEA) and left internal thoracic artery (LITA) was successfully done, since the saphenous vein and right gastroepiploic artery were not suitable for bypass graft. Post operative cource was uneventful and good patency of LIEA and LITA graft were revealed by postoperative angiography 34 days after surgery.

Abdominal Muscles↗

PubMed1994

[A case of re-operation after 14 years following radical correction of the anomalous origin of right pulmonary artery from ascending aorta].

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital malformation, which is usually fatal without early surgical correction. The number of reports of the radical operation has been recently increasing, but reports of its long-term postoperative results are rare, especially those of the reoperative cases. The 14-year-old patient, who had been operated radically with a 8 mm diameter graft at 7 months of age, weighing 4550 g at the time, was reoperated, because he developed pulmonary hypertension due to the narrowing of the graft. He had no clinical symptoms and no abnormal signs on chest X-P nor ECG, eventhough severe stenosis of the graft was present. The graft was replaced with a larger 12 mm diameter graft under ECC, and PFO closure and TAP were done at the same time. The patient's pulmonary artery pressure reduced substantially following surgery. We conclude that cautious postoperative follow-up including angiographical examination is important, and that early reoperation before occlusion of the graft should be done.

Adolescent↗

PubMed1994

[A two staged extending graft replacement for dissecting aortic aneurysm with Marfan's syndrome].

We experienced four cases of dissecting aortic aneurysms with Marfan's syndrome, in which two staged operations were performed with satisfactory results. The operations performed in the four patients were the replacement of the ascending aorta, transverse aortic arch and the entire descending thoracic aorta in DeBakey type I dissecting aortic aneurysm, replacement of the entire descending thoracic and abdominal aorta in type IIIb, replacement of the aortic valve, ascending aorta, transverse aortic arch, the entire descending thoracic and upper abdominal aorta in type I, and replacement of the total aorta including the aortic valve in type II + IIIb, respectively. There were no operative deaths, but a 42-year-old woman with DeBakey type IIIb died suddenly 2 years 11 months after the second operation. The cause of death was presumed to be due to rupture of a dissecting aneurysm (DeBakey type II). Dissecting aortic aneurysm with Marfan's syndrome must be observed carefully and corrected surgically, because the lesion is progressive and the residual dissecting aneurysm usually dilates eventually. In view of our clinical results, we conclude that the operation for dissecting aortic aneurysm with Marfan's syndrome should be performed as extensively as possible.

Adult↗

PubMed1994

[Discrete subaortic stenosis after aortic valve replacement--a case report].

A 51-year-old woman, who had undergone aortic valve replacement (SJM 19 mm) and open mitral commissurotomy for aortic valve stenosis with regurgitation, and mitral stenosis, was admitted for redo surgery. We found discrete subaortic ring just below the prosthetic valve. The fibrous ring was resected and the aortic valve was replaced (SJM 21 mm) after augmentation of the aortic annulus by Nicks procedure. Mitral and tricuspid valves were replaced. Discrete subaortic stenosis after aortic valve replacement are mostly in cases with small prosthetic valve. The turbulence caused by the small valve may produce discrete subaortic ring.

Aortic Stenosis, Subvalvular↗

PubMed1994

[A case of staged operation for a dissecting aneurysm (DeBakey type IIIb+II) with Marfan's syndrome].

A 34-year-old woman with Marfan's syndrome had severe heart failure due to annulo-aortic ectasia and aortic insufficiency, which was accompanied also by a dissecting aneurysm (DeBakey type IIIb) that was demonstrated by aortography. 4 days before the operation, sudden progression of the aneurysm to a DeBakey type II, and finally DeBakey type I dissecting aneurysm was seen. The first operation was an extended aortic resection with replacement from the aortic valve to the descending thoracic aorta (level of the 7th thoracic vertebra) using selective cerebral perfusion. The second operation was a replacement of the residual dissecting aorta from the level of the 8th thoracic vertebra to the celiac artery with partial extracorporeal circulation. The postoperative course of the patient was uneventful. Dissecting aneurysm with Marfan's syndrome should be operated as extensively as possible if necessary.

Adult↗