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Biomedical subjects

K Kusajima

Publications and source records attributed to K Kusajima.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Endoventricular circular patch plasty (dor operation) for postinfarction left ventricular aneurysm and ischemic cardiomyopathy].

The determination of purse-string suture line is one of the most important point in endoventricular circular patch plasty (Dor operation) for postinfarction left ventricular aneurysm (LVAN), especially for ischemic cardiomyopathy (ICM). We suggest following three points to decide appropriate suture line. First, the purse-string suture on the basal side should be placed on the 1-2 cm level under diagonal branch. Secondly, lateral wall should not be over excluded to maintain left ventricular function. And the third, akinetic or dyskinetic lesion of apex and septal wall should be excluded as much as possible. Nine cases of five LVAN and four ICM were underwent Dor operation in our institute from Dec. 1999 to Jan. 2000. All patients were weaned from cardiopulmonary bypass easily except one patient, who was operated under IABP support, because of his preoperative severe heart failure. All patients recovered well without any serious complications and postoperative left ventricular graphies were satisfactory. Left ventricular ejection fraction and stroke volume index were increased from 34 +/- 17 to 55 +/- 16% and from 38 +/- 7 to 47 +/- 6 ml/m2, end-diastric and systric volume index decreased from 141 +/- 37 to 88 +/- 19 ml/m2 and from 96 +/- 41 to 41 +/- 23 ml/m2 respectively. The Dor procedure adopted our idea led to satisfactory result in hemodynamic and also in morphologic study.

Aged↗
PubMed2001

Bronchial stump reinforcement in right pneumonectomy with fascia lata and gelatin resorcin formalin (GRF) glue: case report.

We reinforced the bronchial stump with fascia lata and Gelatin Resorcin Formalin (GRF) glue in a right pneumonectomy. This method was found to be simple and useful. We describe our case and the method herein. A 62-year-old woman had a malignant polypoid lesion which completely occluded the introitus of the right main bronchus and deviated to the introitus of the left main bronchus. Right pneumonectomy was done but materials (pleura, pericardium, intercostal muscle, etc.) obtained from the thoracic cavity were insufficient for bronchial stump reinforcement due to severe adhesion caused by prior tuberculosis. Therefore, we reinforced the bronchial stump using the fascia lata and GRF glue. Fascia lata is a superior material for reinforcement in terms of strength and ease of molding, as well as harvesting. GRF glue is a superior adhesive with rapid and strong fixation. We consider this method of reinforcing the bronchial stump with fascia lata and GRF glue to be feasible, in particular, for pneumonectomy or lobectomy without adequate material in the thoracic cavity because of severe adhesion or lesions.

Drug Combinations↗
PubMed2001

[Detection of visceral ischemia with doplex scanning method of mesenteric arteries: in patients with acute type B aortic dissection].

Between March, 1997 and January, 1999, 11 patients with acute type B aortic dissection underwent doplex scanning evaluation of mesenteric arteries for the early detection of visceral ischemia. Peak systolic velocity (PSV) of the celiac artery (CeA) and superior mesenteric artery (SMA) was measured on their admission. Mean PSV of CeA in the non-ischemic group (8 patients) and in the ischemic group (3 patients) was 1.66 +/- 0.34 m/sec and 3.60 +/- 0.49 m/sec (p = 0.0481), respectively. Mean PSV of the SMA in the non-ischemic group and in the ischemic group was 1.93 +/- 0.52 m/sec and 3.33 +/- 0.37 m/sec (p = 0.00768), respectively. All patients with PSV of the mesenteric arteries above 3.00 m/sec presented visceral ischemia that required emergency operation. If PSV of the mesenteric arteries exceeds 3.00 m/sec, urgent surgical repair should be considered.

Aged↗
PubMed2001

[A case of mucosa associated lymphoid tissue (MALT) lymphoma].

We examined a 49-year-old man, who was referred to our hospital for resection of abnormal findings on the X-ray. Before hospital admission, he was performed TBLB and aspiration biopsy in other hospital, but the results was not decided diagnosis. Because the possibility of the lung cancer was not completely nagated, we performed the tumor resection (partial pulmonary resection) in use of thoracoscopy. The tumor was diagnosed as a MALT (mucosa associated lymphoid tissue) lymphoma at histologically and immunohistologically (CD 79), and resectable lymph node did not detected malignant cell. He has had no evidence of recurrence for 5 months after the operation.

Humans↗
PubMed2001

[Relationship between Noguchi's classification for small adenocarcinomas of the lung and tumor markers in serum].

We evaluated the relationship between Noguchi's classification for small adenocarcinomas of the lung and tumor markers in serum (CEA, Cyfra, SLX, CA 19-9, CA 125). Fifty surgically resected small peripheral adenocarcinomas measuring 2 cm or less in greatest diameter were examined. The tumors were divided into three groups on the basis of Noguchi's classification: group AB of tumors belonging to Noguchi's classification A or B, group C of tumors belonging to Noguchi's classification C, and group DEF of tumors belonging to Noguchi's classification D, E, or F. The level of serum CEA was higher in group DEF (5.9 +/- 7.6 ng/ml) than in group AB (2.3 +/- 2.4 ng/ml) and group C (2.0 +/- 1.3 ng/ml). There were no differences in the levels of the other serum tumor markers among the three groups. The incidences of anormality in serum CEA and Cyfra were higher in group DEF (6/18 and 6/18, respectively) than in group AB (1/7 and 0/7) and group C (1/25 and 1/25). Although a high level of serum CEA or Cyfra is a strong indication that the tumor is Noguchi's classification D, E, or F of pulmonary adenocarcinoma, it is difficult to classify small adenocarcinomas by Noguchi's classification using a serum tumor marker level.

Adenocarcinoma↗
PubMed2001

[A case of carcinosarcoma of the lung].

A 63-year-old man was admitted to our hospital because of cough and slight fever up. A tumor shadow in right S6 and obstructive pneumonia was detected by X-ray and CT. Bronchoscopic study showed that right B6 bronchous was occluded by the tumor and in which malignant cell (squamous cell carcinoma suspect) were detected. Therefore right middle and lower lobectomy was performed. Histological examination of the resected specimen showed that the tumor was composed of poorly differentiated squamous cell carcinoma and abnormal spindle cell component. Both components of the tumor were mixed each other in part. Immunohistologically, malignant cell of sarcomatous elements were positively stained by vimentin and actine, but was not found such as osteosarcoma or rabdomyosarcoma. He was diagnosed as so-called carcinosarcoma of the lung.

Carcinosarcoma↗
PubMed2000

[A therapeutic metastasectomy of pulmonary metastases by VATS].

The use of VATS to perform diagnostic metastasectomy is uniformly accepted, but the role of therapeutic VATS metastasectomy remains controversial. We retrospectively compared the value of therapeutic metastasectomy by VATS with that by open thoracotomy in the management of pulmonary metastatic tumors. The forty-six patients who underwent a complete metastasectomy of pulmonary metastatic tumors were divided into groups: one group in which metastasectomy was performed by VATS (VATS group; 23 cases, 25 operations) and another group in which metastasectomy was performed by open thoracotomy (Thoracotomy group 23 cases, 26 operations). Here, complete metastasectomy means compete resection of all tumors, which were detected by preoperative high resolution computed tomography in both groups and also by intraoperative manipulation in the thoracotomy group, without positive lesions of the surgical margin. The groups were matched with respect to preoperative clinical characteristics (age, sex, primary lesion, disease-free interval) and histological findings (maximum tumor size, number of metastatic tumors, minimum distance between surgical margin and tumor edge). The cumulative survival one-year and three-year rates were 83.5 and 83.5% in the VATS group, and 89.5 and 77.5% in the thoracotomy group, respectively. The cumulative one-year and three-year non-recurrence rates were 72.3 and 68.0% in the VATS group and 83.9 and 63.8% in the thoracotomy group, respectively. There were no significant differences between the two groups. We conclude that pulmonary metastasectomy by VATS can be used safely not only as a diagnostic but also therapeutic tool if complete resection is done following diagnosis by preoperative high resolution computed tomography.

Aged↗
PubMed2000

[Aortic valve replacement with a stentless porcine aortic root bioprosthesis].

From April, 1999 to November, 1999, 8 patients underwent the aortic valve replacement using Medtronic Freestyle aortic root bioprosthesis. Mean age was 67.8 years old. Aortic valve etiology was as follows, AS: 1 case, AR: 2 cases, ASR: 3 cases, IE: 1 case, mechanical valve malfunction due to subvalvular pannus: 1 case. The implanted valve size was 25: 2 cases, 23: 3 cases, 21: 1 cases, 19: 2 cases. Surgical technique was subcoronary: 7 cases, full-root: 1 case. Post-op 2D-echo revealed tribial aortic valve incompetence in two cases because of size discrepancy between the aortic annulus and the ascending aorta. Pacemaker implantation was needed in 1 case because of the complete A-V block. In comparison with 5 cases of aortic valve replacement with Hancock II performed in same period, there were no significant differences about the implanted valve size and mean systolic pressure gradient, but the effective orifice area in Freestyle cases was significantly larger than Hancock II cases.

Aged↗
PubMed2000

[A case of chronic localized thoracoabdominal aortic dissecting aneurysm].

A rare case of chronic localized thoracoabdominal aortic dissecting aneurysm was surgically treated. The patient was a 76-year-old woman. She was reffered to our hospital because of the abnormality of the chest roentogenogram. Chest CT and aortography revealed localized thoracoabdominal dissecting aneurysm 70 mm in diameter. Patch closure of intimal tear was carried out under partial cardiopulmonary femoro-femoral bypass. The patient discharged on the 23rd post operative day without any complications.

Aortic Dissection↗
PubMed2000

[Concomitant surgical treatment of valvular heart disease and coronary artery disease].

Concomitant valvular surgery and coronary artery bypass grafting were performed in 24 patients. Aortic valve replacement was carried out in 18 cases (A group), and mitral valve surgery (M group) was done in 6 cases (replacement in 3, and plasty in 3). There were two hospital deaths (11.1%) in the A group, and two (33.3%) in the M group of mitral valve replacement with Hancock II. One late death was observed in the M group. Aortic valve replacement with coronary revascularization resulted in satisfactory outcome. However, surgical management of concomitant mitral valve and coronary artery disease may need to be improved.

Aged↗
PubMed2000

[The validity and problems of a new staging system for lung cancer from the point of view of surgical results].

The validity and problems of the new staging system for resected lung cancer were assessed. In the new staging system for primary lung cancer, stage I is divided into two groups (A and B) on the basis of the tumor diameter. The boundary is 30 mm in maximum diameter of the tumor. On the other hand, intrapulmonary satellite nodules in the resected lung (PM1) are considered as T4. This means that a patient with PM1 is classified as stage IIIB or IV. The five-year cumulative survival rates of 191 consecutive patients of T1 or T2N0M0 who had undergone complete lung resection were calculated. The patients were divided two groups on the basis of the boundaries of the tumor diameter, such as 15, 20, 25, 30 and 40 mm (The tumor diameter in group A is the boundary and less than boundary and the diameter in group B is more than the boundary), and the cumulative survival rates of the two groups were compared. The 5-year cumulative survival rate (Kaplan-Meier survival rate) of each group and the p-value (logrank test) were 85.0%, and 0.463 in the case of the boundary of 15 mm; 84.8%, 79.9%, and 0.374 in the case of 20 mm, 82.3%, 80.0%, and 0.553 in the case of 25 mm, 79.5, 83.5, 0.524 in the case of 30 mm and 81.0%, 82.2%, and 0.783 in the case of 40 mm. In all cases, there were no significant differences between the rates in the two groups. On the other hand, 15 cases of T4N0M0 lung cancer included 12 cases of pm1, 2 cases of p3 and 1 case of d2. The five-year cumulative survival rate for T4N0M0 patients with pm1 was 71.1%, which was similar to the rate for stage I or II patients, while the two T4N0M0 patients with p3 died of recurrences of lung cancer at 10 and 13 months after the operation, and the T4N0M0 patient with d2 died of local recurrence of lung cancer 60 months postoperatively. We concluded that the sub-classification of stage I on the basis of the boundary of tumor diameter was meaningless, if the boundary was between 15 and 40 mm and that N0M0 patients with PM1 should be classified as stage II or less, or as 1 grade up of T status.

Adolescent↗
PubMed2000

[Minimally invasive direct coronary artery bypass grafting using subxiphoid approach].

We report twelve cases of minimally invasive coronary artery bypass grafting via small laparotomy using right gastroepiploic artery (RGEA) to the right coronary artery. Seven patients were operated on without partial sternotomy (N group), and lower partial sternotomy with Octopus 2 stabilization system was used in five of the cases (P group). Postoperative Doppler echographic imaging or angiographic study showed all RGEA grafts were functioning well in P group. However, graft occlusion was observed in two of the cases in N group. Inferior partial sternotomy combined with Octopus 2 stabilization system produce a clear surgical view, which avoids of both full-sternotomy and cardiopulmonary bypass. This method might be useful especially for reoperation.

Aged↗
PubMed1999

Ruptured distal aortic arch aneurysm associated with arteriosclerosis obliterans.

A 73-year-old man with a ruptured distal aortic arch aneurysm into the pericardial space, mediastinum and right pleural space is described. The patient underwent a successful total aortic arch replacement using deep hypothermia, systemic circulatory arrest and selective cerebral perfusion. Extracorporeal circulation was established with right axillar arterial perfusion due to arteriosclerosis obliterans (ASO). Presentation and management are discussed.

Aged↗
PubMed1999

[Axillary artery perfusion for the extensive arterial vascular disease].

Usefulness of axillar artery perfusion for the cases with severe systematic atherosclerosis was reported. It is generally accepted that the femoral artery is a common arterial cannulation site when performing the surgery of ascending aorta and total aortic arch. However, atheroembolism is one of the most severe complication for the patients with extensive arterial vascular disease by using femoral arterial perfusion. Axillar artery perfusion can prevent these complications, and the perfusion through the artificial graft anastomosed to the axillar artery can also avoid the malperfusion of the vertebral artery and axillar artery. We concluded that the axillar artery perfusion via artificial graft is useful alternative for aortic surgery.

Aged↗
PubMed1999

[Mitral valve annuloplasty with U-shaped flexible band using Duran ring].

To preserve the physiologic function and correct annular dilatation, U-shaped flexible band was applied for mitral valve annuloplasty in 6 cases. U-shaped flexible band was made by cutting Duran ring to the proper length of posterior annulus using Carpentier-Edwards ring sizer. Echocardiographic mitral regurgitation decreased from 3.8 +/- 0.4 to 0.7 +/- 0.5 after repair. All patients discharged without any complications. This annuloplasty method is effective for mitral insufficiency.

Aged↗
PubMed1999

[Graft replacement from ascending aorta to descending aorta with endovascular stent graft under median sternotomy].

We reported a 62-year-old man with DeBakey IIIa dissecting aortic aneurysm involving distal aortic arch who underwent graft replacement from ascending to descending aorta using a endovascular stent graft. Median sternotomy was carried out, because of severe pleural adhesion. Endovascular stent graft composed of 30 mm Gianturco Z stent and 24 mm woven Dacron graft was inserted to descending aorta with the aid of hypothermia, systemic circulation arrest and selective cerebral perfusion. Transesophageal echocardiography was used to measure the diameter and the length of descending aorta and the graft. And ascending and total aortic arch replacement was performed with four branched woven Dacron graft. Postoperative chest CT and aortography showed satisfactory reconstruction with the thrombosed false lumens. We think placement of stent graft to descending aorta through median sternotomy is useful method when left thoracotomy is impossible or distal anastomotic site is too far for the anastomosis.

Aortic Dissection↗