Biomedical subjects

K Kusajima

Publications and source records attributed to K Kusajima.

At least 55 records · Page 3Linked to original sources

PubMed1999

[Compensatory increases in residual lobar volume following lung resection].

To investigate compensatory increases in residual lobar volume after lobectomy and pneumonectomy, we measured lung lobar volumes on the basis of pre- and postoperative computed tomographic (CT) images obtained on 40 patients (11 right upper, 7 right lower, 10 left upper, 8 left lower lobectomies and 4 left pneumonectomies). A personal computer image processing program was utilized to calculate lung lobar volumes from sequential CT images. Decreases in whole lung volume after lung resection averaged from 7.4% to 9.5% of preoperative whole lung volume in the lobectomy patients, and 30% in the patients who underwent left pneumonectomy. Those values were much smaller than the volumes of resected lobe, as measured on the basis of preoperative CT images. Increased residual lobar volume after lung resection averaged from 11% to 15% of preoperative whole lung volume in both the lobectomy and left pneumonectomy patient groups. Residual lobes compensated for approximately 60% of the resected lobar volume in the lobectomy patients, but only about 30% of resected lung volume in the left pneumonectomy patients. Increases in residual lobar volume tended to be larger in patients who underwent upper lobectomies, and on the operative side in patients other than those who underwent left lower lobectomies. We concluded that compensatory increases in residual lobar volume should be taken into full consideration when making predictions about postoperative pulmonary function.

Adult↗

PubMed1998

[A case of Stanford type A acute aortic dissection associated with a distal aortic arch atherosclerotic aneurysm].

We report a rare case of Stanford type A acute aortic dissection associated with a distal aortic arch atherosclerotic aneurysm. A 71-year-old female was referred to us with the diagnosis of thrombosed Stanford type A acute aortic dissection, however on the next day transesophageal echocardiography revealed the false lumen has been recanalized. In the operation, there was a distal aortic arch atherosclerotic aneurysm which was unidentified at the preoperation. It is very rare that the dissection originated from atherosclerotic aneurysm and proceeded to proximal and distal portion of the aorta.

Acute Disease↗

PubMed1998

Idiopathic saccular azygos vein aneurysm.

We present a case of asymptomatic saccular aneurysm of the azygos vein. This abnormality is exceedingly rare. Dynamic computed tomography revealed strong enhancement of the mass, suggesting a vascular structure, which was very important for preoperative diagnosis. It is unclear whether the mass should be resected if the preoperative diagnosis has been made and the mass is not so large.

Aneurysm↗

PubMed1998

[Clinical study of hypopharyngeal carcinoma].

A clinical study was performed of 83 patients with hypopharyngeal cancer treated in the Sapporo Medical University Hospital from 1982 to 1995. Five-year cumulative survival rate was 34.9% in the whole group and 37.2% in the radical surgical and/or radiation treatment group. In the radiation treatment group, the patients with T1, T2, N0 or N1 stage disease, especially those whose original disease responded almost completely to 40Gy irradiation, showed high tumor control rates following full-dose irradiation with or without radical neck dissection. In the radical surgery group, the patients with T4 or N2 stage disease showed better prognosis than those in the radiation group. However, among the patients with N3 lymph node metastases, there were no long-term survivors in either the radiation or the surgery groups.

Adult↗

PubMed1998

[Total aortic arch replacement for distal aortic arch aneurysms].

Between January 1991 to April 1997, 13 consecutive patients underwent the total aortic arch replacement for distal aortic arch aneurysms. The operation was performed through the median sternotomy and the cardiopulmonary bypass was instituted with the cannulation of ascending aorta for arterial perfusion and of right atrium for venous return. Then the aortic arch was totally replaced with four limbed artificial graft with the aid of selective cerebral perfusion and open distal anastomosis of the distal end of the aneurysm. The mortality was 16% (2 patients) and these cases had ruptured aneurysm and had deep shock preoperatively. There were no severe cerebral complication. Total aortic arch replacement would be the acceptable procedure for the distal aortic arch aneurysm and antegrade ascending aortic perfusion was useful method to avoid the thromboembolic attack due to the retrograde femoral perfusion.

Aged↗

PubMed1998

[Minimally invasive direct coronary artery bypass grafting (MIDCAB) for multivessel disease in a 86 year-old patient].

An 86-year-old male underwent minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass, for severe triple-vessel coronary disease. Left descending coronary artery was anastomosed with the in situ left internal thoracic artery through a limited anterior thoracotomy, and right coronary artery was anastomosed with the in situ right gastroepiploic artery through a small upper laparotomy. The postoperative angiography showed patent grafts, and the patient has been doing well without any complications. MIDCAB is a useful technique even for multivessel coronary diseases in selected cases.

Aged↗

PubMed1998

[A case of painless Standford type A acute aortic dissection complicating acute occlusion of the right subclavian artery].

We reported about a rare case of painless Stanford type A acute aortic dissection with the only complaints being numbness and paleness in the right arm. A 68-year-old male who hed been treated in another hospital under the diagnosis of acute occlusion of the right subclavian artery was referred to our hospital because of severe heart failure and shock. After being admitted to our hospital, the patient was diagnosed as Standford type A acute aortic dissection with transesophageal echocardiography and underwent an emergency graft replacement of the ascending aorta and total aortic arch. The postoperative course was uneventful and the patient was discharged without any complications.

Acute Disease↗

PubMed1998

[The early results of the minimally invasive direct coronary artery bypass (MIDCAB)].

The clinical experiences of 29 consecutive MIDCAB procedures performed at our institution between October, 1996, and October, 1997, were analyzed. Preoperative patient's characteristics were as follows; LAD single vessel disease: 25, double vessel disease: 1, triple vessel disease: 1, RC single vessel disease: 1, LMT lesion: 1, concomitant procedures: 2 (ASO: 1, AAA: 1). LITA harvesting was performed using the video-assisted thoracoscopy in initial 4 patients, and in last 10 patients we used the specially designed retractor THORALIFT (Autosuture Co., Ltd.) for harvesting LITA by direct vision. LAD was stabilized mechanically using the stabilizer when we performed the anastomosis in last 10 patients to enhance the quality of the anastomosis. The patency rate was 96%, but there were two patients (6%) who had the stenosis of the anastomosis site. Coronary artery occlusion time was 13.2 minutes in the mean. We also studied the hemodynamics of blood flow in LITA grafts with the aid of 7.5 MHz transthoracic duplex imaging in these MIDCAB patients and compared with the LITA grafts in conventional CABG performed in same periods. There were no statistical differences between the two groups about the graft flow and velocity. We conclude that MIDCAB would be an alternative procedure that can be performed with low risk and acceptable early results in selected patients.

Aged↗

PubMed1998

[A case of Poland's syndrome with giant bulla resected by using autologous fascia lata].

We reported a case of giant bulla with Poland's syndrome, only left pectoral major and minor muscles defect. A 58-year-old man was admitted to our hospital with shortness of breath on exertion. Computed tomographic scan revealed right giant bulla in emphysematous lung. The giant bulla was resected by linear stapler with autologous fascia lata. Though minor air leakage persisted for 5 postoperative days, the postoperative course was uneventful. It could be effective to reinforce staple line by using autologous fascia lata in emphysematous bulla without any infectious problem.

Fascia Lata↗

PubMed1998

[Minimally invasive direct coronary artery bypass grafting (MIDCAB) for re-operation in a 85 year-old patient].

An 85-year-old male, who had undergone aorto-coronary bypass grafting to left anterior descending coronary artery (LAD) using saphenous vein graft (SVG) seventeen years before, was operated with minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass. LAD was anastomosed with the in situ left internal thoracic artery through a limited anterior thoracotomy. The postoperative angiography showed patent graft, and the patient has been doing well without any complications. MIDCAB is a useful technique even for re-operation of coronary diseases in selected cases.

Aged↗

PubMed1998

[The long-term results of surgical treatment for acute type A aortic dissection].

Between 1992 and 1996, 31 patients with acute type A aortic dissection underwent the surgical treatment on an emergency basis. The overall early mortality rate was 12.3% (4 patients), and the overall 5-year survival rate (calculated by Kaplan-Meier method) was 76.9% respectively. Although there is controversy about the operative procedure whether the aortic arch should be replaced or not in aortic arch dissection in which the primary intimal tear is located at or extends into the arch, the resection of the aortic arch tear and simultaneous arch repair with graft replacement of the ascending aorta would be the acceptable procedure in the long term period with the recent improvement of adjunct technique for the prevention of cerebral ischemia and heart protection. The composite graft replacement of the aortic root is also indicated in patients with acute dissection associated with annuloaortic ectasia or Marfan's syndrome and severely destroyed aortic root with the extension of dissection to the aortic root with acceptable mortality and survival rate in the early and late period.

Aortic Dissection↗

PubMed1998

[Successful surgical treatment for severe mitral valve annulus enlargement and mitral regurgitation 5 years after aortic root replacement in Marfan syndrome: a case report].

Major cardiovascular lesions associated with Marfan syndrome include aortic diseases such as aortic root dilatation and mitral disease. If untreated, cardiovascular manifestations of the Marfan syndrome cause death in one half of patients during the first four decades of life. Although aortic diseases in the Marfan syndrome are responsible for most of serious morbidity and mortality, 60-80% of patients with Marfan syndrome have mitral valve dysfunction. The results of surgical treatment for aortic diseases in Marfan patients have recently shown significant improvement. However, there is no acceptable consensus about the timing and the technique of surgical intervention for mitral diseases. Especially mitral valve diseases is the most common cause of morbidity and mortality in infants with the Marfan syndrome. We report herein a case of Marfan syndrome (21-year-old female) who had undergone two operations for aortic root dilatation five years before she underwent the surgical treatment for progressive heart failure due to severe mitral annulus enlargement and mitral regurgitation.

Adult↗

PubMed1997

The reinforcement of tracheoplasty with a self-fascia lata and Gelatin-Resorcin-Formal (GRF) glue.

We examined the efficacy of protecting the suture line in tracheoplasty by using a self-fascia lata and Gelatin-Resorcin-Formal (GRF) glue. Fifteen dogs underwent a resection of four rings of the trachea and reconstruction, and we then observed them for one month; group A (n = 5) without reinforcement, group B (n = 5) with a self-fascia-lata spread with GRF glue, and group C (n = 5) with only a self-fascia-lata. In the reinforced dogs (group B, three cases, and group C, five cases), in which the continuity of the suture line had been conserved, eight cases were resistant to pressures of from 240 mmHg to 300 mmHg, and two cases (both in group B) which had a partial discontinuity of the suture line were resistant to the same pressure of 160 mmHg. But in the five dogs without reinforcement (group A), four died from infection due to leakage of the trachea within 2 weeks; only one that had a continuity of the suture line survived and was resistant to pressure of 300 mmHg. These results show that a reinforcement of tracheoplasty using a self-fascia lata and GRF glue is useful for preventing air leakage from the suture line.

Animals↗

PubMed1997

Influence of oxygen in inflation gas during lung ischemia on ischemia-reperfusion injury.

OBJECTIVES: Previous studies have reported that hyperinflation during lung ischemia improves pulmonary function after reperfusion. However, it has not been clarified whether hyperinflation itself or oxygen in inflation gas causes good pulmonary function. The aim of this study is to evaluate the effect of oxygen in pulmonary inflation gas during lung ischemia on ischemia-reperfusion injury. METHODS: Twenty-one mongrel dogs were randomly divided into three groups: the lung during a 90-minute period of warm ischemia was inflated to 30 cm H2O with 100% oxygen in group A and 100% nitrogen in group B; it was not inflated in group C. Pulmonary function and hemodynamics were measured before ischemia and 1, 2, and 3 hours after reperfusion. Total protein and phosphorus of phospholipid in bronchoalveolar lavage fluid were measured 210 minutes after reperfusion. Adenine nucleotide levels in lung tissue were estimated 210 minutes after reperfusion. RESULTS: No significant differences in pulmonary function and hemodynamics were noted between group A and group B, but these two groups had significantly better pulmonary function and hemodynamics than group C. No significant differences were detected in the concentrations of total protein and phosphorus of phospholipids in bronchoalveolar lavage fluid and in adenine nucleotide levels of lung tissue after reperfusion among the three groups. CONCLUSIONS: The results indicate that pulmonary inflation during warm ischemia improves pulmonary function and hemodynamics after reperfusion in this model. The effect is caused by inflation itself and is not due to oxygen as a metabolic substrate during warm ischemia.

Adenine Nucleotides↗

PubMed1997

[A case of paraplegia after graft replacement of the ascending aorta and the total aortic arch for the DeBakey type I acute aortic dissection].

A rare case of paraplegia after an emergency operation for DeBakey type I acute aortic dissection was reported. The patient was a 52-year-old female who complained of severe chest and back pain. She underwent graft replacement of the ascending aorta and the total aortic arch. No neurological symptoms were observed before the operation. The cause of the paraplegia was assumed to be a thrombotic occlusion of costal arteries which originated from the false lumen.

Aortic Dissection↗

PubMed1997

[Minimally invasive coronary artery bypass grafting and percutaneous coronary angioplasty in the patient with left main disease and chronic renal failure].

This paper describes the utility of the minimally invasive CAB procedure as an adjuvent therapy to allow angioplasty for left main stenosis. A 73-year-old male who had chronic renal failure and left main coronary disease underwent a combined therapy with minimally invasive CABG and PTCA. The operation was reformed with a 9 cm incision. The fifth costal cartilage was removed. Internal thoracic artery (ITA) was dissected from the left side of the chest wall and anastomosed to the midportion of the left anterior descending coronary artery (LAD) with 7-0 with 7-0 Prolene. He was extubaded a few hours after the operation and resumed his dialysis schedule. On the fifth postoperative day he was electively returned to the catheterization laboratory, where he underwent successful angioplasty of the LMT to Lcx after patency of the LITA-LAD graft had been verified. He was discharged from our hospital ten days postoperatively.

Aged↗

PubMed1996

Contralateral lung injury associated with single-lung ischemia-reperfusion injury.

BACKGROUND: There have been very few studies on the effect of single-lung ischemia-reperfusion on the function of the contralateral lung. This study was designed to clarify the effect. METHODS: Fifteen mongrel dogs were divided into two groups. In group 1 (n = 7), the left lung was subjected to ischemia without ventilation for 90 minutes, and then reperfused. In group II (n = 8), the lung was not subjected to ischemia, and was ventilated during the 90-minute ischemia of group I. Arterial blood gas, hemodynamics, extravascular lung water, and airway pressure were measured. Pulmonary biopsy was performed to evaluate adenine nucleotide levels. The protein concentration and phosphorous concentration of phospholipids in bronchoalveolar lavage fluid were measured. RESULTS: Group I, with perfusion and ventilation of the right lung alone, was significantly inferior to group II with respect to arterial blood gas, right pulmonary compliance, extravascular lung water of the right lung, and the protein concentration in the bronchoalveolar lavage fluid of the right lung after the 90-minute period. CONCLUSIONS: These results indicate that 90 minutes of warm ischemia and reperfusion of the left lung caused deterioration of not only the left but also contralateral right pulmonary function.

Adenine Nucleotides↗

PubMed1996

[Investigation on 19 operated cases of intrathoracic thyroid tumors].

We investigated in this paper nineteen patients who had undergone removal of intrathoracic thyroid tumors. They were 4 males and 15 females, aged 22-73 years, on the pathological classification, 4 with follicular adenomas, 4 with adenomatous goiters, 6 with papillary carcinomas, 1 with follicular carcinoma, 3 with papillary and follicular mixed carcinomas and 1 with anaplastic carcinoma. A 10-year survival rate of carcinomas is 77.1%, and there were 4 cases that had long term interval (6-30 years) between removal of cervical thyroid carcinoma and finding out of intrathoracic thyroid carcinoma. One case of follicular adenomas gave rise to metastasis to lung after four years from removal of intrathoracic tumor, and so it is necessary to do a long term observation after removal of thyroid tumors.

Adenocarcinoma, Follicular↗