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Biomedical subjects

N Shiiya

Publications and source records attributed to N Shiiya.

At least 19 recordsLinked to original sources
PubMed1999

Abdominal aortic aneurysms in aged patients: analysis of risk factors in non-ruptured cases.

BACKGROUND AND METHODS: A retrospective analysis of 304 patients (274 males and 30 females) surgically treated for non-ruptured, infrarenal abdominal aortic aneurysm (AAA) to determine the relative contribution of preoperative, operative, and postoperative factors to mortality and to the development of postoperative complications. 1) Risk factors, hospital mortality and long-term survival rate were compared between patients aged 75 or older (- group I; n=79) and those under 75 years of age (group II; n=225). 2) These risk factors were subjected to univariate and multivariate analysis to determine their relative contribution to patient hospital mortality and to the development of major postoperative complications in aged patients. RESULTS: Maximum diameter of AAA, the prevalence of respiratory dysfunction, diabetes mellitus and the total volumes of intraoperative blood loss were significantly different between the two groups. A higher hospital mortality was noted in the aged patients (10.1% versus 3.1%, p<0.05). The majority of deaths in group I resulted from organ dysfunctions, especially involved with respiratory failure. The long term survival rate at 3 and 5 years was not different between operative survivors in the two groups. Incremental risk factors for hospital death in aged patients included the presence of symptomatic AAA, the maximum diameter of AAA, the postoperative development of myocardial infarction, respiratory complications and gastrointestinal bleeding. Operation time and the volumes of intraoperative blood loss significantly correlated with the postoperative development of respiratory failure, renal failure and multiple organ failure. CONCLUSIONS: 1) A higher operative mortality and higher prevalence of postoperative complications were noted in aged patients with AAA. 2) To reduce operation time and the volumes of intraoperative blood loss would be essential to improve surgical results of AAA in aged patients.

Adult↗
PubMed1999

[Long-term results of mitral valve regurgitation after surgical repair of incomplete atrioventricular septal defect].

Although the postoperative outcome in patients with incomplete atrioventricular septal defect (iAVSD) is excellent, deterioration of mitral valve regurgitation (MR) is still remained to be resolved. Therefore, this study was undertaken to compare surgical procedures for mitral cleft repair with their long-term results of MR. From 1991 to 1996, 52 patients underwent surgical repair of iAVSD. Age at operation ranged from 2 months to 62 years old with mean age of 14.2 years. Mean follow-up period was 8.6 +/- 4.4 years. All patients underwent patch closure of ostium primum defect. Two patients did not have cleft (Group A). Seven patients did not close the cleft at all (Group B), while 40 patients had the repair of valve by closing cleft near septal attachment only (Group C). The latest 3 patients had the complete closure of cleft from annulus to margin of leaflet where chorda is attached. MR was evaluated by echocardiography grading 0 to IV and regurgitation more than grade II was considered to be significant. In Group A, MR remained grade I. In Group B, MR was deteriorated in 5 patients (71%). Consequently, 6 patients (86%) had grade II or more regurgitation and 4 patients (57%) revealed grade III/IV regurgitation including one (14%) reoperation. In Group C, MR was deteriorated in 10 patients (55%). Consequently, 22 patients (86%) had grade II or more regurgitation and 5 patients (13%) had grade III/IV regurgitation including 3 (7.5%) reoperations. In Group D, no deterioration of MR was noted and all had grade I or less regurgitation. These results suggest that the closure of cleft near septal attachment is not sufficient to prevent MR in late phase and the complete closure of cleft from annulus to margin of leaflet, where chorda is attached, would be useful to prevent the deterioration of MR in late phase.

Adolescent↗
PubMed1999

Ruptured abdominal aortic aneurysms: analysis of factors influencing surgical results in 184 patients.

BACKGROUND: Rupture is often the first manifestation in patients with abdominal aortic aneurysms. Although elective surgery for non-ruptured abdominal aortic aneurysms has provided satisfactory surgical results, operative mortality of ruptured abdominal aortic aneurysms (rAAA) has not improved. The purpose of this study was to identify predictors for early hospital death in patients with rAAA. METHODS DESIGN: A retrospective study. SETTING: A university hospital and 20 affiliated hospitals. PATIENTS: PATIENTS undergoing surgical treatment for rAAA (n=183) between 1968 and 1997. INTERVENTIONS: All patients were surgically treated and divided into operative survivors (n=119) and non-survivors (n=64). MEASURES: The patient-related, procedure-related, and postoperative factors were compared between the two groups. A multivariate analysis was also conducted to determine predictors for hospital deaths. RESULTS: In univariate analysis, age at operation (p=0.004), preoperative hemodynamic conditions (p<0.0001), extent of hematoma (p<0.0001), preexistent renal dysfunction (p=0.001), and volumes of blood loss at operation (p=0.001) were significantly different between the two groups. The morbidity of postoperative renal failure (p<0.0001), gut ischemia (p=0.003), heart failure or ischemic heart disease (p<0.0001), and multiple organ dysfunction syndrome (p<0.0001) was higher in the non-survivors' group. Multivariate analysis also identified preoperative hemodynamic conditions, blood loss volume at operation, pre-existent renal dysfunction, postoperative renal failure, heart failure, and multiple organ dysfunction syndrome as incremental risk factors for hospital deaths. CONCLUSIONS: Every effort to maintain preoperative hemodynamic conditions, to reduce volumes of blood loss at operation, and to minimize deterioration of organ functions postoperatively is all essential to improve patient survival.

Adult↗
PubMed1998

Determinants of postoperative and long-term survival of patients with ruptured abdominal aortic aneurysms.

To compare the surgical results of patients with ruptured (rAAA) and nonruptured abdominal aortic aneurysms (NrAAA), 267 consecutive patients surgically treated for abdominal aortic aneurysms (AAA) were reviewed. The patients' characteristics, preexistent risk factors, perioperative factors, and postoperative early and long-term survival were compared between the rAAA group (n = 27) and the NrAAA group (n = 240). A multivariate analysis to predict postoperative survival was also conducted in the rAAA group. The hospital mortality rate was 3.3% (8/232) for the NrAAA group and 22.2% (6/27) for the rAAA group (P < 0.001). The maximum size of aneurysms, period of preoperative hypotension, and intraoperative bleeding volume were significantly higher in the rAAA group than in the NrAAA group. The 5- and 10-year cumulative survival rates in the rAAA group were 88.1% and 42.0%, which were comparable to those in the NrAAA group. The incremental risk factors for hospital death in the rAAA group included advanced age, preoperative hypotension (< 80 mmHg), and postoperative renal failure requiring dialysis. These findings showed that the interval from rupture to cross-clamping must be shortened, maintaining hemodynamic stability to avoid prolonged hypotension. Reducing risk factors and minimizing deterioration of organ functions postoperatively would be essential to improve the prognosis of patients with rAAA.

Aged↗
PubMed1998

Myxoma of the mitral valve prolapsing into the left atrium and ventricle: report of a case.

A rare case of myxoma originating from the mitral valve is reported. A 25-year-old woman was found to have a mobile mass around the mitral valve that prolapsed into the left atrium and the left ventricular outflow tract. The mitral valve was approached via the left atrium and aorta, and was excised completely along with the tumor; it was thus replaced with a mechanical prosthesis. The patient recovered and demonstrated no signs of recurrence 16 months postoperatively.

Adult↗
PubMed1998

[Surgical treatment for perforated aorta caused by mediastinitis after bidirectional Glenn shunt and closure of atrial septal defect--a case report].

A 24-year-old man with Ebstein anomaly underwent a bidirectional Glenn shunt and closure of an atrial septal defect. Postsurgical prulent mediastinitis was treated by irrigation and drainage, but was followed by rupture of the ascending aorta. During emergency surgery, hypothermic circulatory arrest became necessary due to massive bleeding. Since he had undergone a bidirectional Glenn shunt, left heart venting was essential to obtain deep hypothermic circulatory arrest without cardiac distention and was successfully performed via an anterior thoracotomy approach. The perforated site of the ascending aorta was repaired with a Xeromedica patch. The anterior mediastinum was wrapped with the omentum. Transthoracic left heart venting via an anterior thoracotomy is an useful approach when hypothermic circulatory arrest is required to perform a median sternotomy and to approach the heart.

Adult↗
PubMed1998

Simultaneous total aortic replacement without a sternotomy incision.

Total aortic replacement is preferably performed by staged operations, and reports of a simultaneous operation are few. In these reports, both a median sternotomy and a thoracoabdominal incision are employed. We report a patient who successfully underwent simultaneous total aortic replacement without a sternotomy incision. The technique and the feasibility of the operation are discussed.

Aortic Dissection↗
PubMed1998

Evaluation of 18-hour lung preservation with oxygenated blood for optimal oxygen delivery.

BACKGROUND: Previous studies have shown that availability of oxygen during lung preservation to maintain aerobic metabolism may be essential for the optimal viability of preserved lung tissue. The purpose of this study was to evaluate lung preservation with oxygenated blood for optimal oxygen delivery to the lung graft in a rabbit model. METHODS: Eighteen excised rabbit lungs were flushed and stored for 18 hours at 10 degrees C with one of the following: Euro-Collins solution (EC; n=6), oxygenated homologous blood (OB; n=6), or low-potassium dextran solution (LPD; n=6). Poststorage lung functions were evaluated with isolated, blood-perfused lung model for 10 minutes. RESULTS: The mean oxygen tensions after reperfusion for the EC, OB, and LPD groups (47.0+/-2.8, 76.9+/-13.1, 96.2+/-10.9 mm Hg at 10 minutes, respectively) were significantly different throughout the perfusion period (EC < OB < LPD, p < 0.05; EC < LPD, p < 0.01). Pulmonary artery pressure during the reperfusion period in the EC group (35.8+/-4.4 mm Hg at 10 minutes) was higher than that in the OB and LPD groups (29.8+/-4.3 and 22.4+/-2.2 mm Hg, respectively) (EC > OB, EC > LPD, p < 0.05). However, the E-selectin level in the reperfused blood in the OB group (5.04+/-0.24 ng/mL) was significantly elevated compared with that in other groups (EC, 3.56+/-0.54; LPD, 2.92+/-0.35 ng/mL, p < 0.05), which indicated enhanced neutrophil recruitment in the OB group. Comparisons of thrombomodulin and endothelin among the three groups did not reach statistical significance. CONCLUSIONS: We conclude that OB may enhance lung preservation as compared with EC solution, probably through its enriched oxygen delivery during storage and extracellular composition. However, the availability of oxygenated blood does not exceed that of LPD solution because of augmented neutrophil recruitment, which may activate neutrophil-endothelial interactions.

Animals↗
PubMed1998

Application of the reversed elephant trunk technique during total thoracoabdominal replacement in patients with Marfan's syndrome.

The reversed elephant trunk operation has been applied in patients with extensive aortic involvement as a scheduled staged operation. We report application of the same technique in two patients with Marfan's syndrome. The two patients underwent total replacement of the thoracoabdominal aorta for a DeBakey IIIb aortic dissection. The proximal end of the prosthetic graft was invaginated to facilitate future proximal operation. No complication related to the trunk had been observed during the follow-up period.

Adult↗
PubMed1998

Surgical experiences with peripheral arterial aneurysms due to vasculo-Behçet's disease.

BACKGROUND: Vascular involvement of Behçet's disease is currently considered as an important sign of the clinical evolution of patients with Behçet's disease. In addition, Behçet's disease is important in that it causes peripheral arterial aneurysms. METHODS: In this report, 4 patients with vasculo-Behçet's peripheral arterial aneurysms are presented. These aneurysms were distributed in the carotid artery (n=1), popliteal artery (n=1) and femoral arteries (n=3). Operative procedures included patch closure of a perforated wall for the carotid aneurysm, arterial reconstruction with the autogenous saphenous vein for the femoral and popliteal aneurysms. RESULTS: All four patients tolerated the operation well, however, two of four patients required re-operation due to anastomotic insufficiency later. CONCLUSIONS: Aneurysms associated with Behçet's disease have a sudden onset in many cases and often result in rupture. Appropriate operative procedures, including an adequate choice of anastomotic sites and reinforcement of the suture, may reduce the incidence of complications in patients with arterial aneurysms due to Behçet's disease.

Adolescent↗
PubMed1998

[Long-term results of operation for acute type A aortic dissection].

We report results of surgical treatment in 30 patients with acute type A aortic dissection. The average age of the 25 patients without the Marfan syndrome was 59.2 (range 51-76), and male/female ratio was 11/14. The average age of the five patients with the Marfan syndrome was 36.8 (range 27-48), and male/female ratio was 2/3. As an adjunct, we used deep hypothermic circulatory arrest during ascending aortic replacement, while selective cerebral perfusion was employed during aortic arch replacement. Operative procedures for the non-Marfan patients included 14 ascending aortic replacement and 11 ascending and aortic arch replacement, while the Marfan patients underwent extensive aortic replacement that included three aortic arch replacement combined with the Bentall operation, one extensive replacement from the ascending aorta to the descending thoracic aorta and one ascending and aortic arch replacement. One patient died early after the operation and the early mortality rate was 3.3%. No patient developed new brain complication related to the operation. During the follow-up period, three patients died and two patients required a total of three subsequent distal operations. Cumulative survival rate was 89% at one year, 85% at three years, 85% at five years. Cumulative cardiovascular event-free rate was 89% at one year, 85% at three years, 77% at five years. Early and long-term results of surgical treatment for acute type A aortic dissection was satisfactory. This seems to result from the use of deep hypothermic circulatory arrest and selective cerebral perfusion as an adjunct and application of aortic arch replacement when the aortic arch is dilated or intimal tear is located in the aortic arch or more distally.

Aged↗
PubMed1998

Pancreaticoduodenal artery aneurysm with celiac trunk occlusion. Report of a case.

A case of superior mesenteric artery branch aneurysm is described. A 43-year-old female patient was hospitalized after the incidental discovery of a low echogenic mass next to the superior mesenteric artery trunk. A selective superior mesenteric arteriography confirmed aneurysms of the inferior pancreaticoduodenal artery and an aortogram demonstrated occlusion of the celiac trunk. Bypass between the abdominal aorta and the common hepatic artery and resection of aneurysms were performed. The possible etiology and operative procedure are discussed.

Adult↗
PubMed1998

Successful repair of cardio-Behçet's disease with aortic and mitral regurgitation.

A case of Behçet's disease with cardiac involvement of aortic and mitral regurgitation is presented. The patient underwent aortic and mitral valve replacement, along with plication of the ascending aorta. Histological examination revealed chronic inflammation with degenerative changes, consistent with Behçet's disease. Anti-inflammatory therapy using prednisolone was maintained throughout the postoperative period. This is the first case of cardio-Behçet's disease surgically treated for both aortic and mitral valves with a successful long-term survival.

Aortic Valve Insufficiency↗
PubMed1997

Extensive replacement of the aorta from the ascending aorta to the supraceliac abdominal aorta during a one-stage operation.

A successful replacement of the aorta from the ascending aorta to the supraceliac abdominal aorta in one operation is herein reported. The patient was 66-year-old woman who had DeBakey type I chronic aortic dissection with a pre-disseminated intravascular coagulation (DIC) condition. The image diagnosis revealed a markedly enlarged false lumen with a narrow true lumen in the ascending aorta extending to the diaphragm level while below the diaphragm level, the aortic dilatation was mild. The operation was performed through both a thoracoabdominal incision and a median sternotomy to expose the whole thoracic aorta, and the aorta was replaced from the ascending aorta to the supraceliac abdominal aorta. Selective cerebral perfusion was used for cerebral protection and this was a useful adjunct since no time limitations were thus required during repair of the aortic arch. Although the patient developed several complications postoperatively, she eventually recovered and was discharged from the hospital without any neurological disorders.

Aged↗
PubMed1997

Inflammatory abdominal aortic aneurysms and atherosclerotic abdominal aortic aneurysms--comparisons of clinical features and long-term results.

A total of 274 patients with abdominal aortic aneurysms due to atherosclerosis (AAA) and 16 patients with inflammatory abdominal aortic aneurysms (IAAA) were reviewed to compare and contrast the clinical characteristics of the 2 groups. The AAA group comprised 243 men and 31 women with a mean age of 69.2 +/- 0.4 (range 51-86) years. The IAAA group comprised 15 men and 1 woman with a mean age of 67.4 +/- 2.0 (range 53-81) years. Most patients with IAAA (12/16; 75.0%) had pain at presentation, whereas only 37 out of 274 patients (13.5%) with AAA had pain (p < 0.001). Fifty out of 274 patients (18.2%) with AAA were asymptomatic, the most common principal complaint being a pulsatile tumor, which was found in 150 out of 274 patients (54.7%; p < 0.005 vs IAAA). Regarding laboratory findings of inflammation, preoperative erythrocyte sedimentation rate values were elevated in 15 out of 16 (93.8%) patients, and C-reactive protein values were elevated in 13 out of 16 (81.3%) patients with IAAA. The incidence of perioperative complications was similar in the 2 groups. The 30-day postoperative mortality among AAA patients was 6.2% (17/274 cases), including 12 cases of non-ruptured and 5 cases of ruptured AAA; in contrast, no early deaths occurred among patients with IAAA. The cumulative 5-year survival rate was 80.2% for IAAA patients and 74.6% for AAA patients (NS). The results of our review suggest that careful diagnosis and intra- and postoperative management could lead to patients with IAAA having a similar survival rate to those with AAA.

Aged↗
PubMed1997

[A case report of primary repair for thoracic and thoracoabdominal and iliac artery aneurysms associated with severe visceral artery occlusive diseases--a redo operation for thoracoabdominal aortic aneurysm after infrarenal abdominal aortic aneurysm repair].

Abdominal aortic aneurysms can now be successfully repaired with low mortality and few early complications. On the other hand, the cases that required operations for recurrent aneurysms have been increased during long term follow-up period. In such cases, there are many difficulties for operative procedures compared to their first operations and many risk factors. A case of successful operation for the thoracoabdominal aortic aneurysm associated with severe stenotic lesions of the visceral arteries and descending thoracic aneurysm and left common iliac artery aneurysm are reported. A 74-year-old man who underwent operation for infrarenal abdominal aortic aneurysm and left nephrectomy 7 years and 9 months ago at our institution developed an aneurysm just above the proximal anastomosis with severe stenotic lesions of the visceral arteries. At the same time, descending thoracic aortic aneurysm and left common iliac artery aneurysm were associated. And he had ischemic heart disease. Under selective perfusion of the visceral arteries, graft replacement of these aneurysms and reconstruction of superior mesenteric artery and right renal artery were done. The patient had good post operative course and started oral feeding at 3 post operation day. He returned to his occupation and is doing well with no trouble one and half year after operation.

Aged↗