[Hazard developing during the follow-up after reparative surgery for complete transposition of great arteries].
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Child, Preschool↗
Biomedical subjects
S Kawada
Publications and source records attributed to S Kawada.
[Early and late results of cardiac and thoracic aortic surgery in patients older than 75 years from a quality of life point of view].
To determine the early and late results of cardiovascular surgery in patients older than 75 years old, we performed a retrospective study of 28 consecutive elderly patients between January, 1987 and July, 1996. Fourteen patients had cardiac surgery, and 14 had thoracic aortic surgery. Among all of them, nine patients had an emergency operation. The follow-up time ranged 7 to 76 months (mean 20.7 +/- 25.0). The total follow-up time was 561 patients months. The hospital mortality rate was 32.1% (9/28) over all and 15.8% (3/19) for the elective procedures. The early result during the latter five years decreases more than during the early five years (55% vs. 18%, respectively). Three patients died during the follow-up period. One patient dropped out of the follow-up. All 15 survivors were satisfied with their quality of life. Among the survivors of cardiac surgery, the mean New York Heart Association functional classification score decreased significantly (preoperative 3.0 +/- 0.89, follow-up 1.5 +/- 0.55). Though the early mortality is unsatisfactory, it is improving. This follow-up study demonstrates the benefits of cardiovascular surgery in elderly patients in terms of social integration and quality of life.
Age Factors↗
[A case report of postcoarctation mycotic aneurysm after surgical treatment for cerebral arterial aneurysms].
Postcoarctation mycotic aneurysm of the aorta is very rare. We present a case of a 55-year-old man with postcoarctation mycotic aneurysm of the aorta infected with methicillin resistant staphylococcus aureus (MRSA) after surgical treatment for cerebral arterial aneurysms. The operation was performed after negative conversion of MRSA in blood culture using antibiotics. The mycotic false aneurysm was completely resected following institution of an extra-anatomical bypass from the ascending aorta to abdominal aorta above celiac artery.
Aneurysm, Infected↗
[Glutamate neurotoxicity during spinal cord ischemia--development of a delayed-onset paraplegia model].
The incidence and severity of spinal cord dysfunction are related to both the depth and duration of the resulting ischemic state. Evidence is accumulating that glutamate, a major neurotransmitter, has potent neurotoxic activity during ischemia. In our laboratory, it has been confirmed that exogenous glutamate has detrimental effects on spinal cord neurons during brief ischemia in vivo. We hypothesized that glutamate neurotoxicity is associated with delayed-neuronal dysfunction. Delayed-onset paraplegia is defined as a neurologic deficit which develops after initial recovery. Infrarenal aortic segments from 12 New Zealand white rabbits, were isolated for 5 minutes and perfused at a rate of 2 ml/min. Group I (n = 6) received normothermic saline (39 degrees C). Group II (n = 6) received normothermic L-glutamate (20 mM). Neurologic function was assessed at 6, 24, and 48 hours after surgery according to the modified Tarlov scale. After 48 hours, the rabbits were euthanized and their spinal cords were harvested for histologic examination. The neurologic function of all group I was fully intact, whereas three rabbits in group II showed acute paraplegia and the other three showed delayed-onset paraplegia. Histologic examination of spinal cords from rabbits in group I revealed no evidence of cord injury, whereas spinal cords from those in group II had evidence of moderate spinal cord injury with central gray matter and adjacent white matter necrosis and axonal swelling. These results indicate that dose-dependent glutamate neurotoxicity is associated with delayed neuronal dysfunction following ischemia in vivo. The severity of the ischemic event, i.e., extracellular glutamate overload, is suspected to be the etiology of delayed-onset paraplegia which, in turn, is thought to be the result of borderline ischemia. This model may allow a pharmacologic approach to the prevention of ischemic spinal cord injury.
Animals↗
[Extra-anatomic bypass from the ascending aorta to the supraceliac abdominal aorta--surgical option applied to reoperation for aortic coarctation or interruption].
The optimal approach for reoperation following repair of aortic coarctation (CoA) or interruption (IAA) remains controversial. Four patients underwent extra-anatomic bypass for restenosis after repair of CoA or IAA. The age ranged from 4 to 12 years. The initial repairs for two CoA, one type A-IAA, and one type B-IAA consisted of two grafting, one subclavian arterial turning-down aortoplasty, and one subclavian flap aortoplasty. All of them underwent during infancy. Preoperative right arm systolic pressure ranged from 140 to 190 mmHg ar rest. Through a midline sternotomy and an upper laparotmy incision, an extra-anatomic bypass from the ascending aorta to the supraceliac abdominal aorta was employed using a 12 to 18 mm tube graft. All patients survived surgeries, and their hypertension markedly improved. Our experience confirms safety and effectiveness of this option in selected young patients with re-stenosis of following repair of CoA or IAA.
Aorta↗
[Minimally invasive approach for mitral valve, aortic valve, and atrial septal defect surgery].
We successfully introduced minimally invasive cardiac surgery (MICS) to japan by performing thoracoscopic clipping of a patent ductus arteriosus in July 1992. MICS via a small right parasternal incision (Cosgrove procedure) was applied for one patients with severe rheumatic mitral stenosis, one with severe aortic regurgitation, and one with atrial septal defect (ASD). Mitral valve replacement (MVR), aortic valve replacement (AVR), and direct closure of the ASD were performed successfully by MICS for the the first time in Japan. All three patients required no blood transfusion and had no complications postoperatively, being discharged from hospital at 15, 13, and 9 days after their operations. MICS was satisfactory for mitral valve and ASD operations, but AVR by this approach took much longer than by standard midline sternotomy due to the poor surgical field obtained via the small right parasternal incision. A minimally invasive approach for surgery on the aortic valve and ascending aorta may require transection of the sternum or some other method. MICS has several advantages, including less trauma and pain, faster patient recovery, shorter ICU and hospital stays, a lower cost, and a better cosmetic outcome. Therefore, it is better for the patient when it is feasible. MICS should develop and be applied to more patients with cardiovascular disease in the future. Some of the standard cardiovascular operations may soon be replaced by MICS.
Adult↗
Ultrastructural observations of lymphatic vessels in lymphedema in human extremities.
Microsurgical lymphaticovenous anastomoses were done on a total of 14 patients. Six upper extremities of six female patients (average age 56.5 years) were operated on with lymphaticovenous anastomoses and were followed up for 17 months or more after surgery (average 25.5 months). Twelve legs of eight patients (average age 44.6 years) also were operated on and followed up for 12 months or more after surgery (average 23.4 months). Among these patients, 33 biopsied lymphatic trunks with lymphedema in 16 extremities of 12 patients were evaluated histologically by light and electron microscopy. Regarding the operative effect in the arms, the decreased circumference of the arms ranged from 2 to 9 cm (average 5.3 cm). The rate of preoperative versus postoperative excess circumference decreased in range from 25 to 94.7 percent (average 65.7 percent). As for the surgical effect in the legs, half the legs showed improvement. These postoperative improvements showed no correlation with the preoperative duration of edema and excess circumference in either the upper or lower extremities. Histologically, in the initial stage of lymphedema, there was destruction of both endothelial cells and smooth muscle cells in the proximal level of the lymphatic trunks. The lumen of some proximal trunks was then occluded by organization with a few small recanalizations, but the distal lymphatics remained patent with minimal destruction of both the endothelial cells and the smooth muscle cells even in the later stage of lymphedema. These results suggest that the occlusions of the lymphatic trunks and degeneration of the smooth muscle cells may start from the proximal ends of the extremities and that the timing of the occlusions and the degeneration of smooth muscle cells may not correspond to the duration of edema. It is also considered that because of the smooth muscle degeneration, the lymph-drainage capacity of the lymphatic trunks may be remarkably weakened in the proximal lymphatics of the extremities. Therefore, it is suggested that the remaining lymphatic drainage function with the smooth muscle cells may correlate with the postoperative improvement of edema. It is also suggested that the preoperative ultrastructural examination of the lymph-drainage capacity may be a suitable method for predicting the surgical effect and operative indication for lymphatic edema in the extremities.
Adult↗
A ferrofluidic seal specially designed for rotary blood pumps.
One of the key technologies required for rotary blood pumps is sealing of the motor shaft. A ferrofluidic seal was developed for an axial flow pump. The seal body was composed of a plastic magnet and two pole pieces. This seal was formed by injecting ferrofluid into the gap between the pole pieces and the motor shaft. To contain the ferrofluid in the seal and to minimize the possibility of ferrofluid making contact with blood, a shield with a small cavity was provided on the pole piece. Sealing pressure of the seal was measured. The sealing pressure was maintained at more than 23.3 kPa (175 mm Hg) for a motor speed up to 11,000 rpm. The specially designed ferrofluidic seal for sealing out liquids is useful for axial flow blood pumps.
Blood Flow Velocity↗
[A successful surgical case of a dissecting aortic aneurysm with right-sided aortic arch and right-sided descending aorta].
The patient was a 70-year-old female whose aortogram and chest computer tomogram revealed DeBakey type IIIb dissecting aortic aneurysm in association with right-sided aortic arch, right-sided descending aorta and aberrant left subclavian artery arising from the Kommerell's diverticulum. Because she had cachexy with hoarseness and difficulty in swallowing caused by an aneurysm she received hypotensive therapy until recovery of her general condition before elective operation. The aneurysm was 7 cm in diameter and was replaced with vascular graft. Reconstruction of the aberrant left subclavian artery and closure of the false lumen via right thoracotomy were also performed under partial bypass installed between the right common femoral vein and artery using modified PCPS. Postoperative computer tomogram and aortogram showed properly replaced vascular graft and closure of false lumen. Dissecting aortic aneurysm complicated with a right-sided arch is quite rare. Including our case, 12 cases have been reported in the world and 9 cases were in Japan. This is one of the most successful surgical case for DeBakey type IIIb dissecting aortic aneurysm in association with right-sided aortic arch, right-sided descending aorta and aberrant left subclavian artery arising from the Kommerell's diverticulum.
Aged↗
[Surgical repair of a dissecting aortic aneurysm with entry at proximal descending aorta through left thoracotomy--a case report].
A 45-year-old man underwent a distal arch and descending aortic replacement through a left thoracotomy. His chronic type A dissecting aortic aneurysm had the entry at the proximal descending aorta. After 9 years of his first dissection, he suffered from a second dissection. In computerized tomogram (CT), the ascending and descending aorta enlarged to 6.0 cm and 7.0 cm in diameter, respectively and descending aorta showed a three channeled dissection. The open proximal anastomosis technique was used under the deep hypothermic circulatory arrest (HCA) followed by selective cerebral perfusion (SCP). Surgical repair included the obliteration of the proximal false lumen at the level between the left carotid and subclavian artery. A thrombosed retrograde dissection in the ascending aorta was revealed in postoperative evaluation, and decreased in size at follow up CT.
Aortic Dissection↗
[Operative results and long-term prognosis of aortic dissections].
We retrospectively analyzed the operative results and the long-term prognosis of aortic dissections. Between 1966 and 1996, we operated upon 137 patients with aortic dissection. According to the date of the first operation, they were classified into early (1966, 1985), middle (1985, 1992), and late (1992, 1996) cases. The hospital mortality rates of Stanford type. A patients were 40% (12/30) for early cases, 21 (6/28) for middle cases, and 13% (3/24) for late cases. Those of type-B patients were 10% (3/30) for early cases, 21% (3/11) for middle cases and 6% (1/16) for late cases. Actuarial survival rates for the all operative survivors of type-A patients (n = 60) were 77% at five year and 63% at 10 year. Those of type-B patients were 63% at five year and 20% at ten year. The difference of the two survival curves was significant (p < 0.01). In conclusion, the operative mortality rates for both type-A and type-B aortic dissection have reduced. But the more extended and rationale operation is recommended especially for type-B dissection in order to improve long-term prognosis.
Adult↗
Interferon alpha therapy for chronic active hepatitis type C after renal transplantation and allograft rejection.
An acute type rejection episode occurred in one of two patients treated with Interferon alpha (IFN alpha) for type C hepatitis (CHC). Histopathological examination of the graft kidney revealed focal cellular infiltration and chronic transplant glomerulopathy which showed acute or chronic type rejection. In spite of bolus administration of methyl-prednisolone, the elevation of serum creatinine level continued. After administration of anti-human lymphocyte globulin (AHLG), renal function improved, but urinary protein was still positive. Another patient had no episode of rejection during or after IFN alpha therapy.
Adult↗
Progress in the management of patients with aneurysmal subarachnoid hemorrhage: a single hospital review for 20 years. Part I: Younger patients.
BACKGROUND: This study was carried out to clarify if there has been any improvement in the outcome of patients with aneurysmal subarachnoid hemorrhage during the past 20 years. Because elderly patients have apparently poorer prognoses than younger patients, patients older than 70 years were analyzed separately in the following article. METHODS: Five hundred seventy-one patients with aneurysmal subarachnoid hemorrhage, under 70 years, who were consecutively admitted to Kagawa Prefectural Central Hospital from July 1972 to December 1992, were reviewed. These patients were divided into four groups according to the time of admission. The ultimate outcome was evaluated by means of Glasgow Outcome Scale 6 months after the ictus. RESULTS: Changes in treatment protocol in this period included the induction of early surgery and the invention of a variety of modalities for the treatment of cerebral vasospasm. This resulted in a distinct increase in patients who actually underwent direct aneurysm clipping. Outcome has been significantly improved during this period, especially in patients with Hunt and Kosnik grade III (p<0.05, chi2). Patients in good clinical condition at follow-up (Glasgow Outcome Scale: good recovery) increased from 8.7% to 60.7%. Mortality decreased from 28.7% to 10.7%. CONCLUSIONS: Current therapeutic modalities have significantly improved the outcome of patients with aneurysmal subarachnoid hemorrhage. Rebleeding before early surgery remains as a major cause of unfavorable outcome and further progress on this subject is mandatory.
Aged↗
Progress in the management of patients with aneurysmal subarachnoid hemorrhage: a single hospital review for 20 years. Part II: Aged patients.
BACKGROUND: We have reported improvement in the outcome of the younger patients with aneurysmal subarachnoid hemorrhage in the preceding article. The purpose of this article is to study if the same management protocol has simultaneously benefited the elderly patients. METHODS: One hundred twenty-nine patients with aneurysmal subarachnoid hemorrhage, over 70 years old, who were consecutively admitted to Kagawa Prefectural Central Hospital from July 1972 to December 1992, were reviewed. Patient grouping and outcome evaluation were the same as those of younger patients. RESULTS: Changes in treatment protocol in this period, which were similar to those of the younger counterparts, resulted in an increased number of patients who actually underwent aneurysm clipping. Although the outcome evaluated at 6 months after initial hemorrhage was significantly poorer than that of the younger counterparts, there have been some improvements during the study period. Patients in good clinical condition at 6 months' follow-up (Glasgow Outcome Scale: Good Recovery) increased from 37.5% to 42.9% in grades I-II and from 0% to 23.1% in grade III, respectively. CONCLUSIONS: The improvement in the outcome of elderly patients was less remarkable than that observed in younger patients. Significantly higher incidence of preoperative rebleeding and postoperative symptomatic vasospasm has proven to be the major cause of mortality and major morbidity at present. More careful and sophisticated perioperative care is required in elderly patients with aneurysmal subarachnoid hemorrhage.
Aged↗
Flow-through anterior thigh flaps for one-stage reconstruction of soft-tissue defects and revascularization of ischemic extremities.
"Flow-through" anterior thigh flaps are used to reconstruct defects accompanied by major vessel damage in the extremities. These flaps have long flow-through pedicle vessels (which are the descending branch of the lateral circumflex femoral system) that can be interposed into the vascular gaps in the extremities and are composed anatomically of the rectus femoris muscle. The defects of eight patients were repaired successfully with flow-through anterior thigh flaps, which were from 10 to 30 cm in length and 7 to 15 cm in width. The advantages of these flaps are (1) the damaged main vessels (< 20 cm in length) can be reconstructed simultaneously with large skin defects (up to 30 cm in length and 15 cm in width), (2) double arterial inflow by means of both ends of the pedicle artery ensures safe blood circulation of the flap, (3) the lateral circumflex femoral system, the pedicle of the anterior thigh flaps, can be used for chimeric composite flaps for the reconstruction of composite defects with major vessel loss in the extremities, (4) two concomitant veins can be used as a drainage system in extremities with severe edema, and (5) multistage flap transfers are possible to repair recurring defects in the extremities with a single major vessel using additional transection and pedicle interposition.
Adult↗
Connected deep femoral and gluteal perforator-based flap for repair of an extensive defect on the posterior thigh.
An island connected "Siamese" deep femoral and gluteal perforator-based flap with double vascular pedicles, the perforators from the deep femoral and superior gluteal arteries, was transferred successfully to repair an extensively large posterior thigh defect in an 84-year-old man. For reconstruction of large, massive defects of the posterior thigh region, this connected "Siamese" flap has the following advantages: (1) the flap and the pedicles are nearest to the defect, (2) the skin territory of the flap is extremely long, (3) the flap elevation is easy, because there are several perforators that can be considered as pedicle candidates in both the deep femoral and the gluteal perforator-based flaps, (4) there is no necessity for positional change to elevate the flap, and (5) no sacrifice of muscles implies little postoperative functional limitation of the donor leg.
Aged↗
Free combined thin wrap-around flap with a second toe proximal interphalangeal joint transfer for reconstruction of the thumb.
The combined thin wrap-around flap from the big toe and the proximal interphalangeal joint of the second toe is characterized by (1) a single vascularized joint, which is used to preserve the second toe with a free iliac bone graft, (2) a thin wrap-around flap, which allows the pulpal fatty tissue on the remaining bone of the big toe to be retained and accept a skin graft, (3) a wrap-around flap with a partial distal phalangeal bone, and (4) a microplate for firm fixation at the proximal bone union and early joint motion. The advantages of this method are (1) the cosmetic appearance is excellent with use of the thin wrap-around flap; (2) there is joint motion in the reconstructed thumb with strong pinch and vice pinch; (3) the vascularized joint with a microplate allows for early postoperative motion; (4) bone grafting from another donor site is unnecessary; (5) bone growth is possible in children with open epiphyses; and (6) the big and second toes are preserved with minimal donor-site morbidity. This method is indicated for thumb losses at a level distal to the metacarpophalangeal joint or at the level of the proximal phalanx.
Adult↗
Effects of Ca2+ and Mg2+ on dynamics of the polar head group of phosphatidylserine bilayers.
The effects of Ca2+ and Mg2+ on the molecular motion of the polar head group in phosphatidylserine (PS) bilayers were measured by the time-resolved fluorescence depolarization method probed by 1,2-dihexadecanoyl-sn-glycero-3-phospho-[N-(4-nitrobenzo- 2-oxa-1,3-diazole)]ethanolamine [formula: see text] (NBD-PE). By this method, the rate and width of the molecular motion at the fluorescent moieties in the probe molecules could be evaluated as the wobbling diffusion rate (Dw, s-1) and the half cone angle of the wobbling cone (theta c, degree). The values of Dw and theta c measured for NBD-PE embedded in bovine brain phosphatidylserine bilayers were 3.7 x 10(7) s-1 and 46 degrees in the absence of divalent cations at 25 degrees C. When 3 mM of Ca2+ was added, both Dw and theta c distinctly dropped to 1.7 x 10(7) s-1 and 38 degrees, respectively. By the addition of 3 mM of Mg2+, however, only Dw decreased to 2.7 x 10(7) s-1 and theta c remained unchanged. These results show that both Ca2+ and Mg2+ decrease the rate of motion at the head part in PS molecules, but only Ca2+ narrows the distance between the neighboring head groups. Since Mg2+ does not promote vesicle fusion, it appears that the deformation at the head group region in the bilayer structure induced by Ca2+ is an important step in the membrane fusion process.
Animals↗