Biomedical subjects

T Hadama

Publications and source records attributed to T Hadama.

At least 19 recordsLinked to original sources

PubMed2002

Tuberculous pseudoaneurysm of the ascending aorta associated with intracranial tuberculoma.

A tuberculous aneurysm is rare and fatal because it may lead to a rupture due to the forming of a pseudoaneurysm. A lesion is especially uncommon in the ascending aorta. We report an unusual case of tuberculous pseudoaneurysm of the ascending aorta which developed 7 months after the onset of multiple intracranial tuberculoma in a 59-year-old man. He was treated for multiple intracranial tuberculomas in another hospital because of headache and left homonymous hemianopia. The temporal intracranial tuberculomas were reduced after antituberculous drug administration. However, they enlarged again shortly thereafter. At that time, a pseudoaneurysm of the ascending aorta was found, so he was introduced to our department. Intensive antituberculous drugs were administered perioperatively and postoperatively. The intracranial tuberculoma was reduced preoperatively. After that, the ascending aorta was successfully replaced with a Dacron graft. A hole was noted in the back of the ascending aorta. Three years after the operation, no symptoms of recurrence have been recognized. A tuberculous pseudoaneurysm of the ascending aorta may easily cause systemic tuberculosis or rupture, therefore it should be treated as early as possible.

Aneurysm, False↗

PubMed2002

[Arch translocation method for an arch aneurysm with open stent grafting using a nephrostomy catheter].

An 81-year-old female found to have an aneurysm in the distal aortic arch was successfully treated with arch translocation method. Under selective cerebral perfusion, a stent graft bound to a nephrostomy balloon catheter with a chainstitch was inserted from the ascending aorta into the descending aorta and its proximal end was sutured together with the distal aortic stump. Then a 4-branched Dacron graft replaced the ascending aorta reconstructing cephalobracheal branches individually. Each proximal end of cephalobracheal branches was ligated. The patient had no neurological deficit except for recurrence nerve palsy that had already existed before the operation. Postoperative angiography revealed complete thrombocclusion of the aneurysm.

Aged↗

PubMed2001

Left ventricular free wall rupture possibly induced by coronary spasm. Surgical repair in the emergency room.

A 68-year-old woman complained of chest discomfort after a traffic accident in which she driving hit a child. At about twenty-five minutes later, she went into sudden cardiogenic shock due to acute myocardial infarction caused by non-occlusive intracoronary thrombosis without significant organic coronary stenosis and without any sign of extraluminal contrast pooling on coronary angiography. She was transported to our emergency room by ambulance because of cardiac tamponade caused by a left ventricular free wall rupture following the acute myocardial infarction. On arrival, she was near cardio-pulmonary arrest on intraaortic balloon pumping. We performed emergency open cardiac massage and pericardiotomy. The hairline perforation responsible for the blowout-type left ventricular free wall rupture was successfully closed with Teflon-reinforced sutures. In conclusion, it was strongly suspected that the present case of left ventricular free wall rupture was caused by acute myocardial infarction due to intracoronary thrombosis following coronary spasm without significant organic coronary stenosis or rupture of atheromatous plaque.

Aged↗

PubMed2001

Stented elephant trunk method for multiple thoracic aneurysms.

Stent-grafting and open graft replacement was introduced to reduce the complications of suture anastomosis in the descending aorta. We applied this technique in the treatment of a patient with multiple thoracic aneurysms. The elephant trunk procedure was used for thromboexclusion. A single branched graft was placed easily without twisting. In patients with aneurysms at both the proximal and distal thoracic aorta, combined stent-grafting and open graft replacement is an excellent approach.

Aged↗

PubMed2001

Roles of alpha(1) and alpha(1)/beta subunits derived from cardiac L-type Ca(2+) channels on voltage-dependent facilitation mechanisms.

Strong depolarization pulses facilitate L-type Ca(2+) channels in various cell types including cardiac myocytes. The mechanisms underlying prepulse facilitation are controversial with respect to the requirements for channel subunits, cAMP-dependent protein kinase, and additional anchor proteins. The properties of voltage-dependent facilitation of the L-type Ca(2+) channel was studied in recombinant cardiac alpha(1) subunits with or without cardiac beta subunit, expressed in Chinese hamster fibroblast cells. The magnitude of voltage-dependent I(Ba) facilitation in the alpha(1) subunit channel is dependent on the duration of the prepulse as well as on the interval duration between prepulse and test pulse. The characteristics of this facilitation were not affected by coexpression of the beta subunit. These results indicate that cardiac alpha(1) subunits exhibit voltage-dependent facilitation because of their own intrinsic structure, independent of any other accessory subunit or additional regulatory proteins, and that cardiac beta subunits have no essential regulatory role at the onset or continuance of the voltage-dependent facilitation.

Animals↗

PubMed2001

[A case report of Ebstein's anomaly treated with Hetzer's procedure].

A 27-year-old male who had been diagnosed with Ebstein's anomaly was admitted with uncontrollable congestive heart failure. The echocardiogram revealed severe tricuspid valve incompetence and the electrocardiogram showed atrial fibrillation. He underwent Hetzer's repair procedure for tricuspid valve incompetence and Minzioni's right atrial isolation technique to restore sinus rhythm. His congestive heart failure quickly disappeared and sinus rhythm was restored after operation. He was discharged 3 weeks postoperatively and remains well 22 months after his operation. Hetzer's technique for tricuspid valve repair in Ebstein's anomaly restructures the valve mechanism at the level of the true tricuspid anulus by using the most mobile leaflet for valve closure without plication of the atrialized chamber. We conclude that Hetzer's procedure is an effective operation for Ebstein's anomaly.

Adult↗

PubMed2001

Early and long-term results of cardiovascular surgery in octogenarians.

The purpose of this study was to evaluate characteristics and outcomes of octogenarians undergoing cardiovascular surgery with cardiopulmonary bypass in a Japanese population. Thirty-one consecutive patients over 80 years of age underwent coronary artery bypass grafting 19 (61%), combined coronary artery bypass grafting and ventricular septal perforation closure 1 (3%), valve replacement 3 (10%), and prosthetic graft replacement 8 (26%). The early mortality rate was 16.1%. Survival estimates were 74% after 1 year, 74% after 3 year, and 64% after 5 years. Emergency and urgent cases involved 16 (51.6%), and 2 patients (6.5%), respectively. Multivariate analyses revealed that predictors of early mortality was preoperative left ventricular ejection fraction. Predictors of hospital death (within 3 months after surgery) were preoperative renal dysfunction, intraaortic balloon pumping, and age. Predictors of late mortality were chronic lung disease and age. Twenty-one patients expected to have died before surgery were living at home, and 9 (40.9%) patients were completely autonomous. Multivariate analyses revealed diabetes mellitus and a small number of bypass grafts were predictive risk factors for postoperative autonomy. Thus, cardiovascular surgery can be performed in octogenarians under 85 years of age with a favorable long-term outcome, when appropriately applied in selective octogenarians without significant comorbidity. If patients are over 85 years of age or have significant comorbidity, clinical treatment recommendations should be individually tailored while evaluating the risk of having or not having surgery and their life expectancy. QOL of survivors was almost satisfactory and significantly improved compared with a preoperative state.

Age Factors↗

PubMed2000

Primary hepatic leiomyosarcoma in a patient with hepatitis C virus-related liver cirrhosis.

We describe an autopsy case of primary hepatic leiomyosarcoma in a 68-year-old man with hepatitis C virus-related liver cirrhosis. The patient, who had a history of acute hepatitis 20 years previously, died of a ruptured hepatic tumor. At autopsy, a well-circumscribed 14 x 16 x 15 cm tumor replaced the medial site of the right hepatic lobe with multiple intrahepatic and distant metastases. Histologically the tumor, which had extensive central necrosis, consisted predominantly of well or moderately differentiated spindle-shaped cells, which were positive for smooth muscle actin and vimentin on immunohistochemical staining. In addition, clusters of markedly atypical cells and myxoid change of the matrix were discretely found in the focal and small areas of the tumor. These findings indicated that many sections were necessary for the histologically accurate estimation of primary hepatic smooth muscle tumor. The histological examination of a non-tumorous lesion showed liver cirrhosis. Hepatitis C virus was detected in the cytoplasm of cirrhotic hepatocytes by immunohistochemistry and reverse transcriptase-polymerase chain reaction, but not in the tumor cells. This suggested that the virus was not directly involved in the development of primary hepatic leiomyosarcoma.

Actins↗

PubMed2000

The benefits and new predictors of early extubation following coronary artery bypass grafting.

OBJECTIVE: This study researched cardiorespiratory effects and cost-effectiveness of early extubation in patients following coronary artery bypass grafting. METHODS: We retrospectively examined the character of 86 (38 preoperative, 12 intraoperative, 36 postoperative) variables in 78 patients after coronary artery bypass grafting (CABG) at our hospital. The patients were classified into three groups according to the time of extubation: Group A (less than 8 hours), Group B (8 to 24 hours) and Group C (24 hours or more). RESULTS: There were 43 patients in Group A (55%), 27 patients in Group B (35%), and 8 patients in Group C (10%). Univariate preoperative analysis revealed several differences between Groups A and B: 15 variables were found to reach statistical significance. Stepwise logistic regression analysis implicated decreased forced expiratory volume rate in the first second (FEV1.0%), postoperative cardiac index (CI) after admission to the intensive care unit (ICU) and usage of postoperative temporary pace-makers as predictors of late extubation. Also, there was a statistical significance in usage of diuretics within the first day (15.8+/-11.6 vs 28.8+/-22.6 mg; p = 0.044) and in the ICU days (3.6+/-0.8 vs 4.2+/-1.0; p = 0.004) between early and late extubation groups. CONCLUSIONS: Early extubation within 8 hours into the ICU stay was accomplished in 55% of the patients in this study. We speculate that the benefits of early extubation contain improvement of cardiac function, reduction in respiratory infection and complications, and cost saving as the result of diminished ICU admission. Also, we have shown that decreased FEV1.0%, decreased CI and the usage of a postoperative temporary pacemaker were independent predictors of prolonged intubation in our study.

Aged↗

PubMed2000

Atherosclerotic aneurysm of the intrathoracic segment of the subclavian artery: a case report.

True aneurysms of the intrathoracic segment of the subclavian artery are extremely rare. Atherosclerosis is the most common etiology. The surgical approach and timing of repair remain controversial. We successfully treated a patient with a large proximal subclavian artery aneurysm which was secondary to atherosclerosis. The patient was asymptomatic for 30 years as the aneurysm enlarged. Three-dimensional computed tomography provided the most useful information regarding anatomy of the cervical vasculature. The patient underwent closure of the inlet port of the aneurysm and repair using a 6-mm Dacron bypass graft (Gelsoft , VASCTEK, Scotland) via a minimally invasive surgical approach.

Aged↗

PubMed2000

Ascending aortic infected pseudoaneurysm with aortic insufficiency following cardiac operation for infective endocarditis.

An infected pseudoaneurysm of the ascending aorta after heart surgery is a fatal disease due to its rapid progress, worsening of the systemic condition and a tendency of recurrence. We report a 53-year-old man with this condition who presented with fever and an aortic regurgitation due to compression of the ascending aortic root 2 months after mitral valve replacement for infective endocarditis. We performed an aneurysmectomy with a cardiopulmonary bypass using groin cannulation and moderate systemic hypothermia. A pseudoaneurysm developed 5 mm proximally of the previous aortotomy. There was no dehiscence of the former aortic suture line. After debridement of the ascending aorta involving the previous aortotomy and pseudoaneurysm, we elected to directly close the aortic defect using Teflon felt strips to avoid a prosthetic graft. The aortic valve had no infective endocarditis and other abnormality. Postoperatively, there was no aortic regurgitation, and the cause of the previous aortic regurgitation was believed to be due to a compression of the aortic root from outside. The postoperative course has been good.

Aneurysm, False↗

PubMed1999

Surgical treatment of abdominal aortic aneurysms located close to the visceral arteries: report of three cases.

The standard surgical treatment for abdominal aortic aneurysms (AAA) is in situ replacement of the infrarenal aorta, which is associated with a low mortality rate. On the other hand, thoracoabdominal aortic aneurysms (TAA) remain a formidable challenge and the complications that can occur may be severe including neurologic dysfunction and renal failure. We report herein three cases of patients with AAA located very close to the visceral arteries, for which in situ replacement of the infrarenal aorta was not feasible due to severe inflammation and adhesion. Therefore, aortic stump closure and in situ bypass grafting was performed to avoid reconstruction of the visceral arteries. No major complications or operation-related deaths occurred. Thus, while in situ replacement is usually recommended over bypass grafting for patients whose aneurysms are located very close to the visceral arteries, aortic stump closure and in situ bypass grafting should be considered as a more effective surgical option.

Aged↗

PubMed1999

Automated and simultaneous identification of microsatellite instability by fluorescence-based polymerase chain reaction (PCR) in four loci.

Genomic instability is sometimes due to impairment of DNA repair systems, which results in a change in the number of microsatellite repeats in tumor cells, produced by slippage during DNA replication. Such abnormal repeats are manifested as microsatellite instability (MSI). We have devised a simple assay using four-color fluorescence for the detection of MSI by an automatic sequencer. Using this method, MSI and loss of heterozygosity (LOH) at four microsatellite loci can be identified simultaneously. We have also developed an algorithm and software for automated analysis of MSI and LOH with this method. Using our method for the detection of MSI in four microsatellite loci and the algorithm and software that we developed, 18 (94.7%) of 19 patients with hereditary nonpolyposis colorectal cancer (HNPCC), meeting the Amsterdam Minimum Criteria, were found to exhibit MSI.

Colorectal Neoplasms, Hereditary Nonpolyposis↗

PubMed1999

Detection of acute cardiac rejection by analysis of heart rate variability in heterotopically transplanted rats.

BACKGROUND: A less-invasive method for cardiac allograft surveillance than endocardial biopsy is needed. We analyzed heart rate variability of heterotopically transplanted rat hearts as a method of detecting rejection of rat cardiac allografts. METHODS: Two kinds of heterotopic transplants were performed: 1) Brown-Norway rats received Brown-Norway rat isografts, and 2) Lewis rats received Brown-Norway rat allografts. The electrocardiogram (ECG) of the grafts were serially recorded under non-anesthetized and non-restricted conditions using a telemetric ECG transmitter implanted in the recipient's abdomen. Frequency domain analysis of the ECGs was performed using a fast Fourier algorithm. RESULTS: Total power of the heart rate variability in the isograft heart was reduced to 1.1%, compared to normal subjects without transplantation (p < .001). In the allograft heart, it was also reduced to 1.0% on days 1.5 (rejection score 0 to 1), but gradually increased thereafter up to 185% on day 6 (rejection score 3.75+/-0.50). The increase in spectral power was frequency-dependent (i.e., changes in the power in lower frequency range [LF, 0.04 to 0.67 Hz] were significantly higher than other ranges). This increase was reversible when immunosuppressive therapy was performed with the use of cyclosporine A. In the allograft group, peak-to-peak amplitudes of the QRS complex and heart rate were significantly decreased on day 5.5 or later, whereas the power of the LF was significantly increased by day 3.5 or later. CONCLUSIONS: Our data suggest that heart rate variability analysis is a promising noninvasive marker for early detection of cardiac allograft rejection. This method may also provide a sensitive means of assessing the effects of immunosuppressive therapy.

Abdomen↗

PubMed1999

Penetrating atherosclerotic ulcer at the proximal aorta complicated with cardiac tamponade and aortic valve regurgitation.

A 56-year-old man had a penetrating atherosclerotic ulcer originating in the proximal ascending aorta, which is an unusual case of penetrating aortic ulcer complicated with the aortic valve regurgitation and cardiac tamponade. This hemodynamically unstable patient was successfully treated by conservative management to control his blood pressure and was also monitored closely with follow-up imaging studies.

Aortic Diseases↗

PubMed1999

[Detection of TT virus in healthy volunteer].

A novel DNA virus, TT virus(TTV), has been reported in Japanese patient with non A to G posttransfusion hepatitis. We sought to determine whether TTV infection occurs in healthy volunteer, and to compared with DNA extraction methods and polymerase chain reaction(PCR) primer for TTV in diagnostic system. Using a nested PCR assay, serum sample of healthy volunteer serve our laboratory in Japan were examined for the presence of TTV DNA. Twenty of 90(22%) healthy volunteer were detected to have TTV sequences in their serum. Also, we found that DNA extraction methods with a modified phenol-chloroform method. Our result suggested that detection of TTV DNA are high ratio of adults in Japan and were necessary to take care of selected using diagnostic systems.

Adult↗

PubMed1999

The role of previous infection of hepatitis B virus in Hbs antigen negative and anti-HCV negative Japanese patients with hepatocellular carcinoma: etiological and molecular biological study.

The aim of this study is to elucidate the important role of the previous infection of HBV, and the relations among HBV genome integration and p53 gene mutation, telomerase activity and genetic instability in liver tissue with HBsAg-negative (NB) and anti-HCV negative (NC) hepatocellular carcinoma (HCC). We examined the backgrounds of 34 NB and NC (NBNC) Japanese patients with chronic liver disease (CLD) patients not associated with HCC and 26 NBNC CLD patients with HCC. HBV genome integration into host cell genome, p53 gene mutation telomerase activity and genetic instability were examined in 6 with NBNC HCC (NBNC-HCC) tumorous tissue (T) and non-tumorous tissues (NT). In the NBNC group, HBV-related antibody positive patients with HCC are significantly more than the patients without HCC. Moreover, concerning the stage of the coexisted liver diseases, in NBNC CLD, LC patients with HCC is 19 of 26 (73.1%) , on the other hand, LC patients without HCC is 16 of 34 (47.1%). LC patients with HCC group is significantly more than that without HCC. Three (50%) of 6 in T and 3 cases (50% ) in NT were found to integrated genome of HBV. p53 gene mutation was observed in 3 (50%) of T. Concerning the telomerase activity, 3 of 6 cases (50%) in T and 1 case in NT was recognized. There was no genetic instability (LOH or RER) of D2S123, D3S1067 and TP 53 in T and NT. Finally in T of NBNC HCC cases, TTVDNA was detected in 3 of 5. Even in the HBsAg-negative and anti-HCV negative HCC cases, CLD coexisting with LC, previous HBV infection and HBVDNA integration were observed. There were a few cases with HBVDNA integration, p53 gene mutation, telomerase activity and genetic instability, simultaneously in HCC tissue, and in some cases, the coexistence with TTVDNA were concurrently confirmed. It is speculated that the important role of the previous infection of HBV may have also been proposed for HCC oncogentic progression in NBNC CLD [corrected].

Adolescent↗

PubMed1998

[A case of congenital partial pericardial defect and anomaly of phrenic nerve with cystic bronchiectasis].

Congenital partial pericardial defect is a rare anomaly that causes no symptoms and is often noticed by chance at autopsy or thoracotomy. During an operation on a patient with bronchiectasis, a partial pericardial defect and anomaly of left phrenic nerve were found incidently. A 58-year-old man complaining hemoptysis was referred to our hospital for surgical treatment of the left cystic bronchiectasis. During a thoracotomy, a partial pericardial defect was noticed. Moreover the left phrenic nerve could not be found within the operative field. We performed left pneumonectomy without repair of pericardial defect, and the patient had a satisfactory postoperative course. A relationship was suggested between congenital pericardial defect and the anomaly of the phrenic nerve.

Bronchiectasis↗