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T Hiranaka

Publications and source records attributed to T Hiranaka.

At least 19 recordsLinked to original sources
PubMed2001

Recurrent hepatic portal venous gas in a patient with hemodialysis- dependent chronic renal failure.

We report a case of recurrent hepatic portal venous gas (HPVG). A 51-year-old woman who had been undergoing hemodialysis for 19 years was admitted with abdominal pain. Computed tomography (CT) scans revealed the presence of HPVG, and bowel necrosis was confirmed at operation. After 1 year, the abdominal pain recurred. CT scans on the second admission also revealed HPVG; however, an exploratory laparotomy was negative. Recurring presentation of HPVG in the same patient has not been described previously.

Embolism, Air↗
PubMed1999

Choledochal cyst associated with polycystic kidney disease: report of a case.

We report a very rare case of type I choledochal cyst associated with a polycystic kidney disease. A 48-year-old female had been dependent on hemodialysis for chronic renal failure due to polycystic kidney disease and was incidentally diagnosed to have a dilated common bile duct by an ultrasonography. An endoscopic retrograde cholangiopancreatography showed a spindle-shaped, dilated common bile duct (type I choledochal cyst) without visualization of the pancreatic duct. She underwent a resection of the choledochal cyst. Intraoperative cholangiography showed no reflux of contrast medium into the pancreatic duct. Amylase level of the aspirated bile from the bile duct was not elevated. In the case of choledochal cyst combined with renal fibropolycystic disease, pancreaticobiliary maljunction may not contribute to the etiology of choledochal cyst. In such cases, management of choledochal cyst is still controversial and requires further discussion.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

[Electromyographic findings in muscles around the osteoarthritic knee: integrated electromyography and frequency analysis].

An evaluation of the muscular functions of the vastus medialis, vastus lateralis, rectus femoris, medial hamstring, and of the lateral hamstring was performed using electromyography in 33 knees of 26 female patients with osteoarthritis (OA group) and in 25 knees of 19 healthy female volunteers (control group). During standing on both feet, all muscles in the OA group showed higher IEMG (integrated electromyography) and higher LMR (IEMG of vastus lateralis/IEMG of vastus medialis ratio in the quadriceps; and lateral hamstring/medial hamstring ratio in the hamstrings) than the control group. These augmentary muscular activities ameliorated the varus deformity caused by the osteoarthritis. During maximum isometric voluntary contraction, the OA group showed lower extension and flexion torque of the knees and also lower IEMG than to the control group, while the IEMG of vastus lateralis was not lower. These findings indicated decreased muscular activities in the osteoarthritic knee, and that the activity of the quadriceps was maintained mainly by the vastus lateralis under such conditions. Frequency analysis of the myoelectric signal during maximum isometric voluntary contraction revealed a single peak of low frequency in the power spectrum density function of the quadriceps and double peaks of low and of high frequency in the hamstring. In the OA group, the peak height of the low frequency component was increased in the quadriceps and decreased in the hamstring. We concluded that the duration of the motor unit action potentials was affected in the osteoarthritic knee.

Aged↗
PubMed1994

[A case report of patch angioplasty of the left main coronary artery for isolated left main coronary artery disease].

A 49-year-old woman was admitted to our hospital because of palpitation and right shoulder pain. Examinations showed isolated left main coronary artery disease. Surgical angioplasty of left main coronary artery was considered. The left main stem was approached anteriorly. Pericardium was chosen for patch material and the left main coronary artery was enlarged from 1.5 to 4.0 mm in diameter. Postoperative course was very stable, and postoperative angiography revealed an excellent result.

Angioplasty↗
PubMed1994

[A case report of type A acute aortic dissection, which arose from true aneurysm in aortic arch].

A 69-year-old woman was admitted to our hospital because of back pain. Examinations showed type A acute aortic dissection, which arose from true aneurysm in aortic arch, and emergency operation was considered. Deep hypothermic selective cerebral perfusion was carried out for brain protection. Ascending to aortic arch was replaced with 24 mm woven Dacron graft. There was no postoperative neurological complication.

Acute Disease↗
PubMed1994

[Analysis of left ventricular function early after coronary artery bypass grating in patients with left ventricular dysfunction].

We analyzed left ventricular (LV) function early after coronary artery bypass grafting (CABG) in patients with LV dysfunction, whose LV ejection fraction (LVEF) was less than 0.4. 11 patients were divided into two groups: Group-A patients (G-A: n = 6) improved LVEF (post-op LVEF > 0.4) and Group-B patients (G-B: n + 5) did not improve LVEF (post-op LVEF < 0.4) one month after CABG. Preoperative status of coronary artery disease, cardiac function, operative procedure, and postoperative cardiac function were compared between two groups. All patient had old myocardial infarction. There were no differences in preoperative LVEF (0.30 +/- 0.06 in G-A and 0.31 +/- 0.06 in G-B), CI, and LVEDP between two groups. LVEDVI (85 +/- 19 in G-A and 159 +/- 50 ml/m2 in G-B) and LVESVI (60 +/- 14 in G-A and 113 +/- 49 ml/m2 in G-B) values were higher in G-B, respectively. Number of grafts was not different between two groups (2.3 in G-A and 2.4 in G-B). Postoperative LVEF value (0.53 +/- 0.07 in G-A and 0.34 +/- 0.04 in G-B) was lower in G-B. Thus, it might be difficult to obtain the recovery of LV function in patients with LV dilatation, early after CABG.

Adult↗
PubMed1993

Coronary artery bypass grafting for left main trunk coronary artery lesion associated with essential thrombocythemia.

Effort angina due to left main trunk (LMT) lesion was diagnosed in a 58-year-old man. Platelet count was markedly increased and essential thrombocythemia was also diagnosed. Because of LMT disease, coronary artery bypass grafting (CABG) was performed prior to medication for essential thrombocythemia. There were no complications during the operation or in the early postoperative period. Melphalan was administered postoperatively resulting in the decrease of platelet count. Postoperative coronary angiography demonstrated that both grafts were patent; however, immediately after coronary angiography, the patient suffered from a sudden onset of myocardial infarction and cerebral infarction. The therapeutic problems associated with hematological disorder in such patients are discussed in this report.

Angina Pectoris↗
PubMed1993

[Coronary artery bypass grafting in six patients with familial hypercholesterolemia].

UNLABELLED: From June 1989 through November 1991, six patients with familial hypercholesterolemia underwent surgical treatments. The surgical procedures were coronary artery bypass grafting (CABG) alone 4, ligation of coronary aneurysm + CABG 1, and CABG + femoro-femoral bypass 1. There were no operative or hospital deaths. Early post operative patency rate of the grafts was 100%. CASE PRESENTATION: A 44-year-old man whose anginal pain recurred 11 years after CABG. Coronary angiogram revealed stenosis and a large aneurysm in the circumflex coronary artery. Previous grafts to the left anterior descending coronary artery and diagonal branch were patent. Ligation of the aneurysm and internal mammary artery bypass grafting were performed. Postoperatively, the patient has remained asymptomatic. Our data indicate that CABG for FH patients is effective in the early postoperative period.

Adult↗
PubMed1993

[A case report of congenitally bicuspid aortic valve and ascending aortic aneurysm treated by wheat operation].

A 59-year-old man who complained of palpitation was diagnosed as having a congenitally bicuspid aortic valve, severe aortic regurgitation, and an ascending aortic aneurysm. He underwent aortic valve replacement and conduit replacement by the modified Wheat technique. Since this technique requires no coronary artery anastomosis, it causes no problems associated with reconstruction of the coronary artery. Postoperative angiogram revealed no aneurysm formation of the aortic root or paravalvular leakage. This case suggest that aneurysm of the ascending aorta with aortic regurgitation is more effectively treated by the modified Wheat technique if cephalad displacement of the coronary ostium is not extensive.

Aorta↗
PubMed1993

[The effectiveness of preservation of hepatic arterial blood flow by modified Appleby procedure with reconstruction of the hepatic artery--serial changes in postoperative liver function].

We investigated whether modified Appleby procedure with reconstruction of the hepatic artery can avoid complications due to a decrease in heptic arterial flow which has been comprehended in conventional Appleby's operation. The postoperative liver function of 17 patients undergoing modified Appleby's procedure was compared with that of 16 patients undergoing total gastrectomy and distal pancreato-splenectomy (control group). (1) Anticoagulant therapy was not required during and after operation. The common hepatic arterial flow after vascular anastomosis was 396 +/- 101 ml/min. Postoperative celiac arteriography revealed good patency of anastomosis. (2) There were no significant differences between the modified Appleby group and the control group in any of the blood levels of GOT, GPT total bilirubin and alkaline phosphatase at any point until the fourth postoperative week. In none of the patients in the modified Appleby group, the blood levels of GOT and GPT exceeded 250 IU/l. (3) In the modified Appleby group, ICG-R15 was 4 +/- 1% before operation and 6 +/- 3% at the first postoperative month. These results suggested that modified Appleby procedure enabled us to perform resection according to Appleby's operation safely, without need for preoperative or intraoperative examination about the retrograde blood flow mediated by the gastrodudenal artery.

Adult↗
PubMed1993

[Report of a case of angiodysplasia of the sigmoid colon associated with aortic stenosis].

Partial sigmoidectomy and then after 84 days aortic valve replacement were performed as a staged operation on a patient with Heyde syndrome, consisting of aortic stenosis and angiodysplasia of the sigmoid colon. An emergent sigmoidectomy was performed because of continuous bleeding from angiodysplasia of the sigmoid colon. Postoperative arteriography showed the persistence of angiodysplasia. Endoscopic examination of the residual angiodysplasia was performed before and after valve replacement and there was no morphological change.

Aged↗
PubMed1993

[Single-stage management of postoperative sternal wound infection using a pectoral musculocutaneous flap].

Two patients with postoperative sternal wound infection were successfully treated by a pectral musculocutaneous flap. A single-stage procedure of debridement and immediate closure with a pectral musculocutaneous flap can eliminate irrigation, open wound management, or reoperation for closure. Therefore, this method is very safe, simple, and effective for the management of sternal wound infections.

Aged↗
PubMed1992

[A case of ischemic mitral regurgitation treated by mitral annuloplasty (MAP) and coronary artery bypass grafting (CABG)].

A 79-year-old woman with a previous history of myocardial infarction, suffered acute myocardial infarction again. A coronary angiogram revealed triple vessel disease, and a left ventriculogram showed severe mitral regurgitation. The patient fell into cardiogenic shock after cardiac catheterization, and IABP was started. She underwent MAP and saphenous vein bypass grafting to the left anterior descending coronary artery and left circumflex coronary artery. Although the postoperative course was complicated by acute renal failure and respiratory dysfunction, the patient recovered from the operation and was discharged on the 137th postoperative day. Since the operative mortality of conventional valve replacement combined with CABG in ischemic mitral regurgitation has been high, we preferred MAP for this case.

Aged↗
PubMed1992

[Two cases of severe ischemic mitral regurgitation treated with CABG alone].

We report here two cases in which patients fell into pulmonary edema due to ischemic mitral regurgitation (ischemic MR) after cardiac catheterization and underwent emergency coronary artery bypass grafting (CABG) using an intra-aortic balloon pumping. The patient were a 65-year-old man and a 80-year-old woman, and both had a chief complaint of angina after myocardiac infarction. In both cases, coronary angiography revealed triple vessel disease, and left ventriculography showed severe MR. However echocardiography, when they were hospitalized, did not show significant MR. Therefore we thought that they had gone into congestive heart failure because cardiac ischemia and volume load following cardiac catheterization provoked MR. In fact, postoperative left ventriculography and echocardiography showed decreased MR. We now think that it is important to keep in mind the cases of severe ischemic MR for which CABG alone is adequate treatment and to evaluate ischemic MR not only by left ventriculography but also by echocardiography.

Aged↗
PubMed1991

[Timing of operation based on evaluation of postoperative left ventricular contractility in patients with aortic regurgitation].

To evaluate the effect of aortic valve replacement on left ventricular function in aortic regurgitation, the ratio of end-systolic wall stress to end-systolic volume index (ESS/ESVI) and standard ejection phase indexes of left ventricular function were measured angiographically in 29 patients with isolated, chronic aortic regurgitation before and an average of 26 months after aortic valve replacement. The patients were divided into three groups based on preoperative left ventricular volume at end-systole (ESVI); 12 patients had an ESVI smaller than 100 ml/m2 (group I), 11 had an ESVI of 100 to 200 ml/m2 (group II) and 6 had an ESVI greater than 200 ml/m2 (group III). Postoperatively, end-diastolic volume index and ESVI decreased markedly in all 3 groups and end-systolic stress also decreased. Systolic pump performance assessed as ejection phase indexes improved in all groups with group I and group II showing normal or near-normal ejection fraction, while group III still had a depressed ejection fraction. Left ventricular contractile function as assessed by ESS/ESVI improved significantly in each group postoperatively. After operation, group I patients had normal values. However, both group II and group III still had a subnormal ratio, suggesting a depressed contractility despite normal or near normal systolic pump performance. Surgical correction for aortic regurgitation should be considered before a preoperative ESVI exceeds 100 ml/m2, to preserve postoperative left ventricular contractility.

Adult↗
PubMed1991

[Operation of coronary artery aneurysm after previous coronary artery bypass grafting].

A 43-year-old male, who had undergone coronary artery bypass grafting 11 years ago, developed exertional chest pain. Selective coronary angiograms revealed severe stenosis and a large aneurysm in the obtuse marginal branch of the circumflex coronary artery. Previous grafts to the left anterior descending coronary artery and diagonal branch were patent. Ligation of the aneurysm and internal mammary artery grafting were performed through a left anterolateral thoracotomy. This approach made it easy to reach the aneurysm and to minimize bleeding during dissecting the adhesions. The patient had an uncomplicated postoperative course, and postoperative coronary angiograms revealed an obstructed aneurysm and a patient internal mammary artery graft. He has done well without recurrence of symptoms.

Adult↗
PubMed1990

[A successful surgical repair of ventricular septal perforation following acute myocardial infarction in a 83-year-old man].

A 83-year-old man, who experienced a sudden severe malacia 13 days before, was admitted, complaining of dyspnea since 8 hours before. A loud systolic murmur of Levine IV/VI was audible on the left sternal border of the 4th intercostal space. The chest X-ray film demonstrated severe pulmonary congestion. The ECG showed abnormal Q waves in II, III, a VF and V1-5. The right heart catheterization revealed an intraventricular shunt from left to right and thus ventricular septal perforation (VSP) 13 days after acute anteroseptal-inferior myocardial infarction was diagnosed. Continuing an aggressive medical treatment with the intraaortic balloon pumping, an emergency operation for VSP was performed 2 days after the onset. A single Teflon patch was sutured on the left side of the septum around VSP (2.5 x 2.5 cm) and the ventricular free wall was closed including the patch with two felt strips. The patient survived through the operation and is doing well at the 11 months of follow-up. Twenty patients above 70 years old have been surgically treated with success for VSP after acute myocardial infarction in Japan. Our patient was the oldest.

Aged↗