Search PubMed⌕ Search

Biomedical subjects

T Hiranaka

Publications and source records attributed to T Hiranaka.

44 records · Page 3Linked to original sources
PubMed1982

Reconstructive surgery for acquired valve disease.

There has been a continuing controversy between reconstructive valve surgery and replacement. In this paper, an analysis of clinical and hemodynamic late results of the patients undergoing open mitral commissurotomy (OMC, 135 patients), repair of mitral regurgitation (MAP, 32 patients), and combined valvuloplasty (62 patients) was presented. 1) OMC: The 10-year actuarial survival rate was 86.5% postoperatively. None of the patients required reoperation in this series. Clinical and hemodynamic improvements mainly depended upon the anatomical severity of a stenosed mitral valve. 2) MAP: The 10-year actuarial survival rate was 94% postoperatively. Especially, good to excellent results were obtained in the patients with mitral regurgitation due to ruptured chordae or dilated annulus. 3) Combined valvuloplasty: The 10-year actuarial survival rates postoperatively were 90% in OMC + tricuspid annuloplasty group (31 patients), 100% in MAP + tricuspid annuloplasty group (7 patients), and 87.2% in OMC + aortic commissurotomy group (24 patients). The reconstructive valve surgery provides very small operative risk, very low late mortality and morbidity. Therefore, it should be the treatment of choice for most of the patients with symptomatic valve disease.

Aortic Valve↗
PubMedDate not supplied

A new technique for the resection of gastric cancer: modified Appleby procedure with reconstruction of hepatic artery.

The Appleby operation allows resection of gastric cancer with lymph nodes around the stomach and celiac axis en bloc. Hepatic arterial blood flow after resection of the celiac axis is supplied by the superior mesenteric artery. In some patients, however, hepatic arterial flow becomes decreased after resection of the celiac axis. This abrupt reduction of hepatic arterial blood flow sometimes causes postoperative complications such as severe liver dysfunction or gallbladder necrosis. To prevent the reduction of hepatic arterial blood flow and to perform the Appleby operation more safely, we modified the Appleby operation to include reconstruction of the hepatic artery. We found that after dissection of lymph nodes around the hepatoduodenal ligament, the proper hepatic artery and gastroduodenal artery can be well mobilized and it becomes possible to anastomose the celiac axis to the common hepatic artery directly without using anticoagulants. From May, 1989 to November, 1990, 15 patients with advanced gastric cancer underwent the modified Appleby procedure at Kinan General Hospital. Postoperatively, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were determined for evaluation of liver function. These levels were almost the same as those found after traditional total gastrectomy without resection of the celiac axis. Indocyanine green (ICG) clearance tests were performed before and 1 month after operation. There was no significant difference between the preoperative and postoperative values. Common hepatic arterial flow after celiacohepatic anastomosis was 390 ml/min on average. The modified Appleby procedure can be done quite safely.

Adult↗
PubMedDate not supplied

Effects of sevoflurane anaesthesia on renal function.

The effects of sevoflurane on renal function were investigated in 34 patients anaesthetized with sevoflurane. Based on preoperative serum creatinine levels, patients were classified into three groups: Group 1 (n = 25) had normal renal function (serum creatinine < 1.0 mg/dl); Group 2 (n = 5) had slight renal dysfunction (1.0 < or = serum creatinine < 1.5 mg/dl); Group 3 (n = 4) had moderate renal dysfunction (serum creatinine > or = 1.5 mg/dl]. Serum creatinine, blood urea nitrogen and urine volume were measured preoperatively, and at Days 0, 1, 2, 7 and 28 after operation. Serum creatinine and blood urea nitrogen showed no significant postoperative differences (P < 0.05) in each group, whereas urine volume showed a significant increase until Day 2, with no further changes thereafter. Our results suggest that sevoflurane anaesthesia causes no significant renal damage in patients with normal and insufficient renal function under normal-duration anaesthesia within 3-4 h.

Adult↗