Biomedical subjects
Publications and source records attributed to T Iwa.
A 62-year-old woman with adenoid cystic carcinoma which recurred 10 years after sleeve middle lobectomy was reported. Completion pneumonectomy was performed and her postoperative course was uneventful. If pulmonary function permits, reoperation for recurrent lung cancer should be attempted.
Treatment for patients with ischemic heart disease and hypothyroidism contains many difficulties, such as a dilemma that thyroid hormone to hypothyroid patients may worsen angina. The purpose of this study is to propose an appropriate control of thyroid function in these patients before coronary artery bypass grafting (CABG), and to clarify the change of thyroid function during postoperative period. Because of progressive angina pectoris, five hypothyroidism patients underwent CABG. Preoperatively, minimal dose of L-Thyroxine (0-75 micrograms, daily) was administered orally to keep thyroid function at slightly low level before CABG. Ten consecutive CABG patients with normal thyroid function were selected as control group. Between both groups, there was no significant difference in age, coronary artery disease, and the number of bypass grafts. Serum T4, free-T4, T3, free-T3, and TSH were measured at 1st, 2nd, 3rd, and 7th P.O.D. In control group, pituitary-thyroid function was suppressed transiently. In hypothyroid group, T4 revealed no change and was kept at slightly low level during observed period. There was no significant difference in postoperative hemodynamics between both groups. Postoperatively all of hypothyroid patients got free from angina and received an adequate thyroid hormone replacement therapy without complications. It is concluded that CABG for patients with angina and hypothyroidism can be performed safely by keeping preoperative thyroid function at slightly low level.
Greater clarification has resulted since the discussion at the 38th Stomach Cancer Research Meeting on the frequency of a cancer developing in the remaining portion of a stomach after excision of a previous gastric cancer. Further, fewer reports have appeared of early stage cancers in the remaining stomach. Reported here is a case of a patient with an early stage stomach cancer, type I, that occurred 5.5 years after resection of an early stomach cancer, type IIc + III, at a point some distance removed from the anastomosis of the remaining stomach. Total extirpation of the remaining stomach resulted. Two years later, surgery to remove a pulmonary small cell carcinoma in this patient also was performed. The paper presents a study of this case.
The electrical phenomena produced during the fulguration impulses are analyzed using a digital oscilloscope which enables the calculation, with precision, of the energies consumed all along the curve or between chosen times. Moreover, it enables the calculation of the corresponding impedance values and shows that the latter varies during all the discharge. The explanation for these impedance variations is obtained thanks to rapid cinematography, showing the formation of the fulguration bubble. Hence, one can observe an impedance variation which is quite distinctive from the one which would correspond to the simple passage of an electrical current in saline solution. Particularly at the end of the impulse, an important increase in the impedance corresponds to the loss of ionization of the bubble. Therefore, by simply reading these electrical parameters, it is possible to know the main stages of the fulguration phenomenon for impulses situated around the deflagration threshold.
A case of successful surgical treatment of DeBakey IIIb dissecting aortic aneurysm with the true lumen obstruction of the thoracic descending aorta is presented. A 64-year-old male was admitted to our hospital with a complaint of severe chest and back pain. Immediately antihypertension therapy was carried out. But, after 14 days, acute renal failure was occurred by the true lumen obstruction of the thoracic descending aorta. On the 78 days after hospitalization, the flow reversal thromboexclusion by ascending aorta-abdominal aorta bypass and permanent aortic clamping was done. The reasons why this procedure was selected are as follows: 1) widely extended dissection, 2) renal failure, 3) poor pulmonary function, 4) left hemiparesis due to apoplexy. The post-operative course was excellent, paraplegia did not occur and renal function improved very well. The post-operative CT revealed thrombi formation within the thoracic descending aorta.
We described two patients with postoperative sternal osteomyelitis with mediastinal abscess who were successfully treated by omentopexy. One was a 15-year-old boy. Five days after accessory pathway division for Wolff-Parkinson-White syndrome, he was diagnosed as having sternal osteomyelitis. Cultures of the exudate yielded staphylococcus epidermidis. Closed continuous irrigation with diluted povidone-iodine was not effective. After open drainage, omentopexy with an omental pedicle flap was performed. Postoperatively, computed tomography showed no abnormal findings in the omental flap and surrounding tissue. The second patient was a 33-year-old man. Re-aortic valve replacement for aortic regurgitation was performed. Eleven days after the operation, he was diagnosed as having postoperative sternal osteomyelitis. Cultures of the drainage fluid yielded staphylococcus epidermidis. Continuous closed irrigation with povidone-iodine was ineffective. Thus, the wound was opened and omentopexy with an omental pedicle flap was performed. The postoperative course was uneventful. Computed tomography showed no residual abscess or recurrent inflammation. We conclude that the omentopexy is useful in the treatment of postoperative sternal osteomyelitis.
This paper reports a 73-year-old male case of lung cancer presenting as thin-walled cavity which was suspected to be pulmonary mycosis of the fungus ball type. Routine chest X-ray film showed a thin-walled cavity without a round shadow inside it. CR tomogram taken 2 months after the previous plain chest X-ray film showed an irregular thickening of the cavity wall and a round shadow inside it. Pulmonary mycosis of the fungus ball type was suspected based on the CR tomogram. But chest X-ray CT film taken 1 month after the previous CR tomogram revealed that the entire cavity wall was thickened with irregular convexity and no round shadow was seen in the cavity. Cavitary lung cancer was also suspected based on the findings of X-ray CT film. The surgical specimen, obtained by right upper lobectomy, revealed a moderately differentiated squamous cell carcinoma unaccompanied by pulmonary mycosis in the cavity space. Even in cases suggestive of mycosis, aggressive surgical intervention is recommended in those suspected of malignancy.
Using the same methods as for the measurement of electrical parameters by means of an oscilloscope with a wave shape calculator to determine at all points the energy and impedance values, as well as high speed cinematography, the analysis of the behavior of these parameters for shocks with energies close to those used in clinical medicine can be carried out. It shows namely an important decrease in the impedance at the current peak due to an important ionization of the fulguration bubble. It underlines the different behavior of the anode and cathode bubbles, in relation with the size of the bubbles obtained thanks to rapid cinematography. Comparative measurements concerning the polarity, the size of the indifferent electrode, the medium used in vitro and in vivo have supplied the elements to enable the precise determination of the adequate electrical parameters for the good use of fulguration.
Reestablishment of gastrointestinal continuity following resection of pharyngoesophageal carcinoma can be a challenging problem. Recent developments in vascular surgery have made microvascular anastomosis possible and practical. At present free intestinal interposition grafts and revascularization of the proximal end of pedicle grafts offer the surgeon new options. From 1983 through 1989, reconstruction with vascular anastomosis was performed in 18 cases with pharyngoesophageal carcinoma. Patients were 47 to 88 years old, mean 62.1 years. Reconstructive methods included; free jejunal graft in 14, revascularization of proximal end of a pedicled gastric tube in 1, revascularization of proximal end of a pedicled jejunum in 1, interposition of free jejunal graft between a pedicled gastric tube and the pharynx in 1 and interposition of free ileal graft between a pedicled jejunum and the cervical esophagus in 1 case. Modified radical neck dissection was performed in all cases and superior mediastinal lymph node dissection with median sternotomy was added in 5. The internal jugular vein and common carotid artery were the donor vessels of choice, but in the case of severe sclerosis of the carotid artery, another cervical artery was chosen. The vascular anastomosis was performed using interrupted 7-0 Prolene sutures in the anterior wall and running 7-0 Prolene sutures in the posterior wall under 2.25 magnification. The patency of the anastomosed vessels was confirmed by Doppler flowmeter. The postoperative following-up periods ranged from 1 to 73 months with a mean of 16.5 months, and the survival rate was 66.2% at 1 year and 42.6% after 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Transesophageal two-dimensional echocardiography (TEE) was evaluated in 14 patients who underwent coronary bypass surgery. The TEE transducer was positioned to view the left ventricular short axis at the level of the papillary muscle. Global left ventricular function was assessed by measuring left ventricular end-diastolic and end-systolic area and computing the fractional area change (FAC). Regional left ventricular function was analyzed after dividing the short axis view of the left ventricle into four anatomic segments. The mean FAC was 48% after intubation, 48% after skin incision, 47% after sternotomy, and 51% after pericardiotomy. The mean FAC increased significantly to 55% 0 to 30 minutes after cardiopulmonary bypass, and was 53% at the end of the operation. In 5 patients, FAC decreased and regional wall motion abnormalities appeared around sternotomy. These abnormalities was considered due to transient myocardial ischemia. In 7 patients, a paradoxical motion of the ventricular septum occurred at closing of the sternum. TEE was performed without complication and found to be a good method for assessing global and regional left ventricular function.
The occurrence of both tricuspid atresia and WPW syndrome is quite rare. To our knowledge, only two operated cases have been reported. In this report, a 8-year-old boy with this combination was reported. Tachycardia via the right side accessory pathway was for the first time pointed out after Kreutzer's operation. Epicardial mapping showed the earliest excitation at the right free wall. When fatty tissue around this area was removed by CUSA, a large cardiac vein appeared. By holding this vein with a forceps, the delta wave disappeared temporarily. ACP seemed to be present near this vein. Permanent disappearance of the delta wave was obtained after ligation and division. Four months after surgery, he is free from tachycardia attacks.
Two cases of atrial tachyarrhythmias with atrial flutter requiring cryosurgical treatment are reported. In two cases, preoperative electrophysiological studies revealed supraventricular reentrant tachyarrhythmias during atrial flutter and showed enhanced conduction through the AV node that conducted atrial impulses rapidly to the ventricle. Based on intraoperative endocardial mapping, the earliest excitation site was localized along the AV node and His bundle during supraventricular tachyarrhythmias in one case. The cryosurgical treatment was administered at Koch's triangles and in one case additionally at coronary sinus. After the operation, supraventricular tachyarrhythmias were not inducible and no clinical recurrences have occurred. Normal atrioventricular conduction was preserved in two cases. We concluded that cryosurgical treatment is useful for the treatment of the atrial tachyarrhythmias.
The internal mammary artery has been advocated for use in coronary artery bypass grafting because of its excellent long-term patency. We compared the flow capacities of internal mammary artery and saphenous vein grafts under exercise conditions by means of radionuclide angiocardiography. Fifty-two patients were divided according to the type of bypass graft done to the left anterior descending artery: group 1 comprised 27 patients with the internal mammary artery graft, and group 2 included 25 patients with the saphenous vein graft. Saphenous vein grafts were placed into the right and circumflex systems. Before the operation, global and regional ejection fractions decreased similarly in both groups with exercise. After the operation, the global ejection fraction measured in groups 1 and 2 increased significantly from 54% +/- 2% to 57% +/- 2% and from 54% +/- 1% to 60% +/- 2%, respectively, the anteroseptal ejection fraction from 29% +/- 1% to 32% +/- 2% and from 29% +/- 1% to 35% +/- 1%, respectively, and the apical ejection fraction from 75% +/- 3% to 82% +/- 2% and from 77% +/- 2% to 86% +/- 2%, respectively. There were no differences in exercise-induced increases in the global and regional ejection fractions between groups 1 and 2. Six patients in group 1 had exercise-induced wall motion abnormalities at the anteroseptal and/or apical segments. In contrast, patients in group 2 had no exercise-induced wall motion abnormalities at these segments (p less than 0.05, group 1 versus group 2). Results of this study show that internal mammary artery grafts respond to the increased blood flow demand of exercise in essentially the same way as saphenous vein grafts. However, there seems to be a slightly greater potential for inadequate flow in patients with the internal mammary artery graft, as evidenced by the small group of patients with exercise-induced wall motion abnormalities.
The patient was 21 year-old male with recurrent sustained VT following complete repair of tetralogy of Fallot. He underwent complete repair of tetralogy of Fallot at the age of 3. Eight years after the operation, he first noted episode of tachycardia. Sustained VT was first documented 15 years after operation, and he required direct-current cardioversion for this tachycardia. Because of life threatening arrhythmia he was transferred to our hospital for surgical management. Sustained VT was induced and found to originate from the inflow-septal and outflow area of right ventricle. During the operation only right outflow type tachycardia could be induced by programmed stimulation. Diastolic fractionated local electrical activity, which suggested a reentrant circuit, was recorded at the outflow epicardial area. The outflow muscle (2 X 2 cm) showing the earliest excitation during VT was excised with cryocoagulation at the outflow tract. The resected area was closed with a Gore-Tex patch using continuous sutures. Another cryocoagulation was applied to the inflow-septal area prophylactically. After surgery, a so-called non-clinical VT was inducible, however this VT could be prevented by antiarrhythmic drugs. No spontaneous episodes of VT have been postoperatively observed for 2 months.
Twelve patients had elective surgical treatment for the aneurysm of the ascending aorta with aortic insufficiency at the Kanazawa University School of Medicine between 1976 and 1987. There were 9 men and 3 women aged from 26 to 39 years (mean, 33.0 years). Seven patients had a Marfan's syndrome and 6 of these patients also had aortic dissection. Three patients had aortic valve replacement plus supracoronary tube graft (Wheat's operation) and the other 9 patients underwent composite tube graft, with Bentall's operation in 3, Cabrol's operation in 2, and the modified Bentall's operation in which prosthetic valve was offset inside the tube graft in 4. Early deaths accounted for an operative mortality of 16.7%. The mean aortic cross-clamp time and the amount of bleeding were less with the modified Bentall's operation than with the other composite tube graft procedures. This modification seems to decrease the morbidity and to simplify the procedure in treatment of aneurysm of the ascending aorta with aortic insufficiency. There were 2 late deaths of patients with Marfan's syndrome associated with type I aortic dissection. Regular periodic examinations of the patients is needed, especially when Marfan's syndrome is present, in order to detect and surgically correct residual lesions.
Simultaneous recording of epicardial activation from multiple sites during anti-arrhythmic surgery is essential to determine the location of the arrhythmic source. We formed a new sock from Presnet tubular dressing material with 87 snap electrodes. Bipolar recording sites, 1.0 mm in diameter and separated 1.5 mm, are constructed of gold and attached to steel wire directly at the male snap without button. This new Sock and Snap electrode was used to record in 7 patients; 5 of WPW syndrome and 2 of non-ischemic ventricular tachycardia. Satisfactory epicardial contact was obtained in all patients without any hemodynamic change. We could get a rapid display of epicardial mapping using a computer.
A patient with complex cardiac anomalies who developed severe respiratory insufficiency due to high pulmonary blood flow from a giant PDA was treated successfully by PDA banding. PDA-dependent heart disease causes a reduction in pulmonary blood flow in many patients and is often treated by palliative shunt operation. Although the present patient had PDA-dependent heart disease, heart failure occurred due to increased pulmonary blood flow through PDA and required surgical treatment. We performed PDA banding, because it is technically simple and allows adjustment of the postoperative pulmonary blood flow according to the degree of constriction. The degree of constriction was determined according to the PaO2 value. SO2 levels of 60-70% have been used as an index of the extent of banding, but PaO2 is considered to be equally appropriate.
Endocavitary discharge produces an electrical spark at the end of the probe. This in turn produces a plume of steam which lasts for about ten milliseconds and which subsequently acts like a cavitation bubble. This phenomenon is well known in the branch of physics dealing with dynamics and fluids, and should be subjected to rapid kinetic recording. It may make it possible to explain various barotraumas which are observed during the discharge. However, the plumes of steam produced by the discharge have some highly specific features which are due to the fact that the discharge is usually produced using a monopole in an electrolyte. In addition, the shape of the electrode also affects the formation of the bubble. This results in a description of the cavitation bubble produced by the discharge as the "discharge bubble".