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Biomedical subjects

T Iwa

Publications and source records attributed to T Iwa.

At least 127 records · Page 7Linked to original sources
PubMed1989

[Complete occlusion both left main coronary artery and right coronary artery].

A 67-year-old man, who had complete occlusion both of left main coronary artery (LMCA) and right coronary artery (RCA), underwent coronary revascularization. He had been suffering from severe angina pectoris preoperatively. Exercise electrocardiogram (single Master) showed myocardial ischemia. On cardiac catheterization, he showed extensive collaterals from right main coronary artery, and well-preserved left ventricular function. At operation, coronary arteries revealed severe sclerosis, especially in RCA, but there was no evidence of old myocardial infarction. Three saphenous vein grafts were bypassed to LAD, LCX, and RCA. Postoperatively, he remained free of angina pectoris at 6 months after uneventful surgery.

Aged↗
PubMed1989

[Two cases of leiomyosarcoma of the duodenum].

Two cases of a leiomyosarcoma of the duodenum are reported. The first patient, a seventy-year-old woman, had experienced repeated instances of melena. She was diagnosed as having a leiomyosarcoma of the duodenum preoperatively, and was successfully given a pancreatoduodenectomy. The second patient, a fifty-one year-old woman, also had experienced instances of melena. Similarly, she was diagnosed an having leiomyosarcoma of the duodenum preoperatively, and was given a partial gastrectomy. A pathological examination showed little mitosis in either patient. The first patient is still alive three months after the operation, and the second patient also has been surviving for twelve years postoperatively.

Aged↗
PubMed1989

[Application of a lung stapler to reduce tension on the internal mammary artery].

In-situ internal mammary artery (IMA) grafts have a better patency rate than free IMA grafts. Every effort is made to leave the IMA as an in-situ graft attached to the subclavian artery. A 56-year-old patient underwent reoperation because of occlusion of the vein graft to the left anterior descending coronary artery (LAD). At the second operation, the left IMA was anastomosed to the segment of the LAD distal to the first anastomotic site. The hyperinflated lung crossed the midline and stretched the IMA graft. The herniated portion of the left lung which stretched the IMA graft was resected with a 9-cm long linear stapler along the course of the IMA graft. No harmful effects were observed. This is a simple and safe method to reduce the tension on the IMA graft due to the hyperinflated lung.

Hernia↗
PubMed1989

[Skeletal muscle ventricle used for right ventricle assistance].

There are a number of advantages in using an electrically stimulated autogenous skeletal muscle to construct an auxiliary ventricle to assist a heart. The purpose of this study was to determine the feasibility of biological right ventricular assistance using long-term electrically stimulated skeletal muscle grafts. In fourteen dogs, the latissimus dorsi muscles and the right thoracodorsal nerves were exposed and unipolar pulse generator was implanted. The initial rate of 70 cycle/min. was increased to a rate of 100 cycle/min. Six or 12 months later, the latissimus dorsi was wrapped around a latex pouch equipped with inflow and outflow valved conduit (skeletal muscle ventricles; SMVs). The SMVs were connected to main pulmonary artery and right atrium. These SMVs were stimulated 20 Hz for 200 msec at a fixed rate of 90 cycle/min, the hemodynamic changes with or without skeletal muscle ventricular assistance (SMVA) were measured. In as animals the circulation failed after total right ventricular bypass without SMVA. But the SMVA increased aortic blood pressure, aortic blood flow, left atrial pressure and peak pulmonary pressure significantly. There was a linear correlation between central venous pressure and skeletal muscle ventricular assist flow. Histologic studies showed the conditioned muscles had a greater percentage of slow-twitch, fatigue resistant fibers on ATPase stain. These results suggested the long-term electrical conditioning skeletal muscle could be possible to use SMVs in humans to provide support in children with some types of congenital heart disease.

Animals↗
PubMed1989

[Successful surgical treatment of atrial tachyarrhythmias].

Three cases with ectopic atrial tachycardia and two cases with atrial flutter (AF), unresponsive to drugs, are described clinically and electrophysiologically. The three patients of ectopic atrial tachycardia were treated by surgical removal of ectopic focus and cryocoagulation of the adjacent area, not using cardiopulmonary bypass. All of them have been in sinus rhythm and had shown no tachycardia since the operation. In one patient of AF, cryosurgical ablation around the atrioventricular (AV) node and His bundle has prevented AF without AV block. Another patient of AF underwent cryoablation around the orifice of the coronary sinus, which was the earliest activation area during AF in endocardial mapping. In this patient, AF reappeared, so cryoablation around the AV node and His bundle was performed. His heart rate decreased to 120 beat/min from 270 beats/min during AF and a radiofrequency pacemaker (Atricon) was implanted to interrupt the remaining AF. This cryosurgical procedure is successful to modify and preserve AV conduction.

Adolescent↗
PubMed1989

[A successful surgical treatment of mitral stenosis of double mitral valve combined with aortic regurgitation].

The purpose of this paper was to present a successful double mitral commissurotomy concomitant with aortic valve replacement for 45-year-old female who was found to have rheumatic fever in her history. Double mitral valve was incidentally diagnosed by means of preoperative echocardiography. Both orifice areas were almost same and measured as 0.70 and 0.71 cm2 in size. Double mitral commissurotomy was successful to obtain optimal areas of mitral valve at surgery and aortic valve replacement was carried out with #23 Björk Shiley prosthesis. Her postoperative course was uneventful and followed up one year after operation at present. This is the first case in the literature of successful surgical treatment of double mitral commissurotomy combined with aortic valve replacement.

Aortic Valve↗
PubMed1989

[A successful treatment of Cabrol's procedure for annuloaortic ectasia with an acute aortic dissection (Stanford type A)].

A 67-year-old female who has an Annuloaortic ectasia with an acute aortic dissection was urgently admitted to our hospital. She was also suspected to have developed into an acute cardiac tamponade. An aortic dissection was arised from just above the right coronary artery orific and extended to the innominate artery and the right common carotid artery. In this case Cabrol's procedure with cerebral perfusion technique was considered to be a good indication, but standard Cabrol's procedure provided almost satisfactory results without utilizing a cerebral perfusion technique because disappearance of pressure difference between both hands and the right common carotid artery after reconstruction. Her postoperative course was uneventful and aortography confirmed competence of the prosthetic valve, good patency of the coronary arteries without false aneurysm formation. Cabrol's procedure is a reliable method for Annulo-aortic ectasia especially with an acute aortic dissection of the ascending aorta.

Acute Disease↗
PubMed1989

[Evaluation of internal mammary artery graft patency by intraarterial digital subtraction angiography].

Intraarterial digital subtraction angiography (DSA) was performed to evaluate graft patency in 45 patients undergoing coronary artery bypass grafting with the use of internal mammary artery (IMA). Fourty-five IMA grafts and 59 saphenous vein grafts were evaluated using a DSA equipment with a pulse mode of 2 frames per second. A 4F catheter was introduced percutaneously into the left brachial artery. Nonionic contrast medium was nonselectively injected into the left subclavian artery for visualization of IMA grafts and also into the aortic root for visualization of vein grafts. No serious complications occurred. Forty-four IMA grafts and 53 vein grafts were patent. The patency rate was 97.8% for IMA grafts, 89.8% for vein grafts, and 93.3% for all grafts. In 11 patients (24%), intercostal or pericardial branches were visualized. Two patients showed a string sign of the IMA. Intraarterial DSA with nonselective injection of contrast medium into the subclavian artery is a new method for evaluation of IMA graft patency with a low risk.

Adult↗
PubMed1989

[A surgical case of mediastinal cystic lymphangioma].

A surgical case of a 33-year-old male with mediastinal cystic lymphangioma is reported. He was referred to our hospital for examination of mediastinal tumor. Chest X-ray film revealed an abnormal shadow in the left aorto-pulmonary window. CT scan of the chest visualized a smooth-walled, homogenous structure of this mass. MRI showed same findings as CT scan but could not suggest further information. He was operated on under the diagnosis of Castleman's lymphoma or thymic cyst. On thoracotomy, a bulging cystic mass was found in the middle mediastinum just beneath the aortic arch. The cyst was completely removed, and his postoperative course was uneventful. Pathological diagnosis was a mediastinal cystic lymphangioma. Cystic lymphangioma usually occurs in the neck, and rarely occurs in the mediastinum. Only about 30 cases of mediastinal cystic lymphangioma have been reported in the Japanese literatures.

Adult↗
PubMed1988

Total gastrectomy with left oblique abdominothoracic approach for gastric cancer involving the esophagus.

From January 1972 to December 1982, we performed 70 total gastrectomies with left oblique abdominothoracic approach for gastric cancer involving the esophagus. We emphasize that the diaphragm should be incised "U-shaped" from its origin to avoid respiratory tract failure due to phrenic nerve damage. Combined resection was performed in all cases either because of direct tumor invasion or because of lymph node dissection. Operative mortality occurred in only three cases (4.3%). There were nine cases (12.8%) of postoperative complications; in these cases, the complications were nonfatal. The five-year survival rates of patients were 60% in stage II, 27% in stage III, and 20% in stage IV, according to the Union Internationale Contre le Cancer-1978 staging classifications.

Adenocarcinoma↗
PubMed1988

Intraoperative evaluation of coronary bypass grafts by measuring myocardial blood flow using the electrolytic hydrogen clearance method.

The regional myocardial blood flow (MBF) was measured in 33 patients who underwent coronary bypass graft surgery in order to evaluate the efficiency of coronary bypass grafts in restoring MBF. MBF was measured by the electrolytic hydrogen clearance method during the coronary bypass surgery. The mean prebypass MBF was 161 +/- 19, 162 +/- 12, 80 +/- 12, 43 +/- 14, 104 +/- 18 ml/min/100 g in segments supplied by the left anterior descending coronary artery (LAD) showing less than or equal to 50 per cent, 75 per cent, 90 per cent, 99 per cent, and 100 per cent stenosis with collaterals, respectively. After bypass grafting of the LAD, the mean MBF increased from 70 +/- 13 and 126 +/- 12 ml/min/100 g to 133 +/- 14 and 163 +/- 9 ml/min/100 g in the segments with and without infarction, respectively. The mean postbypass MBF was 149 +/- 10 and 152 +/- 14 ml/min/100 g in the segments supplied by the LAD bypassed with saphenous vein grafts and mammary artery grafts, respectively. Postbypass MBF was dependent upon the magnitude of myocardial infarction. Measurement of MBF by the electrolytic hydrogen clearance method made it possible to quantitatively evaluate myocardial perfusion at the time of operation. It also provided direct information about the effectiveness of myocardial revascularization.

Blood Flow Velocity↗
PubMed1988

Bronchial stricture due to endobronchial tuberculosis.

From 1974 to 1986, there were 14 cases of bronchial stricture or obliteration caused by endobronchial tuberculous lesions. Nine cases had histories of tuberculosis but five were suspected of having malignant respiratory passage obstruction at the initial diagnosis. Five cases were kept under observation because of mildness of the subjective symptoms or refusal of operation. Nine cases underwent operation. As the bronchial lesions in three cases were confined to the lobar or segmental bronchus, lobectomies were done. One case with a history of infantile tuberculosis developed complete obliteration of the left main bronchus and cystic bronchiectasis in the entire lung parenchyma, so pneumonectomy was inevitable. Five cases which had strictures in the main bronchus underwent bronchoplastic surgery. The operative procedures were right sleeve upper lobectomy in four cases and left sleeve upper lobectomy in one case. All of the cases undergoing operation showed no post-operative complication or recurrence of the tuberculosis. The results of our present series of tuberculous bronchial stricture indicate the need for early detection and operation. For the cases with main bronchus involvement, bronchoplastic surgery should be selected as an alternative to pneumonectomy to preserve the pulmonary function.

Adult↗
PubMed1988

Median sternotomy as an approach for pulmonary surgery.

A median sternotomy incision was employed in 73 cases of pulmonary surgery instead of posterolateral thoracotomy. An anterior mediastinal approach was used in three groups of patients: group 1 patients (47 cases) underwent simultaneous bilateral surgery for pulmonary disorders on both sides, in group 2 patients (15 cases), this approach was selected to facilitate surgery on the involved mediastinal structures, and group 3 patients (11 cases) had left lung cancer with extensive dissection of lymph nodes done via median sternotomy, as well as routine dissection of nodes by posterolateral thoracotomy. A median sternotomy approach for pulmonary surgery provided an excellent operative field, and most patients experienced less postoperative pain and a quicker recovery. The surgical indications for this approach, the surgical procedure, the results, and the advantages and disadvantages of using a median sternotomy incision are discussed.

Angiography↗
PubMed1988

Serial assessment of left ventricular function following coronary bypass surgery by radionuclide angiocardiography.

The serial change in left ventricular function was investigated by radionuclide angiocardiography in 25 patients undergoing coronary artery bypass grafting (CABG). Multiple gated equilibrium blood pool imaging was performed at rest before, and at 1, 2 and 4 weeks after the operation and also during exercise on a supine bicycle ergometer before and 4 weeks after surgery. Global ejection fraction at rest was unchanged after CABG while peak ejection rate increased significantly at 1 and 2 weeks (p less than 0.01 and p less than 0.05 respectively) after the operation. Peak filling rate at rest was generally unchanged after surgery but peak filling rate during the first third of diastole at rest decreased significantly at 1 and 2 weeks (p less than 0.01 and p less than 0.05). After CABG, the increases in ejection fraction and peak ejection rate with exercise were significantly greater than those values measured before surgery. The increases, due to exercise, in peak filling rate and peak filling rate during the first third of diastole were unchanged after the operation. Radionuclide angiocardiography affords a safe, noninvasive, and highly reproducible procedure for serially assessing ventricular function in patients undergoing CABG. Our study revealed early diastolic dysfunction within 2 weeks of surgery and that CABG abolished abnormalities in left ventricular function induced by exercise.

Aged↗
PubMed1988

The clinical value of high-frequency jet ventilation in major airway reconstructive surgery.

High-frequency jet ventilation (HFJV) via a catheter with internal diameter 2.4 mm was employed in 21 patients to facilitate airway reconstructive surgery. Tracheal reconstruction was performed in six cases, sleeve lobectomy in six and sleeve pneumonectomy in nine. An HFO-Jet-Ventilator was used at individually selected settings of 0.5-2.4 kg/cm2 for driving gas pressure and 4-10 Hz frequency. Intermittent positive pressure ventilation (IPPV) was used initially, with switch to HFJV at the time of tracheobronchial reconstruction. The time during which HFJV was employed ranged from 25 to 65 min. Except for transient hypoxia or hypercapnia in a few patients, the results of blood gas analyses during HFJV were satisfactory. The most appropriate HFJV settings for each surgical procedure and the advantages of HFJV over IPPV are discussed.

Adult↗