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Biomedical subjects

T Takaba

Publications and source records attributed to T Takaba.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Coronary artery disease in patients with abdominal aortic aneurysm].

To evaluate the influence of coronary artery disease (CAD), we reviewed 102 patients who underwent elective repair of abdominal aortic aneurysm (AAA) between 1982 and 1992. Prior to surgery, all patients underwent clinical evaluation for the presence of CAD including dipyridamole thallium scintigraphy. They were classified into the following groups: Group I (n = 66), no clinical evidence of CAD; Group II (n = 26), clinical evidence of stable CAD; Group III (n = 10), unstable CAD. Coronary angiography (CAG) was performed in group II and group III patients only. All patients in group I and group II underwent elective repair of their AAA without coronary revascularization. Eight patients in group III underwent CABG followed by elective AAA repair within two months. One of two patients who had impending ruptured AAA underwent combined CABG and AAA repair as a single operation and the other underwent AAA repair followed by CABG. One case of perioperative myocardial infarction occurred in group II, but there was no early postoperative death related to cardiac disease in group I and II. In group III, however one patient who underwent combined surgery died of low-output syndrome in the early postoperative period, no death or myocardial infarction occurred following staged operation in the other nine patients. This present results support the contention that CAG is not necessary in all AAA patients, and that they can be managed according to appropriate risk by a selective approach based upon clinical assessment of their CAD. It is also apparent that a staged operation can be performed very safely in patients with unstable CAD.

Adult↗
PubMed1994

[Dissecting aortic aneurysms that occurred in aged brothers without Marfan syndrome].

The occurrence of familial dissecting aortic aneurysms without Marfan syndrome is rare. This report describes two aged siblings who underwent successful surgery for this disease. Neither patient had the clinical features of Marfan syndrome, and both had histories of systemic hypertension. Case 1: A 76-year-old man had dissecting aortic aneurysm, DeBakey type IIIa, which was localized and had multiple lumina with thrombi. Case 2: A 71-year-old man (younger brother of case 1) had retrograde dissecting aortic aneurysm, DeBakey type IIIa. Histological examinations of the aortae showed cystic medial necrosis in both cases, and also showed atherosclerotic changes in case 1. These two siblings had no familial history of cardiovascular incidents and were much older than previously reported cases. Therefore it may be possible that the dissecting aortic aneurysms of these two cases occurred coincidently rather than due to hereditary factors.

Aged↗
PubMed1994

[Asymptomatic bilateral spontaneous pneumothorax].

Two surgical cases of bilateral pneumothorax founded at a medical examination were reported. Case 1; A 15-year-old male was admitted to our hospital pointed out left spontaneous pneumothorax without complaints. The interval between the first and the contralateral pneumothorax was 3 weeks. He was treated with a one-stage operation through a bilateral axillary incision. Case 2; A 19-year-old male was admitted to our hospital pointed out left spontaneous pneumothorax without complaints. Surgical operation was performed with a left axillary incision. One year after the treatment, he was pointed out right spontaneous pneumothorax on his chest X-ray film. Partial resection of the right lung was performed with a right axillary incision. Of the 261 pneumothorax patients, 28 had bilateral pneumothorax in our hospital. The majority of these patients had complaints which were chest pain, dyspnea and cough. Of the 28 patients, 2 had no complaints at the time of admission. We conclude that we have to follow up carefully the patients with hemilateral spontaneous pneumothorax.

Adolescent↗
PubMed1994

[A case of mediastinal malignant lymphoma; 16 years follow up after surgery].

A 32-year-old female was admitted to our hospital on September 1976 because of left mediastinal mass shadows on chest roentgenogram. Needle biopsy studies provided no definitive diagnosis, and exploratory operation was carried out through left postero-lateral thoracotomy. Two large masses were seen in the mediastinum and five small tumors were seen on the diaphragm. All of these masses were removed. Histopathological examination of the tumors indicated non-Hodgkin's lymphoma, diffuse small cell type. Radiation therapy was carried out postoperatively, but chemotherapy could not continue because of side effect. Eight years after surgical therapy, recurrence was seen at left parietal pleura, ten years at peritoneum, twelve years at left parietal pleura, thirteen years at upper mediastinal lymph node, 16 years at post-peritoneal space. These tumors disappeared after radiation therapy. She is doing well seventeen years after the surgery.

Adult↗
PubMed1994

[Coronary artery bypass grafting to total occlusion of all three coronary vessels].

We studied total occlusion of all three coronary arteries. From 1975 to 1992, a total of 4,100 patients underwent coronary arteriography at Show University Hospital. Of these, four patients (0.1%) had complete occlusion of all three coronary arteries and all of them underwent coronary artery bypass grafting (CABG). The mean numbers of coronary risk factors were only 2.3 but history of angina of effort were long-standing such as 4 to 29 years (mean 16.3 yr). All cases had previous episodes of myocardial infarction. Three cases (75%) had aortic aneurysm. One case was also diagnosed as Leriche syndrome besides coexisting aneurysm. Coronary arteriogram showed total occlusion of right coronary artery, left anterior descending artery and left circumflex artery in the segment of 1.6 or 7 and 11 respectively. All cases had intracoronary anastomosis and intercoronary anastomosis. Among 12 occluded coronary arteries of all four cases, 11 were distally visualized with contrast medium via collateral flow but good opacification of the distal coronary trees were not seen. Also proper assessments of cardiac performance including viability of myocardium were not established because all cases were in the state of C.C.S grades IV. But significant clinical recovery were obtained in all cases after CAGB of three or four bypass. We conclude that these results might be a useful suggestion for the treatment of total occlusion of all three coronary arteries.

Aged↗
PubMed1993

[Surgical treatment of tuberculous abscess in chest wall].

A case of chest wall tuberculosis with empyema is reported. A 45-year-old woman with a history of right lung pleuritis was admitted to our hospital with right shoulder pain. The chest X-ray film showed abnormal shadow in the right lower lung field. Chest CT revealed right posterior chest wall abscess and localized empyema. Bacterial examination of the chest wall abscess obtained by needle aspiration biopsy disclosed positive acid-fast bacilli. Three months after starting antituberculous therapy with INH, RFP and SM, the chest wall abscess had been increased and abscess drainage was performed. After two months of tube drainage, the abscess was diminished in size and enucleation with primary closure was performed. Antituberculous chemotherapy was continued. One year after surgery, no sign of recurrence was observed and the residual empyema was decreased.

Abscess↗
PubMed1993

[A case of intrathoracic colon perforation due to adult Bochdalek hernia].

The patient, a 70-year-old man, diagnosed as having left pneumothorax and hydrothorax, was admitted and had a thoracic drain inserted. The evacuation of stool was noted from 3 days after insertion. With the abscess in the left thoracic cavity shown on emergency CT, a diagnosis of perforation of the digestive tract in the left thoracic cavity was made and emergency operation was performed. On the basis of the intraoperative findings, the case was diagnosed as adult Bochdalek hernia with intrathoracic colon perforation, and repair of hernia and colostomy were done by laparotomy and thoracotomy. However, the patient died of DIC and sepsis 5 days after operation. Two cases of adult Bochdalek hernia complicated with spontaneous pneumothorax have hitherto been report. However, there has been no reported case which had adult Bochdalek hernia complicated with pneumothorax considered due to intrathoracic colon perforation as in this case. So this case was considered very rare and worthy of reporting.

Aged↗
PubMed1993

[Single selective cerebral perfusion for aortic arch replacement].

The patients underwent aortic arch replacement for aneurysmal disease from 1988 to 1993 using a simplified cardiopulmonary bypass (CPB) technique with single selective cerebral perfusion (single SCP). Recently cold cerebral perfusion technique was also used. In order to study the effect of this technique, we monitored bilateral carotid artery pressure, blood oxygen saturation of jugular vein and brain oxygenation by near infrared spectroscopy during CPB. Of the ten patients with arch aneurysm, five had urgent operation for ruptured aneurysm. The cold single SCP was accomplished by perfusion to the right axillary artery using separate pump and separate heat exchanger (flow 10-15 ml/kg/min, pressure 40-60 mmHg, perfusion temperature under 12 degrees C) under the low CPB flow (1,000-1,500 ml/min), moderate systemic cooling (23-25 degrees C) and retro-grade cardioplegia. There were no strokes caused by this technique. This simplified technique of cold single SCP was simple and attractive method, provide satisfactory cerebral protection.

Aged↗
PubMed1991

[Aortitis syndrome associated with aortic regurgitation and coronary ostial stenosis: a case of successful surgical treatment at the active stage].

A 24-year-old woman with aortic regurgitation and ostial stenosis of coronary artery due to aortitis syndrome was reported. She was admitted to the hospital with anterior chest pain. Retrograde aortogram showed aortic regurgitation and selective coronary angiogram revealed severe ostial stenosis. In spite of steroid therapy, chest pain was not controlled. In spite of the active stage, she underwent aorto-coronary bypass and aortic valve replacement. Intra-aortic balloon pumping (IABP) was necessary to wean from cardio-pulmonary bypass, but she recovered well and no complication was recognized after operation.

Adult↗
PubMed1991

[Mitral valve replacement in idiopathic hypereosinophilic syndrome].

Idiopathic hypereosinophilic syndrome (IHES) is a rare systemic manifestation of eosinophilia that may cause endocardial fibrosis and thrombus formation. We presented a 48-year-old man with rapid onset of intractable congestive heart failure during the course of chemotherapy for IHES. After the urgent operation, which included left ventricular thrombectomy and mitral valve replacement the patient was asymptomatic, but died 1 month after operation because of development of IHES. Atrioventricular valve replacement may be beneficial to selected patients with congestive heart failure associated with the cardiac process of the IHES and review of the literature led us to prefer porcine heterograft prostheses in patients with IHES.

Eosinophilia↗
PubMed1991

[Evaluation of treatment of lung cancer combined with the disease which has needed a semi-emergency operation].

Six cases of lung cancer combined with the disease which has needed semi-emergency operation, two cases of unstable angina, two of ileus due to colon cancer, one of impending rupture of abdominal aortic aneurysm and one of purulent cholecystitis with cholelithiasis, were discussed. Mean age was 62.0 years (range, 36 to 73); four were male and two were female. Case 1 and 2 were admitted with anterior chest pain, Case 3 with lumbago and abdominal pain, Case 4 and 5 with an abnormal shadow on chest x-ray film and Case 6 with abdominal pain. Of the two with unstable angina, one was operated on with right upper lobectomy during the first months after aorto-coronary bypass. Of the two with colon cancer, one was operated on with right upper lobectomy during about 5 weeks after right hemi-colectomy. Case 3 with abdominal aortic aneurysm operated on with left upper lobectomy during 4 weeks after replacement of abdominal aorta. Case 4 with cholecystitis was operated on with left pneumonectomy during about 3 weeks after cholecystectomy. The postoperative course of 4 cases and the post-chemotherapy condition of 2 cases were uneventful.

Adenocarcinoma↗
PubMed1991

[A surgically treated case with lung cancer on maintenance hemodialysis].

Maintenance hemodialysis for chronic renal failure has spread all over the country, and the number of patients in whom surgical indications are considered to concomitant diseases has been increasing. A 76-year-old male was admitted due to lung cancer on maintenance hemodialysis. The chest roentgenogram showed a 2.5 cm sized coin lesion in the right middle lung field. Preoperative examinations, chest tomography, chest CT-scanning, bone scintigraphy, bronchofiberscopic biopsy, etc. led to a diagnosis of primary lung cancer (squamous cell carcinoma). Hemodialysis with prescribing nafamostat mesilate (40 mg/hour) was performed the day before the operation and on the first, fourth and sixth postoperative days. There was no postoperative bleeding. The patient has been well for 27 months postoperatively.

Aged↗
PubMed1991

[A case of spontaneous rupture of the esophagus].

Spontaneous rupture of the esophagus is rare. It's initial symptoms are so varied that we often have a hard time for making early diagnosis of esophageal rupture. In this case, emergency surgery was performed immediately after early diagnosis by chest CT. When the left thoracotomy was done, the upper portion of the stomach protruded with it's mucous membrane was reflected outward into the thoracic cavity above the diaphragm. When the reflected stomach was drawn back into the abdominal cavity for replacement, a ruptured wound of about 5 cm was observed on the left wall of the esophagus above the diaphragm. The stomach was seen protruded from this ruptured wound of the esophagus, with the mucous membrane reflected outward. No pathological abnormalities of esophagus itself was detected even after through investigation to search the cause for this clinically manifested weakness of the esophageal wall which eventually ruptured causing protrusion of the upper portion of the stomach into the thoracic cavity. The mechanism of this gastric protrusion is difficult to define. The most informative diagnostic investigation was the chest CT.

Adult↗
PubMed1991

[Combined valvular and coronary artery surgery].

We report 14 consecutive patients who have undergone myocardial revascularization combined with valve surgery during 7 years (1983-1989). There were 7 males and 7 females with a mean age of 53.8 years. All patients had congestive heart failure and 7 had angina pectoris. Coronary angiography revealed single-vessel disease in 6 patients, double-vessel disease in 5, triple-vessel disease in 3. Mitral regurgitation was predominant in 5, aortic regurgitation in 5, mitral stenosis in 3 and aortic stenosis in 1. The indicated operations were: valve replacement in 12 and mitral anuloplasty in 2 with coronary artery bypass grafting (mean 1.6). One operative and 1 late death were seen in our series, however, NYHA functional class was improved from 3.4 to 1.7 postoperative. Postoperative evaluation by UCG showed good recovery of cardiac function (EF, MVcf, LVEDV, CI). No angina pectoris was evident in surviving patients, the quality of life was significantly improved.

Aged↗
PubMed1991

[A study of glomerular damage due to extracorporeal circulation--meaning and usefulness of measuring of urinary microalbumin].

An increase of excretion of urinary microalbumin (U-Alb) is thought to demonstrate earlier glomerular damage than deterioration of Glomerular Filtration Rate (GFR). In this study, the meaning and usefulness of measuring U-Alb before, during and after Extracorporeal Circulation (ECC) was estimated. In 25 cases of adult cardiac surgery, we measured U-Alb, and simultaneously as current indices of glomerular function, serum and urinary creatinine, blood urea nitrogen, serum beta 2-microglobulin, urine volume, and cardiac output were measured. Albumin Excretion Rate (AER) [U-Alb X urine volume] and Albumin Index (AlbI) [U-Alb/U-Cr] were calculated as indices of U-Alb, and Creatinine clearance (Ccr) was calculated as GFR. The changes of each parameter, the correlation AER and AlbI during and after ECC with parameters that relate to ECC, and the assessment of the prolongation of glomerular damage after operation that possibly progress to acute renal failure were investigated. Our results showed AER and AlbI to increase following ECC with high values maintained during and after ECC, in spite of recovery of Ccr, from 24 hours to 4 days postoperatively. AER and AlbI recovered at 7 days and 14 days after surgery, respectively. The existence of glomerular damage, not indicated by a change in Ccr, was indicated by increases of AER and AlbI. The damage was thought to be temporary glomerular dysfunction. In correlation of AER and AlbI with ECC parameters, ECC of long duration influenced the glomerular damage as indicated by an increase of AER and AlbI.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[A case of esophageal duplication cyst associated with a total left pericardial defect].

Esophageal duplication cyst associated with pericardial defect in a 57-year-old man is reported. Differential diagnosis was very difficult in the preoperative examination. The tumor was a cyst and its wall was a perfect replica of normal esophagus e.g. esophageal duplication, and total left pericardial defect also was found at the operation. There was no malignant or inflammation findings in the excised specimens. The association of esophageal duplication cyst associated with pericardial defect is very rare.

Esophageal Cyst↗
PubMed1990

[Nonsurgical retrieval of intra-cardiovascular catheter fragments].

Migrated intra-cardiovascular fragments from broken catheters were retrieved transvenously in 6 cases. In all of these cases, the catheters had been used for total parenteral nutrition. The catheter fragments were lodged in the pulmonary artery in 3 cases and in the right atrium in the others. A basket-type grasping forceps modified for this retrieval technique was inserted via the subclavian vein, femoral vein or basilic vein percutaneously. The migrated catheter fragments were removed successfully without any clinical complications in all 6 cases. Appropriate evaluation of the lodging site and length of the fragment, and careful examination of general condition should be carried out prior to this procedure. This noninvasive maneuver is simple, safe and reliable, and can be promptly. It is considered to be a reliable method of choice in cases of migrated catheter fragment.

Aged↗