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Taijiro Sueda

Publications and source records attributed to Taijiro Sueda.

At least 37 records · Page 2Linked to original sources
PubMed2006

[A case of recurrent esophageal cancer responding to second-line chemotherapy of TS-1/docetaxel combination].

A 70-year-old man suffering from advanced esophageal cancer (Stage II) underwent subtotal esophagectomy in December 2000. He then had postoperative chemotherapy, called low-dose FP, and was followed in an ambulatory setting. In December 2003, he was diagnosed as a recurrence of esophageal cancer with multiple liver metastases and upper mediastinum lymph node, so he was treated by combined chemotherapy consisting of TS-1 and docetaxel as a second-line chemotherapy. After 3 courses of this therapy, CT scan showed that the size of liver and lymph node metastases was reduced and the effect of this therapy was PR. PR continued for about 6 months. This chemotherapy made it possible to treat liver and lymph node metastasis in an ambulatory setting. It is conceivable that this combination chemotherapy might be a promising regimen for a short period.

Aged↗
PubMed2006

[Bacteria isolated from surgical infections and its susceptibilities to antimicrobial agents--special references to bacteria isolated between April 2003 and March 2004].

Tendency of isolated bacteria from infections in general surgery during the period from April 2004 to March 2005 were investigated in a multicenter study in Japan, and the following results were obtained. In this series, 645 strains including 17 strains of Candida spp. were isolated from 226 (79.0%) of 286 patients with surgical infections. Three hundred and seventeen strains were isolated from primary infections, and 345 strains were isolated from postoperative infections. From primary infections, anaerobic Gram-positive bacteria and anaerobic Gram-negative bacteria were predominant, while aerobic Gram-positive bacteria were predominant from postoperative infections. The isolation rate of aerobic Gram-positive bacteria, such as Enterococcus spp. and Staphylococcus aureus were higher from both types of infections. Among anaerobic Gram-positive bacteria, the isolation rate of Peptostreptococcus spp. was the highest from both types of infections. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Pseudomonas aeruginosa, Klebsiella pneumoniae and Citrobacter freundii in this order, and from postoperative infections, P. aeruginosa was the most predominantly isolated, followed by E. coli, E. cloacae, and K. pneumoniae. Among anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group was the highest from both primary infections followed by Bilophila wadsworthia. While the isolation rate of B. fragilis group was also the highest from postoperative infections, the following bacteria were Bacteroides thetaiotaomicron and B. wadsworthia in this order. In this series, we noticed no vancomycin-resistant Gram-positive cocci, but a few strains of moderately arbekacin-resistant MRSA. Carbapenem-resistant P. aeruginosa but not multidrug-resistant was seen in 13.3 per cents. Also cefazolin-resistant E. coli probably producing extended spectrum beta-lactamase was seen in 7.0 per cents. We should be carefully followed up the facts that an increasing isolation rates of B. fragilis group and B. wadsworthia which were resistant to both penicillins and cephems.

Anti-Bacterial Agents↗
PubMed2006

Evoked spinal cord potentials monitored at thoracoabdominal region after trans-intercostal stimulation.

To investigate the feasibility of a novel recording method for trans-intercostal evoked spinal cord potentials (Tic-ESCPs) and the properties of the waveforms, the potentials were recorded and analyzed in an animal model. In two beagle dogs, Tic-ESCPs were recorded at the left twelfth intercostal to fourth lumbar nerves following stimulation at the left eleventh intercostal nerve, either with or without the use of a muscle relaxant. The amplitude and latency of the Tic-ESCP waves were then measured and compared with those of conventional transcranial spinal motor evoked potentials (MEPs). Tic-ESCPs could be obtained at any nerve, with or without the use of a muscle relaxant. The Tic-ESCP waveform was clear and simple, consisting of a small positive (P1) wave and a subsequent large negative (N1) wave. As the site of recording moved farther from the stimulation site, the N1 amplitudes were reduced and the P1 latency was prolonged. Under muscle relaxation, the N1 amplitudes were reduced, and the P1 latencies were shorter. As compared with MEPs, Tic-ESCPs could be evoked by a weaker stimulus, the N1 amplitude was smaller, and the P1 latency was shorter. Tic-ESCP recording was feasible either with or without the use of a muscle relaxant. The Tic-ESCPs showed simple and clear waveforms with smaller stimulations. Therefore, Tic-ESCPs may be useful for intraoperative spinal cord monitoring.

Abdomen↗
PubMed2005

Perioperative diagnosis of mesenteric ischemia in acute aortic dissection by transesophageal echocardiography.

OBJECTIVE: Although computed tomography, angiography, or magnetic resonance imaging is most commonly used for diagnosing mesenteric ischemia caused by acute aortic dissection, use of these modalities is often limited in the perioperative period. Thus, we have introduced transesophageal echocardiography to cover this deficit. Purpose of this study is to report the feasibility and accuracy of transesophageal echocardiographic diagnosis on mesenteric ischemia. METHODS: The consecutive 24 cases with acute aortic dissection which involved abdominal aorta and underwent surgery were examined. The celiac artery and superior mesenteric artery was visualized with 5 MHz biplane transesophageal echocardiography and was assessed for presence of dissection and blood flow in each of true and false lumen. The transesophageal echocardiographic findings were then correlated to the clinical course, computed tomographic findings, and laboratory data. RESULTS: The celiac artery and superior mesenteric artery was successfully visualized in 24 cases (100%) and 23 cases (95.8%), respectively. Perfusion patterns in superior mesenteric artery were categorized into four patterns: (1) intact artery with adequate perfusion (type A: 14 cases); (2) dissection in the artery but with adequate perfusion in true lumen (type B: 5 cases); (3) dissection in the artery with narrowed true lumen compressed by false lumen without detectable blood flow (type C: 1 case); and (4) obstruction of arterial orifice by the intimal flap with narrowed true lumen in the proximal aorta (type D: 2 cases). One case with immediate postoperative death and another case with unsuccessful visualization of superior mesenteric artery were excluded from the analysis. Clinically apparent intestinal ischemia was present in three cases: one case with type C and two cases with type D, but in none of the remaining 19 cases with type A or type B (both sensitivity and specificity were 100%). The superior mesenteric artery was opacified in all of these three cases with ischemia. CONCLUSIONS: The transesophageal echocardiographic assessment is feasible in nearly all patients and potentially provides correct diagnosis on intestinal ischemia in the perioperative period of acute aortic dissection. Types C and D indicate significant mesenteric malperfusion.

Acute Disease↗
PubMed2005

Bacterial translocation: not a clinically relevant phenomenon in colorectal cancer.

The aim of this study was to identify the risk factors for bacterial translocation and to determine the clinical significance of bacterial translocation in patients with colorectal cancer. Mesenteric lymph node sampling was performed to identify the presence of bacterial translocation in 75 patients with colorectal cancer undergoing laparotomy. Bacterial translocation was identified in 29 patients (39%), with the most common organism being Escherichia coli (31%). Three factors for bacterial translocation were identified, including a preoperative low peripheral lymphocyte count, metastasis to lymph nodes, and invasion depth (= T3). Stepwise regression analysis, however, selected only = T3 [odds ratio (OR) 4.0, 95% confidence interval (CI) 1.2-13.5]. Altogether, 35% of patients with bacterial translocation developed septic complications, compared with 20% in patients without bacterial translocation. In the multivariate analysis, bacterial translocation was not an independent risk factor for infection, with an OR of 1.8 (95% CI 0.56-5.96). Systemic inflammatory response syndrome developed on the first day in 62% of patients with bacterial translocation, compared with 50% of patients without bacterial translocation. Adjusting for the other factors, bacterial translocation was not a significant risk factor in the occurrence of systemic inflammatory response syndrome after surgery (OR 1.1, 95% CI 0.37-3.29). We concluded that in patients with colorectal cancers bacterial translocation does occur and is increased in patients with deep invasion. However, it appears to be of no clinical significance.

Adolescent↗
PubMed2005

A novel endothelial function test using Doppler flow: the snuff-box technique.

Precise measurement of Doppler estimated blood flow volume using the standard technique of flow-mediated vasodilation is not possible because the anatomic course of the brachial or radial artery goes against the principle of Doppler measurements that the insonation angle should be less than 30 degrees . The radial artery in the anatomic snuff-box area is useful for the measurement of Doppler signals as the insonation angle is less than 30 degrees and because the size of the artery allows observation of laminar flow. We introduce the snuff-box technique as a novel endothelial function test that enables measurement of both blood flow and diameter of the radial artery. Changes in diameter and blood flow volume during reactive hyperemia were examined in 15 healthy volunteers. Changes in blood flow determined using the snuff-box technique were compared with changes in forearm blood flow determined by plethysmography. The diameter of the radial artery increased from 2.3 +/- 0.2 mm at baseline to 2.8 +/- 0.4 mm at 60 s after deflation (P = 0.0017), and blood flow increased from 52.3 +/- 21.4 ml/min at baseline to 108.6 +/- 33.1 ml/min at 15 s after deflation (P = 0.0014). Percentile blood flow determined by the snuff-box technique correlated significantly with that determined by plethysmography (r = 0.824, P = 0.0002). Both blood flow volume and artery diameter can be measured with high reliability using the snuff-box technique, as has been shown in subjects with reactive hyperemia.

Adult↗
PubMed2005

A novel canine model of spinal cord ischemia with reproducible neurologic outcomes.

PURPOSE: To develop a canine model of spinal cord ischemia (SCI) with highly reproducible neurologic outcomes. METHODS: Spinal cord ischemia was induced by cross-clamping the proximal descending aorta. To produce substantial ischemia in the critical lumbar region, the proximal aortic blood pressure (PAP) was reduced to 80 mmHg by withdrawing blood into a reservoir connected to the left subclavian artery. We conducted an intraischemia spinal cord electrophysiologic study and a postischemia assessment of hindlimb motor function in six animals subjected to this procedure with an aortic occlusion time of 40 min, and in six animals subjected only to aortic occlusion for 60 min. RESULTS: All the animals subjected to this procedure exhibited a significant decrease in motor-evoked spinal cord potentials to transcranial electric stimulation (MEPs) during the acute ischemic phase, and they were paraplegic 48 h after ischemia. In contrast, two of the animals not subjected to PAP reduction showed complete functional recovery with intact MEP findings. CONCLUSION: This model is feasible for experimental SCI studies because it can reliably and easily reproduce substantial ischemia.

Animals↗
PubMed2005

Vascular function in patients with lower extremity peripheral arterial disease: a comparison of functions in upper and lower extremities.

Peripheral arterial disease (PAD) is caused by atherosclerosis. Assessment of endothelial function in patients with PAD has been limited to that in forearm circulation in previous studies. The purpose of this study was to evaluate vascular function in upper and lower extremities in patients with PAD and to determine the relationship between the ankle-brachial pressure index (ABPI) and endothelial function in forearm and leg circulation. Forearm blood flow (FBF) and leg blood flow (LBF) responses to reactive hyperemia and sublingual administration of nitroglycerin (NTG) were measured using strain-gauge plethysmography in 57 PAD patients and 24 control patients. LBF during reactive hyperemia was significantly less in PAD patients than in control patients (p<0.001). FBF during reactive hyperemia in PAD patients was similar to that in control patients. NTG-induced vasodilation in upper and lower extremities was similar in the two groups. There was a significant relationship between the maximal LBF response to reactive hyperemia and the ABPI in both the patients with PAD and control patients (r=0.384, p<0.001), whereas maximal FBF response to reactive hyperemia was not correlated with ABPI (r=0.182, p=0.12). These findings suggest that LBF response to reactive hyperemia is impaired in PAD patients compared with that in control patients. Impairment of vascular reactivity of leg circulation may occur before impairment of vascular reactivity of forearm circulation in PAD patients and may be a better indicator of the degree of PAD than impairment of vascular reactivity of forearm circulation.

Administration, Sublingual↗
PubMed2005

Left internal thoracic artery graft assessed by means of intraoperative transesophageal echocardiography.

BACKGROUND: We report a method of intraoperative assessment of left internal thoracic artery (LITA) graft with transesophageal echocardiography regarding patency, stenosis, and presence of remnant branch artery. METHODS: In 52 consecutive coronary artery bypass grafting surgery patients, blood flow velocity was measured at the origin of the LITA after coronary artery bypass grafting by means of transesophageal echocardiography. The flow pattern and velocity change at temporary clamping of the graft was examined and was compared with the postoperative angiographic findings. RESULTS: The LITA was visualized in 47 of 52 cases (90.4%). The LITA flow was diastolic dominant, systolic dominant, or equivalent in 41, 3, and 3 cases, respectively. The anastomosis was stenotic in 2 of 6 cases of the latter two groups, but in none of the 41 cases with diastolic dominant flow (p = 0.0139). The branch artery was present in 4 of 6 cases of the latter two groups, but in only 2 of 41 cases with diastolic dominant flow (p = 0.0012). Remnant branch artery was found in all three cases with systolic dominant flow. The LITA flow was instantaneously reduced at clamping and recovered at declamping in every case with graft occlusion but one. The ratio of velocity change at clamping was less than 0.50 in all 41 cases without remnant branch, whereas it was more than 0.50 in 5 of 6 cases with a branch (p < 0.0001). CONCLUSIONS: The transesophageal echocardiographic assessment with the clamp test is feasible intraoperatively in the majority of patients, enabling us to assess LITA graft patency, stenosis, or presence of a remnant branch.

Adult↗
PubMed2005

Midterm results of pulmonary vein isolation for the elimination of chronic atrial fibrillation.

BACKGROUND: This study aims to clarify midterm results of chronic atrial fibrillation elimination after pulmonary vein isolation and provides an evaluation of factors influencing results. METHODS: Forty-nine patients were enrolled in this study. We performed a simple pulmonary vein isolation with the aid of cryoablation or radiofrequency ablation directed towards the left posterior remnant of the posterior left atrium. Results were evaluated using elimination rates of atrial fibrillation during the postoperative follow-up for > 12 months. We also examined factors influencing the recurrence of atrial fibrillation. RESULTS: There were no hospital deaths or serious complications among the 49 patients. The total follow-up duration was 137.2 patient years. Forty-seven patients (96%) were followed with serial consultations, but 2 patients were dropped from this study because of changes in residence. Thirty-five of 49 patients (71.4%) showed regular sinus or nodal rhythms at discharge. In 4 patients atrial fibrillation recurred during the follow-up period, whereas in another 4 patients sinus rhythm was restored, although they showed atrial fibrillation at discharge. The cumulative elimination rate was 70.2% (33 of 47 patients), which was determined at the last follow-up period. Large left atrial diameters, a long history of atrial fibrillation, and low-voltage fibrillatory waves in V1 leads were preoperative indicators of recurrence of atrial fibrillation. CONCLUSIONS: Pulmonary vein isolations were effective in the treatment of chronic atrial fibrillation patients and sinus rhythms were restored within the follow-up period.

Adult↗
PubMed2005

Newly developed aortic dissection in the abdominal aorta after femoral arterial perfusion.

BACKGROUND: Aortic dissection after femoral arterial perfusion has been reported as a dreadful complication. Apart from such a drastic event, using intraoperative transesophageal echocardiography we detected aortic dissection confined to the abdominal aorta that was associated with visceral malperfusion. METHODS: We examined 11 consecutive patients with aortic dissection in whom the abdominal aorta was intact, and surgeries were performed with femoral perfusion. The abdominal aorta and visceral branches were examined for new development of dissection or malperfusion by means of transesophageal echocardiography before, during, and after cardiopulmonary bypass. These echocardiographic findings were then related to the postoperative assessment and midterm results. RESULTS: Aortic dissection was found in 3 of 11 cases (27.2%). Unusual progression of metabolic acidosis (base excess < or =10 mEq/L) occurred, possibly as a result of malperfusion of visceral arteries, in 2 of these 3 cases, whereas none of the 8 cases presented with such findings. The presence of dissection was later confirmed by postoperative computed tomography in all but 1 case. In the midterm follow-up period, aneurysm formation was found in the infrarenal aorta and iliac arteries in 2 of the 3 cases with new aortic dissection but not in any of the remaining 8 cases. CONCLUSIONS: New development of aortic dissection after femoral arterial perfusion was found in 27% of the cases in this series. Although these occurred without dramatic symptoms, this event may be related to unusual metabolic acidosis during cardiopulmonary bypass or to subsequent aneurysmal formation of the infrarenal aorta or iliac arteries, or both.

Acidosis↗
PubMed2005

Thrombosed arch vessels after cardiac arrest because of pulmonary embolism.

An unusual case of thrombus formation in the arch vessels after cardiac arrest because of pulmonary embolism is reported. A 67-year-old woman developed pulmonary embolism that soon led to cardiac arrest. Although percutaneous cardiopulmonary support was started, the blood pressure of her upper extremity was below 20 mm Hg and blood gas analysis showed marked metabolic and respiratory acidosis. Transesophageal echocardiography revealed thrombus in the right pulmonary artery, thrombus with floppy movement in the aortic arch, and 3 arch branch arteries filled with thrombus with little blood flow around it. After thrombolytic therapy, the thrombi gradually shrunk and perfusion in the upper extremities improved. The patient was successfully weaned from percutaneous cardiopulmonary support and was discharged alive. Thrombus formation can occur in the arch branch arteries after cardiac arrest, causing unusual laboratory data. Transesophageal echocardiography is useful for obtaining real-time information in the cardiovascular system at bedside in such a critically ill patient.

Aged↗
PubMed2005

Malposition of selective cerebral perfusion catheter is not a rare event.

OBJECTIVE: Although malposition of a catheter for selective cerebral perfusion can lead to postoperative neurologic complications, the clinical relevance or even an incidence of this event is not clear because there have been no measures to diagnose it. The purpose of this study is to report the results of intraoperative diagnosis of catheter malposition by means of near-infrared spectroscopy, orbital ultrasound, and transesophageal echocardiography. METHODS: The 35 consecutive patients of aortic arch aneurysm undergoing total arch replacement (13 patients) or transaortic stent graft implantation (22 patients) were examined. The regional oxygen saturation in the frontal lobe was continuously monitored with near-infrared spectroscopy. When cerebral malperfusion was suspected with saturation drop and reduced blood flow in orbital ultrasound, blood flow in the cervical branches and catheter position were examined with transesophageal echocardiography. RESULTS: Catheter malposition was detected in 4 of 35 cases (11.4%). The echo findings included: (1) reduced or absent flow and/or collapsed lumen in the common carotid artery despite an adequate perfusion rate; and (2) the balloon of catheter blocking the inflow to the common carotid artery. There was no unusual changes in parameters of other conventional monitors. After the catheter was withdrawn (three cases) or replaced (one case) based on the above diagnosis, cerebral perfusion was restored, confirmed by these three modalities. An accidental entry of catheter into the right common carotid artery was detected by transesophageal echocardiography in one case, in which there was no abnormal finding of oxygen saturation or orbital blood flow. CONCLUSIONS: Catheter malposition on the right side is not a rare event during selective cerebral perfusion. The catheter can migrate into the right subclavian artery or common carotid artery. Pressure monitoring cannot reliably detect an occurrence of catheter migration into the right subclavian artery. Combined use of near-infrared spectroscopy, orbital ultrasound, and transesophageal echocardiography can be useful for detecting this event and making an appropriate decision without delay to prevent irreversible brain damage.

Aged↗
PubMed2005

Duodenal cancer arising from the remaining duodenum after pylorus-preserving pancreatoduodenectomy for ampullary cancer in familial adenomatous polyposis.

We herein report a rare occurrence of duodenal cancer arising from the remaining duodenum after pylorus-preserving pancreatoduodenectomy for ampullary cancer in familial adenomatous polyposis (FAP). In this patient, proctocolectomy and ileoanal anastomosis for FAP had been performed 11 years earlier. During the current admission, the patient was diagnosed with adenocarcinoma in the Vater's ampulla using imaging and pathological examinations. In addition, a pylorus-preserving pancreatoduodenectomy was performed. The tumor was a well-differentiated tubular adenocarcinoma and no other polyps were identified in the duodenum by pathological examination. However, 1 year after surgery, a polypoid lesion measuring 15 x 15 mm was indicated in the remaining duodenum by endoscopic surveillance. This lesion was completely resected by endoscopic mucosal resection and the resected specimen revealed well-differentiated tubular adenocarcinoma in an adenomatous lesion. This report suggests that resection of the total duodenum is essential for duodenal neoplasms in FAP to prevent a recurrence in the remaining duodenum.

Adenocarcinoma↗
PubMed2005

In vitro tissue engineering of a cardiac graft using a degradable scaffold with an extracellular matrix-like topography.

OBJECTIVE: Cardiac tissue engineering has been proposed as a treatment to repair impaired hearts. Bioengineered cardiac grafts are created by combining autologous cell transplantation with a degradable scaffold as a temporary extracellular matrix. Here we present a system for engineered myocardium combining cultured cardiomyocytes and a novel biodegradable scaffold with a unique extracellular matrix-like topography. METHODS: Cardiomyocytes were harvested from neonatal rats and cultured in vitro on biodegradable electrospun nanofibrous poly(epsilon-caprolactone) meshes. Between days 5 and 7, the meshes were overlaid to construct 3-dimensional cardiac grafts. On day 14 of in vitro culture, the engineered cardiac grafts were analyzed by means of histology, immunohistochemistry, and scanning electron microscopy. RESULTS: The cultured cardiomyocytes attached well to the meshes, and strong beating was observed throughout the experimental period. The average fiber diameter of the scaffold is about 250 nm, well below the size of an individual cardiomyocyte. Hence the number of cell-cell contacts is maximized. Constructs with up to 5 layers could be formed without any incidence of core ischemia. The individual layers adhered intimately. Morphologic and electrical communication between the layers was established, as verified by means of histology and immunohistochemistry. Synchronized beating was also observed. CONCLUSIONS: This report demonstrates the formation of thick cardiac grafts in vitro and the versatility of biodegradable electrospun meshes for cardiac tissue engineering. It is envisioned that cardiac grafts with clinically relevant dimensions can be created by using this approach and combining it with new technologies to induce vascularization.

Animals↗