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Taijiro Sueda

Publications and source records attributed to Taijiro Sueda.

104 records · Page 6Linked to original sources
PubMed2002

Cold blood spinal cord plegia for prediction of spinal cord ischemia during thoracoabdominal aneurysm repair.

BACKGROUND: This clinical study was undertaken to evaluate changes in motor evoked potentials (MEPs) during cold blood infusion into a thoracoabdominal aortic aneurysm. We also determined the efficacy of this infusion method for predicting spinal cord injury during thoracoabdominal aortic aneurysmal surgery. METHODS: We monitored descending evoked spinal cord potentials (ESCPs), segmental ESCPs, and MEPs during the prosthetic replacement phase of thoracoabdominal aneurysmal surgery. We perfused cold blood (4 degrees C, 300 to 450 mL) into aneurysms after clamping the aorta, while monitoring spinal cord potentials in 6 cases of thoracoabdominal aortic aneurysm. If the spinal cord potentials decreased during infusion of cold blood, we reconstructed the intercostal arteries in the aneurysm. If the potentials did not change during the infusion of cold blood and after the aneurysmectomy, we did not reconstruct the intercostal arteries and ligated all of them. RESULTS: Postoperative paraplegia did not occur in any case. The MEPs decreased in amplitude after infusion of cold blood in 3 cases, but amplitude recovered after reconstruction of the intercostal arteries. The other 3 cases did not show any change after infusion of cold blood, and all of the intercostal arteries in the aneurysm were ligated. CONCLUSIONS: Cold blood infusion into the aneurysm while monitoring MEPs was a useful adjunct to detect the presence of critical intercostal arteries and to facilitate thoracoabdominal aortic aneurysmal surgery.

Aged↗
PubMed2002

Surgical treatment of atypical aortic coarctation associated with occlusion of all arch vessels in Takayasu's disease.

We report a patient with Takayasu's disease surgically treated who had presented severe manifestation due to aortic coarctation associated with occlusion of all arch branches. This patient had suffered cardiac failure and recurrent fainting attacks before surgery. The operative procedures included ascending to infra-renal aortic bypass grafting combined with reconstruction of the right axillary artery. Cardio-pulmonary bypass (CPB) was used to facilitate the proximal aortic anastomosis. Regional oxygen saturation in the bilateral frontal lobes was measured intraoperatively using near-infrared spectroscopy to detect cerebral ischemia. Regional oxygen saturation was managed above the critical level throughout the CPB. No new cerebral complications occurred in the perioperative period.

Aortic Coarctation↗
PubMed2002

Successful pre-operative diagnosis of malignant intraductal papillary mucinous tumor of the pancreas by detecting telomerase activity.

BACKGROUND: Pre-operative differential diagnosis between benign and malignant intraductal papillary mucinous tumor (IPMT) of the pancreas is markedly difficult by imaging examination. In recent years, telomerase activity has been reported to be detected only in malignant tumors. METHODS: A 52-yr-old man with abdominal pain was diagnosed with a IPMT through imaging examination. Telomerase activity of the pure pancreatic juice, which was obtained pre-operatively by endoscopic retrograde pancreatic juice aspiration (ERPJA), was analyzed by telomeric repeat amplification protocol (TRAP) assay. RESULTS: Telomerase activity was detected in the pure pancreatic juice of the patient, who was diagnosed with a malignant IPMT. A pylorus-preserving pancreatoduodenectomy was performed, and subsequent pathological findings revealed the tumor to be adenocarcinoma in adenoma with papillary growth. CONCLUSION: Detection of telomerase activity of the pure pancreatic juice might be useful to distinguish benign from malignant IPMT pre-operatively.

Abdominal Pain↗
PubMed2002

Comparative study of noninvasive cerebrovascular monitoring methods in cardiac surgery.

Unfavorable incidents during cardiac operations due to inadequate cerebral perfusion can be avoided by the utilization of noninvasive blood flow monitoring methods. The purpose of this study was to evaluate monitoring systems for cebrovascular perfusion. We compared currently available blood flow monitoring devices including transcranial Doppler (TCD), central retinal artery color Doppler (CRAD) and near-infrared spectroscopy (NIRS). The maximum flow velocity (Vmax) of the right central retinal artery was measured with a 7.5 MHz Doppler system. The Vmax of the right middle cerebral artery was measured with a TCD system. Regional tissue oxygen saturation (rSO2) was continuously measured with a NIRS system. The total number of individual data for each monitoring method collected from 25 patients was 184. The CRAD-Vmax was correlated more closely with the corresponding maximum blood pressure than the TCD-Vmax (r = 0.742 and 0.607, respectively). No missing data were seen in CRAD, but 20 missing data were seen in TCD, mostly during the period of cardiopulmonary bypass with lowered blood pressure. All 184 data were divided into two groups: Group 1 (rSO2 > or = 60 %, n=175) and Group 2 (rSO2 <60 %, n=9 data). The CRAD-Vmax was significantly lower in Group 2 (5.2+/-2.4 cm/s versus 3.0+/-0.4 cm/s, p<0.001). However, there was no significant difference in the TCD-Vmax between these two groups. Thus, CRAD may be superior to TCD in detecting insufficiency of cerebral blood flow correlating to rSO2, and could be used as the first choice monitoring system of cerebral blood flow during cardiac surgery.

Adolescent↗
PubMed2002

[Bacteria isolated from surgical infections and their susceptibilities to antimicrobial agents. Special references to bacteria isolated between April 1999 and March 2000].

The annual multicenter studies on isolated bacteria from infections in general surgery and their antimicrobial susceptibility have been conducted in Japan since July 1982. In this paper, the results obtained in the academic year 1999 (from April 1999 to March 2000) have been summarized. Two hundred seven cases were investigated, and 411 strains were isolated from 169 cases (81.6%). Of those strains, 184 and 227 strains were from primary infections and postoperative infections, respectively. In primary infections, the isolation rates of anaerobes, Streptococcus spp., and Escherichia coli were higher than in postoperative infections, while in postoperative infections, those of Gram-positive aerobes were higher than in primary infections. Staphylococcus aureus were most frequently isolated among Gram-positive aerobes, Peptostreptococcus prevotii among Gram-positive anaerobes, E. coli among Gram-negative aerobes, and Bacteroides fragilis among Gram-negative anaerobes. In primary infections, the percentage of Gram-negative aerobes, which gradually increased by the year 1998, decreased in the year 1999. The percentage of Gram-negative anaerobes increased, while that of Gram-negative bacteria was equivalent to that in the last year. In postoperative infections, the percentage of Gram-negative anaerobes, which continuously increased after the year 1990, decreased, while that of Gram-positive aerobes, which decreased in the last year, increased. Methicillin-resistant S. aureus accounted for 70.7% of S. aureus (41 strains). Either the number of strain or the percentage of MRSA decreased. The susceptibilities of E. coli and Klebsiella pneumoniae decreased against third and forth generation cephems, oxacephems, and monobactams. The susceptibilities of P. aeruginosa to carbapenems tend to decrease after the year 1997. S. aureus showed good susceptibilities to the tested drugs including arbekacin, vancomycin, and teicoplanin.

Anti-Bacterial Agents↗
PubMedDate not supplied

Celiac axis occlusion with replaced common hepatic artery and pancreatoduodenectomy.

A rare case of intraductal papillary mucinous tumor of the pancreas associated with a replaced common hepatic artery and celiac axis occlusion, which was treated by pancreatoduodenectomy, is reported. In this patient, the celiac trunk was occluded at its root and the splenic and left gastric artery could be visualized serially via the enlarged collateral artery on superior mesenteric arteriography. At surgery, the collateral artery was carefully preserved and pancreatoduodenectomy was successfully performed without ischemia of the stomach, spleen, and remnant pancreas. Although celiac axis occlusion is an uncommon finding for patients undergoing pancreatoduodenectomy, we recommend performing celio-mesenteric angiography before pancreatoduodenectomy, and, at surgery, clamping of the gastroduodenal artery is required for patients with celiac axis occlusion.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Pancreatic head resection with segmental duodenectomy for intraductal papillary mucinous tumors of the pancreas.

Various modifications of organ-preserving pancreatic resections have been performed for intraductal papillary mucinous tumor (IPMT) of the pancreas. The aim of this study was to evaluate usefulness of pancreatic head resection with duodenal segmentectomy (PHRSD), which is one of the organ-preserving pancreatic resections for IPMT. Pancreatic head resection with duodenal segmentectomy was indicated for the branch duct type of IPMT. Eight patients underwent PHRSD. The mean operative time was 390 minutes, and the mean blood loss was 1270 ml. Duodenal ischemia was prevented by preserving the duodenal branches of the gastroduodenal artery and the anterior inferior pancreaticoduodenal artery. Complications occurred in four patients: one with pancreatic leak, one with choledochoduodenal anastomotic stenosis, and two with delayed gastric emptying. However, no deaths occurred. The final pathologic diagnosis was adenoma in seven patients and carcinoma in situ in one patient. Six of eight patients had an adenoma with papillary growth in the main pancreatic duct. Postoperative pancreatic endocrine and exocrine functions were satisfactory. All patients were alive without recurrent disease at a median follow-up of 30 months. Pancreatic head resection with duodenal segmentectomy appears to be a useful procedure as an organ-preserving pancreatic resection for the branch duct type of IPMT, because this procedure allows a safe and complete resection of the pancreatic head without ischemia of the common bile duct and the duodenum.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Comparative analysis of K-ras point mutation, telomerase activity, and p53 overexpression in pancreatic tumours.

K-ras point mutation, p53 over-expression, and telomerase activity have been proposed as molecular markers for clinical diagnosis of pancreatic carcinoma. To evaluate the clinical usefulness of these markers, we performed comparative analysis in 61 resected pancreatic samples including 15 intraductal papillary-mucinous tumours (IPMTs), 4 mucinous cystic tumours, 37 ductal adenocarcinomas, and five chronic pancreatitis samples. K-ras point mutation, telomerase activity, and p53 overexpression were analyzed using mutant allele specific amplification, the telomeric repeat amplification protocol, and immunohistochemical staining, respectively. In malignant tumours, K-ras mutation, telomerase activity, and p53 overexpression were detectable in 76, 91, and 46%, respectively, while in benign tumours, these alterations were detectable in 38, 0, and 0%, respectively. Among 15 IPMTs, K-ras mutation was detectable in 4 (80%) of 5 IPMT-adenomas, 4 (80%) of 5 IPMT-carcinomas and 2 (66%) of 3 papillary-mucinous carcinomas, which are invasive carcinomas derived from IPMTs. Telomerase activity was not detectable in IPMT-adenomas, but was detected in all 5 IPMT-carcinomas and 3 papillary-mucinous carcinomas. p53 overexpression was not detected in IPMTs, but was detected in 2 (66%) of 3 papillary-mucinous carcinomas, indicating that telomerase is likely to be activated concomitant with carcinogenesis. These results suggest that telomerase activity is the most useful as a differential diagnostic marker between malignant and benign pancreatic tumours.

Adolescent↗
PubMedDate not supplied

Successful diagnosis and resection of icteric type hepatocellular carcinoma.

We report a rare case of icteric type hepatocellular carcinoma with successful preoperative diagnosis and curative resection. A 50-year-old man was admitted to our hospital with fever elevation and jaundice. Endoscopic retrograde cholangiography revealed a tumor at the hepatic hilum, which caused obstruction of the right and left hepatic duct. The tumor was suspected of being a hilar cholangiocarcinoma, but it was diagnosed as being a hepatocellular carcinoma by endoscopic retrograde bile duct biopsy. After percutaneous transhepatic biliary drainage a right hemihepatectomy was performed. Subsequent pathological finding showed the tumor to be moderately-differentiated hepatocellular carcinoma (Edmondson III) which invaded into the right hepatic duct. The patient survived for three years without recurrence. Although patients with icteric type hepatocellular carcinoma have been reported to have a poor prognosis, earlier diagnosis and curative resection may occasionally bring them an improved prognosis.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Laparoscopic adhesiolysis for recurrent postoperative small bowel obstruction.

BACKGROUND/AIMS: Recurrent small bowel obstruction caused by postoperative adhesions has been treated by conventional laparotomy, however laparoscopic management of acute and recurrent small bowel obstruction has been demonstrated. This study assessed the clinical outcome and long-term efficacy of laparoscopic adhesiolysis for recurrent adhesive small bowel obstruction. METHODOLOGY: Elective laparoscopic treatment following conservative management was attempted in 25 patients hospitalized for recurrent small bowel obstruction after abdominal or pelvic surgery. RESULTS: The pathologic sites of postoperative adhesions and adhesive types were identified laparoscopically in all patients. Complete laparoscopic adhesiolysis was feasible in 18 patients (72%), while conversion to laparoscopic-assisted adhesiolysis (mini-laparotomy with an incision less than 4 cm long) was required in 6 patients (24%) because of dense adhesion or the technical difficulties due to adhesion in the pelvic cavity. Conversion to laparotomy was required for one patient because of excessive adhesions and intestinal perforation (4%). Long-term follow-up was possible in all patients. There was no recurrence of small bowel obstruction over a mean follow-up period of 41 months. CONCLUSIONS: Laparoscopic adhesiolysis is a safe and effective treatment for recurrent small bowel obstruction in selected cases. Conversion to mini-laparotomy or laparotomy should be considered in patients with dense or pelvic adhesion.

Adolescent↗
PubMedDate not supplied

Systemic inflammatory response syndrome (SIRS) as a predictor of strangulated small bowel obstruction.

BACKGROUND/AIMS: Strangulated small bowel obstruction may often carry severe morbidity or mortality when a differential diagnosis from simple small bowel obstruction was made in the past. The aim of this study is to clarify preoperative indications that can be useful for predicting strangulation in acute small bowel obstruction, and to evaluate the efficacy of systemic inflammatory response syndrome as a predictor. METHODOLOGY: Seventy clinical cases were rated between strangulated (n=40) and simple (n=30) small bowel obstruction that were postoperatively identified and were analyzed using univariate and multivariate procedure. RESULTS: Age (p=0.0377), female gender (p=0.0121), white blood cells counts (p=0.0272), presence of abdominal tenderness (p=0.0074), presence of abdominal muscle guarding (p=0.0002), American Society of Anesthesiology score (p=0.0191), number of systemic inflammatory response syndrome factors (p=0.0001), and presence of systemic inflammatory response syndrome (p=0.0001) were evaluated for correlated predictive factors in the univariate analysis. The presence of systemic inflammatory response syndrome (odds ratio= 14.3, p=0.0151) and presence of abdominal muscle guarding (odds ratio=5.87, p=0.0158) were independent predictive factors in the multivariate analysis. CONCLUSIONS: These predictive factors were considered to be useful to predict strangulated small bowel obstruction, and to contribute to the improvement of outcomes in the management of acute small bowel obstruction.

Acute Disease↗