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Biomedical subjects

Y Kuniyoshi

Publications and source records attributed to Y Kuniyoshi.

At least 37 records · Page 2Linked to original sources
PubMed1998

[A case of traumatic aneurysm of the brachiocephalic artery].

Traumatic aneurysm of the brachiocephalic artery is rate. We presented a case of traumatic aneurysm of the brachiocephalic artery caused by traffic accident. A 28-year-old woman suffered a blunt chest trauma. A chest X-ray revealed a widening of the superior mediastinum and multiple rib fractures. CT scanning demonstrated left hemothorax with lung contusion and upper mediastinal hematoma. An aortography was performed which showed aneurysmal dilatation at the origin of the brachiocephalic artery. The patient underwent an operation 24 hours after chest injury. An aorto-right common carotid artery and right subclavian artery bypass with bifurcated Dacron graft was performed while monitoring temporary artery pressure. After resection of aneurysm, We found that about 3 cm longitudinal laceration of intima on the posterior wall of brachiocephalic artery. Her post operative condition was good and no neurological defect was noted.

Accidents, Traffic↗
PubMed1998

Successful treatment of bilateral deep femoral aneurysms and multiple iliac aneurysms associated with severe aortic valve disease: report of a case.

We report herein the case of a patient in whom aneurysms of the bilateral deep femoral arteries (DFA) and multiple iliac aneurysms associated with severe aortic valve disease were successfully treated by a two-staged operation. The patient was a 74-year-old man who had dense calcification of the ascending aorta and aortic arch. Prior to aortic valve replacement (AVR), the aneurysms of the DFA and internal iliac arteries were resected. The terminal end of the abdominal aorta and bilateral common iliac arteries were then reconstructed with a Y graft to be used as a possible alternative arterial input route in place of the ascending aorta for extracorporeal circulation during the AVR. The inferior mesenteric artery (IMA) was well developed, and the external iliac arteries and their branches were preserved at aneurysmectomy. Postoperatively, there was no ischemia of the pelvic organs or the hip muscles. The AVR was subsequently performed 5 weeks after the first operation, and the patient was discharged after an uneventful postoperative course.

Aged↗
PubMed1998

Improvement in esophageal varices and liver histology postoperatively in Budd-Chiari syndrome.

BACKGROUND: In the past 17 years, 32 patients with Budd-Chiari syndrome were treated by reconstruction of the occluded inferior vena cava and reopening of the hepatic veins under femoro-femoral normothermic extracorporeal partial bypass. The mean follow-up was 8 years (range, 1.5 to 17 years). METHODS: To evaluate the benefits of our operative procedure, we compared the preoperative, early postoperative, and late postoperative endoscopic appearance of the esophageal varices and the histologic findings of the liver tissue obtained intraoperatively and at a later date. RESULTS: The esophageal varices found preoperatively in 29 patients (90.6%) had disappeared in 7 patients by the time of discharge, and in 2 patients they disappeared 4 to 7 years after surgery. In the remaining 20 patients, the grade of the esophageal varices was reduced markedly. Histologic examination of the liver showed cirrhosis in 22 patients, fibrosis in 9 patients, and severe congestion in 1 patient. Inspection of the liver in the late postoperative period (in 10 patients) showed improvement in centrilobular congestion and no increase in interlobular fibrosis. CONCLUSIONS: Gradual and steady improvement of esophageal varices and hepatic fibrosis can be achieved after our operative procedure.

Adult↗
PubMed1998

Online evolution for a self-adapting robotic navigation system using evolvable hardware.

Great interest has been shown in the application of the principles of artificial life to physically embedded systems such as mobile robots, computer networks, home devices able continuously and autonomously to adapt their behavior to changes of the environments. At the same time researchers have been working on the development of evolvable hardware, and new integrated circuits that are able to adapt their hardware autonomously and in real time in a changing environment. This article describes the navigation task for a real mobile robot and its implementation on evolvable hardware. The robot must track a colored ball, while avoiding obstacles in an environment that is unknown and dynamic. Although a model-free evolution method is not feasible for real-world applications due to the sheer number of possible interactions with the environment, we show that a model-based evolution can reduce these interactions by two orders of magnitude, even when some of the robot's sensors are blinded, thus allowing us to apply evolutionary processes online to obtain a self-adaptive tracking system in the real world, when the implementation is accelerated by the utilization of evolvable hardware.

Biological Evolution↗
PubMed1998

A ruptured syphilitic descending thoracic aortic aneurysm. The characteristic findings on computed tomography for the etiological diagnosis of aneurysm.

We report the case of a 72-year-old man with a ruptured syphilitic descending thoracic aneurysm who underwent an emergency operation and successful graft replacement. Preoperative physical examination showed a pulsative mass on the left back. Preoperative computed tomography showed bone destruction in the TH6 to TH10 thoracic vertebrae and ribs and penetration (or rupture) of the aneurysm into the subcutaneous tissue. During the period of preoperative evaluations, free wall rupture of the aneurysm occurred and emergency operation for graft replacement was performed. The microscopical examination of the aneurysmal wall revealed the syphilitic changes. In literature, the vertebral destruction by atherosclerotic aneurysm is usually located at the TH12 to L3 of vertebral bodies. From the findings of this patient and a study of existing literature, we concluded that the finding of vertebral bone beyond TH12 to L3 region on CT examination of the aneurysm could be a etiological characteristic finding for syphilitic aortic aneurysm.

Aged↗
PubMed1997

[A case report of surgical treatment of constrictive pericarditis with coronary artery disease].

We performed the concomitant operation for constrictive pericarditis and coronary artery disease in an octogenarian. A 82-year-old male was hospitalized with dyspnea, edema of the lower extremities and pleural effusion on chest X-ray film. Cardiac catheterization revealed constrictive pericarditis and 75% stenosis of left anterior descending artery. Extensive pericardiectomy was performed including posterior wall of left ventricle and left atrium under the beating heart by using femoro-femoral partial bypass. Single CABG with a saphenous vein graft was performed following pericardiectomy. Postoperative cardiac catheterization showed good recovery of hemodynamics and patency of the bypass graft. Postoperative course was uneventful. The patient was discharged on twenty fifth postoperative day.

Aged↗
PubMed1996

Radical open endvenectomy with autologous pericardial patch graft for correction of Budd-Chiari syndrome.

A surgical technique for the treatment of Budd-Chiari syndrome associated with vena caval obstruction has been devised. The occluded hepatic vena cava and hepatic veins were reconstructed by open endvenectomy, using an autologous pericardial patch graft and a femorofemoral bypass technique. The hepatic artery and portal vein were not controlled with vascular clamps during the surgery. Between 1979 and 1994, 29 patients were treated using this technique and achieved good results. All the patients did well with good function of the reconstructed vena cava and of the hepatic veins, and showed acceptable reduction of symptoms caused by portal hypertension and caval stagnation.

Adult↗
PubMed1996

[Clinical experience with normothermic selective cerebral perfusion during graft replacement of ascending-arch-descending aortic aneurysms with annuloaortic ectasia].

We treated three cases of ascending-arch-descending aortic aneurysm with annuloaortic ectasia by performing graft replacement. The patients included a 34 year old female, a 34 year old male and a 42 year old male. In one case the aneurysm was atherosclerotic and of type I and II + IIIb dissection in the other two cases. During the operation we were able to utilize normothermic selective cerebral perfusion during construction of the left common carotid artery. Specially, normothermic partial F-F bypass and normothermic selective cerebral perfusion to the left common carotid artery were used during graft replacement from the descending aorta to the left common carotid artery. This was followed by regular hypothermic total ECC and hypothermic cerebral selective perfusion during subsequent graft replacement of the innominate artery and a modified Bentall's operation. This new protocol in which normothermic cerebral perfusion is utilized during the procedure on the left common carotid artery and hypothermic perfusion is utilized only during the subsequent procedure on the innominate artery permits significant shortening of the cardiac arrest time and cerebral perfusion time compared with when only hypothermic perfusion is used. This significant shortening contains obvious benefits in the areas of cardiac and brain protection.

Adult↗
PubMed1995

[Staged operation of multiple aortic aneurysms with myocardial infarction and stenosis of three coronary arteries].

A 69-year-old man with multiple aortic aneurysms was admitted to the university hospital because of increasing the size of aneurysms. A coronary angiogram revealed three vessel disease (LAD at seg 7: 90%, D1: 75%, LCX at seg 13: 95%, RCA at seg 3: recanalization) and left ventriculography showed hypokinesis of the inferior wall. Staged extending operation was performed. Graft replacement of ascending and arch aortic aneurysms associated with coronary artery bypass grafting was done in the first operation. Two months after the 1st operation, thoracoabdominal and infrarenal aortic aneurysms were replaced by synthetic graft and the intercostal arteries (Th10, 11, 12) and the lumbar arteries (L1, 4) were reconstructed with synthetic bypass from the implanted graft. Postoperative course was uneventful and he has been well without any symptoms of paraplegia 26 months after the first operation.

Aged↗
PubMed1994

Primary leiomyosarcoma or leiomyoma of the pubic bone? A case report.

We report a case of what appeared to be a primary leiomyosarcoma of the left pubic bone of a female aged 23 years. Forty-eight cases of the tumour have been recorded in the literature since 1944, only two of which were in the pelvis. The tumour in our patient was treated by curettage and there was no recurrence in the following 3 years. The tumour cells showed only mild cellular atypism and 2 to 3 mitoses per 10 high-power fields. These finding suggest that the tumour might be an extremely rare leiomyoma of bone.

Adult↗
PubMed1994

[Use of the inferior epigastric artery in redo coronary artery bypass grafting--a case report].

A 71-year-old man who had undergone coronary artery bypass grafting (CABG) 9 years ago, was admitted for chest compression on exertion. A severe stenotic lesion (75%) of the main trunk of the left coronary artery and occlusion of the bypass graft previously implanted to the right coronary artery were showed by coronary angiography. Redo-CABG using the left inferior epigastric artery (LIEA) and left internal thoracic artery (LITA) was successfully done, since the saphenous vein and right gastroepiploic artery were not suitable for bypass graft. Post operative cource was uneventful and good patency of LIEA and LITA graft were revealed by postoperative angiography 34 days after surgery.

Abdominal Muscles↗
PubMed1994

[A case of re-operation after 14 years following radical correction of the anomalous origin of right pulmonary artery from ascending aorta].

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital malformation, which is usually fatal without early surgical correction. The number of reports of the radical operation has been recently increasing, but reports of its long-term postoperative results are rare, especially those of the reoperative cases. The 14-year-old patient, who had been operated radically with a 8 mm diameter graft at 7 months of age, weighing 4550 g at the time, was reoperated, because he developed pulmonary hypertension due to the narrowing of the graft. He had no clinical symptoms and no abnormal signs on chest X-P nor ECG, eventhough severe stenosis of the graft was present. The graft was replaced with a larger 12 mm diameter graft under ECC, and PFO closure and TAP were done at the same time. The patient's pulmonary artery pressure reduced substantially following surgery. We conclude that cautious postoperative follow-up including angiographical examination is important, and that early reoperation before occlusion of the graft should be done.

Adolescent↗
PubMed1994

[A two staged extending graft replacement for dissecting aortic aneurysm with Marfan's syndrome].

We experienced four cases of dissecting aortic aneurysms with Marfan's syndrome, in which two staged operations were performed with satisfactory results. The operations performed in the four patients were the replacement of the ascending aorta, transverse aortic arch and the entire descending thoracic aorta in DeBakey type I dissecting aortic aneurysm, replacement of the entire descending thoracic and abdominal aorta in type IIIb, replacement of the aortic valve, ascending aorta, transverse aortic arch, the entire descending thoracic and upper abdominal aorta in type I, and replacement of the total aorta including the aortic valve in type II + IIIb, respectively. There were no operative deaths, but a 42-year-old woman with DeBakey type IIIb died suddenly 2 years 11 months after the second operation. The cause of death was presumed to be due to rupture of a dissecting aneurysm (DeBakey type II). Dissecting aortic aneurysm with Marfan's syndrome must be observed carefully and corrected surgically, because the lesion is progressive and the residual dissecting aneurysm usually dilates eventually. In view of our clinical results, we conclude that the operation for dissecting aortic aneurysm with Marfan's syndrome should be performed as extensively as possible.

Adult↗
PubMed1994

[Discrete subaortic stenosis after aortic valve replacement--a case report].

A 51-year-old woman, who had undergone aortic valve replacement (SJM 19 mm) and open mitral commissurotomy for aortic valve stenosis with regurgitation, and mitral stenosis, was admitted for redo surgery. We found discrete subaortic ring just below the prosthetic valve. The fibrous ring was resected and the aortic valve was replaced (SJM 21 mm) after augmentation of the aortic annulus by Nicks procedure. Mitral and tricuspid valves were replaced. Discrete subaortic stenosis after aortic valve replacement are mostly in cases with small prosthetic valve. The turbulence caused by the small valve may produce discrete subaortic ring.

Aortic Stenosis, Subvalvular↗
PubMed1994

[A case of staged operation for a dissecting aneurysm (DeBakey type IIIb+II) with Marfan's syndrome].

A 34-year-old woman with Marfan's syndrome had severe heart failure due to annulo-aortic ectasia and aortic insufficiency, which was accompanied also by a dissecting aneurysm (DeBakey type IIIb) that was demonstrated by aortography. 4 days before the operation, sudden progression of the aneurysm to a DeBakey type II, and finally DeBakey type I dissecting aneurysm was seen. The first operation was an extended aortic resection with replacement from the aortic valve to the descending thoracic aorta (level of the 7th thoracic vertebra) using selective cerebral perfusion. The second operation was a replacement of the residual dissecting aorta from the level of the 8th thoracic vertebra to the celiac artery with partial extracorporeal circulation. The postoperative course of the patient was uneventful. Dissecting aneurysm with Marfan's syndrome should be operated as extensively as possible if necessary.

Adult↗
PubMed1993

[Angiographic evaluation of reconstructed spinal arteries in thoracic aortic aneurysm surgery].

Revascularization of the spinal arteries with thoracic aortic aneurysm were performed on nineteen patients using partial extracorporeal bypass. They were 16 men and 3 women. Age range were from 33 to 70 years (mean 49.9 +/- 10.3 years). There were eleven patients of dissecting aneurysm (DeBakey type IIIb in eight patients, type I in two patients and type IIIa in one patient), and eight patients of non-dissecting thoracoabdominal aneurysm (including two patients with ruptured aneurysm). The number of revascularized spinal arteries were 60 pairs (average 3.2 pairs per each patient). The revascularized spinal arteries were localized between levels T4 and L5.36 pairs of the 60 existed between levels T8 and L2 from where the artery of Adamkiewicz arises. Seven patients (eleven spinal arteries) underwent selective angiography of the revascularized spinal arteries postoperatively, and the anterior spinal artery and the artery of Adamkiewicz was identified in three patients. Two patients died within one month, one from MOF and the another from intestinal perforation respectively (operative mortality 11.1%). One patient, with ruptured thoracoabdominal aortic aneurysm showed paraparesis postoperatively, but no paraplegia was found in any patients. We recommend that not only the artery of Adamkiewicz but also the spinal arteries at the midthoracic area from T4 to T8 should be revascularized, to prevent postoperative paraplegia. Replacing of extended thoracic aneurysm, our method (using partial extracorporeal circulation and segmental aortic clamping) was thought to prevent spinal cord ischemia.

Adult↗
PubMed1993

[Surgical treatment of aortic arch aneurysm with coronary artery disease].

A 69-year-old man with aortic arch aneurysm was admitted for abnormal shadow of chest X-ray. Computed tomography (CT) and aortography revealed aneurysm of aortic arch. His coronary angiogram showed 60% stenosis at LMT (seg 5), 90% stenosis at LAD (seg 7) and 75% stenosis at LCX (seg 11). The graft replacement for arch aneurysm and CABG were performed simultaneously. Postoperative course was good. Postoperative angiogram demonstrated successful reconstruction of the aortic arch and patent three bypass grafts. This patient has been worked healthy 14 months postoperatively.

Aged↗