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Biomedical subjects

Y Sezai

Publications and source records attributed to Y Sezai.

At least 91 records · Page 5Linked to original sources
PubMed1994

[A case of mitral stenosis with a new open pivot bileaflet valve].

The ATS Medical Open Pivot Bileaflet Valve was developed by Villafana who also developed St. Jude Medical valve and put to the first clinical use by Sadeghi on May 4, 1992. Since then, its clinical uses have been made in cases more than 1,000 in the world, centering on Europe, and its usefulness has been reported elsewhere from the aspected of its durability, anti-thrombogenic property, hemolysis, less noise and surgical operability. ATS valve was developed with 9 characteristics as (1) open pivot; (2) removed Struts; (3) wide area orifice; (4) improved stillness; (5) improved durability; (6) small loss of energy; (7) rotating orifice; (8) x-ray impermeability of orifice; (9) and easily sutured orifice. A report is made here on our experience of a clinical case of mitral stenosis by ATS valve (the first case in Japan) on September 28, 1993.

Female↗
PubMed1994

[Clinical experience with the CHAUX multi-purpose retractor].

We have performed dissection of the ITA using the CHAUX retractor in many patients. This retractor is a two-point sternal/IMA and valve retractor, with four sternal blades with individual and independent dual movement. The sliding sternal blade assemblies permit movement along the horizontal plane of the side arm. This retractor can be used for other types of cardiac surgery, as well. We obtained good results with its use for repair of distal aortic arch aneurysm. We conclude that this retractor is safe and useful for cardiac surgery.

Humans↗
PubMed1993

[A case of multiple colon cancer appeared after thymectomy for thymoma with myasthenia gravis].

A 62-year-old woman was admitted to our hospital because of diarrhea and melena. Thymectomy for thymoma with myasthenia gravis was carried out on this patient four years ago. Barium enema revealed four tumor shadows in the ascending and transverse colon. Multiple colon cancer was diagnosed and extended right hemicolectomy was carried out. The postoperative course was uneventful and she has been free from any symptom. In this paper, we discussed the relationship between thymoma and the incidence of nonthymic malignancy.

Adenocarcinoma↗
PubMed1993

Multivariate analysis of risk factors for thrombus formation in University of Tokyo ventricular assist device.

Of 77 University of Tokyo ventricular assist devices used in a total of 70 patients at 21 institutions, 13 pumps were found to have macroscopic thrombus formations. Because 19 devices that were used for less than 24 hours showed no thrombus deposition, they were considered not to have been sufficiently exposed to the thrombogenic environment for macroscopic thrombus deposition and were removed from the subsequent multivariate study. A total of eight potential risk factors were assessed in relation to thrombosis. Prevalences of thrombus formation were compared between two groups with or without each of the risk factors. In a univariate analysis, the following categoric variables were demonstrated to be significantly associated with complications, in descending order of significance: use of gabexate mesilate (protease inhibitor) as an anticoagulant (p = 0.005), normal platelet count (p = 0.010), duration of support (p = 0.038), leukocytosis (p = 0.042), and minimum pumping flow (p = 0.042). Use of heparin and the consequent increase in activated clotting time showed no relationship. Multivariate discriminant analysis, which was done to identify risk factors rejecting cross correlation between each variable, demonstrated platelet count (p = 0.006), use of gabexate mesilate (p = 0.007), and minimum flow (p = 0.008) to have significant and independent risks. These results indicate the importance of maintaining pumping flow above a certain minimum level, addition of antiplatelet drugs to the antithrombogenic regimen, and nonuse of gabexate mesitate.

Adolescent↗
PubMed1993

[Successful resection of a pseudoaneurysm and reconstruction of the left ventricle following myocardial infarction].

A 56-year-old male experienced an anterolateral myocardial infarction and was readmitted to our department at the age of 57 for treatment of his effortive back pain. A chest X-ray disclosed that his cardiac silhouette was slightly enlarged and he was diagnosed by angiography as having a pseudoaneurysm of the left ventricle. He underwent surgery using ventricular fibrillation. We resected his pseudoaneurysm of the left ventricle, and then we reconstructed his left ventricle with double EPTFE (Gore-Tex patch) supported by his own pericardium. He has received a normal post-operative course and is making satisfactory progress. We believe that left ventricular reconstruction could be recommended for treatment of some left ventricular aneurysm.

Cardiopulmonary Bypass↗
PubMed1993

[Management of the severe calcified ascending aorta during coronary bypass surgery].

The best management of the calcified ascending aorta during coronary surgery has not established. Clamping of the calcified aorta causes cerebral embolism, aortic rupture and laceration as a lethal complication. Recently we had two successful cases of surgical treatment and these were treated by "Non-touch aortic technique". The femoral cannulation and ventricular fibrillation with moderate hypothermia or circulatory arrest will reduce the risk of coronary bypass surgery in the calcified aorta.

Aged↗
PubMed1993

[A case report of mediastinal teratoma complicated with cardiac tamponade].

A 10-year-old Japanese boy was admitted to our hospital with complaints of the sudden and severe chest pain having occurred when he caught a ball on his chest. A chest X-ray film and MRI made a diagnosis of cardiac tamponade caused by perforation into the pericardial sac of a mediastinal teratoma and pericardial drainage was carried out. Pericardial effusion showed cloudy yellow and CA 19-9 level in the effusion was 6, 538.2 U/ml. The tumor was extirpated after recovery of his general condition. The tumor was consisted of solid material (5 x 6 x 3 cm) and of cystic part (4 x 6 x 0.8 cm) involving of viscous yellowish fluid. Microscopic sections showed ulcer with bleeding, granulation and pancreatic tissue. Histopathological diagnosis was benign mature teratoma. Including this case, fourteen cases of mediastinal teratomas with cardiac tamponade have been reported and this is the youngest case. Pancreatic tissue were observed histopathologically in most cases and it was thought that autodigestion by digestive enzyme from pancreas was major cause of perforation of the tumor into the pericardial sac.

Cardiac Tamponade↗
PubMed1992

New sequential synchronized driving system of intraaortic balloon pumping and left ventricular assist device: influence on endocardial viability ratio and renal blood flow in their combination.

Intraaortic balloon pumping (IABP) and left ventricular assist devices (LVAD) have shown remarkable progress individually, but how to combine them is still unknown. A new sequential synchronized driving system was developed to control concomitant use of IABP and LVAD, and then its hemodynamic effectiveness was evaluated in swine, especially on endocardial viability ratio (EVR) and renal blood flow. This system (pulsatile bypass pump-delay divide system, PBP-DDS) made it possible to change the driving phase of IABP and LVAD easily. In 12 swine, IABP and LVAD were set up, and these devices were driven in the following 5 modes with the PBP-DDS: mode I, IABP alone; mode II, LVAD alone; mode III, IABP + LVAD (same timing); mode IV, IABP (early diastole) + LVAD (late diastole); and mode V, LVAD (early diastole) + IABP (late diastole). EVR was increased more markedly by combined use of both IABP and LVAD (modes III, IV, and V) than by individual drive, but there was no significant difference among these modes. On the other hand, renal blood flow was decreased so dramatically by the same timing optimal counterpulsation method of mode III that it was thought to be harmful for renal function. But, the delay divide combination method of modes IV and V resulted in no change in the renal circulation. So, it was concluded that this delay divide combination mode appeared to be a more promising support to both failed heart and renal circulation.

Animals↗
PubMed1992

[Treatment of pericardial cyst under thoracoscopy].

Thoracoscopic therapy was carried out on two cases of pericardial cyst. The first patient was a 24-year-old male. An abnormal shadow on a chest X-ray was pointed out at a regular checkup. Thoracoscopy was carried out under the local anesthesia and a thin-walled cyst was discovered. The cyst was punctured and serous fluid was aspirated. Then, several biopsy specimens were obtained from the cyst wall, a pathological diagnosis of the cyst was made as a pericardial cyst. One year after the thoracoscopy, no abnormal shadow is observed on chest X-ray. The second patient was a 26-year-old male. It was also discovered that he had an abnormal shadow on a chest X-ray at a regular medical checkup. Since a solid mass couldn't be completely denied, thoracoscopy was carried out in preparing for thoracotomy under the general anesthesia. The cyst observed between SVC and the azygos vein, and serous fluid was aspirated form the cyst. Following this, the cyst wall was biopsied and opened. Since no cases of malignant pericardial cysts have been reported, an operation is not usually required for these patients. We suggest that thoracoscopy is very useful tool for the final diagnosis and therapy of pericardial cyst because this method is easily carried out under local anesthesia.

Adult↗
PubMed1992

[Long-term patency of aorto-coronary saphenous vein grafts].

One hundred eighty-two cases with 814 aorto-coronary saphenous vein grafts were studied according to coronary risk factors (smoking, hypertension, hyperlipidemia, diabetes mellitus, obesity and family history). The patency rates of all cases were as follows, early-term (within one year after operation): 92.3%, mid-term (within 5 years after operation) 80.7%, long-term (more than 5 years after operation): 66.0%. Coronary risk factors have great influence upon the mid- and long-term patency, especially upon the latter. The long-term patency rate of the grafts complicated with hyperlipidemia was 57.4% and that without hyperlipidemia was 81.8% (p less than 0.01). Hyperlipidemia, complicating 55.5% of all cases, was one of the most influential factors on the patency and also the most difficult one to be controlled. In the United States and Europe, many cases were complicated with hyperlipidemia, and it was considered that the poor patency of the saphenous vein grafts in those countries was due to this fact. Pathological studies revealed that hyperplasia of intima and media, characteristics of venosclerosis, appeared frequently in the saphenous vein grafts having more than three risk factors, and that the factors had effect not only upon arteries but also upon veins. So we conclude that saphenous vein grafts are the materials of good long-term patency, and that the control of the risk factors, particularly hyperlipidemia, is the key to improve the patency.

Adolescent↗
PubMed1992

[Surgical techniques of ventricular assist device].

Since October 1982 to April 1990, we had 16 ventricular assist device (VAD) cases in our institute. Using this VAD system that was produced by Nippon Zeon company, surgical techniques for cannulation and de-cannulation could be made very easily, and connection between cannulae and pump also could be performed quickly. In this article, the actual surgical techniques and the know-how were illustrated in detail. If this techniques can be more accustomed, the clinical results of VAD cases will be improved.

Cardiac Catheterization↗
PubMed1992

[Right-sided patent ductus arteriosus with a right aortic arch and right descending aorta].

We experienced an extremely rare anomaly, i.e. right-sided persistent ductus arteriosus with a right aortic arch and right descending aorta. Reviewing the literature, we found only two cases clinically reported in Japan as far as we know. The diagnosis was established by angiography and MRI. We treated the patient successfully through right thoracotomy.

Aorta, Thoracic↗
PubMed1992

[A case report of true palmar aneurysm].

True palmar aneurysm is a rare disease of the hand. Only 12 cases of true palmar aneurysm have been reported in Japan. This occurs commonly in the hypothenar region. We experienced a 12-year-old boy who had a aneurysm of the left palmar hand successfully treated by surgery. The clinical diagnosis was established by ultra sound. Vascular reconstruction by end to end anastomosis was performed after excision of aneurysm. Pathology revealed this was true aneurysm.

Anastomosis, Surgical↗
PubMed1991

[A successful report of emergency CABG for severe calcified thoracic aorta--the porcelain aorta].

The best management for patients requiring CABG with severe calcification of the thoracic aorta has not be established. To clamp ascending aorta in such cases produce cerebral embolization, aortic dissection or mural laceration. We reported a 60-year-old male for unstable angina with LMT lesion. Emergency CABG using IABP was performed with femoral cannulation, moderate hypothermia and induced ventricular fibrillation. His postoperative course was uneventful and coronary arteriography revealed a satisfactory patent graft of the RITA to the LAD system.

Aorta, Thoracic↗
PubMed1991

[A case of malignant hemangioendothelioma effectively treated with intra-arterial continuous infusion of interleukin-2].

An 82-year-old female presented with a tumor in the right-frontal region and was diagnosed as MHE, based on the clinical and pathological findings. Increased LAK (lymphokine-activated killer cell) activity was observed during treatment with intraarterial continuous infusion of rIL-2. In addition, the decrease in tumor size was started when LAK activity became high. Treatments for MHE and mechanism of these therapies were discussed using data from this case and other authors' reports.

Aged↗
PubMed1991

[Trans-sternal bilateral thoracotomy for bilateral lung lesions].

The trans-sternal bilateral thoracotomy had been used widely in the early days of cardiac surgery, but since the 1960's the median sternotomy has played a great part in open heart surgery. Recently, the simultaneous bilateral thoracotomy has been used for bilateral lung lesions such as bilateral giant bullae, bilateral pneumothoraces and bilateral metastatic lung tumors. Since 1965 we have performed 6 operations using trans-sternal bilateral thoracotomy for several bilateral lung lesions. The diseases which led to the use of the trans-sternal bilateral thoracotomy technique were 2 cases of bilateral simultaneous pneumothoraces and 4 cases of bilateral lung metastatic tumors. The ages of the patients ranged from 17 to 45 years old. The operative blood loss was between 100 and 810 gm. No case showed postoperative respiratory distress or severe thoracic pain. It would like to be pointed out that the trans-sternal bilateral thoracotomy is the most ideal approach for the multiple bilateral lung metastatic lesions which often invade the chest wall or diaphragm.

Adolescent↗