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Biomedical subjects

Y Tamiya

Publications and source records attributed to Y Tamiya.

At least 19 recordsLinked to original sources
PubMed1999

Selective visceral and renal perfusion in thoracoabdominal aneurysm repair.

OBJECTIVE: Whether or not selective visceral and renal perfusion during thoracoabdominal aortic aneurysm (TAAA) repair has a protective effect on visceral and renal function remains unknown. The aim of this study was to clarify if selective perfusion has such an effect. METHODS: From May 1982 to December 1997, 82 consecutive patients underwent TAAA repair. Patients receiving hypothermic circulatory arrest or cooling of the kidney using Ringer's lactate solution were excluded, thus 73 patients were enrolled into this study. They were divided into three groups: those in whom selective visceral and renal perfusion was performed using a roller pump (n = 41), those in whom it was performed using a centrifugal pump with a reduced heparin regimen (n = 22) and those who underwent simple aortic clamping alone (n = 10). RESULTS: Serum creatinine, total bilirubin and alanine aminotransferase levels were elevated postoperatively in patients undergoing simple cross-clamp repair, but remained almost within normal limits in patients undergoing TAAA repair with selective visceral and renal perfusion. Urine output was more in selective perfused patients than in non-perfused patients. Renal dysfunction, defined by requirement of hemodialysis or by a serum level of creatinine above 3 mg/dl, occurred in four patients (10%) of the roller pump group and in two patients (9%) of the centrifugal pump group, while in four patients (40%) of the simple cross-clamping group. CONCLUSION: Our experience suggests that selective visceral and renal perfusion has a protective effect on hepato-renal function during TAAA repair.

Adult↗
PubMed1999

[Surgical management for acute aortic dissection with organ ischemia].

In a series of one hundred and one cases of surgical treatment for acute aortic dissection between January 1986 and September 1997, we evaluated 29 cases presenting with organ ischemia. These consisted of 23 cases of acute type A dissection (type A) and 6 cases of type B dissection (type B). Organ ischemia was diagnosed by (1) aortography, (2) a retrospective review of the history and (3) physical examination or laboratory data. The 23 surgical cases of acute type A dissection consisted of, coronary ischemia 8 cases, cerebral and spinal cord ischemia 9 cases, intestinal ischemia 3 cases, lower extremities ischemia 10 cases, and plural organs ischemia 8 cases. In the 6 cases of acute type B, we noted 4 intestinal ischemias and 2 lower extremities ischemias. The operative mortality rates when subdivided according to ischemic organ were: coronary ischemia 50%, cerebral and spinal cord ischemia 11%, intestinal ischemia type A 33%, type B 50%, and lower extremities ischemia type A 33%, type B 0%. The operative mortality rates, especially for patients presenting with acute myocardial infarction or intestinal ischemia, were relatively high. In cases of acute aortic dissection when organ ischemia occurred, we believed that it was necessary to perform early thoracic aortic repair and reconstruction of the ischemic organ.

Acute Disease↗
PubMed1999

Successful surgical treatment of primary aorto-duodenal fistula associated with inflammatory abdominal aortic aneurysm: A case report.

We report a rare case of a 50-year-old woman with intermittent gastrointestinal (GI) bleeding and diagnosed as having primary aortoenteric fistula (PAEF) with inflammatory abdominal aortic aneurysm (IAAA). She was transferred to our institution with suspected PAEF as assessed by duodenoscopy and CT scan. As the patient was in shock due to massive GI-bleeding two days after admission, we performed an emergency laparotomy. The fistula was closed and the aneurysm replaced by a Woven Dacron Graft with an inter-positioning omental flap. A high index of suspicion is the most important diagnostic aid to prevent overlooking this often fatal disease.

Aortic Aneurysm, Abdominal↗
PubMed1999

A single-stage operation for bicuspid aortic valve, annulo-aortic ectasia, hypoplastic aortic arch, and coarctation of the aorta: A case report.

The patient was an 18-year-old man who had been diagnosed as having a bicuspid aortic valve and dilatation of the ascending aorta six years previously. As he grew up, aneurysmal change of the ascending aorta and hypertension in the upper body gradually progressed. Preoperative evaluation showed annulo-aortic ectasia and the following congenital abnormalities: bicuspid aortic valve, hypoplastic aortic arch, and coarctation of the aorta. Composite graft replacement and extended total aortic arch replacement were carried out.

Adolescent↗
PubMed1998

Do the level of nodal disease according to the TNM classification and the number of involved cervical nodes reflect prognosis in patients with differentiated carcinoma of the thyroid gland?

BACKGROUND AND OBJECTIVES: The importance of nodal involvement as a prognostic factor in differentiated carcinoma of the thyroid gland remains controversial. We therefore attempted to confirm the prognostic factors in differentiated thyroid carcinoma, with special reference to nodal status. PATIENTS AND METHODS: A total of 139 patients with differentiated thyroid cancer followed for 2-27 years, with a median follow-up of 7 years were studied. All patients underwent surgical resection, either subtotal, total, or lobectomy, with modified radical neck dissection. Survival was calculated using the Kaplan-Meier method. RESULTS: Ten (7%) patients have died from thyroid cancer. Adverse prognostic factors included age >45 years (P=0.0120), the presence of distant metastases (P=0.0006), and TNM stage (P=0.0002). The number of lymph nodes dissected ranged from 6 to 92, with an average of 26. Lymph node metastases were found in 102 (73%) patients. There was no difference in survival according to the level of nodal disease by the TNM classification. Furthermore, the number of cervical lymph nodes involved had no effect on the survival. CONCLUSION: Our results suggest that the presence of histologically confirmed lymph node metastases is not an important prognostic factor in patients with differentiated thyroid carcinoma.

Adult↗
PubMed1998

Occlusion of the abdominal aorta caused by enlargement of the false lumen after graft replacement for a DeBakey type IIIb dissecting aneurysm: report of a case.

We report herein a case of abdominal aorta occlusion caused by enlargement of the false lumen after a graft replacement. The patient was a 70-year-old man who underwent a graft replacement of the descending thoracic aorta for a DeBakey type IIIb dissecting aneurysm. Digital subtraction angiography performed on postoperative day 18 revealed an abdominal aorta occlusion caused by enlargement of the false lumen. A new intimal defect was found in the aortic wall 2 cm distal to the suture line, the cause of which was suspected to be clamp injury during the initial operation. Graft replacement of the abdominal aorta was subsequently carried out. Postoperatively, he had no complications, and digital subtraction angiography showed excellent reconstruction of the abdominal aorta. The patient was discharged from hospital 1 month after his second operation.

Aged↗
PubMed1998

[A case of graft replacement of the ascending aorta to the aortic arch and the partial descending aorta in a single stage for thrombosed aortic dissection (DeBakey type II + IIIb)].

We report here a case of graft replacement of the ascending aorta to the aortic arch and the middle portion of the descending aorta in a single stage for thrombosed aortic dissection. The patient was a 53-year-old male who was transferred to our hospital with a diagnosis of thrombosed aortic dissection. Conservative therapy was continued but three weeks after the onset, chest enhanced CT scan and digital subtraction angiography revealed an opacified false lumen in the ascending aorta and a ulcer like projection in the middle portion of the descending aorta. He was therefore diagnosed as having redissecction in DeBakey type II + IIIb thrombosed aortic dissection. Graft replacement of the ascending aorta, the aortic arch, and a part of the descending aorta was performed in a single stage via median stenotomy with the aid of extracorporeal circulation and selective cerebral perfusion. Postoperative digital subtraction angiography showed satisfactory reconstruction of the thoracic aorta. The patient is still leading a normal life two years after the operation.

Aortic Dissection↗
PubMed1998

[A case report of ruptured pseudoaneurysm into the left lung after graft replacement of the descending thoracic aorta].

We report a successful case of total aortic arch replacement using selective cerebral perfusion for ruptured pseudoaneurysm into the left lung after graft replacement of the descending thoracic aorta. A 74-year-old female who had graft replacement of the descending thoracic aorta for ruptured acute type B dissecting aneurysm into the left pleural cavity was admitted with a complaint of severe hemoptysis. Preoperative enhanced computed tomography revealed a large pseudoaneurysm of the aortic arch and massive hematoma around it. She was diagnosed as having a ruptured pseudoaneurysm into the left lung. A graft replacement of the total aortic arch with the aid of selective cerebral perfusion was performed. At the time of operation, a pseudoaneurysm which was from an intimal defect in the aortic wall 2 cm proximal to the suture line was found. It was suspected that the cause of the pseudoaneurysm was due to clamp injury during the initial operation. Postoperatively, she had no cerebral complications, and digital subtraction angiography showed excellent reconstruction of the aortic arch. One month after the operation, she had recovered sufficiently to be discharged from our hospital.

Aged↗
PubMed1998

[Operative results and long-term prognosis of type A acute aortic dissection].

Between 1983 and 1997, we operated upon 91 patients with type A acute aortic dissection. The dissection was localized in 22 patients and extensive in 69 patients. All patients underwent graft replacement and 61 (67%) patients underwent simultaneous replacement of ascending aorta and total aortic arch. The hospital mortality rate were 9% for the localized dissection and 21% for the extensive dissection. The actuarial survival rates in patients with localized dissection at 5 and at 10 years was 91% and 76%, whereas those in patients with extensive dissection at 5 and at 10 years was 68% and 62%. The freedom from dissection related death or reoperation in operative survivors with localized dissection at 5 and at 10 years was 100% and 83%, whereas those in patients with extensive dissection at 5 and at 10 years was 78% and 56%. The simultaneous replacement of ascending aorta and total aortic arch in patients with extensive dissection was effective to obliteration of the distal false channel, although this extended procedure has to be carefully adopted in high risk patients with associated complications such as acute dissection organ ischemia.

Acute Disease↗
PubMed1997

Absence of RET proto-oncogene mutations in a father and son with pheochromocytoma and pancreatic islet cell tumor.

BACKGROUND: We describe a father and son with a combination of pheochromocytoma and pancreatic islet cell tumor. Although its familial occurrence is rare, this syndrome could be called overlapping-type multiple endocrine neoplasia (MEN), since it fulfills the criteria for both type 1 and type 2 MEN. Recently, germ line mutations of the RET proto-oncogene (RET) were found to be related to tumorigenesis and disease phenotypes in type 2 MEN. METHODS: Using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis, we looked for germ line mutations of RET in 8 members of this family, including the 2 patients. RESULTS: Analysis of RET exons 10, 11 and 16, which contain the hot-spot codons for MEN type 2, revealed no mutations in any individual examined. CONCLUSION: These findings suggest that these 3 exons in RET are not related to tumorigenesis in overlapping-type MEN.

Adenoma, Islet Cell↗
PubMed1997

[A case report of ruptured distal aortic arch aneurysm into pericardial space].

We report a case of successful total aortic arch replacement using selected cerebral perfusion for ruptured distal aortic arch aneurysm (DAAA) into the pericardial space. A 75 year-old man who had preoperative episode of severe chest pain and tachycardia was transferred to our hospital. Computed tomography showed saccular DAAA and pericardial effusion, so the patient was diagnosed as ruptured DAAA into pericardial space. Immediately after CT-scanning, urgent operation of a graft replacement of aortic arch with selective cerebral perfusion was carried out. Postoperatively, he had no cerebral complication, but develop transient respiratory failure and renal dysfunction. Three months after the operation he was discharged from the hospital. The patient is now leading a normal life.

Aged↗
PubMed1997

[Extended total aortic arch replacement involving the proximal descending aorta through a median sternotomy].

From January 1986 to September 1995, total aortic arch replacement (TAR) for aortic dissection was performed using selective cerebral perfusion in 151 patients. In 18 patients, the surgical procedures of extended aortic arch replacement (EAR) involving the proximal descending aorta through a median sternotomy were applied. To evaluate the outcome of EAR, the early and late results were compared with those of non-extended aortic arch replacements (NAR) through a median sternotomy (n = 66). The early mortality rates for EAR and NAR were 5.6% and 16.7%, respectively (NS); the lower rate for EAR may be due to the fact that EAR were performed more recently than NAR. The differences between EAR and NAR with respect to the amount of blood transfused intraoperatively and the respiratory index at 12 hours after surgery were not statistically significant. In addition, the extracorporeal bypass time in EAR was no longer than that in NAR. Thus, as compared with the NAR procedure, the EAR procedure did not have a negative effect on early outcome. Regarding late results, the actuarial survival rates after EAR and NAR, respectively were 87% and 72% at 1 year, 87% and 69% at 3 years (NS). The early thrombo-occlusion rates of the remaining false lumens after TAR in broad aortic dissections were 56% after EAR and 33% after NAR (p = 0.21). These results suggest that EAR may be a more useful procedure in some patients requiring TAR.

Aged↗
PubMed1997

[Surgical strategy for Stanford type A aortic dissection with Marfan syndrome].

Between January 1979 and May 1996, 23 Marfan patients underwent surgeries for type A aortic dissection; 8 patients with localized type dissection and 15 with extensive type. All of the 23 patients suffered from annuloaortic ectasia (AAE) which was treated by composite graft replacement, 10 of these patients had a concomitant replacement of the aortic arch. The operative mortality rate was 8.7%, and the causes were associated with the methods of coronary artery reattachment to the graft. Of the 15 patients with the extensive type dissection, there were 11 patients who had a non-thrombotic communicating false lumen in the untreated segments of the distal dissected aorta after the first operation and from this group there were seven patients who had anastomotic leakage around the distal suture line of the graft replacement that was demonstrated by aortography. Extensive graft replacement ranging from the entire thoracic aorta to the total aorta were performed in 10 (43.5%). Late deaths occurred in three patients (13.0%) and these causes were LOS and graft infection after the second operation and prosthetic valve endcarditis 6 months after the first operation. The present data indicate that Stanford type A aortic dissection with Marfan syndrome should be undertaken on the basis of a prior achievable plan to perform an entire aortic replacement. The dissection should also be performed using a procedure which doesn't leave distal anastomotic leakage.

Adolescent↗
PubMed1996

Extended aortic replacement for acute type A dissection with the tear in the descending aorta.

OBJECTIVE: There has been controversy as to the selection of surgical treatments for acute type A dissection with the tear in the descending thoracic aorta, a subtype of acute aortic dissection in which the limited tear is located distal to the left subclavian artery but the dissection extends retrogradely to the ascending aorta. METHODS: Total replacement of the ascending aorta and aortic arch was performed in 12 patients with acute type A dissection with the tear in the descending thoracic aorta between March 1991 and the end of September 1995. The indications for total replacement of the ascending aorta and aortic arch were cardiac tamponade, acute aortic regurgitation, cerebral ischemia, and dilatation of the ascending aorta. The operation was performed with the aid of extracorporeal circulation, blood cardioplegia, selective cerebral perfusion, and open distal anastomosis. The surgical procedure used was total replacement of the ascending aorta and aortic arch with a graft provided with three limbs accompanied by resection of the intimal tear in the descending thoracic aorta. RESULTS: Hospital death occurred in two patients (16.7%). In both, death was due to dissection/related complications of renal/mesenteric ischemia. The other 10 patients have had uneventful postoperative courses over a mean period of 24 months. CONCLUSIONS: Total replacement of the ascending aorta and aortic arch accompanied by resection of an intimal tear distal to the left subclavian artery seems to be justified in selected patients with acute type A dissection with the tear in the descending thoracic aorta.

Acute Disease↗
PubMed1995

Electrogastrography prior to and following total gastrectomy, subtotal gastrectomy, and gastric tube formation.

On electrogastrography (EGG) spectral analysis, an activity of 3 cycles per minute (cpm) is supposed to be specific for the stomach. After total or subtotal gastrectomy, the original site of the stomach is occupied mainly by the intestine. We attempted to determine if intestinal activity could be recorded in this region with EGG. Epigastric recordings were performed in patients prior and following gastrointestinal or control surgeries. Spectral analysis, using the maximal entropy method and ensemble means was applied to data analysis from these recordings. Preoperatively, the majority of the power peaks were found around 3, 6, and 11 cpm. The postprandial-to-fasting power ratio of all of these power peaks increased significantly postprandially (P < 0.05-0.01). Following total gastrectomy, the power peak around 3 cpm disappeared or was significantly diminished in amplitude (P < 0.05). The postoperative-to-preoperative power ratio ranged from 0.03 to 0.10 (P < 0.001-0.01). However, the power peak around 11 cpm did not significantly change prior to or following total gastrectomy, and the 11 cpm peak appeared relatively dominant. Simultaneous manometric studies in the Roux limb demonstrated a correlation between the power spectral frequency of EGG and manometry at 11 cpm. Therefore, the 11 cpm peak appeared to reflect jejunal or Roux limb electrical activity. The postoperative to preoperative power ratio for the 3 cpm also was significantly reduced following subtotal gastrectomy and gastric tube formation in patients in the postprandial state (P < 0.05-0.001).

Adult↗