Atherosclerosis is a generalized disease which afflicts a considerable number of patients in both... more Atherosclerosis is a generalized disease which afflicts a considerable number of patients in both the carotid and coronary arteries. Although the risk of stroke or death use to combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) is thought to be higher than that of each individual operation, the combined procedure is generally preferred over staged operations to treat such patients. We performed the combined procedure safely with the aid of intraoperative portable digital subtraction angiography (DSA). This report describes our experience with the operative strategy of simultaneous CEA and CABG. Ninety CEA and 404 CABG were carried out between January 1989 and December 1997. A total of six patients received the combined procedure with the aid of intraoperative DSA; they were studied retrospectively. Postoperative mortality and morbidity after the combined procedure was 0%. In the combined procedure, neurological complications are difficult to detect after C...
日本胸部外科学会雑誌 the Japanese Journal of Thoracic and Cardiovascular Surgery, Jan 10, 2006
We report the case of a 4-year-old girl who had quadricuspid aortic valve regurgitation with tetr... more We report the case of a 4-year-old girl who had quadricuspid aortic valve regurgitation with tetralogy of Fallot and pulmonary atresia. This combination is very uncommon. Aortic valve replacement was performed successfully due to aortic regurgitation which had progressed one year after the total repair. The dilated aortic annulus plus quadricuspid aortic valve may result in progressive aortic regurgitation for a short period.
I n surgery for acute aortic dissection, the choice of appropriate arterial access for cardiopulm... more I n surgery for acute aortic dissection, the choice of appropriate arterial access for cardiopulmonary bypass is sometimes difficult because of dissection in large branches of the aorta. We report the efficacy of transapical aortic cannulation in acute type A aortic dissection in a patient with diffuse atherosclerotic disease.
A 22 year oldJapanese man with popliteal artery entrapment syndrome in which both popliteal arter... more A 22 year oldJapanese man with popliteal artery entrapment syndrome in which both popliteal arteries were segmentally occluded and deviated medially, underwent surgical treatment by grafting and patching with autologous veins. His identical co-twin was also found to have a less severe form ofpopliteal artery entrapment syndrome. This is the first report of popliteal artery entrapment syndrome presenting in a pair of monozygotic twins and the concordance of the syndrome suggests that genetic factors may play a part in the development of this rare syndrome.
The International journal of artificial organs, Jan 30, 2015
Ventricular assist devices are a potent alternative or bridge therapy to heart transplants for di... more Ventricular assist devices are a potent alternative or bridge therapy to heart transplants for dilated cardiomyopathy patients. However, ventricular assist devices have problems related to biocompatibility, hemocompatibility, and thromboembolic events, especially in younger patients. The present study examined the hemodynamic effects of a direct cardiac compression device using circumferential artificial rubber muscles in a young swine model of dilated cardiomyopathy. Dilated cardiomyopathy was established in 6 pigs (6-8 weeks of rapid right ventricular pacing; average weight, 22.6 ± 2.1 kg). The device was designed using pneumatic rubber muscles (Fluidic Muscle, Festo). Hemodynamic parameters were monitored under baseline conditions, after the assistance, and after inducing ventricular fibrillation. Hemodynamic data were acquired using a PiCCO, multilumened thermodilution catheter in the pulmonary artery, left ventricular pressure monitoring, and epicardial echocardiography. Direct...
The Japanese Journal of Thoracic and Cardiovascular Surgery, May 11, 2008
Axillary artery perfusion is an attractive alternative to reduce the frequency of atheroembolism ... more Axillary artery perfusion is an attractive alternative to reduce the frequency of atheroembolism in extensive atherosclerotic aorta and aortic aneurysms. This study was conducted to evaluate the flow dynamics of axillary artery perfusion. Transparent glass models of a normal aortic arch and an aortic arch aneurysm were used to evaluate hydrodynamic properties. Streamline analysis and distribution of the shear stress was evaluated using a particle image velocity method. In the normal aortic arch model, rapid flow of 80 cm/s from the right axillary artery ran out from the brachiocephalic artery and grazed the lesser curvature of the aortic arch. There was secondary reversed flow in the ascending aorta. Flow from left axillary perfusion went straight to the descending aorta. In the aortic arch aneurysm model, flow from both axillary arteries hit the lesser curvature of the aortic arch and went into the ascending aorta with vortical flow. Distribution of shear stress was high along the jet from the ostium of the brachiocephalic artery and left subclavian artery. Flow in the aortic arch and the ascending aorta was unexpectedly rapid. Special care must be taken when the patient has frail atheroma around arch vessels or the lesser curvature of the aortic arch during axillary artery perfusion.
The radial artery is used frequently in cardiac revascularization and requires an average 23-cm f... more The radial artery is used frequently in cardiac revascularization and requires an average 23-cm forearm incision. With proper instrumentation (Tsukuba-West Virginia Endoscopic Radial Artery: TW-ERA series, Takumi Cardio Co., Chiba, Japan), the radial artery can be harvested utilizing two small transverse incisions. The authors report six cases of endoscopic harvest of a radial artery graft. Length of the endoscopic incision is 2 cm proximally and 3 cm distally. Operation time and tourniquet times were approximately 80 to 120 minutes. No complications such as hematomas, nerve damage, or delay in healing were observed at the donor sites. Plastic surgeons, with their expertise in radial forearm flaps, hand surgery, and subcutaneous endoscopic techniques, can contribute greatly to the minimally invasive harvesting of the radial artery, preventing associated morbidity and improving the aesthetic and functional outcome of the donor site.
Mycotic aneurysms located on aortic arch are rare and have extremely high mortality. The presente... more Mycotic aneurysms located on aortic arch are rare and have extremely high mortality. The presented case is a 75-year-old man with a thoracic aortal mycotic aneurysm successfully treated with surgical intervention. To prevent recurrent infection and postoperative pulmonary complications, we performed single-stage surgery including extensive debridement, graft replacement using rifampicin soaked prosthetic graft and omental wrapping. Although mycotic aneurysm with inflammation tissue usually interferes with surgical manipulation because of severe adhesion to the lung, semi-clamshell approach helped us perform all these procedures. The patient rapidly recovered from the surgery, and has shown no recurrence after 35 months follow-up.
Kyobu Geka the Japanese Journal of Thoracic Surgery, Apr 1, 2010
A 74-year-old man who had been treated by endocrine therapy for prostatic cancer for 7 years was ... more A 74-year-old man who had been treated by endocrine therapy for prostatic cancer for 7 years was pointed out an abnormal shadow on the chest X-ray. Computed tomography showed solitary tumor in the lower lobe of the left lung. Transbronchial lung biopsy revealed pulmonary metastasis form prostatic cancer. Because no other metastatic lesions were detected, the patient underwent surgery for pulmonary lesion. The wedge resection of the left lung was performed. Microscopically, the diagnosis of pulmonary and multiple pleural metastases was established. The pulmonary metastasis without bone nor lymph node metastasis is rare. Pleural metastasis should be considered in case of pulmonary metastasis from prostatic cancer. Surgical indication for pulmonary metastasis from prostatic cancer has to be decided carefully.
Kyobu Geka the Japanese Journal of Thoracic Surgery, 2014
Twenty patients underwent chest wall reconstruction using expanded polytetrafluoroethylene(ePTFE)... more Twenty patients underwent chest wall reconstruction using expanded polytetrafluoroethylene(ePTFE) soft tissue patch following resection between June 1996 and December 2012. The patients included 15 men and 5 women, aged 18 to 80 years. The indications for resection included 4 primary tumors, 8 metastatic tumors, and 8 infiltrating tumors. The lesions were located anteriorly in 10 patients, laterally in 5 patients and posteriorly in 5 patients. Skeletal resection involved an average of 2 ribs in 19 patients, and a partial sternectomy in 1 patient. The size of chest wall defects ranged from 20 to 210 cm2( mean, 69.8 cm2). Lung resection was performed in 7 patients included a wedge resection, 5 lobectomy, and a bilobectomy. Chest wall defects were closed primarily with ePTFE soft tissue patch. There were no critical complications or postoperative mortalities. The mean follow-up in all patients is 72.7 months. Recurrence of malignancy occurred in 10 patients included a local recurrence in 1 patient, and metastases in 9 patients. The overall postoperative 5-year survival rate is 61.0%. Non-rigid prosthetic reconstruction with ePTFE soft tissue patch provides satisfactory outcome. New prosthetic materials have to be examined whether they are superior to ePTFE soft tissue patch.
Annals of Thoracic and Cardiovascular Surgery Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, Aug 1, 2003
Objective: Although deep sternal wound infection (DSWI) after cardiac surgery is infrequent, its ... more Objective: Although deep sternal wound infection (DSWI) after cardiac surgery is infrequent, its consequences are serious. The purposes of this study were to define the risk factors, and to establish the best surgical treatment for DSWI. Methods: Retrospective analysis for 863 patients who underwent cardiac surgery was performed. The patients were divided into the DSWI group (n=17) and the non-infection group (n=846). Preoperative, perioperative, and postoperative variables were compared between the two groups using univariate and multivariate logistic regression analysis. The modality of treatment for DSWI was also analyzed. Results: The incidence of DSWI was 1.97%. Independent predictors for DSWI were concomitant coronary artery bypass grafting CABG) with valve or aortic surgery [odds ratio, 4.1; 95% confidence interval, (1.1, 15.1)] and postoperative use of intraaortic balloon pumping [4.4, (1.6, 12.3)]. An independent predictor in isolated CABG patients was emergency operation [10.9, (2.7, 44.7)]. Four of 17 patients died. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from 10 (58.8%) patients, and all four of the deceased subjects died of its infection. Seventeen patients were treated by debridement, primary closure, and the addition of an omentum or muscle flap if necessary. Conclusions: Patients in poor perioperative condition are at high risk for the development of this infection. It was difficult to establish the best treatment, owing to the small series of this study. Mortality and morbidity of DSWI due to MRSA was high. (Ann Thorac Cardiovasc Surg 2003; 9: 226-32)
Annals of Thoracic and Cardiovascular Surgery Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, Sep 1, 2008
Purpose: This study was designed to evaluate the relationship among free radicals and vascular en... more Purpose: This study was designed to evaluate the relationship among free radicals and vascular endothelial growth factor (VEGF) and inducible nitric oxide synthase (iNOS) during the progression of left ventricular hypertrophy (LVH) in pressure-overload rat heart. Methods: Hypertrophied rat heart created by abdominal aortic banding at the age of 4 weeks was studied at the ages of 14, 15, 18, 21, 26, and 30 weeks (n = 5 in each group). Free radicals were detected by an electron spin resonance (ESR) method using LV tissue. The levels of messenger ribonucleic acid (mRNA) for VEGF, superoxide dismutase (SOD), and iNOS in myocardium were analyzed by reverse transcription (RT)-polymerase chain reaction (PCR). Results: Free radicals consisting of superoxide families increased over time after aortic banding and were highest in the 30-week group. The SOD mRNA level decreased with the progression of hypertrophy and was inversely proportional to the free radicals level. As compared to the control, the level of mRNA for VEGF and iNOS was significantly increased in 18-and 21-week hypertrophied hearts, but significantly decreased in 26-and 30-week hearts. Conclusion: The increased level of free radicals with the decrease of VEGF and iNOS levels may contribute to the progression of the pressure-overload hypertrophied heart to the failing heart. (Ann Thorac Cardiovasc Surg 2008; 14: 210-217)
The Japanese Journal of Thoracic and Cardiovascular Surgery, Jul 1, 2006
We report a systolic anterior motion of the anterior mitral leaflet despite employing the sliding... more We report a systolic anterior motion of the anterior mitral leaflet despite employing the sliding leaflet technique for repair of mitral valve regurgitation. A 65-year-old man with chronic, symptomatic mitral regurgitation due to ruptured chordae tendineae underwent mitral valve repair by quadrangular resection of the posterior leaflet and sliding leaflet technique with ring annuloplasty. After weaning from cardiopulmonary bypass, left ventricular outflow obstruction developed and transesophageal echocardiography demonstrated systolic anterior motion of the mitral valve and severe mitrai regurgitation. Non-operative treatment resolved the outflow tract obstruction, systolic anterior motion and mitral regurgitation. We conclude that post-repair systolic anterior motion can still occur after the sliding plasty procedure and that medical treatment can successfully resolve systolic anterior motion and outflow tract obstruction in most patients. (Jpn J Thorac Cardiovasc Surg 2006; 54: 249-252) Case A 65-year-old man (height 163 cm, weight 60.4 kg)
This study was conducted to clarify the prevalence of venous thromboembolism (VTE) in neurosurgic... more This study was conducted to clarify the prevalence of venous thromboembolism (VTE) in neurosurgical patients. Prospective study for venous thromboembolism screening after neurosurgery was conducted. Thirty-seven patients were screened by ultrasonography for deep vein thrombosis in the lower extremities at an average of 12 days postoperatively. All patients received standard thromboprophylaxis using graded compression stocking with/without intermittent pneumatic compression following the VTE prevention guidelines. Definitive diagnosis of venous thromboembolism was made by contrast-enhanced whole-body computed tomography. Prevalence of deep vein thrombosis of the lower legs was 13.5% (5/37). Incidence of pulmonary embolism was 60% (3/5) in patients having deep vein thrombosis. All patients having venous thromboembolism were asymptomatic. In high-risk patients, VTE prevalence after neurosurgery was high even under mechanical prophylaxis. Additional pharmacological prophylaxis should be considered for patients with high risk of VTE.
Kyobu Geka the Japanese Journal of Thoracic Surgery, Jun 1, 2011
A 76-year-old man, who had underwent radiation for laryngeal cancer 5 years before, was pointed o... more A 76-year-old man, who had underwent radiation for laryngeal cancer 5 years before, was pointed out abnormal pulmonary lesion on computed tomography. The 4.6 cm-sized lesion was seen in the upper lobe of the left lung. Endoscopic brushing cytology revealed adenocarcinoma. The patient was diagnosed as primary lung cancer of T2N0M0, clinical stage IB. Preoperative serum CA19-9 was elevated to 250 U/ml, although other tumor markers were within normal limits. The patient underwent left upper lobectomy with mediastinal lymph node dissection. Histologically, the lesion was diagnosed as well differentiated adenocarcinoma, mucinous subtype of bronchioloalveolar carcinoma (BAC) in World Health Organization (WHO) classification. Immunohistochemistry shows positive for CA19-9 and thyroid transcription factor-1 (TTF-1).
α-Synuclein was originally identified as the precursor of non-amyloid β component of Alzheimer's ... more α-Synuclein was originally identified as the precursor of non-amyloid β component of Alzheimer's disease amyloid (NAC). NAC is detected in cerebral amyloid angiopathy; and we studied whether cerebral vascular cells express α-synuclein. Immunohistochemical studies of normal human cerebral tissues revealed the expression of α-synuclein in vascular endothelial and smooth muscle cells. Also cultures of human umbilical vein endothelial cells and umbilical artery smooth muscle cells were found, by reverse transcription-polymerase chain reaction (RT-PCR) and Northern blot analysis, to constitutively express α-synuclein mRNA. Western blot analysis disclosed the presence of α-synuclein protein in lysates of these cells. We conclude that vascular cells express α-synuclein, and it may play some role in the physiology of the vascular wall.
Atherosclerosis is a generalized disease which afflicts a considerable number of patients in both... more Atherosclerosis is a generalized disease which afflicts a considerable number of patients in both the carotid and coronary arteries. Although the risk of stroke or death use to combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) is thought to be higher than that of each individual operation, the combined procedure is generally preferred over staged operations to treat such patients. We performed the combined procedure safely with the aid of intraoperative portable digital subtraction angiography (DSA). This report describes our experience with the operative strategy of simultaneous CEA and CABG. Ninety CEA and 404 CABG were carried out between January 1989 and December 1997. A total of six patients received the combined procedure with the aid of intraoperative DSA; they were studied retrospectively. Postoperative mortality and morbidity after the combined procedure was 0%. In the combined procedure, neurological complications are difficult to detect after C...
日本胸部外科学会雑誌 the Japanese Journal of Thoracic and Cardiovascular Surgery, Jan 10, 2006
We report the case of a 4-year-old girl who had quadricuspid aortic valve regurgitation with tetr... more We report the case of a 4-year-old girl who had quadricuspid aortic valve regurgitation with tetralogy of Fallot and pulmonary atresia. This combination is very uncommon. Aortic valve replacement was performed successfully due to aortic regurgitation which had progressed one year after the total repair. The dilated aortic annulus plus quadricuspid aortic valve may result in progressive aortic regurgitation for a short period.
I n surgery for acute aortic dissection, the choice of appropriate arterial access for cardiopulm... more I n surgery for acute aortic dissection, the choice of appropriate arterial access for cardiopulmonary bypass is sometimes difficult because of dissection in large branches of the aorta. We report the efficacy of transapical aortic cannulation in acute type A aortic dissection in a patient with diffuse atherosclerotic disease.
A 22 year oldJapanese man with popliteal artery entrapment syndrome in which both popliteal arter... more A 22 year oldJapanese man with popliteal artery entrapment syndrome in which both popliteal arteries were segmentally occluded and deviated medially, underwent surgical treatment by grafting and patching with autologous veins. His identical co-twin was also found to have a less severe form ofpopliteal artery entrapment syndrome. This is the first report of popliteal artery entrapment syndrome presenting in a pair of monozygotic twins and the concordance of the syndrome suggests that genetic factors may play a part in the development of this rare syndrome.
The International journal of artificial organs, Jan 30, 2015
Ventricular assist devices are a potent alternative or bridge therapy to heart transplants for di... more Ventricular assist devices are a potent alternative or bridge therapy to heart transplants for dilated cardiomyopathy patients. However, ventricular assist devices have problems related to biocompatibility, hemocompatibility, and thromboembolic events, especially in younger patients. The present study examined the hemodynamic effects of a direct cardiac compression device using circumferential artificial rubber muscles in a young swine model of dilated cardiomyopathy. Dilated cardiomyopathy was established in 6 pigs (6-8 weeks of rapid right ventricular pacing; average weight, 22.6 ± 2.1 kg). The device was designed using pneumatic rubber muscles (Fluidic Muscle, Festo). Hemodynamic parameters were monitored under baseline conditions, after the assistance, and after inducing ventricular fibrillation. Hemodynamic data were acquired using a PiCCO, multilumened thermodilution catheter in the pulmonary artery, left ventricular pressure monitoring, and epicardial echocardiography. Direct...
The Japanese Journal of Thoracic and Cardiovascular Surgery, May 11, 2008
Axillary artery perfusion is an attractive alternative to reduce the frequency of atheroembolism ... more Axillary artery perfusion is an attractive alternative to reduce the frequency of atheroembolism in extensive atherosclerotic aorta and aortic aneurysms. This study was conducted to evaluate the flow dynamics of axillary artery perfusion. Transparent glass models of a normal aortic arch and an aortic arch aneurysm were used to evaluate hydrodynamic properties. Streamline analysis and distribution of the shear stress was evaluated using a particle image velocity method. In the normal aortic arch model, rapid flow of 80 cm/s from the right axillary artery ran out from the brachiocephalic artery and grazed the lesser curvature of the aortic arch. There was secondary reversed flow in the ascending aorta. Flow from left axillary perfusion went straight to the descending aorta. In the aortic arch aneurysm model, flow from both axillary arteries hit the lesser curvature of the aortic arch and went into the ascending aorta with vortical flow. Distribution of shear stress was high along the jet from the ostium of the brachiocephalic artery and left subclavian artery. Flow in the aortic arch and the ascending aorta was unexpectedly rapid. Special care must be taken when the patient has frail atheroma around arch vessels or the lesser curvature of the aortic arch during axillary artery perfusion.
The radial artery is used frequently in cardiac revascularization and requires an average 23-cm f... more The radial artery is used frequently in cardiac revascularization and requires an average 23-cm forearm incision. With proper instrumentation (Tsukuba-West Virginia Endoscopic Radial Artery: TW-ERA series, Takumi Cardio Co., Chiba, Japan), the radial artery can be harvested utilizing two small transverse incisions. The authors report six cases of endoscopic harvest of a radial artery graft. Length of the endoscopic incision is 2 cm proximally and 3 cm distally. Operation time and tourniquet times were approximately 80 to 120 minutes. No complications such as hematomas, nerve damage, or delay in healing were observed at the donor sites. Plastic surgeons, with their expertise in radial forearm flaps, hand surgery, and subcutaneous endoscopic techniques, can contribute greatly to the minimally invasive harvesting of the radial artery, preventing associated morbidity and improving the aesthetic and functional outcome of the donor site.
Mycotic aneurysms located on aortic arch are rare and have extremely high mortality. The presente... more Mycotic aneurysms located on aortic arch are rare and have extremely high mortality. The presented case is a 75-year-old man with a thoracic aortal mycotic aneurysm successfully treated with surgical intervention. To prevent recurrent infection and postoperative pulmonary complications, we performed single-stage surgery including extensive debridement, graft replacement using rifampicin soaked prosthetic graft and omental wrapping. Although mycotic aneurysm with inflammation tissue usually interferes with surgical manipulation because of severe adhesion to the lung, semi-clamshell approach helped us perform all these procedures. The patient rapidly recovered from the surgery, and has shown no recurrence after 35 months follow-up.
Kyobu Geka the Japanese Journal of Thoracic Surgery, Apr 1, 2010
A 74-year-old man who had been treated by endocrine therapy for prostatic cancer for 7 years was ... more A 74-year-old man who had been treated by endocrine therapy for prostatic cancer for 7 years was pointed out an abnormal shadow on the chest X-ray. Computed tomography showed solitary tumor in the lower lobe of the left lung. Transbronchial lung biopsy revealed pulmonary metastasis form prostatic cancer. Because no other metastatic lesions were detected, the patient underwent surgery for pulmonary lesion. The wedge resection of the left lung was performed. Microscopically, the diagnosis of pulmonary and multiple pleural metastases was established. The pulmonary metastasis without bone nor lymph node metastasis is rare. Pleural metastasis should be considered in case of pulmonary metastasis from prostatic cancer. Surgical indication for pulmonary metastasis from prostatic cancer has to be decided carefully.
Kyobu Geka the Japanese Journal of Thoracic Surgery, 2014
Twenty patients underwent chest wall reconstruction using expanded polytetrafluoroethylene(ePTFE)... more Twenty patients underwent chest wall reconstruction using expanded polytetrafluoroethylene(ePTFE) soft tissue patch following resection between June 1996 and December 2012. The patients included 15 men and 5 women, aged 18 to 80 years. The indications for resection included 4 primary tumors, 8 metastatic tumors, and 8 infiltrating tumors. The lesions were located anteriorly in 10 patients, laterally in 5 patients and posteriorly in 5 patients. Skeletal resection involved an average of 2 ribs in 19 patients, and a partial sternectomy in 1 patient. The size of chest wall defects ranged from 20 to 210 cm2( mean, 69.8 cm2). Lung resection was performed in 7 patients included a wedge resection, 5 lobectomy, and a bilobectomy. Chest wall defects were closed primarily with ePTFE soft tissue patch. There were no critical complications or postoperative mortalities. The mean follow-up in all patients is 72.7 months. Recurrence of malignancy occurred in 10 patients included a local recurrence in 1 patient, and metastases in 9 patients. The overall postoperative 5-year survival rate is 61.0%. Non-rigid prosthetic reconstruction with ePTFE soft tissue patch provides satisfactory outcome. New prosthetic materials have to be examined whether they are superior to ePTFE soft tissue patch.
Annals of Thoracic and Cardiovascular Surgery Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, Aug 1, 2003
Objective: Although deep sternal wound infection (DSWI) after cardiac surgery is infrequent, its ... more Objective: Although deep sternal wound infection (DSWI) after cardiac surgery is infrequent, its consequences are serious. The purposes of this study were to define the risk factors, and to establish the best surgical treatment for DSWI. Methods: Retrospective analysis for 863 patients who underwent cardiac surgery was performed. The patients were divided into the DSWI group (n=17) and the non-infection group (n=846). Preoperative, perioperative, and postoperative variables were compared between the two groups using univariate and multivariate logistic regression analysis. The modality of treatment for DSWI was also analyzed. Results: The incidence of DSWI was 1.97%. Independent predictors for DSWI were concomitant coronary artery bypass grafting CABG) with valve or aortic surgery [odds ratio, 4.1; 95% confidence interval, (1.1, 15.1)] and postoperative use of intraaortic balloon pumping [4.4, (1.6, 12.3)]. An independent predictor in isolated CABG patients was emergency operation [10.9, (2.7, 44.7)]. Four of 17 patients died. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from 10 (58.8%) patients, and all four of the deceased subjects died of its infection. Seventeen patients were treated by debridement, primary closure, and the addition of an omentum or muscle flap if necessary. Conclusions: Patients in poor perioperative condition are at high risk for the development of this infection. It was difficult to establish the best treatment, owing to the small series of this study. Mortality and morbidity of DSWI due to MRSA was high. (Ann Thorac Cardiovasc Surg 2003; 9: 226-32)
Annals of Thoracic and Cardiovascular Surgery Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, Sep 1, 2008
Purpose: This study was designed to evaluate the relationship among free radicals and vascular en... more Purpose: This study was designed to evaluate the relationship among free radicals and vascular endothelial growth factor (VEGF) and inducible nitric oxide synthase (iNOS) during the progression of left ventricular hypertrophy (LVH) in pressure-overload rat heart. Methods: Hypertrophied rat heart created by abdominal aortic banding at the age of 4 weeks was studied at the ages of 14, 15, 18, 21, 26, and 30 weeks (n = 5 in each group). Free radicals were detected by an electron spin resonance (ESR) method using LV tissue. The levels of messenger ribonucleic acid (mRNA) for VEGF, superoxide dismutase (SOD), and iNOS in myocardium were analyzed by reverse transcription (RT)-polymerase chain reaction (PCR). Results: Free radicals consisting of superoxide families increased over time after aortic banding and were highest in the 30-week group. The SOD mRNA level decreased with the progression of hypertrophy and was inversely proportional to the free radicals level. As compared to the control, the level of mRNA for VEGF and iNOS was significantly increased in 18-and 21-week hypertrophied hearts, but significantly decreased in 26-and 30-week hearts. Conclusion: The increased level of free radicals with the decrease of VEGF and iNOS levels may contribute to the progression of the pressure-overload hypertrophied heart to the failing heart. (Ann Thorac Cardiovasc Surg 2008; 14: 210-217)
The Japanese Journal of Thoracic and Cardiovascular Surgery, Jul 1, 2006
We report a systolic anterior motion of the anterior mitral leaflet despite employing the sliding... more We report a systolic anterior motion of the anterior mitral leaflet despite employing the sliding leaflet technique for repair of mitral valve regurgitation. A 65-year-old man with chronic, symptomatic mitral regurgitation due to ruptured chordae tendineae underwent mitral valve repair by quadrangular resection of the posterior leaflet and sliding leaflet technique with ring annuloplasty. After weaning from cardiopulmonary bypass, left ventricular outflow obstruction developed and transesophageal echocardiography demonstrated systolic anterior motion of the mitral valve and severe mitrai regurgitation. Non-operative treatment resolved the outflow tract obstruction, systolic anterior motion and mitral regurgitation. We conclude that post-repair systolic anterior motion can still occur after the sliding plasty procedure and that medical treatment can successfully resolve systolic anterior motion and outflow tract obstruction in most patients. (Jpn J Thorac Cardiovasc Surg 2006; 54: 249-252) Case A 65-year-old man (height 163 cm, weight 60.4 kg)
This study was conducted to clarify the prevalence of venous thromboembolism (VTE) in neurosurgic... more This study was conducted to clarify the prevalence of venous thromboembolism (VTE) in neurosurgical patients. Prospective study for venous thromboembolism screening after neurosurgery was conducted. Thirty-seven patients were screened by ultrasonography for deep vein thrombosis in the lower extremities at an average of 12 days postoperatively. All patients received standard thromboprophylaxis using graded compression stocking with/without intermittent pneumatic compression following the VTE prevention guidelines. Definitive diagnosis of venous thromboembolism was made by contrast-enhanced whole-body computed tomography. Prevalence of deep vein thrombosis of the lower legs was 13.5% (5/37). Incidence of pulmonary embolism was 60% (3/5) in patients having deep vein thrombosis. All patients having venous thromboembolism were asymptomatic. In high-risk patients, VTE prevalence after neurosurgery was high even under mechanical prophylaxis. Additional pharmacological prophylaxis should be considered for patients with high risk of VTE.
Kyobu Geka the Japanese Journal of Thoracic Surgery, Jun 1, 2011
A 76-year-old man, who had underwent radiation for laryngeal cancer 5 years before, was pointed o... more A 76-year-old man, who had underwent radiation for laryngeal cancer 5 years before, was pointed out abnormal pulmonary lesion on computed tomography. The 4.6 cm-sized lesion was seen in the upper lobe of the left lung. Endoscopic brushing cytology revealed adenocarcinoma. The patient was diagnosed as primary lung cancer of T2N0M0, clinical stage IB. Preoperative serum CA19-9 was elevated to 250 U/ml, although other tumor markers were within normal limits. The patient underwent left upper lobectomy with mediastinal lymph node dissection. Histologically, the lesion was diagnosed as well differentiated adenocarcinoma, mucinous subtype of bronchioloalveolar carcinoma (BAC) in World Health Organization (WHO) classification. Immunohistochemistry shows positive for CA19-9 and thyroid transcription factor-1 (TTF-1).
α-Synuclein was originally identified as the precursor of non-amyloid β component of Alzheimer's ... more α-Synuclein was originally identified as the precursor of non-amyloid β component of Alzheimer's disease amyloid (NAC). NAC is detected in cerebral amyloid angiopathy; and we studied whether cerebral vascular cells express α-synuclein. Immunohistochemical studies of normal human cerebral tissues revealed the expression of α-synuclein in vascular endothelial and smooth muscle cells. Also cultures of human umbilical vein endothelial cells and umbilical artery smooth muscle cells were found, by reverse transcription-polymerase chain reaction (RT-PCR) and Northern blot analysis, to constitutively express α-synuclein mRNA. Western blot analysis disclosed the presence of α-synuclein protein in lysates of these cells. We conclude that vascular cells express α-synuclein, and it may play some role in the physiology of the vascular wall.
Uploads
Papers by Ikuo Fukuda