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1.
Kyobu Geka ; 61(5): 367-70, 2008 May.
Article in Japanese | MEDLINE | ID: mdl-18464480

ABSTRACT

We performed direct implantation of a left ventricular pacemaker-lead through left thoracotomy for cardiac resynchronization therapy (CRT). We exposed the left ventricular free wall using a pericardium lifting method without hemodynamic deterioration or arrhythmia. Intraoperative ultrasonic cardiography is useful for determining a suitable implantation site for CRT.


Subject(s)
Cardiac Pacing, Artificial/methods , Electrodes, Implanted , Heart Failure/therapy , Pacemaker, Artificial , Thoracotomy , Aged, 80 and over , Echocardiography , Female , Heart Ventricles , Humans , Male , Middle Aged , Monitoring, Intraoperative , Severity of Illness Index
2.
Kyobu Geka ; 58(9): 765-8; discussion 768-71, 2005 Aug.
Article in Japanese | MEDLINE | ID: mdl-16104559

ABSTRACT

It is controversial that the effect of induction chemotherapy for bulky N2, T4 non-small cell lung cancer. We examined a retrospective study to assess this issue. Ten patients with bulky N2, T4 disease were given bronchial arterial infusion consisting of cisplatin (60 mg/m2) and docetaxel hydrate (60 mg/m2) intravenously, followed by standardized surgical resection (group A). Thirty patients had pathological N2, T4 disease after surgery (group B). Pathologically downstaging was seen in 6 patients in group A. The overall long-term survival at 1-, 2-year were 87.5, 87.5% in group A. The long-term survival at 1-, 2-, and 5-year were 78.9, 49.8, 43.6% in group B. There was no statistically significant difference in survival between both groups (p = 0.3015). The effect of induction chemotherapy for bulky N2, T4 non-small cell lung cancer was not demonstrated in our data. We suggest that our induction chemotherapy in group A was effective on T4 disease. A prospective study is needed to investigate our regimen.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Pneumonectomy/methods , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/surgery , Cisplatin/administration & dosage , Combined Modality Therapy , Docetaxel , Drug Administration Schedule , Female , Humans , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Middle Aged , Prospective Studies , Survival Analysis , Taxoids/administration & dosage
3.
Kyobu Geka ; 57(12): 1117-20, 2004 Nov.
Article in Japanese | MEDLINE | ID: mdl-15553028

ABSTRACT

Two cases of traumatic aneurysm of the thoracic aorta associated with blunt chest trauma are described. We underwent the operation for the aorta at 23 days in case 1 and 39 days in case 2 after the injury. Immediate repair may be thought to be the first choice for acute traumatic injury of the thoracic aorta, but delayed surgery can be achieved more safely in the patients, especially with associated injury.


Subject(s)
Aorta, Thoracic/injuries , Aorta, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Wounds, Nonpenetrating/surgery , Accidents, Traffic , Adult , Aneurysm, False/surgery , Aortic Aneurysm, Thoracic/surgery , Humans , Male , Vascular Surgical Procedures/methods
4.
Kyobu Geka ; 57(12): 1165-7, 2004 Nov.
Article in Japanese | MEDLINE | ID: mdl-15553040

ABSTRACT

We reported a successful operative case of solitary metastasis in the sternum 15 years after radical operation for a breast cancer and a primary lung cancer. The patient was a 59-year-old woman who was admitted for skin ulcer and tumor of the anterior chest wall. Histological diagnosis by skin biopsy was metastasis of breast cancer. Concurrently, chest computed tomography (CT) revealed a coin lesion with slight spiculation at the right lower lobe. Because histological diagnosis by the partial resection of the right lower lobe was primary lung cancer, we performed right lower lobectomy. Twenty-four days after the operation, subtotal sternal resection was carried out. She is alive and well without any complaints.


Subject(s)
Adenocarcinoma/surgery , Bone Neoplasms/secondary , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/secondary , Lung Neoplasms/surgery , Neoplasms, Multiple Primary , Sternum , Adenocarcinoma/diagnosis , Bone Neoplasms/surgery , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Female , Humans , Lung Neoplasms/diagnosis , Mastectomy, Radical , Middle Aged , Neoplasms, Multiple Primary/surgery
5.
Kyobu Geka ; 57(10): 961-3, 2004 Sep.
Article in Japanese | MEDLINE | ID: mdl-15462348

ABSTRACT

A 56-year-old woman was underwent mitral valve repair for prolapse of the posterior mitral leaflet. Intraoperative transesophageal echocardiography (TEE) showed systolic anterior motion (SAM) of the mitral valve at the weaning from cardiopulmonary bypass (CPB). Sliding technique was easily performed at the second pump run. Intraoperative TEE demonstrated no SAM or residual mitral regurgitation after the second pump run.


Subject(s)
Cardiac Surgical Procedures/methods , Mitral Valve Prolapse/surgery , Mitral Valve , Mitral Valve/physiopathology , Mitral Valve/surgery , Motion , Echocardiography, Transesophageal , Female , Humans , Intraoperative Complications/diagnostic imaging , Middle Aged , Mitral Valve/diagnostic imaging , Systole
6.
Kyobu Geka ; 57(5): 370-3, 2004 May.
Article in Japanese | MEDLINE | ID: mdl-15151035

ABSTRACT

UNLABELLED: Beneficial effect of preoperative intraaortic balloon pumping (IABP) treatment in high-risk patients who had open heart surgery have been demonstrated. The purpose of this study is to determine the impact of preoperative IABP use on survival in high-risk patients undergoing coronary artery bypass grafting (CABG). METHODS: Two hundred seventy-seven consecutive patients having CABG at our institution were reviewed. Patients having an IABP were identified retrospectively and grouped into one of 3 groups as follows. Group A (n = 14): preoperative IABP for high-risk urgent or elective cases. Group B (n = 26): preoperative IABP for emergency cases. Group C (n = 6): unplanned intraoperative or postoperative IABP. RESULTS: Forty-six patients had an IABP (16.6% of total). Parsonnet score in group B was significantly higher (p < 0.05). Length of operation for group C was significantly longer (p < 0.05). Overall hospital mortality in the total group of 277 cases was 4.2%. Hospital mortality was 7.1% in group A, 7.7% in group B, and 50% in group C. Hospital mortality in group C was significantly higher (p < 0.01). CONCLUSIONS: The beneficial effect of preoperative treatment with IABP in high-risk patients undergoing CABG was confirmed. This approach resulted in a significantly lower hospital mortality.


Subject(s)
Coronary Artery Bypass/methods , Intra-Aortic Balloon Pumping/statistics & numerical data , Postoperative Complications/prevention & control , Aged , Angina, Unstable/surgery , Coronary Artery Bypass/mortality , Female , Hospital Mortality , Humans , Male , Middle Aged , Myocardial Infarction/surgery , Retrospective Studies , Survival Rate
7.
Kyobu Geka ; 56(9): 765-7, 2003 Aug.
Article in Japanese | MEDLINE | ID: mdl-12931587

ABSTRACT

We examined the possibility to avoid the homologous blood transfusion in patients undergoing open heart surgery by predonation of 200 ml or 400 ml on the day before operation. Between March 1999 and December 2001, 117 patients underwent scheduled open heart surgery. In these patients, preoperatively collected autologous blood on the day before operation amounted 200 ml or 400 ml. We divided these patients into 3 groups according to the necessity of homologous blood, no transfusion (group A, n = 77), intraoperative transfusion (group B 1, n-29) and postoperative transfusion (group B 2, n = 11). In 65.8% of patients the homologous blood transfusion could be avoided. Preoperative, intraoperative and postoperative factors were compared in the 3 groups. Especially, old age, female, body weight and preoperative hemoglobin value were significantly different between 3 groups. Postoperative Svo2 and postoperative hemoglobin value were significantly different between 3 groups. The purpose of this study was to evaluate that the predonation of 200 ml or 400 ml on the day before operation may be to avoid the homologous blood transfusion and that preoperative, intraoperative and postoperative factors in regard to homologous blood transfusion.


Subject(s)
Blood Transfusion, Autologous/statistics & numerical data , Cardiac Surgical Procedures , Age Factors , Aged , Blood Loss, Surgical/statistics & numerical data , Coronary Artery Bypass , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation , Humans , Middle Aged
8.
Kyobu Geka ; 56(4): 329-31, 2003 Apr.
Article in Japanese | MEDLINE | ID: mdl-12701197

ABSTRACT

A 24-year-old pregnant female was admitted to our hospital because of congestive heart failure. When she was 3 month old, she underwent closure of patent ductus arteriosus. Echocardiography, cardiac catheterization and selective angiocardiography showed a left ventricular-right atrial shunt. At the operation, we found a left ventricular right-atrial communication (group I) and repaired the defect directly. The patient was discharged and returned to her social life.


Subject(s)
Ductus Arteriosus, Patent/surgery , Heart Septal Defects, Ventricular/surgery , Hypertension, Pulmonary/complications , Pregnancy Complications, Cardiovascular/surgery , Adult , Cardiac Surgical Procedures/methods , Ductus Arteriosus, Patent/diagnosis , Female , Heart Septal Defects, Ventricular/diagnosis , Humans , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Tricuspid Valve Insufficiency/diagnosis , Tricuspid Valve Insufficiency/surgery
9.
Kyobu Geka ; 54(5): 428-31, 2001 May.
Article in Japanese | MEDLINE | ID: mdl-11357311

ABSTRACT

A 60-year-old man, who had undergone implantation of a transvenous pacemaker system on the left chest wall for sick sinus syndrome 19 years ago, was admitted because of endocarditis with septicemia and lung abscess 2 months after reimplantation of the generator. His blood culture revealed Staphylococcus aureus. Following debridement of the infected pacemaker pocket and antibiotics therapy, we tried to remove the pacemaker system under cardiopulmonary bypass 1 month after admission. In intraoperative inspection, the electrodes had become firmly encased with fibrous tissue within the tricuspid valve and the right ventricle. After the operation, antibiotic therapy was performed for 4 weeks. His postoperative course was uneventful. Patients with pacemaker infection should undergo aggressive total removal of the pacemaker system, particularly incase with endocarditis and bacteremia.


Subject(s)
Bacteremia/complications , Cardiopulmonary Bypass , Device Removal , Endocarditis, Bacterial/complications , Lung Abscess/complications , Pacemaker, Artificial/adverse effects , Prosthesis-Related Infections/surgery , Staphylococcal Infections/complications , Staphylococcus aureus , Humans , Male , Middle Aged
10.
Kyobu Geka ; 53(13): 1095-100, 2000 Dec.
Article in Japanese | MEDLINE | ID: mdl-11127554

ABSTRACT

From January, 1996 to December, 1999, eight patients with chronic renal failure received open heart surgery. They consists of six males and two females aged between 45 and 72 with a mean of 59.6. The duration of hemodialysis was 4.0 years in a mean. Seven of them had isolated coronary artery bypass grafting (CABG), one of them had CABG and aortic valve replacement. All patients were dialysed dialy two days before operation. Intraoperative hemodialysis (HD) was used in all patients. In recent six patients extracorporeal ultrafiltration methods (ECUM) were also performed intraoperatively in addition to HD. In postoperatively continuous hemodiafiltration (CHDF) has been preferred to HD in all patients, and nafamostat mesilate is a useful anticoagulation agent to prevent postoperative bleeding complications. The duration of CHDF was 3.2 days in a mean (the shortest for one day and the longest for eight days). When the circulatory situation were stable, HD was performed on early postoperative day. One patients died of low output syndrome and multiple organ failure. We reported problems in perioperative management of patients with chronic renal failure and our protocol.


Subject(s)
Cardiac Surgical Procedures , Kidney Failure, Chronic/complications , Perioperative Care , Aged , Extracorporeal Circulation , Female , Hemodiafiltration , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Myocardial Ischemia/complications , Myocardial Ischemia/surgery , Renal Dialysis
11.
Kyobu Geka ; 53(7): 600-4, 2000 Jul.
Article in Japanese | MEDLINE | ID: mdl-10897576

ABSTRACT

A case of malignant fibrous histiocytoma of the chest wall. A 56-year old man was admitted to the hospital with a complaint of showing abnormal shadow on chest X-ray. Chest X-ray and chest CT scan showed a calcified tumor of the chest wall. Histological diagnosis could not be made prior to the operation. Wide resection of the right chest wall containing the tumor and partial resection of the right lung were done. Malignant fibrous histiocytoma (MFH) showing a striform-pleomorfic pattern was recognized histologically with resected specimen. MFH commonly arises in the soft tissues of the extremities, but rarely in those of the chest. This paper also presents a review of 38 reported cases of MFH originated from the chest wall.


Subject(s)
Histiocytoma, Benign Fibrous/surgery , Thoracic Neoplasms/surgery , Histiocytoma, Benign Fibrous/pathology , Humans , Male , Middle Aged , Radiotherapy, Adjuvant , Thoracic Neoplasms/pathology , Treatment Outcome
12.
Artif Organs ; 23(6): 513-7, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10392276

ABSTRACT

We studied the changes in arterial baroreceptor reflex (ABR) afferent activity and efferent activity induced by nonpulsatile systemic circulation (NC) during total left heart bypass (TLHB) in rabbits. To evaluate the influence of the circuit priming fluid and exposure to NC, we directly measured aortic depressor nerve activity (ADNA) (n = 5) and renal sympathetic nerve activity (RSNA) (n = 5) before the start of partial left heart bypass (PLHB) (Before), after PHLB (After), and 5 min after the start of TLHB (During THLB) while maintaining the mean aortic pressure. The circuit priming fluid did not affect the ABR. ADNA exhibited periodic discharge at Before and After, but at During THLB, this periodic discharge transformed into a continuous discharge, and ADNA increased significantly. However, there were no significant differences in RSNA. Our results suggested that in the acute phase under NC, the ABR differed from that under natural circulation.


Subject(s)
Baroreflex/physiology , Blood Circulation/physiology , Heart Bypass, Left , Pressoreceptors/physiology , Adrenergic Agonists/blood , Afferent Pathways/physiology , Animals , Aorta/innervation , Blood Pressure/physiology , Efferent Pathways/physiology , Epinephrine/blood , Heart Bypass, Left/instrumentation , Heart Bypass, Left/methods , Heart Rate/physiology , Kidney/innervation , Norepinephrine/blood , Rabbits , Sympathetic Nervous System/physiology , Sympathomimetics/blood , Synaptic Transmission/physiology , Time Factors , Ventricular Function, Left/physiology , Ventricular Pressure/physiology
13.
Artif Organs ; 22(12): 1056-63, 1998 Dec.
Article in English | MEDLINE | ID: mdl-9876099

ABSTRACT

We directly measured aortic depressor nerve activity (ADNA) in rabbits to investigate changes in arterial baroreceptor afferent activity (ABAA) in response to nonpulsatile systemic circulation (NC) during total left heart bypass (TLHB). ADNA was measured before and 5, 20, 30, 40, 50, and 60 min after the start of TLHB while maintaining the mean aortic pressure (MAP) at preestablished values (n=10). At 5 min, the ADNA was significantly increased compared to its baseline value. At 30 min, it was significantly decreased compared to its value at 5 min and thereafter remained the same. The ADNA was then measured before and 5 and 30 min after the start of TLHB under increased MAP (n=10). The results showed that the percentage changes in ADNA during TLHB were significantly less than that observed when the MAP was increased before TLHB. We conclude that ABAA acutely adapts to NC 30 min after its initiation, but changes in ABAA are depressed under NC combined with increased MAP.


Subject(s)
Afferent Pathways/physiology , Aorta/innervation , Heart Bypass, Left , Pressoreceptors/physiology , Animals , Aorta/physiology , Blood Pressure , Heart Rate , Heart-Assist Devices , In Vitro Techniques , Pulsatile Flow , Rabbits , Vascular Resistance
14.
Ann Thorac Surg ; 63(6): 1730-6, 1997 Jun.
Article in English | MEDLINE | ID: mdl-9205175

ABSTRACT

BACKGROUND: A membrane oxygenator consisting of a microporous polypropylene hollow fiber with a 0.2-microm ultrathin silicone layer (cyclosiloxane) was developed. Animal experimental and preliminary clinical studies evaluated its reliability in bypass procedures. METHODS: Five 24-hour venoarterial bypass periods were conducted on dogs using the oxygenator (group A). In 5 controls, bypass periods were conducted using the same oxygenator without silicone coating (group B). As a preliminary clinical study, 14 patients underwent cardiopulmonary bypass with the silicone-coated oxygenator. RESULTS: Eight to 16 hours (mean, 12.2 hours) after initiation of bypass, plasma leakage occurred in all group B animals, but none in group A. The O2 and CO2 transfer rates after 24 hours in group A were significantly higher than at termination of bypass in group B (p < 0.005 and p < 0.03, respectively). Scanning electron microscopy of silicone-coated fibers after 24 hours of bypass revealed no damage to the silicone coating of the polypropylene hollow fibers. In the clinical study, the oxygenator showed good gas transfer, acceptable pressure loss, low hemolysis, and good durability. CONCLUSIONS: This oxygenator is more durable and offers greater gas transfer capabilities than the previous generation of oxygenators.


Subject(s)
Extracorporeal Membrane Oxygenation/instrumentation , Materials Testing , Oxygenators , Polypropylenes , Animals , Carbon Dioxide/blood , Cardiopulmonary Bypass , Dogs , Equipment Design , Evaluation Studies as Topic , Hemoglobins/analysis , Microscopy, Electron, Scanning , Oxygen/blood , Silicones
15.
ASAIO J ; 42(5): M451-4, 1996.
Article in English | MEDLINE | ID: mdl-8944922

ABSTRACT

The authors developed a new membrane oxygenator that consists of microporous polypropylene hollow fibers coated with a 0.2 micron ultrathin silicone layer. Five venoarterial bypasses were conducted on mongrel dogs for 24 hr using these new oxygenators. The blood flow rate was maintained at 750 ml/min, and the V/Q ratio was maintained at 1:1. As a control, three venoarterial bypasses were conducted under the same conditions using an oxygenator with the same design but without the silicone coating. Eight to 16 hr after the initiation of bypass, severe plasma leakage occurred in all control experiments, so the bypasses were terminated. However, plasma leakage did not occur throughout the 24 hr of any of the experiments using the new oxygenator. The O2 transfer rate of the new oxygenators after 24 hr of perfusion was 59.7 +/- 6.6 ml/min/m2, and the plasma free hemoglobin level 8 hr after the initiation of bypass was 41.4 +/- 40.2 mg/dl, compared with 145.3 +/- 189.6 mg/dl in the control group. Scanning electron microscopic examination of the silicone coated fibers after 24 hr of bypass revealed a few scattered platelet adherents and no damage to the silicone coated surface. These results suggest that this new oxygenator has satisfactory gas transfer and good durability.


Subject(s)
Oxygenators, Membrane , Animals , Arteriovenous Shunt, Surgical , Carbon Dioxide/blood , Dogs , Equipment Design , Evaluation Studies as Topic , Extracorporeal Membrane Oxygenation/instrumentation , Hemolysis , Humans , Oxygen/blood , Oxygenators, Membrane/adverse effects , Polypropylenes , Silicones
16.
Artif Organs ; 20(6): 711-4, 1996 Jun.
Article in English | MEDLINE | ID: mdl-8817984

ABSTRACT

The Nikkiso HPM-15 is a minimally sized centrifugal pump. Preliminary results regarding clinical use of this pump for cardiopulmonary bypass (CPB) procedures have been reported previously. Recently, we have managed some additional cases using a newly developed controller. This article reports our clinical experiences with the use of this pump. We have managed 23 cases with a Nikkiso centrifugal pump. Twenty-two patients underwent CPB and 1 patient with fulminant viral myocarditis underwent percutaneous cardiopulmonary support (PCPS). With this pump, the circuit was extremely easy to prepare and deaeration was achieved readily. Hemodynamics during CPB and PCPS were stable in all cases. The increase in serum-free hemoglobin levels during CPB with this pump was as low as that seen in preliminary tests. A decrease in the platelet count was observed after the initiation of CPB with this pump; however, platelet counts returned to preoperative values 7 days after surgery. Moreover, urine output during CPB with this pump was as high as that seen in preliminary tests. No abnormalities in renal or liver function occurred during CPB. It appears that this new centrifugal pump is safe and easy to operate, and we conclude that it is useful for CPB and PCPS.


Subject(s)
Cardiopulmonary Bypass/methods , Heart-Assist Devices/standards , Hemodynamics/physiology , Intra-Aortic Balloon Pumping/methods , Adult , Aged , Alanine Transaminase/analysis , Bilirubin/analysis , Blood Urea Nitrogen , Centrifugation , Female , Hemoglobins/analysis , Humans , Kidney Function Tests , Liver Function Tests , Male , Middle Aged , Platelet Count , Quality Control
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