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Volume 22, Issue 2
Displaying 1-15 of 15 articles from this issue
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Susumu ISHIKAWA, Yoshimi OOTANI, Hajime YANAGISAWA, Akio OOTAKI, Kazuh ...1993 Volume 22 Issue 2 Pages 73-76
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSSurgical interventions for aorto-iliac obstructive diseases were studied through the operative results. Eighteen patients underwent aorto-femeral bypass (AOF) and 23 who were over 70 years of age or who had serious preoperative complications had axillofemoral bypass (AXF). No perioperative death occurred in AOF patients, while the mortality rate of AXF patients was 8%. Postoperative ankle pressure indexes were significantly higher in AOF patients than in AXF patients. Follow-up graft patency rate was 100% in AOF patients at 54 months (mean), and 85% in AXF patients at 44 months respectively. AOF should be the first choice for patients with aorto-iliac obstructive disease, and AXF is suitable only for high-risk patients.View full abstractDownload PDF (451K) -
Hitoshi YOKOYAMA, Kiyoharu SATOH, Yoshihisa AKINO, Mikio OHMI1993 Volume 22 Issue 2 Pages 77-82
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe purpose of this study is to clarify the effects and limitation of high-dose therapy with dopamine (DOP) and dobutamine (DOB) for the patients with severe low cardiac output syndrome (LOS) after coronary artery bypass grafting (CABG). Among the patients who underwent CABG in Sendai Tokusyukai Hospital between 1986 and 1991, two groups were selected: More than 20μg/kg/min of both DOP and DOB were administered within 48 hours after CABG in “high-dose group” patients (n=6); Less than 5μg/kg/min of DOP and DOB were administered in the same period in “low-dose group” patients (n=9). All patients in the high-dose group had episodes of acute myocardial infarction in the pre- or intra-operative period. The operative mortality rate of this group was 34% (2/6). Significant stenoses of the left main trunk were observed preoperatively in both dead cases. The postoperative changes of cardiac index, heart rate, serum CPK-MB, dose of lidocaine given, urine output, total peripheral resistance and incidence of cardiac arrhythmia within 48 hours after CABG were compared between the two groups. There were no significant differences in all parameters except cardiac index, heart rate and total dose of lidocaine. However the maximal value of the mean heart rate in high-dose group was less than 120beats/min and lidocaine was effective in all patients with premature ventricular contraction. We conclude that high-dose therapy with DOP and DOB is useful for the selected patients with severe LOS after CABG when side effects caused by these drugs are carefully managed.View full abstractDownload PDF (798K) -
Comparative Study on the Aorto-Iliac and Femoro-Popliteal OcclusionSaihou HAYASHI, Yoshiharu HAMANAKA, Taijiro SUEDA, Tsuyoshi MATSUSHIMA ...1993 Volume 22 Issue 2 Pages 83-85
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSPatients who underwent the bypass operation during 5 years from 1987 to 1992 in the 1st Department of Surgery, Hiroshima University School of Medicine, were divided into 2 groups; AIOD group (51 cases) had lesions in the aorta and iliac artery, and FPOD group (46 cases) had lesions in the femoral artery and popliteal artery. A comparative study of these two groups was made. There was no significant difference in age, sex, symptom severity, smoking history, serum cholesterol level, serum triglyceride level. The complication rate of peripheral lesions of the AIOD group was 24% and of the FPOD group was 57%. The cumulative patency rate for 5 years of the AIDO group was 100% and of the FPOD group was 61%. The AIOD group exhibited better patency. In addition to the lower complication rate of peripheral lesions, all the AIOD group had underwent reconstruction operation for peripheral lesions simultaneously. The run-off state of the peripheral region may thus possibly be related to patency.View full abstractDownload PDF (398K) -
Mikihiko KUDO, Kouzou KAWADA, Ryouhei YOZU, Kiyokazu KOKAJI, Harukazu ...1993 Volume 22 Issue 2 Pages 86-91
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSTwo hundred fourteen cases treated surgically for aortic aneurysms between Jan. 1986 and Dec. 1991 at our hospital. Among them, 15 cases (7.0%) had multiple aortic aneurysms. In 10 cases, aneurysms were resected completely: 9 simultaneously (one-stage operation) and 1 separately (two-stage operation), although in 5 cases there remained another aneurysm left even after operation. In all cases who had one-stage operation, the combination of sites of aneurysms were descending thoracic aorta and infra-renal abdominal aorta. Temporary bypass (n=4), centrifugal pump (n=4) or cardiopulmonary bypass (n=1) were employed as supportive methods during aortic cross-clamp. There were neither operative nor late death in one-stage operation group, although one patient died due to rupture residual aneurysm 1.2 years after the first operation. In these patients, vascular disease are expected to be present systemically, so that operative method should be determined carefully under consideration of poor general condition and another risk factors. We recommend, however, that simultaneous one-stage operation for multiple aortic aneurysm might be safe and fully acceptable procedure, especially in case of those whose aneurysms exist in descending thoracic and infra-renal abdominal aorta.View full abstractDownload PDF (1806K) -
Mikio OHMI, Kaori SATO, Katsuo MATSUKI, Hitoshi YOKOYAMA, Makoto MIURA ...1993 Volume 22 Issue 2 Pages 92-96
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSDuring past 7 years, 43 patients less than 2 years of age underwent closure of the ventricular septal defect. Durations of postoperative use of a respirator were 3 days or less in 30 patients (short-period group) and over 3 days in remaining 13 patients (long-period group). There was no operative death. Pre-, intra- and postoperative factors affecting prolonged respiratory care were analyzed between two groups. Results were as follows: There were statistically significant differences between short- and long-period groups on age (9.7 versus 6.5 months), body weight (6.3 versus 5.2kg) at surgery, necessity of preoperative respiratory care on respirator (0/30 versus 4/13), duration of cardiopulmonary bypass (108 versus 132min.), aortic clamp time (56 versus 70min.) and respiratory index at the first postoperative day (1.1 versus 1.7). These results revealed the necessity of far earlier surgical intervention in symptomatic patients before respiratory distress develops. Furthermore, shorter cardiopulmonary bypass and aortic clamp times should always be in mind for attaining smooth postoperative course.View full abstractDownload PDF (612K) -
Tatsuo TSUTSUI, Hideya UNNO, Naotaka ATSUMI, Tomoaki JIKUYA, Yuzuru SA ...1993 Volume 22 Issue 2 Pages 97-102
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSCausative factors for thrombi formation in left atria of 38 patients with mitral stenosis who underwent mitral valve surgery (open mitral commissurotomy or mitral valve replacement) alone or in combination with other procedures were studied. There were 9 cases of left atrial thrombosis (LAT). Left atrial diameter was increased in LAT(+) group (6.1±1.6cm) compared with LAT(-) group (4.6±0.7cm). There was significant difference in the left atrial diameter between the two groups of patients (p<0.01). Cardiac output was decreased in LAT(+) group (3.04±0.74l/min) compared with LAT(-) group (3.99±1.07l/min). Cardiac output of LAT (-) group was significantly larger than that of LAT(+) group (p<0.05). Mean transition time of blood through left atrium (MTTLA) was calculated using left atrial volume and cardiac output. In LAT (+) group, MTTLA was significantly increased (6.2±3.9sec) compared with LAT(-) group (2.9±1.6sec). It is considered that, in mitral stenosis, prolongation of MTTLA is one of the risk factors for thrombi formation in the left atrium.View full abstractDownload PDF (646K) -
Usefulness of the Autotransfusion SystemNobuhiko MUKOHARA, Kyoichi OGAWA, Tatsuro ASADA, Masami NISHIWAKI, Tet ...1993 Volume 22 Issue 2 Pages 103-106
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe reviewed the results of 14 patients who underwent the operation of thoracic aneurysms using a centrifugal pump. Nine patients had atherosclerotic aneurysms and 5 had aortic dissections. The autotransfusion system (ATS) was used to keep hemodynamic stability by rapid transfusion. The ATS consisted of a roller pump, a 2, 000ml reservoir and a heat exchanger. Two mg/kg of heparin was given to the patients to keep ACT over 400 seconds. All patients survived. Body temperature increased 0.08±0.59°C during bypass with the ATS, and no patients showed hemodynamic instability after aneurysmotomy under the help of the ATS. We conclude that 1) the centrifugal pump is a useful and safe assisting means for the surgery of thoracic aneurysms, 2) the autotransfusion system has advantages as follows: keeping stable circulation and preventing loss of body temperature during bypass.View full abstractDownload PDF (510K) -
Ichiro MORITA, Takashi FUJIWARA, Soroku DOKO, Hiroshi INADA, Hisao MAS ...1993 Volume 22 Issue 2 Pages 107-112
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSBetween 1974 and 1991, we treated 10 aortic arch branch aneurysms in eight men and two women, who ranged in age from 17 to 81 years old (mean age, 55 years). Five patients had subclavian artery aneurysms, four had carotid artery aneurysms, and one had an inominate artery aneurysm. The chief complaint was a mass on the neck and supraclavicular fossa in five patients, rupture and an abnormal shadow on chest X-rays in two patients each, and acute artery occlusion in the upper limb in one patient. The operative method was usually excision of the aneurysm and reconstruction. The causes were arteriosclerosis in five patients, the thoracic outlet syndrome in two patients, and inflammatory, traumatic and iatrogenic in one patient each. Intraoperative hemorrhage occurred in one patient and graft occlusion in another one. The other patients have had a good course. This disease is rare, but because of complicated rupture and acute artery occlusion, it is desirable to perform surgery as soon as possible after the first diagnosis.View full abstractDownload PDF (2077K) -
Noboru MURATA, Masato KUME, Satoshi KOBAYASHI, Koji MORIYASU, Hideo YO ...1993 Volume 22 Issue 2 Pages 113-117
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSTwenty six adult patients who underwent prosthetic heart valve replacement and treated anti-thrombogenic therapy, were divided into 2 groups. One was administered Warfarin alone, another was administered Warfarin plus Aspirin (162mg/day) as antiplatelet therapy. Trapidil (300mg/day) was administered to all of the patients. Platelet aggregation, plasma level of TXB2 (stable metabolite of thromboxane A2), and 6-keto-PGF1 (stable metabolite of PGI2) were measured before and 1, 3, 6 months after Trapidil therapy. Platelet aggregability suppressed in both 2 groups. Plasma TXB2 level, and TXB2/6-keto-PGF1 ratio showed a tendensy to decrease (p<0.05) 6 months after administration. In the Aspirin plus Trapidil group, platelet aggregability, serum TXB2 level, and TXB2/6-keto-PGF1 ratio are significantly lower than that in the Trapidil only. These results suggest that Trapidil is clinically useful for antiplatelet agent, but the combined Aspirin plus Trapidil therapy is more efficacious than the Aspirin or Trapidil single therapy.View full abstractDownload PDF (586K) -
Yoshifumi IGURO, Hitoshi TOYOHIRA, Shinzi SHIMOKAWA, Yuusuke UMEBAYASH ...1993 Volume 22 Issue 2 Pages 118-122
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSSurface induced hypothermia was introduced in six cases with low cardiac output syndrome after open heart surgery to reduce oxgen consumption. The patients were consisted of two ACBG, two LV rupture after MVR, MVR with ACBG and AVR with poor LV function. Hemodynamic changes such as heart rate, mean arterial pressure, cardiac index, systemic vascular resistance, pulmonary artery wedge pressure, were measured every 3-4 hours throughout the course of hypothermia. Acid-base balance, mixed venous oxgen saturation and oxygen consumption were also monitored. Hypothermia was induced using a blanket and ice-beutels. Temperature in hypothermia was maintained at about 33°C. We are intended to increase SVO2 up to the level of 50% and to improve anerobic condition. Hypothermia was continued for 45 hours in the shortest and 148 hours in the longest case with a mean of 78 hours. Arrythmia was not seen. Hemodynamic and acid-base balance were in significantly changed in comparison of the control values. However, SVO2 and VO2 changed significantly after introduction of hypothermia. They increased from 47.8±7.5% to 58.7±7.9% and reduced from 231±29.7 to 188±31.3ml O2/min respectively. Hemodynamic condition was improved and IABP was successfully weaned in all cases. We suggest that the use of hypothermia is one of the effective modality in the management of low cardiac output syndrome after open heart surgery.View full abstractDownload PDF (595K) -
Takashi NISHIMOTO, Hitoshi FUKUMOTO, Eiji TSUJII, Seiji KINUGASA1993 Volume 22 Issue 2 Pages 123-126
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 22-year-old man was referred to our medical center with an impending rupture of an aneurysm of the descending thoracic aorta. Blood pressure was 180/110mmHg in the right arm but 110/60mmHg in the right foot. The diagnosis was confirmed by chest Xray, enchanced computed tomography and aortogram. Five days later, the chest Xray showed massive effusion in the left pleural cavity. Surgery was immediately performed via a left thoracotomy. Five hundred ml of bloody fluid was found in the pleural cavity but the site of bleeding could not be identified. The aneurysm was 7×10cm in size. Under percutaneous cardio pulmonary support, the aneurysm was replaced by a 22mm Gel-Seal Dacron vascular graft. The intima and the media of the aneurysm were lacerated longitudinally at the region receiving jet flow from isthmus, There was blood coagula between the media and adventitia. During replacement, activated clotting time was maintained at 200∼300sec. As a result, bleeding was limited to 200ml. The postoperative course was uneventful with little difference in pressure between the right arm and right foot.View full abstractDownload PDF (1928K) -
Norihiko KAMADA, Tatsuo SATOU, Tomoyuki YAMADA, Minoru AOSHIMA1993 Volume 22 Issue 2 Pages 127-130
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 76-year-old man underwent the aorto-femoral bypass with prosthetic graft at other hospital. Prosthetic graft infection with abcess at inguinal wound occurred 4 months later. A obturator foramen bypass was performed and the infected graft and the inguinal vessels were removed. The obturator foramen bypass is useful extra-antomical bypass.View full abstractDownload PDF (2135K) -
Arifumi TAKAZAWA, Koki TSUCHIDA, Akimasa HASHIMOTO1993 Volume 22 Issue 2 Pages 131-134
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe performed a surgical correction on a 53-year-old male patient, who had suffered from Stanford type A aortic dissection. The thoracic aorta was dilated along its whole length. Under retrograde cerebral perfusion, the correction consisted of extended Cooley's hemiarch repair and the closure of the tear, which was an entry into the pseudolumen of the descending thoracic aorta. The postoperative course was uneventful except a temporary DIC due to extensive thrombosis of the pseudolumen of the descending thoracic aorta. We think that the second operation of the descending thoracic aorta is unneccesary. Although the staged operation is generally approved for broad Stanford type A aortic dissection, we succeeded in a clinically curative one-staged operation using extended Cooley's hemiarch repair only with a median sternotomy.View full abstractDownload PDF (1772K) -
Hiroaki KURODA, Akihiko INOUE, Naoaki TAKEMOTO, Shingo ISHIGURO, Seiic ...1993 Volume 22 Issue 2 Pages 135-137
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSRetrograde cardioplegia is now an alternative or adjunctive method used worldwide as a cardiac protection during open heart surgery. However, its use involves some limitation. We operated on a patient suffering from aortic stenosis associated with PLSVC. During the operation on this patient for aortic valve replacement, retrograde infusion of cardioplegic solution could not be performed because the coronary sinus was excessively dilated and prevented the balloon from occluding it. Other anomalous lesion of the coronary sinus make the retrograde infusion of the cardioplegic solution difficult and these must always be kept in mind when cardioplegia is infused from the coronary sinus.View full abstractDownload PDF (1022K) -
Naoki YOSHIMURA, Masayoshi OKADA, Chojiro YAMASHITA, Toshiaki OTA, Kei ...1993 Volume 22 Issue 2 Pages 138-141
Published: March 15, 1993
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe report an unusual case of a 71 year-old man who developed chronic consumption coagulopathy caused by an abdominal aortic aneurysm. He was diagnosed as having the dissecting aortic aneurysm (DeBakey type IIIa) and the abdominal aortic aneurysm in 1989, and had been attending to our hospital as an outpatient since then. He developed macrohematuria in March 1990. The laboratory data showed the decrease in platelet, fibrinogen, plasminogen and α2 plasmin inhibitor and the increase in FDP. The bleeding tendency was controlled by the administration of gabexate mesilate and heparin, but the laboratory data revealed that consumption coagulopathy continued. The abdominal aortic aneurysm was successfully replaced with a prosthetic vascular graft in June 1992. Postoperative hematological findings revealed the improvement, and he discharged 32nd day and doing well after operation.View full abstractDownload PDF (1367K)
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