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Abstract
We studied clinicopathological and immunohistochemical features of hepatocellular carcinoma (HCC) with sarcomatous change among surgically resected HCC cases. Among 308 HCC cases, 6 (1.9%) showed partial (5 cases) or entire (1 case) sarcomatous change. Only 1 case received preoperative anti-cancer therapy among the 6 cases, suggesting that sarcomatous change is not always related to anti-cancer therapy. Immunohistochemically, the sarcomatous components were positive for albumin and alpha 1-antichymotrypsin and negative for alpha-fetoprotein in all cases. Expressions of intermediate filament-related proteins (e.g., cytokeratin and vimentin) in the sarcomatous components were heterogeneous. The sarcomatous components showed stronger expressions of p53 protein and/or mouse double minute-2 protein, and higher proliferating cell nuclear antigen labeling index, suggesting their high proliferative activity and high malignant potential.
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2
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Tanaka Y, Mori A, Tazaki H, Imai S, Shiina J, Kusaba A, Ozawa T, Yoshida T, Kimura N, Hayashi T, Kenyon PR, Blair H, Arai T. Plasma metabolite concentrations and hepatic enzyme activities in pregnant Romney ewes with restricted feeding. Res Vet Sci 2007; 85:17-21. [PMID: 17920647 DOI: 10.1016/j.rvsc.2007.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 08/13/2007] [Accepted: 08/22/2007] [Indexed: 11/26/2022]
Abstract
Plasma metabolite concentrations and activities of enzymes related to energy metabolism in plasma, peripheral leukocytes and liver of pregnant Romney ewes with restricted feeding were measured to assess those metabolites and enzymes as indicators for evaluating metabolic conditions in the ewes. The body weights and plasma lactate concentrations of the low-feeding ewes (about 1.0 times maintenance) were significantly lower than those of the high-feeding ewes (about 1.5 times maintenance). There were no significant differences in plasma protein, glucose, triglyceride, cholesterol, pyruvate and immunoreactive insulin concentrations and plasma and leukocyte enzyme activities between both groups. Hepatic malate dehydrogenase activities were significantly higher and hexokinase activities were significantly lower in the low-feeding ewes than in the high-feeding ewes. Restricted feeding could maintain pregnancy and some plasma metabolites and peripheral leukocyte enzymes may be useful indicators for evaluating metabolic changes in ewes.
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Affiliation(s)
- Y Tanaka
- Department of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
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3
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Sako T, Urabe S, Kusaba A, Kimura N, Yoshimura I, Tazaki H, Imai S, Ono K, Arai T. Comparison of plasma metabolite concentrations and lactate dehydrogenase activity in dogs, cats, horses, cattle and sheep. Vet Res Commun 2007; 31:413-7. [PMID: 17216306 DOI: 10.1007/s11259-006-3482-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2005] [Indexed: 11/27/2022]
Affiliation(s)
- T Sako
- Department of Veterinary Science, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
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4
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Arai T, Kusaba A, Takeguchi A, Tanaka Y, Ozawa T, Yoshida T, Sako T, Hayashi T, Blair H. Comparison of plasma metabolite concentrations and peripheral leukocyte enzyme activities in sheep fed on different diets in New Zealand and Japan. Vet Res Commun 2007; 31:681-4. [PMID: 17252317 DOI: 10.1007/s11259-007-3548-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2006] [Indexed: 10/23/2022]
Affiliation(s)
- T Arai
- Department of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Tokyo.
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5
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Arai T, Tanaka Y, Urabe S, Kusaba A, Tazaki H, Ozawa T, Kimura N, Jung KK, Waragaya K, Yuyama T, Haseba Y, Imai S. Changes in peripheral leukocytes enzymes activity and plasma metabolite concentrations in growing Holstein calves. Res Vet Sci 2005; 81:19-23. [PMID: 16310816 DOI: 10.1016/j.rvsc.2005.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 10/03/2005] [Accepted: 10/05/2005] [Indexed: 11/30/2022]
Abstract
Plasma metabolite and immunoreactive insulin concentrations and activities of enzymes related to energy metabolism in peripheral leukocytes were measured in growing Holstein calves. A ratio of girth of abdomen divided by girth of thorax (A/T ratio) of calves was significantly elevated after weaning, and the A/T ratio maybe a good indicator to evaluate rumen development. Plasma glucose and free fatty acid concentrations were changed in calves accompanying change in feeding. Activities of lactate dehydrogenase with pyruvate as substrate (LDH-P) and hexokinase (HK) in cytosolic fractions of peripheral leukocytes decreased significantly after weaning the calves reflecting the change of energy source from milk replacer with high percentages of fat and glucose and lactose as absorbable carbohydrate to pelleted feed containing starch as less absorbable carbohydrate and roughage. Some peripheral leukocyte enzymes such as LDH and HK may be good indicators to evaluate changes in energy metabolism of growing calves.
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Affiliation(s)
- T Arai
- Department of Veterinary Science, Nippon Veterinary and Animal Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan.
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Kusaba A, Ansai T, Akifusa S, Nakahigashi K, Taketani S, Inokuchi H, Takehara T. Cloning and expression of a Porphyromonas gingivalis gene for protoporphyrinogen oxidase by complementation of a hemG mutant of Escherichia coli. Oral Microbiol Immunol 2002; 17:290-5. [PMID: 12354210 DOI: 10.1034/j.1399-302x.2002.170505.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Porphyromonas gingivalis, a bacterium implicated in periodontal pathogenesis, has a growth requirement for iron protoporphyrin IX. By complementation with a P. gingivalis 381 chromosomal DNA library, we were able to isolate a clone that enhanced the poor growth of a hemG mutant of Escherichia coli. The DNA sequence analysis of this clone revealed three open reading frames (ORFs). ORF3 encoded a protein of 466 amino acids with a calculated molecular weight of 51 695 Da. The deduced amino acid sequence of the ORF3 gene had significant similarity to sequences of protoporphyrinogen oxidase (PPO) from Myxococcus xanthus (30% identical residues). When the ORF3 gene was overexpressed in E. coli, the extract had much higher PPO activity than a control extract, and this activity was inhibited by acifluorfen, a specific inhibitor of PPO. Thus, ORF3 was named PgHemG. Furthermore, several porphyrin-related genes, including hemD, hemN and hemH, were identified in the data bases on the websites available on-line. We postulated that a porphyrin biosynthetic pathway to heme from preuroporphyrin may be conserved in P. gingivalis.
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Affiliation(s)
- A Kusaba
- Department of Preventive Dentistry, Kyushu Dental College, Kokurakita-ku, Kitakyushu 803-8580, Japan
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7
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Takata Y, Ansai T, Matsumura K, Awano S, Hamasaki T, Sonoki K, Kusaba A, Akifusa S, Takehara T. Relationship between tooth loss and electrocardiographic abnormalities in octogenarians. J Dent Res 2001; 80:1648-52. [PMID: 11597026 DOI: 10.1177/00220345010800071001] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Recent reports have suggested that periodontal disease is a risk factor for coronary heart disease (CHD). However, little is known about the relationship between periodontal disease and CHD in the very elderly. Therefore, we evaluated the association between tooth loss and abnormal ECG findings in octogenarians. Of the 1,282 octogenarians in Fukuoka Prefecture, Japan, 697 participated. Oral examinations--including a tooth count and an assessment of the Community Periodontal Index--and a 12-lead ECG were performed. Logistic regression analysis revealed that individuals with < 20 teeth had increased prevalence of ST segment depression, and T-wave abnormalities, after we adjusted for gender, smoking, serum cholesterol and glucose, blood pressure, and body mass index. Compared with individuals with > or = 20 teeth, edentulous individuals had an increased prevalence of T-wave abnormalities and arrhythmias after adjustment for coronary risk factors. We conclude that tooth loss may be an independent predictor of abnormal ECG findings in octogenarians.
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Affiliation(s)
- Y Takata
- Department of Internal Medicine, Kyushu Dental College, Kitakyushu City, Japan.
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8
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Hirose I, Kawauchi K, Kondo S, Tashiro I, Kusaba A, Itoh Y, Hemmi N, Morohoshi T, Maki M, Kuroki Y. Histological evaluation of allograft bone after acetabular revision arthroplasty: report of two cases. J Orthop Sci 2001; 5:515-9. [PMID: 11180911 DOI: 10.1007/s007760070032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/1999] [Accepted: 03/16/2000] [Indexed: 02/09/2023]
Abstract
We recently had the opportunity to take histological sections from two patients who underwent acetabular reconstruction in which allograft and ME Müller acetabular roof reinforcement rings were used. In one patient (case 1), histological sections of the chipped allograft were taken on two separate occasions from the same area, at 7 months, and at 3 years and 11 months after the bone graft. The histology of the chipped allograft showed necrosis at 7 months, but almost normal morphology of trabecular bone formation at 3 years and 11 months after the bone graft. In the other patient (case 2) histological sections of the block allograft and chipped allograft were taken at 1 year and 8 months after the bone graft. The block allograft showed only a small amount of admixture of newly formed bone with the necrotic bone, while the chipped allograft showed a large amount of newly formed bone, with only a small amount of necrotic bone remaining. Therefore, we principally use chipped allograft for acetabular reconstruction, in order to achieve early and complete graft incorporation. If a block allograft is used in a weight-bearing area, it should be protected from excessive load by using an acetabular reinforcement device.
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Affiliation(s)
- I Hirose
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Japan
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9
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Shiraishi F, Takahashi F, Goto T, Harada K, Kusaba A, Morimoto S. Double blind study of the effect of caffeine on the mental calculation. Fukuoka Igaku Zasshi 2000; 91:100-3. [PMID: 10826223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The double blind study of the effect of caffeine on the mental calculation has been carried out in the practical exercise course for the undergraduate students of clinical pharmacology, in the Medical School, Kyushu University. The results obtained from 1997 to 1999 were summarized and evaluated.
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Affiliation(s)
- F Shiraishi
- Department of Pharmacology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
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10
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Tamaki M, Tamashiro M, Kamada Y, Koja K, Kusaba A. Distribution and localization of cells and collagens in the proliferated intima of arterially implanted autovein grafts. Surg Today 1999; 29:614-25. [PMID: 10452239 DOI: 10.1007/bf02482987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We examined the microscopic features and distribution of collagens in the hyperplastic intima of arterially implanted autovein bypass grafts under conditions of a reduced blood flow with a poor distal outflow. Vascular anastomosis was made using 7-0 nonabsorbable polypropylene sutures (PP group), or absorbable polydioxanone sutures (PDS group). On the contralateral limb, an autovein bypass graft was performed under normal flow conditions (NF group). The thickness of the intima in the NF group was approximately 50 microm throughout the duration of the study, while in the PP and PDS groups, intimal hyperplasia progressed to 290+/-112 microm and 267+/-123 microm, respectively, at 13 months after grafting. Collagen accumulated significantly in both the PP and PDS groups; types IV and V collagen in particular increased considerably in the deep layer. Regardless of the suture materials, the progression of intimal hyperplasia was considered to be closely related to the poor distal outflow to be and caused by the proliferation of myofibroblasts and active production of collagen. The increase in types IV and V collagen, particularly in the deep layer of the hyperplastic intima, was due to development of numerous vasa vasora in this region.
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Affiliation(s)
- M Tamaki
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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11
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12
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Abstract
A method was developed to take radiographs showing the inner articulation of bipolar hip prostheses. By this method, wear was measured in 68 hips whose inner head diameter was 22 mm. Average annual wear rate was 0.17 mm. Osteolysis was observed in 25 hips (37%) and there was no difference between the annual wear rate of hips with and without osteolysis. Studying 19 retrieved prostheses, abrasion of the rim was deeper in hips with osteolysis than those without it. Wear rate of the inner articulation in bipolar hip prosthesis is much larger than that in Charnley's prosthesis, as linear penetration into the articulation surface reduces the motion range of the inner articulation and this increases impingement and advances rim abrasion.
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Affiliation(s)
- A Kusaba
- Department of Orthopaedic Surgery, Showa University, Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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13
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Abstract
BACKGROUND/AIMS We sought to clarify important unresolved points regarding angioarchitecture and blood circulation in focal nodular hyperplasia. METHODS Twenty-nine surgically resected focal nodular hyperplasia lesions were examined histologically, immunohistochemically, and radiologically. In three autopsy cases, red- and blue-colored gelatin was injected into the hepatic artery and the portal vein, respectively, to demonstrate the vasculature in focal nodular hyperplasia. RESULTS Histologically, no orientation with respect to portal tracts and central veins was evident in any lesion. Within lesions, vessels were classified as: (i) anomalous arteries in the fibrous septa, (ii) capillaries in the fibrous septa, or (iii) venous vessels located mainly in the parenchyma. Vessels and sinusoids adjacent to fibrous septa were stained for CD 34 and von Willebrand factor. The anomalous arteries were connected to the capillaries. Capillaries in the fibrous septa were connected to sinusoids adjacent to fibrous septa. Venous vessels were connected to central or hepatic veins surrounding the lesions. Intranodular sinusoids were connected to the sinusoids in the surrounding normal liver. Red-colored gelatin, injected at autopsy into the hepatic artery, appeared not only in the anomalous arteries but also in capillaries and in sinusoids adjacent to the fibrous septa of the lesion. Angiography clearly depicted hepatic veins located near the lesions in nine cases. Computed tomography during arterial portography disclosed no portal blood flow in the lesions. CONCLUSIONS In focal nodular hyperplasia, arterial blood flows from the anomalous arteries via the capillaries into sinusoids adjacent to fibrous septa. The blood in the sinusoids drained to the hepatic vein either directly or via perinodular sinusoids.
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Affiliation(s)
- Y Fukukura
- The First Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
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14
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Higaki K, Jimi A, Watanabe J, Kusaba A, Kojiro M. Epidermoid cyst of the spleen with CA19-9 or carcinoembryonic antigen productions: report of three cases. Am J Surg Pathol 1998; 22:704-8. [PMID: 9630177 DOI: 10.1097/00000478-199806000-00007] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
True splenic cyst is a relatively rare disease, and the majority of the cases are classified as epidermoid cysts. Three cases of epidermoid cysts in the spleen or accessory spleen were studied using an immunohistochemical technique and staining for mucin. In case 1, serum carcinoembryonic antigen (CEA) and CA19-9, and in cases 2 and 3, serum CA19-9, before surgery were markedly elevated, and these levels decreased postoperatively. This strongly indicates the relationship between the increase of tumor marker levels and the presence of the epidermoid cyst. In addition, stratified squamous epithelium in the resected tissues of cases 1 and 2 was positive for anti-CEA antibody and anti-CA19-9 antibody, and that of case 3 was positive for anti-CA19-9 antibody. This strongly supports CEA or CA19-9 production in the squamous epithelium.
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Affiliation(s)
- K Higaki
- First Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
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15
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Kudaka M, Koja K, Kuniyoshi Y, Akasaki M, Miyagi K, Kusaba A. [A case report of surgical treatment of constrictive pericarditis with coronary artery disease]. Nihon Kyobu Geka Gakkai Zasshi 1997; 45:1880-3. [PMID: 9430971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We performed the concomitant operation for constrictive pericarditis and coronary artery disease in an octogenarian. A 82-year-old male was hospitalized with dyspnea, edema of the lower extremities and pleural effusion on chest X-ray film. Cardiac catheterization revealed constrictive pericarditis and 75% stenosis of left anterior descending artery. Extensive pericardiectomy was performed including posterior wall of left ventricle and left atrium under the beating heart by using femoro-femoral partial bypass. Single CABG with a saphenous vein graft was performed following pericardiectomy. Postoperative cardiac catheterization showed good recovery of hemodynamics and patency of the bypass graft. Postoperative course was uneventful. The patient was discharged on twenty fifth postoperative day.
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Affiliation(s)
- M Kudaka
- Second Department of Surgery, University of the Ryukyus, Okinawa, Japan
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16
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Kusaba N, Nakamura H, Yoshimoto K, Ogata H, Sata M, Tanikawa K, Kusaba A, Yoshida H. [A case of cat scratch disease identified by an elevated Bartonella henselae antibody level using enzyme immunoassay]. Kansenshogaku Zasshi 1997; 71:1075-9. [PMID: 9394562 DOI: 10.11150/kansenshogakuzasshi1970.71.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 68-year-old male was admitted to our hospital because of fever and a 2-week history of inguinal adenomegaly. Since he owned a cat, cat scratch disease was suspected. But it was necessary to distinguish cat scratch disease from lymphoma type adult T-cell leukemia because he showed a high level of antibody against HTLV-1. An excisional biopsy of the inguinal node was performed. Histopathologic examination revealed abscess-forming granulomatous lymphadenitis compatible with cat scratch disease. A Warthin-Starry silver stain showed pleomorphic bacilli in the lymph node. So we confirmed a serological response to Bartonella henselae, the causative agent of cat scratch disease, using enzyme immunoassay (EIA). The IgG antibody level to B. henselae was positive at 42 EIA Unit before treatment. After treatment with intravenous cefepime and oral tosufloxacin, his physical symptoms improved and the antibody level decreased to less than 12 EIA Unit. EIA was very useful for diagnosis of this case. Serology to B. henselae may replace traditional diagnostic criteria for cat scratch disease.
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Affiliation(s)
- N Kusaba
- Second Department of Medicine, Kurume University School of Medicine
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17
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Haramaki M, Yano H, Iemura A, Momosaki S, Ogasawara S, Inoue M, Yamaguchi R, Kusaba A, Utsunomiya I, Kojiro M. A new human hepatocellular carcinoma cell line (HAK-2) forms various structures in collagen gel matrices. Hum Cell 1997; 10:183-92. [PMID: 9436038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We established a new human hepatocellular carcinoma (HCC) cell line, designated HAK-2, from a surgically resected HCC of a 57-yr-old Japanese man. The patient's tumor consisted of 5 different histological features in a single nodule: well-differentiated HCC with trabecular pattern; and moderately differentiated HCC with 4 different patterns (i.e., trabecular, pseudoglandular, solid, and scirrhous). Morphologically, HAK-2 cells on a plastic dish showed oval-shaped nuclei and large flat, polygonal eosinophilic cytoplasm and proliferated in a monolayered sheet with a population doubling time of 36.8 hours. Meanwhile, various structures, such as compact, trabecular, and tubular arrangements, were induced in HAK-2 cells cultured in type I collagen gel matrix. Also, HAK-2 cells in vitro underwent spontaneous apoptosis more frequently than other HCC cell lines examined. HAK-2 cells secreted various plasma proteins including albumin into the culture medium. Chromosome and flow cytometric analyses revealed that HAK-2 had many structural abnormalities with human karyotype and a single aneuploid cell population with a DNA index of 3.7, respectively. These findings suggest that HAK-2 is a new human HCC cell line representing two morphological characteristics; (1) formation of various structures in the presence of extracellular matrix and (2) frequent spontaneous apoptosis in vitro.
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Affiliation(s)
- M Haramaki
- First Department of Pathology, Kurume University School of Medicine
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18
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Ohta O, Kusaba A. Development of vasa vasorum in the arterially implanted autovein bypass graft and its anastomosis in the dog. INT ANGIOL 1997; 16:197-203. [PMID: 9405016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Using stereomicroscopy, light microscopy, and scanning electron microscopy, we investigated the development of vasa vasorum in the proliferated neointima of the autovein graft and its anastomoses implanted in the canine femoral artery against a background of poor distal runoff. In the stereomicroscopic examination, a microfil silicone rubber compound (MF) was injected transluminally or via perivascular vasa, and the vascular specimen was prepared for clearing by immersion in a methyl-salicylate solution. Vessel interstices filled with MF were found adjacent to the suture materials within 5 days of grafting. Fourteen days after implantation, luminally originating vasa vasorum were often visible in the neointima along the suture line and distributed into the media and adventitia connecting to the original vasa vasorum. At 6 months or more after grafting, many orifices of luminally originating vasa vasorum were seen along the suture line of both proximal end-to-end and distal end-to-side anastomoses and distributed into the thickened neointima forming a vasa network when the neointima had proliferated to over 250 microm in depth. On the other hand, some clefts filled with MF were found in mural thrombi deposited on the vascular sinus of the graft within 5 days, and these appeared to be one of the sources of luminally originating vasa vasorum on the graft distant from the suture line. Moreover, the development of numerous vasa vasorum was constantly demonstrated in the neointima when it had proliferated to over 250 microm in depth.
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Affiliation(s)
- O Ohta
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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19
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Kusaba A. [The significance of the medical research study: hemodynamic and pathophysiologic characteristics in peripheral arterial reconstruction]. Nihon Geka Gakkai Zasshi 1997; 98:697-9. [PMID: 9330385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In cases of peripheral arterial reconstructive surgery, it is important to prevent postoperative early and late occlusion of the reconstructed artery. The postoperative early outcome of the reconstructed artery were related to electromagnetically determined flow waveform of the reconstructed artery. Flow waveform was classified in 5 types, i. e. types O, I, II, III, and IV. The prognosis of the reconstructed arteries with types O and I was excellent. Type II showed no postoperative early occlusion but late occlusion did occur in 31%. Type III and IV were all failed within 48 hours postoperatively. Correlation between prognosis of the reconstructed artery and flow waveform was established by the intraluminal velocity profile of blood flow, using a specially designed flow wave simulation pump system. Postoperative late occlusion in arterial reconstruction often occurs in cases with poor distal runoff and caused by intimal hyperplasia of implanted autovein graft and its distal end-to-side anastomosis. The features of intimal hyperplasia of the implanted autovein graft differed from those at the distal end-to-side anastomosis; the former being related to active proliferation of smooth muscle cells while the latter displayed an excessive proliferation of fibroblasts and collagen fibers.
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Affiliation(s)
- A Kusaba
- Department of Surgery II, Faculty of Medecine, University of Ryukyus, Okinawa, Japan
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20
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Abstract
We retrieved 159 femoral heads at revision surgery to determine changes in surface configuration. Macroscopic wear of the head was observed in three bipolar hip prostheses as a result of three-body wear. There was a considerable change in surface roughness in the internal articulation of bipolar hip prostheses. Roughness in alumina heads was almost the same as that in new cobalt-chromium heads. The annual linear wear rate of polyethylene cups with alumina heads was less than that of cups with cobalt-chromium alloy heads. Polyethylene wear was increased in the prostheses which had increased roughness of the head.
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Affiliation(s)
- A Kusaba
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
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21
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Abstract
We retrieved 159 femoral heads at revision surgery to determine changes in surface configuration. Macroscopic wear of the head was observed in three bipolar hip prostheses as a result of three-body wear. There was a considerable change in surface roughness in the internal articulation of bipolar hip prostheses. Roughness in alumina heads was almost the same as that in new cobalt-chromium heads. The annual linear wear rate of polyethylene cups with alumina heads was less than that of cups with cobalt-chromium alloy heads. Polyethylene wear was increased in the prostheses which had increased roughness of the head.
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Affiliation(s)
- A. Kusaba
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama 227, Japan
| | - Y. Kuroki
- Showa University Fujigaoka Rehabilitation Hospital, 2-1-1 Fujigaoka, Aoba-Ku, Yokohama 227, Japan
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22
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Koja K, Kusaba A, Kuniyoshi Y, Iha K, Akasaki M, Miyagi K. Radical open endvenectomy with autologous pericardial patch graft for correction of Budd-Chiari syndrome. Cardiovasc Surg 1996; 4:500-4. [PMID: 8866089 DOI: 10.1016/0967-2109(95)00137-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A surgical technique for the treatment of Budd-Chiari syndrome associated with vena caval obstruction has been devised. The occluded hepatic vena cava and hepatic veins were reconstructed by open endvenectomy, using an autologous pericardial patch graft and a femorofemoral bypass technique. The hepatic artery and portal vein were not controlled with vascular clamps during the surgery. Between 1979 and 1994, 29 patients were treated using this technique and achieved good results. All the patients did well with good function of the reconstructed vena cava and of the hepatic veins, and showed acceptable reduction of symptoms caused by portal hypertension and caval stagnation.
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Affiliation(s)
- K Koja
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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23
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Shiroma H, Kusaba A. Ultrastructural features of progressive intimal hyperplasia at the distal end-to-side anastomosis of vein grafts. Cardiovasc Surg 1996; 4:393-8. [PMID: 8782945 DOI: 10.1016/0967-2109(95)00081-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The features of intimal hyperplasia at the distal end-to-side anastomosis of arterially implanted autovein bypass grafts in dogs were examined using light and transmission electron microscopy. The bypass grafting was done under conditions of reduced blood flow with an abnormal flow wave and high peripheral resistance. Anastomotic intimal hyperplasia was evident 14 to 31 days after implantation, then gradually increased, particularly at the toe portion of the anastomosis. From 6 to 12 months after implantation, the intimal hyperplasia was excessively increased and severe luminal stenosis had developed. The hyperplastic neointima consisted of two layers; a laminated superficial layer and a randomly arranged deeper layer. The superficial layer had three to four layers of smooth muscle cells, while the deeper layer was mostly fibrocollagenous tissues. Thus, the intimal hyperplasia at the distal end-to-side anastomosis of the arterially implanted autovein graft developed as a result of infiltration of fibroblast-like cells, presumably tissue-synthesizing mesenchymal cells. The neointima at the distal anastomosis, under conditions of reduced blood flow with high peripheral resistance, remained in an active phase of intimal hyperplasia even 12 months after bypass grafting.
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Affiliation(s)
- H Shiroma
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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24
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Kuniyoshi Y, Koja K, Iha K, Akasaki M, Miyagi K, Shimoji M, Kudaka M, Kusaba A. [Clinical experience with normothermic selective cerebral perfusion during graft replacement of ascending-arch-descending aortic aneurysms with annuloaortic ectasia]. Nihon Kyobu Geka Gakkai Zasshi 1996; 44:19-24. [PMID: 8683167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We treated three cases of ascending-arch-descending aortic aneurysm with annuloaortic ectasia by performing graft replacement. The patients included a 34 year old female, a 34 year old male and a 42 year old male. In one case the aneurysm was atherosclerotic and of type I and II + IIIb dissection in the other two cases. During the operation we were able to utilize normothermic selective cerebral perfusion during construction of the left common carotid artery. Specially, normothermic partial F-F bypass and normothermic selective cerebral perfusion to the left common carotid artery were used during graft replacement from the descending aorta to the left common carotid artery. This was followed by regular hypothermic total ECC and hypothermic cerebral selective perfusion during subsequent graft replacement of the innominate artery and a modified Bentall's operation. This new protocol in which normothermic cerebral perfusion is utilized during the procedure on the left common carotid artery and hypothermic perfusion is utilized only during the subsequent procedure on the innominate artery permits significant shortening of the cardiac arrest time and cerebral perfusion time compared with when only hypothermic perfusion is used. This significant shortening contains obvious benefits in the areas of cardiac and brain protection.
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Affiliation(s)
- Y Kuniyoshi
- Second Department of Surgery, University of the Ryukyus, Okinawa, Japan
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25
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Kusaba A. [Deep vein thrombosis, deep vein thrombophlebitis]. Ryoikibetsu Shokogun Shirizu 1996:512-6. [PMID: 9047920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Kusaba
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus
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26
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Kusaba A. [Superficial thrombophlebitis]. Ryoikibetsu Shokogun Shirizu 1996:545-6. [PMID: 9047927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Kusaba
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus
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27
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Kusaba A. [Postphlebitic syndrome]. Ryoikibetsu Shokogun Shirizu 1996:502-5. [PMID: 9047917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Kusaba
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus
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28
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Shimoji M, Koja K, Kuniyoshi Y, Akasaki M, Miyagi K, Kusaba A. [Staged operation of multiple aortic aneurysms with myocardial infarction and stenosis of three coronary arteries]. Nihon Kyobu Geka Gakkai Zasshi 1995; 43:1752-6. [PMID: 7594833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 69-year-old man with multiple aortic aneurysms was admitted to the university hospital because of increasing the size of aneurysms. A coronary angiogram revealed three vessel disease (LAD at seg 7: 90%, D1: 75%, LCX at seg 13: 95%, RCA at seg 3: recanalization) and left ventriculography showed hypokinesis of the inferior wall. Staged extending operation was performed. Graft replacement of ascending and arch aortic aneurysms associated with coronary artery bypass grafting was done in the first operation. Two months after the 1st operation, thoracoabdominal and infrarenal aortic aneurysms were replaced by synthetic graft and the intercostal arteries (Th10, 11, 12) and the lumbar arteries (L1, 4) were reconstructed with synthetic bypass from the implanted graft. Postoperative course was uneventful and he has been well without any symptoms of paraplegia 26 months after the first operation.
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Affiliation(s)
- M Shimoji
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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29
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Kusaba A. In vivo wear of bipolar endoprosthesis. Nihon Seikeigeka Gakkai Zasshi 1995; 69:411-25. [PMID: 7561344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In vivo wear was evaluated in 39 bipolar endoprostheses retrieved at revision surgery. The duration from the implantation until the revision surgery was 5.2 +/- 1.3 years. The annual wear rate of the inner articulation was 0.21 mm, and the annual wear rate (in depth) of the polyethylene rim was 0.54 mm. The annual wear rate of the rim was greater in cases with radiological osteolysis than in those without osteolysis. Improvement in the configuration of the rim, and the device such as coating the stem neck with a cobalt-chromium alloy mirror surface are necessary to prevent rim abrasion. It is also important to make careful consideration on the indication of bipolar endoprosthesis especially for cases of dysplastic osteoarthritis, in which rim abrasion was found to be very severe.
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Affiliation(s)
- A Kusaba
- Department of Orthopaedic Surgery, Fujigaoka Hospital, Showa University School of Medicine, Kanagawa, Japan
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30
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Abstract
To design a more rational and effective surgical method of performing lymphatic-venous anastomosis to treat secondary lymphedema of the lower extremities, the following experiments were conducted on three groups of dogs: group A underwent an end-to-side lymphatic node-to-vein anastomosis at the inferior vena cava; group B underwent a "burying" lymphatic vessel-to-vein anastomosis at the femoral vein; and group C underwent a burying lymphatic vessel-to-isolated-vein anastomosis at the femoral vein. In group C, the femoral venous segment was isolated by distal ligation and proximal valvuloplasty and the patency of the anastomosis was investigated by infusing yellow Microfils through the distal lymphatic vessel. The patency of the anastomosis was nil in group A by 10 days after the anastomosis, 40% in group B by 180 days; and 71.4% in group C by 180 days, respectively. Thus, we clinically applied the technique of lymphatic vessel-to-isolated-saphenous-vein anastomosis in a patient with secondary lymphedema of the bilateral lower extremities. A satisfactory reduction in the size of the limbs was achieved and there has been no further recurrence of cellulitis in the 42 months since her surgery. This study shows that lymphatic vessel-to-vein anastomosis is an effective technique for the surgical management of secondary lymphedema, so long as the anastomosis is completely protected from any contact with blood.
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Affiliation(s)
- O Kinjo
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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31
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Abstract
We designed a study to evaluate three factors (siphon gradient [PH], the right atrial pressure [RAP], and the inferior vena caval flow [IVCF]) to be optimized to maximize the venous drainage flow (DF) during partial cardiopulmonary bypass using eight venous cannulas of three different types and an original model circuit. The relationship between venous DF and the three factors is indicated by the multiple regression equation DF2 = alpha PH + beta RAP + gamma IVCF2 + C, where alpha, beta, and gamma are regression estimates and C is a constant. Multiple regression analysis results showed that DF was positively correlated with PH and RAP and negatively correlated with IVCF. A long cannula with 12 side holes and 60 cm long was considered to be useful to yield the optimal venous drainage flow under the condition of maintenance of the flow balance (DF and ICVF) and the pressure balance (RAP and IVCP) at the zero point. Moreover, this model may allow extensive research in flow dynamics of venous cannula without involving human subjects.
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Affiliation(s)
- T Kugai
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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32
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Shimoji M, Koja K, Kuniyoshi Y, Iha K, Akasaki M, Kusaba A. [Use of the inferior epigastric artery in redo coronary artery bypass grafting--a case report]. Nihon Kyobu Geka Gakkai Zasshi 1994; 42:2150-4. [PMID: 7836833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 71-year-old man who had undergone coronary artery bypass grafting (CABG) 9 years ago, was admitted for chest compression on exertion. A severe stenotic lesion (75%) of the main trunk of the left coronary artery and occlusion of the bypass graft previously implanted to the right coronary artery were showed by coronary angiography. Redo-CABG using the left inferior epigastric artery (LIEA) and left internal thoracic artery (LITA) was successfully done, since the saphenous vein and right gastroepiploic artery were not suitable for bypass graft. Post operative cource was uneventful and good patency of LIEA and LITA graft were revealed by postoperative angiography 34 days after surgery.
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Affiliation(s)
- M Shimoji
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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33
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Iha K, Koja K, Kusaba A. Morphological, immunohistological and fibrinolytic features of patch grafts for reconstruction of the inferior vena cava. Cardiovasc Surg 1994; 2:592-7. [PMID: 7820519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Morphological and immunohistological features and fibrinolytic activity of the neointima of various grafts implanted in the thoracic inferior vena cava (IVC) in dogs were examined. Autologous pericardium (group 1), treated porcine pericardium (group 2), treated bovine pericardium (group 3), treated horse pericardium (group 4) and expanded polytetrafluorethylene (e-PTFE) (group 5) were used as patch grafts. Grafts harvested 12-30 (mean 15.2) months after implantation were all patent in each group. The luminal surface of the grafts was completely covered with endothelial cells, which were positive for immunohistological staining of factor VIII and had active fibrinolytic activity. The gross appearance of the neointima of the grafts in group 1 was smooth; however, the grafts in groups 2-5 were severely deformed with retraction. The concavity of the retracted grafts in groups 2-5 was filled with thick neointima, which consisted of a superficial layer with mature smooth muscle cells and the deeper layer with fibroblast-like cells and extracellular collagen fibres. Fibroblast-like cells were thought to be a synthetic form of fibroblasts. The deeper layer of the neointima of the implanted biografts and e-PTFE graft was considered to be in the active phase in cell proliferation, even at > or = 12 months after implantation. It is concluded that autologous pericardium is the material of choice for patch grafts in reconstruction of the IVC and that biografts and synthetic grafts are less than satisfactory.
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Affiliation(s)
- K Iha
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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Miyagi K, Koja K, Kuniyoshi Y, Iha K, Akasaki M, Shimoji M, Kugai T, Kamada Y, Shiroma H, Kusaba A. [A two staged extending graft replacement for dissecting aortic aneurysm with Marfan's syndrome]. Nihon Kyobu Geka Gakkai Zasshi 1994; 42:1027-1031. [PMID: 8089567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We experienced four cases of dissecting aortic aneurysms with Marfan's syndrome, in which two staged operations were performed with satisfactory results. The operations performed in the four patients were the replacement of the ascending aorta, transverse aortic arch and the entire descending thoracic aorta in DeBakey type I dissecting aortic aneurysm, replacement of the entire descending thoracic and abdominal aorta in type IIIb, replacement of the aortic valve, ascending aorta, transverse aortic arch, the entire descending thoracic and upper abdominal aorta in type I, and replacement of the total aorta including the aortic valve in type II + IIIb, respectively. There were no operative deaths, but a 42-year-old woman with DeBakey type IIIb died suddenly 2 years 11 months after the second operation. The cause of death was presumed to be due to rupture of a dissecting aneurysm (DeBakey type II). Dissecting aortic aneurysm with Marfan's syndrome must be observed carefully and corrected surgically, because the lesion is progressive and the residual dissecting aneurysm usually dilates eventually. In view of our clinical results, we conclude that the operation for dissecting aortic aneurysm with Marfan's syndrome should be performed as extensively as possible.
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Affiliation(s)
- K Miyagi
- Second Department of Surgery, Faculty of Medicine, University of The Ryukuys, Okinawa, Japan
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35
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Iha K, Koja K, Kuniyoshi Y, Akasaki M, Miyagi K, Kusaba A. [Discrete subaortic stenosis after aortic valve replacement--a case report]. Nihon Kyobu Geka Gakkai Zasshi 1994; 42:1073-1076. [PMID: 8089577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A 51-year-old woman, who had undergone aortic valve replacement (SJM 19 mm) and open mitral commissurotomy for aortic valve stenosis with regurgitation, and mitral stenosis, was admitted for redo surgery. We found discrete subaortic ring just below the prosthetic valve. The fibrous ring was resected and the aortic valve was replaced (SJM 21 mm) after augmentation of the aortic annulus by Nicks procedure. Mitral and tricuspid valves were replaced. Discrete subaortic stenosis after aortic valve replacement are mostly in cases with small prosthetic valve. The turbulence caused by the small valve may produce discrete subaortic ring.
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Affiliation(s)
- K Iha
- Second Department of Surgery, Faculty of Medicine, University of Ryukyus, Okinawa, Japan
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36
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Kuniyoshi Y, Koja K, Iha K, Akasaki M, Miyagi K, Kusaba A. [A case of re-operation after 14 years following radical correction of the anomalous origin of right pulmonary artery from ascending aorta]. Nihon Kyobu Geka Gakkai Zasshi 1994; 42:598-602. [PMID: 8035085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital malformation, which is usually fatal without early surgical correction. The number of reports of the radical operation has been recently increasing, but reports of its long-term postoperative results are rare, especially those of the reoperative cases. The 14-year-old patient, who had been operated radically with a 8 mm diameter graft at 7 months of age, weighing 4550 g at the time, was reoperated, because he developed pulmonary hypertension due to the narrowing of the graft. He had no clinical symptoms and no abnormal signs on chest X-P nor ECG, eventhough severe stenosis of the graft was present. The graft was replaced with a larger 12 mm diameter graft under ECC, and PFO closure and TAP were done at the same time. The patient's pulmonary artery pressure reduced substantially following surgery. We conclude that cautious postoperative follow-up including angiographical examination is important, and that early reoperation before occlusion of the graft should be done.
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Affiliation(s)
- Y Kuniyoshi
- Second Department of Surgery, Faculty of Medicine, University of Ryukyus, Okinawa, Japan
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37
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Miyagi K, Koja K, Kuniyoshi Y, Iha K, Akasaki M, Kusaba A. [A case of staged operation for a dissecting aneurysm (DeBakey type IIIb+II) with Marfan's syndrome]. Nihon Kyobu Geka Gakkai Zasshi 1994; 42:423-426. [PMID: 8176304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A 34-year-old woman with Marfan's syndrome had severe heart failure due to annulo-aortic ectasia and aortic insufficiency, which was accompanied also by a dissecting aneurysm (DeBakey type IIIb) that was demonstrated by aortography. 4 days before the operation, sudden progression of the aneurysm to a DeBakey type II, and finally DeBakey type I dissecting aneurysm was seen. The first operation was an extended aortic resection with replacement from the aortic valve to the descending thoracic aorta (level of the 7th thoracic vertebra) using selective cerebral perfusion. The second operation was a replacement of the residual dissecting aorta from the level of the 8th thoracic vertebra to the celiac artery with partial extracorporeal circulation. The postoperative course of the patient was uneventful. Dissecting aneurysm with Marfan's syndrome should be operated as extensively as possible if necessary.
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Affiliation(s)
- K Miyagi
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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38
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Miyagi K, Koja K, Kuniyoshi Y, Iha K, Akasaki M, Shimoji M, Kugai T, Kamada Y, Oomine Y, Kusaba A. [Angiographic evaluation of reconstructed spinal arteries in thoracic aortic aneurysm surgery]. Nihon Kyobu Geka Gakkai Zasshi 1993; 41:2054-8. [PMID: 8228409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Revascularization of the spinal arteries with thoracic aortic aneurysm were performed on nineteen patients using partial extracorporeal bypass. They were 16 men and 3 women. Age range were from 33 to 70 years (mean 49.9 +/- 10.3 years). There were eleven patients of dissecting aneurysm (DeBakey type IIIb in eight patients, type I in two patients and type IIIa in one patient), and eight patients of non-dissecting thoracoabdominal aneurysm (including two patients with ruptured aneurysm). The number of revascularized spinal arteries were 60 pairs (average 3.2 pairs per each patient). The revascularized spinal arteries were localized between levels T4 and L5.36 pairs of the 60 existed between levels T8 and L2 from where the artery of Adamkiewicz arises. Seven patients (eleven spinal arteries) underwent selective angiography of the revascularized spinal arteries postoperatively, and the anterior spinal artery and the artery of Adamkiewicz was identified in three patients. Two patients died within one month, one from MOF and the another from intestinal perforation respectively (operative mortality 11.1%). One patient, with ruptured thoracoabdominal aortic aneurysm showed paraparesis postoperatively, but no paraplegia was found in any patients. We recommend that not only the artery of Adamkiewicz but also the spinal arteries at the midthoracic area from T4 to T8 should be revascularized, to prevent postoperative paraplegia. Replacing of extended thoracic aneurysm, our method (using partial extracorporeal circulation and segmental aortic clamping) was thought to prevent spinal cord ischemia.
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Affiliation(s)
- K Miyagi
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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39
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Iha K, Koja K, Kuniyoshi Y, Akasaki M, Miyagi K, Kusaba A. [Surgical treatment of aortic arch aneurysm with coronary artery disease]. Nihon Kyobu Geka Gakkai Zasshi 1993; 41:1058-62. [PMID: 8336034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 69-year-old man with aortic arch aneurysm was admitted for abnormal shadow of chest X-ray. Computed tomography (CT) and aortography revealed aneurysm of aortic arch. His coronary angiogram showed 60% stenosis at LMT (seg 5), 90% stenosis at LAD (seg 7) and 75% stenosis at LCX (seg 11). The graft replacement for arch aneurysm and CABG were performed simultaneously. Postoperative course was good. Postoperative angiogram demonstrated successful reconstruction of the aortic arch and patent three bypass grafts. This patient has been worked healthy 14 months postoperatively.
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Affiliation(s)
- K Iha
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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40
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Iha K, Koja K, Kuniyoshi Y, Akasaki M, Miyagi K, Shinya E, Ohmine Y, Shiroma H, Kina M, Kusaba A. [Extravascular lung water in patients after cardiac surgery]. Nihon Kyobu Geka Gakkai Zasshi 1993; 41:389-95. [PMID: 8478565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Extravascular lung water (EVLW) measured by a double indicator dilution method using thermal-dye indicator was evaluated in 204 patients after cardiac surgery during last 7 years. The measurement of EVLW was done at 2, 4, 8, 24 and 48 hours after extracorporeal circulation (ECC), EVLW showed no significant change except transient decrease at 4 hours after ECC, average of that was 7.62 +/- 3.58 ml/kg, EVLW of group I (MVR) and group III (AVR + MVR) were significantly higher than those of group II (AVR), group IV (noncyanotic congenital heart disease) and group V (A-C bypass). EVLW of 7 patients with postoperative pulmonary edema was 14.47 +/- 4.44 ml/kg, and that was significantly higher than those of others (7.54 +/- 3.06 ml/kg). EVLW of the patients using bubble oxygenator (8.60 +/- 3.90 ml/kg) was significantly higher than those of membrane oxygenator (7.15 +/- 3.40 ml/kg). Postoperative EVLW correlated with mean pulmonary artery pressure (mPAP), mean left atrial pressure (LAP) and microvascular hydrostatic pressure (PMV), and showed inverse correlation with cardiac index (CI). But there was no correlation of EVLW with duration of ECC. In the preoperative parameter, EVLW correlated with age, mPAP, mean pulmonary wedge pressure (mPAWP), PMV, serum BUN and serum creatinine, and showed inverse correlation with CI, %VC, FEV%, PSP test and creatinine clearance. We concluded that the patients with mitral valve disease who have high mPAP and LAP, respiratory and renal dysfunction and old aged preoperatively showed upward trend of EVLW. In perioperative management, care must be taken in such patients and membrane oxygenator was thought useful for prevention of pulmonary edema.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K Iha
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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41
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Abstract
We report a 29-year-old Japanese female with severe hypertension and unilateral renal dysplasia, which is rarely found in adults. The involved kidney was surgically removed and then the blood pressure fell to borderline levels without any changes in plasma renin activity or plasma aldosterone concentration. Histological examinations revealed typical renal dysplasia without hyperplasia of the juxtaglomerular apparatus. Unilateral renal dysplasia may be a cause of secondary hypertension in adults, though the mechanisms are still unknown.
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Affiliation(s)
- O Sunagawa
- Third Department of Internal Medicine, School of Medicine, University of the Ryukyus, Okinawa, Japan
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42
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Shrestha DR, Shiroma H, Kamada Y, Kusaba A. Microscopic and immunohistological studies on intimal hyperplasia of the arterially implanted autovein graft and its anastomosis in dogs. Surg Today 1992; 22:443-50. [PMID: 1421866 DOI: 10.1007/bf00308796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The fate of intimal hyperplasia of arterially implanted autovein bypass grafts and their distal end-to-side anastomoses in dogs was studied microscopically and immunohistologically. The bypass grafting was done under conditions of abnormal blood flow and high peripheral resistance. Intimal hyperplasia of the graft first became evident 7 days after implantation and the thickness increased to about 500 microns 3 months or more after the implantation. The intimal hyperplasia was related to an active proliferation of smooth muscle cells which proved positive for alpha-smooth muscle actin staining. Moreover, it was more dominant at the toe and heel of the anastomosis and moderately apparent on the floor of the host artery. The constituent elements of the hyperplastic intima at the anastomosis were fibroblast-like cells and extracellular collagen fibers which were negative for alpha smooth muscle actin staining. This study revealed that the features of intimal hyperplasia at the distal anastomosis in autovein bypass grafting differed from those of the implanted autovein graft itself; the former being related to excessive proliferation of fibroblasts and collagen fibers while the latter displayed an active proliferation of smooth muscle cells.
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Affiliation(s)
- D R Shrestha
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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Ohta M, Kusaba A, Shrestha DR, Koja K, Kina M, Shiroma H, Ohmine Y. Popliteal artery entrapment syndrome. Report of two cases. J Cardiovasc Surg (Torino) 1991; 32:697-701. [PMID: 1939335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We treated two patients with popliteal artery entrapment syndrome. In one, the popliteal artery was entrapped and obstructed in its abnormal course around the medial head of the gastrocnemius muscle, which was inserted into the femur laterally and cephalad (type II in Delaney's classification). In the other patient, the popliteal artery followed a normal course but was compressed laterally by the medial head of the gastrocnemius muscle, which was aberrantly inserted into the femur considerably higher and more lateral than usual, and was occluded. This could not be fitted into Delaney's or Insua's classification. Arterial reconstruction was successful with an autovein graft in the former case and an in situ bypass graft in the latter. We suggest a modification of type IV in Delaney's classification, so that when the popliteal artery is compressed by an aberrant muscular or tendinous structure in the popliteal fossa it can be included.
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Affiliation(s)
- M Ohta
- Second Department of Surgery, Faculty of Medicine University of the Ryukyus, Okinawa, Japan
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Matsumura K, Muratani H, Kinjou K, Kimura Y, Eto T, Fukiyama K, Kusaba A. Severe hypertension with segmental renal infarction following surgical removal of a retroperitoneal malignant hemangiopericytoma: a case report. Angiology 1991; 42:331-6. [PMID: 2014923 DOI: 10.1177/000331979104200411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Severe hypertension developed in a fifty-five year-old woman after surgical removal of a retroperitoneal tumor, when the renal artery was injured. Renal arteriography after the surgery demonstrated a segmental infarction of the right kidney. A close relationship between activation of the renin-angiotensin system and the development of severe hypertension was observed. Satisfactory control of blood pressure concomitant with reduction of plasma renin activity was achieved by a combination of an angiotensin-converting anzyme inhibitor, beta-blocking agent, and calcium-entry blocker. The mechanism of activation of the renin-angiotensin system in renal infarction is discussed.
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Affiliation(s)
- K Matsumura
- Third Department of Internal Medicine, Faculty of Medicine, University of Ryukyus, Okinawa, Japan
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Kusaba A, Shiroma H, Shrestha DR, Koja K, Kina M, Kuniyoshi Y, Iha K, Kinjo O, Akasaki M, Kugai T. Clinical studies on the vasodilating and anti-platelet effects of OP-41483, a prostacyclin derivative. Jpn J Surg 1991; 21:8-13. [PMID: 2041246 DOI: 10.1007/bf02470860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The vasodilating and anti-platelet actions of OP-41483 was studied to determine the effective dose of this drug for the treatment of ischemic lower limbs. The compound was given to 11 patients intravenously at rates of 2.5, 5.0 and 10.0 ng/kg/min. Infusion at a rate of 10 ng/kg/min increased the mean flow rate of the tibial arteries from 3.15 +/- 1.77 ml/min before the infusion, to 7.89 +/- 2.51 ml/min (p less than 0.001) and to 6.38 +/- 3.19 ml/min (p less than 0.001), at the time of, and 60 minutes after the cessation of the infusion, respectively. The peripheral flow resistance of the tibial arteries was reduced from 2.1 +/- 1.12 X 10(5) dyne.sec/cm5 before the infusion to 0.9 +/- 0.33 X 10(5) dyne.sec/cm5 (p less than 0.001) and to 1.2 +/- 0.78 X 10(5) dyne.sec/cm5 (p less than 0.05), at the time of, and 60 minutes after the cessation of the infusion. ADP-induced platelet aggregation was reduced from 73.3 +/- 17.6% before the infusion to 50.7 +/- 24.5% (p less than 0.01) and to 64.0 +/- 23.5% (p less than 0.05), at the time of, and 60 minutes after the cessation of the infusion, respectively. Collagen-induced platelet aggregation was also reduced from 71.4 +/- 24.0% to 66.6 +/- 21.5% before and after the infusion (p less than 0.05).
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Affiliation(s)
- A Kusaba
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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Kusaba A, Koja K, Kina M, Shiroma H, Shrestha DR. Crural artery bypass with adjunctive arteriovenous fistula. A modification in distal anastomosis. J Cardiovasc Surg (Torino) 1990; 31:739-44. [PMID: 2262498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We carried out crural artery bypass with an adjunctive arteriovenous fistula in 8 lower extremities of 7 patients with severe ischemic symptoms and poor distal run-off. Mean blood flow rates in the implanted grafts ranged from 43 to 340 ml/min and those of the reconstructed crural arteries from 20 to 100 ml/min. A stenotic lesion was noted on postoperative angiogram in one patient and stasis symptoms caused by downward blood flow into the distal veins in another. The other patients have remained well with good function of the grafts 1-5 years after surgery. We modified the distal corner of the anastomosis as follows: three additional interrupted simple sutures were made on the anterior wall of the concomitant arteriotomy and venotomy incisions after making the common posterior wall of the vessel incisions. A vascular pocket formed at the distal corner of the anastomosis prevents stricture at the anastomosis. The vein is finally ligated just distal to the fistula to intercept downward blood flow into the distal veins. This modification in technique is recommended to prevent stricture of the distal anastomosis and postoperative stasis symptoms.
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Affiliation(s)
- A Kusaba
- Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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Kuniyoshi Y, Kosha K, Iha K, Akasaki M, Shinya E, Kusaba A. [A study on surgical cases of pulmonary aneurysm]. Nihon Kyobu Geka Gakkai Zasshi 1990; 38:1073-7. [PMID: 2398290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We performed 830 cases of open heart surgery in the past 12 years and two of those cases were complicated by pulmonary aneurysm. The first case was a 21-year-old female with annuloaortic ectasia and treated by partial resection and plication of the pulmonary aneurysm associating of partial resection and plication of the pulmonary aneurysm associating of Bentall's procedure. Pathological examination revealed the findings of Aortitis syndrome, i.e., inflammatory granuloma with round cells infiltration and fragmentation of elastic fibers in the medial as well as adventitial layers. The second case, a reoperation case, was a 44-year-old female with valvular disease, MSR, TSR, Pr and treated by partial resection of the pulmonary aneurysm associating with MVR, TVR, and PA valve plasty. Pathological examination revealed hyalin and necrobiotic degeneration of the media. Both cases involved had pulmonary hypertension suggesting a role for pulmonary hypertension along with organic changes of the vessel in the pathogenesis of the aneurysm.
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Affiliation(s)
- Y Kuniyoshi
- Second Department of Surgery, Faculty of Medicine, University of Ryukyus, Okinawa, Japan
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Abstract
We investigated the alpha-L-iduronidase activity of various pig tissues. Furthermore, we examined the tissues using antibody, enzyme immunoassay (EIA), and immunohistochemical methods. The amounts of enzyme measured by the EIA method in the various tissues were proportional to their enzyme activities and also to their immunohistochemical characteristics. The tissues could thus be classified into three groups: a high enzyme activity group composed of the liver, kidney, and spleen; a moderate activity group comprising the lung, lymph nodes, stomach, ileum, colon, and pancreas; and a low activity group consisting of the heart, diaphragm, iliopsoas muscle, cerebrum, cerebellum, and skin. The molecular weight of the enzyme in each tissue did not reveal any heterogeneity, having two components of 70 KD and 62 KD by Western blot analysis. Immunohistochemically, alpha-L-iduronidase was strongly detected in the lysosomal membranes of cells of the mononuclear phagocyte system, epithelial cells of the proximal tubules in the kidney, and some blastic cells, whereas hepatocytes revealed weak positive reactions. The tissue and cellular distribution of the enzyme appeared to have a close relation to tissues that manifest or are affected by alpha-L-iduronidase deficiency.
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Affiliation(s)
- H Sakuda
- Department of Surgery, Ryukyu University School of Medicine, Okinawa, Japan
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Okadome K, Muto Y, Eguchi H, Kusaba A, Sugimachi K. Venous reconstruction for iliofemoral venous occlusion facilitated by temporary arteriovenous shunt. Long-term results in nine patients. Arch Surg 1989; 124:957-60. [PMID: 2757511 DOI: 10.1001/archsurg.1989.01410080093015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In nine patients with iliofemoral venous occlusion, venous reconstructions using a temporary arteriovenous shunt were performed by open thromboendvenectomy with autogenous vein patch angioplasty in four, expanded polytetrafluoroethylene (ePTFE) bypass grafts (including two with external ring-supported ePTFE) in four, and Palma's procedure in one patient. There was an adequate function in the reconstructed venous segments in two of four who underwent thromboendvenectomy and in all four with ePTFE bypass grafting for nine months to 13 years after surgery. In those with a temporary arteriovenous shunt, prepared to maintain patency of the reconstructed venous segments, blood flow through the shunt exceeded 100 mL/min, determined by an electromagnetic flowmeter. Postoperative shunt closure was readily facilitated, using a looping technique and a 2-0 nylon. The increased blood flow through the graft made feasible by the temporary arteriovenous shunt enhanced the patency of the reconstructed venous graft and hence there was an improvement in the affected limb.
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Affiliation(s)
- K Okadome
- Second Department of Surgery, Kyushu University Faculty of Medicine, Fukuoka, Japan
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Naito Y, Hotta T, Yamamoto H, Iwamoto K, Murakami S, Tomimatu J, Kusaba A, Sakabe H, Nakanishi K, Yoshikawa T. [A case of cloacogenic carcinoma originating from the anal gland and presenting as a rectal submucosal mass]. Nihon Shokakibyo Gakkai Zasshi 1988; 85:281-6. [PMID: 3385966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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