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Differences in flaA gene sequences, swimming motility, and biofilm forming ability between clinical and environmental isolates of Aeromonas species. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:11740-11754. [PMID: 36098923 DOI: 10.1007/s11356-022-22871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
The flagellin A gene (flaA) sequences, swimming motility, and biofilm forming ability were investigated in order to reveal the genetic and functional differences of flagella between clinical and environmental isolates of Aeromonas species. Twenty-eight clinical and 48 environmental strains of Aeromonas species isolated in Okinawa Prefecture of Japan were used in this study. The full-length flaA genes of these strains were sequenced and aligned, and a phylogenetic tree was constructed. In addition, swimming motility and biofilm forming ability were evaluated by conventional methods. Aeromonas veronii biovar sobria and A. hydrophila clearly divided into clinical and environmental strain clusters in the flaA phylogenetic classification, and the six and 13 specific amino acids respectively, of FlaA of both species were different in clinical and environmental strains. Furthermore, the flaA size of the clinical strain of A. veronii bv. sobria was mainly 909, 924, and 939 bp, and the size of A. hydrophila was 909 bp. The swimming motility of clinical isolates of both species was lower than the environmental isolates; however, the biofilm forming ability of the clinical isolates was high. Thus, the clinical isolates of A. veronii bv. sobria and A. hydrophila had different genetic and functional characteristics of flagellin than the environmental isolates. The characteristics of flagellin could serve as indicators to distinguish between clinical and environmental isolates of the both species. It may contribute to diagnosis of these diseases and the monitoring of clinical strain invasion into the natural environment.
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158 Telemedicine and Cleft Care in the UK: Adequacy and Appropriateness. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
The efficacy of teleconsultations for cleft lip/palate (CLP) patients is not established. Accurate speech assessment and intraoral examinations pose unique challenges. This study evaluates the adequacy, benefits, and limitations of video-consultation for CLP patients.
Method
Retrospective analysis of all cleft multidisciplinary team (MDT) clinics on the electronic hospital system, Epic, from 05/2020–03/2021 covering East Anglia, UK. Adequacy of video consultations was based on: difficulties faced during the consultation, conversion to telephone, and whether additional face-to-face appointments were generated. MDT members were surveyed to identify benefits of teleconsultation, and types of appointments deemed most suitable for teleconsultation.
Results
Of 353 cleft MDT clinic appointments, 90% were by video and 10% by telephone; 75% of video consultations were rated as ‘adequate’. 72 additional face-to-face appointments were generated, 38 (53%) of which were due to technical factors such as connectivity. Child (e.g., shyness) and carer (e.g., digital literacy) factors accounted for 8 and 4 cases respectively. Three- and five-year reviews, and those requiring formal speech assessment, generated most additional appointments, followed by surgical reviews requiring intraoral examination. Staff survey revealed reduced travel, flexibility, and regular contact as most frequently reported benefits, concerns were raised over the loss of the ‘human touch’. Overall, respondents agreed that teleconsultation is suitable for select patients, and as a screening tool.
Conclusions
Selective use of teleconsultations that considers patient preference, age, and clinical factors is necessary. Anticipated surgical examination, speech assessment, and younger patients should be scheduled for face-to-face appointments. Technical issues must be addressed as a priority.
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Comparison of species, virulence genes and clones of Aeromonas isolates from clinical specimens and well water in Okinawa Prefecture, Japan. J Appl Microbiol 2021; 131:1515-1530. [PMID: 33570830 DOI: 10.1111/jam.15038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
AIMS To reveal the sources of Aeromonas infection in Okinawa Prefecture of Japan, the species, virulence genes and clones of strains isolated from clinical specimens and well water were compared. METHODS AND RESULTS The properties of both isolates were investigated by sequencing of rpoD, detection of 10 virulence genes using PCR and genotyping with pulsed-field gel electrophoresis. In all, 68 clinical and 146 well water strains of Aeromonas were isolated and the main species were A. caviae, A. dhakensis, A. hydrophila and A. veronii biovar sobria. Aeromonas dhakensis possessed various virulence genes; however, A. caviae possessed only fla. The same or similar clones were distributed in certain areas of Okinawa and one clone had survived several months in the biliary system of two patients, respectively. CONCLUSION Although the same Aeromonas clone was not isolated from clinical and well water samples, our study revealed the detected patterns of virulence genes in both isolates, the distribution of identical/similar clones in the Okinawan environment and long-time survival in patient's organs. SIGNIFICANCE AND IMPACT OF THE STUDY We investigated the association between Aeromonas patients and well water exposure. This study provides the properties of species, virulence genes and clones of Aeromonas isolated from samples of these origins.
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Successful Endovascular Repair of a Kommerell's Diverticulum and a Right-Sided Aortic Arch. Heart Surg Forum 2020; 23:E860-E862. [PMID: 33234198 DOI: 10.1532/hsf.3267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND A 57-year-old woman was diagnosed with Kommerell's diverticulum in the setting of a right aortic arch on computed tomography. CASE REPORT Although asymptomatic, the maximum diameter of the aneurysm was 55 mm; thus, she underwent surgery to prevent rupture of the aneurysm. A bypass was constructed from the left common carotid artery to the left subclavian artery. A stent-graft was deployed from the distal right subclavian artery, and coil embolization of the diverticulum was performed via the left subclavian artery. She was discharged after 12 days of surgery. The postoperative four-month follow up showed a smaller aneurysm. CONCLUSION Thoracic endovascular aortic repair is feasible and effective for Kommerell's diverticulum.
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Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair for Type B Dissection. Heart Surg Forum 2020; 23:E524-E526. [PMID: 32726209 DOI: 10.1532/hsf.3009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND A 64-year-old woman presented with dilatation of the distal aortic arch secondary to chronic type B aortic dissection. CASE REPORT The patient underwent fenestrated thoracic endovascular aortic repair (TEVAR) for closure of the entry site, and reconstruction of the left subclavian artery with a covered stent. On the 40th postoperative day, a retrograde type A aortic dissection (RTAD) was observed on computed tomography and she underwent emergency surgery. The entry tear, related to the proximal bare metal stent, was located in front of the aortic arch. A partial aortic arch replacement was performed. CONCLUSION Consideration of the risk factors of RTAD is important when performing TEVAR.
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A survey of extended-spectrum β-lactamase-producing Enterobacteriaceae in environmental water in Okinawa Prefecture of Japan and relationship with indicator organisms. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:7697-7710. [PMID: 30666574 DOI: 10.1007/s11356-019-04189-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
Abstract
Surveys of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-pE) in stream water and untreated wastewater were carried out in Okinawa Prefecture, Japan. Thirty-six samples of water were collected from 18 streams in Okinawa Prefecture, as well as ten samples of wastewater flowing into four wastewater treatment plants (WWTPs). We investigated bacterial species, Escherichia coli O antigen, ESBL phenotype, ESBL genotype, and pulsed-field gel electrophoresis (PFGE) type of isolates, and total viable count and fecal coliforms as indicator organisms. The relation between indicator organisms and ESBL-pE was also validated using the same samples. A total of 141 ESBL-pE including 107 E. coli, 15 Klebsiella pneumoniae, 2 Proteus mirabilis, and 17 other species was isolated from stream water and wastewater. Of the 141 ESBL-pE, 14.9% and 54.6% were found to be blaCTX-M-15 and blaCTX-M-14-like types, respectively, which have been found in hospital isolates in Okinawa. Two pairs of possibly related patterns according to PFGE criteria were isolated from stream water and wastewater in two districts. When ESBL-pE was significantly isolated, total viable count and fecal coliform boundaries were ≥ 6.0 × 103 CFU/ml and ≥ 4.3 × 102 most probable number/100 ml, respectively. These results suggested that ESBL-pE isolated from stream water is human derived, and that total viable count and fecal coliforms will be useful as indicators for confirming the spread of ESBL-pE to the environment by means of simple hygiene surveys.
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[A Case of Cecum Cancer with Synchronous Adrenal Solitary Metastasis]. Gan To Kagaku Ryoho 2018; 45:2036-2038. [PMID: 30692276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We herein report a case of cecum cancer with synchronous adrenal solitary metastasis. A 62-year-old woman who had been treated for other disease complained of weight loss. Lower endoscopy revealed cecum cancer, and computed tomography( CT)demonstrated a solitary left adrenal tumor; thus, she was diagnosed with a metastatic tumor. We concluded that the patient was a possible candidate for surgical resection because she did not present with local metastasis other than in the adrenal glands. Ileocecal resection and left adrenalectomy were performed. The histological findings indicated moderately differentiated adenocarcinoma, which was compatible with cecum cancer. The patient was administered chemotherapy containing mFOLFOX6, and no recurrence has been detected 4 years after the surgery. Some patients who develop solitary adrenal metastasis from colonic cancer appear to be good candidates for surgery in anticipation of a good prognosis.
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Exploration of immobilization conditions of cellulosic lyotropic liquid crystals in monomeric solvents by in situ polymerization and achievement of dual mechanochromism at room temperature. RSC Adv 2018; 8:24724-24730. [PMID: 35542165 PMCID: PMC9082404 DOI: 10.1039/c8ra04878a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/30/2018] [Indexed: 11/21/2022] Open
Abstract
We investigated conditions to prepare cellulosic cholesteric liquid crystalline (ChLC) films in order to accomplish dual mechanochromism, i.e., colour control and circular dichroic inversion upon mechanical stimulus, at room temperature. Flexible propionylated hydroxypropyl cellulose (PHPC) was prepared by a simple reaction and found to be capable of forming lyotropic ChLC in various monomeric solvents. The ChLC solutions were subjected to in situ polymerization to obtain PHPC/synthetic polymer composite films incorporating the ChLC structure. However, the immobilization behaviour depended on the type of original monomers. Differential scanning calorimetry and solid-state NMR measurement revealed that the ChLC structure was more highly fixed when the compatibility between PHPC and the coexisting polymers was lower. Eventually, thus obtained ChLC composite films exhibited dual mechanochromism under ambient temperature. We obtained cellulosic/synthetic polymer composites incorporating a cholesteric liquid crystalline structure by in situ polymerization and accomplished dual mechanochromism at room temperature.![]()
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Sanitary evaluation of domestic water supply facilities with storage tanks and detection of Aeromonas, enteric and related bacteria in domestic water facilities in Okinawa Prefecture of Japan. WATER RESEARCH 2017; 119:171-177. [PMID: 28458058 DOI: 10.1016/j.watres.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/31/2017] [Accepted: 04/01/2017] [Indexed: 06/07/2023]
Abstract
To provide for temporary restrictions of the public water supply system, storage tanks are commonly installed in the domestic water systems of houses and apartment buildings in Okinawa Prefecture of Japan. To learn more about the sanitary condition and management of these water supply facilities with storage tanks (hereafter called "storage tank water systems") and the extent of bacterial contamination of water from these facilities, we investigated their usage and the existence of Aeromonas, enteric and related bacteria. Verbal interviews concerning the use and management of the storage tank water systems were carried out in each randomly sampled household. A total of 54 water samples were collected for bacteriological and physicochemical examinations. Conventional methods were used for total viable count, fecal coliforms, identification of bacteria such as Aeromonas, Enterobacteriaceae and non-fermentative Gram-negative rods (NF-GNR), and measurement of residual chlorine. On Aeromonas species, tests for putative virulence factor and an identification using 16S rRNA and rpoB genes were also performed. Water from the water storage systems was reported to be consumed directly without boiling in 22 of the 54 houses (40.7%). 31 of the sampled houses had installed water storage tanks of more than 1 cubic meter (m3) per inhabitant, and in 21 of the sampled houses, the tank had never been cleaned. In all samples, the total viable count and fecal coliforms did not exceed quality levels prescribed by Japanese waterworks law. Although the quantity of bacteria detected was not high, 23 NF-GNR, 14 Enterobacteriaceae and 5 Aeromonas were isolated in 42.6%, 7.4% and 3.7% of samples respectively. One isolated A. hydrophila and four A. caviae possessed various putative virulence factors, especially A. hydrophila which had diverse putative pathogenic genes such as aer, hlyA, act, alt, ast, ser, and dam. Many bacteria were isolated when the concentration of residual chlorine was below 0.1 mg/l and the water temperature was above 20 °C. These results suggest that elevated water temperature and mismatch between tank size and water demand lead to loss of residual chlorine in tap water. Therefore, to minimize growth of aquatic bacteria such as Aeromonas spp. and Pseudomonas spp., we recommend that an appropriate size tank and/or volume of stored water is always used, and also suggest installation of some means of reducing water temperature such as shading.
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Aneurysm of an Aberrant Celiac Axis: Revascularization of Hepatic and Splenic Arteries—A Case Report. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449202600310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In a fifty-three-year old Japanese woman, a 3-cm-diameter saccular, calci fied aneurysm was detected beneath the pancreas during surgery for cholelithi asis. She was then referred to the authors' institution, where an aneurysm was detected on the medial wall of an anomalous celiac axis, that is, the hepato splenic trunk as a branch of an anomalous hepatosplenomesenteric trunk. This vascular anomaly was identified as type III in Adachi's classification of the structural variation of the celiac axis. The aneurysm was resected, and revascu larization of the hepatic and splenic arteries was successful following insertion of an autogenous vein graft.
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Abstract
A 63-year old man presented with back pain and abdominal pain that worsened after eating. Contrast-enhanced computed tomography revealed type B aortic dissection. Arteriography 20 days after dissection revealed celiac trunk stenosis and the superior mesenteric artery did not arise from the true lumen. Saphenous vein bypass grafting from the right common iliac artery to the superior mesenteric and gastroduodenal arteries was performed. The postoperative course was uneventful and the abdominal symptoms completely disappeared.
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Current status of extended spectrum β-lactamase-producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis in Okinawa prefecture, Japan. J Infect Chemother 2016; 22:281-6. [DOI: 10.1016/j.jiac.2016.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 11/25/2022]
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Distribution of Aeromonas species in environmental water used in daily life in Okinawa Prefecture, Japan. Environ Health Prev Med 2016; 21:287-294. [PMID: 27075357 DOI: 10.1007/s12199-016-0528-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/21/2016] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The genus Aeromonas is known to causes diseases such as food poisoning, sepsis, and wound infection. However, the mode of Aeromonas transmission from environment to humans is not clearly understood. To evaluate the health risks of Aeromonas spp. in environmental freshwater, the number, proportion and putative virulence factors of Aeromonas species were investigated in Okinawa Prefecture, Japan. METHODS Environmental freshwater samples were collected from three dams, two springs and three private wells. Aeromonas strains were identified by the biochemical method and the viable count was calculated. The production of extracellular enzymes and the virulence genes were investigated for possessing putative virulence factors using representative isolates. RESULTS At least seven species of already-known Aeromonas isolates as well as unidentified Aeromonas spp. with/without arginin dehydrolase (ADH) exist in water at these sites. Aeromonas spp. was found to exist at over 1000 CFU/100 ml in one spring and two wells. A. veronii biovar sobria and A. jandaei were the predominant species in dams, and A. hydrophila and/or A. eucrenophila were predominant in wells. Almost all the sampled Aeromonas species produced protease, gelatinase, lipase, esterase and DNase, but A. caviae, A. caviae-like bacteria, and A. eucrenophila had low hemolytic activity. Most sampled A. hydrophila strains possessed both aerolysin gene (aer) and hemolysin gene (hlyA), but A. caviae and A. eucrenophila strains did not possess either gene. CONCLUSIONS Since these results indicated that several Aeromonas species having potential pathogenicity exist in environmental water in Okinawa, surveys are recommended as a public health measure.
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Use of a modified early warning score system to reduce the rate of in-hospital cardiac arrest. J Intensive Care 2016; 4:12. [PMID: 26865981 PMCID: PMC4748572 DOI: 10.1186/s40560-016-0134-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022] Open
Abstract
Background Physiological abnormalities are often observed in patients prior to cardiac arrest. A modified early warning score (MEWS) system was introduced, which aims to detect early abnormalities by grading vital signs, and the present study investigated its usefulness. Methods Based on previous reports, the Chubu Tokushukai Hospital-customized MEWS was developed in Okinawa, Japan. The MEWS was calculated among all inpatients, and the rates of in-hospital cardiac arrests (IHCAs) were compared according to the score. The warning zone (WZ) was set as 7 or more because of the high possibility of acute deterioration. The MEWS system was introduced to provide immediate interventions for patients who reached the WZ in accordance with the callout algorithm. The numbers of IHCAs were compared between the 18 months before and after introduction of the MEWS system. Results The numbers of patients who experienced IHCA with each score were as follows: score of 6, 1 of 556 patients (0.18 %); score of 7, 4 of 289 (1.40 %); score of 8, 2 of 114 (1.75 %); and score of 9 or more, 2 of 56 (3.57 %). There was no significant difference in the mean age or sex between before and after the introduction of the MEWS system. The rate of IHCAs per 1000 admissions decreased significantly from 5.21 (79/15,170) to 2.05 (43/17,961) (p < 0.01). Conclusions The Chubu Tokushukai Hospital-customized MEWS was applied to all inpatients, and the rate of IHCA decreased owing to the introduction of the system, as the system enables early interventions for patients who have the possibility of acute deterioration.
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1579 Efficacy and safety of olanzapine combined with aprepitant, palonosetron, and dexamethasone for preventing nausea and vomiting induced by cisplatin-based chemotherapy in gynecological cancer: Comparison of two prospective phase II trials. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Novel use of LigaSure Impact™ electrosurgical bipolar vessel sealing system in skin-sparing mastectomy. J Plast Reconstr Aesthet Surg 2015; 68:e126-8. [DOI: 10.1016/j.bjps.2015.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/11/2015] [Accepted: 01/18/2015] [Indexed: 11/30/2022]
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P232 Clinical study on imported malaria cases in Okinawa islands, Japan. Int J Antimicrob Agents 2013. [DOI: 10.1016/s0924-8579(13)70473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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FRI0104 Cohort study of infectious disease risk management in RA patients receiving tocilizumab at 48 weeks (ACT4U-study48). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P289 Influenza epidemics in a subtropical region of Japan during 2007–2012: Impact of the pandemic 2009. Int J Antimicrob Agents 2013. [DOI: 10.1016/s0924-8579(13)70530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Intensity Modulated Radiation Therapy Using Simultaneous Integrated Boost for Hypopharyngeal Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Impact of Overall Treatment Time on Local Control After Stereotactic Body Radiation Therapy for Lung Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nonsurgical treatment of scalp arteriovenous malformation using a combination of ultrasound-guided thrombin injection and transarterial coil embolization. J Vasc Surg 2012; 55:833-6. [DOI: 10.1016/j.jvs.2011.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 11/25/2022]
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The unwritten price of cosmetic tourism: an observational study and cost analysis. J Plast Reconstr Aesthet Surg 2011; 65:22-8. [PMID: 21865103 DOI: 10.1016/j.bjps.2011.07.027] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 07/03/2011] [Accepted: 07/22/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND AIMS Cosmetic tourism, driven by the promise of inexpensive operations abroad, is increasingly popular despite warnings from professional bodies regarding associated risks. Increasing numbers of individuals have presented to our department requesting NHS treatment of complications from such surgery. We set out to characterize these patients and evaluate costs incurred through their assessment and management. MATERIAL AND METHODS An observational study was conducted from 2007 to 2009 on patients presenting to a tertiary referral Plastic Surgery practice with complications of cosmetic tourism surgery. Demographic characteristics, as well as those related to the operation, were recorded. Hospital patient flow pathways were constructed, cost analysis performed using Patient Level Costing, and expenditure and profitability calculated. KEY RESULTS Nineteen patients presented within the study period. Most operations were performed in Europe or Asia, and were primarily breast augmentation procedures (n=13). The principal complications were wound infection or dehiscence, and poor cosmetic results. Eleven patients received NHS treatment, at a cost of £120,841. The mean cost for all patients' management was £6360 (range: £114-£57,968), rising to £10,878 for those accepted for treatment. For 8 of the 9 patients (89%) for whom full patient level costing was available, the hospital incurred a financial loss. CONCLUSION The costs to the NHS of managing complications of cosmetic tourism are substantial, and underestimated by central funding agencies.
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818 poster AN INVESTIGATION OF SEQUENTIAL BOOST IMRT VERSUS SIB IMRT FOR HEAD AND NECK CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Patterns of Failure in Patients with Clinical Stage IA Thoracic Esophageal Cancer treated with Definitive Radiotherapy Using Localized Field. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Interfractional Variations of Lung Tumor in the Stereotactic Body Radiotherapy with Cine EPID at Treatment. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Radiotherapy for the Second Lung Mass after Surgical Resection of the First Lung Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Quantitative evaluation of blood flow distribution to exercising and resting skeletal muscles in patients with cardiac dysfunction using whole-body thallium-201 scintigraphy. Clin Cardiol 2009; 20:785-90. [PMID: 9294671 PMCID: PMC6656281 DOI: 10.1002/clc.4960200914] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS Decreased blood flow to working muscles makes an important contribution to exercise intolerance in patients with chronic heart failure. This study was undertaken to examine whether maldistribution of skeletal muscle blood flow is closely related to exercise intolerance in patients with cardiac dysfunction. METHODS Whole-body thallium scintigraphy was performed during one-leg exercise in 11 patients with left ventricular (LV) dysfunction (LV ejection fraction < 45%). Blood flow distribution to the exercising and resting legs was quantified by expressing regional thallium counts as a percentage of the whole-body counts at rest, at the level of anaerobic threshold, and at peak exercise. RESULTS At anaerobic threshold, the thallium activity of exercising muscle increased from 4.2 +/- 0.7 to 14.0 +/- 2.5% (p < 0.05) in the thigh and from 1.7 +/- 0.3 to 4.1 +/- 0.9% (p < 0.05) in the calf, compared with the resting value. Consequently, the ratio of thallium activity between exercising and resting legs increased to 2.7 +/- 0.7 (p < 0.05) in the thigh and to 2.3 +/- 0.7 (p < 0.05) in the calf. When plotted as a function of anaerobic threshold, thallium activity of the exercising thigh (r = 0.78, p < 0.05) and the thallium ratio between exercising and resting thigh (r = 0.69, p < 0.05) declined with the reduction of exercise tolerance. These correlations were not observed in calves. CONCLUSION Whole-body thallium scintigraphy demonstrated a maldistribution of leg blood flow in patients with reduced aerobic exercise capacity, suggesting that this abnormality could play an important role in exercising intolerance in these patients.
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International Study of Wheezing in Infants (EISL): validation of written questionnaire for children aged below 3 years. J Investig Allergol Clin Immunol 2009; 19:35-42. [PMID: 19274927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The multicenter International Study of Wheezing in Infants (EISL) was developed to study the prevalence of recurrent wheezing and related risk factors in infants during the first year of life using a written questionnaire (EISL-WQ). OBJECTIVES To constructively validate a modified, shortened version of the EISL-WQ in children up to 36 months of age in São Paulo, Brazil, and to verify its usefulness in diagnosing probable asthma in these children. METHODS The parents of 170 infants aged 12 to 36 months answered the shortened EISL-WQ in an emergency room and were asked if their child was currently wheezing before a diagnosis was made by a physician. The consistency between parent perception and the physician's diagnosis was then evaluated. A second group (n = 55) participated in the validation of the short-term repeatability of the shortened questionnaire by completing it twice (mean interval, 23 days). RESULTS There was good agreement between parent perception of wheezing and the physician's diagnosis following auscultation (Kappa statistic = 0.7; odds ratio = 38.33; 95% confidence interval, 15.8 to 92.8; P < .001); sensitivity (82.8%), specificity (85.0%), positive predictive value (81.5%), and negative predictive value (86.0%) were all high.The short-term repeatability of the shortened version of the EISL-WQ was also high (kappa > 0.75). Questions added to the shortened EISL-WQ improved the internal consistency of the original questionnaire (Cronbach alpha = 0.823, P < .001) and a high Youden index was found for patients defined as probable asthmatics. CONCLUSIONS The shortened version of the EISL-WQ translated into Portuguese has high internal consistency, and is a valid, reliable, and reproducible instrument for obtaining data on wheezing in children below 36 months of age and for identifying those with probable asthma.
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EFFECT OF MIGLITOL ON POSTPRANDIAL GLUCOSE AND LIPID METABOLISM IN TYPE 2 DIABETIC PATIENTS. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70840-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cardioprotective effects of tetrahydrobiopterin in cold heart preservation after cardiac arrest. Ann Thorac Cardiovasc Surg 2006; 12:95-104. [PMID: 16702930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND It has recently been shown that tetrahydrobiopterin (BH4), an essential cofactor of nitric oxide synthase (NOS), reduces ischemia-reperfusion myocardial injury. The aim of this study was to determine if supplementation with BH4 after cardiac arrest followed by cold heart preservation would exert a cardioprotective effect against ischemia-reperfusion injury. MATERIALS AND METHODS Isolated perfused rat hearts were subjected to 4 degrees C cold ischemia and reperfusion. Hearts were treated with cold cardioplegic solution with or without BH4 just before ischemia and during the first 5 min of reperfusion period. Effects of BH4 on left ventricular function, myocardial contents of high-energy phosphates, and nitrite plus nitrate were measured in the perfusate, before ischemia and after reperfusion. Moreover, the effect of BH4 on the cold-heart preservation followed by normothermic (37 degrees C) ischemia was determined. RESULTS BH4 improved the contractile and metabolic abnormalities in reperfused cold preserved hearts that were subjected to normothermic ischemia. Furthermore, BH4 significantly alleviated ischemic contracture during ischemia, and restored the diminished perfusate levels of nitrite plus nitrate after reperfusion. CONCLUSION These results demonstrated that BH4 reduces ischemia-reperfusion injury in cold heart preservation. The cardioprotective effect of BH4 implies that BH4 could be a novel and effective therapeutic option in the preservation treatment of donor heart after cardiac arrest.
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Abstract
Nine cases of mycotic thoracic aortic aneurysm were treated surgically between July 1995 and March 2003. The aneurysms were located in the ascending aorta in 1 patient, the descending thoracic aorta in 5, and the thoracoabdominal aorta in 3. Preoperatively, 3 patients were in shock due to rupture of the aneurysm. All patients underwent aneurysmectomy and in-situ graft placement. In 5 patients, the graft was covered with a pedicled omental flap to prevent postoperative graft infection. There were 2 hospital deaths: one patient died of multi-organ failure, and the other died from intrathoracic bleeding. After discharge, one patient died from intrathoracic bleeding 3 months after surgery. These 3 patients had not received omental wrapping. Postoperative graft infection did not occur in the 6 surviving patients during a mean follow-up period of 4.0 +/- 3.1 years. It was concluded that covering the prosthetic graft with a pedicled omental flap may help prevent postoperative graft infection and improve the surgical results.
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CpG oligodeoxynucleotides promote the host protective response against infection with Cryptococcus neoformans through induction of interferon-gamma production by CD4+ T cells. Clin Exp Immunol 2005; 140:220-9. [PMID: 15807845 PMCID: PMC1809361 DOI: 10.1111/j.1365-2249.2005.02772.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In the present study, we elucidated the effect of synthetic CpG-containing oligodeoxynucleotides (ODN) on pulmonary and disseminated infection caused by Cryptococcus neoformans. CDF-1 mice were inoculated intratracheally with a highly virulent strain of this pathogen, which resulted in massive bacterial growth in the lung, dissemination to the brain and death. Administration of CpG-ODN promoted the clearance of C. neoformans in the lungs, decreased their dissemination to brain and prolonged the survival of infected mice. These effects correlated well with the enhanced production of interleukin (IL)-12 and interferon (IFN)-gamma and attenuated secretion of IL-4 in bronchoalveolar lavage fluids (BALF) and promoted development of Th1 cells, as indicated by the increased production of IFN-gamma by paratracheal lymph node cells upon restimulation with cryptococcal antigens. The IFN-gamma synthesis in BALF was inhibited by depletion of CD8(+) and CD4(+) T cells on days 7 and 14 after infection, respectively, but not by depletion of NK and gammadelta T cells. Consistent with these data, intracellular expression of IFN-gamma was detected predominantly in CD8(+) and CD4(+) T cells in the lung on days 7 and 14, respectively. The protective effect of CpG-ODN, as shown by the prolonged survival, was completely and partially inhibited by depletion of CD4(+) or CD8(+) T cells, respectively, but not by depletion of other cells. Finally, TNF-alpha was markedly induced by CpG-ODN, and the protective effect of this agent was strongly inhibited by neutralizing anti-TNF-alpha MoAb. Our results indicate that CpG-ODN alters the Th1-Th2 cytokine balance and promotes host resistance against infection with C. neoformans.
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Lower expression of Th1-related cytokines and inducible nitric oxide synthase in mice with streptozotocin-induced diabetes mellitus infected with Mycobacterium tuberculosis. Clin Exp Immunol 2005; 139:57-64. [PMID: 15606614 PMCID: PMC1809276 DOI: 10.1111/j.1365-2249.2005.02677.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Diabetes mellitus is an important predisposing factor for tuberculosis. The aim of this study was to investigate the mechanism underlying this association using a murine model. Mice with streptozotocin-induced diabetes mellitus were prone to Mycobacterium tuberculosis infection, as indicated by increased numbers of live bacteria in lung, liver and spleen. In diabetic mice, the levels of IL-12 and IFN-gamma in the lung, liver and spleen were lower than those in control animals on day 14 postinfection, while the opposite was true for IL-4 levels in the lung and liver. The expression pattern of inducible nitric oxide synthase (iNOS), in the two mice types was as for IL-12 and IFN-gamma. In addition, peritoneal exudate cells obtained from diabetic mice produced lower amounts of IL-12 and NO than those from control mice, when stimulated in vitro with M. bovis BCG. Spleen cells from diabetic mice infected with M. tuberculosis produced a significantly lower amount of IFN-gamma upon restimulation with purified protein derivatives (PPD) than those from infected nondiabetic mice. Interestingly, addition of high glucose levels (33 mM) to the cultures of PPD-restimulated spleen cells reduced the synthesis of IFN-gamma only in diabetic mice, and not in nondiabetic mice. Finally, control of blood glucose levels by insulin therapy resulted in improvement of the impaired host protection and Th1-related cytokine synthesis. Our results suggest that the reduced production of Th1-related cytokines and NO account for the hampered host defense against M. tuberculosis infection under diabetic conditions.
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Improvement of Liver Function After Surgery for Budd-Chiari Syndrome. Surg Today 2005; 35:122-5. [PMID: 15674492 DOI: 10.1007/s00595-004-2884-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Accepted: 05/18/2004] [Indexed: 11/30/2022]
Abstract
PURPOSE We evaluated the relationship between liver histology and postoperative improvement of liver function after surgery for Budd-Chiari syndrome (BCS). METHODS Over a period of 23 years, we operated on 46 patients with BCS by reconstructing the occluded inferior vena cava (IVC) and reopening as many occluded hepatic veins as possible. We divided the patients into a liver cirrhosis group (group I, n = 30) and a hepatic fibrosis or liver congestion group (group II, n = 16), and compared the ages, duration of illness, preoperative liver function, changes in liver function, and changes in esophageal varices (EV). RESULTS There were no hospital deaths. In group I the patients were older, and the duration of illness was longer. The group I patients also had a lower thrombotest percentage and a higher serum ammonia. The indocyanine green clearance (ICG) test showed more remarkable improvement in liver function in group II. The rate of disappearance of EV was also higher in group II. CONCLUSION Surgery during the early stage of BCS is important in improving postoperative liver function.
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Malignant Fibrous Histiocytoma of the Heart Complicated By Factor XI Deficiency in a Jehovah's Witness Patient. Ann Thorac Surg 2005; 79:351-3. [PMID: 15620983 DOI: 10.1016/j.athoracsur.2003.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2003] [Indexed: 11/24/2022]
Abstract
We describe a 16-year-old girl with malignant fibrous histiocytoma (MFH) of the heart complicated by factor XI deficiency. The preoperative diagnosis was left atrial myxoma. We decided to perform the operation owing to a normal bleeding time. Operative findings suggested a malignant tumor. The patient was a Jehovah's Witness, and extensive excision was not performed because blood transfusion was not allowed. We resected as much of the tumor and left atrial appendage as possible. The pathologic diagnosis was MFH. Excessive bleeding was not observed during the operation. Bleeding time helps to determine whether a surgical procedure is indicated in patients with factor XI deficiency.
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The prevention of nerve injury in aortic arch aneurysmal surgery. Asian Cardiovasc Thorac Ann 2004; 12:374-5. [PMID: 15585714 DOI: 10.1177/021849230401200422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a case of aortic arch aneurysm associated with adhesion to the surrounding structures, we devised an operative technique to avoid nerve injury during the surgical procedure. By preserving the adventitial layer of the aortic arch aneurysm to which the phrenic and recurrent nerves were attached, injury to the nerves was avoided, and the aneurysmectomy was completed with the distal anastomosis being performed intraluminally.
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Selective visceral perfusion during thoracoabdominal aortic aneurysm repair. Ann Thorac Cardiovasc Surg 2004; 10:367-72. [PMID: 15658910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of selective visceral perfusion during repair of an thoracoabdominal aortic aneurysm (TAAA), we compared the postoperative renal and hepatic functions (blood urea nitrogen, serum creatinine, total bilirubin, glutamate pyruvate transaminase) between the two groups with and without perfusion. PATIENTS AND METHODS We operated on 52 patients with TAAA. Among them, the visceral vessels were reconstructed in 22 patients with selective visceral perfusion and in 12 patients without perfusion. The average selective perfusion time was 49.5+/-25.5 min. in the celiac and superior mesenteric arteries and 32.8+/-18.8 min. in the renal arteries. The average perfusion flow rate per each visceral vessel was 155.4+/-97.4 ml/min. RESULTS There were five hospital deaths. There was no significant difference between the groups in the postoperative value of four factors. The selective perfusion time for vessel reconstruction in the selective visceral perfusion group was significantly longer than the arterial clamp time for vessel reconstruction in the non-perfusion group (49.5+/-25.5 min. vs. 25.6+/-13.4 min.). CONCLUSION Our selective visceral perfusion method is not only beneficial for organ protection, but also provides us with the necessary time to reimplant the visceral as well as intercostal or lumbar arteries.
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Huge IgD plasmacytoma in the abdomen presenting coagulation necrosis. J Int Med Res 2004; 32:552-7. [PMID: 15458289 DOI: 10.1177/147323000403200514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 65-year-old Japanese woman was diagnosed in 1996 with a pathological fracture of the left femur caused by immunoglobulin D-type myeloma (IgD myeloma). She responded well to combination chemotherapy followed by irradiation. The patient experienced renal failure and became dependent on haemodialysis. In 1999, large plasmacytomas developed in the abdomen and left humerus. The abdominal tumour appeared to induce gastroduodenal ulcers and jejunal obstruction. We initiated irradiation therapy without chemotherapy to prevent further growth of the plasmacytoma, although treatment-resistant gastroduodenal ulcers developed. Continued blood loss from the gastroduodenal ulcers resulted in a deterioration in the patient's health, which prevented successful haemodialysis. An autopsy showed that the plasmacytoma had undergone coagulation necrosis. We conclude that the use of combination chemotherapy with topical irradiation was an acceptable treatment measure against IgD plasmacytoma; irradiation without chemotherapy was the most likely cause of the coagulation necrosis seen in the plasmacytoma at autopsy.
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A calcified caecal mass. Gut 2004; 53:1063, 1081. [PMID: 15247166 PMCID: PMC1774155 DOI: 10.1136/gut.2003.034009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Diaphragmatic plication in adult patients with diaphragm paralysis after cardiac surgery. Ann Thorac Cardiovasc Surg 2004; 10:160-6. [PMID: 15312011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE We investigated the benefit of diaphragmatic plication for weaning from mechanical ventilation in these adult patients. PATIENTS AND METHODS Four patients underwent diaphragmatic plication for difficulty of weaning from mechanical ventilation due to diaphragmatic paralysis. They were all men with an average age of 70.5 +/- 6.3 years. Three of the patients had undergone cardiac surgeries for coronary artery bypass grafting and one patient ascending aortic replacement for pseudoaneurysm after coronary revascularization. Right diaphragmatic plication (muscle sparing procedure) was performed between 30 to 61 days after cardiac surgery. RESULTS The mean forced tidal volume improved dramatically from 216 to 415 ml after plication in all patients, and it was possible to discontinue mechanical ventilation from 2 to 12 days after plication. One patient with obstructive respiratory dysfunction died from aspiration pneumonia 15 days after plication. However, postoperative tidal volume in this patient improved to 420 ml and he was able to be weaned from ventilatory support five days after plication. The other three patients were discharged between 26 to 58 days after plication and continue to do well without symptoms. CONCLUSION Diaphragmatic plication is a useful procedure for treatment of diaphragmatic paralysis in adults as well in children.
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Direct cannulation of the common carotid artery during the ascending aortic or aortic arch replacement. ACTA ACUST UNITED AC 2004; 52:247-53. [PMID: 15195747 DOI: 10.1007/s11748-004-0118-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate cerebral perfusion using direct cannulation into the common carotid artery. A new technique is needed to protect brain ischemic injury during ascending aortic or aortic arch replacement. METHODS This technique was evaluated for patients who would have difficulty maintaining adequate cerebral perfusion during surgery. The procedure was performed when patients had the following diagnoses: pseudoaneurysm formation in contact with the sternum with the risk of aneurysmal rupture (n = 5), acute aortic dissection with compression of the true lumen of the innominate artery by the pseudolumen (n = 3), or a large volume of thrombus in the lumen of the aneurysm with the risk of cerebral thromboembolism if standard extracorporeal circulation was used (n = 2). The perfusion catheter was cannulated into one side of the common carotid artery (right side: n = 6, left side: n = 4) and mean perfusion flow rate was found to be 175 mL/min. The operative procedures consisted of ascending aortic and aortic arch replacement with coronary artery bypass grafting in six patients, ascending aortic replacement in 2 patients, and innominate artery reconstruction/innominate artery and right subclavian artery reconstruction in one patient. RESULTS No cerebral accidents or deaths occurred while patients were hospitalized. We have followed up patients for a mean of 2.1 years (maximum 3.6 years), with no complications noted from the surgical procedure. CONCLUSIONS Direct cannulation of the common carotid artery is a simple, safe, and acceptable cerebral protection for patients undergoing aortic or aortic arch replacement procedures in the patients with these specific conditions.
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[Spinal cord protection during thoracoabdominal aortic aneurysm repair; efficacy of distal aortic perfusion and segmental aortic clamping]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2004; 57:268-73. [PMID: 15071858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Despite improvement in adjuncts for thoracoabdominal aortic aneurysms (TAAA) repairs, many devastating complications remains after the surgery. Our experience with these aneurysms has been reviewed in order to identify those methods at risk of major morbidity, as well as which further improvements required. During last 16 years, 53 consecutive patients were operated on TAAA. The mean age was 58 years. Twenty patients had dissecting aneurysms and 13 patients had had prior aortic surgery. A femoro-femoral bypass was used to maintain distal aortic perfusion in most patients. Reimplantation of intercostal or lumbar arteries under the multi-segmental aortic clamping is consistent in our technique. Motor evoked potentials (MEP) were measured to monitor spinal cord protection since 2000. The hospital mortality was 9.4% (5/53), 22.2% (2/9) for emergency operation and 15.4% (2/13) for patients with prior aortic surgery. The mortality for the first and elective operations was 3.2% (1/31). No any neurologic dysfunction was observed in all patients including the hospital deaths. In view of clinical results, our adjuncts and techniques are useful for prevention of spinal cord ischemia during the TAAA surgery.
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Pannus formation in aortic valve prostheses in the late postoperative period. J Artif Organs 2004; 6:179-82. [PMID: 14598101 DOI: 10.1007/s10047-003-0226-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2003] [Accepted: 06/12/2003] [Indexed: 10/26/2022]
Abstract
We present three patients who underwent repeat aortic valve replacement for prosthetic valve dysfunction caused by tissue ingrowth in the late postoperative period. These patients (three women aged 48-51 years, mean 49.3 +/- 1.53 years) underwent operations for restriction of prosthetic valve leaflet movement by pannus in the left ventricular outflow tract. The interval from the previous operation ranged from 8.0 to 9.6 years (mean 9.6 +/- 2.0 years). The symptoms of the patients were New York Heart Association functional class I, II, and IV in one patient each. Diagnosis was made by cinefluoroscopy in two patients and aortography in one patient. The operative procedures consisted of aortic valve replacement ( n = 1) and aortic valve replacement with mitral valve replacement ( n = 2). Pannus was found at the left ventricular aspect of the prosthetic valve in all patients. In two patients, the pannus directly restricted movement of the leaflet and also severely narrowed the inflow orifice of the prosthetic valve. In the other patient, the pannus had grown at a distance of 7 mm from the valve and narrowed the left ventricular outflow tract circularly. The postoperative course was uneventful and all three patients were discharged in a good condition. One patient died of pneumonia 8 months after surgery and the other two patients have remained well and have been followed up for one and a half years. In conclusion, there may be a discrepancy between the clinical symptoms and the grade of subvalvular stenosis caused by pannus. Therefore, it is essential for satisfactory operative results that early diagnosis be made by various means.
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Two cases of ventricular tachycardia with congenital left ventricular malformation in an adult. Ann Thorac Cardiovasc Surg 2004; 10:42-6. [PMID: 15008699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Two patients without any risk factors for coronary artery disease presented with symptomatic, recurrent, nonsustained ventricular tachycardia. They were found to have a postero-lateral left ventricular aneurysm and diverticulum. Coronary angiography revealed normal coronary arteries. The 12-lead electrocardiogram showed sinus rhythm with frequent premature ventricular contractions. Their nonsustained ventricular tachycardias were reproduced by programmed electrical stimulation and was unresponsive to procainamide, mexiletine, and disopyramide. Aneurysmal resection and cryoablative surgery were performed. The pathological examination of the aneurysmal wall revealed focal defect of muscle fibers in case 1. On the other hand, the wall of case 2 was formed by all three cardiac layers. After surgery, ventricular programmed stimulation was negative, and premature ventricular contraction had disappeared.
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Off-pump redo coronary artery bypass grafting via left thoracotomy. Ann Thorac Cardiovasc Surg 2003; 9:378-83. [PMID: 15003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE We evaluated the usefulness of off-pump coronary artery bypass grafting (CABG) via left thoracotomy (LT) in redo coronary revascularization. METHODS Over the past 23 years, 21 patients (2.3%) underwent redo coronary revascularization in our hospital. The period between the first and the redo surgeries was 9.1+/-4.4 years. They were divided into two groups according to the method of surgical approach in the redo CABG: re-median sternotomy group (RMS group, n=12) and LT group (n=9). RESULTS In the RMS group, five of 12 patients suffered prolonged postoperative respiratory failure with ventilatory support, and the RMS patients stayed in the hospital for a significantly longer period of time than the LT patients. Four patients (19.0%, 4/21), who were all in the RMS group, died during the hospitalization. In the LT group, there were no hospital deaths and no cases of respiratory failure. CONCLUSION Redo CABG via LT provided acceptable and satisfactory surgical results. As it is expected that the number of emergency reoperative surgical cases will increase, the LT approach may be useful for rapid exposure of the target coronary artery without causing significant myocardial damage.
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A rare case of dermatomyositis associated with immune-complex type glomerulonephritis, idiopathic thrombopenic purpura, pulmonary fibrosis and lung cancer. Clin Exp Rheumatol 2003; 21:801-2. [PMID: 14740466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
MESH Headings
- Autopsy
- Biopsy, Needle
- Carcinoma, Squamous Cell/complications
- Carcinoma, Squamous Cell/pathology
- Dermatomyositis/complications
- Dermatomyositis/pathology
- Dermatomyositis/therapy
- Disease Progression
- Fatal Outcome
- Glomerulonephritis, IGA/complications
- Glomerulonephritis, IGA/pathology
- Glomerulonephritis, IGA/therapy
- Humans
- Immunohistochemistry
- Lung Neoplasms/complications
- Lung Neoplasms/pathology
- Male
- Middle Aged
- Pulmonary Fibrosis/complications
- Pulmonary Fibrosis/pathology
- Pulmonary Fibrosis/therapy
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/pathology
- Purpura, Thrombocytopenic, Idiopathic/therapy
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Prevention of postoperative paraplegia during thoracoabdominal aortic surgery1This article has been selected for the open discussion forum on the CTSNet Web site: http://www.ctsnet.org/discuss1. Ann Thorac Surg 2003; 76:1477-84. [PMID: 14602271 DOI: 10.1016/s0003-4975(03)00871-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We present data showing the impact of sequential multisegmental aortic clamping accompanied by reimplantation of as many segmental arteries as possible on the prevention of postoperative paraplegia or paraparesis during thoracoabdominal aortic graft replacement. METHODS Since 1987 we have performed graft replacements in 51 individuals undergoing thoracoabdominal aortic surgery using the technique of normothermic partial bypass with sequential multisegmental aortic clamping. The procedure was performed emergently in 10 patients and electively in 41 patients. The patients ranged in age from 22 to 82 years (mean, 57.6 +/- 13.8 years). Indications for surgery included dissecting thoracoabdominal aortic aneurysm (n = 19) and nondissecting thoracoabdominal aortic aneurysm (n = 32). The extent of aneurysm was Crawford type I in 19 patients, type II in 7 patients, type III in 12 patients, and type IV in 13 patients. Along the entire extent of aneurysm to be replaced, we reimplanted as many of the patent segmental arteries as feasible. RESULTS Five patients died during hospitalization, for an in-hospital mortality rate of 9.8%. The number of aortic clampings per patient ranged from one to five (median, three). A total of 124 segmental arteries were reimplanted in 44 (86.3%) of 51 patients. Of the 124 arteries, 90 (72.6%) were distributed between T9 and L2. Postoperative paraplegia or paraparesis did not develop in any of the patients. CONCLUSIONS Our results demonstrate that extensive reimplantation of segmental arteries using sequential multisegmental aortic clamping, accompanied by adequate intraoperative distal aortic perfusion, is effective in preventing spinal cord ischemia.
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