1.A Case of Anastomotic Pseudoaneurysm due to Late Dysruption of Knitted Dacron Graft Treated by Hybrid Operation
Shinya TAKIMOTO ; Takanori TANIGUCHI ; Atsushi IWAKURA ; Kyokun UEHARA ; Manabu MORISHIMA ; Yasue FUJIWARA ; Junpei KOBIKI ; Yosuke SUGITA ; Taku SHIRAKAMI
Japanese Journal of Cardiovascular Surgery 2022;51(5):314-320
Knitted Polyester prosthetic grafts can cause long-term dilatations and formation of anastomotic or non-anastomotic aneurysms, and rupture in result. We experienced a case of anastomotic pseudoaneurysm and recurrent non-anastomotic dilatation of the ascending aorta-abdominal aorta bypass by Cooley Double Velour Knitted Dacron (CDVKD) graft for a patient with atypical coarctation of the aorta (Takayasu Aortitis, type III), which case needed treatment two times over 30 years after the initial operation. The first additional treatment was Thoracic Endovascular Aortic Repair (TEVAR) for non-anastomotic aneurysm was done as 1st operation. Thirty-two years after the initial operation, the second treatment was a hybrid operation consisting of 4 procedures: bilateral axillo-external iliac bypass, taking down of the CDVKD graft at the proximal anastomotic site, endovascular repair (EVAR) with modified Double D Technique, and coil packing at the distal anastomotic site of the CDVKD graft. The patient was discharged at 37-POD. No complication and no endoleak has occurred in the 2.5 years since the operation.
2.Two Cases of Successful Treatment of Percutaneous Transarterial Embolization via Costocervical Trunk Approach for Patients with Persistent Type II Endoleak and Sac Enlargement of Arch Aneurysm after Thoracic Endovascular Aortic Repair (TEVAR)
Shinya TAKIMOTO ; Takanori TANIGUCHI ; Atsushi IWAKURA ; Kyokun UEHARA ; Manabu MORISHIMA ; Yasue FUJIWARA ; Junpei KOBIKI ; Yosuke SUGITA ; Taku SHIRAKAMI
Japanese Journal of Cardiovascular Surgery 2023;52(2):109-113
Among the less reported complications after thoracic endovascular aortic repair (TEVAR) is type II endoleak (T2EL). The intercostal and bronchial artery are known as feeder vessels to T2EL after TEVAR. We experienced two cases of successful treatment of percutaneous transarterial feeder vessels embolization via right costocervical trunk approach for patients with persistent T2EL and sac enlargement of an arch aneurysm after TEVAR. The costocervical trunk route is possible for key vessels to construct a collateral pathway to feeder vessels of the endoleak nidus of T2EL after TEVAR procedures for aortic arch aneurysm. A preembolizational Catheter-Directed CT angiogram (CTA) can be helpful to prevent harmful complications (e.g., spinal cord infarction).
3.External Quality Assessment Survey for Hematological Laboratories in Mongolia
Bayarzaya A ; Bolor A ; Uranbaigali E ; Bayarmaa E ; Uyanga B ; Delgermurun A ; Sumiya D ; Saruultuya D ; Naran G ; Atsushi Shirakami
Health Laboratory 2017;7(2):5-15
Backround:
Hematology departments of health laboratories, over capital city and 21 provinces both of governmental and private sectors in this country, have to take responsibilities for providing hematology analysis. A wide range of technology and methods have been implemented among these laboratories.
Harmonization of the hematology investigations of different laboratories with standard service all over the country is the major goal to reach. We organized the MEQAS (Mongolian External Quality Assessment Scheme) since 2008 on basis the Cooperation agreement between Ministry of Health and Sysmex Corporation in the establishment of Hematology external quality control and reference laboratory system in Mongolia. This is the report of our 8-year experience of MEQAS as the national project, covering increasing numbers of laboratory members. In 2008-2017 years we set up total 18 MEQAS in Mongolia.
Materials and Methods:
Survey Materials
In each survey, the following three different of survey materials were used;
Sample A : Hematology Control Material 1*
Sample B : Hematology Control Material 2*
Sample C : Fresh Whole Blood Sample**
*Hematology Control Material provided by Sysmex Corporation
**Under cooperation of National Center for Transfusiology, a fresh whole blood sample was drawn from a healthy donor and prepared on the same day of sample delivery, according to the procedures reported by Kondo H et. all.
Standard Analyzers
3 units of fully-automated standard analyzers (KX-21, pocH-100i, XS-1000i), installed at the Shastin Central Hospital, were used to assign the target values for the survey materials. These standard analyzers have been calibrated with SCS-1000® before the survey, and monitored with hematology controls, e-CHECK(XS) ® and EIGHTCHECK-3WP® on daily basis.
Instructions & Sample Distribution
On every survey, the workshop was held to give guidance and distribute the survey samples to each participant.
Categorization of Peer Group
Participating data were divided into two peer groups, based on methodology; Group 1: laboratories used automated hematology analyzer (in further Auto’s), Group 2: manually examined group. Each laboratory was given ID number and was asked to analyze these samples 3 times and report the all data and average for CBC 8 parameters.
Statistical Evaluation Method
For individual reports, the results for each participant were evaluated and expressed according to peer group mean and standard deviation index (SDI), Precision index (PI), Absolute evaluation, Scoring system and Target-value evaluation methods (A B C D evaluation).
Results:
The Auto’s inter-lab CV% of WBC for fresh whole blood showed decrease from 6.1 to 4.2 comparing with17th and 18th MEQAS.
The Auto’s Inter-lab CV% of RBC for fresh whole blood showed decrease from 3.7 to 3.4 comparing with 17th and 18th MEQAS.
The Auto’s inter-lab CV% of HGB for fresh whole blood were very stable (2.9%, 3.0%), respectively from 17th to 18th MEQAS.
The Auto’s inter-lab CV% HCT for the fresh whole blood showed go down from 5.5% to 4.8% comparing with 17th and 18th MEQAS.
The Auto’s inter-lab CV% PLT for fresh blood showed go down from 10.2% to 8.2% comparing with 17th and 18th MEQAS.
The Auto’s inter-lab CV% of CBC parameter for fresh blood and control Material (Sample A) showed go down from 1st to 18th MEQAS.
The Auto’s inter-lab CV% of WBC, RBC, HGB, PLT for Control Material (Sample A) were big difference comparing with Japan’s CV%.
Conclusion:
1. The Auto’s inter-lab CV% of WBC, RBC and PLT for fresh whole blood has been decrease respectively 4.2%, 3.4%, 8.2% in the 18th MEQAS and there was difference in the CV% between manufacturers.
2. The Auto’s inter-lab CV% of WBC, RBC, HGB, PLT for Control Material (Sample A) showed go down from 1st to 18th MEQAS but were big difference comparing with Japan’s CV%.
Acknowledgements
We would like to express our appreciation to the Sysmex Corporation (Japan) for providing financial supports investigate this study.