1.An 84-year-old Case of Abdominal Aortic Aneurysm with Three-vessel Coronary Artery Disease.
Hiroaki Nozawa ; Hiroshi Shigematsu ; Ichihiro Kobayashi ; Tetsuichiro Muto ; Keita Tanaka ; Yutaka Kozuka ; Akira Furuse ; Takeshi Serizawa
Japanese Journal of Cardiovascular Surgery 1996;25(1):46-49
An 80-year-old male patient had complained of left abdominal pain since 1990, and an abdominal aortic aneurysm (AAA) 5.3cm in diameter was diagnosed by computed tomography (CT). The patient was NYHA class III with complaints of chest pain during exercise. Coronary arteriography showed that he had three-vessel disease. At that time, aneurysmectomy was not anticipated due to his age and because the AAA showed no tendency to enlarge. However, in October 1993, CT showed that the AAA rapidly enlarged to 6.8cm in diameter. Due to the greater risk of rupture of the AAA, aneurysmectomy was considered necessary. The operative mortality associated with aneurysmectomy in patients with coronary artery disease (CAD) is higher than that in patients without CAD. Therefore, coronary artery bypass grafting (CABG) was indicated prior to aneurysmectomy. The patient underwent CABG (two vessels) in December 1993, and aneurysmectomy was successfully performed in February 1994. He was discharged uneventfully 17 days after the operation.
2.A Case of Subtotal Gastrectomy for Gastric Cancer and Cholecystectomy with Preservation of the Right Gastroepiploic Artery Graft Used for Coronary Artery Bypass Grafting.
Keita Tanaka ; Takeshi Miyairi ; Jun Matsumoto ; Tomohiro Murakawa ; Akira Mizuno ; Hirofumi Saitoh
Japanese Journal of Cardiovascular Surgery 1996;25(4):264-267
A 69-year-old man, who had undergone coronary artery bypass grafting using the right gastroepiploic artery 2 years previously, was hospitalized with acute epigastralgia. Gastroscopy showed an early gastric cancer in the greater curvature of the corpus and ultrasonography of the abdomen revealed acute cholecystitis due to a stone impacted in the cystic duct. The subtotal gastrectomy and the cholecystectomy with preservation of the right gastroepiploic artery graft were performed. The surgical margin of the resected specimen was negative for cancer. The postoperative course was uneventful. After coronary artery bypass grafting using the right gastroepiploic artery, annual gastroscopy is recommended.
3.The Role of Macrophages in Saphenous Vein Graft Disease.
Toshiya Kobayashi ; Haruo Makuuchi ; Yoshihiro Naruse ; Masahiro Goto ; Keita Tanaka ; Yasuo Arimura ; Masatake Katsu
Japanese Journal of Cardiovascular Surgery 2000;29(5):295-298
This study was designed to assess the role of macrophages in saphenous vein graft disease after coronary artery bypass grafting (CABG). Three newly harvested saphenous vein grafts (SVGs) and 6 SVGs removed from patients 8 to 15 years after CABG (3 were occluded soon after the operation and 3 became diseased after a long period) were immunostained for macrophages and investigated microscopically. No macrophages were detected in the newly harvested SVGs. In the grafts with early occlusion, macrophages were detected only in the superficial layer of the intima. In the grafts that became diseased after a long period, macrophage accumulation was detected at the site of atherosclerotic lesions. In the pathogenesis of arterial atherosclerotic lesions, vascular endothelial cell damage and subsequent subendothelial migration of monocytes/macrophages in the early phase are thought to be very important. This study revealed that macrophage migration into the intima of SVGs occurs soon after surgery and suggested it could be the basis of saphenous vein graft disease occurring long after CABG.
4.A Case of Acute Retrograde Aortic Dissection during TALENT Endovascular Repair of a Thoracic Aortic Aneurysm
Kentaro Sawada ; Atsuhisa Tanaka ; Seiji Onitsuka ; Keita Mikasa ; Tomokazu Ohno ; Satoru Tobinaga ; Teiji Okazaki ; Shinichi Hiromatsu ; Hidetoshi Akashi ; Shigeaki Aoyagi
Japanese Journal of Cardiovascular Surgery 2011;40(6):306-309
An 83-year-old woman underwent stent graft endovascular repair using a Medtronic TALENT device for a saccular aortic aneurysm in the distal arch. The landing zone which targeted the proximal side was directly distal to the orifice of the left common carotid artery (Z2), and the stent graft was placed at the targeted position. However, a decline in the right radial arterial pressure was observed immediately following this, and a retrograde dissected ascending aorta was observed on a transesophageal echocardiogram. The endovascular surgery was immediately converted to open surgery, and an intimal tear to the lesser curvature of the arch, caused by a bare spring (bare stent) of the proximal stent graft, was observed. Total arch replacement was performed by means of the concomitant use of the placed stent graft. Sometimes a TALENT stent graft exhibits specific movements (e.g. a misaligned opening) on its initial deployment. It is therefore believed that special attention is necessary when placing it in the aortic arch.
5.A Questionnaire Survey on Shift and On-Call System Targeting Under-Forty Cardiovascular Surgeons No.3
Tatsuki FUJIWARA ; Akinori HIRANO ; Chiharu TANAKA ; Junko KATAGIRI ; Hiroko KOGO ; Hironobu SAKURAI ; Kenichiro TAKAHASHI ; Kazuma DATE ; Keita HAYASHI ; Keita MARUNO ; Kunihiko YOSHINO
Japanese Journal of Cardiovascular Surgery 2020;49(3):3-U1-3-U6
We conducted a questionnaire survey on shift and on-call system targeting under-forty cardiovascular surgeons and obtained responses from 35 surgeons. We report the questionnaire results.
6.A Questionnaire Survey on Extracorporeal Membrane Oxygenation Targeting Under-Forty Cardiovascular Surgeons No.8
Tatsuki FUJIWARA ; Akinori HIRANO ; Chiharu TANAKA ; Hiroo KINAMI ; Hiroko KOGO ; Kenichiro TAKAHASHI ; Keita HAYASHI ; Toshiki FUJIYOSHI ; Keita MARUNO ; Toshiyuki YAMADA ; Kunihiko YOSHINO
Japanese Journal of Cardiovascular Surgery 2018;47(6):6-U1-6-U7
Basic procedures that cardiovascular surgeons routinely perform are rarely discussed, despite the great variability among facilities. We conducted a questionnaire survey on Extracorporeal Membrane Oxygenation (ECMO) targeting under-forty cardiovascular surgeons and obtained responses from 53 surgeons. We report the questionnaire results.
7.Discussion about 2 cases of intractable headache from brain tumor in which opioids were effective and a hypothesis regarding the underlying mechanism
Keiko Onishi ; Toyoshi Hosokawa ; Takuji Tsubokura ; Keita Fukazawa ; Hiroshi Ueno ; Chul Kwon ; Akiho Harada ; Madoka Fukazawa ; Akiko Yamashiro ; Ayano Taniguchi ; Kiyohiko Hatano ; Moegi Tanaka ; Arisa Nakasone ; Megumi Okada
Palliative Care Research 2015;10(2):509-513
Headaches caused by metastatic brain tumors result from dural tension and traction of the sites of nociceptive nerves that originates from displacement of cerebral vessels and intracranial hypertension caused by the tumor. Causes of such headaches also include meningeal irritation resulting from intrathecal dissemination of tumor and carcinomatous meningitis.Treatment of headaches resulting from intracranial hypertension involves alleviation of cerebral edema and reduction of intracranial pressure using hyperosmolar therapy and steroid administration, but treatment is often complicated by a lack of pressure reduction. We encountered 2 cases of headaches with intracranial hypertension that did not improve following hyperosmolar therapy and steroid administration, but resolved with increased opioid dose.In cases where intracranial pressure does not decrease, or for headaches attributed to direct stimulus of intracranial nociceptive nerves rather than intracranial hypertension, attempts to treat the patient with initiation or increased dosage of opioids may prove effective from a clinical standpoint.
8.Influence of Helicobacter pylori Infection on Endoscopic Findings of Gastric Adenocarcinoma of the Fundic Gland Type
Fumiaki ISHIBASHI ; Keita FUKUSHIMA ; Takashi ITO ; Konomi KOBAYASHI ; Ryu TANAKA ; Ryoichi ONIZUKA
Journal of Gastric Cancer 2019;19(2):225-233
PURPOSE: Gastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) was first reported as a rare adenocarcinoma found in the normal fundic mucosa. Recent studies have proposed the possibility that GA-FG-CCPs were also generated in the atrophic mucosa after Helicobacter pylori (HP) eradication therapy. However, little is known on the endoscopic findings of GA-FG-CCP generated in the atrophic mucosa due to its extreme rarity. MATERIALS AND METHODS: A total of 8 patients who underwent endoscopic submucosal resection and were diagnosed with GA-FG-CCP generated in the HP-uninfected mucosa (4 cases, HP-uninfected group) or HP-eradicated atrophic mucosa (4 cases, HP-eradicated group) were retrospectively analyzed, and their endoscopic findings, including magnifying endoscopy with narrow band imaging (M-NBI), and pathological features were compared. RESULTS: While GA-FG-CCPs in the 2 groups displayed similar macroscopic appearance, M-NBI demonstrated that characteristic microvessels (tapered microvessels like withered branches) were specifically identified in the HP-eradicated group. Pathological investigation revealed that a decreasing number of fundic glands and thinned foveolar epithelium covering tumor ducts were thought to lower the thickness of the covering layer over tumor ducts in the HP-eradicated group. Moreover, dilation of vessels just under the surface of the lesions contributed to the visualization of microvessels by M-NBI. CONCLUSIONS: The change in background mucosa due to HP infection influenced the thickness of the covering layer over the tumor ducts and M-NBI finding of GA-FG-CCP.
Adenocarcinoma
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Endoscopy
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Epithelium
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Helicobacter pylori
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Helicobacter
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Humans
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Microvessels
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Mucous Membrane
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Narrow Band Imaging
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Retrospective Studies
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Stomach Neoplasms
9.What Do Young Cardiovascular Surgeons Think about Research ?
Hironobu SAKURAI ; Shun TANAKA ; Yuta KUWAHARA ; Satoshi HOSHINO ; Kunihiko YOSHINO ; Rihito TAMAKI ; Ayako KATAGIRI ; Keita HAYASHI ; Daiki HARADA ; Kenichiro TAKAHASHI
Japanese Journal of Cardiovascular Surgery 2024;53(2):2-U1-2-U5
Along with clinical practice and education, research is among the most important activities for medical doctors. The same is true in cardiovascular surgery: Young cardiovascular surgeons are expected to improve their surgical techniques and prioritize their clinical practice. However, their perspective on the role of research in their field of expertise is unknown. Therefore, we conducted a survey of and discussion with young cardiovascular surgeons to clarify their thoughts and concerns about performing research. Here we review and report the survey and discussion results.
10.Quality Indicators for the Detection of Helicobacter pylori-Negative Early Gastric Cancer: A Retrospective Observational Study
Fumiaki ISHIBASHI ; Konomi KOBAYASHI ; Keita FUKUSHIMA ; Ryu TANAKA ; Tomohiro KAWAKAMI ; Junko KATO ; Kazuaki SUGIHARA
Clinical Endoscopy 2020;53(6):698-704
Background/Aims:
While Helicobacter pylori (HP)-negative gastric cancer is frequently reported, little is known about the predictors for detecting HP-negative early gastric cancer (EGC). We aimed to evaluate the predictors for the detection of HP-negative EGC.
Methods:
We retrospectively reviewed 13,477 consecutive asymptomatic cases where upper endoscopy was performed by nine physicians from April 2017 to March 2019 and analyzed the detection rate of high-risk lesions (HRLs), including EGC, tubular adenoma, and lymphoma, according to the status of HP infection. The observation time was corrected for multiple regression analyses.
Results:
For all physicians, the average observation time for screening HP-eradicated and -naïve patients was shorter than that for screening HP-positive patients (p<0.05). Multiple regression analyses revealed that the observation time in the three groups was an independent predictor for detecting HRLs in HP-eradicated patients (p=0.03106, 0.01263, and 0.02485, respectively), while experience of endoscopy was an independent predictor for detecting HRLs in HP-naïve patients (p=0.02638).
Conclusions
While observation time during screening endoscopy was a quality indicator for detecting HRLs in HP-eradicated patients, experience of endoscopy was a quality indicator for detecting HRLs in HP-naïve patients.