3.Tuberculous Aortic Regurgitation. A Case Report with Successful Surgical Treatment.
Kenji Takahashi ; Satoshi Odagiri ; Koji Nagao
Japanese Journal of Cardiovascular Surgery 1996;25(3):189-191
Tuberculous valvular endocarditis is rare and diagnosis before death is seldom achieved. A case of severe aortic regurgitation due to tuberculous endocarditis in a 56-year-old man is presented. Replacement of the aortic valve in emergency and administration of anti-tuberculuos medication permitted an uneventful recovery. This is a rare case report of successful surgical treatment of tuberculous valvular disorder.
4.CABG Operation Using Arterial Grafts Only.
Kenji Takahashi ; Koji Nagao ; Atushi Narita ; Satoshi Iwabuchi
Japanese Journal of Cardiovascular Surgery 1994;23(3):161-166
In our department, we perform CABG operations using arterial grafts as much as possible, and in the present study, we investigated 96 patients who underwent CABG operations using arterial grafts alone during the 4-year period from October 1988 to August 1992. The sex ratio (M/F) was 64/32, and the mean age was 63.2 years. Of those 56 patients underwent bypass surgery for one artery each, using a total of 56 grafts. In 18 cases of bypass surgery for 2 arteries 34 grafts were used for 36 arteries, and in 16 patients who underwent surgery for 3 arteries, 42 grafts were used for 48 arteries. In 6 patients who underwent bypass surgery for 4 arteries, 16 grafts were used for 24 arteries. All 148 arteries harvested from 96 patients were available. Forty-one RITAs were used for 43 arteries, 68 LITAs for 72 arteries and 39 RGEAs for 49 arteries. There were 2 (2.0%) operative deaths. Among 135 grafts for 146 arteries on which arteriography was performed after operation, 133 grafts (98.6%) among 142 arteries (97.3%) were patent. In detail, the patency rate of ITA was 98 of 100 grafts (98.0%) and 102 of 105 arteries (97.1%), that of RGEA was 35 of 35 grafts (100%) and 40 of 41 arteries (97.6%), and therefore, good patency was observed in both ITA and RGEA.
5.A Successful Case of Surgical Repair for a True Aneurysm of the Brachial Artery Caused by Blunt Injury.
Satoshi Taketani ; Satoru Kuki ; Ryuichi Matsumura ; Akihiro Okuda ; Yumiko Takahashi
Japanese Journal of Cardiovascular Surgery 1995;24(5):344-346
We present one case of true aneurysm of the branchial artery which is very rare among peripheral aneurysms. A 52-year-old woman developed a bruise on the right upper arm around June 1993, but did nothing about it because she felt no symptoms. A pulsating mass became palpable at this site around the following month. Digital subtraction angiography revealed an aneurysm formation of 1.5×1.5cm in size in the right brachial artery. Operative findings showed that the wall of the aneurysm joined the normal region and all the vascular layers in the aneurysm were maintained. After resection of the aneurysm, end-to-end anastomosis was carried out. A diagnosis of true aneurysm was confirmed by the pathohistological findings that the vascular three-layer structure was maintained, with few arteriosclerotic changes.
6.Spontaneous Rupture of the Abdominal Aorta in a Young Adolescent
Yuko Tosaka ; Hiroshi Kanazawa ; Yoshiki Takahashi ; Satoshi Nakazawa ; Yoshihiko Yamazaki
Japanese Journal of Cardiovascular Surgery 2004;33(1):57-60
We describe a young adolescent patient with spontaneous abdominal aortic rupture who was treated successfully. A 14-year-old boy was admitted to our hospital with severe abdominal pain and hypovolemic shock, without any episode of trauma. Computed tomography (CT) revealed massive hematoma in the retroperitoneal space and extravasation of copious amounts of contrast medium in front of the terminal aorta. Neither aortic aneurysm nor dissection was observed in this CT. An emergency operation was carried out. At first, left thoracotomy and clamping of the thoracic descending aorta were performed in order to reduce the aortic bleeding. Midline laparotomy revealed an aortic perforation of approximately 8mm at the bifurcation of the abdominal aorta. The aortic wall surrounding the perforation was nearly normal without any aortic aneurysm or dissection. A segment of the terminal aorta (length, 3cm) including the perforated lesion was excised and reconstruction was performed with a woven Dacron tube graft (10mm in diameter). On microscopic examination, the marginal tissue near the perforation showed diminished elastic fibers and minimal dissection of the medial layer of the aortic wall; however, no cystic medial necrosis or inflammation was seen.
7.Facilitation of web-based internet PBL: What is an adequate group size?
Masayuki Niwa ; Satoshi Yoshida ; Kazuhiro Takamizawa ; Satoshi Nagaoka ; Nobumitsu Kawakubo ; Yuzo Takahashi ; Yasuyuki Suzuki
International e-Journal of Science, Medicine and Education 2014;8(2):4-11
Background: Development in internet technology
enables e-learning at the higher education level. We have
developed the Internet PBL-Tutorial System/Rakuichi
that allows multi-directional communication among
participants with web-based bulletin boards. Although
this system has been successful in medical education at
the undergraduate level, we sought to encourage “readonly
members” to participate more fully in the program.
Methods: To this end, we compared the posting
frequency among three strategies: (1) students and
tutors had an off-site meeting to promote face-to-face
communication during the course, (2) several classes
were allowed to watch the discussion in other classes
in the second half of the course, (3) three classes (5 –
6 students each) in one topic were combined into one
class (16 students) in the second half.
Results: No meaningful effects were observed for
strategies (1) or (2). However, the posting frequency
increased 50 % for strategy (3).
Conclusion: Facilitation of communication among
participants was achieved by increasing the number
of student participants. We predicted that an optimal
number of students in each class in internet-based PBL
would be ~20 people.
8.Short latency afferent inhibition in schizophrenia patients
Masaru Shoyama ; Shun Takahashi ; Tadahiro Hashimoto ; Tomikimi Tsuji ; Satoshi Ukai ; Kazuhiro Shinosaki
ASEAN Journal of Psychiatry 2013;14(2):1-8
The objective of this study was to test our preliminary in vivo evaluations of central cholinergic abnormalities in schizophrenia patients. Short latency afferent
inhibition (SAI) is based on coupling peripheral nerve stimulation with motor cortex Transcranial Magnetic Stimulation (TMS), which has been shown to be a putative
marker of central cholinergic activity. Methods: We evaluated SAI in 5 patients with schizophrenia and 5 healthy subjects. Results: The level of SAI was significantly lower in the patients with schizophrenia than in the controls (p=0.008). Conclusion:
Our findings suggest involvement of central cholinergic neurotransmission in schizophrenia, which indicates a possible approach for treatment of cognitive
dysfunction related to the disease.
9.A Successful Operation Case of Budd-Chiari Syndrome.
Akiyuki TAKAHASHI ; Syuuji SHIRAKATA ; Satoshi NIU ; Yutaka KANKI ; Yukio WADA ; Kouichi OGA ; Takahiro OKA
Japanese Journal of Cardiovascular Surgery 1991;20(7):1294-1298
A case of Budd-Chiari syndrome in which direct surgical intervention was successfully performed is reported. A 43-year-old female who had had a history of hepatic coma was pointed out complete obstruction of inferior vena cava (IVC) between the right atrium and diaphragma, associated with hepatic dysfunction and esophageal varices. At operation, the IVC lesion was visualized directly by thoracotomy through midsternal incision and by laparotomy through right hypochondrial oblique incision, with the liver retracted. Under partial extracorporeal circulation with suction of blood from hepatic vein, the IVC was incised, 3cm in length, and membranous tissue causing obstruction was resected. The defect of the IVC wall was repaired with ringed EPTFE patch. Postoperatively, both central venous and portal pressure were decreased, 21 mmHg to 10mmHg and 26cm H2O to 21cm H2O, respectively, with good patency of the IVC on venogram. Now the patient is up and well, 11 months after operation. Thus, complete removal of obstruction under direct vision is thought to be important for surgical treatment of Budd-Chiari syndrome.
10.A Case of Primary Cardiac Angiosarcoma.
Kenji TAKAHASHI ; Atushi NARITA ; Koji NAGAO ; Satoshi IWABUCHI ; Sohei SUZUKI ; Hisaaki KOIE
Japanese Journal of Cardiovascular Surgery 1993;22(6):493-496
Cardiac angiosarcoma is a rare disease which occurs most often in young males and has a remarkably unfavorable prognosis. We experienced one male case aged 46 who had an initial symptom of cardiac tamponade due to rupture of the right ventricle. Hemostasis was made under extracorporeal circulation, and the patient was discharged temporarily. However, a large volume of hemoptysis occurred from right B6 about 1 month after discharge, because of which resection of the right lower lobe was performed. Tumorous cells identical to those in the perforated cardiac region were detected in the resected tissue, and it was diagnosed histopathologically that the cardiac rupture was caused by angiosarcoma, resulting in pulmonary metastasis. Multiple pulmonary metastases were observed in bilateral lung following fields by CT, but administration of CDDP in iv×2 and in 150mg/day cyclophosphamide, the pulmonary metastases disappeared completely on CT on the 45th day. However, the metastases recurred soon thereafter without responding to chemotherapy, and the patient died 5 months after diagnosis of this disease because of exacerbated dyspnea.