1.A Case of Redo Aortic Valve Replacement for Bioprosthetic Aortic Valve Endocarditis Combined with Pyogenic Vertebral Osteomyelitis, Causing Prosthetic Valve Deterioration despite Effective Antibiotic Therapy
Hitoshi Suhara ; Toshiki Takahashi ; Takashi Kido ; Masaya Kainuma
Japanese Journal of Cardiovascular Surgery 2015;44(2):87-91
Infective endocarditis in association with pyogenic vertebral osteomyelitis is rarely observed. We report an 80-year-old man with infective endocarditis and pyogenic vertebral osteomyelitis requiring reoperation due to aortic prosthetic valve dysfunction. He suffered from back pain as the initial symptom, and he was admitted to our hospital. On magnetic resonance imaging, vertebral osteomyelitis was revealed, and antibiotics were started. On blood sampling α-streptococcus was identified and infective endocarditis was diagnosed. He responded to the antibiotic treatment. Despite the improvement in his general condition and the inflammatory parameters of blood samples, the aortic prosthetic valve dysfunction progressed. On echocardiography, aortic regurgitation worsened to 4/4, and the ejection fraction decreased from 72 to 46%. As heart failure was apparent, we performed a redo aortic valve replacement. Tears were found in the leaflets of the removed prosthetic valve (Hancock II). The 21-mm Carpentier-Edwards PERIMOUNT valve (CEP Magna Ease TFX) was replaced. His post-operative course was uneventful, and intravenous administration of ampicillin was continued. Oral rifampicin was also continued. On the 69th post-operative day, he was discharged and was ambulatory. Although we have no evidence that the tissue valve deterioration had resulted from bacterial damage, we were able to confirm that the structural valve deterioration involved bacterial contact in this case. Patients with infective endocarditis and pyogenic vertebral osteomyelitis should be treated cautiously regardless of whether or not the inflammation is controlled.
2.Right Parasternal Vertical Approach for Tricuspid Valve Replacement in Repeated Cardiac Surgery
Masaya Takahashi ; Yoshinori Tanimoto ; Hidetoshi Tsuboi ; Kensuke Esato
Japanese Journal of Cardiovascular Surgery 2005;34(1):33-36
Median sternotomy is the most common approach used for repeated cardiac surgery, but it is associated with potential risks such as cardiac injury. Patients with valvular heart disease may be especially prone to these complications because of severe cardiomegaly and adherence of the heart to the posterior sternum. To avoid these risks, we began using a right thoracotomy approach, performed through a right parasternal vertical incision, which is better than the traditional right anterolateral thoracotomy, in selected patients. A 50-year-old woman who had undergone 3 previous cardiac operations at another hospital presented with remarkable cardiomegaly. We performed successful tricuspid valve replacement for tricuspid stenosis, through a right parasternal vertical incision. This approach provides excellent exposure of the tricuspid valve with minimal need for dissection. The right parasternal vertical incision has 3 main advantages over right anterolateral thoracotomy; first, it provides an excellent view of the right atrium underneath the wound; second, it allows for easy cannulation because of the position of the spine; and third, the skin incision is smaller. In conclusion, we think that the parasternal vertical incision is a better approach for repeated cardiac surgery than anterolateral thoracotomy because it provides a better operative view and an easier maneuver.
3.Prototype single-balloon enteroscopy with passive bending and high force transmission improves depth of insertion in the small intestine
Yasuhiro MORITA ; Shigeki BAMBA ; Osamu INATOMI ; Kenichiro TAKAHASHI ; Takayuki IMAI ; Masaki MURATA ; Masashi OHNO ; Masaya SASAKI ; Tomoyuki TSUJIKAWA ; Akira ANDOH
Intestinal Research 2020;18(2):229-237
Background/Aims:
We retrospectively analyzed Crohn’s disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE.
Methods:
Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points.
Results:
The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn’s Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon’s signed-rank test).
Conclusions
In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102)
4.Magnified single-balloon enteroscopy in the diagnosis of intestinal follicular lymphoma: a case series.
Kenichiro TAKAHASHI ; Shigeki BAMBA ; Masahiro KAWAHARA ; Atsushi NISHIDA ; Osamu INATOMI ; Masaya SASAKI ; Tomoyuki TSUJIKAWA ; Ryoji KUSHIMA ; Mitsushige SUGIMOTO ; Katsuyuki KITOH ; Akira ANDOH
Intestinal Research 2018;16(4):628-634
The objective of this study was to evaluate the magnified endoscopic findings in the diagnosis of follicular lymphoma in the small intestine in comparison with those of intestinal follicular lymphoma and lymphangiectasia. Four patients with follicular lymphoma and 3 with lymphangiectasia in the small intestine were retrospectively analyzed. A prototype magnifying singleballoon enteroscope was used. The findings of the intestinal follicular lymphoma and lymphangiectasia were retrospectively analyzed to determine the magnified endoscopic findings of follicular lymphoma in the small intestine. Opaque white granules were observed in 3 of the 4 patients with follicular lymphoma. Magnified narrow-band imaging (NBI) of the opaque white granules showed stretched microvessels, which had a diminutive tree-like appearance. The remaining patient had no opaque white granules and only displayed whitish villi. Magnified NBI observation of the whitish villi revealed the absence of marginal villus epithelium, which was confirmed by histology. The magnified NBI enteroscopy revealed the diminutive tree-like appearance on the opaque white granules and the absence of marginal villus epithelium of the whitish villi in intestinal follicular lymphoma. These findings may be useful in diagnosing follicular lymphoma.
Diagnosis*
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Epithelium
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Humans
;
Intestine, Small
;
Lymphoma, Follicular*
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Microvessels
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Narrow Band Imaging
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Retrospective Studies
5.Efficacy and safety of cold forceps polypectomy utilizing the jumbo cup: a prospective study
Hiroshi HASEGAWA ; Shigeki BAMBA ; Kenichiro TAKAHASHI ; Masaki MURATA ; Taketo OTSUKA ; Hiroshi MATSUMOTO ; Takehide FUJIMOTO ; Rie OSAK ; Hirotsugu IMAEDA ; Atsushi NISHIDA ; Hiromitsu BAN ; Ayano SONODA ; Osamu INATOMI ; Masaya SASAKI ; Mitsushige SUGIMOTO ; Akira ANDOH
Intestinal Research 2019;17(2):265-272
BACKGROUND/AIMS: There are few prospective studies on cold forceps polypectomy (CFP) using jumbo cup forceps. Therefore, we examined patients with diminutive polyps (5 mm or smaller) treated with CFP using jumbo cup forceps to achieve an adenoma-free colon and also assessed the safety of the procedure and the recurrence rate of missed or residual polyp after CFP by performing follow-up colonoscopy 1 year later. METHODS: We included patients with up to 5 adenomas removed at initial colonoscopy and analyzed data from a total of 361 patients with 573 adenomas. One-year follow-up colonoscopy was performed in 165 patients, at which 251 lesions were confirmed. RESULTS: The one-bite resection rate with CFP was highest for lesions 3 mm or smaller and decreased significantly with increasing lesion size. Post-procedural hemorrhage was observed in 1 of 573 lesions (0.17%). No perforation was noted. The definite recurrence rate was 0.8% (2/251 lesions). The probable recurrence rate, which was defined as recurrence in the same colorectal segment, was 17%. Adenoma-free colon was achieved in 55% of patients at initial resection. Multivariate analysis revealed that achievement of an adenoma-free colon was significantly associated with number of adenomas and years of endoscopic experience. CONCLUSIONS: CFP using jumbo biopsy forceps was safe and showed a high one-bite resection rate for diminutive lesions of 3 mm or smaller. The low definite recurrence rate confirms the reliability of CFP using jumbo biopsy forceps. Number of adenomas and years of endoscopic experience were key factors in achieving an adenoma-free colon.
Adenoma
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Biopsy
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Colon
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Colonoscopy
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Follow-Up Studies
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Hemorrhage
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Humans
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Multivariate Analysis
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Polyps
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Prospective Studies
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Recurrence
;
Surgical Instruments
6.Effectiveness of Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid as a Non-Surgical Treatment for Internal Hemorrhoids
Yuichi TOMIKI ; Jun AOKI ; Shunsuke MOTEGI ; Rina TAKAHASHI ; Toshiaki HAGIWARA ; Yu OKAZAWA ; Kosuke MIZUKOSHI ; Masaya KAWAI ; Shinya MUNAKATA ; Shun ISHIYAMA ; Kiichi SUGIMOTO ; Kazuhiro SAKAMOTO
Clinical Endoscopy 2019;52(6):581-587
BACKGROUND/AIMS: Sclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) has a potent effect on internal hemorrhoids. In this retrospective study, we compared the effects of endoscopic ALTA therapy and standard ALTA therapy.METHODS: We investigated patients who underwent treatment for internal hemorrhoids at our institution between 2014 and 2016. They were divided into a standard ALTA group (n=33, treated using proctoscopy) and an endoscopic ALTA group (n=48). We compared the clinical findings between the 2 groups.RESULTS: There were no intergroup differences in background factors. The mean ALTA dose was 21.9±7.2 mL and 17.8±3.4 mL in the standard and endoscopic ALTA groups, respectively (p<0.01). Adverse events occurred in 4 patients (12.1%) from the standard ALTA group and 6 patients (12.5%) from the endoscopic ALTA group. In both groups, the patients reported good satisfaction with the therapeutic effect at 1 month after the procedure. Hemorrhoids recurred in 2 patients (6.3%) from the standard ALTA group and 4 patients (8.3%) from the endoscopic ALTA group.CONCLUSIONS: Endoscopic ALTA sclerotherapy is equivalent to standard ALTA therapy in terms of efficacy, adverse events, and recurrence. Therefore, it is a useful non-surgical option for patients with internal hemorrhoids who prefer a less invasive treatment.
Aluminum
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Endoscopy
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Hemorrhoids
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Humans
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Potassium
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Recurrence
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Retrospective Studies
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Sclerotherapy
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Tannins
7.A Case of Total Arch Replacement Using Coil Embolization for a Thoracic Aortic Aneurysm Derived from a Kommerell Diverticulum
Ryunosuke SAKAMOTO ; Masaya TAKAHASHI ; Yoshitaka IKEDA ; Hiroshi ITO
Japanese Journal of Cardiovascular Surgery 2023;52(3):168-171
An 81-year-old man who visited a local physician for evaluation of hoarseness was admitted to our hospital for management of a thoracic aortic aneurysm. Careful examination revealed a thoracic aortic aneurysm, aortic regurgitation, and left ventricular aneurysm. We performed total arch replacement using a frozen elephant trunk prosthesis (combined right axillary artery bypass and coil embolization), aortic valve replacement, papillary muscle approximation, and a septal anterior ventricular exclusion operation. The patient's postoperative course was uneventful, and he was discharged on the 25th postoperative day. A Kommerell diverticulum is located at the origin of an aberrant subclavian artery, and subclavian artery reconstruction via thoracotomy is challenging in such cases. Although increasing numbers of thoracic endovascular aortic repairs have been performed in recent years, the procedure is associated with complications such as endoleak and aortic esophageal fistula, and the surgical risk-benefit ratio should be carefully determined. We report a case of safe non-anatomical subclavian artery reconstruction and coil embolization.
8.Association between Osteoporosis and Skeletal Muscle Mass in Men
Masaya MIZUTANI ; Yawara EGUCHI ; Toru TOYOGUCHI ; Sumihisa ORITA ; Kazuhide INAGE ; Yasuhiro SHIGA ; Satoshi MAKI ; Junichi NAKAMURA ; Shigeo HAGIWARA ; Yasuchika AOKI ; Masahiro INOUE ; Masao KODA ; Hiroshi TAKAHASHI ; Tsutomu AKAZAWA ; Seiji OHTORI
Asian Spine Journal 2024;18(1):73-78
Methods:
This study included 99 men (mean age, 74.9 years; range, 28–93 years) who visited Qiball Clinic for BMD and body composition examinations. The osteoporosis group consisted of 24 patients (mean age, 72.5 years; range, 44–92 years), and the control group consisted of 75 individuals (mean age, 74.9 years; range, 28–93 years). Whole-body skeletal muscle mass was measured using a bioelectrical impedance analyzer. BMD was measured by dual X-ray absorptiometry. Skin autofluorescence (SAF), a marker of dermal AGE accumulation, was measured using a spectroscope. Osteoporosis was defined as a bone density T score of –2.5 or less. Physical findings, skeletal muscle mass, BMD, grip strength, and SAF were compared between the osteoporosis and control groups.
Results:
The osteoporosis group had significantly lower trunk muscle mass (23.1 kg vs. 24.9 kg), lower leg muscle mass (14.4 kg vs. 13.0 kg), and skeletal mass index (7.1 kg/m2 vs. 6.7 kg/m2) than the control group (all p<0.05). Lower limb muscle mass was identified as a risk factor for osteoporosis in men (odds ratio, 0.64; p=0.03).
Conclusions
Conservative treatment of osteoporosis in men will require an effective approach that facilitates the maintenance or strengthening of skeletal muscle mass, including exercise therapy with a focus on lower extremities and nutritional supplementation.
9.Successful Use of a Stent-Graft for Treating a Pseudoaneurysm Located at the Anastomosis of the Ascending Aorta and the Great Saphenous Vein
Ryo AYATA ; Masaya TAKAHASHI ; Yoshitaka IKEDA ; Noriyasu MORIKAGE ; Hiroshi ITO
Japanese Journal of Cardiovascular Surgery 2023;52(1):46-49
Takayasu Arteritis causes annuloaortic ectasia and coronary ostial stenosis, which may necessitate open heart surgery. However, pseudoaneurysms are sometimes observed postoperatively, making subsequent treatment difficult. We report thoracic endovascular aortic repair of a pseudoaneurysm of the ascending aorta with an anastomosis of the great saphenous vein in a 61-year-old female with a history of multiple open-heart procedures. Thirty years earlier, she underwent aortic valve replacement and coronary artery bypass surgery for aortic regurgitation, and right coronary ostial stenosis. Eleven years after surgery, an ascending aortic aneurysm was found and Bentall's surgery was performed. Multiple open thoracotomies were subsequently performed. Postoperatively, a pseudoaneurysm was found at the anastomosis between the ascending aorta and the great saphenous vein. The patient was transferred to the emergency room owing to hemoptysis and was diagnosed with a ruptured pseudoaneurysm at the anastomosis of the ascending aorta and the great saphenous vein. By inserting a stent graft into the ascending aorta, we avoided further complications and her prognosis was good. She was discharged on postoperative day 18 and did not experience any end leak for a year. Thoracic endovascular aortic repair in the ascending aorta is a minimally invasive procedure that may be useful for high-risk patients.
10.Conservative and Surgical Treatment Improves Pain and Ankle-Brachial Index in Patients with Lumbar Spinal Stenosis.
Seiji OHTORI ; Masaomi YAMASHITA ; Yasuaki MURATA ; Yawara EGUCHI ; Yasuchika AOKI ; Hiromi ATAKA ; Jiro HIRAYAMA ; Tomoyuki OZAWA ; Tatsuo MORINAGA ; Hajime ARAI ; Masaya MIMURA ; Hiroto KAMODA ; Sumihisa ORITA ; Masayuki MIYAGI ; Tomohiro MIYASHITA ; Yuzuru OKAMOTO ; Tetsuhiro ISHIKAWA ; Hiroaki SAMEDA ; Tomoaki KINOSHITA ; Eiji HANAOKA ; Miyako SUZUKI ; Munetaka SUZUKI ; Takato AIHARA ; Toshinori ITO ; Gen INOUE ; Masatsune YAMAGATA ; Tomoaki TOYONE ; Gou KUBOTA ; Yoshihiro SAKUMA ; Yasuhiro OIKAWA ; Kazuhide INAGE ; Takeshi SAINOH ; Kazuyo YAMAUCHI ; Kazuhisa TAKAHASHI
Yonsei Medical Journal 2013;54(4):999-1005
PURPOSE: The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI. MATERIALS AND METHODS: One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment. RESULTS: Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05). CONCLUSION: This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.
Adult
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Aged
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Aged, 80 and over
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Alprostadil/therapeutic use
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*Ankle Brachial Index
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Decompression, Surgical/methods
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Female
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Humans
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Low Back Pain/drug therapy/physiopathology/surgery/*therapy
;
Lumbar Vertebrae/physiopathology/*surgery
;
Male
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Middle Aged
;
Pain/surgery
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Spinal Nerve Roots/physiopathology
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Spinal Stenosis/physiopathology/*surgery/*therapy
;
Treatment Outcome