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Kumamoto-shi, Japan

Goto T.,Itoh Dento Maxillofacial Hospital | Maekawa K.,Kumamoto Chuo Hospital
Journal of Anesthesia | Year: 2014

Cerebral dysfunction after cardiac surgery remains a devastating complication and is growing in importance with our aging populations. Neurological complications following cardiac surgery can be classified broadly as stroke, encephalopathy (including delirium), or postoperative cognitive dysfunction (POCD). These etiologies are caused primary by cerebral emboli, hypoperfusion, or inflammation that has largely been attributed to the use of cardiopulmonary bypass. Preventative operative strategies, such as off-pump coronary artery bypass grafting (CABG), can potentially reduce the incidence of postoperative neurological complications by avoiding manipulation of the ascending aorta. Although off-pump CABG is associated with reduced risk of stroke, there are no convincing differences in POCD between off-pump and on-pump CABG. Recently, the focus of postoperative neurological research has shifted from managing cardiopulmonary bypass to patient-related factors. Identifying changes in brains of aged individuals undergoing cardiac surgery may improve strategies for preventing cerebral dysfunction. Advanced age is associated with more undiagnosed cerebrovascular disease and is a major risk factor for stroke and POCD following cardiac surgery. Preoperative cerebrovascular evaluation and adaptation of surgical strategies will provide preventative approaches for cerebral dysfunction after CABG. This review focuses on recent findings of the relationship between perioperative stress and underlying fragility of the brain in cardiac surgical patients. © 2013 Japanese Society of Anesthesiologists. Source

Funama Y.,Kumamoto University | Taguchi K.,Johns Hopkins University | Utsunomiya D.,Kumamoto University | Oda S.,Kumamoto University | And 3 more authors.
Physica Medica | Year: 2014

Purpose: To compare the noise and accuracy on images of the whole porcine liver acquired with iterative reconstruction(IMR, Philips Healthcare, Cleveland, OH, USA) and filtered back projection (FBP) methods. Materials and methods: We used non-enhanced porcine liver to simulate the human liver and acquired it 100 times to obtain the average FBP value as the ground-truth. The mean and the standard deviation ("inter-scan SD") of the pixel values on the 100 image acquisitions were calculated for FBP and for three levels of IMR (L1, L2, and L3). We also calculated the noise power spectrum (NPS) and the normalized NPS for the 100 image acquisitions. Results: The spatial SD for the porcine liver parenchyma on these slices was 9.92, 4.37, 3.63, and 2.30 Hounsfield units with FBP, IMR-L1, IMR-L2, and IMR-L3, respectively. The detectability of small faint features was better on single IMRthan single FBP images. The inter-scan SD value for IMR-L3 images was 53% larger at the liver edges than at the liver parenchyma; it was only 10% larger on FBP images. Assessment of the normalized NPS showed that the noise on IMR images was comprised primarily of low-frequency components. Conclusion: IMR images yield the same structure informations as FBP images and image accuracy is maintained. On level 3 IMR images the image noise is more strongly suppressed than on IMR images of the other levels and on FBP images. © 2014 . Source

Masuda Y.,Kumamoto Chuo Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

Situs inversus, which occurs in 1-2 of every 10,000 births, is a congenital malformation in which the thoracic and abdominal viscera are arranged in partial on complete mirror image of the normal anatomy. In the case of situs inversus, special attention must be taken in performing surgery. We present a surgical case of primary lung cancer in an 81-year-old patient with situs inversus totalis. During surgery, we used the Univent bronchial tube for one-lung ventilation. The appearance of the right lung and the arrangement of the pulmonary vessels and the bronchi corresponded to those normally found on the right side was noted at left thoracotomy. Left middle lobectomy and partial resection of left upper lung were successfully performed. In lung resection for situs inversus, it is important to be aware the mirrorimage anatomy. The three dimensional computed tomography (3D-CT) images were useful for preoperative evaluation of vessel variation. Source

Marutsuka T.,Kumamoto Chuo Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

A 62-year-old man, with chronic renal failure and receiving hemodialysis, pointed out to have an abnormal shadow on a chest X-ray. A chest computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET) examination showed a 6 cm size mass lesion in the middle of left thoracic cavity. Confirmed diagnosis was not obtained by needle biopsies. Left upper lobectomy was performed on suspicion of a lung cancer. Histopathologically, fungal hyphae were detected in these surgical specimens and it was diagnosed as pulmonary mucormycosis caused by Rhizopus species. Source

Inaba M.,Kumamoto Chuo Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

A 76-year-old man who was taking prednisolone and methotrexate for rheumatoid arthritis presented with gastric ulcers. Chest X-ray images showed multiple pulmonary nodules. Transbronchial lung biopsy specimens showed lymphocytic infiltrates but no malignant cells. The radiographic findings gradually ameliorated over a month, but then deteriorated 5 months later. We performed video-assisted thoracoscopic biopsy of the left lung, and the biopsy specimens showed lymphocytic infiltration with necrosis, in which the atypical lymphocytes were positive for Epstein-Barr virus-encoded small RNAs in situ hybridization (EBER-ISH). A diagnosis of lymphomatoid granulomatosis was determined. One year before this diagnosis, the patient was found to have an inflammatory liver tumor that had disappeared spontaneously within a month. A new pathological review of the liver and stomach lesions demonstrated EBER-ISH-positive lymphocytes, and therefore we assumed that they were pathological features of lymphomatoid granulomatosis. The chest radiographic findings improved gradually after the discontinuation of methotrexate. We therefore suggest that methotrexate treatment may be associated with the development of lymphomatoid granulomatosis in patients with rheumatoid arthritis. Lymphoproliferative disorders, including lymphomatoid granulomatosis, should be considered in patients with rheumatoid arthritis who are receiving methotrexate. Source

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