Maeba S.,Takeda General Hospital Foundation |
Taguchi T.,Takeda General Hospital Foundation |
Midorikawa H.,Southern Tohoku General Hospital |
Kanno M.,Southern Tohoku General Hospital |
Sueda T.,Hiroshima University
Interactive Cardiovascular and Thoracic Surgery | Year: 2013
OBJECTIVES: Functional tricuspid regurgitation (FTR) is generally caused by the dilation of the tricuspid annulus (TA) and the tethering of tricuspid leaflets; however, it also occurs in patients without dilatation of the TA. The aim of this study was to develop and to use a four-dimensional tracking system, utilizing cardiac magnetic resonance imaging (MRI), and to assess TA flexibility in patients with early FTR without right ventricle dilation as a preliminary investigation for the mechanism of early FTR. METHODS: The structure and movement of the TA were examined in 20 healthy subjects and 19 FTR patients whose right ventricle was not dilated. We analysed the short axis and longitudinal movement of a mid-septal point (S), a mid-lateral point (L), a mid-anterior point (A) and a mid-posterior point (P) on the TA throughout the cardiac cycle. The tethering distance of the tricuspid leaflets and the integrated orbiting volume of the TA were also measured. RESULTS: The TA area (mm2) and AP and LS distances (mm) did not differ significantly between the two groups, but the longitudinally moving distances (mm) of the four points were significantly shorter in patients with FTR than in healthy subjects. Also, the mean tethering distance (mm) was significantly longer in patients with FTR than in healthy subjects (9.0 ± 1.5 vs 4.0 ± 1.3, respectively; P < 0.001), and the integrated volume (mm3) of the annular moving track, throughout the cardiac cycle, was significantly larger in healthy subjects than in patients with FTR (40 428 ± 10 951 vs 22 967 ± 6079, P < 0.001). CONCLUSIONS: The longitudinal flexibility of the TA in FTR patients was significantly less than that in the healthy subjects, and the tethering of the tricuspid leaflets occurred in FTR patients despite the absence of TA and RV dilation, which can be one triggering factor of early FTR. Four-dimensional geometric assessment, using cardiac MRI and the tracking program that we have developed, is capable of determining TA structure and flexibility. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Midorikawa H.,Southern Tohoku General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013
We report the initial and long-term results of open stent-grafting (OSG) applied with a Matsui-Kitamura (MK) stent in the treatment of thoracic aortic aneurysm (TAA). From August 2005 to March 2013, OSG for TAA was applied in 46 cases( male/female, 36/10, 54-86 years old, mean age 71). During deep hypothermic circulatory arrest with antegrade selective cerebral perfusion, stent graft was delivered through the transected proximal aortic arch, followed by arch replacement with a 4-branched prosthesis. Operative mortality within 30 days was 6.5%(respiratory failure in 1, multiple organ failure in 1and ischemic enteritis in 1) and there was 1 in hospital death due to brain stem infarction. Perioperative morbidity included 2( 4.3%) stroke, 5( 10.9%) spinal cord injuries( paraplegia in 1, paraparesis in 1 and transient paraparesis in 3). In long-term follow-up, survival was 86.8%, 77.2%, and 72.0% for 1, 3 and 5 years. Freedom from aortic event was 97.3%, 93.8% and 89.1% for 1, 3 and 5 years. Theseresults suggested the OSG method applied with a MK stent is a useful surgical procedure for the treatment of TAA.
Fujiu K.,Southern Tohoku General Hospital |
Sakuma H.,Southern Tohoku General Hospital |
Miyamoto H.,Southern Tohoku General Hospital |
Yamaguchi B.,Southern Tohoku General Hospital
General Thoracic and Cardiovascular Surgery | Year: 2010
An 82-year-old man presented with a nodule in the right S2a of the lung as seen by chest computed tomography (CT). He had undergone treatment for chronic obstructive lung disease. He had a 53-year history of smoking 20 cigarettes a day. Subsequent to the appearance of the nodule in the right S 2a, the CT images revealed consolidations in the right S 2b, right S3, and left S5. The nodule in the right S2a was diagnosed as squamous cell carcinoma after performing video-assisted thoracoscopic wedge resection of the lung. After 4 months, the size of the consolidation in the right S2b increased. Recurrence of lung cancer was suspected. Using transbronchial lung biopsy, the consolidation in the left S5 was diagnosed as organizing pneumonia; therefore, right upper lobectomy was performed. The consolidations in the right S 2b and right S3 were diagnosed as infl ammatory pseudotumors with infi ltrations of immunoglobulin G4-positive plasma cells. © 2010 The Japanese Association for Thoracic Surgery.
Tomii M.,Southern Tohoku General Hospital
Neurosurgical Review | Year: 2012
Olfactory dysfunction may influence the quality of life tremendously. This study investigated the strength of the human olfactory nerve at the frontal skull base using cadavers. A total of 180 olfactory nerves were examined in 90 human cadaveric heads. The cut edges of the olfactory nerves were pulled until they were pulled out from the skull base. In the first set of 30 cases, each right olfactory nerve was pulled 0° laterally and 0° upward, and each left olfactory nerve was pulled 0° laterally and 15° upward. In the second set of 30 cases, each right olfactory nerve was pulled 0° laterally and 15° upward, and each left olfactory nerve was pulled 15° laterally and 15° upward. In the third set of 30 cases, each right olfactory nerve was pulled 15° laterally and 15° upward, and each left olfactory nerve was pulled 30° laterally and 15° upward. The strength of the olfactory nerve was measured when pulled in each direction. There was no significant difference in the strength of the olfactory nerves when pulling them in the postero-upward direction between 0° and 15° upward. The strengths of the olfactory nerves when pulling them in the postero-lateral direction 0° and 15° laterally were 3.14±1.87 and 4.05±1.70 g (mean ± standard deviation [SD]), respectively; the difference was almost significant. The olfactory nerve could be pulled more laterally than posteriorly because the retraction force is absorbed by the lateral wall of the olfactory fossa. © Springer-Verlag 2012.
Fujiu K.,Southern TOHOKU General Hospital |
Miyamoto H.,Southern TOHOKU General Hospital
Annals of Thoracic and Cardiovascular Surgery | Year: 2012
Purpose: It has been reported that Integran®, a sheet-type absorbable topical collagen hemostat, is feasible for preventing pulmonary fistula after lung surgery. The most favorable aspect of Integran® is that it contains no blood products. However, the microscopic findings of post-surgery application of Integran® to the lung are not known. We identified 2 such cases of Integran® application, which were carried out a few years earlier, and described the microscopic findings. Method: In case 1, a 53-year-old man underwent video-assisted left upper lobectomy for primary lung cancer. Integran® was applied to the left lower lobe. Completion left pneumonectomy was performed after 2 years and 1 month due to recurrence. In case 2, a 77-year-old woman underwent video-assisted right middle lobectomy for primary lung cancer. Integran® was applied to the right upper lobe. Completion right upper lobectomy was performed after 1 year and 8 months due to recurrence. Results: The repaired visceral pleura of the 2 patients were covered with proliferated collagen fibers. However, there was little infiltration of inflammatory cells and fibroblasts. Conclusion: The microscopic findings revealed that the ability of Integran® to generate inflammation or adhesion is weak, but it has the ability to repair damaged visceral pleura. © 2012 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.
Watanabe S.,Southern Tohoku General Hospital |
Watanabe S.,Rush University Medical Center |
Inoue N.,Rush University Medical Center |
Inoue N.,Doshisha University |
And 6 more authors.
European Spine Journal | Year: 2012
Purpose Development of adjacent segment degeneration following anterior cervical decompression and fusion (ACDF) is still controversial, as adjacent-level kinematics is poorly understood. This study reports preliminary data from a high-accuracy 3D analysis technique developed for in vivo cervical kinematics. Methods From nine cervical spondylosis patients, four underwent single-level ACDF, and five underwent two-level ACDF using cylindrical titanium cage implant(s). Pre- and post-surgical CT scans were taken in flexion, neutral and extended positions, allowing us to compute segmental ranges of motion for rotation and translation, and 3D disc-height distributions. Differences in segmental motions and disc-height between fused and adjacent levels were analyzed with a Wilcoxon signed-rank test.Results are presented as mean ± SEM. Results The flexion/extension angular-ROM at the fusion level decreased after surgery (7.46 ± 1.17° vs. 3.14 ± 0.56°, p\0.003). The flexion/extension angular-ROM at one caudal adjacent level to the fusion level (3.97 ± 1.29°) tended to be greater post-operatively (6.11 ± 1.44°, p = 0.074). Translation in the anterior-posterior direction during flexion/ extension at the fusion level decreased after surgery (1.22 ± 0.20 mm vs. 0.32 ± 0.11 mm, p\0.01). No differences were found in adjacent-level disc heights between both study time-points. Conclusions This study showed increased segmental motion in flexion/extension angular-ROM at one level adjacent to ACDF. However, increases in the rotational angular-ROM were not statistically significant when cranial/ caudal adjacent levels were analyzed separately. This preliminary study highlighted the capabilities of a 3Dkinematic analysis method to detect subtle changes in kinematics and disc height at the adjacent levels to ACDF. Thus, reliable evidence related to ACDF's influence on adjacent-level cervical kinematics can be collected. © 2011 Springer-Verlag.
Nieda M.,Biotherapy Institute of Japan |
Terunuma H.,Biotherapy Institute of Japan |
Terunuma H.,Southern Tohoku General Hospital |
Eiraku Y.,Biotherapy Institute of Japan |
And 2 more authors.
Experimental Dermatology | Year: 2015
Dendritic cells (DCs) can be differentiated from CD14+ monocytes in the presence of interferon-α (IFNα) and granulocyte/macrophage-colony stimulating factor (GM-CSF) in vitro and are known as IFN-DCs. Circulating blood CD56+ cells expressing high levels of CD14, HLA-DR and CD86 have been shown to spontaneously differentiate into DC-like cells in vitro after their isolation from blood. We show here that IFN-DCs expressing high levels of CD56 (hereafter, CD56high+ IFN-DCs) can be differentiated in vitro from monocytes obtained as adherent cells from healthy donors and patients with metastatic melanoma. These cells expressed high levels of CD14, HLA-DR and CD86 and possessed many pseudopodia. These CD56high+ IFN-DCs may be an in vitro counterpart of the circulating CD56+ CD14+ CD86+ HLA-DR+ cells in blood. Conventional mature DCs differentiated from monocytes as adherent cells in the presence of GM-CSF, IL-4 and TNF-α (hereafter, mIL-4DCs) did not express CD56 or CD14. In contrast to mIL-4DCs, the CD56high+ IFN-DCs exhibited a stronger capacity to stimulate autologous CD56+ Vγ9γδT cells highly producing IFNγ in the presence of zoledronate and IL-2. The CD56high+ IFN-DCs possessing HLA-A*0201 effectively induced Mart-1-modified melanoma peptide (A27L)-specific CD8+ T cells through preferential expansion of CD56+ Vγ9γδT cells in the presence of A27L, zoledronate and IL-2. Vaccination with CD56high+ IFN-DCs copulsed with tumor antigens and zoledronate may orchestrate the induction of various CD56+ immune cells possessing high effector functions, resulting in strong immunological responses against tumor cells. This study may be relevant to the design of future clinical trials of CD56high+ IFN-DCs-based immunotherapies for patients with melanoma. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Murakami T.,Chiba Cardiovascular Center |
Niwa K.,Chiba Cardiovascular Center |
Yoshinaga M.,National Hospital Organization Kagoshima Medical Center |
Nakazawa M.,Southern Tohoku General Hospital
International Journal of Cardiology | Year: 2012
Background: Despite the recent progress of cardiac surgery, the indications for surgical intervention during the active phase of infective endocarditis have not yet been established in patients with congenital heart diseases due to the limited number of such patients. The present study aims to determine the surgical indications for active infective endocarditis in congenital heart diseases. Methods: A retrospective observational cohort multi-center study on infective endocarditis with congenital heart diseases was conducted from January 1997 to December 2001 in Japan and 239 patients were registered. Sixty-one (26%) of the 239 patients had undergone surgical therapy for active infective endocarditis, which was defined as cardiac surgery during administration of intravenous antibiotics. Results: There were 7 deaths (11%). A univariate regression analysis revealed that the factors significantly associated with the need for surgical intervention for active IE were the lack of diagnosis of cardiac disorders before the onset of infective endocarditis, aortic valve infective endocarditis, perivalvular abscess, presence of heart failure, and change of antibiotics. A stepwise logistic regression analysis revealed that the presence of a perivalvular abscess, heart failure and a change in the antibiotics were independent determinant factors for the need for surgical treatment of active infective endocarditis in patients with congenital heart diseases. Conclusions: Surgery should therefore be considered even during the active phase in patients with congenital heart diseases and infective endocarditis, when they develop associated with heart failure, a perivalvular abscess, or the need for a change in antibiotics. © 2010 Elsevier Ireland Ltd. All rights reserved.
Midorikawa H.,Southern Tohoku General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2011
For the improvement in the clinical results of open stent-grafting, the development of a device system and prevention of spinal cord injury are important. For that reasons, we devised 2 methods for the open stent-grafting with the Matsui-Kitamura (MK) stent. First, the applicator using transesophagial echo transducer cover made insertion of the stent-graft system easy and safe. Next, to prevent ischemic spinal injury and protect major abdominal organ, blood return to lower body was established from femoral artery with occluding the stent graft by balloon. However, these procedures might need to examine whether it really contributes to the improvement in the clinical results.
Enomoto J.,Toyo University |
Nakazawa M.,Southern Tohoku General Hospital
Circulation Journal | Year: 2014
Background. Improvements in life expectancy among adults with congenital heart disease (ACHD) provide them with unique challenges throughout their lives and age-related psychosocial tasks in this group might differ from those of healthy counterparts. This study aimed to clarify age-related differences in psychosocial functioning in ACHD patients and determine the factors influencing anxiety and depression.Methods and Results. A total of 133 ACHD patients (aged 20–46) and 117 reference participants (aged 20–43) were divided in 2 age groups (20 s and 30 s/40 s) and completed the Hospital Anxiety and Depression Scale, IndependentConsciousness Scale, and Problem-Solving Inventory. Only ACHD patients completed an illness perception inventory. ACHD patients over 30 showed a significantly greater percentage of probable anxiety cases than those in their 20 s and the reference group. Moreover, ACHD patients over 30 who had lower dependence on parents and friends, registered higher independence and problem-solving ability than those in their 20 s, whereas this element did not vary with age in the reference participants. Furthermore, ACHD patients may develop an increasingly negative perception of their illness as they age. The factors influencing anxiety and depression in patients were aging, independence, problem-solving ability, and NYHA functional class.Conclusions. Although healthy people are psychosocially stable after their 20 s, ACHD patients experience major differences and face unique challenges even after entering adulthood. © 2014, The Japanese Circulation Society