Multichannel monitoring of cerebral circulatory and oxygenation status using optical topography during deep hypothermic retrograde cerebral perfusion.

In this study, we evaluated changes in the cerebral circulatory and oxygenation status during deep hypothermic total circulatory arrest (TCA) and retrograde cerebral perfusion (RCP) using optical topography, a form of multichannel near-infrared spectrophotometry, to monitor the broad area perfused by the middle cerebral artery. Seven patients underwent thoracic aortic surgery with TCA and RCP via the superior vena cava. Pressure-regulated RCP was performed under pH-stat.

Seasonal changes of serum 25-hydroxyvitamin D and intact parathyroid hormone levels in a normal Japanese population.

We conducted an observational study in order to assess the prevalence of hypovitaminosis D and its seasonal changes, in the Tokai area (N35.3 E137.0), in 197 normal subjects in Japan.

Beneficial effect of acute normovolemic hemodilution in cardiovascular surgery.

Objective: The efficacy of acute normovolemic hemodilution (ANH) in avoiding homologous blood transfusion (HBT) during cardiovascular surgery remains controversial. Our objective was to evaluate the impact of ANH on blood transfusion requirements during open cardiovascular surgery using cardiopulmonary bypass (CPB).

Methods: We retrospectively reviewed 243 patients who had undergone open cardiac or thoracic aortic surgery using CPB between September 2001 and July 2003 in our department.

Alternatives to the double vena cava method in partial liver transplantation.

Minimizing graft congestion in partial liver transplantation is important, especially when the graft weight is marginal for the recipient metabolic demand. We prefer the double vena cava technique for reconstructing middle hepatic vein tributaries with thick, short hepatic veins because the technique can reduce the warm ischemic time of the graft and make a wide anastomosis. This technique requires a cryopreserved superior or inferior vena cava.

Human umbilical cord blood cells improve cardiac function after myocardial infarction.

Human umbilical cord blood (UCB) contains an abundance of immature stem/progenitor cells and has been clinically used as an alternative to bone marrow transplantation. In addition, cord blood can be obtained non-invasively, in contrast to invasive bone marrow aspiration. We investigated the potential of human UCB CD34(+) cells to improve cardiac function following myocardial infarction.

[Survey on the threshold for platelet transfusions].

We carried out a survey on platelet transfusions performed in nine general hospitals. We evaluated 303 adults who received a total of 24455 units over 1864 platelet transfusions. The underlying diseases were hematologic disorders with chemotherapy (59.

Effect of preoperative transbronchial biopsy on prognosis of non-small cell lung cancer.

The aim of this study was to examine the hypothesis that post-surgical prognosis of patients with non-small cell lung cancer (NSCLC) proven by preoperative transbronchial biopsy (TBLB) was inferior to that of patients with NSCLC determined at time of surgery. Patients with NSCLC undergoing complete resection were divided into two groups. Group 1: pathologic diagnosis determined by TBLB consisting of 335 cases, and Group 2 where TBLB was unsuccessful and exploratory thoracotomy or thoracoscopy was followed by surgical resection, consisting of 186 cases.

Cardioprotection afforded by ischemic preconditioning interferes with chronic beta-blocker treatment.

Objectives: The efficacy of ischemic preconditioning of the heart has remained controversial. We investigated whether chronic treatment with beta-blockers affects the ischemic preconditioning in the isolated rat heart model.

Design: Wistar rats were treated with propranolol (50 mg/kg/day, p.

Usefulness of intraoperative color doppler ultrasonography in decision making regarding conversion of an accessory hepatic vein after a Fontan-type operation.

An accessory hepatic vein (AHV) after a Fontan-type operation will result in progressive desaturation if left intact. We report a case in which intraoperative color Doppler ultrasonography revealed the absence of AHV flow and reversed portal vein flow when the AHV was clamped, suggesting that simple ligation of the AHV would lead to liver dysfunction in the area affected. Based on the results of the ultrasonography evaluations, diversion of the AHV into the pulmonary circulation was performed without cardiopulmonary bypass, and the clinical outcome has been favorable.

The angiotensin II type 1 receptor blocker valsartan attenuates graft vasculopathy.

Objective: Transplant arteriosclerosis remains the major cause of graft failure after cardiac transplantation. Here, we investigated the effects of the angiotensin II type 1 receptor blocker valsartan on the development of transplant arteriosclerosis in a murine model of cardiac transplantation.

Methods: Hearts from DBA/2 (H-2(d)) mice were heterotopically transplanted into B10.

Reevaluation of histomorphometric analysis of lung tissue in decision making for better patient selection for fontan-type operations.

Background: The various types of cavopulmonary connection are occasionally unsuccessful even when the indications have been strictly fulfilled based on preoperative hemodynamic studies. We performed a detailed study of lung specimens from 60 patients who were judged to be candidates for the modified Fontan procedures based on a catheterizaton study in order to reevaluate the role of histologic studies of the pulmonary vasculature and to determine histologic criteria for the Fontan-type operation.

Methods: We performed a histomorphometric analysis of specimens from 53 biopsy and 7 autopsy cases (0.

Thoracic surgery residency program and health care system in the United States.

The Japanese Board of General Surgery as well as the Japanese Board of Thoracic Surgery voted to change the educational and training requirements for certification eligibility. The health care system has been modified due to a reduction of the budget for national health care, such as introduction of Diagnosis Related Groups (DRG)/Prospective Payment System (PPS). Several problems regarding the system have already been discussed in the United States, ranging from 30-year experience of residency program to 20-year experience of health care system.

Hypoplasia of the small pulmonary arteries in hypoplastic left heart syndrome with restrictive atrial septal defect.

Background: Restrictive atrial septal defect (ASD) (including intact atrial septum [IAS]) has been reported to be a risk factor that negatively impacts survival in hypoplastic left heart syndrome (HLHS). Although lymphangiectasia and "arterialization" of the veins of the lung in HLHS with restrictive ASD have been reported, they cannot fully explain the high mortality. We have introduced a new method of evaluating the development of the pulmonary vasculature in histological sections and used it to assess patients' lungs.

[Acute type A aortic dissection].

Background: Current surgical results for acute type A aortic dissection has been getting better, though the mortality rate still remains high, up to 10-15% in Japan. Our strategy consists of #1 make the most use of echography for better understanding of hemodynamics; #2 the extent of replacement depends on the site of initial entry; #3 deep hypothermic circulatory arrest and retrograde cerebral perfusion for brain protection.

Patients And Methods: Between January 2000 and December 2003, 45 consecutive patients were treated.

Epicardial pulmonary vein isolation with a hook-shaped cryoprobe to treat atrial fibrillation.

Purpose: After it was shown that a rapidly firing focus in a pulmonary vein (PV) can cause atrial fibrillation, percutaneous endocardial PV isolation using radiofrequency began to be used as a method of treatment. However, this technique is time consuming. It requires fluoroscopy and contrast media to identify the PV, and cardiac tamponade and PV obstruction are major complications.

The limiting factors for the transxiphoid approach in congenital cardiac surgery.

Objective: Minimally invasive cardiac surgery is currently being performed for a wide variety of cardiothoracic procedures. Since August 1998, the transxiphoid approach using a direct cannulation to the ascending aorta has been selected for the closure of atrial septal defects (ASD) and ventricular septal defects (VSD) in our institution. However, this approach cannot be performed for all patients because of the small "xiphoid window.

[Aortic root replacement using an allograft for active infective endocarditis with periannular abscess: single center experience].

Objectives: Results of aortic root replacement using an allograft for active infective endocarditis in the aortic position and periannular abscess were studied.

Methods: Aortic root replacement using a cryopreserved aortic allograft was performed 13 times in 12 patients (9 men, 3 women, mean age 52.8 years) at Saitama Medical School.

Three-dimensional echocardiography-guided atrial septectomy: an experimental study.

Objectives: The surgical feasibility of beating-heart atrial septectomy under the guidance of two different types of real-time 3-dimensional echocardiography systems was examined.

Methods: A modified real-time 3-dimensional echocardiography system with a x4 matrix transducer (Sonos 7500; Philips Medical Systems, Andover, Mass) or a mechanical 1-dimensional array transducer (SSD-5500; Aloka Co, Ltd, Tokyo, Japan) was used. Small porcine atrial septal defects (n = 8) were enlarged with a Kerrison bone punch in the tank model.

Successful treatment of ascending aortic graft infection after operation for acute aortic dissection with peripheral malperfusion.

Mediastinitis with infection of an ascending aortic graft is hard to heal and is a highly fatal complication. We had a patient in whom mediastinitis with infection of such a graft as well as an ascending aorta-femoral artery bypass graft developed after the initial operation for type A aortic dissection accompanied by peripheral malperfusion. We treated it successfully by inserting a stent into the true lumen of the thoracoabdominal aorta and using a cryopreserved homograft to replace the infected ascending aortic fabric graft.

Monitoring of urinary acrolein concentration in patients receiving cyclophosphamide and ifosphamide.

Acrolein, the metabolite of cyclophosphamide and ifosphamide, irritates mucous membranes and is considered pathogenetically important in hemorrhagic cystitis. Increasing fluid intake or administering sodium 2-mercaptoethanesulfonate (mesna), a thiol compound, can reduce the risk of this complication. We measured urinary acrolein concentrations using headspace-solid-phase microextraction gas chromatography and mass spectrometry (headspace-SPME-GC-MS) in 19 patients receiving cyclophosphamide and ifosphamide (36 occasions).

Neurocognitive outcome after retrograde cerebral perfusion.

Background: Neurocognitive outcome in patients undergoing thoracic aortic surgery using retrograde cerebral perfusion (RCP) remains uncertain.

Methods: Forty-two patients undergoing thoracic aortic surgery using RCP were enrolled in the study. The patients' neurocognitive state was assessed by the revised Wechsler Adult Intelligence Scale (WAIS-R) a few days before operation, at 2 to 3 weeks, and at 4 to 6 months after operation.

Pseudoaneurysm developed after aortic root homograft implantation.

A 55-year-old man with severe infective endocarditis underwent aortic root replacement using a homograft concomitant with saphenous vein grafting to the left anterior descending artery. The patient developed angina due to stenosis of the proximal anastomosis of the vein graft accompanied by a 2-cm pseudoaneurysm. This complex lesion was successfully managed with urgent coronary artery bypass surgery through a left thoracotomy, followed by a redo replacement of the old aortic homograft.

[Novel strategy for spinal cord protection during thoracoabdominal aortic aneurysm surgery using Doppler ultrasonography].

Paraplegia remains one of the most serious complications after thoracoabdominal aortic aneurysm surgery. Spinal cord ischemia during the operation is thought to be the most important contributor to the development of this neurological deficit. So, it is important to preserve or reconstruct the critical segmental arteries for spinal cord protection.