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Find video protocols related to scientific articles indexed in Pubmed.
Hepatic resection for hepatocellular carcinoma in super-elderly patients aged 80 years and older in the first decade of the 21st century.
Surg. Today
PUBLISHED: 08-13-2014
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We evaluated the preoperative and postoperative characteristics and prognosis of super-elderly patients with hepatocellular carcinoma (HCC).
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Successful surgical treatment of traumatic transection of the innominate artery: a case report.
Ann Vasc Dis
PUBLISHED: 03-14-2014
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Blunt traumatic injury to the innominate artery is relatively rare. We present the case of a 40-year-old woman who fell from a fourth-floor window and was transferred to our hospital with multiple injuries, hemodynamic shock, and disturbance of consciousness. Computed tomography with image reconstruction revealed transection of the innominate artery near its origin. Emergent surgery required establishment of cardiopulmonary bypass before sternotomy in preparation for uncontrollable hemorrhage. Proximal aortic arch replacement with a branch to the right axillary artery was successfully performed using circulatory arrest and selective cerebral perfusion.
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Pulmonary Sequestration Presenting Elevated CA19-9 and CA125 with Ovarian Cysts.
Ann Thorac Cardiovasc Surg
PUBLISHED: 03-04-2014
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A 41-year-old woman was evaluated because of elevated serum levels of the tumor markers CA19-9 and CA125. Whole-body examination revealed an intralobar pulmonary sequestration in the right lower lobe and bilateral cystic ovarian tumors (right: 20 mm, left: 60 mm in diameter, respectively). The left ovarian cyst was resected and diagnosed as an endometrioma. The right ovarian cyst was preserved because of its small size. However, the tumor marker levels remained elevated postoperatively. S10 segmentectomy of the right lung was subsequently performed. Immunohistochemical examination of the sequestrated lung demonstrated positive staining for CA19-9 in the bronchial and alveolar epithelia and mucus. After the pulmonary resection, the CA19-9 and CA125 levels decreased to their normal ranges.
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Myristoylated alanine-rich C-kinase substrate as a prognostic biomarker in human primary lung squamous cell carcinoma.
Cancer Biomark
PUBLISHED: 11-19-2013
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To identify novel biomarkers for the diagnosis and prognosis of human primary lung squamous cell carcinoma (SCC), we compared the spectrum of proteins expressed in SCC and in the adjacent non-cancer tissue, using QSTAR Elite liquid chromatography with tandem mass spectrometry (LC-MS/MS), coupled with iTRAQ technology. We identified 410 proteins differentially expressed in more than 75% of patients, and validated the expression of candidate target proteins by immunohistochemistry. Based on the results of LC-MS/MS, Ingenuity Pathway Analysis and immunohistochemical analyses, myristoylated alanine-rich C-kinase substrate (MARCKS) (upregulated 2.28-fold, p< 0.005) was selected as a potential biomarker of human lung SCC. In order to evaluate the association between patient prognosis and the expression of candidate biomarkers, univariate survival analysis was performed with disease-specific survival curves according to the Kaplan-Meier method, and differences in survival were assessed with the log-rank test. Immunohistochemical evaluation of MARCKS in 99 patients with lung SCC revealed a significant association between positive expression and poor prognosis compared with patients with negative expression (log-rank test; p=0.024). These results indicate that MARCKS may represent a potential biomarker for the prognosis of primary lung SCC.
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Does rich coronary collateral circulation distal to chronically occluded left anterior descending artery compete with graft flow?
Interact Cardiovasc Thorac Surg
PUBLISHED: 08-19-2013
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In coronary artery bypass grafting (CABG), graft flow distal to a mild stenosis can compete with relatively preserved native flow through the stenosis and the competition can result in graft stenosis. In chronic total occlusion (CTO), coronary collateral circulation, which is essential to maintain myocardial viability distal to CTO, varies in extent among patients and the extent can be scored by Rentrop grade in coronary angiography. We investigated whether rich collateral circulation distal to CTO competes with distally anastomosed graft flow in association with Rentrop grade.
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Complexin-2 (CPLX2) as a potential prognostic biomarker in human lung high grade neuroendocrine tumors.
Cancer Biomark
PUBLISHED: 08-06-2013
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The present study aimed to identify novel useful clinical biomarker of high grade lung neuroendocrine tumors (LNETs). Based on the results of QSTAR LC-MS/MS analysis, we selected complexin-2 (CPLX2) (upregulated 8.7-fold) as a potential biomarker in high grade human LNETs, and validated its expression immunohistochemically in comparison with non-small cell lung carcinomas (NSCLCs). CPLX2 was strongly positive in 16.3% of examined LNETs, but completely negative in all adjacent non-cancerous tissues and NSCLCs. Importantly, positive CPLX2 expression was associated with lymph vessel invasion (P=0.016), pathological stage (P=0.031), and poor disease-specific survival (P=0.004) of patients with LNETs. Preoperative serum CPLX2 level measured by ELISA was significantly elevated in high grade LNETs as compared with %NCs non-cancer controls (NCs) (P=0.002) and NSCLCs (P< 0.001). Receiver operating characteristic (ROC) curve analysis was used for separating high-grade LNET patients from NSCLC patients. The area under the ROC curve (AUC) was 0.825. The calculated optimal cut-off point for CPLX2 level in the serum was 17.8 pg/ml (Youden index=0.591), while sensitivity and specificity was 94.1% and 65.0%, respectively. CPLX2 is suggested as a novel potential clinically useful biomarker for the diagnosis, prognosis and adequate choice of therapy for patients with high grade LNETs.
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Clinicopathological significance of combined analysis of cytokeratin19 expression and preoperative serum CYFRA21-1 levels in human lung squamous cell carcinoma.
Osaka City Med J
PUBLISHED: 08-06-2013
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To identify a useful biomarker for human lung squamous cell carcinoma (SCC), the expression of cytokeratin19 (CK19) in human SCC tissue was investigated. In addition, we examined the significance of CK19 expression levels by immunostaining and CYFRA21-1 levels in preoperative serum, and their correlation with the clinicopathologic features of human lung SCC.
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Is elimination of cardiotomy suction preferable in aortic valve replacement? Assessment of perioperative coagulation, fibrinolysis and inflammation.
Interact Cardiovasc Thorac Surg
PUBLISHED: 05-31-2013
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Guidelines recommend the avoidance of direct return of pericardial blood based on evidence from coronary surgery. A continuous auto-transfusion system (CATS) can be a good alternative to cardiotomy suction by reinfusing aspirated pericardial blood without the necessity of intermittent collection. To clarify the effects of direct return of pericardial blood in aortic valve replacement (AVR), we compared the effects of cardiotomy suction and an alternative CATS on perioperative coagulofibrinolysis and inflammation systems, and clinical outcomes.
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[Axillo-axillary bypass for coronary-subclavian steal syndrome].
Kyobu Geka
PUBLISHED: 05-16-2013
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We describe a case of coronary-subclavian steal syndrome in a 77-year-old man who presented with progressive coronary ischemia 8 years after coronary artery bypass grafting with an in-situ left internal thoracic artery graft. Coronary and left subclavian artery angiogram revealed completely patent internal thoracic artery graft and 90% stenosis in the proximal left subclavian artery. We performed axilloaxillary artery bypass using expanded polytetrafluoroethylene (ePTFE)[8 mm] graft. No coronary ischemia was noted postoperatively. Axillo-axillary artery bypass grafting was effective for coronary subclavian steal syndrome.
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Sialyl Lewis X as a predictor of skip N2 metastasis in clinical stage IA non-small cell lung cancer.
World J Surg Oncol
PUBLISHED: 04-17-2013
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Radical segmentectomy has been performed for small-sized non-small cell lung cancer (NSCLC). However, underestimation of mediastinal lymph node metastasis in the absence of hilar or interlobar metastasis (skip N2) affects surgical strategy. Our aim was to investigate preoperative and intraoperative predictors of skip N2 in clinical stage (c-stage) IA NSCLC.
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Aortoesophageal Fistula after Endovascular Repair for Aberrant Right Subclavian Artery Aneurysm.
Ann Thorac Cardiovasc Surg
PUBLISHED: 03-23-2013
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A 76-year-old woman with malignant rheumatic arthritis developed dysphagia and hoarseness secondary to an aberrant right subclavian artery aneurysm. We performed a hybrid endovascular repair with concomitant surgical treatment for the aberrant right subclavian artery aneurysm. One month after discharge, she was emergently admitted to our hospital because of chest pain and fever. We diagnosed aortoesophageal fistula and stent graft infection based on computed tomography, gallium scintigraphy, and esophagoscopy results. Esophagectomy, elimination of the infected stent graft, and muscle plombage were performed during several surgeries. However, she died of hemorrhagic shock secondary to an aortobronchial fistula.
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Adding coronary artery bypass grafting to aortic valve replacement increases operative mortality for elderly (70 years and older) patients with aortic stenosis.
Gen Thorac Cardiovasc Surg
PUBLISHED: 03-01-2013
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This retrospective study aimed to determine the effect of simultaneous aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) on operative outcomes and long-term survival in elderly patients with a high prevalence of comorbidity.
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Preoperative Increasing C-reactive Protein Affects the Outcome for Active Infective Endocarditis.
Ann Thorac Cardiovasc Surg
PUBLISHED: 02-15-2013
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Purpose: This study aimed to determine if preoperative time course changes in serum C-reactive protein (CRP) levels can predict clinical outcome of surgical intervention for active infective endocarditis. Methods: Surgically treated patients (n = 109) with active infective endocarditis were reviewed retrospectively. We divided the patients into 2 subgroups according to preoperative transition of increasing or decreasing serum CRP levels, and performed a comparative study. The increasing CRP group included 29 patients and the decreasing CRP group included 80 patients. Results: There were more patients with methicillin-resistant Staphylococcus aureus and New York Heart Association functional class IV in the increasing CRP group. Hospital mortality was signifi cantly higher in the increasing CRP group (34.5%) than that in the decreasing CRP group (5.0%) (p <0.05). In multivariate analysis, 3 signifi cant risk factors of surgical outcome were identifi ed: a tendency for increasing preoperative CRP levels (odds ratio [OR]: 18.15, 95% confi dence interval [CI]: 1.03-320.78), nosocomial infective endocarditis (OR: 18.73, 95% CI: 1.57-223.60), and dialysis (OR: 1025.46, 95% CI: 2.89-363587.12). Conclusion: The outcome of operations for patients with increasing preoperative CRP levels is poor. For treatment of active infective endocarditis, a better operative result is expected when preoperative CRP levels are decreasing.
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Preoperative serum value of sialyl Lewis X predicts pathological nodal extension and survival in patients with surgically treated small cell lung cancer.
J Surg Oncol
PUBLISHED: 08-22-2011
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We investigated various tumor markers in patients with surgically treated small cell lung cancer (SCLC) to identify the markers closely correlated to pathological staging and to predict survival by retrospective analyses.
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Pulmonary resection for lung cancer with impaired pulmonary function due to severe spinal deformity: report of a case.
Surg. Today
PUBLISHED: 05-28-2011
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A 58-year-old man underwent surgery for the treatment of lung adenocarcinoma at our hospital. He had a history of spinal caries at the age of 3 and frequent recurrent asthma-like symptoms thereafter. Chest plain radiography revealed an irregularly shaped mass in the left hilum and a thoracic cage severely deformed by kyphosis. A pulmonary function test demonstrated a severe restrictive ventilation pattern. He underwent a left upper lobectomy without mediastinal dissection. His asthma-like symptoms were exacerbated by difficulty in expectoration of sputum for several days after surgery, but the symptoms disappeared without any medical care. Dyspnea, hemoptysis, and intrathoracic hemorrhage were observed on the 8th postoperative day. Computed tomography revealed torsion of the residual left lower lobe, but the symptoms spontaneously disappeared in a week. The patient had complained of frequent coughing and mild dyspnea on exertion for years, but his quality of life was unchanged after the lobectomy. Bone metastasis was detected 3 years after the surgery, and the patient then underwent chemotherapy. However, he died of the disease 4 years 2 months after the surgery.
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Increase in preoperative serum reactive oxygen metabolite levels indicates nodal extension in patients with clinical stage I lung adenocarcinoma.
Gen Thorac Cardiovasc Surg
PUBLISHED: 05-06-2011
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Reactive oxygen species contribute to various features of malignant tumors, including carcinogenesis, aberrant growth, metastasis, and angiogenesis. Investigation of serum oxidative stress levels may predict the tumors condition, including malignant and metastatic potential.
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PlGF repairs myocardial ischemia through mechanisms of angiogenesis, cardioprotection and recruitment of myo-angiogenic competent marrow progenitors.
PLoS ONE
PUBLISHED: 04-25-2011
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Despite preclinical success in regenerating and revascularizing the infarcted heart using angiogenic growth factors or bone marrow (BM) cells, recent clinical trials have revealed less benefit from these therapies than expected.
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Evaluation of risk factors for hospital mortality and current treatment for poststernotomy mediastinitis.
Gen Thorac Cardiovasc Surg
PUBLISHED: 04-12-2011
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Poststernotomy mediastinitis (PSM) following cardiovascular surgery remains an intractable complication associated with considerable mortality. It is therefore necessary to assess the risk factors associated with hospital mortality and evaluate the surgical treatment options for PSM.
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Preoperative serum oxidative stress marker as a strong indicator of nodal involvement in clinical stage I lung adenocarcinoma.
Int. J. Clin. Oncol.
PUBLISHED: 04-05-2011
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Reactive oxygen species stimulate lymphatic metastasis by accelerating epithelial-to-mesenchymal transition and lymphangiogenesis in the tumor microenvironment. Hence, systemic oxidative stress level may correlate with nodal involvement in patients with a malignant tumor.
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Relation of aortic arch complex plaques to risk of cerebral infarction in patients with aortic stenosis.
Am. J. Cardiol.
PUBLISHED: 03-26-2011
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Aortic stenosis (AS) and systemic atherosclerosis have been shown to be closely related. We evaluated the prevalence of aortic arch plaques and their possible association with the risk of cerebral infarction in patients with severe AS. Transesophageal echocardiography was performed in 116 patients with severe AS (55 men, mean age 71 ± 7 years, mean aortic valve area 0.68 ± 0.15 cm(2)) who were scheduled for aortic valve replacement. The presence, thickness, and morphology of the aortic arch plaques were evaluated using transesophageal echocardiography. Cerebral infarcts (chronic cerebral infarction and cerebral infarction after cardiac catheterization and aortic valve replacement) were assessed in all patients. Compared to age- and gender-matched control subjects, the patients with severe AS had a significantly greater prevalence of aortic arch plaques (74% vs 41%; p <0.0001) and complex arch plaques such as large plaques (?4 mm), ulcerated plaques, or mobile plaques (30% vs 10%; p = 0.004). Multivariate logistic analyses showed that the presence of complex arch plaques was independently associated with cerebral infarction in patients with AS after adjusting for traditional atherosclerotic risk factors and coronary artery disease (odds ratio 8.46, 95% confidence interval 2.38 to 30.12; p = 0.001). In conclusion, the results from the present study showed that there is a greater prevalence of aortic arch plaques in patients with AS and that the presence of complex plaques is independently associated with cerebral infarction in these patients. Therefore, the identification of complex arch plaques using transesophageal echocardiography is important for risk stratification of cerebrovascular events in patients with severe AS.
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Aortic valve translocation for treatment of a deteriorated stentless valve.
Eur J Cardiothorac Surg
PUBLISHED: 01-25-2011
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A 54-year-old woman was admitted to our hospital with recurrent chest pain for 1 month. She had a history of aortic root replacement with a stentless valve following aortic valve replacements done twice 12 years ago, and coronary artery bypass grafting 6 years ago. The stentless valve was implanted with the full-root technique. After admission, she was diagnosed with a saphenous vein graft aneurysm in the proximal anastomotic site and severe aortic regurgitation due to stentless valve deterioration. These lesions were successfully treated using aortic valve translocation. The advantage of this procedure is that it avoids dissection and removal of the stentless valve implanted using the full-root technique. Aortic valve translocation can be one of useful alternatives for stentless valve reoperation.
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[Hybrid repair of thoracoabdominal aortic aneurysm in high-risk patients using a quadrifurcated graft].
Kyobu Geka
PUBLISHED: 01-15-2011
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Surgical treatment for thoracoabdominal aortic aneurysm is still challenging and is associated with a high risk of paraplegia. Hybrid repair with stent graft insertion for the thoracoabdominal aorta excluding the branches of the lumbar and visceral arteries and bypass grafting to the visceral branches has been introduced as a less invasive treatment that reduces the risk of paraplegia. For hybrid repair, it is important to have appropriate management of the revascularized grafts to the 4 visceral arteries with sufficient inflow. We have recently adopted a knitted quadrifurcated graft applied inversely from the abdominal aorta or the iliac artery to the 4 visceral arteries; the celiac, superior mesenteric, and bilateral renal arteries. To date, we have used the graft in hybrid repair of thoracoabdominal aortic aneurysm in 2 high-risk elder patients who had disseminated intravascular coagulopathy and severe renal failure, respectively. We found that a knitted quadrifurcated graft was easy to handle and useful for reducing the number of anastomoses, which were expected to shorten the operation time. Postoperative courses were uneventful without paraplegia in either patient. Postoperative computed tomography showed excellent patency of the inversely applied quadrifurcated graft without any endoleak or migration in the thoracoabdominal stent. In conclusion, revascularization of 4 visceral arteries using a quadrifurcated graft should be considered a preferable option in hybrid treatment for thoracoabdominal aortic aneurysm.
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Serum AGR2 as an early diagnostic and postoperative prognostic biomarker of human lung adenocarcinoma.
Cancer Biomark
PUBLISHED: 01-01-2011
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In the present study, the human orthologue of the secreted Xenopus laevis anterior gradient 2 (AGR2) protein was evaluated as a potential serum biomarker of lung adenocarcinoma. AGR2 protein levels were preoperatively measured in the serum of 111 primary lung adenocarcinoma patients and in 46 non-cancer controls with subsequent calculation of sensitivity and specificity in comparison with serum CEA levels. Correlations with clinicopathological variables were also assessed and survival analyses were performed according to the Kaplan-Meier method and differences determined with the log-rank test. The mean serum AGR2 level of lung adenocarcinoma patients in each stage, even Stage I, was significantly higher than in non-cancer controls (P < 0.001 for all stages, Mann-Whitney U test). The sensitivity was 65.8% (52.9% for stage IA), even higher than that of CEA, which was 45.0% (29.4% for stage IA), and the specificity was 87.0% according to the ROC curve (AUC=0.858). Positive serum AGR2 expression was significantly associated with the incidence of recurrence after surgery (P=0.025) and with a poor prognosis (P=0.037 for overall survival and P=0.004 for disease-free survival). Preoperative serum AGR2 might become a clinically useful biomarker for early detection, prediction of recurrence and prognosis with lung adenocarcinomas.
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Lung metastases from various malignancies combined with primary lung cancer.
Gen Thorac Cardiovasc Surg
PUBLISHED: 10-13-2010
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Various tumors metastasize to the lung, and they are often detected as multiple nodules. We report on two cases of such multiple lung metastases combined with primary lung cancer: a myxoid liposarcoma in the right thigh and a colon cancer. In each case, a pulmonary metastasectomy revealed that one of the tumors was primary lung cancer. Regardless of recent advances in computed tomography for detecting small pulmonary nodules and ground-glass opacity components, which indicate possible primary lung cancer, the preoperative differential diagnosis for either metastatic or primary lung cancers is usually difficult because they are too small to obtain enough tissue for diagnosis, except by surgery. When nodules are removed and diagnosed as lung metastasis combined with primary lung cancer, additional treatment should be considered depending on the prognosis of each disease.
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Right subclavian artery aneurysm: report of a case.
Osaka City Med J
PUBLISHED: 10-07-2010
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A subclavian artery aneurysm is relatively rare in comparison with other peripheral aneurysms. Surgical repair should be considered regardless of size and location, because thromboembolism or rupture can occur when a small aneurysm is untreated. We describe the management and surgical treatment in a patient with a right subclavian artery aneurysm. Surgical repair included the ligation of the right vertebral artery and reconstruction of the subclavian artery through an upper partial median sternotomy with right supraclavicular extension. Successful repair of the aneurysm was accomplished and the patients postoperative course was uneventful with no medication.
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Considerations in timing of surgical intervention for infective endocarditis with cerebrovascular complications.
J. Heart Valve Dis.
PUBLISHED: 06-30-2010
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The timing of the surgical intervention for active infective endocarditis (IE) is particularly difficult when there is a cerebrovascular complication. The study aim was to investigate the results of surgical treatment for active IE in patients with recent cerebrovascular events, and to evaluate the relationship between the size of cerebral infarction and timing of the surgical intervention.
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Coadministration of carvedilol attenuates nitrate tolerance by preventing cytochrome p450 depletion.
Circ. J.
PUBLISHED: 06-22-2010
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Long-term administration of nitroglycerin (NTG) causes tolerance secondary to increased vascular formation of reactive oxygen species. Carvedilol, which has potent antioxidant activity in addition to functioning as an adrenergic blocker, prevents nitrate tolerance by a still to be elucidated mechanism. The present study investigated how carvedilol attenuates nitrate tolerance, particularly with reference to cytochrome P450 (CYP), an enzyme involved in the development of tolerance.
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Single-incision laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: an initial report.
Surg Endosc
PUBLISHED: 05-14-2010
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This report describes the first use of single-incision, two-port access for single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) to manage inguinal hernia in children.
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Simultaneous surgery for chronic aortic dissection and adrenal adenoma with primary aldosteronism.
Gen Thorac Cardiovasc Surg
PUBLISHED: 05-07-2010
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A 38-year-old man had Stanford type B chronic aortic dissection. Blood pressure was difficult to control, and further examination revealed primary aldosteronism. Magnetic resonance images showed a 1-cm nodule in the left adrenal gland. Graft replacement for aortic dissection under extracorporeal circulation and resection of the left adrenal gland were undertaken simultaneously. The postoperative course was uneventful, and blood pressure was controlled without antihypertensive drugs.
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Carbon monoxide-releasing molecule CORM-3 suppresses vascular endothelial cell SOD-1/SOD-2 activity while up-regulating the cell surface levels of SOD-3 in a heparin-dependent manner.
Free Radic. Biol. Med.
PUBLISHED: 04-28-2010
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The role of CO in the modulation of antioxidant enzyme function has not been investigated, yet. In this study we assessed the effects and potential mechanisms of the ruthenium-based water-soluble CO-releasing molecule CORM-3 in the modulation of superoxide dismutase (SOD) activity/binding in vascular endothelial cells (HUVECs). To this end, HUVECs were treated with CORM-3 (100 ?M) and assessed for total SOD activity in cell lysates (cell-associated SOD activity) and cell culture supernatants (soluble SOD). In parallel, release/binding of extracellular SOD (SOD-3) in the absence or presence of heparin (1-10 IU/ml), a key factor regulating SOD-3 cell-surface binding, was investigated. In addition, the effects of CORM-3 on the modulation of purified SOD-1 and SOD-2 activity in a cell-free system were also assessed. The results obtained indicate that CORM-3 effectively suppresses the activity of both purified SOD-1 and SOD-2. These findings were accompanied by CORM-3-dependent attenuation of total cell-associated SOD activity (without affecting SOD-1/SOD-2 protein expression) and a subsequent increase in ROS production (DHR123 oxidation) in HUVECs. In parallel, a concomitant increase in soluble-SOD activity (due to increased SOD-3 release from the cell surface) was observed in the cell culture supernatants. However, in the presence of heparin, total cell-associated SOD activity was significantly increased by CORM-3, because of increased binding of SOD-3 to HUVECs. Taken together these findings indicate for the first time that CORM-3 modulates both the activity of intracellular SOD (i.e., SOD-1 and SOD-2) and the binding of extracellular SOD (SOD-3) to the cell surface.
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Identification and validation of DNA methylation markers to predict lymph node metastasis of esophageal squamous cell carcinomas.
Ann. Surg. Oncol.
PUBLISHED: 04-19-2010
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The presence of lymph node metastasis in esophageal squamous cell carcinoma (ESCC) patients is a critical factor for decision of treatment strategy. However, there have been no molecular markers to assess lymph node metastasis. In this study, we aimed to identify CpG islands (CGIs) whose DNA methylation statuses are associated with the presence of lymph node metastasis.
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Platypnea-orthodeoxia diagnosed by sitting transesophageal echocardiography.
Ann. Thorac. Surg.
PUBLISHED: 03-27-2010
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Platypnea-orthodeoxia is a rare syndrome presenting with dyspnea and cyanosis induced by an upright position and relieved by recumbency. We report a patient with an excessively enlarged aortic root who had critical hypoxia due to a paradoxical shunt through the patent foramen ovale only when seated. The postural changes of the shunt, caused by changes in posture, were dynamically detected by transesophageal Doppler echocardiography. We believe that this syndrome should be considered when patients with aortic root dilatation present with inexplicable hypoxia, and that transesophageal Doppler echocardiography in the sitting position can be useful for detecting platypnea-orthodeoxia syndrome.
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Unilateral acute lower extremity ischemia with popliteal artery aneurysm as a result of vascular type III entrapment in an elderly patient.
Vascular
PUBLISHED: 03-27-2010
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Popliteal artery entrapment syndrome (PAES) is a rare cause of acute limb ischemia in adult patients but commonly demonstrates as claudication in young patients. The most significant, although rare, complication associated with PAES is aneurysm formation. We present the case of an elderly patient with a unilateral popliteal artery aneurysm owing to symptomatic anatomic entrapment. This report presents the oldest patient ever reported with this syndrome and highlights the advantage of multimodal treatment. As multidetector computed tomography highly contributed to the rapid diagnostic confirmation and choice of treatment in the popliteal fossa, limb salvage was achieved in this patient.
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Cardiotomy suction, but not open venous reservoirs, activates coagulofibrinolysis in coronary artery surgery.
J. Thorac. Cardiovasc. Surg.
PUBLISHED: 03-21-2010
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Closed and miniaturized cardiopulmonary bypass circuits, which eliminate cardiotomy suction and open venous reservoirs with a reduced priming volume, have been reported to be advantageous. We comparatively examined the respective contribution of cardiotomy suction and open venous reservoirs to perioperative activation in coagulofibrinolysis and inflammation systems, with identical conditions of priming volume and anticoagulation.
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Risk factor analysis in patients with liver cirrhosis undergoing cardiovascular operations.
Ann. Thorac. Surg.
PUBLISHED: 02-23-2010
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Variable outcomes of cardiac operations have been reported in cirrhotic patients, but no definitive predictive prognostic factors have been established. This retrospective study assessed operative results to identify risk factors associated with morbidity after cardiovascular operations in cirrhotic patients.
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Open stent-grafting for an aortobronchial fistula.
Ann Vasc Surg
PUBLISHED: 02-18-2010
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A 78-year-old woman was admitted to our hospital with intermittent hemoptysis. She had undergone descending aortic replacement through a left thoracotomy 7 years previously. Enhanced computed tomography revealed a pseudoaneurysm at the proximal suture line in the descending aorta and an ascending aortic aneurysm. Bronchoscope revealed bleeding from the left lower bronchus. Ascending and total aortic arch replacement and simultaneous open stent-graft placement into the descending aorta were performed through a median sternotomy. Selective antegrade cerebral perfusion and moderate hypothermia were used during these procedures. The postoperative course was favorable. Open stent-graft placement is a good alternative for treating aortobronchial fistula caused by suture line pseudoaneurysm in the descending aorta.
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Closed cardiopulmonary bypass circuits suppress thrombin generation during coronary artery bypass grafting.
Interact Cardiovasc Thorac Surg
PUBLISHED: 01-08-2010
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Thrombin generation is considered unavoidable during cardiac surgery using cardiopulmonary bypass (CPB). We compared the effects of open and closed circuits on coagulation and fibrinolysis under identical conditions of priming volume, heparin-coating, and anticoagulation and transfusion protocols. Thirty coronary surgery patients were randomized to surgery using open circuits with open reservoirs and cardiotomy suction (open group, n=15) or closed circuits without either (closed group, n=15). In the closed group, a cell-saving device was used instead of cardiotomy suction. Blood samples were collected at eight time points from before the operation to the first postoperative morning. Thrombin-antithrombin III (TAT), fibrinogen degradation products, and D-dimer were not elevated during CPB in the closed group, but were significantly increased in the open group (P<0.0001 for all markers). The peak TAT value at the termination of CPB in the open group was significantly correlated with CPB time (r(2)=0.879, P=0.037) and the simultaneous peak D-dimer value (r(2)=0.640, P=0.040). In conclusion, the use of closed circuits maximally suppressed thrombin generation and coagulofibrinolytic activation during coronary artery bypass grafting. The respective contribution of open reservoirs and cardiotomy suction to the perioperative thrombin generation remains to be elucidated.
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Intraoperative fluorescence imaging during surgery for coronary artery fistula.
Interact Cardiovasc Thorac Surg
PUBLISHED: 12-29-2009
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A 45-year-old man had a history of myocardial infarction at one month prior to admission. Coronary angiography revealed a dilated fistula originating from the left anterior descending coronary artery to the pulmonary artery. Two orifices of the draining artery were closed through pulmonary arteriotomy. Ligation of the fistulous vessels was performed at three places to ensure complete closure of the fistula. Before and after the cardiopulmonary bypass, fluorescent dye angiography was performed with indocyanine green. Fluorescence imaging revealed complete closure of the fistula and no residual shunt flow. Postoperative coronary angiography revealed neither a residual fistula nor injury to the coronary artery.
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Clinical and pathological features of ascending testis.
Osaka City Med J
PUBLISHED: 09-15-2009
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The clinical features and principles of surgery of the Ascending Testis (AT), in which the testis ascends from the scrotum with age, are controversial. We selected AT that met the treatment guidelines and examined the clinical features and principles of surgery.
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S-allylcysteine is effective as a chemopreventive agent against porcine serum-induced hepatic fibrosis in rats.
Osaka City Med J
PUBLISHED: 09-15-2009
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Hepatic fibrosis is a chronic progressive disorder with a poor prognosis for which no definitive treatment exists. S-allylcysteine (SAC), an ingredient of aged garlic extract, is known to have antioxidant and hepatoprotective effects. The aim of this study was to investigate the antifibrotic effects of SAC in the liver.
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Therapeutic potential of unrestricted somatic stem cells isolated from placental cord blood for cardiac repair post myocardial infarction.
Arterioscler. Thromb. Vasc. Biol.
PUBLISHED: 08-13-2009
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Unrestricted somatic stem cells (USSCs) were successfully identified from human cord blood. However, the efficacy of USSC transplantation for improving left ventricular (LV) function post myocardial infarction (MI) is still controversial.
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Primary pulmonary meningioma presenting with hemoptysis on exertion.
Ann. Thorac. Surg.
PUBLISHED: 07-28-2009
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An 18-year-old woman presented with hemoptysis during long-distant running. A chest computed tomographic scan revealed a well-demarcated, round-shaped, solitary mass (3.0 cm in diameter) in the left pulmonary hilum. The bleeding was getting more often and a left upper lobectomy was carried out to avoid critical airway bleeding. A solid proliferation of short spindle cells with a remarkable whorl pattern was demonstrated histologically. Immunohistochemical studies showed positive for vimentin and S-100, and focally positive for epithelial membrane antigen. Primary pulmonary meningioma was thus diagnosed. The patient is well without recurrent disease 15 months after surgery.
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Squamous cell carcinoma presenting as a solitary growing cyst in lung: a diagnostic pitfall in daily clinical practice.
Ann Thorac Cardiovasc Surg
PUBLISHED: 07-15-2009
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Gradually growing cystic lesion of the lung is commonly encountered in daily clinical practice. Thin-walled cavitary lung cancer is a rare entity; however, it could be a pitfall in the diagnosis of such radiographically benign-looking lesions, especially without an obvious solid, nodular, or tumorous appearance in the lesion. We herein report a rare case of lung cancer successfully treated by surgical resection that appeared as a gradually growing cystic lesion mimicking benign emphysematous disease, with a review of the literature. A 68-year-old man with a 24-year history of hypothyroidism presented with an abnormal cystic shadow in the left lung on routine chest X-ray. Twelve months later, occasional bloody sputa had started and was gradually getting worse. The patient was then referred to our department for surgical intervention. He received clarithromycin by daily oral administration, and the bloody sputa soon disappeared. However, a malignancy was still suspected because the wall was slightly thickened unevenly in comparison with the previous chest X-ray and computed tomography findings. Thus we performed a left lower lobectomy followed by mediastinal dissection because a squamous cell carcinoma was diagnosed by intraoperative frozen section. The patient postoperatively received 4 courses of paclitaxel-carboplatin therapy. Twelve months after surgery, he survives without recurrence.
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Does overgrowth of costal cartilage cause pectus excavatum? A study on the lengths of ribs and costal cartilages in asymmetric patients.
J. Pediatr. Surg.
PUBLISHED: 07-04-2009
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The cause of pectus excavatum has been hypothesized to be overgrowth of the costal cartilage. According to this theory, the length of costal cartilages must be longer in the side of deep depression in asymmetric patients. To challenge this hypothesis, we measured the lengths of ribs and costal cartilages and investigated lateral differences.
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CORM-3-derived CO modulates polymorphonuclear leukocyte migration across the vascular endothelium by reducing levels of cell surface-bound elastase.
Am. J. Physiol. Heart Circ. Physiol.
PUBLISHED: 06-26-2009
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Recently, it has been shown that carbon monoxide (CO)-releasing molecule (CORM)-released CO can suppress inflammation. In this study, we assessed the effects and potential mechanisms of a ruthenium-based water-soluble CO carrier [tricarbonylchloroglycinate-ruthenium(II) (CORM-3)] in the modulation of polymorphonuclear leukocyte (PMN) inflammatory responses in an experimental model of sepsis. Sepsis in mice was induced by cecal ligation and puncture. CORM-3 (3 mg/kg iv) was administered 15 min after the induction of cecal ligation and puncture. PMN accumulation in the lung (myeloperoxidase assay), bronchoalveolar lavage (BAL) fluid, and lung vascular permeability (protein content in BAL fluid) were assessed 6 h later. In in vitro experiments, human PMNs were primed with LPS (10 ng/ml) and subsequently stimulated with formyl-methionyl-leucylphenylalanine (fMLP; 100 nM). PMN production of ROS (L-012/dihydrorhodamine-123 oxidation), degranulation (release of elastase), and PMN rolling, adhesion, and migration to/across human umbilical vein endothelial cells (HUVECs) were assessed in the presence or absence of CORM-3 (1-100 muM). The obtained results indicated that systemically administered CORM-3 attenuates PMN accumulation and vascular permeability in the septic lung. Surprisingly, in in vitro experiments, treatment of PMNs with CORM-3 further augmented LPS/fMLP-induced ROS production and the release of elastase. The latter effects, however, were accompanied by an inability of PMNs to mobilize elastase to the cell surface (plasma membrane), an event required for efficient PMN transendothelial migration. The CORM-3-induced decrease in cell surface levels of elastase was followed by decreased PMN rolling/adhesion to HUVECs and complete prevention of PMN migration across HUVECs. In contrast, treatment of HUVECs with CORM-3 had no effect on PMN transendothelial migration. Taken together, these findings indicate that, in sepsis, CORM3-released CO, while further amplifying ROS production and degranulation of PMNs, concurrently reduces the levels of cell surface-bound elastase, which contributes to suppressed PMN transendothelial migration.
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Successful surgical treatment for rupture of an iliac artery aneurysm into a ureter.
Ann Vasc Dis
PUBLISHED: 04-15-2009
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We describe a case of successful surgical treatment for spontaneous rupture of an iliac artery aneurysm into a ureter. An 80-year-old man was admitted with massive hematuria. Immediate enhanced abdominal computed tomography scan and cystoscopy were suspicious for a uretero-arterial fistula caused by aneurysmal rupture. Emergent surgical intervention was performed because of the high mortality rate of this condition. Intraoperative findings revealed the fistula between the true aneurysm of the right common iliac artery and the ureter. Repair of the aneurysm and ligation of the ureter was performed, with an uneventful postoperative course.
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Aggressive repeat surgery for a recurrent synovial sarcoma in the pleura.
Ann Thorac Cardiovasc Surg
PUBLISHED: 03-06-2009
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Pleural synovial sarcomas are an extremely rare disease entity, and only 21 surgical cases, including this one, have been reported. We present a case of synovial sarcoma that underwent pneumonectomy for a recurrence of the disease. A 31-year-old female, who in June 2005 had undergone surgical resection of a monophasic synovial sarcoma in the left pleural cavity combined with the affected left diaphragm, was admitted to our hospital in January 2007 and underwent chemotherapy with ifosfamide, pirarubicin, and methotrexate for a recurrent synovial sarcoma in the left pleural cavity. The chest computed tomography revealed multiple tumors in the left pleura, and the tumors increased rapidly to occupy the left hemithorax. She began to complain of a severe dry cough. No other recurrent sites were found, and she underwent tumor resection combined with the entire left lung in March 2007. The tumor remained around the descending aorta. Pathological examination revealed dense proliferation of atypical spindle cells, the same findings as in the initial operation, and a diagnosis of synovial sarcoma was made. External radiation therapy up to 60 Gray was given to the tumor remaining around the descending aorta. She is now ambulatory without evidence of recurrent disease at 6 months after the second operation and 27 months after the initial surgery. Any aggressive repeat surgery as in the case here has not been previously reported. The present case suggests that aggressive tumor reduction followed by radiotherapy can achieve a good result for controlling local disease. Although optimal strategies for synovial sarcoma have yet to be established, aggressive repeat surgery could be considered in selected cases even when response to chemotherapy is insufficient and complete resection is difficult.
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Abdominal aortic grafting for spontaneous infrarenal abdominal aortic dissection.
Ann Vasc Surg
PUBLISHED: 01-27-2009
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This case report concerns a 62-year-old woman with spontaneous infrarenal abdominal aortic dissection, which developed into claudication and rest pain in the lower extremity. Multi-row detector computed tomography showed the entry site of the abdominal aortic dissection at the second lumbar artery, while the reentry site was found intraoperatively at the median sacral artery, indicating that the false lumen had progressed and compressed the true lumen. A direct approach involving grafting appears to be an effective procedure for resolving mesenteric and lower extremity hypoperfusion due to aortic dissection with a dilated false channel, even during the acute period.
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Impact of non-di-(2-ethylhexyl)phthalate cardiopulmonary bypass tubes on inflammatory cytokines and coagulation-fibrinolysis systems during cardiopulmonary bypass.
J Artif Organs
PUBLISHED: 01-26-2009
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Di-(2-ethylhexyl)phthalate (DEHP), an excellent plasticizer for poly(vinyl chloride) (PVC), is a known endocrine-disrupting chemical. This study was designed to investigate whether a new non-DEHP bilayer tube reduced the release of DEHP, suppressed inflammatory cytokines, and altered coagulation-fibrinolysis systems. Sixteen patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to the non-DEHP bilayer group (group B, n = 8), or the noncoated PVC group (group N, n = 8). The level of DEHP in the blood was measured before and after cardiopulmonary bypass (CPB). The levels of interleukin-6 (IL-6), D-dimer, and thrombin-antithrombin complex (TAT) were also measured at six points during and after CPB. DEHP was significantly lower in group B (472 +/- 141 ng/ml) after CPB compared with group N (2094 +/- 1046 ng/ml). The IL-6 level was significantly lower in group B (151 +/- 131 pg/ml) than group N (206 +/- 224 pg/ml) 180 min after protamine administration. The D-dimer level was significantly lower in group B 60 min after protamine administration (6.2 +/- 2.4 microg/ml in group B vs 10.4 +/- 4.5 microg/ml in group N) and 180 min after protamine administration (4.4 +/- 0.7 microg/ml in group B vs 7.3 +/- 2.7 microg/ml in group N). Group B had a tendency toward reduced postoperative bleeding compared with group N at any time. The bilayer tube was superior to the noncoated tube in terms of the inhibition of DEHP release, inflammatory cytokines, and the fibrinolysis system.
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Outcome after the modified Bentall technique with a long interposed graft to the left coronary artery.
Ann. Thorac. Surg.
PUBLISHED: 01-23-2009
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The modified Bentall technique, which was reported by Svensson in 1992, is an aortic root composite valve graft replacement involving reimplantation of the left coronary ostium with a long interposed graft wrapping behind the composite graft. The technique is technically advantageous, particularly for complicated or redo aortic roots. To justify the technique, the midterm outcome needs to be evaluated.
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Efficacy of landiolol hydrochloride for prevention of atrial fibrillation after heart valve surgery.
Int Heart J
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The goal of this prospective study was to examine the effects of landiolol hydrochloride on prevention of atrial fibrillation and on hemodynamics in the acute postoperative phase after heart valve surgery. The subjects were 60 patients who underwent valve surgery at our hospital from April 2008 to July 2010. The patients were randomly divided into two groups: the landiolol group (30 patients) and the control (no landiolol) group (30 patients). In the landiolol group, continuous intravenous landiolol was initiated immediately on admission to the intensive care unit at a dose of 10 µg/kg/ minute. Occurrence of atrial fibrillation was compared between the groups over an observation period of 72 hours after surgery. Atrial fibrillation occurred in 6 patients (20%) in the landiolol group and 16 (53.3%) in the control group during the observation period. Landiolol hydrochloride significantly reduced the occurrence of atrial fibrillation in the acute postoperative phase after heart valve surgery. Heart rate was significantly decreased by landiolol, but aggravation of hemodynamics was not observed. These results suggest that landiolol is a useful drug for prevention of atrial fibrillation after valve surgery.
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Risk factors for late valve-related mortality after aortic valve replacement in elderly patients.
Ann Thorac Cardiovasc Surg
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Few recent studies have examined the long-term outcomes after aortic valve replacement (AVR), and independent predictors for long-term survival and valve-related mortality have not been elucidated.
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AGR2 as a potential biomarker of human lung adenocarcinoma.
Osaka City Med J
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The present study aimed to identify useful candidate biomarkers of lung adenocarcinoma for clinical diagnosis and treatment using proteomics technology.
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Features and outcome after liver resection for non-B non-C hepatocellular carcinoma.
Hepatogastroenterology
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We investigated the clinicopathological findings and outcome after surgery for hepatocellular carcinoma in patients without hepatitis B or C virus infection.
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Lobectomy for indeterminate lung tumors with a strong suspicion of lung cancer.
Ann Thorac Cardiovasc Surg
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Wedge resection for tissue diagnosis of indeterminate lung tumors that is strongly suspected of being lung cancer, is sometimes difficult, and lobectomy, followed by a thorough pathological examination, is required. In the present report, four cases are presented, and the following indications, which have never been discussed before, are recommended for lobectomy without a pre-resectional diagnosis. First, where larger tumors are involved, and lobectomy is expected to result in a more favorable patient status and second, where the lesions are deeply located near major pulmonary vessels, or the patient is not a candidate for wedge resection or segmental resection. In each case, tolerance to surgery and detailed, informed consent for potentially complete resection are mandatory.
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A case of warfarin-induced eosinophilia.
Intern. Med.
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Warfarin is widely used in clinical practice all over the world. We report a man in whom prominent eosinophilia appeared after the initiation of warfarin administration following aortic valve replacement. Laboratory data following the administration and discontinuation of warfarin suggested that this drug was responsible for the eosinophilia. It is important to recognize the possibility of warfarin-induced hypereosinophilia as a latent adverse effect even when there are no clinical signs or symptoms.
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Mitral bioprosthetic valve stenosis in a patient with antiphospholipid antibody syndrome and systemic lupus erythematosus.
Gen Thorac Cardiovasc Surg
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A 45-year-old woman with antiphospholipid antibody syndrome (APS) and systemic lupus erythematosus was admitted because of severe dyspnea. She had undergone mitral valve replacement (MVR) using a Mosaic bioprosthesis for infective endocarditis 9 years previously. She developed congestive heart failure secondary to mitral bioprosthetic valve stenosis resulting from relatively early structural valve deterioration. She underwent a second MVR using a mechanical valve prosthesis. The explanted bioprosthesis showed marked pannus formation and mineralization with fibrin thrombus formation, especially on the outflow surfaces of the leaflets. After the second operation, she was discharged without APS-related thromboembolic events under meticulous anticoagulant and antiplatelet therapies.
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Very-low-dose continuous drip infusion of landiolol hydrochloride for postoperative atrial tachyarrhythmia in patients with poor left ventricular function.
Gen Thorac Cardiovasc Surg
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Three patients with poor left ventricular function (left ventricular ejection fraction <30 %) developed postoperative atrial tachyarrhythmia in intensive care. Case 1 was a 64-year-old man who underwent a modified Bentall procedure and mitral valve annuloplasty. Case 2 was a 63-year-old woman who underwent quintuple coronary artery bypass grafting. Case 3 was a 65-year-old man who underwent mitral valve replacement. Preoperative intra-aortic balloon pumping was required in Cases 2 and 3. Excellent heart rate control with no hemodynamic deterioration was achieved in all three cases by very-low-dose continuous drip infusion of landiolol hydrochloride (2-5 ?g/kg/min). Very-low-dose continuous drip infusion of landiolol hydrochloride is a safe and useful alternative for the control of perioperative atrial tachyarrhythmias in patients with poor left ventricular function.
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Hypomethylation of Alu repetitive elements in esophageal mucosa, and its potential contribution to the epigenetic field for cancerization.
Cancer Causes Control
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Aberrant hypermethylation of specific genes is present in esophageal squamous cell carcinomas (ESCCs). Such hypermethylation is also present in normal-appearing esophageal mucosae of ESCC patients and is considered to contribute to the formation of a field for cancerization. On the other hand, the presence of global hypomethylation in ESCCs or in their background esophageal mucosae is unknown.
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Effect of interferon therapy on first and second recurrence after resection of hepatitis C virus-related hepatocellular carcinoma.
Hepatol. Res.
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Aim:? Several investigators have shown that interferon (IFN) therapy can suppress the recurrence of hepatocellular carcinoma (HCC) after curative treatment. We investigated the effect of IFN therapy on the first and second HCC recurrence following hepatic resection of hepatitis C virus (HCV)-related HCC. Methods:? Subjects included 166 patients who had undergone curative resection for a single HCV-related HCC. We analyzed the outcome after initial hepatic resection and risk factors of a second HCC recurrence following treatment for the first HCC recurrence. Results:? Using multivariate analysis, a non-sustained virological response (non-SVR) was significantly associated with a high incidence of first HCC recurrence. The rate of second HCC recurrence tended to be higher in the non-SVR group than in the SVR group. In the patients with recurrence of multiple tumors or who received non-curative treatment for recurrent HCC, the second HCC recurrence rates were significantly higher. Multivariate analysis demonstrated that non-curative treatment for first HCC recurrence was an independent risk factor for a second HCC recurrence. Among the patients who received curative treatment for their first HCC recurrence, the rates of second recurrence were significantly higher in the non-SVR group than in the SVR group. Multivariate analysis also revealed that SVR was independently associated with prevention of a second HCC recurrence. Conclusions:? These results suggest that on first HCC recurrence, a curative treatment should be considered in order to prevent a second recurrence if possible. In addition, IFN therapy contributes to improved prognosis after curative treatment, even in patients with recurrent HCC.
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