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| 1.
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Kise, Yuya ; Kuniyoshi, Yukio ; Higa, Syotaro ; Ando, Mizuki ; Maeda, Tatuya ; Inafuku, Hitoshi ; Nakaema, Moriyasu
概要:
Ductus arteriosus aneurysm (DAA) is a rare disease, and the underlying mechanisms have not yet been fully elucidated. 1) In addition, few reports have described patency of the pulmonary arterial side in adult DAA cases.1) DAA is
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typically found either incidentally on examination of imaging2) or when the patient develops hoarseness. However, serious complications such as compression of the bronchus and esophagus, embolism due to thrombosis in the aneurysm, and rupture can occur, leading to the diagnosis of DAA.1,3) We report a case of patent DAA in an adult that was detected incidentally and treated by open repair with femorofemoral (FF) bypass.
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| 2.
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Kise, Yuya ; Kuniyoshi, Yukio ; Ando, Mizuki ; Maeda, Tatuya ; Inafuku, Hitoshi ; Yamashiro, Satoshi
概要:
Deep hypothermia in thoracoabdominal aortic aneurysm operations is considered extremely useful for ensuring sufficient time to reconstruct the segmental arteries feeding the spinal cord. However, because the amplitude of motor evoked
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potentials (MEPs) decrease or disappear during deep hypothermia, feasible methods for assessing spinal cord circulation have not yet been reported. Performing additional segmental arterial reconstructions that rely on MEPs is also impractical. In the present case, to ascertain spinal cord circulation under deep hypothermia, we intraoperatively measured the reconstructed segmental arterial pressure in real time and investigated whether sufficient spinal cord blood flow had been attained.
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| 3.
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Maruyama, Nobuyuki ; Sasaki, Takanobu ; Arasaki, Akira ; Matsuzaki, Akiko ; Nakasone, Toshiyuki ; Teruya, Takao ; Matayoshi, Akira ; Maruyama, Tessho ; Karube, Kennosuke ; Fujita, Jiro ; Yoshimi, Naoki ; Kuniyoshi, Yukio ; Nishihara, Kazuhide
概要:
The occurrence of second primary tumor (SPT)following malignancy treatment is common. In patients with head and neck (H&
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N) cancer, SPTs principally occur in the H&N region, lungs or esophagus. Therefore, patient follow‑up after cancer treatment is important in order to detect recurrence, metastasis and new primary tumors. However, no standard guidelines on lifelong follow‑up imaging are available. Herein, we report a patient who presented with three metachronous primary tumors‑squamous cell carcinoma (SCC) of the tongue, SCC of the lip and type A thymoma. The third tumor was incidentally detected during follow‑up using contrast‑enhanced computed tomography (CT) 9 years following resection of the second tumor. To the best of our knowledge, this specific combination of metachronous tumors has not yet been reported. Based on the literature review, we observed that thymoma occurs following H&N cancer treatment. Therefore, to ensure that the presence of subsequent thymomas is not overlooked, we suggest regular lifelong follow‑up using contrast‑enhanced CT in patients who had previously been diagnosed with H&N cancer. The literature review revealed that thymomas occur in patients with H&N cancer and should be detected at the earliest convenience.
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| 4.
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Maruyama, Tessho ; Saio, Masanao ; Arasaki, Akira ; Nakasone, Toshiyuki ; Teruya, Takao ; Haranaga, Shusaku ; Nimura, Fumikazu ; Kawano, Toshihiro ; Matayoshi, Akira ; Yoshimi, Naoki ; Kuniyoshi, Yukio ; Fujita, Jiro ; Nishihara, Kazuhide
概要:
Sarcoidosis is a systemic, chronic inflammatory disease with unknown cause and is characterized by formation of epitheli
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oid granulomas in various organs, mainly the lungs and lymphatic system as mediastinal lymph nodes (LNs). Lymphadenopathy is common in sarcoidosis. Subsequent cancer also tends to occur in patients with the disease, and the most frequent is lymphoma and cancer of the lung. Head and neck cancer is uncommon but possible. We report a 70-year-old woman with squamous cell carcinoma (SCC) of the mandibular gingiva concomitant with mediastinal multiple lymphadenopathy, and a medical history of chronic sarcoidosis. Mediastinal LNs showed increased uptake of 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) with positron emission tomography (PET). Subsequent to lymphadenectomy, the histological diagnosis was lymphadenopathy caused by sarcoidosis. Next, we performed wide local excision of the gingival tumor. During follow-up, a pulmonary lesion was detected by computed tomography at 3 years and 11 months after surgery, and diagnosed as pulmonary sarcoidosis, which had been stable without treatment until now. After follow-up of 5 years, the patient was alive without signs of local recurrence or metastasis. The combination of oral SCC and sarcoidosis of the mediastinal LNs in a sarcoidosis patient has not been previously reported. FDG-PET was not able to distinguish LN metastasis from lymphadenopathy caused by sarcoidosis. In our case, her chronic inflammatory condition with sarcoidosis as well as ill-fitting dentures could have increased the risk of oral cancer. We suggest that clinicians should carefully check for the development of subsequent oral cancer in patients with a past history of sarcoidosis. To avoid inaccurate staging and incorrect therapy, LN biopsy should be promptly performed following a diagnosis of cancer and multiple lymphadenopathies in patients with a history of sarcoidosis. Lymphadenopathy with sarcoidosis patients have malignant potential, especially those who develop subsequent cancer. Misdiagnosis of LN malignancy and sarcoidosis may lead to unnecessary adjuvant therapy or worse prognosis.
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| 5.
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Kise, Yuya ; Kuniyoshi, Yukio ; Ando, Mizuki ; Inafuku, Hitoshi ; Nagano, Takaaki ; Yamashiro, Satoshi
概要:
Background: Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery. Case presentation: A 56-year-old man had undergone surgery for type I aortic dissection four times. The residual
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thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis. The deep hypothermia was induced with bilateral infusion of cardiopulmonary bypass by femoral artery cannulation for the lower body and by transapical cannulation for the upper body because of easy access. There was no hemorrhagic tendency after deep hypothermic bypass. The patient was discharged uneventfully. Conclusions: For upper body perfusion, transapical aortic cannulation was a simple and effective procedure during left thoracotomy.
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| 6.
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Shiohira, Hideo ; Nakamatsu, Masashi ; Kise, Yuya ; Higa, Futoshi ; Tateyama, Masao ; Hokama, Nobuo ; Kuniyoshi, Yukio ; Ueda, Shinichiro ; Nakamura, Katsunori ; Fujita, Jiro
概要:
Teicoplanin, a glycopeptide antibiotic for methicillin-resistant Staphylococcus aureus, is recommended for therapeutic d
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rug monitoring during treatment. Maintaining a high trough range of teicoplanin is also recommended for severe infectious disease. However, the optimal dose and interval of treatment for severe renal impairment is unknown. We report a 79-year-old man who received long-term teicoplanin treatment for methicillin-resistant Staphylococcus aureus bacteremia due to postoperative sternal osteomyelitis with renal impairment. Plasma teicoplanin trough levels were maintained at a high range (20-30 μg/mL). Although the patient required long-term teicoplanin treatment, a further decline in renal function was not observed, and blood culture remained negative after the start of treatment. Teicoplanin treatment that is maintained at a high trough level by therapeutic drug monitoring might be beneficial for severe methicillin-resistant Staphylococcus aureus infection accompanied by renal impairment.
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| 7.
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Kudaka, Wataru ; Inafuku, Hitoshi ; Iraha, Yuko ; Nakamoto, Tomoko ; Taira, Yusuke ; Taira, Rie ; Kamiya, Hisashi ; Tsubakimoto, Maho ; Totsuka, Yuichi ; Kuniyoshi, Yukio ; Tamaki, Tomoko ; Aoyama, Hajime ; Saio, Masanao ; Yoshimi, Naoki ; Aoki, Yoichi
概要:
Background. A rare case of low-grade endometrial stromal sarcoma (LG-ESS) extending to inferior vena cava (IVC) and card
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iac chambers. Case Report. A 40-year-old woman had IVC tumor, which was incidentally detected by abdominal ultrasonography during a routine medical checkup. CT scan revealed a tumor in IVC, right iliac and ovarian veins, which was derived from the uterus and extended into the right atrium and ventricle. The operation was performed, the heart and IVC were exposed, and cardiopulmonary bypass was initiated. A right atriotomy was performed, and the intracardiac mass was removed. Then the tumor in IVC and the right internal iliac vein were removed after longitudinal venotomies in the suprarenal and infrarenal vena cava, the right common iliac vein. Next the pelvis was explored. Tumors were found originating from the posterior wall of the uterus and continuing into both the right uterine and ovarian vein. The patient underwent total hysterectomy with bilateral salpingooophorectomy. Complete tumor resection was achieved. Histopathological analysis confirmed a diagnosis of LG-ESS. She showed no evidence of disease for 2 years and 3 months. Conclusions. Our case highlights the importance of a multidisciplinary approach in treating this rare cardiovascular pathological condition through preoperative assessment to final operation.
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| 8.
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Chinen, Tetsuji ; Hirayasu, Tsuneo ; Kuniyoshi, Yukio ; Uehara, Kanou ; Kinjo, Takao
概要:
Purpose: To investigate tracheal reconstruction with autologous bladder wall using modern refined surgical procedures. Methods: Experiments were performed on 16 female beagle dogs. Six tracheal cartilages were resected to create a
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tracheal deficit, then tracheal replacement with autologous bladder wall was performed. In the first 10 dogs (first series), the transplant site was covered with pedicled omental flap. In the next six dogs (second series), we performed tracheal reconstruction without omental covering, and secured tracheal cartilages above and below the graft with sutures to prevent excessive graft stretching. Results: No surgical mortality or lethal infection of the transplant site was encountered in either series. Complications in the first series comprised tracheal stenosis in four dogs. One dog died suddenly at 4 months postoperatively due to stent migration, so cartilage sutures were adopted in the second series. The lumen surface of the grafts was covered with squamous metaplastic epithelium. Osseous tissue was present in the submucosa of grafts, particularly prominently in areas lacking omental covering. Conclusions: Tracheal reconstruction using bladder wall may become clinically useful. A pedicled omental covering does not appear always necessary to prevent graft necrosis and infection. Ischemic stimulation may be involved with bone formation in grafts.
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| 9.
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Miyazato, Minoru ; Yamashiro, Satoshi ; Goya, Masato ; Inafuku, Hitoshi ; Ikehara, Akashi ; Oshiro, Yoshinori ; Saito, Seiichi ; Kuniyoshi, Yukio
概要:
Background: Renal cell carcinoma with tumor thrombus extension into the inferior vena cava occurs in approximately 5% of
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cases. Despite such situations, an aggressive surgical approach is recommended. However, intraoperative prevention of pulmonary embolism by a fragmended tumor thrombus is necessary. To prevent pulmonary embolism, placement of a temporary suprarenal filter has been attempted, however, the precise placement of a temporary filter between the level of the hepatic vein and right atrium is not always easy because of its migration, tilting, and strut fracture. Here we report a method for early occlusion control of the intrapericardial inferior vena cava to prevent pulmonary embolism during nephrectomy in level II or III renal cell carcinoma tumor thrombus.\nCase presentation: Our first case was a 37-year-old Japanese man with left renal cell carcinoma extending into the inferior vena cava below the main hepatic vein (level II) and our second was a 75-year-old Japanese man with right renal cell carcinoma extending into the retrohepatic inferior vena cava at the main hepatic vein (level III). En block resection of the kidney and the tumor thrombus was performed with the aid of partial extracorporeal circulation; the postoperative course of both patients was uneventful.\nConclusion: Control of intrapericardial inferior vena cava is a feasible method to prevent pulmonary embolism.
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| 10.
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Miyazato, Minoru ; Yamashiro, Satoshi ; Goya, Masato ; Inafuku, Hitoshi ; Ikehara, Akashi ; Oshiro, Yoshinori ; Saito, Seiichi ; Kuniyoshi, Yukio
概要:
Background: Renal cell carcinoma with tumor thrombus extension into the inferior vena cava occurs in approximately 5% of
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cases. Despite such situations, an aggressive surgical approach is recommended. However, intraoperative prevention of pulmonary embolism by a fragmended tumor thrombus is necessary. To prevent pulmonary embolism, placement of a temporary suprarenal filter has been attempted, however, the precise placement of a temporary filter between the level of the hepatic vein and right atrium is not always easy because of its migration, tilting, and strut fracture. Here we report a method for early occlusion control of the intrapericardial inferior vena cava to prevent pulmonary embolism during nephrectomy in level II or III renal cell carcinoma tumor thrombus.\nCase presentation: Our first case was a 37-year-old Japanese man with left renal cell carcinoma extending into the inferior vena cava below the main hepatic vein (level II) and our second was a 75-year-old Japanese man with right renal cell carcinoma extending into the retrohepatic inferior vena cava at the main hepatic vein (level III). En block resection of the kidney and the tumor thrombus was performed with the aid of partial extracorporeal circulation; the postoperative course of both patients was uneventful.\nConclusion: Control of intrapericardial inferior vena cava is a feasible method to prevent pulmonary embolism.
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