RESUMEN
A previous, proof-of-concept clinical study suggested that dermal sheath cup cell injections into the affected areas of male/female pattern hair loss (PHL) may have some amelioratory effects, the clinical efficacy of which needs further examination. A phase III equivalent clinical study was conducted to further probe the therapeutic potential of this novel approach and verify its safety and efficacy in improving the appearance of PHL. Thirty-six participants with PHL were injected with dermal sheath cup cell harvested from non-affected occipital hair follicles twice in quarterly intervals. Global photographic assessment and phototrichogram were performed in a blinded manner. Patient-reported outcomes were assessed for 12 months. On global photographic assessment, 30% of the participants showed improvement. The analysis of phototricogram data detected the increases in the cumulative hair diameter, hair cross-sectional area, and mean hair diameter of 107.6 ± 152.6 µm/cm2 , 13069.1 ± 10960.7 µm2 /cm2 , and 0.9 ± 0.9 µm (ratios vs. baseline: +1.4%, +3.4%, and +2.2%), respectively. The female and high terminal hair ratio groups achieved better improvement. Of the total participants, 62.9% noted some degree of improvement. No serious adverse events were detected. This novel approach exhibited visible effects while ensuring safety and patient satisfaction. Therefore, it holds promise as a possible therapeutic option for treating PHL, especially in women.
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Alopecia , Cabello , Femenino , Humanos , Masculino , Alopecia/cirugía , Trasplante de Células , Folículo Piloso , Resultado del TratamientoRESUMEN
BACKGROUND: The efficacy of therapeutic modalities for hair disease can be evaluated globally by photo assessment and more precisely by phototrichogram (PTG). However, the latter procedure is laborious, time consuming, subject to inter-observer variation, and requires hair clipping. OBJECTIVE: To establish an automated and patient/investigator friendly methodology enabling quantitative hair amount evaluation for daily clinical practice. METHODS: A novel automated numerical algorithm (aNA) adopting digital image binarization (i.e., black and white color conversion) was invented to evaluate hair coverage and measure PTG parameters in scalp images. Step-by-step improvement of aNA was attempted through comparative analyses of the data obtained respectively by the novel approach and conventional PTG/global photography assessment (GPA). RESULTS: For measuring scalp hair coverage, the initial version of aNA generally agreed with the cumulative hair diameter as assessed using PTG, showing a coefficient of 0.60. However, these outcomes were influenced by the angle of hair near the parting line. By integrating an angle compensation formula, the standard deviation of aNA data decreased from 5.7% to 1.2%. Consequently, the coefficient of determination for hair coverage calculated using the modified aNA and cumulative hair diameter assessed by PTG increased to 0.90. Furthermore, the change in hair coverage as determined by the modified aNA protocol correlated well with changes in the GPA score of images obtained using clinical trials. CONCLUSION: The novel aNA method provides a valuable tool for enabling simple and accurate evaluation of hair growth and volume for clinical trials and for treatment of hair disease.
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Enfermedades del Cabello , Cuero Cabelludo , Humanos , Alopecia , Invenciones , Cabello/diagnóstico por imagen , Fotograbar/métodos , Enfermedades del Cabello/diagnóstico por imagenRESUMEN
Objective: The aim of this study was to elucidate the long-term results of crossover bypass (CB) for iliac atherosclerotic lesions in the era of endovascular treatment (EVT). Methods: A retrospective multicenter cohort study was performed. CB was performed in 242 patients between 2003 and 2014 by vascular surgeons at multiple medical centers in Japan. Results: Perioperative mortality was 1.7%. Primary patency rates were 86% at 5 years and 82% at 8 years. Univariate analysis showed that critical limb ischemia (Rutherford class 4-6), vein graft, and superficial femoral artery occlusion were significantly associated with low primary patency. In multivariate analysis, only critical limb ischemia influenced primary patency. The secondary patency rate was 87% at both 5 and 8 years. The limb salvage rate was 98% at both 5 and 8 years. The overall survival rates were 71% at 5 years and 49% at 8 years. Conclusion: The long-term results of CB were good in our study, compared with previous reports. Our results suggest that CB remains an option for the arterial reconstruction in unilateral iliac occlusive disease after EVT failed.
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The outcome in functional mitral regurgitation after aortic valve replacement is unclear. A frail 82-year-old woman with severe aortic valve regurgitation and mild to moderate functional mitral valve regurgitation (NYHA functional class III) was referred to our clinic. In consideration of her frail condition, aortic valve replacement without mitral surgery was performed. She had hemodynamic instability and difficulty to wean off cardiopulmonary bypass caused by severe functional mitral valve regurgitation with left ventricular dilatation. A central Alfieri edge-to-edge stitch was placed between the anatomical middle of the two leaflets of the mitral valve after reinstitution of cardiopulmonary bypass. This eliminated the mitral regurgitation, which enabled successful separation from cardiopulmonary bypass.
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Acute occlusion of abdominal aortic aneurysm (AAA) is a rare complication and is usually treated with surgical reconstruction. We present a case of acute AAA occlusion that was successfully treated by endovascular aneurysm repair (EVAR) with Fogarty balloon thrombectomy. A 77-year-old man with a history of acute myocardial ischemia presented with limb weakness and coldness. Contrast-enhanced computed tomography showed a 42-mm-diameter infrarenal AAA that was completely thrombosed in the distal portion. The proximal neck of the aneurysm was patent, and its shape was suitable for EVAR. Therefore, we performed balloon thrombectomy of the aortoiliac thrombus that was followed by EVAR. EVAR can be a less invasive alternative than traditional treatment for acute occlusion of AAA.
Asunto(s)
Aneurisma de la Aorta Abdominal/terapia , Procedimientos Endovasculares/métodos , Trombolisis Mecánica/métodos , Trombosis de la Vena/terapia , Enfermedad Aguda , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Humanos , Masculino , Trombolisis Mecánica/instrumentación , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico por imagenRESUMEN
BACKGROUND: Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. METHODS: Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery (non-CABG). RESULTS: In men, EATV, EATV index (EATV/body surface area) and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP) and type 2 diabetes mellitus (Corrected R2 = 0.262, p < 0.0001), while in women, type 2 diabetes mellitus is a single strong predictor for CABG, excluding EATV Index (Corrected R2 = 0.266, p = 0.005). CONCLUSIONS: Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.
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Tejido Adiposo/patología , Puente de Arteria Coronaria , Válvulas Cardíacas/cirugía , Pericardio/patología , Caracteres Sexuales , Anciano , Femenino , Humanos , Masculino , Análisis Multivariante , Tamaño de los Órganos , Análisis de RegresiónRESUMEN
INTRODUCTION: Postoperative pulmonary edema is a fatal adverse event after a cardiac surgery. We here report successful management using airway pressure release ventilation (APRV) for severe hypoxia with pulmonary edema after a cardiac surgery. PRESENTATION OF CASE: A 58-year-old man underwent an uneventful mitral valve repair. Immediately afterwards, the patient became agitated and made vigorous inspiratory efforts. His oxygen saturation dropped to 90%. Coarse inspiratory rhonchi were heard on auscultation, and copious, pink, frothy sputum was obtained with suctioning. Initial chest radiograph showed right-sided patchy opacities and interstitial infiltrates. A transthoracic echocardiogram demonstrated normal cardiac function. With worsening respiratory failure on mechanical ventilation, APRV was attempted. His condition and blood gas was subsequently improved. Over the following 3days, the patient experienced an uneventful postoperative course and was discharged to home on postoperative day 14. DISCUSSION: Extracorponeal membrane oxygenation (ECMO) is the most effective for severe hypoxia with pulmonary edema; however, ECMO is associated with hemorrhage and infectious complications. Alteratively, APRV was required for the successful management for severe hypoxia with pulmonary edema. CONCLUSION: APRV could be effective for severe hypoxia with pulmonary edema after a cardiac surgery.
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INTRODUCTION: There are many publications reporting the use of TachoSil sheets for sutureless repair. Trauma doctors have recently reported that chitosan-based sheets can efficiently achieve hemostasis for active bleeding. PRESENTATION OF CASE: An 85-year-old man was diagnosed with left ventricle free wall rupture that caused cardiac tamponade and cardiogenic shock. Extracorporeal membrane oxygenator (ECMO) was started immediately and surgical repair was planned. Bleeding occurred from a 1-cm tear in the center of the necrotic area in the territory of the left circumflex artery. The tear was treated with a chitosan-based HemCon Bandage. After hemostasis of the myocardium was achieved, the bandage was peeled off and a patch repair was performed using collagen fleece with fibrinogen-based impregnation. His condition subsequently improved. The tracheal tube was extubated and ECMO was removed 2days after the surgery. One month later, the patient had no complications at his postoperative follow-up visit. DISCUSSION: To our knowledge, this is the first report of a hybrid patch repair utilizing chitosan-based sheets for a left ventricle rupture after myocardial infarction. Further studies are necessary to evaluate the short- and long-term efficacy of this procedure, and these results must be compared with those of classical surgical repairs. CONCLUSION: The new hybrid sutureless patch utilizing chitosan was demonstrated as safe, easy and effective.
RESUMEN
Blunt abdominal aortic injury (BAAI) is very rare. In general, BAAI occurs in high-energy accidents. Here, we present a case of BAAI in a low-energy accident. A 70-year-old female was injured after falling 3 m. Her vital signs were stable. She had lumbar fractures (L1, L2) and BAAI associated with a fragment of the fractured L2 vertebral body. On the fifth posttrauma day, we performed an operation because computed tomography showed a bone fragment of the lumbar fractures (L1, L2) threatening the abdominal aorta. The aortic injury site was transected, and the fragment of the L2 vertebral body was removed. Even in low-energy accidents, BAAI should be considered. BAAI with stable vital signs can be electively treated.
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Accidentes por Caídas , Aorta Abdominal/lesiones , Vértebras Lumbares/lesiones , Fracturas de la Columna Vertebral/etiología , Lesiones del Sistema Vascular/etiología , Heridas no Penetrantes/etiología , Anciano , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aortografía/métodos , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Fracturas de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/cirugía , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugíaAsunto(s)
Traumatismos Abdominales/cirugía , Procedimientos Endovasculares/métodos , Arteria Mesentérica Inferior/lesiones , Arteria Mesentérica Inferior/cirugía , Stents , Heridas no Penetrantes/cirugía , Traumatismos Abdominales/diagnóstico por imagen , Anciano , Hematoma , Humanos , Masculino , Arteria Mesentérica Inferior/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Heridas no Penetrantes/diagnóstico por imagenAsunto(s)
Quiste Mediastínico/complicaciones , Quiste Mediastínico/diagnóstico por imagen , Pericarditis Constrictiva/diagnóstico por imagen , Pericarditis Constrictiva/etiología , Tomografía Computarizada por Rayos X , Anciano , Calcinosis/complicaciones , Calcinosis/diagnóstico por imagen , Ecocardiografía Transesofágica , Humanos , Cirrosis Hepática , Masculino , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiologíaRESUMEN
A 62-year-old man was crushed in a car accident and diagnosed with a fractured left ninth rib, pulmonary and heart contusion, hemopneumothorax, and descending aortic injury based on a computed tomography scan. He underwent chest tube drainage and was intubated for mechanical ventilation because a bone fragment of the ninth rib threatened to penetrate the descending aorta. On the second posttrauma day, computed tomography showed the bone fragment of the ninth rib approaching the descending aorta. He underwent graft replacement of the injured portion of the descending thoracic aorta, and we removed the fractured left ninth rib.
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Accidentes de Tránsito , Aorta Torácica/cirugía , Rotura de la Aorta/prevención & control , Implantación de Prótesis Vascular , Fracturas de las Costillas/etiología , Lesiones del Sistema Vascular/cirugía , Heridas no Penetrantes/etiología , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/lesiones , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/etiología , Aortografía/métodos , Drenaje , Humanos , Masculino , Persona de Mediana Edad , Respiración Artificial , Fracturas de las Costillas/diagnóstico , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/etiología , Heridas no Penetrantes/diagnósticoRESUMEN
Aortic pseudoaneurysm is a rare, life-threatening complication after cardiac or aortic surgery. In this article, we report reoperation on an 86-year-old man undergoing total arch replacement and omentoplasty for an infectious aortic aneurysm, 5 years previously. He was transferred to our hospital and fell into shock. Prompt drainage of the right-side pleural cavity manifested 2000 ml of blood. Computed tomography revealed contrast extravasation into a pseudoaneurysm, which arose from the proximal anastomotic site of the ascending aorta. The patient underwent emergent surgery that included an extremely careful dissection of the omentum and pericardial adherences, through the re-sternotomy. The patient recovered without neurological sequelae.
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Aneurisma Falso/cirugía , Rotura de la Aorta/cirugía , Epiplón/cirugía , Anciano de 80 o más Años , Urgencias Médicas , Humanos , Masculino , Complicaciones Posoperatorias , ReoperaciónRESUMEN
We report our experience of long-term extracorporeal membrane oxygenator (ECMO) support to resuscitate a 62-year-old man who had critical three-vessel disease of coronary artery complicating intractable hibernating myocardium (HM) and sudden cardiogenic shock. Intra-aortic balloon pump and ECMO were deployed to restore the circulatory support while emergent revascularization surgery was performed.The patient was weaned from ECMO successfully after 15 days of support and discharged with recovered left ventricular function. ECMO is effective in resuscitation of patients with cardiogenic shock and HM. To our knowledge the present case necessitated the longest term of ECMO support to get rid of HM.
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Puente de Arteria Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/cirugía , Oxigenación por Membrana Extracorpórea , Aturdimiento Miocárdico/terapia , Resucitación/métodos , Humanos , Contrapulsador Intraaórtico , Masculino , Persona de Mediana Edad , Aturdimiento Miocárdico/etiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Intra-atrial extension of a superior vena cava (SVC) tumor is rare and it is associated with high mortality rates. An 80-year-old woman presented with malignant mediastinal tumor invading the superior vena cava and right atrium. The unresectable tumor caused uncontrolled SVC syndrome and led to the risk of pulmonary artery tumor thrombosis. Palliative surgery for the intracaval and atrial tumor was performed. Presently, 6 months after surgery, the patient remains free from SVC syndrome and has received effective adjuvant chemotherapy to reduce the size of the tumor.
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Adenocarcinoma/patología , Adenocarcinoma/cirugía , Atrios Cardíacos/patología , Neoplasias del Mediastino/patología , Neoplasias del Mediastino/cirugía , Cuidados Paliativos , Síndrome de la Vena Cava Superior/patología , Síndrome de la Vena Cava Superior/cirugía , Vena Cava Superior/patología , Anciano de 80 o más Años , Angiografía , Implantación de Prótesis Vascular , Ecocardiografía , Femenino , Humanos , Invasividad Neoplásica , Politetrafluoroetileno , Tomografía Computarizada por Rayos XRESUMEN
We have experienced 2 cases of heparin-induced thrombocytopenia during unfractionated heparin treatment for disseminated intravascular coagulation after surgery for an abdominal aortic aneurysm. In the first case, as a symptom of disseminated intravascular coagulation gradually improved with antithrombin concentrates and heparin treatment, mesenteric artery thrombosis suddenly occurred, associated with a >50% decrease in platelet count on the 11th day. Although the platelet counts were increasing due to heparin cessation, clinical symptom and coagulation abnormalities worsened to multiple organ failure. In the second case, the platelet count decreased to <10 x 10(4)/microL on the 13th day after the start of unfractionated heparin anticoagulation along with continuous hemodiafiltration, which was indicated for postoperative renal failure. The extracorporeal circuit clotted frequently under an adequate dose of unfractionated heparin. Serologically, heparin-platelet factor 4 complex antibodies were repeatedly detected by enzyme-linked immunosorbent assay. Argatroban, a direct thrombin inhibitor, was introduced as an alternative to unfractionated heparin, and the platelet count improved with a decrease in titers of the antibodies. Disseminated intravascular coagulation is a common complication in cases of abdominal aortic aneurysm and is usually treated in association with unfractionated heparin. It is important to recognize the onset of heparin-induced thrombocytopenia that acute declines in the platelet count and appearance of thrombosis with positive for heparin-platelet factor 4 complex antibodies would suddenly occur in clinical course of disseminated intravascular coagulation.
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Anticoagulantes/efectos adversos , Aneurisma de la Aorta Abdominal/cirugía , Coagulación Intravascular Diseminada/tratamiento farmacológico , Heparina/efectos adversos , Complicaciones Posoperatorias/tratamiento farmacológico , Trombocitopenia/inducido químicamente , Anciano , Anticoagulantes/administración & dosificación , Arginina/análogos & derivados , Autoanticuerpos/sangre , Coagulación Intravascular Diseminada/sangre , Coagulación Intravascular Diseminada/etiología , Heparina/administración & dosificación , Humanos , Masculino , Arterias Mesentéricas , Ácidos Pipecólicos/administración & dosificación , Factor Plaquetario 4/inmunología , Complicaciones Posoperatorias/sangre , Sulfonamidas , Trombocitopenia/sangre , Trombosis/tratamiento farmacológicoRESUMEN
A 63-year-old man complained of abdominal angina and intermittent claudication. Multidimensional angiography showed focal calcified obstruction of the suprarenal aorta, occlusion of the right external iliac artery, and instent restenosis in the right coronary artery. Extraanatomic bypass was performed from the ascending aorta to the left external iliac and right femoral arteries, using an 8-mm bifurcated graft, with concomitant off-pump coronary artery grafting. The patient's digestive symptoms and leg claudication disappeared.
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Aorta Abdominal/cirugía , Arteriopatías Oclusivas/cirugía , Aterosclerosis/cirugía , Implantación de Prótesis Vascular , Calcinosis/cirugía , Puente de Arteria Coronaria Off-Pump , Reestenosis Coronaria/cirugía , Arteria Ilíaca/cirugía , Dolor Abdominal/etiología , Aorta Abdominal/diagnóstico por imagen , Aortografía , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/diagnóstico por imagen , Aterosclerosis/complicaciones , Aterosclerosis/diagnóstico por imagen , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Calcinosis/complicaciones , Calcinosis/diagnóstico por imagen , Angiografía Coronaria , Reestenosis Coronaria/complicaciones , Reestenosis Coronaria/diagnóstico por imagen , Humanos , Arteria Ilíaca/diagnóstico por imagen , Claudicación Intermitente/etiología , Masculino , Persona de Mediana Edad , Tereftalatos Polietilenos , Diseño de Prótesis , Resultado del TratamientoRESUMEN
A 68-year-old woman was referred to our hospital with left leg edema and dull pain. Magnetic resonance imaging and enhanced computed tomography (CT) revealed a huge myoma uteri compressing the left common iliac vein, thus resulting in iliofemoral venous thrombosis. A total hysterectomy was uneventfully performed under the placement of a temporary inferior vena cava (IVC) filter. The postoperative enhanced CT-scan and cavography revealed the 90 degrees -tilted filter incorporated with a large thrombus. As an increased dose of heparin that was administered during the following week resulted in no reduction of the thrombus, a surgical removal was indicated. The infrarenal IVC was clamped proximal and distal to the filter, and the tilted filter with the large thrombus was removed through a longitudinal cavotomy. The postoperative course was uneventful, and she had no recurrence or residual symptoms for 6 months following the surgery.