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1.
Acta Med Okayama ; 76(2): 225-228, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35503451

RESUMO

A 75-year-old man presented to our hospital 1 year after partial renal resection for clear cell carcinoma. A right lower lobe lung nodule noted at the time of surgery had increased to 3.0 cm in diameter and was confirmed as squamous cell lung carcinoma by bronchoscopic cytology. Computed tomography had also revealed paratracheal lymph node swelling. He underwent right lower lobectomy with lymph node dissection by video-assisted thoracic surgery. Pathological examination confirmed squamous cell carcinoma of the lung but diagnosed the right hilar and mediastinal lymph node metastases as clear cell carcinoma.


Assuntos
Carcinoma de Células Renais , Carcinoma de Células Escamosas , Neoplasias Renais , Neoplasias Pulmonares , Idoso , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Pulmão/patologia , Neoplasias Pulmonares/patologia , Excisão de Linfonodo/métodos , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Estadiamento de Neoplasias
2.
Kyobu Geka ; 75(7): 537-542, 2022 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-35799489

RESUMO

Minimally invasive cardiac surgery( MICS) has emerged in 1990s. Nowadays, MICS via mini thoracotomy became popular for valvular heart disease. Robot-assisted cardiac surgery was introduced with extension to MICS. Robot-assisted cardiac surgery for valvular heart disease has been covered by health insurance since 2018. So far, the number of authorized facilities for robot-assisted cardiac surgery is only 25. Currently available da Vinci surgical system is a burden to not only the surgical team but also the facility. There are a lot of problems to overcome for applying robot-assisted cardiac surgery as a standardized procedure. An educational institution like a university hospital needs to expand systematic human resource development and technological innovation for continuing and developing the robot-assisted cardiac surgery. The most important thing for the surgeon is to keep in mind for true minimally invasive surgery for the patients not for minimally incisional surgery for the cosmetic reason.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doenças das Valvas Cardíacas , Procedimentos Cirúrgicos Robóticos , Robótica , Doenças das Valvas Cardíacas/cirurgia , Humanos , Toracotomia
3.
Surg Today ; 51(11): 1755-1763, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34013428

RESUMO

PURPOSE: The effect of uniportal video-assisted thoracoscopic surgery (uni-VATS) versus that of conventional VATS on postoperative quality of life (QOL) is unclear. This prospective randomized controlled study compared uni-VATS and conventional 3-port VATS in terms of QOL and patient satisfaction. METHODS: The subjects of this study were 84 patients with pulmonary nodules or bullous formation, randomized to undergo uniportal or conventional 3-port video-assisted thoracoscopic partial lung resection. The primary endpoint was postoperative pain, assessed using a numeric rating scale on postoperative day (POD) 1. RESULTS: No differences were found in the numeric rating scale on POD 1 after uni-VATS and conventional 3-port VATS. There were also no differences in blood loss, operative time, complication rate, surgical margin, analgesic requirement, vital capacity (VC), forced expiratory volume in 1 s (FEV1), the 6-min walk test (6MWT), C-reactive protein (CRP) levels, white blood cell count (WBC), or duration of chest tube drainage and hospital stay. Differences were found in the numeric rating scale on days 2, 3, 5, and 10 and in the patient satisfaction score on PODs 5 and 10. CONCLUSIONS: Uni-VATS is associated with less chest pain and better patient satisfaction in the short term but without differences in complication rates or surgical margins from the lesions. CLINICAL TRIAL REGISTRY NUMBER: University Hospital Medical Information Network Clinical Trial Registry (UMIN000015340 http://www.umin.ac.jp/english/ ).


Assuntos
Neoplasias Pulmonares/cirurgia , Pulmão/cirurgia , Pneumonectomia/métodos , Qualidade de Vida , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/psicologia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/psicologia , Satisfação do Paciente , Pneumonectomia/psicologia , Estudos Prospectivos , Cirurgia Torácica Vídeoassistida/psicologia , Resultado do Tratamento
4.
Int J Mol Sci ; 22(19)2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34638873

RESUMO

The characterization of aortic valve interstitial cells (VICs) cultured under optimal conditions is essential for understanding the molecular mechanisms underlying aortic valve stenosis. Here, we propose 2% hypoxia as an optimum VIC culture condition. Leaflets harvested from patients with aortic valve regurgitation were digested using collagenase and VICs were cultured under the 2% hypoxic condition. A significant increase in VIC growth was observed in 2% hypoxia (hypo-VICs), compared to normoxia (normo-VICs). RNA-sequencing revealed that downregulation of oxidative stress-marker genes (such as superoxide dismutase) and upregulation of cell cycle accelerators (such as cyclins) occurred in hypo-VICs. Accumulation of reactive oxygen species was observed in normo-VICs, indicating that low oxygen tension can avoid oxidative stress with cell-cycle arrest. Further mRNA quantifications revealed significant upregulation of several mesenchymal and hematopoietic progenitor markers, including CD34, in hypo-VICs. The stemness of hypo-VICs was confirmed using osteoblast differentiation assays, indicating that hypoxic culture is beneficial for maintaining growth and stemness, as well as for avoiding senescence via oxidative stress. The availability of hypoxic culture was also demonstrated in the molecular screening using proteomics. Therefore, hypoxic culture can be helpful for the identification of therapeutic targets and the evaluation of VIC molecular functions in vitro.


Assuntos
Antígenos CD34/biossíntese , Insuficiência da Valva Aórtica/metabolismo , Valva Aórtica/metabolismo , Técnicas de Cultura de Células , Regulação da Expressão Gênica , Células-Tronco/metabolismo , Valva Aórtica/patologia , Insuficiência da Valva Aórtica/patologia , Hipóxia Celular , Feminino , Humanos , Masculino , RNA Mensageiro/biossíntese , Células-Tronco/patologia
5.
Kyobu Geka ; 73(7): 484-489, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32641666

RESUMO

Minimally invasive cardiac surgery (MICS) through partial sternotomy or parastenal incision was introduced for valvular heart disease in 1990s, it has gradually faded because it was somehow challenging without standardized manner or positive merits for the patients. Conversely, MICS via mini-thoracotomy has been started for mostly the patients undergoing mitral valve repair in 2000s, the number of MICS through mini-thoracotomy cases has increased progressively with the supports by academic societies and a national registry database system. Some enthusiasm for less invasiveness fashion oriented smaller skin incision and endoscopic procedures. Recently, robotically-assisted mitral valve surgery has taken place under strict regulation. Performing MICS requires not only surgeon's skills but also heart team strength including anesthesiologists and perfusionists. MICS should give cosmetic benefit and patient satisfaction, and credibility for cardiologists and society. Past and current status of MICS in Japan is described based on over 20-year author's experience from partial sternotomy MICS to robotically-assisted surgery for valvular heart disease.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Japão , Procedimentos Cirúrgicos Minimamente Invasivos , Toracotomia
6.
Kyobu Geka ; 73(2): 99-103, 2020 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-32393714

RESUMO

A 47-year-old woman with a history of mitral valve replacement (MVR) through a median sternotomy was admitted to our hospital due to dyspnea on exertion. Echocardiography showed bioprosthetic valve dysfunction with mitral stenosis. Right heart catheter examination revealed severe pulmonary hypertension and right ventricular dysfunction. We considered that she could not tolerate the hemodynamic changes during induction of general anesthesia without any cardiopulmonary support. Therefore, the percutaneous cardiopulmonary support was started before induction of anesthesia. To avoid the risk of injury to cardiac structures, we performed redo mitral valve replacement via right mini-horacotomy in the 4th intercostal space. Severe calcification was found in the leaflets of the prosthetic valve. She was discharged home on postoperative day 42.


Assuntos
Anestesia , Implante de Prótese de Valva Cardíaca , Hipertensão Pulmonar , Estenose da Valva Mitral , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Pessoa de Meia-Idade , Valva Mitral , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/cirurgia
10.
Cancer Sci ; 108(2): 208-215, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27987332

RESUMO

Vascular endothelial (VE)-cadherin, a major endothelial adhesion molecule, regulates vascular permeability, and increased vascular permeability has been observed in several cancers. The aim of this study was to elucidate the role of the NEDD8-Cullin E3 ligase, in maintaining barrier permeability. To this end, we investigated the effects of the inhibition of Cullin E3 ligases, by using inhibitors and knockdown techniques in HUVECs. Furthermore, we analyzed the mRNA and protein levels of the ligases by quantitative RT-PCR and Western blotting, respectively. The results revealed that NEDD8-conjugated Cullin 3 is required for VE-cadherin-mediated endothelial barrier functions. Treatment of HUVECs with MLN4924, a chemical inhibitor of the NEDD8-activating enzyme, led to high vascular permeability due to impaired cell-cell contact. Similar results were obtained when HUVECs were treated with siRNA directed against Cullin 3, one of the target substrates of NEDD8. Immunocytochemical staining showed that both treatments equally depleted VE-cadherin protein localized at the cell-cell borders. However, quantitative RT-PCR showed that there was no significant difference in the VE-cadherin mRNA levels between the treatment and control groups. In addition, cycloheximide chase assay revealed that the half-life of VE-cadherin protein was dramatically reduced by Cullin 3 depletion. Together, these findings suggest that neddylated Cullin 3 plays a crucial role in endothelial cell barrier function by regulating VE-cadherin.


Assuntos
Antígenos CD/fisiologia , Caderinas/fisiologia , Permeabilidade Capilar/fisiologia , Proteínas Culina/fisiologia , Endotélio Vascular/fisiologia , Ubiquitinas/fisiologia , Antígenos CD/efeitos dos fármacos , Antígenos CD/genética , Caderinas/efeitos dos fármacos , Caderinas/genética , Permeabilidade Capilar/efeitos dos fármacos , Comunicação Celular/efeitos dos fármacos , Proteínas Culina/análise , Proteínas Culina/antagonistas & inibidores , Cicloeximida/farmacologia , Ciclopentanos/farmacologia , Endotélio Vascular/efeitos dos fármacos , Células Endoteliais da Veia Umbilical Humana , Humanos , Proteína NEDD8 , Inibidores da Síntese de Proteínas , Pirimidinas/farmacologia , RNA Mensageiro/metabolismo , RNA Interferente Pequeno/farmacologia , Ubiquitinas/análise
13.
Surg Today ; 44(12): 2378-81, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24643265

RESUMO

Hereditary hemorrhagic telangiectasia (HHT) is caused by an autosomal dominant gene and characterized by multiple arteriovenous malformations in several organs, leading to bleeding or shunting. These patients often suffer severe infections and heart failure, which should be managed in the perioperative period, when open heart surgery is indicated. We report a case of successful aortic root replacement for active prosthetic valve endocarditis and ventricular septal perforation in a patient with HHT, who had severe heart failure.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca , Infecções Estafilocócicas , Staphylococcus epidermidis , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/cirurgia , Idoso , Malformações Arteriovenosas/complicações , Progressão da Doença , Endocardite Bacteriana/etiologia , Feminino , Humanos , Assistência Perioperatória , Reoperação , Resultado do Tratamento , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia
14.
Ann Med Surg (Lond) ; 86(8): 4854-4860, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39118757

RESUMO

Introduction and importance: Elderly and frail patients with thoracic aortic aneurysms (TAAs) near to origins of cervical arteries present facing challenges with aortic arch replacement with cardiopulmonary bypass, and traditional tube-type stent-grafts are also inadequate for transcatheter endovascular aortic repair (TEVAR). Thus, necessitating precise treatment with fenestrated stent-grafts from zone 0. This approach is crucial for achieving favorable postoperative outcomes without compromising activities of daily living (ADL). Case presentations: An 85-year-old-man admitted to the hospital for treatment of a large TAA. While arch replacement is a definitive procedure, it is highly invasive, and the postoperative ADL are expected to be significantly lower than preoperative levels. Therefore, we performed a debranching TEVAR from Zone 0 with fenestrated stent-graft. The patient was discharged from the hospital on the 11th postoperative day. Clinical discussion: In frail and elderly patients for whom conventional surgery may not be viable, TEVAR emerges as a preferred alternative. However, TEVAR of TAA proximal to the aortic arch continues to pose challenges, necessitating meticulous attention to the cervical branches in the intervention strategy. While surgical intervention in these patients necessitates careful consideration of its suitability, including the potential for postoperative enhancement in ADL, the use of fenestrated stent-grafts from Zone 0 emerges as one of the treatment modalities. Conclusion: The authors present a very elderly case in which fenestrated stent-grafts were used to avoid aortic arch replacement for a large aortic arch aneurysm, resulting in a good postoperative course with no decline in ADL.

15.
J Med Case Rep ; 18(1): 394, 2024 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-39183313

RESUMO

BACKGROUND: Sternoclavicular joint arthritis is a rare condition that poses considerable diagnostic and therapeutic challenges, leading to severe complications and a high mortality rate. Although surgical interventions are often considered necessary for advanced cases, some reports have suggested that conservative management with antibiotic therapy can be effective in certain cases. However, to our knowledge, there are no reports of successful conservative treatment in cases exhibiting aggressive spread. This report highlights a case of advanced sternoclavicular joint arthritis with bone destruction and pulmonary infiltration, successfully treated conservatively with outpatient antibiotic therapy. CASE PRESENTATION: A 58-year-old Japanese male presented with a 1-month history of left-sided shoulder pain. Contrast-enhanced computed tomography showed abscess formation and clavicular bone destruction, with infiltrative shadows suggesting lung involvement. The diagnosis of sternoclavicular joint arthritis was made, and outpatient oral antibiotic therapy was initiated. The patient exhibited a marked reduction in inflammatory marker levels and symptoms, and antibiotic therapy was discontinued after 3 weeks, with no recurrence observed at a 4-month follow-up. CONCLUSIONS: This case highlights that conservative management with antibiotics can be effective for treating advanced sternoclavicular joint arthritis, emphasizing the need for individualized management and further research into non-surgical treatment options.


Assuntos
Antibacterianos , Artrite Infecciosa , Tratamento Conservador , Osteomielite , Articulação Esternoclavicular , Humanos , Masculino , Articulação Esternoclavicular/diagnóstico por imagem , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Osteomielite/tratamento farmacológico , Osteomielite/diagnóstico , Osteomielite/terapia , Osteomielite/diagnóstico por imagem , Artrite Infecciosa/terapia , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/complicações
16.
Cureus ; 15(10): e47262, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38022182

RESUMO

A left ventricular thrombus (LVT) in cardiac disease is associated with various adverse events. To understand the risk of thromboembolism, it is necessary to recognize when LVT is most likely to occur. We present a case of acute lymphocytic myocarditis in a young patient, where the LVT manifestation occurred within 48 hours after the beginning of the disease and was treated by thrombectomy. We have not found any reports of LVT formation earlier than in this case. Patients with acute myocarditis are younger, at a median age of 34 years, and the social impact of embolic complications is considerable. Echocardiography is effective in detecting LVT noninvasively in low- and high-risk patients. Patients with myocarditis can benefit from careful observation by echocardiography.

17.
Gen Thorac Cardiovasc Surg ; 71(8): 437-446, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36525218

RESUMO

OBJECTIVES: In pulmonary valve replacement (PVR) after tetralogy of Fallot (TOF) repair, the right ventricular end-diastolic and end-systolic volume index (RVEDVI and RVESVI) of cardiac magnetic resonance imaging (cMRI) are often used as indicators of the RV volume. We examined the utility of QRS duration, cardiothoracic ratio (CTR), and plasma brain natriuretic peptide (BNP) as indicators of the appropriate timing of cMRI to assess the RV volume and function before PVR. METHODS: We assessed the correlation of QRS duration, CTR, and BNP with RVEDVI and RVESVI on cMRI in 26 patients after TOF repair. Fifteen underwent PVR (age, 45.2 ± 11.4 years). Twelve underwent post-PVR cMRI. The RV volume change from before to after PVR was investigated. RESULTS: QRS duration, BNP, and CTR were positively correlated with RVEDVI and RVESVI after TOF repair. The post-PVR QRS duration was also positively correlated with post-PVR RVEDVI (p = 0.017) and RVESVI (p = 0.001). From before to after PVR, in 5 cases with QRS duration ≤ 160 ms, the QRS duration decreased from 110.4 ± 28.9 to 101.8 ± 30.5 ms (p = 0.063). Both RVEDVI and RVESVI decreased to the normal range in 4 of 5 cases. In contrast, in 7 cases with QRS duration > 160 ms, the QRS duration decreased from 183.0 ± 17.4 to 160.3 ± 23.8 ms (p = 0.013); however, RVESVI did not normalize in 6 of 7 cases. CONCLUSIONS: A prolonged QRS duration is a useful marker of RVEDVI and RVESVI enlargement after TOF repair. We recommend performing cMRI before the QRS duration reaches 160 ms due to normalization of the RV volume after PVR.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Pulmonar , Valva Pulmonar , Tetralogia de Fallot , Humanos , Adulto , Pessoa de Meia-Idade , Tetralogia de Fallot/cirurgia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/etiologia , Imageamento por Ressonância Magnética , Função Ventricular Direita , Implante de Prótese de Valva Cardíaca/efeitos adversos , Resultado do Tratamento , Estudos Retrospectivos
18.
JACC Basic Transl Sci ; 8(7): 862-880, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37547071

RESUMO

Histologic evaluations revealed excessive accumulations of macrophages and absence of fibroblastic interstitial cells in explanted bioprosthetic valves. Comprehensive gene and protein expression analysis and histology unveiled an accumulation of fibrinogen and plasminogen, an activator of infiltrated macrophages, from degenerated valve surfaces in the interstitial spaces. These pathologies were completely reproduced in a goat model replaced with an autologous pericardium-derived aortic valve. Further preclinical animal experiments using goats demonstrated that preventing infiltration of macrophages and circulating proteins by increasing collagen density and leaflet strength is an effective treatment option.

19.
Circulation ; 124(11 Suppl): S107-14, 2011 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-21911799

RESUMO

BACKGROUND: We assessed changes in left ventricular (LV) volume and function and in regional myocardial wall stress in noninfarcted segments after restrictive mitral annuloplasty (RMA) with or without surgical ventricular restoration (SVR). METHODS AND RESULTS: Thirty-nine patients with ischemic cardiomyopathy (ejection fraction ≤ 0.35) and severe mitral regurgitation (≥ 3) were studied before and 2.8 months after surgery with cine-angiographic multidetector computed tomography (cine-MDCT). Eighteen underwent RMA alone (RMA group) and 21 underwent RMA and SVR (RMA+SVR group). In addition to measuring conventional parameters (LV end-diastolic volume index [LVEDVI], LV end-systolic volume index [LVESVI], and LV ejection fraction), we evaluated the regional circumferential end-systolic wall stress and mean circumferential fiber shortening in both the basal and mid-LV regions using 3-dimensional cine-MDCT images. LV end-diastolic and end-systolic volume indexes were significantly greater in the RMA+SVR group than in the RMA group preoperatively, but these values did not differ significantly postoperatively. LV end-diastolic and end-systolic volume indexes decreased significantly, by 21% and 27% after RMA and by 35% and 42% after RMA and SVR, and the percent reductions in LV end-diastolic and end-systolic volume indexes were significantly larger in the RMA+SVR group. Regional end-systolic wall stress decreased and circumferential fiber shortening increased significantly in the noninfarcted regions after RMA with or without SVR. CONCLUSIONS: RMA plus SVR showed a potentially greater reduction of LV end-diastolic and end-systolic volume indexes than RMA alone. In selected patients with more advanced LV remodeling, concomitant SVR may favorably affect the LV reverse-remodeling process induced by RMA.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Ventrículos do Coração/cirurgia , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Disfunção Ventricular Esquerda/cirurgia , Idoso , Angiografia , Pressão Sanguínea/fisiologia , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/fisiopatologia , Feminino , Seguimentos , Frequência Cardíaca/fisiologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Volume Sistólico/fisiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
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