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1.
Kyobu Geka ; 73(9): 695-699, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32879275

RESUMO

In recent years, re-rupture due to endoleaks after thoracic endovascular aortic repair (TEVAR) for ruptured thoracic aortic aneurysms has become a problem. Hemoptysis has been reported in patients after pneumocentesis. We report a patient who developed delayed hemoptysis not related to endoleak after TEVAR. An 80-year-old male underwent emergent TEVAR due to a ruptured thoracic aortic aneurysm accompanying sudden hemoptysis. Eleven days after the operation, recurrent hemoptysis was noted, but contrast-enhanced computed tomography (CT) revealed no endoleak or re-rupture. Bronchoscopy demonstrated hemorrhage from the left upper lobe. As hemostasis was difficult by conservative treatment, left upper lobectomy was performed. The aortic rupture hole exhibited thrombus, and there was no hemorrhage. On histopathological examination of the resected lung, formation accompanied by severe intra-alveolar fibrosis and cholesterin clefts, and marked foreign body reactions in the interstitium and small blood vessels of the lung were observed. Cholesterol embolism is associated with not only organ ischemia due to microembolism, but also immunological mechanisms. Thus, cholesterol embolism due to aorta-derived cholesterin may have led to the delayed pulmonary hemorrhage. Differentiation from re-rupture due to endoleaks is important.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso de 80 Anos ou mais , Aortografia , Hemoptise , Humanos , Masculino , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento
2.
Kyobu Geka ; 66(13): 1186-9, 2013 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-24322363

RESUMO

A 61-year-old male had undergone coronary artery bypass grafting (CABG) using a saphenous vein. Postoperative angiography represented an ascending aortic pseudoaneurysm derived from the proximal anastomotic site of the saphenous vein graft( SVG) which was connected to the obtuse marginal branch and left posterior descending branch sequentially. We performed the closure of tear and the plication of pseudoaneurysmal wall through median sternotomy on the 56th postoperative day. A 7mm length longitudinal tear in the ascending aorta close to the proximal anastomotic site of the SVG was observed. This tear was considered to be caused by the intimal injury during the anastomosis of SVG to ascending aorta. Aortic pseudoaneurysm formation close to the proximal anastomotic site of SVG is a rare and potentially lethal complication requiring urgent operation. Postoperative angiography or enhanced 3 dimensional computed tomography after CABG should be performed before hospital discharge.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Aórtico/cirurgia , Ponte de Artéria Coronária , Falso Aneurisma/etiologia , Aneurisma Aórtico/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Veia Safena/cirurgia
3.
Clin Drug Investig ; 43(3): 155-165, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36746851

RESUMO

BACKGROUND AND OBJECTIVE: Perampanel is a once-daily oral anti-seizure medication indicated for focal-onset seizures and generalized tonic-clonic seizures. This study investigated the single- and multiple-dose pharmacokinetics of perampanel in healthy Chinese adults. METHODS: Study 052 (NCT03424564) was a phase I, single-center, open-label, parallel-group study. In the single-dose part of the study, subjects received a single oral dose of perampanel 2, 4, or 8 mg. In the multiple-dose part, subjects received once-daily oral perampanel 2 mg on Days 1-7 and 4 mg on Days 8-21. Pharmacokinetic parameters were determined from perampanel plasma concentrations using non-compartmental analysis. Dose proportionality after single doses of perampanel was assessed. Safety and tolerability were evaluated. RESULTS: In the single-dose part (N = 30), median time to reach maximum concentration (tmax) was 0.75-1.0 h, mean terminal elimination phase half-life (t½) was 85.6-122 h, mean maximum observed concentration (Cmax) was 77.9-276 ng/mL, and mean area under the concentration-time curve from time zero to time of the last quantifiable concentration (AUC(0-t)) was 4070-15100 ng·h/mL. Single-dose pharmacokinetics were linear for perampanel 2-8 mg. In the multiple-dose part (N = 12), Day 21 steady-state (4 mg/day) parameters were median time at which the highest drug concentration occurs at steady state (tss,max), 1.25 h; mean t½, 109 h; mean maximum observed concentration at steady state (Css,max), 453 ng/mL; and mean area under the concentration-time curve over the dosing interval on multiple dosing (AUC(0- τ)), 7540 ng·h/mL. For single- and multiple-dose perampanel, the most common treatment-emergent adverse events were dizziness and somnolence. CONCLUSIONS: Single- and multiple-dose pharmacokinetics of perampanel in healthy Chinese adults revealed rapid perampanel absorption, slow elimination, and a linear relationship with single perampanel doses of 2-8 mg. Findings were consistent with previous studies of perampanel pharmacokinetics in other ethnic/racial populations of healthy subjects. Single and multiple doses of perampanel were generally safe and well tolerated. CLINICAL TRIAL REGISTRATION: NCT03424564; registered February 2018.


Assuntos
População do Leste Asiático , Nitrilas , Piridonas , Adulto , Humanos , Área Sob a Curva , Relação Dose-Resposta a Droga , Voluntários Saudáveis , Nitrilas/farmacocinética , Piridonas/farmacocinética
4.
Ann Thorac Cardiovasc Surg ; 27(2): 132-135, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32281578

RESUMO

We describe a 69-year-old woman with primary lung cancer in the right lower lobe invasive to the left atrium (LA) via the pulmonary vein (PV). The tumor in the LA measured 30 × 26 mm, and to avoid critical embolism preoperative induction therapy was not performed. The patient underwent right thoracotomy under cardiopulmonary bypass (CPB), and the atrial septum was incised via the right atrium. The tumor was placed out of the LA, followed by lobectomy. For right lung tumors invading the LA, the bilateral trans-septal approach is useful for confirming the surgical margin.


Assuntos
Átrios do Coração/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Toracotomia , Idoso , Ponte Cardiopulmonar , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Margens de Excisão , Invasividade Neoplásica , Resultado do Tratamento
6.
Gen Thorac Cardiovasc Surg ; 63(2): 109-11, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23868200

RESUMO

A 59-year-old male who had undergone mitral valve replacement with the Starr-Edwards ball valve Model 6120 (S-E ball valve) 45 years ago was admitted to our hospital for hemolytic anemia and heart failure. Echocardiography revealed that there was no valve dysfunction but paravalvular leakage between the annulus of P2 and the sewing ring of the Starr-Edwards ball valve. He underwent mitral valve replacement. The S-E ball valve was successfully replaced with bileaflet mechanical valve. The explanted S-E ball valve was free from signs of structural valve degeneration. This case shows one of the longest durability of the S-E ball valve in mitral position in the world.


Assuntos
Insuficiência Cardíaca/cirurgia , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Remoção de Dispositivo , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Desenho de Prótese , Reoperação , Fatores de Tempo
7.
Ann Thorac Surg ; 76(3): 944-6, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12963242

RESUMO

A 28-year-old man arrived at our hospital complaining of severe dyspnea. Bronchoscopic findings demonstrated that a tumor was located approximately 4 cm distant from the vocal cord, occupying most of the tracheal lumen. To urgently relieve the dyspnea, some parts of the tumor were cauterized with the neodymium:yttrium-aluminum garnet laser. Histopathologic examination of the cauterized specimen revealed malignant hemangiopericytoma. During the operation, the tumor was resected en bloc with a tracheal segment containing four tracheal cartilages. The patient's postoperative course was uneventful with no evidence of recurrence 1 year after the operation.


Assuntos
Hemangiopericitoma/patologia , Neoplasias da Traqueia/patologia , Adulto , Humanos , Masculino
8.
Kyobu Geka ; 56(12): 1062-4, 2003 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-14608933

RESUMO

An 85-year-old man had a 2 vessel coronary disease. Preoperative echogram showed the lateral femoral circumflex artery (LFCA) had enough diameter and length. We performed coronary artery bypass grafting (OPCAB) with the left internal thoracic artery (LITA) and LFCA. Postoperative coronary angiogram showed that the LFCA bypass graft was patent and supplied sufficient blood to the anastomosed vessel.


Assuntos
Ponte de Artéria Coronária/métodos , Doença das Coronárias/cirurgia , Artéria Femoral/transplante , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Resultado do Tratamento , Grau de Desobstrução Vascular
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