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1.
J Vasc Surg ; 79(3): 632-641.e3, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37939747

RESUMEN

OBJECTIVE: There is no established consensus or guidelines for wound management after revascularization for patients with chronic limb-threatening ischemia (CLTI) without severe infection. This study is designed to evaluate the clinical effect of the wound management strategy on toe wounds after revascularization for CLTI. METHODS: This retrospective cohort study was performed at eight institutions affiliated with Keio University School of Medicine in Japan and included 261 patients who underwent revascularization for CLTI between April 2019 and July 2021. We identified 132 patients with toe wounds from the database who had restored in-line blood flow to the foot. Patients were divided into two groups by the timing of toe resection after revascularization, which dictated the wound management policy. Group A (62 patients) underwent early toe amputation for suspected osteomyelitis, whereas group B (70 patients) underwent watchful waiting. The primary outcome was wound healing after revascularization; the secondary outcome was major amputation. We compared outcomes between groups A and B after propensity score matching. RESULTS: Using propensity score matching, each patient in group A (33 patients) was matched with a patient in group B (33 patients). Wound healing in matched group A was significantly better than that in matched group B (respectively: 1-year wound healing rate: 90.0% vs 68.2%, P < .001; median wound healing time: 65 days vs 258 days, P < .01). Although five major amputations were necessary in matched group B, none were required in matched group A (P = .05). The high rate of major amputations in group B was attributed to the sudden exacerbation of infection. Limb salvage rate in matched group A exceeded matched group B (100.0% vs 90.5%: 1-year limb salvage rate, P = .02). CONCLUSIONS: Early toe amputation for highly suspected osteomyelitis in patients with CLTI with toe wounds may expedite wound healing compared with watchful waiting, potentially avoiding unnecessary major amputation. Considering the wound management strategy is crucial when evaluating wound healing outcomes in patients with CLTI with revascularization.


Asunto(s)
Procedimientos Endovasculares , Osteomielitis , Enfermedad Arterial Periférica , Humanos , Isquemia Crónica que Amenaza las Extremidades , Estudios Retrospectivos , Resultado del Tratamiento , Factores de Riesgo , Isquemia/diagnóstico por imagen , Isquemia/cirugía , Recuperación del Miembro/efectos adversos , Enfermedad Crónica , Procedimientos Endovasculares/efectos adversos
2.
J Endovasc Ther ; 30(4): 571-579, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35414228

RESUMEN

PURPOSE: To compare the long-term outcomes of the most widely used third-generation stent grafts, the Endurant and Excluder stent grafts, in Japanese patients using a multicenter registry. MATERIALS AND METHODS: A retrospective analysis of endovascular aneurysm repairs for abdominal aortic and iliac artery aneurysms using either the Endurant or the Excluder stent grafts from January 2012 to July 2019 at 10 Japanese hospitals was performed. RESULTS: A total of 332 and 378 repairs using the Endurant and Excluder stent grafts, respectively, were analyzed. Although the patients' characteristics were generally similar in the two groups, the Endurant group exhibited significantly shorter (Endurant: 31.5±18.6 mm, Excluder: 37.4±21.0 mm; p<0.001), larger (Endurant: 22.4±4.2 mm, Excluder: 21.7±3.8 mm; p=0.029), and more reversed tapered (Endurant: 12.1%, Excluder: 5.8%; p=0.003) proximal necks. The incidence of instructions for use (IFU) violations was similar between the two groups (Endurant: 59.0%, Excluder: 54.5%; p=0.223). However, the Endurant group had significantly more proximal neck-related IFU violations (54.1% and 46.3%, respectively; p=0.039), more access-related IFU violations (8.1% and 4.0%, respectively; p=0.019), and fewer bilateral hypogastric artery embolizations (5.1% and 9.3%, respectively; p=0.035) compared with the Excluder group. The incidence of intraoperative (Endurant: 3.6%, Excluder: 3.7%; p=0.950) and perioperative complications (Endurant: 3.6%, Excluder: 3.4%, p=0.899) was equivalent in the two groups. However, there was a significantly higher incidence of postoperative type II endoleaks in the Excluder group (Endurant: 28%, Excluder: 46.0%, p<0.001). Aneurysm sac regression was more frequent in the Endurant group (Endurant: 40.7%, Excluder: 31.7%, p=0.013). The Endurant group also had significantly higher rates of sac increase (Endurant: 13.0%, Excluder: 7.7%, p=0.020). Kaplan-Meier curve and log-rank analyses revealed no statistical differences in late complications (p=0.868) and overall survival (p=0.926). CONCLUSIONS: There were no statistically significant differences between the Endurant and the Excluder stent grafts in terms of intraoperative, perioperative, and late complication rates; however, the anatomical characteristics of the patients were significantly different.


Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Stents , Reparación Endovascular de Aneurismas , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Estudios Retrospectivos , Pueblos del Este de Asia , Factores de Riesgo , Procedimientos Endovasculares/efectos adversos , Diseño de Prótesis , Resultado del Tratamiento
3.
Circ J ; 84(7): 1183-1188, 2020 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-32522903

RESUMEN

BACKGROUND: NT5Egenetic mutations are known to result in calcification of joints and arteries (CALJA), and worldwide, 14 patients from 7 families have been reported.Methods and Results:A total of 5 patients from 2 independent families with CALJA were found in Japan. Of them, 3 complained of intermittent claudication (IC), and 1 suffered from bilateral chronic limb-threatening ischemia (CLTI). Whole-exome sequencing analysis revealed an identical mutation pattern (c.G3C on the exon 1 start codon) that was unique compared withNT5Emutations reported in other countries. CONCLUSIONS: Vascular specialists need to recognize CALJA as a rare cause of ischemic IC and CLTI.


Asunto(s)
5'-Nucleotidasa/genética , Calcinosis/genética , Claudicación Intermitente/genética , Isquemia/genética , Artropatías/genética , Mutación , Calcificación Vascular/genética , Enfermedades Vasculares/genética , Adulto , Anciano , Anciano de 80 o más Años , Calcinosis/diagnóstico , Calcinosis/enzimología , Enfermedad Crónica , Exones , Femenino , Proteínas Ligadas a GPI/genética , Predisposición Genética a la Enfermedad , Humanos , Claudicación Intermitente/diagnóstico , Claudicación Intermitente/enzimología , Isquemia/diagnóstico , Isquemia/enzimología , Artropatías/diagnóstico , Artropatías/enzimología , Masculino , Persona de Mediana Edad , Fenotipo , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/enzimología , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/enzimología , Secuenciación del Exoma
4.
Ann Vasc Surg ; 66: 120-131, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31953142

RESUMEN

BACKGROUND: Although the use of aneurysmal common iliac artery (CIA) as the landing zone during endovascular aortic aneurysm repair EVAR remains an essential procedure, this procedure may increase the risk of late complications such as ongoing CIA dilatation and type Ib endoleak (CIA-related complications). We hypothesized that incomplete sealing of the aneurysmal CIA segment during EVAR could increase the incidence of CIA-related complications. In this study, we evaluated the midterm results of EVAR with aneurysmal CIA used as the landing zone and assessed the importance of distal sealing in this procedure. METHODS: We retrospectively reviewed all cases of endovascular aneurysm repair using CIA as landing zone between 2007 and 2015 that had at least 3 years' follow-up. We defined aneurysmal CIA as maximum diameter ≥18 mm. The main outcome was the incidence of CIA-related complications. We compared midterm results between normal CIA and aneurysmal CIA. Next, we analyzed risk factors for CIA-related complications in aneurysmal CIA. RESULTS: Four complications occurred in normal CIA (mean follow-up, 66.5 ± 22.1 months); 21 occurred in aneurysmal CIA (mean follow-up, 62.2 ± 20.5 months). The 5-year portion of freedom from CIA-related complications was 97.3% in normal CIA and 69.4% in aneurysmal CIA (P < 0.001). Multivariable analysis in aneurysmal CIA showed that unsealed CIA segment length was only risk factor for CIA-related complications. Given the receiver operating characteristic curve results, we defined the unsealed CIA segment ≥10 mm as incomplete sealing. The hazard ratio for incomplete sealing associated with CIA-related complications was 3.92 (95% confidence interval 1.62-9.46, P = 0.02). CONCLUSIONS: Use of aneurysmal CIA as landing zone increases the risk of CIA-related complications. However, maximum sealing of the aneurysmal CIA segment could prevent these complications.


Asunto(s)
Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/efectos adversos , Endofuga/etiología , Procedimientos Endovasculares/efectos adversos , Aneurisma Ilíaco/cirugía , Arteria Ilíaca/cirugía , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/fisiopatología , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Bases de Datos Factuales , Endofuga/diagnóstico por imagen , Endofuga/fisiopatología , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Aneurisma Ilíaco/fisiopatología , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Masculino , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Stents , Factores de Tiempo , Resultado del Tratamiento
5.
Eur J Vasc Endovasc Surg ; 58(6): 839-847, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31607678

RESUMEN

OBJECTIVE/BACKGROUND: It was hypothesised that a helical stent with expanded polytetrafluoroethylene (ePTFE) grafts could provide a preventive effect for external iliac artery (EIA) limb occlusion following endovascular aortic aneurysm repair (EVAR). Therefore, a post-hoc analysis of a Japanese multicentre database was conducted to assess the impact of the stent graft design on EIA limb occlusion rates. METHODS: Patients who underwent EVAR with EIA limb deployment between 2008 and 2016 were evaluated. The stent graft limbs were divided into two groups: group A comprised stent graft limbs made of a helical stent with ePTFE grafts (Excluder; n = 255), and group B comprised stent graft limbs made of a Z stent with polyester grafts (Zenith, Flex and Endurant; n = 173). The main outcome was the incidence of limb occlusion and severe limb stenosis (EIA related limb complications). The risk factors for EIA related limb complications were analysed and the midterm results between groups A and B compared. Fine-Gray generalisation of the proportional hazards model was used after propensity score matching to calculate the hazard ratio (HR). RESULTS: One complication occurred in group A and 10 complications occurred in group B. The risk factors for EIA related limb complications for the entire group were a stent graft limb size ≤10 mm (HR 5.41; p = .01) and inclusion in group B (HR 14.9; p = .009). After propensity matching, group A (n = 159) was matched with group B (n = 159). The cumulative incidence function of EIA related limb complications at five years was 0.66% in group A and 7.8% in group B (HR 8.67; p = .039). CONCLUSION: Stent graft design can affect limb patency in EIA limb deployment. When EIA limb deployment is necessary for patients with a small EIA, such as Japanese patients, stent graft limbs made of a helical stent with ePTFE should be used to reduce the risk of limb occlusion.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Arteriopatías Oclusivas/epidemiología , Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Oclusión de Injerto Vascular/epidemiología , Arteria Ilíaca/patología , Diseño de Prótesis/efectos adversos , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/etiología , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/instrumentación , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/etiología , Humanos , Arteria Ilíaca/diagnóstico por imagen , Imagenología Tridimensional , Japón/epidemiología , Extremidad Inferior , Masculino , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Stents/efectos adversos , Resultado del Tratamiento
6.
Ann Vasc Surg ; 33: 230.e1-4, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26907373

RESUMEN

In Behcet disease (BD), vascular complication such as false aneurysm formation is common after surgical treatment in the arterial lesion, and the optimal treatment method remains controversial. Concerning the innominate artery aneurysm, lack of experience due to its rarity in vasculo BD makes decision making even more difficult. We report a ruptured innominate artery aneurysm in a 70-year-old man with BD, which was successfully treated by innominate artery stent grafting through the right common carotid artery, axillo-axillary artery bypass grafting, and right subclavian artery coil embolization. The patient is doing well without any vascular complications at eighth postoperative month.


Asunto(s)
Aneurisma Roto/terapia , Síndrome de Behçet/complicaciones , Implantación de Prótesis Vascular , Tronco Braquiocefálico/cirugía , Embolización Terapéutica , Procedimientos Endovasculares , Anciano , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/etiología , Síndrome de Behçet/diagnóstico , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Tronco Braquiocefálico/diagnóstico por imagen , Procedimientos Endovasculares/instrumentación , Humanos , Masculino , Stents , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
7.
Surg Today ; 44(4): 748-52, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23443822

RESUMEN

Profunda femoris artery aneurysms (PFAAs) are rare and difficult to diagnose in the early stage. They are often found due to the presence of complicated conditions, such as rapid expansion, rupture, or acute lower limb ischemia. Surgical procedures such as aneurysmectomy and endoaneurysmorrhaphy tend to be technically challenging because of the patient status and the extent of the aneurysm. We experienced three cases of PFAAs that were treated by proximal ligation (PL) without complete control of the distal branches. The exclusion of PFAAs was confirmed by duplex ultrasound or angiography at the end of the operation. There was no mortality in the perioperative period. During a 12-month follow-up, all cases exhibited complete exclusion of aneurysms with marked size reduction. Based on these findings, we propose that PL, with a careful follow-up for PFAA exclusion and distal limb circulation, could be an alternative treatment for complicated PFAAs.


Asunto(s)
Aneurisma/cirugía , Arteria Femoral/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Anciano de 80 o más Años , Aneurisma/diagnóstico , Implantación de Prótesis Vascular , Diagnóstico por Imagen , Estudios de Seguimiento , Humanos , Ligadura/métodos , Extremidad Inferior/irrigación sanguínea , Masculino , Resultado del Tratamiento
8.
Kyobu Geka ; 67(2): 165-8, 2014 Feb.
Artículo en Japonés | MEDLINE | ID: mdl-24743491

RESUMEN

An 76-year-old man was referred to our hospital due to right hydrothorax. The diffuse thickening of parietal pleura with increased fluoro-2-deoxy-D-glucose (FDG) uptake was noted by computed tomography (CT) and positron emission tomography (PET). Surgical biopsy was performed and the tumor was diagnosed as mucosal associated lymphoid tissue (MALT) lymphomas of parietal pleura origin by pathology. Complete remission was achieved by postoperative chemotherapy (R-CHOP), and the patient is now alive without recurrence.


Asunto(s)
Linfoma de Células B de la Zona Marginal/patología , Neoplasias Pleurales/patología , Anciano , Humanos , Linfoma de Células B de la Zona Marginal/diagnóstico , Masculino , Neoplasias Pleurales/diagnóstico
9.
J Surg Case Rep ; 2024(2): rjae078, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38370602

RESUMEN

In recent years, endovascular treatment has become the first-line revascularisation method for aortoiliac artery occlusive disease. Rarely, aortoiliac artery occlusive disease may be associated with stenosis of the external iliac artery (EIA) that suggested pseudo-stenosis. We describe a case of aortoiliac artery occlusive disease with EIA stenosis without calcification or atheroma. Stent grafts were inserted from the abdominal aorta to the bilateral common iliac arteries. Pre-operative computed tomography and intravascular ultrasound findings confirmed the absence of calcification or atheroma in both EIA, suggesting that the EIA had developed pseudo-stenosis. Following endovascular treatment, the EIA diameter recovered only with balloon dilation after inflow improvement. Consideration is necessary when placing an easy stent graft in the narrow EIA during endovascular treatment for aortoiliac artery occlusive disease with EIA stenosis to avoid a potential stent graft diameter mismatch.

10.
Cureus ; 16(1): e52775, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38389604

RESUMEN

Ruptured phyllodes tumors, though extremely rare, can necessitate emergency surgery in certain cases, particularly those with active bleeding. A 51-year-old woman presented to our hospital with a newly identified mass in her right breast that developed over the past two months. The tumor had ruptured through the paramammary nipple. While initially diagnosed with a phyllodes tumor and scheduled for elective surgery, she experienced active bleeding from the ruptured tumor, leading to a drop in hemoglobin levels. An emergency right simple mastectomy was performed to control the bleeding. Postoperatively, no complications or recurrences were observed. Phyllodes tumors, which are characterized by rapid growth, may present with active bleeding following rupture and may require emergency surgery.

11.
Surg Case Rep ; 10(1): 100, 2024 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-38656713

RESUMEN

BACKGROUND: Letrozole, an aromatase inhibitor, is used to treat breast cancer in postmenopausal women. Tumor lysis syndrome (TLS) is a complication that can trigger multiple organ failure caused by the release of intracellular nucleic acids, phosphate, and potassium into the blood due to rapid tumor cell disintegration induced by drug therapy. TLS is uncommon in solid tumors and occurs primarily in patients receiving chemotherapy. Herein, we report a rare occurrence of TLS that developed in a patient with locally advanced breast cancer following treatment with letrozole. CASE PRESENTATION: An 80-year-old woman with increased bleeding from a fist-sized left-sided breast mass presented to our hospital. Histological examination led to a diagnosis of invasive ductal carcinoma of the luminal type. The patient refused chemotherapy and was administered hormonal therapy with letrozole. Seven days after letrozole initiation, she complained of anorexia and diarrhea. Blood test results revealed elevated blood urea nitrogen (BUN) and creatinine (Cr) levels, and she was admitted to our hospital for intravenous infusions. On the second day after admission, marked elevations of LDH, BUN, Cr, potassium, calcium, and uric acid levels were observed. Furthermore, metabolic acidosis and prolonged coagulation capacity were observed. We suspected TLS and discontinued letrozole, and the patient was treated with hydration, febuxostat, and maintenance hemodialysis. On the third day after admission, her respiratory status worsened because of acute respiratory distress syndrome associated with hypercytokinemia, and she was intubated. On the fourth day after admission, her general condition did not improve, and she died. CONCLUSIONS: Although TLS typically occurs after chemotherapy initiation, the findings from the present case confirm that this syndrome can also occur after hormonal therapy initiation and should be treated with caution.

12.
Surg Case Rep ; 10(1): 32, 2024 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-38302639

RESUMEN

IgG4-related mastitis is an extremely rare IgG4-related sclerosing disease involving the breast that must be differentiated from breast cancer. There is currently no consensus regarding the optimal treatment strategies. Here, we report a case of IgG4-related mastitis followed up without excision or steroid therapy. Although the association between IgG4-related mastitis and breast cancer remains unclear, regular follow-up imaging and measurement of serum concentrations of disease activity markers may allow for follow-up without excision or steroid therapy.

13.
J Surg Case Rep ; 2023(12): rjad660, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38076305

RESUMEN

Axillary artery injury secondary to shoulder dislocation with humerus fracture is rare. Rupture of the axillary artery during open reduction is extremely rare. Here, we report about a rare case of a ruptured axillary artery during an open reduction for shoulder dislocation with humerus fracture. A 58-year-old man with left shoulder pain because of a fall after alcohol consumption was diagnosed as having left shoulder dislocation with a humerus fracture. He underwent open reduction surgery. During the procedure, bleeding was observed, and further examination through angiography revealed an ruptured axillary artery. To address this urgent situation, stent grafts were promptly deployed retrogradely from the brachial artery. The postoperative course was uneventful, except for brachial plexus palsy. In the emergent setting, endovascular repair is an efficient alternative to conventional open surgery for controlling bleeding when a ruptured axillary artery occur during open reduction for shoulder dislocation.

14.
J Infect Chemother ; 18(6): 816-26, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23143280

RESUMEN

To investigate the trends of antimicrobial resistance in pathogens isolated from surgical site infections (SSI), a Japanese surveillance committee conducted the first nationwide survey. Seven main organisms were collected from SSI at 27 medical centers in 2010 and were shipped to a central laboratory for antimicrobial susceptibility testing. A total of 702 isolates from 586 patients with SSI were included. Staphylococcus aureus (20.4 %) and Enterococcus faecalis (19.5 %) were the most common isolates, followed by Pseudomonas aeruginosa (15.4 %) and Bacteroides fragilis group (15.4 %). Methicillin-resistant S. aureus among S. aureus was 72.0 %. Vancomycin MIC 2 µg/ml strains accounted for 9.7 %. In Escherichia coli, 11 of 95 strains produced extended-spectrum ß-lactamase (Klebsiella pneumoniae, 0/53 strains). Of E. coli strains, 8.4 % were resistant to ceftazidime (CAZ) and 26.3 % to ciprofloxacin (CPFX). No P. aeruginosa strains produced metallo-ß-lactamase. In P. aeruginosa, the resistance rates were 7.4 % to tazobactam/piperacillin (TAZ/PIPC), 10.2 % to imipenem (IPM), 2.8 % to meropenem, cefepime, and CPFX, and 0 % to gentamicin. In the B. fragilis group, the rates were 28.6 % to clindamycin, 5.7 % to cefmetazole, 2.9 % to TAZ/PIPC and IPM, and 0 % to metronidazole (Bacteroides thetaiotaomicron; 59.1, 36.4, 0, 0, 0 %). MIC90 of P. aeruginosa isolated 15 days or later after surgery rose in TAZ/PIPC, CAZ, IPM, and CPFX. In patients with American Society of Anesthesiologists (ASA) score ≥3, the resistance rates of P. aeruginosa to TAZ/PIPC and CAZ were higher than in patients with ASA ≤2. The data obtained in this study revealed the trend of the spread of resistance among common species that cause SSI. Timing of isolation from surgery and the patient's physical status affected the selection of resistant organisms.


Asunto(s)
Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Infección de la Herida Quirúrgica/microbiología , Farmacorresistencia Bacteriana , Humanos , Japón/epidemiología , Pruebas de Sensibilidad Microbiana , Infección de la Herida Quirúrgica/epidemiología
15.
Kyobu Geka ; 65(9): 795-9, 2012 Aug.
Artículo en Japonés | MEDLINE | ID: mdl-22868464

RESUMEN

An 83-year-old man with a decreasing level of consciousness was carried to the emergency room. Computed tomography (CT) revealed a ruptured aortic arch aneurysm. He was deemed a high risk candidate for conventional surgical repair. The case was treated by a hybrid approach. Endo-exclusion of thoracic aortic aneurysm (TAA) was obtained by implanting stentgrafts from the ascending to descending aorta. The brain circulation was maintained by right to left carotid and to left subcravian artery bypasses combined with" chimney endo-debranching graft" of the innominate artery. This could be a method of choice for the acute patients under similar circumstances.


Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Arterias Carótidas/cirugía , Anciano de 80 o más Años , Prótesis Vascular , Humanos , Masculino , Stents , Arteria Subclavia/cirugía
16.
Kyobu Geka ; 65(13): 1123-6, 2012 Dec.
Artículo en Japonés | MEDLINE | ID: mdl-23202706

RESUMEN

A 77-year-old woman was admitted to our hospital with abnormal chest shadow detected on a medical checkup. Chest computed tomography(CT)showed a well-defined tumor in the upper lobe of the right lung. On positron emission tomography by fluorodeoxyglucose(FDG),the tumor revealed to be positive. We performed right upper lobectomy with hilar and mediastinal lymph node dissection. The histopathological diagnosis was lymphoepithelioma-like carcinoma (LELC). In the past 25-years, 41 cases have been reported in Japan. The average age is 64 years old, including 25 male cases and 16 female cases. Among these cases, more than half were in the early resectable stage.


Asunto(s)
Carcinoma de Células Grandes/diagnóstico , Neoplasias Pulmonares/diagnóstico , Anciano , Carcinoma de Células Grandes/patología , Femenino , Humanos , Neoplasias Pulmonares/patología
17.
Kyobu Geka ; 65(12): 1097-100, 2012 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-23117365

RESUMEN

60-year-old woman was admitted with an abnormal shadow on the chest roentgenogram. Computed tomography showed atelectasis of the right middle lobe and hilar and mediastinal lymphadenopathy. Bronchoscopic examination revealed an obstruction at the orifice of the right middle lobe bronchus and biopsy was performed. The biopsy suggested malignant lymphoma. A diagnosis of methotrexate-associated lymphoproliferative disorders was suspected because the patient was administered methotrexate to treat the rheumatoid arthritis. The video-assisted thoracoscopic surgery was performed. Histological examination showed no malignancy and sarcoidosis in the peribronchial lymph nodes. The compressed middle lobe bronchus by enlarged lymph nodes was consider to be the cause of the middle lobe atelectasis.


Asunto(s)
Neoplasias Pulmonares/diagnóstico , Linfoma/diagnóstico , Atelectasia Pulmonar/etiología , Sarcoidosis Pulmonar/complicaciones , Sarcoidosis Pulmonar/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad
18.
Ann Vasc Dis ; 15(2): 126-133, 2022 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-35860822

RESUMEN

Objective: In this study, we aim to evaluate the efficacy of early closed toe amputation on the wound management of toe ulcers with suspected osteomyelitis after revascularization for chronic limb-threatening ischemia (CLTI). Methods: This retrospective study included patients who have underwent revascularization for toe ulcers associated with CLTI at Shizuoka Red Cross Hospital from 2015 to 2021. Wound management comprised early closed toe amputation for toe ulcers with suspected osteomyelitis (19 toes in 17 patients) or conservative treatment (35 toes in 26 patients). The primary endpoint was wound healing after revascularization. We compared the wound healing rate at 90 days and median healing time of early closed toe amputation versus conservative treatment. Results: Compared with the conservative treatment, early closed toe amputation was able to achieve a better wound healing rate at 90 days (89.5% vs. 68.6%; P<0.01) and a shorter median healing time (19 days vs. 62 days; P=0.01). Conclusion: There remains no established wound management for toe lesions associated with CLTI. Despite its several disadvantages including wound infection and possible foot deformity, early closed toe amputation for toe ulcers with suspected osteomyelitis can be considered a safe approach in terms of wound management.

19.
Surg Today ; 41(4): 556-9, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21431493

RESUMEN

A 37-year-old male patient presented with abdominal pain and diarrhea. Computed tomography showed a large superior mesenteric vein aneurysm. The patient had a history of Crohn's disease and underwent an ileocecal resection 7 years previously. A selective angiogram of the superior mesenteric artery revealed that a dilated branch of this artery fed directly into the superior mesenteric vein. The iatrogenic superior mesenteric arteriovenous fistula was successfully closed by transarterial coil embolization. Successful endovascular treatment for a superior mesenteric arteriovenous fistula has been recently reported; however, the complications of this new modality are not well understood. We herein review the current literature and discuss endovascular treatment.


Asunto(s)
Aneurisma/etiología , Aneurisma/cirugía , Fístula Arteriovenosa/etiología , Fístula Arteriovenosa/cirugía , Enfermedad de Crohn/cirugía , Embolización Terapéutica/métodos , Adulto , Angiografía , Diagnóstico Diferencial , Humanos , Enfermedad Iatrogénica , Masculino , Arterias Mesentéricas , Venas Mesentéricas , Tomografía Computarizada por Rayos X
20.
Kyobu Geka ; 64(13): 1163-7, 2011 Dec.
Artículo en Japonés | MEDLINE | ID: mdl-22242294

RESUMEN

A 79-year-old woman presented with sustained thoracolumbar back pain. Contrasted computed tomography (CT) showed a thoracoabdominal aortic aneurysm (TAAA: type I of Crawford classification) and an abdominal aortic aneurysm (AAA) that were not ruptured. Considering her age, the placement of an endovascular stent graft was performed for TAAA at the possible sacrifice of the celiac (CA) and superior mesenteric arteries (SMA). In order to prevent ischemic events, it was necessary that blood supply to the CA and SMA was maintained by placing a graft to each artery from the Y-shaped graft for replacement of AAA. Actually, only CA was sacrificed and coil embolization of CA was needed because of type 2 endoleak. The patient was discharged 17 days after surgery. A hybrid technique, endovascular repair with reconstruction of abdominal branches for TAAA and AAA, can be an alternative procedure for such high-risk operation with multiple aortic aneurysms including TAAA.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Arteria Celíaca/cirugía , Arteria Mesentérica Superior/cirugía , Anciano , Prótesis Vascular , Procedimientos Endovasculares/métodos , Femenino , Humanos , Stents
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