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1.
Artigo em Inglês | MEDLINE | ID: mdl-32024258

RESUMO

This study aimed to reveal the influence of food production experience on dietary knowledge, dietary awareness, dietary behaviors, and health among Japanese populations. We conducted a systematic review of articles published between January 2000 and September 2018 (PROSPERO registration number: CRD42019117163) using the following four databases: PubMed, Web of Science, CiNii, and ICHUSHI. The search formulas were created by combining search terms "agricultural experience," "garden," "diet," "food," "physical activity," "health," and "well-being." The articles were identified by titles, abstracts, and whole texts. We evaluated the content of the articles that met the adoption criteria. We included original articles from peer-reviewed scientific journals, articles written in Japanese or English, observational or interventional studies with statistical analyses, and articles targeting general Japanese people (except for those targeting patients or disabled) to examine the relationship according to the purpose of this review. Nineteen articles met the study criteria, including 10 cross-sectional studies, one retrospective study, seven pre-post studies, and three non-randomized controlled trials. Two studies combined multiple research designs. Thus, food production experiences were suggested to have a positive influence on dietary knowledge, dietary awareness, food preference, dietary behaviors, and mental health among the Japanese. However, the overall quality of the included studies was low. Further verification with randomized controlled trials and prospective cohort studies is required.

2.
Anticancer Res ; 40(2): 1087-1093, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014958

RESUMO

BACKGROUND: The short- and long-term outcomes of esophagectomy for esophageal cancer were fully evaluated in patients older than 75 years of age. PATIENTS AND METHODS: The present study selected patients who received esophagectomy for esophageal cancer. Patients were divided into non-elderly patients [age <75 years (non-elderly group)] and elderly patients [age ≥75 years (elderly group)]. The postoperative surgical morbidity, postoperative 30-days mortality, recurrence-free survival (RFS), and overall survival (OS) rates were evaluated between the non-elderly group and elderly group. RESULTS: One hundred twenty-two patients were evaluated in this study. Ninety-eight patients and 24 patients were classified into the non-elderly group and elderly group, respectively. The postoperative surgical complication rates in the non-elderly and elderly groups were 71.4% and 75.0%. There was not a statistically significant difference between the two groups (p=0.710). Mortality was observed in 1 patient in the elderly group (4.2%) due to cardiovascular disease. Significant differences were observed in the five-year OS and RFS rates of the elderly and non-elderly groups (55.4% vs. 29.7%, p=0.0017 and 42.2% vs. 21.2%, p=0.0334, respectively). CONCLUSION: Although the rate of postoperative surgical complications after esophagectomy for esophageal cancer was almost equal in the elderly and the non-elderly patients, significant differences were observed in the mortality and long-term outcomes of the two groups. Thus, the surgical strategy and perioperative care must be carefully planned for esophageal cancer patients older than 75 years of age.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/mortalidade , Esofagectomia/efeitos adversos , Esofagectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Assistência Perioperatória , Complicações Pós-Operatórias/etiologia , Prognóstico , Resultado do Tratamento
3.
Anticancer Res ; 40(1): 443-449, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892599

RESUMO

BACKGROUND: We investigated the clinical influence of anastomotic leak (AL) on esophageal cancer survival and recurrence after curative surgery. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The patients were classified into those with AL and those without. The risk factors for overall (OS) and recurrence-free (RFS) survival were identified. RESULTS: AL was found in 44 out of the 122 patients (36.1%). The respective OS rates at 3 and 5 years after surgery were 43.9% and 40.2% in the AL group and 63.9% and 53.2% in the non-AL group, which were significantly different (p=0.0049). In contrast, the respective RFS rates at 3 and 5 years after surgery were 44.8% and 29.8%, and 44.9% and 42.4%, which were not significantly different (p=0.2306). A multivariate analysis showed that AL was a significant independent risk factor for both poorer OS and RFS in patients who underwent curative surgery for esophageal cancer. CONCLUSION: To improve survival of patients with esophageal cancer, the surgical procedure, perioperative care and surgical strategy must be carefully planned in order to prevent AL.


Assuntos
Fístula Anastomótica/patologia , Neoplasias Esofágicas/patologia , Recidiva Local de Neoplasia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Sobrevida
5.
Artigo em Inglês | MEDLINE | ID: mdl-30999687

RESUMO

There have been many reports indicating the relationship between gardening and health or healthy lifestyles among adults in developed countries all over the world. However, Japanese evidence is lacking. The aim of this study was to clarify the relationship between community or home gardening and health status or a healthy lifestyle using a web-based survey with Japanese elderly living in the community. A survey was conducted to gather data from 500 gardeners and 500 nongardeners aged 60 to 69. As a result, significant relationships were shown between community gardening and exercise habits, physical activity, eating vegetables, and connections with neighbors. Moreover, the significant relationships between home gardening and the following items were indicated: Subjective happiness, exercise habits, physical activity, sitting time, eating breakfast, eating vegetables, eating balanced meals, and connections with neighbors. No item demonstrated a significant relationship with gardening frequency. A significant relationship was demonstrated between gardening duration and health problems affecting everyday life. Further significant relationships were shown between gardening with others and subjective happiness, having a reason for living. In conclusion, promising positive relationships between community or home gardening and health or healthy lifestyles were indicated.


Assuntos
Jardinagem , Nível de Saúde , Internet , Idoso , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Verduras
7.
J Rural Med ; 13(2): 116-123, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30546800

RESUMO

Objectives: This study aimed at identifying the differences in the vegetable intake frequency among rural, suburban, and urban residents. It also intended to estimate the effects of vegetable cultivation, receiving vegetables, and purchasing vegetables at farmers' markets on the differences in vegetable intake frequency. Based on the results, to promote vegetable intake, we discuss the value of supporting vegetable cultivation in the rural areas. Materials and Methods: We conducted a cross-sectional study targeting residents aged between 20 and 74, living in three parts of a city within the Gunma prefecture in Japan. The three locations were selected to represent the rural, suburban, and urban areas. We mailed two sets of anonymous self-administered questionnaires to all households in the three areas (a total of 2,260 households, comprising about 1,000 people aged between 20 and 74 in each area). The survey requested information on the vegetable intake frequency, vegetable cultivation, frequency of receiving vegetables, frequency of vegetable purchase at farmers' markets, the subjective difficulty in food-store access, economic circumstances, health attitudes, and demographic characteristics. We used the analysis of covariance (ANCOVA) to examine the data obtained. Results: We received 873 responses (from 586 households), of which 90 were irrelevant, thus leaving a sample of 783 residents (257 rural, 259 suburban, 267 urban) available for statistical analysis. The results revealed that the rural residents had significantly greater vegetable intake frequency than the urban and suburban residents did. These regional differences became smaller after the adjustment of the following variables: vegetable cultivation, receiving vegetables, and vegetable purchase at farmers' markets. No significant difference was observed in the vegetable intake frequency between the rural and urban respondents after this adjustment was made. Conclusions: Vegetable intake frequency was higher in the rural area than in the suburban and urban areas. Vegetable cultivation, receiving vegetables, and vegetable purchase at farmers' markets were strongly linked to these regional differences.

8.
J Rural Med ; 13(2): 160-167, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30546805

RESUMO

Objective: To clarify the relationship between the proportion of severely insufficient vegetable intake frequency and 1) vegetable cultivation, 2) frequency of receiving vegetable among non-cultivators. Materials and Methods: Residents aged 20 to 74 years in three areas of a city in Gunma Prefecture, Japan, were invited to participate. In September 2016, two sets of self-administered questionnaires were mailed to all 2,260 households in the three areas. The survey items covered the frequency of vegetable intake, vegetable cultivation (as a farmer, as a non-farmer, or no-cultivation), frequency of receiving vegetable, and basic characteristics. For vegetable cultivators, we asked the proportion of cultivated vegetables for home consumption and for giving to neighbors. Binomial logistic regression models were used to analyze the data collected. The respondents were classified into two groups according to their vegetable intake frequency: fewer than three times per day (severely insufficient), and at least three times per day. Results: We had 796 valid responses. Using the no-cultivation group as reference, both of the other groups -vegetable cultivation as a farmer, and as a non-farmer- had a significantly smaller proportion of severely insufficient vegetable intake frequency. Among the no-cultivation group, using those who had never received vegetable in the past month as reference, those who rarely, sometimes, or often received vegetables had a significantly smaller proportion of severely insufficient vegetable intake frequency. These associations were similar in cases where vegetable juice was or was not included. The proportion of those who cultivated vegetables for home consumption was 96% among farmers and 100% among non-farmers, respectively, and for giving to neighbors was 84% among farmers and 62% among non-farmers, respectively. Conclusion: A negative association of the proportion of severely insufficient vegetable intake with vegetable cultivation, and with receiving vegetable among non-cultivators, was suggested.

9.
Artif Organs ; 42(2): 235-239, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28853178

RESUMO

The AB5000 Circulatory Support System is paracorporeal pulsatile ventricular assist device. The AB Portable Driver is a portable console for this system. We experienced two cases with accelerated hemolysis while receiving support by the AB Portable Driver. The purpose of this study was to clarify the mechanical differences associated with the hemolysis between the AB5000 console and the AB Portable Driver. The mock circulatory system modeled by an AB5000 ventricle and a blood sampling bag of vinyl chloride was run with an AB5000 console or AB Portable Driver. The peak drive-line pressure, the mean arterial cannula pressure and the pumping rate of the VAD were recorded. The AB5000 console generated a peak drive-line pressure of 280-300 mm Hg in LVAD mode and 210-220 mm Hg in RVAD mode, approximately 100 mm Hg lower than officially documented. In contrast, the AB Portable Driver generated pressures of 310-330 mm Hg in LVAD mode and 230-250 mm Hg in RVAD mode, 65-95 mm Hg higher than officially documented. The AB Portable Driver console generates higher drive-line pressures than the AB5000 console, possibly explaining the accelerated hemolysis.


Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Hemólise , Adulto , Desenho de Equipamento , Feminino , Insuficiência Cardíaca/patologia , Humanos , Pressão , Adulto Jovem
10.
Gen Thorac Cardiovasc Surg ; 66(8): 476-479, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29119449

RESUMO

We experienced an arterial switch operation in a patient with d-transposition of the great arteries associated with bilateral intramural coronary arteries from a single coronary ostium. In performing the coronary transfer, intramural course of bilateral coronary arteries was unroofed and coronary ostium was separated into two coronary buttons. The two coronary buttons were translocated to the neo-aorta using modified trap-door technique. The angiogram performed 6 years after the operation revealed well-developed coronary arteries without stenosis, and the patient is doing well 8 years after the operation.


Assuntos
Transposição das Grandes Artérias/métodos , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Transposição dos Grandes Vasos/cirurgia , Angiografia , Aorta , Constrição Patológica/complicações , Coração , Humanos , Recém-Nascido , Masculino , Seio Aórtico , Fosfatase Ácida Resistente a Tartarato
11.
Nihon Koshu Eisei Zasshi ; 64(11): 684-694, 2017.
Artigo em Japonês | MEDLINE | ID: mdl-29249779

RESUMO

Objectives The aims of the study were as follows: 1) to investigate the relationship between community fruit and vegetable (FV) gardening and perceived changes in health-related factors by utilizing community gardens and 2) to determine the relationship of community FV gardening and other types of gardening on health-related factors among men aged 50-74 years living in a suburban area of Japan.Methods In this cross-sectional study, we targeted men aged 50-74 years living in a city in Gunma Prefecture. A survey solicited demographic characteristics, FV gardening information, and health-related factors [BMI, self-rated health status, FV intake, physical activity (PA), and perceived neighborhood social cohesion (PNSC)]. The participants were divided into three groups: community gardeners, other types of gardeners, and non-gardeners. Items related to community gardening and perceived changes in health-related factors were presented only to community gardeners. The relationship between community gardening and perceived changes in health-related factors were analyzed by computing correlation coefficients. The relationships between FV gardening and specific health-related factors were analyzed by logistic regression modeling.Results Significant positive correlations were observed between community FV gardening (the frequency of community gardening, the product of community gardening time and frequency of community gardening) and perceived changes in health-related factors (frequency of FV intake, amount of FV intake, and PA). The logistic regression models showed that 1) the number of participants with ≥23 METs h/week of PA was significantly greater among community gardeners than among non-gardeners; 2) the number of participants whose frequency of total vegetable intake, total vegetable intake (excluding juice), and total FV intake (excluding juice) was ≥5 times/day was significantly greater among other types of gardeners than non-gardeners; 3) participants with scores ≥ the median of PNSC were significantly greater among other types of gardeners than non-gardeners; and 4) participants who spent ≥4 hours/day sitting were significantly fewer among other types of gardeners than non-gardeners.Conclusion Higher frequency of community gardening appears to induce greater perceived positive changes on FV intake and PA. It was indicated that FV gardening in community gardens contributes to increased PA, whereas other types of FV gardening contribute to increased FV intake frequency and decreased sitting time. In the future, higher-quality studies-for example, intervention studies using more rigorous measurements-will be necessary.


Assuntos
Jardinagem , População Suburbana , Idoso , Estudos Transversais , Frutas , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Verduras , Recursos Humanos
12.
Gen Thorac Cardiovasc Surg ; 65(4): 239-241, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27421849

RESUMO

The procedure and efficacy of the intermittent distal perfusion during hypothermic circulatory arrest in total arch replacement was described. During hypothermic circulatory arrest, elephant trunk was fixed inside the descending aorta. Then, the AP Grid Catheter was inserted through the elephant trunk, and blood perfusion at a flow rate of 500 ml/min for 5 min was installed. After the perfusion, distal anastomosis was completed. Clinical results of 23 patients (Group I) with this technique were compared with these of 21 patients without the procedure (Group II). Continuous hypothermic circulatory arrest time was significantly shorter (32.7 vs. 72.7 min; p < 0.05) and postoperative serum creatinine level was significantly lower (1.29 vs. 1.68; p < 0.05) in Group I than Group II. The incidence of abdominal complication was also fewer in Group I. Intermittent distal perfusion shortens hypothermic circulatory arrest time and is protective for the lower body including kidneys.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Perfusão/métodos , Idoso , Feminino , Humanos , Masculino
13.
Kyobu Geka ; 67(4): 299-304, 2014 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-24917160

RESUMO

OBJECTIVE: We retrospectively reviewed our surgical results in patients with hypoplastic left heart syndrome( HLHS) to investigate the influence of surgical strategy on outcome. METHODS: Seventy-seven patients with classic HLHS were involved in this study. For the initial palliation, 23 patients underwent Norwood operation with modified Blalock-Taussig (BT) shunt, 23 patients underwent Norwood operation with right ventricle to pulmonary artery( RV-PA) shunt and 31 patients underwent bilateral pulmonary artery banding (BPAB). Surgical results, freedom from Fontan operation, hemodynamic data and incidence of complication after Fontan operation were compared between the 3 groups. RESULTS: BPAB group had more preoperative risk factors than Norwood group. Total actuarial survival was 62.4% at 1 year and 58.2% at 3 and 5 years, and there was no difference between the groups. Freedom from Fontan completion was 59.4% at 3 years and 48.7% at 5 years without difference between the groups. The incidence of intervention for pulmonary artery stenosis was higher in Norwood with RV-PA shunt group(52.9%). Hemodynamic data obtained by cardiac catheterization were similar in the 3 groups, however, end-systolic elastance, which represents ventricular contractility, was lower in Norwood with RV-PA group. CONCLUSIONS: Surgical results of Norwood with BT shunt and Norwood with RV-PA shunt were comparably satisfactory, however, there was possible concern of reduced ventricular contractility in RV-PA shunt group. BPAB was a effective and useful initial palliation in high risk cases.


Assuntos
Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Procedimento de Blalock-Taussig , Ventrículos do Coração/cirurgia , Humanos , Recém-Nascido , Procedimentos de Norwood , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
14.
Eur J Cardiothorac Surg ; 45(5): e166-72, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24482388

RESUMO

OBJECTIVE: To review the surgical outcome of the Yasui operation in patients with adequate-sized ventricles and ventricular septal defect (VSD) associated with obstructions of the aortic arch and left ventricular outflow tract (LVOT). METHODS: Since 1985, 17 patients have undergone the Yasui operation at our institution. Interrupted aortic arch was present in 11 patients and coarctation of the aorta/hypoplastic arch was present in 6. Twelve patients had aortic stenosis, and 5 patients had aortic atresia. The minimum diameter of the LVOT and the z-score in patients with aortic stenosis were 3.7 ± 0.4 mm and -9.2 ± 1.2, respectively. Primary repair was performed in 6 patients, and 11 patients were staged, with bilateral pulmonary artery banding (PAB) in 8, arch repair with PAB in 2 and Norwood operation in 1. The mean age and body weight at the time of the Yasui operation was 4.7 ± 5.3 months and 4.5 ± 1.8 kg, respectively. The ascending aorta and aortic arch were reconstructed by Damus-Kaye-Stansel (DKS) anastomosis with graft interposition in 2, DKS with direct anastomosis in 6 and Norwood-type reconstruction in 9. VSD was enlarged in 6 patients. Right ventricle to pulmonary artery continuity was established with a valved conduit in 14 patients, the Lecompte manoeuvre in 2 patients and another method in 1 patient. The mean duration of the follow-up was 7.6 ± 9.2 years. RESULTS: There was 1 early death due to myocardial infarction and 1 late death due to non-cardiac cause. The actuarial survival at 10 years was 87.8%. Six patients underwent reoperation, including 5 conduit exchanges, 2 LVOT repairs and 2 aortic arch repairs. The freedom from reoperation for all causes at 5 and 10 years were 71.3 and 28.5%, respectively. In the last echo study, LVOT flow velocity was 1.2 ± 0.8 m/s, and neoaortic valve regurgitation was mild in 1 patient and trivial or absent in the remaining patients. CONCLUSIONS: The results of the Yasui operation were excellent, showing low mortality and good mid-term left ventricular function without outflow tract stenosis or neoaortic valve insufficiency. Bilateral PAB as initial palliation is a useful option in symptomatic neonates.


Assuntos
Coartação Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Aorta Torácica/cirurgia , Coartação Aórtica/epidemiologia , Coartação Aórtica/mortalidade , Procedimentos Cirúrgicos Cardíacos/mortalidade , Estudos de Coortes , Ecocardiografia , Comunicação Interventricular/epidemiologia , Comunicação Interventricular/mortalidade , Ventrículos do Coração/cirurgia , Humanos , Lactente , Recém-Nascido , Reoperação , Análise de Sobrevida , Obstrução do Fluxo Ventricular Externo/epidemiologia , Obstrução do Fluxo Ventricular Externo/mortalidade
15.
Ann Thorac Surg ; 96(6): 2236-8, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24296197

RESUMO

The patient was a 72-year-old man with left hemiparesis. Multiple hemorrhagic cerebral infarctions were recognized on a computed tomographic (CT) scan. A transesophageal echocardiogram showed a huge left atrial mass, which was floating and nearly obstructed the mitral orifice in the diastolic phase. Emergency left atrial mass removal was performed. To reduce the risk of critical brain hemorrhage, the dose of heparin was reduced (100 U/kg) and 1 mg/kg/h of nafamostat mesilate was administered into the venous circuit during extracorporeal circulation. A postoperative brain CT scan showed no evidence of deterioration of cerebral hemorrhage. Pathologic examination showed a ball thrombus.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Hemorragia Cerebral/complicações , Infarto Cerebral/etiologia , Átrios do Coração , Cardiopatias/complicações , Trombose/complicações , Idoso , Anticoagulantes/administração & dosagem , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/tratamento farmacológico , Infarto Cerebral/diagnóstico , Infarto Cerebral/tratamento farmacológico , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Fibrinolisina/antagonistas & inibidores , Guanidinas/administração & dosagem , Cardiopatias/diagnóstico , Cardiopatias/cirurgia , Humanos , Infusões Intravenosas , Período Intraoperatório , Masculino , Trombose/diagnóstico , Trombose/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Transcraniana
16.
Ann Vasc Surg ; 27(7): 975.e1-5, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23891251

RESUMO

The purpose of this study was to describe covered-stent treatment of a ruptured dissection of the superior mesenteric artery (SMA) in a patient with Ehlers‒Danlos syndrome. The patient was a 13-year-old girl initially presenting with abdominal pain. Dissection and rupture of the SMA were diagnosed on detailed examination. Conservative treatment was performed initially because open surgery was considered high risk. However, the abdominal pain recurred, and we decided to perform endovascular therapy. A coronary artery covered stent was placed in the true lumen to close the entry site of the dissection. The false lumen was obliterated using a post-dilation technique, completing treatment of the rupture. The patient recovered uneventfully after surgery. Classic-type Ehlers‒Danlos syndrome was diagnosed on the basis of physical findings and genetic analysis. The stent has remained adequately patent as of 2 years after surgery. This case report shows that dissection and rupture of the SMA can be treated successfully using a covered coronary artery stent in a patient with Ehlers‒Danlos syndrome.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Roto/cirurgia , Implante de Prótese Vascular , Síndrome de Ehlers-Danlos/complicações , Procedimentos Endovasculares , Artéria Mesentérica Superior/cirurgia , Dor Abdominal/etiologia , Adolescente , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/etiologia , Aneurisma Roto/diagnóstico , Aneurisma Roto/etiologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Colágeno Tipo V/genética , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/genética , Procedimentos Endovasculares/instrumentação , Feminino , Predisposição Genética para Doença , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Mutação , Fenótipo , Desenho de Prótese , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Eur J Cardiothorac Surg ; 44(1): e40-5, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23543204

RESUMO

OBJECTIVES: We sought to examine our long-term results of mitral valve (MV) repair with expanded polytetrafluoroethylene (ePTFE) sutures and to determine the predictors for the outcome of this procedure. METHODS: Between 1995 and 2011, MV repair with chordal reconstruction by artificial chordae was achieved in 78 patients (34 males and 44 females). Median age at repair was 1.5 years (range 3.6 months-13.4) and weight was 9.1 kg (2.5-31.4). The mean follow-up was 8.3 years. A Cox proportional hazards model was used to analyse the risk factors for a composite outcome of death, conversion to other MV repair techniques or MV replacement, reoperation on MV and recurrent mitral regurgitation (MR). RESULTS: According to Carpentier classification, 65 (83.3%) patients were Type 2 and 13 (16.7%) were Type 3. Mitral annuloplasty was performed in all cases, except 2. During MV repair, 8 (10.3%) patients were ineffective with artificial chordae and converted to other techniques. Six (7.7%) patients underwent MV reoperation (three repairs and three replacements). Freedom from MV reoperation was 92.5 and 90.4% at 5 and 10 years, respectively. There was 1 in-hospital death. At the latest follow-up, moderate or more MR was observed in 3 (3.8%) patients. Risks for the composite outcome were low body weight at operation and Carpentier classification Type 3. CONCLUSIONS: MV repair with artificial chordae in infants and children is safe and effective and associated with a low reoperation rate. Further investigation into the long-term durability and biological adaptation of ePTFE sutures after patient growth is mandatory.


Assuntos
Próteses Valvulares Cardíacas , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adolescente , Análise de Variância , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Anuloplastia da Valva Mitral/métodos , Anuloplastia da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/mortalidade , Politetrafluoretileno/uso terapêutico , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Fatores de Risco , Suturas , Resultado do Tratamento
18.
Diagn Cytopathol ; 41(6): 527-32, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22807421

RESUMO

We evaluated the differences in cytologic findings between conventional and thin-layer preparations in endometrial cytology to introduce the thin-layer method into routine cytology. Eighty patients who had undergone endometrial cytology and biopsy on the same day were selected and we compared the cytological findings between conventional- and thin-layer preparations (TLP) in endometrial cytology. The numbers of neutrophils and cell clusters in the thin-layer method were lower than those in the conventional smear (CSS) method. The average number of neutrophils in endometrioid adenocarcinoma was significantly higher than that in normal morphology endometrium and endometrial hyperplasia. Regarding the shape of the cell clusters, ball-like patterns and round-edged cell clusters were not identified in CSS. The average number of clusters in CSS was significantly greater than that using the TLP. The average of the nuclear area in CSS was significantly larger than that using the TLP, indicating that the nuclear areas in CSS were more uneven than that using the TLP. In the future, it is expected that liquid-based cytology will be applied to the cytological diagnosis of a variety of lesions. The influence on cells due to fixation is considerable in liquid-based preparations. Therefore, if we strive to pick up the differences between CSS and TLP of endometrial samples, the diagnostic accuracy of the latter could be improved.


Assuntos
Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Interpretação de Imagem Assistida por Computador , Esfregaço Vaginal/métodos , Endométrio/patologia , Feminino , Humanos , Neutrófilos/patologia
19.
Ann Thorac Surg ; 92(2): 568-70, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21704975

RESUMO

BACKGROUND: We evaluated the probability of vertebrobasilar system malperfusion due to occlusion of the left subclavian artery as assessed by preoperative magnetic resonance angiography in patients scheduled to undergo thoracic aortic surgery. METHODS: (Study 1) From January 2000 through March 2009, we studied variations of vertebral arteries in 301 patients scheduled to undergo thoracic aortic surgery. We classified vertebral artery variations into 3 categories according to the findings on preoperative magnetic resonance angiography: connection type, interrupted right vertebral artery, and interrupted left vertebral artery. (Study 2) From February 2007 through January 2010, we evaluated the cerebral complication in 41 patients who had occlusion of the left subclavian artery with a stent graft. RESULTS: (Study 1) On preoperative magnetic resonance angiography, the vertebral artery was classified as connection type in 247 patients, interrupted right vertebral artery in 34, and interrupted left vertebral artery in 20. (Study 2) We performed subclavian obstruction test, left-right subclavian artery bypass, or left subclavian artery-left common carotid artery bypass to the 3 patients with interrupted right vertebral artery, respectively. Forty patients (98%) out of 41 patients had no complication after occlusion of the left subclavian artery. CONCLUSIONS: Preoperative magnetic resonance angiography is useful for detection of the patients with high risk of vertebrobasilar system malperfusion due to occlusion of the left subclavian artery.


Assuntos
Aneurisma Dissecante/cirurgia , Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Artéria Carótida Primitiva/cirurgia , Angiografia por Ressonância Magnética , Artéria Subclávia/cirurgia , Artéria Vertebral/anormalidades , Insuficiência Vertebrobasilar/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Stents
20.
Ann Vasc Surg ; 25(6): 838.e9-11, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21616635

RESUMO

A 30-year-old man had a sudden bout of severe abdominal pain. An enhanced computed tomographic scan revealed dissections of the celiac artery, superior mesenteric artery, left renal artery, and right external iliac artery; stenosis of the right renal artery; and left kidney infarction. After careful evaluation, the patient was diagnosed with fibromuscular dysplasia (medial dysplasia), based on the findings obtained from the enhanced computed tomographic scan. This case is extremely rare because fibromuscular dysplasia occurred concurrently with simultaneous spontaneous dissections of four peripheral arteries in a young man.


Assuntos
Aneurisma Dissecante/etiologia , Artéria Celíaca , Displasia Fibromuscular/complicações , Artéria Ilíaca , Artéria Mesentérica Superior , Artéria Renal , Dor Abdominal/etiologia , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/terapia , Artéria Celíaca/diagnóstico por imagem , Humanos , Artéria Ilíaca/diagnóstico por imagem , Infarto/diagnóstico por imagem , Infarto/etiologia , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Tomografia Computadorizada por Raios X
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