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Suzuki, Yasuyuki ; Daitoku, Kazuyuki ; Minakawa, Masahito ; Fukui, Kozo ; Fukuda, Ikuo
概要:
We have proved that Sivelestat preserved lung function after cardiopulmonary bypass（ CPB） in the rabbit model. We now r
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eport the therapeutic efficacy of Sivelestat in the clinical case. From July 2005, 16 patients who underwent aortic arch replacements were enrolled in this study. Diagnosis included dissected aortic aneurysm in 6 patients, true aortic arch aneurysm in 8, and traumatic aortic arch aneurysm in 1 patient. We randomly divided these patients into two groups. In the Pre-Group（ Pre:n=8）, infusion of Sivelestat（ 0.2mg/kg/hr） was started before the operation; in the Post-Group（ Post:n=8）, it was started after the operation. Serum elastase activity, interleukin-8（ IL-8） levels were measured before the operation, before cessation of CPB and at the end of operation. Blood gas analyses were measured before the operation, at one and three hours after the CPB and the next morning. Because the preoperative P/F ratio（ arterial PO2/FiO2） varies with each case, the value of the P/F ratio at one hour after the CPB was calculated for 100%. Elastase activity of both groups were increased at the end of CPB（ Pre:8.9±10.6, Post:4.6± 3.5）, then returned to baseline level at end of operation（ NS）. IL-8 of both groups were increased at end of CPB, then in the Pre-Group decreased to 59.3± 25.0 pg/ml, but in the Post-Group increased to 97.9±45.7 pg/ml（ p=0.09）. The P/F ratio in the Pre- Group was well maintained from post CPB to next morning, but in the Post-Group was decreased three hours after the CPB （p<0.05）. In conclusion, these fi ndings showed that Sivelestat reduced the infl ammatory reaction associated with cardiopulmonary bypass, and prevented the pulmonary dysfunction caused by infl ammatory reaction.
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Fujita, Wakako ; Fukuda, Ikuo ; Kitagawa, Reiko ; Kimura, Daisuke ; Yamada, Yoshitsugu ; Tsushima, Takao
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We report a rare case of esophageal schwannoma. The patient was a 41-year-old man who was admittedto our hospital due to
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chest oppression. Chest imaging showed a solid mass in the middle mediastinum compressingthe esophagus and the trachea. Neurogenic tumor was suspected and the patient underwent extirpation of thetumor through right thoracotomy. The tumor, 4.5×4.3×3.4 cm in size, was strongly attached to the esophageal wall.Pathological examination revealed myxomatous pattern in the tumor. Immunohistochemical staining for S-100 proteinwas positive and the diagnosis of schwannoma was made. The majority of mediastinal schwannomas arise fromsympathetic nerve cells in the posterior mediastinum. Esophageal schwannoma is rare and only 27 cases were reportedin literature to date.
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Sutoh, Takemichi ; Fukuda, Ikuo ; Kimura, Daisuke ; Tsushima, Takao
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Nafamostat mesilate（ FUT-175）, a synthetic serine protease inhibitor, has been reported to have antitumouractivities tow
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ard solid tumours. The objective of this study was to characterize the biological activities of FUT-175 ina malignant mesothelioma cell line. We used MSTO-211H, a biphasic-type human malignant pleural mesothelioma cellline. The effect on cell growth was evaluated by 3（- 4,5-dimethylthiazol-2-yl）-2,5-diphenyltetrazolium bromide assay.Secretion of urokinase-type plasminogen activator（ u-PA） and plasminogen activator inhibitor-1（ PAI-1） was analysedby enzyme-linked immunosorbent assay. The eff ects on relative mRNA expression levels were measured by reversetranscription polymerase chain reaction. The eff ect on cell invasiveness was evaluated by cell invasion assay. FUT-175at 10-5 M signifi cantly inhibited cell growth and cell invasiveness. Cell growth reduced to 47.0 ± 2.1% compared withthe control. The number of invasive cells also reduced to 16.0 ± 0.7 cells/hpf, while that of control cells was 41.4 ± 8.0cells /hpf. U-PA and PAI-1 secreted from the cells were also reduced by FUT-175 in a dose-dependent manner. Theseresults suggest that FUT-175 has the potential to act as a therapeutic agent against local growth and invasion, andfunctions by reducing PAI-1 and u-PA production of the human malignant mesothelioma（195 words）
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Yokoyama, Hiroaki ; Saito, Shin ; Higuma, Takumi ; Hanada, Hiroyuki ; Osanai, Tomohiro ; Daitoku, Kazuyuki ; Fukuda, Ikuo ; Okumura, Ken
概要:
Adipose tissue secretes various bioactive molecules （adipokines）, and apelin is one kind of adipokines.Recently, it was
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shown that plasma apelin level is decreased in patients with chronic heart failure, and apelin mightplay an important role in the pathogenesis of cardiovascular disease. However, plasma apelin level in coronary arterydisease（ CAD） or other heart disease such as valvular heart disease（ VHD） has not been elucidated. We enrolled 31patients with CAD and 14 patients with VHD who underwent elective cardiac surgery. We also examined plasmaapelin level in 20 healthy subjects （Control）. Blood samples were obtained before the surgery. Paired samples ofvisceral and subcutaneous adipose tissues were harvested during surgery. Plasma apelin level was lower in both CADand VHD than in Control. When compared between CAD and VHD, it was lower in CAD than in VHD, and was notaff ected by treatment with HMG-CoA reductase inhibitors （statins） which was shown to increase adiponectin level.Left ventricular ejection fraction（ LVEF） was lower in CAD than in VHD. There was no correlation between plasmaapelin level and LVEF. Gene expression of apelin in visceral adipose tissue was higher than that in subcutaneousadipose tissue, but it was similar between two groups. These suggest that plasma apelin level was decreased inpatients with cardiac diseases, especially in those with CAD. Its role in the pathophysiology of CAD remains to beelucidated.
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Abe, Yukiko ; Hu, Dong-Liang ; Omoe, Katsuhiko ; Fukuda, Ikuo ; Nakane, Akio
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Coagulase-negative staphylococci （CNS） are increasingly recognized to cause clinically significant infections. To invest
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igate relationship of antibiotic resistance profiles, staphylococcal cassette chromosome mec （SCCmec） and superantigenic toxin genes in CNS, a total of 79 clinical CNS isolates from patients with surgical operations were comprehensively determined for minimum inhibitory concentration （MIC） of antibiotics, and searched for SCCmec and staphylococcal superantigenic toxin genes by novel multiplex PCR. Among 79 CNS isolates, at least one SCCmec gene was detected in 55 isolates （69.6%）. The most of SCCmec type was type III （36.7%）, and other detected types were type IVa（ 20.3%）, type II（ 19.0%）, type V（ 16.5%）, type I（ 15.2%）, and type IVb（ 3.8%）. The isolates with type I or IVa gene showed highly resistance to clindamycin and gentamicin, the isolates with type II showed more resistance to teicoplanin, the isolates with type III or type V showed more resistance to clindamycin. se and tst-1 genes were detected in none of the CNS isolates tested. These results suggested that there is high prevalence of SCCmec in clinical CNS isolates, and the SCCmec types are related to the resistances against specific antibiotics, but SCCmec do not related to superantigenic toxin genes in the CNS.
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Ogasawara, Takashi ; Minakawa, Masahito ; Kondo, Norihiro ; Suzuki, Yasuyuki ; Fukuda, Ikuo
概要:
Objectives: The aim of this study is to investigate the effect of washed salvaged red blood cells on hemostasis in open
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heart surgery using the cardiopulmonary bypass（ CPB）. Methods: Nine patients were enrolled in this study. The cell salvage system was used throughout the surgery. Three blood samples（ 1mL each） were obtained from each patient one hour after the CPB for the measurements consisting of control blood sample（ Control group）, 1.0ml of blood added with 0.2mL salvage blood（ CS group） or 0.2mL normal saline （NS group）. Test samples were evaluated using rotational thromboelastometry （ROTEM®）. Coagulation was triggered by ellagic acid. Results: No significant differences were observed in the clotting time among the three groups. Clot formation time in the CS group and NS group was prolonged significantly compared with Control group （Control, 138±51; CS, 103± 28; NS, 135±48 sec）. Amplitude of ROTEM® band at 10 minutes and maximum clot firmness in both the CS and NS group were significantly narrower than that of Control group. Conclusions: This ex-vivo study using ROTEM® suggested that the perioperative administration of washed salvagedred blood cells might have a potential to induce coagulopathy in cardiac surgery using the CPB.
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Fukuda, Wakako ; Chiyoya, Mari ; Saito, Yoshiaki ; Taniguchi, Satoshi ; Daitoku, Kazuyuki ; Fukuda, Ikuo
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Background: Retrievable inferior vena cava （IVC） filter devices have been developed to overcome thelong-term complicatio
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ns of permanent filters. It is of interest to evaluate the retrievability of retrievable IVC filtersand how safely the IVC filters indwelled for a long period of time can be retrieved. We reviewed a group of 44patients, who were selected for ALN retrievable filter implantation and reviewed the indications, efficacy as well ascomplications.Material and Methods: 300 venous thromboembolism （VTE） patients were treated in our institution between2003 and 2014. IVC filters were inserted in 84 cases （28%） and 44 of 84 patients received ALN retrievable filterimplantation. We retrospectively reviewed the indications, efficacy and complications of 44 patients with ALN filters.Results: All 44 patients had deep vein thrombosis（ DVT） and 39 patients（ 88.6%） also had pulmonary embolism（ PE）.The most frequent associated risk factor for DVT was cancer（ n=19）. The filter was implanted for a median durationof 708.8 days（ range 68-1717）. While the filter was in place, at least one venous thromboembolic event occurred in 4.5%（2 of 44 patients）. Filter retrieval was attempted in 8 patients（ 18.2%） after a median period of 271.9 days（ range 79- 559）. Filter retrievals were successful in all cases.Conclusion: This study showed the efficacy of ALN filter. It also demonstrated the safety of retrieval after a longterm placement.
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Fukuda, Ikuo ; Wada, Mitsuyoshi
概要:
The objective of this study was to investigate the role of immediate cerebral angiography and local thrombolysis for str
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oke after cardiovascular surgery. Patients and methods: Aggressive approach including early cerebral angiography and intraarterial administration of fibrinolytic agent for stroke after cardiovascular surgery was employed. Seven patients who had stroke after surgery among 1244 patients who underwent cardiovascular surgery were enrolled this investigation. Results: In-hospital cerebral thrombosis or thromboembolism occurred 3 to 9 days (average: 6.3±2.7 days) after surgery. Immediate cerebral angiography revealed cerebral embolism in 4 and cerebral thrombosis in 3 with occlusion or stenosis of intracranial arteries. Local, intraarterial administration of a thrombolytic agent was carried out in 5 patients with cerebral thromboembolism (n=4) or thrombosis (n=1), and complete recanalization of the occluded artery was obtained in 3 patients (60%) and partial recanalization in 2 patients (40%). Additional angioplasty for basilar artery stenosis was performed in one patient. No patients exhibited bleeding complication. All patients survived with moderate or full functional recovery. Conclusions: Immediate cerebral angiography with/without local thrombolysis may improve functional outcome and survival in patients with postcardiotomy cerebral thromboembolism.
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| 9.
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Yu, Zaiqiang ; Kimura, Daisuke ; Tsushima, Takao ; Fukuda, Ikuo
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INTRODUCTION: Although spontaneous regression (SR) of anterior mediastinal seminoma is very rare with normalization of p-human chorionic gonadotropin (beta-hCG) level, video-assisted thoracic surgery (VATS) is the most effective
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solution for definite diagnosis of indeterminate anterior mediastinal masses. DIAGNOSIS, THERAPEUTIC INTERVENTIONS, AND OUTCOMES: A rare case of an asymptomatic 37-year-old man with an anterior mediastinal mass that was detected on a routine chest X-ray is presented. Computed tomography (CT) showed a large anterior mediastinal tumor with superior vena cava invasion and SR before VATS for definitive diagnosis. On pathology, the definitive diagnosis was seminoma. Microscopic examination showed abundant apoptotic cells within the tumor. Chemotherapy (bleomycin 30 mg/day, etoposide 200 mg/day, cisplatin 40 mg/day) was given to this patient, and the tumor showed high sensitivity. CONCLUSION: Anterior mediastinal seminoma showing SR induced by spontaneous apoptosis of tumor cells may have good sensitivity to chemotherapy, and a good clinical outcome may be achieved in these patients. This case also highlights that VATS is the most effective solution for definite diagnosis of indeterminate anterior mediastinal masses. (C) 2017 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
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| 10.
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Aoki, Chikashi ; Kondo, Norihiro ; Saito, Yoshiaki ; Taniguchi, Satoshi ; Fukuda, Wakako ; Daitoku, Kazuyuki ; Fukuda, Ikuo
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Objective: Endovascular repair has become the treatment of choice for ruptured abdominal aortic aneurysms (RAAAs). To improve surgical outcomes, preoperative management is important. In 2011, we introduced integrated management, which
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involves endovascular aneurysm repair, stabilization of hemodynamics by endovascular clamping, and open abdominal decompression to address abdominal compartment syndrome (ACS). Methods: To evaluate the efficacy of this management strategy, 62 patients who had undergone emergency surgery for an RAAA were analyzed retrospectively: group A (n=39), where an old strategy was used, and group B (n=23), where integrated management was introduced. Patient characteristics and 30-day mortality rates were compared between the two groups. Results: The average patient age was 67.7 years and 74.7 years for groups A and B, respectively (P=0.032). Group B patients required more frequent use of vasopressors (P=0.035). Other patient characteristics did not differ between the two groups. The duration of surgery was significantly shorter in group B than in group A (P=0.001). The total amount of transfused blood did not differ between the two groups. No patients showed symptoms of ACS. Early mortality rates were 12.8% and 8.7% in groups A and B, respectively. The number of wound infections was significantly fewer in group B than in group A. Conclusion: Although group B patients were significantly older and had a higher rate of vasopressor use, early mortality was improved in both groups. Morbidity was significantly better in group B with respect to the duration of surgery and number of wound infections than in group A.
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