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Fukuda, Wakako ; Chiyoya, Mari ; Saito, Yoshiaki ; Taniguchi, Satoshi ; Daitoku, Kazuyuki ; Fukuda, Ikuo
概要:
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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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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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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Fukuda, Ikuo ; Daitoku, Kazuyuki
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Acute pulmonary thromboembolism is a catastrophic event, especially for hospitalized patients. The prognosis of pulmonary thromboembolism depends on the degree of pulmonary arterial occlusion. The mortality of massive pulmonary
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embolism is reportedly as high as 25% without cardiopulmonary arrest and 65% with cardiopulmonary arrest. In patients with unstable hemodynamics due to pulmonary thromboembolism, surgical pulmonary embolectomy is indicated for patients with a contraindication to thrombolysis, failed catheter therapy, or failed thrombolysis. Thrombolytic therapy adds an additional burden on patients who are at risk of potential hemorrhagic complications. It is also indicated if patients are already on a veno-arterial extra-corporate membrane oxygenator for circulatory collapse or cardiopulmonary arrest. The outcome for patients who require cardiopulmonary resuscitation for longer than 30 minutes is poor. Therefore, early triage for massive and sub-massive pulmonary embolism is crucial. A team approach including a cardiovascular surgeon may be effective to save critically ill patients. Prompt removal of emboli reduces the right ventricular load with quick recovery of cardiopulmonary function in the early postoperative period. A recent series reported excellent results, with in-hospital mortality of less than 10%. Surgical pulmonary embolectomy is an effective, safe, and easy procedure to save critical patients due to pulmonary thromboembolism.
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Fukuda, Wakako ; Taniguchi, Satoshi ; Fukuda, Ikuo ; Chiyoya, Mari ; Aoki, Chikashi ; Kondo, Norihiro ; Hattori, Kaoru ; Daitoku, Kazuyuki ; Kowatari, Ryosuke ; Minakawa, Masahito ; Suzuki, Yasuyuki
概要:
Background: The incidence of pulmonary thromboembolism has been considered rare in Japan. However, its occurrence has been increasing because of westernized lifestyle and diet, increased diagnostic technique, and recognition of this
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disease. Method: Between January 2003 and September 2014, 179 patients were treated for pulmonary thromboembolism. We classified these patients into 3 groups; Massive (n=35), Sub-massive (n=29) and Nonmassive (n=115) and retrospectively reviewed the treatment options and the outcome. Results: Percutaneous cardiopulmonary support (PCPS) was applied for patients with hemodynamic instability and IVC filter was inserted if there was proximal DVT. In non-massive group (n=115), 95.7% of the patient underwent anticoagulant therapy and 47.0% of the patients received IVC filter. In submassive group (n=29), 48.3% of the patient received thrombolytic therapy and 93.1% of the patient underwent IVC filter insertion. Surgical pulmonary embolectomy was performed in 3 patients who had high risk of thrombolytic therapy in submassive group. There was no death in this group. In massive group, 4 patients who had cardiogenic shock died in acute phase. PCPS was applied in 5 patients, pulmonary embolectomy was performed in 13 patients, thrombolytic therapy was performed in 4 patients and 13 patients underwent anticoagulant therapy alone. There were 7 deaths (20.0%) in this group. Conclusions: In submassive group, treatment should be decided depending on the bleeding risk. In massive group, pulmonary embolectomy was effective.
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