Hideichi Wada

Hepatocellular carcinoma complicating biliary cirrhosis caused by biliary atresia : report of a case

A case of hepatocellular carcinoma complicating biliary cirrhosis caused by biliary atresia is reported. The patient had persistent severe jaundice with hepatosplenomegaly. A liver tumor was suspected because of the elevated serum alpha-fetoprotein and was shown by ultrasonography at 6 years of age. The tumor was treated with percutaneous ethanol injection therapy (PEIT). Nine months after initiation of PEIT, the patient died of massive bleeding from a metastatic tumor.

Age-related distensibility and histology of the ascending aorta in elderly patients with acute aortic dissection.

Degradation and fragmentation of elastic fibers in the media dilate the aortic wall excessively in patients with acute Stanford type A aortic dissection (AD). Such dilatation occurs not via aortic stiffening, which is diagnosed using imaging under physiological loading, but due to the abovementioned intrinsic changes in elastic fibers, which can be detected at the low-stress region of the stress-strain relationship. Our objective is to determine an age-related correlation between distensibility and histology. We conducted uniaxial stretching tests and a histological evaluation of the ascending aorta (AA) using AD samples obtained at surgery from 9 elderly patients (aged 52-85 yr), with no heritable connective tissue disorders, and control (CN) samples from 10 subjects at autopsy (aged 56-86 yr). We compared the distensibility, or an increase in strain for the uniaxial tensile stress of 0-50 kPa, between the AD and CN groups, and correlated it with age and histology. Distensibility was significantly greater in the AD than that in the CN group (p=0.030), but elastin content was significantly lower (p=0.0025). The positive correlation between distensibility and elastin content in CN samples suggests that the distensibility increases with elastic fiber histological abnormalities. The age-matched collagen content decreased with the age of the patients, and did not differ between the AD and CN groups. The age-matched distensibility in the AD and CN groups decreased and became closer with aging. Such intrinsic properties should be considered during imaging to assess distensibility in patients with AD.

Direct and transapical central cannulation for acute type a aortic dissection.

OBJECTIVE The choice of cannulation site for the treatment of acute Stanford type A aortic dissection is much debated. We believe that central cannulation is quick to perform, easy to use, and safe to manage acute type A aortic dissection. MATERIALS AND METHODS We retrospectively investigated 26 cases of acute aortic dissection performed using two different central cannulation methods between April 2011 and March 2012. Direct ascending aortic cannulation was performed using the Seldinger technique in 20 patients, and transapical ascending aortic cannulation was performed in six patients in whom puncture was difficult. RESULTS Patients were 21-86 years old (mean age, 67 years). The surgical techniques used to treat aortic dissection were hemiarch repair in 21 patients and total arch replacement in 5 patients. The mean length of surgery was 393 min. One death (3.8%) was attributed to intestinal ischemia. CONCLUSION During surgery for acute aortic dissection, central cannulation using either transapical or direct puncture can be performed quickly and safely, and satisfactory short-term outcomes can be obtained. Because acute aortic dissection can present with various conditions, there is no single perfect surgical or cannulation method; therefore, the choice of surgical procedure should be individualized for each patient.

Four-Stitch Side-to-Side Anastomosis for Sequential Coronary Artery Bypass Grafting

Sequential bypass (SB) is an effective method of implementing complete myocardial revascularization of complex coronary stenoses. The SB allows a single graft to be used for bypass in several locations, which facilitates multi-branch revascularization. We have developed a simple SB technique, four-stitch side-to-side anastomosis, and report its clinical effectiveness in 428 patients.

A Case of Type-2 Endoleak from a Bronchial Artery after Endovascular Aortic Repair for Kommerell Diverticulum

We describe a case of type-2 bronchial artery endoleak after endovascular aortic repair of Kommerell diverticulum (KD) involving right-sided aortic arch and aberrant left subclavian artery (LSA). A 68-year-old woman underwent an endovascular repair of KD with an aberrant LSA in our hospital. Follow-up computed tomography (CT) at 6 months after the procedure showed an endoleak. Digital subtraction angiography revealed a type-2 endoleak from a bronchial artery, but no type-1 or type-2 endoleak from the aberrant left subclavian artery. We performed coil embolization of the KD and the left subclavian artery. The endoleak disappeared in the postoperative CT.

A Case of Re-Endovascular Repair in Acute Phase after EndovascularAortic Repair for Acute Type B Aortic Dissection Complicated by Visceral,Renal and Lower Limb Malperfusion

We describe a case of re-endovascular aortic repair after endovascular aortic repair for acute type B aortic dissection, complicated by visceral, renal, and leg malperfusion. We performed endovascular aortic repair to cover the primary entry tear at the distal thoracic aortic arch in a 62-year-old male with visceral, renal, and leg malperfusion, after 4 days of conservative therapy. After the first operation, the pressure differential between upper and lower limbs disappeared. However, bilateral leg ischemia appeared at postoperative day 2. CT showed that the true lumen was severely compressed again by a thrombosed false lumen and two re-entries appeared at the level of the proximal celiac artery and infra-renal abdominal artery, respectively. The distal edge of the stent graft was intact with no new stent graft-induced entry. We once again performed endovascular aortic repair by means of thoracic and abdominal stent grafts covering the re-entry tears at the level of proximal celiac artery and infra-renal abdominal artery. After the procedure, the leg ischemia, renal ischemia and mesenteric ischemia improved, and the patient was transferred back to the local hospital without paraplegia.