Tetsuro Uchida

Pericardiectomy for constrictive pericarditis using the Harmonic Scalpel

A 35-year-old man with constrictive pericarditis underwent pericardiectomy. The pericardium was dissected with a Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH). This new device has many advantages including no muscular stimulation, low heat, a smokeless field, and easy hemostasis. The Harmonic Scalpel is beneficial for dissection of thickened pericardium.

Nitric oxide is an effector molecule in inhibition of tumor cell growth by rIFN‐γ‐activated rat neutrophils

This study was designed to determine the effector molecule responsible for the tumor‐inhibitory activity of rat neutrophils treated with rat recombinant interferon gamma (rIFN‐γ) in vitro. The results show that nitric oxide (NO) production by neutrophils is dependent on rIFN‐γ concentration, and that neutrophil‐mediated tumor cytostasis is in turn dependent on the amount of NO. NO production and tumor cytostatis by rIFN‐γ‐activated neutrophils were inhibited completely by NG monomethyl‐L‐arginine (NGMMA), a specific competitive NO production inhibitor. Tumor cytostasis was also inhibited by oxyhemoglobin (HbO2), an NO scavenger. An extracellular oxygen radical scavenger, superoxide dismutase (SOD), was found to increase tumor cell inhibition by rIFN‐γ‐activated neutrophils by a factor of 4. This SOD‐enhanced cytostasis was not even inhibited by catalase. Tumor cytostasis was slightly increased by a hydroxyl radical‐(‐OH) scavanger, dimethylthiourea (DMTU), which did not affect NO production by rIFN‐γ‐activated neutrophils. Our findings suggest that tumor cytostasis of neutrophils activated by rIFN‐γ is mediated by L‐arginine‐derived nitrogen oxidation products, and that O2− produced by these neutrophils reduces NO‐mediated tumor cytostasis at low NO concentrations. Int. J. Cancer 71:223‐230, 1997.

rIFN-γ-activated rat neutrophils induce tumor cell apoptosis by nitric oxide

We have previously shown that 1) neutrophils activated with various cytokines, including rat recombinant interferon γ (rIFN‐γ), inhibit tumor cell growth and that 2) nitric oxide (NO) is the effector molecule in tumor inhibition by rIFN‐γ‐stimulated rat peritoneal exudate neutrophils. In this study, we examined the nature of tumor cell death induced by rat peritoneal neutrophils activated by rIFN‐γ in order to clarify the mechanism of apoptosis in neoplastic tumor cell death. DNA of 3 syngeneic rat tumor cell lines was significantly fragmented within 3 hr of incubation in the presence of rIFN‐γ‐activated neutrophils, and this effect was dependent on both the concentration of rIFN‐γ and the number of neutrophils. This DNA fragmentation was inhibited by L‐N‐(I‐iminoethyl)‐ornithine (L‐NIO), a NO synthase inhibitor, but not by superoxide dismutase (SOD). Tumor cells treated with the activated neutrophils were shown by electron microscopy to be apoptotic, exhibiting necrotic features with a longer incubation. On the other hand, cytolysis of tumor cells, as determined by a [3H]‐uridine release assay, was first observed only at 24 hr of incubation with the rIFN‐γ‐activated neutrophils. Taken together, our results suggest that tumor cell apoptosis by activated neutrophils is NO‐dependent and that apoptotic tumor cells undergo necrosis as a secondary process. We suggest that tumor cell apoptosis induced by activated neutrophils plays an important role in regulation of neoplastic tumor cell growth and death in vivo. Int. J. Cancer 71:231–236, 1997.

Minimized mortality and neurological complications in surgery for chronic arch aneurysm: axillary artery cannulation, selective cerebral perfusion, and replacement of the ascending and total arch aorta.

Abstract  Objective: Cerebral complication is still a major concern in surgery for arteriosclerotic aortic arch disease. For preventing this complication, axillary artery cannulation, selective cerebral perfusion, and replacement of the ascending and arch aorta were applied to thoracic aortic aneurysm involving aortic arch. Method: From May 1999 to July 2002, consecutive 39 patients with true aneurysm (29 patients) or chronic aortic dissection (10 patients) involving aortic arch underwent replacement of the ascending and arch aorta with an elephant trunk under hypothermic cardiopulmonary bypass through the axillary artery cannulation and selective cerebral perfusion. The brain was continuously perfused without any intermission through the axillary artery. Concomitant operation included coronary artery bypass grafting (CABG) in two patients, aortic valve replacement (AVR) in one, Bentall operation in two, mitral valve replacement (MVR) in one, and aortic valve sparing operation in one. Patient age at operation was 40–84 (72 + 9) years and 24 of them were older than 70 years of age. Results: There was one operative death (2.5%) due to bleeding from the left lung, and one hospital death due to respiratory failure. Postoperative permanent neurological dysfunction was found in one patient (2.5%). Two patients presented temporary neurological dysfunction (5%). Thirty‐six of the 39 patients were discharged from hospital on foot. Conclusion: Continuous perfusion through the axillary artery with selective cerebral perfusion and replacement of the ascending and arch aorta may minimize cerebral complication leading to satisfactory results in patients with chronic aortic aneurysm involving aortic arch.

A modified surgical approach for giant left coronary arterial aneurysm

An 80-year-old female with a persistent cough was found on volumerendered tomorgraphy (CT) to have a 6.5× 5.7-cm coronary artery aneurysm compressing the posterior portion of the pulmonary artery (PA) (Fig. 1). Two smaller “daughter aneurysms” 1.5 and 1.4 cm were located on the anterior aspect of the PA (Fig. 1). In addition, a bronchial artery aneurysmwas also noted (Fig. 1). There were no coronary artery occlusions or fistulous communications between the aneurysm and any cardiac chamber seen on a coronary angiogram. At the time of surgery, a mediansternotomy was performed and cardiopulmonary bypass (CPB) was established with ascending aortic and bicaval cannulation. A 6-cm calcifiedmass was noted superior and posterior to the heart between the ascending aorta and PA (Fig. 2). Following cardioplegic arrest with antegrade/retrograde blood cardioplegia, a feeding artery arising from the proximal right coronary artery was ligated at its origin. Inadequate exposure of the proximal left main coronary (LMC) artery and the aneurysm necessitated transection of both the ascending aorta and the main PA (Fig. 3). A feeding artery arising from the LMC artery was ligated at its origin. The aneurysmal

Congenital diverticulum of the left ventricle

We present a case of a congenital left ventricular diverticulum of fibrous type that was surgically repaired. Considering the potential risks such as rupture, systemic thromboembolism, and arrhythmia, an early surgical intervention should be employed for this rare abnormality even in a child without clinical symptoms.

Pulmonary venous obstruction after total cavopulmonary connection in heterotaxy

Pulmonary venous obstruction is a rare complication after total cavopulmonary connection by intraatrial grafting. We experienced this complication in two patients. In one of them, a large prosthesis produced inflow obstruction of the dominant ventricle and was successfully replaced with a smaller tube. In the other patient, the intraatrial tube had become severely adherent to the common pulmonary venous orifice and was removed entirely. Conversion to an extracardiac Fontan circulation was later successfully established.

Spontaneous rupture of a caseous calcification of the mitral annulus in a hemodialysis patient

We report a 56‐year‐old hemodialysis patient with a spontaneously ruptured caseous calcification of the mitral annulus resulting in multiple cerebral emboli. The mass was resected without replacing the mitral valve. The patient has remained symptom‐free 3.5 years following surgery.

Quadricuspid aortic valve illustrated by 64-slice multidetector computed tomography: Surgical treatment of a rare cause of severe aortic regurgitation

The quadricuspid aortic valve (QAV) is a rare congenital malformation that usually presents with aortic regurgitation (AR). The first case was reported in 1862. Most cases were diagnosed at the time of surgery or postmortem examination. With advances in imaging techniques, more cases have been diagnosed before surgery. We describe a 59-year-old man whose QAV had not been noted until the current admission. Transthoracic echocardiography revealed dilation of the left ventricle, severe AR, and suspected QAV. The QAV was confirmed by transesophageal echocardiography and 64-slice multidetector computed tomography. This case was a QAV with three equal cusps and one smaller cusp (type B in Hurwitz and Roberts classification). Because the cardiac catheterization and aortography showed severe AR and a QAV, the patient underwent elective surgery. The surgery consisted of replacing the QAV by a mechanical prosthesis. There were no post-operative complications. The patient revealed no symptoms in the post-operative 7 months.

Bentall operation for a child with Marfan syndrome: a case report.

Abstract Children with Marfan syndrome rarely undergo surgery for annuloaortic ectasia and aortic regurgitation in the first decade. A 7‐year‐old girl presented with congestive heart failure due to severe aortic regurgitation associated with annuloaortic ectasia (6 cm). She also had funnel chest. She underwent a Bentall operation and sternal turn‐over with a satisfactory result. Since the aortic valve cusps had rolled edges, the aortic valve was not spared. Histology of the aortic valve cusps showed myxoid degeneration and fragmentation of elastic fibers.