Publications by authors named "Takahiro Katsumata"

79 Publications

Long-term viability and extensibility of an in situ regenerated canine aortic wall using hybrid warp-knitted fabric.

Interact Cardiovasc Thorac Surg 2021 Apr 21. Epub 2021 Apr 21.

Healthcare Business Development-Medical Device, Teijin Limited, Tokyo, Japan.

Objectives: Many surgical materials promoting tissue regeneration have been explored for use in paediatric cardiac surgery. The aim of this study is to evaluate the long-term viability and extensibility of the canine aortic wall regenerated using a novel synthetic hybrid fabric.

Methods: The sheet is a warp-knitted fabric of biodegradable (poly-l-lactic acid) and non-biodegradable (polyethylene terephthalate) yarns coated with cross-linked gelatine. This material was implanted as a patch to fill an oval-shaped defect created in the canine descending aorta. The tissue samples were explanted after 12, 24 or 36 months (N = 3, 2, 2, respectively) for histological examination and biomechanical testing.

Results: There was no shrinkage, rupture or aneurysmal change after 24 months. The regenerated wall showed prototypical vascular healing without material degeneration, chronic inflammation, calcification or abnormal intimal overgrowth. Bridging tissue across the patch was well-formed and had expanded over time. The biodegradable yarns had completely degraded at 24 months after implantation, as scheduled, but the regenerated aortic wall demonstrated satisfactory levels of mechanical strength and extensibility in tensile strength tests.

Conclusions: The sheet achieved good long-term viability and extensibility in the regenerated aortic wall. These findings suggest that it is a promising surgical material for repairing congenital heart defects. Further developments of the sheet are required, including clinical studies.
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http://dx.doi.org/10.1093/icvts/ivab064DOI Listing
April 2021

The Usefulness of a Simple Classification for Bronchoscopic Findings for Diagnosis of Peripheral Pulmonary Tumour.

Respiration 2021 Apr 9:1-10. Epub 2021 Apr 9.

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Japan.

Background: Normal bronchial epithelium has been described in terms of transparency and smoothness. No studies have compared bronchoscopic and pathological findings in the identification of bronchial epithelium.

Objectives: This study aimed to classify bronchoscopic findings for peripheral pulmonary tumour (PPT) for accurate bronchoscopic diagnosis accounting for the presences of bronchial epithelium and bronchial stenosis using an ultrathin bronchoscope.

Methods: We performed endocytoscopy using narrow-band imaging (NBI) of specimens immediately after lobectomy to investigate the normal bronchial epithelium under the physiological saline injection technique (PSIT) prior to classification of PPT. A retrospective study to classify bronchoscopic findings included 46 patients diagnosed with malignancy by bronchoscopy for PPT.

Results: We recognized a "light blue line" (LBL) with NBI under PSIT, corresponding to strong reflection of short-wavelength light by cilia on the epithelial surface in an ex vivo endocytoscopic study. Bronchoscopic findings of PPT were classified morphologically into stenotic type (ST) and non-stenotic type (NonST). Tumours were also classified as exposed type (ET) and non-exposed type (NonET) based on the presence of epithelium. Most ST and NonET lesions (74%) were adenocarcinoma. Among squamous cell carcinoma, 55% were categorized as ST and ET. All NonST and NonET cases were adenocarcinoma. A significant difference in the presence of LBL was seen between ET and NonET.

Conclusions: Our simple classification based on the appearance of stenosis and LBL in PPT may facilitate pathological diagnosis.
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http://dx.doi.org/10.1159/000515183DOI Listing
April 2021

[Cavernous Hemangioma Originating in the Left Atrial Appendage:Report of a Case].

Kyobu Geka 2021 Mar;74(3):237-240

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Japan.

A 66-year-old male with hypertension was referred for evaluation of abnormal find chest X-ray. A computed tomography (CT) scan revealed a solitary pericardial mass with a diameter of 5 cm, located in the left atrioventricular groove. It showed solid but unevenly enhanced contents suggesting a well vascularized tumor originating in either a part of the left heart or the pericardium. As magnetic resonance imaging showed a clear boundary between the tumor and the pericardium, cardiac origin was suspected. Surgical removal of the tumor was performed via median sternotomy. The tumor originated from the lateral aspect of the left atrial appendage, having a base of 10 mm in diameter. The tumor was fully excised with an associated left atrial cuff under cardiopulmonary bypass. The postoperative course was uneventful. The tumor was histopathologically diagnosed as cavernous hemangioma originating in the left atrial wall. There has been no sign of recurrence for four years following surgery.
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March 2021

Whole-organ analysis of TGF-β-mediated remodelling of the tumour microenvironment by tissue clearing.

Commun Biol 2021 Mar 5;4(1):294. Epub 2021 Mar 5.

Department of Molecular Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Tissue clearing is one of the most powerful strategies for a comprehensive analysis of disease progression. Here, we established an integrated pipeline that combines tissue clearing, 3D imaging, and machine learning and applied to a mouse tumour model of experimental lung metastasis using human lung adenocarcinoma A549 cells. This pipeline provided the spatial information of the tumour microenvironment. We further explored the role of transforming growth factor-β (TGF-β) in cancer metastasis. TGF-β-stimulated cancer cells enhanced metastatic colonization of unstimulated-cancer cells in vivo when both cells were mixed. RNA-sequencing analysis showed that expression of the genes related to coagulation and inflammation were up-regulated in TGF-β-stimulated cancer cells. Further, whole-organ analysis revealed accumulation of platelets or macrophages with TGF-β-stimulated cancer cells, suggesting that TGF-β might promote remodelling of the tumour microenvironment, enhancing the colonization of cancer cells. Hence, our integrated pipeline for 3D profiling will help the understanding of the tumour microenvironment.
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http://dx.doi.org/10.1038/s42003-021-01786-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935961PMC
March 2021

A surgical case of primary perivascular epithelioid cell tumor of the heart.

J Card Surg 2020 Jul 2;35(7):1732-1735. Epub 2020 Jun 2.

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.

Background: We encountered an extremely rare case of perivascular epithelioid cell tumor (PEComa) of the heart.

Case Report: A 54-year-old woman was admitted to our hospital because a solid mass developing in the left atrioventricular groove by computed tomography scans of the chest. Histologic examination of the resected tumor revealed that the tumor had proliferating fusiform or spheroid cells with clear cytoplasm. Immunostaining showed positive results for α-smooth muscle actin, a myogenic marker, and human melanin black-45 (HMB-45), leading to a diagnosis of PEComa. The patient was discharged uneventfully, and there was no recurrence for the last thirteen years postoperatively.

Conclusions: We experienced a surgical case of PEComa primarily occurring in the heart. Although no sign of a recurrence is observed to date, we consider it necessary to follow up the case carefully.
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http://dx.doi.org/10.1111/jocs.14676DOI Listing
July 2020

The 12-year trend report of antipsychotic usage in a nationwide claims database derived from four million people in Japan.

J Psychiatr Res 2020 08 13;127:28-34. Epub 2020 May 13.

Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.

The current study aimed to describe the use of antipsychotics to clarify the gap between clinical guidelines and health care practice in Japan. We used data from the JMDC Claims Database (JMDC Inc., Tokyo, Japan), a nationwide claims database, from 2005 to 2016. Antipsychotics were defined as drugs coded as N05A with the Anatomical Therapeutic and Chemical (ATC) codes. We described the annual changes in proportions based on the number of patients prescribed any antipsychotics. From the database of 4,081,102 people, the data of 12,382 patients was extracted by applying the following exclusion criteria: no use of antipsychotics, missing the prescription date or dose, inpatients, prescribed antipsychotics only for use as needed, prescribed only injectable antipsychotics except for long-acting injections (LAIs), without schizophrenia as the primary disease, not exceeding 75 mg/day chlorpromazine equivalent, and less than 18 years old. The use of second-generation antipsychotics (SGA) has been expanding, while the use of first-generation antipsychotics has been decreasing. Aripiprazole accounted for the highest proportion of prescribed antipsychotics (31.9%) in 2016. Even though clozapine is categorized as a SGA, it accounted for a paltry 0.2%. The proportion of prescribed antipsychotics accounted for by LAIs was less than 5%. Although the use of antipsychotics for schizophrenia in Japan mostly corresponds to various clinical guidelines, limited use of clozapine and LAIs was identified. Further research focusing on the factors affecting the prescription of these underused antipsychotics may help advance the pharmacological therapy of schizophrenia.
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http://dx.doi.org/10.1016/j.jpsychires.2020.05.012DOI Listing
August 2020

Observational study to determine the optimal dose of daptomycin based on pharmacokinetic/pharmacodynamic analysis.

J Infect Chemother 2020 Apr 10;26(4):379-384. Epub 2019 Dec 10.

Infection Control Center, Osaka Medical College Hospital, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan. Electronic address:

High doses of daptomycin (DAP) (>6 mg/kg/day) have been preliminarily recommended in recent practical guidelines for methicillin-resistant Staphylococcus aureus infection, to achieve better clinical effects. While such doses can elevate the plasma trough concentration (Cmin) of DAP, there is an associated risk of creatine phosphokinase (CPK) elevation warranting further investigation. In the current study relationships between DAP Cmin and CPK elevation were investigated, and optimal DAP doses were determined. Plasma DAP concentrations were measured in 20 patients. Logistic regression analysis was performed to assess relationships between DAP Cmin and CPK elevation, then a population pharmacokinetic model of DAP was developed. To determine an optimal DAP dose a Monte Carlo simulation (MCS) was performed to minimize the risk of CPK elevation and maximize the probability of successful treatment. In logistic regression analysis DAP Cmin was significantly associated with CPK elevation (odds ratio 1.21, p = 0.048). With respect to dose-dependent increases in the probability of CPK elevation and exposure to DAP, MCS estimated an optimal DAP dose of 4-6 mg/kg/day, corresponding to a minimum inhibitory concentration (MIC) of ≤0.5 μg/mL. For an MIC of 1 μg/mL, MCS estimated an optimal DAP dose of 10 mg/kg/day. However, the probability of CPK elevation associated with high doses of DAP was higher than that associated with the approved doses. In cases where high doses of DAP are administered, close CPK monitoring is required and therapeutic drug monitoring of DAP may be desirable.
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http://dx.doi.org/10.1016/j.jiac.2019.11.002DOI Listing
April 2020

IgG4-Positive Plasmacytic Infiltration in Aortic Wall and Aortic Valve Surgical Samples and Its Relation to Preoperative Serum IgG4 Levels.

Int Heart J 2019 May 17;60(3):688-694. Epub 2019 May 17.

Department of Cardiology, Osaka Medical College.

The prevalence and extent of immunoglobulin G4 (IgG4)-positive cell infiltration were investigated in 282 surgical samples of aortic wall and aortic valve. Tissue infiltration of IgG4-positive cells was observed in 24 (17.3%) of 139 aortic valve samples and 46 (32%) of 143 aortic wall samples, and the condition of IgG4-positive cell infiltration > 30/hpf together with IgG4/CD138 ratio > 40% was observed in 2 (1.4%) of aortic valve samples and 14 (9.8%) of aortic wall samples. Among 275 patients, preoperative serum IgG4 level was available in 48 patients (50 samples), and it was > 135 mg/dL in only one patient. Of these 48 patients with serum IgG4 measurement, 29 patients had aortic valve stenosis and 12 had aortic aneurysm. Compared with 23 aortic stenosis patients without tissue infiltration of IgG4-positive cells in the aortic valve, six patients with IgG4-positive cell infiltration had a more prevalent smoking history (26% versus 83%) and borderline significantly higher serum IgG4 (median, 24.5 mg/dL versus 55.5 mg/dL), although either preoperative peak pressure gradient between left ventriculum and aorta or aortic valve area did not differ significantly between groups. Compared with six aortic aneurysm patients without tissue infiltration of IgG4-positive cells in the aortic wall, six patients with IgG4-positive cell infiltration had borderline significantly higher serum IgG4 (median, 28.9 mg/dL versus 68.2 mg/dL). The current study showed that tissue IgG4-positive infiltration is not a rare occurrence in the aortic stenosis and aortic aneurysm. Clinical significance of tissue IgG4-postive cell infiltration in these patients requires further investigation.
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http://dx.doi.org/10.1536/ihj.18-490DOI Listing
May 2019

Outcomes of Thoracic Aortic Surgery in Patients With Coronary Artery Disease - Based on the Japan Adult Cardiovascular Surgery Database.

Circ J 2019 04 5;83(5):978-984. Epub 2019 Mar 5.

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College.

Background: Coronary artery disease (CAD) is associated with increased morbidity and mortality after open repair of thoracic aorta. Nevertheless, the efficacy of preoperative coronary angiography (CAG) and revascularization is controversial. The aim of this study was to clarify the effect of preoperative CAD on surgical outcome by reviewing the Japan Adult Cardiovascular Database. Methods and Results: This study involved 4,596 patients who underwent open surgery for true thoracic aortic aneurysm between 2004 and 2009. After excluding patients with concomitant cardiac operation, except coronary artery bypass grafting (CABG), the remaining 1,904 patients with coronary artery stenosis included 995 cases of simultaneous CABG. The prevalence of CAD was significantly higher in patients with diabetes, renal dysfunction, hyperlipidemia, cerebrovascular disorders, peripheral artery lesions, old myocardial infarction (MI), and coronary intervention. Patients with simultaneous CABG had severe CAD compared with those without, with no other major differences in patient background noted. Thirty-day postoperative and in-hospital mortalities were higher in CAD patients. Incidence of perioperative MI was higher in patients who underwent open aortic repair with simultaneous CABG, but simultaneous CABG did not affect operative mortality.

Conclusions: In patients with surgically treated true aortic aneurysm, CAD was frequently observed, suggesting that aggressive preoperative coronary evaluation is needed.
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http://dx.doi.org/10.1253/circj.CJ-18-0703DOI Listing
April 2019

Type B3 thymoma with marked neuroendocrine differentiation: Report of a case.

SAGE Open Med Case Rep 2019 1;7:2050313X19827749. Epub 2019 Feb 1.

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College Hospital, Takatsuki, Japan.

Thymomas are tumors originating from the thymus epithelial cells and are the most common tumors of the anterior mediastinum. They have been classified into types A, AB, B1, B2, and B3 by the World Health Organization. Type B3 thymoma is composed of epithelial cell sheets with mild to moderate atypia and scant lymphocytes. An association between thymic carcinoma and neuroendocrine differentiation has been observed by some authors. However, cases of type B3 thymoma with neuroendocrine differentiation are very rarely discussed in the literature. A 68-year-old woman was referred to our hospital with an abnormal shadow on a chest roentgenogram. Chest computed tomography showed that the lesion was located in the anterior mediastinum. She underwent surgery, and the tumor was diagnosed as a type B3 thymoma with neuroendocrine differentiation. An extremely rare case of a type B3 thymoma showing neuroendocrine differentiation is presented herein.
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http://dx.doi.org/10.1177/2050313X19827749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360637PMC
February 2019

A Case of Aortic Stenosis with Serum IgG4 Elevation, and IgG4-Positive Plasmacytic Infiltration in the Aortic Valve, Epicardium, and Aortic Adventitia.

Int Heart J 2018 Sep 11;59(5):1149-1154. Epub 2018 Aug 11.

Department of Cardiology, Osaka Medical College.

A 74-year-old man was admitted for preoperative screening of aortic stenosis. Five months before this admission, he was found to have elevated serum immunoglobulin G4 (IgG4; 2,010 mg/dL). Computed tomography (CT) showed a soft tissue mass surrounding the abdominal aorta, suggestive of IgG4-related periaortitis. CT coronary angiography showed perivascular thickening of the right coronary artery, and subsequent coronary angiography showed a multi-vessel disease. The patient underwent aortic valve replacement and coronary bypass surgery. Immunohistochemical analysis showed IgG4-positive plasmacytic infiltration in specimens from the aortic valve, epicardium, and aortic adventitia, suggestive of the possible role of IgG4-related immune inflammation for the pathogenesis.
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http://dx.doi.org/10.1536/ihj.17-567DOI Listing
September 2018

Combined lipiodol marking and video-assisted thoracoscopic surgery in a hybrid operating room.

J Thorac Dis 2018 May;10(5):2940-2947

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.

Background: The development of diagnostic technology has led to detection of an increasing number of small pulmonary nodules (SPNs), which can be difficult to locate intraoperatively. Here, we report our experience performing single-stage lipiodol localization and surgical resection in a hybrid operating room (OR).

Methods: Between June 2016 and August 2017, 30 patients with 32 SPNs underwent sliding gantry-based multidetector computed tomography (MDCT)-guided lipiodol marking followed by video-assisted thoracoscopic surgery (VATS) in a hybrid OR. After induction of general anesthesia, all nodules were marked with 0.2 mL lipiodol under MDCT fluoroscopic guidance, followed by immediate VATS.

Results: The mean SPN diameter and distance from the pleural surface were 10.7±4.5 mm (range, 5.0-21.0 mm) and 18.0±9.0 mm (range, 2.8-32.0 mm) respectively. The MDCT-guided localization procedure required 15.8±6.0 min (range, 8.0-32.0 min). All the nodules were marked with lipiodol and detected during fluoroscopy as a clear spot. The median deviation between the radio-opaque nodule and the target nodule was 7.8±3.6 mm (range, 3.0-20.0 mm). In two cases, MDCT scans performed after completion of marking revealed mild pneumothorax, which did not need further intervention. VATS resection was converted to thoracotomy in two patients because of strong pleural adhesions and intraoperative bleeding from the pulmonary vein. No other complications occurred during the combined approach, and there was no intra- or post-operative mortality or morbidity.

Conclusions: These results suggest that a combined approach using MDCT-guided lipiodol marking followed by VATS is feasible and has acceptable accuracy in resection of SPNs.
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http://dx.doi.org/10.21037/jtd.2018.05.28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006053PMC
May 2018

Correction to: Development of a simple device enabling percutaneous flow regulation for a small vascular graft for a Blalock-Taussig shunt capable of flow regulation: complete translation of an original article originally published in Pediatric Cardiology and Cardiac Surgery (154-159, 2016: vol. 32).

Gen Thorac Cardiovasc Surg 2018 09;66(9):556

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

In the original publication of the article, the title was incorrectly published.
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http://dx.doi.org/10.1007/s11748-018-0958-2DOI Listing
September 2018

A modified multi-patch technique for double-layered repair of ischemic posterior ventricular septal rupture.

Surg Case Rep 2018 Mar 27;4(1):27. Epub 2018 Mar 27.

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Background: The rupture of the posterior ventricular septum after acute inferior myocardial infarction is more challenging to repair than ruptures in other sites since it is less accessible and anatomically restricted. We described a modification of Daggett's original technique of multi-patch repair of ruptured posterior septum.

Case Presentation: The technique was employed in the operation of a 67-year-old male who presented with severe heart failure at the 10th day after he developed inferior myocardial infarction. His ventricular septum had ruptured at the level between the posteromedial papillary muscle and the mitral annulus. A large endoventricular patch covered separately over the locally patched septal defect and the ventriculotomy defect which was going to be roofed eventually with an external patch. Both defects were then individually closed in double layers, holding a single continuous patch in common. The common use of a single patch expedited multilayered closure of the left ventricular defects and could minimize geometric remodeling of the covered area. The patches on both the endocardial and the epicardial sides avoided potentially fatal bleeding from the ventriculotomy site. The transmural mattress sutures incorporating ventriculotomy patches required minimal bites toward the posteromedial papillary muscle and mitral annulus, thereby preserving the mitral valve function.

Conclusions: Thus, the technique enhances the advantage of the left ventriculotomy in the repair of posterior septal rupture and avoids ventriculotomy-related morbidity.
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http://dx.doi.org/10.1186/s40792-018-0426-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871608PMC
March 2018

Repair of a Kommerell's diverticulum with an absent left subclavian artery and a right aortic arch.

J Card Surg 2018 Mar 1;33(3):149-150. Epub 2018 Mar 1.

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.

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http://dx.doi.org/10.1111/jocs.13549DOI Listing
March 2018

In situ tissue regeneration using a warp-knitted fabric in the canine aorta and inferior vena cava.

Eur J Cardiothorac Surg 2018 08;54(2):318-327

Healthcare Business Development, Teijin Limited, Hino, Tokyo, Japan.

Objectives: Materials used in paediatric cardiac surgery have drawbacks of deterioration, calcification and pseudointimal proliferation resulting in haemodynamic disturbance. The aim of this study was to investigate whether these drawbacks can be overcome by in situ tissue regeneration using a newly developed synthetic hybrid fabric (SHF).

Methods: The SHF is an expandable, warp-knitted fabric composed of a combination of biodegradable [poly-l-lactic acid (PLLA)] and non-biodegradable (polyethylene terephthalate) yarns. The fabric is coated with cross-linked gelatin. Mechanical properties of the SHF were compared with those of 2 commercial products: expanded polytetrafluoroethylene sheet and glutaraldehyde-treated bovine pericardium. An oval-shaped defect created in the canine descending aorta or inferior vena cava was filled with the SHF patch. After 2 weeks and 1, 3, 6 and 12 (or 24 in the inferior vena cava) months, the patch was removed for histological examination and evaluation of the remaining PLLA.

Results: The SHF exhibited satisfactory tensile and suture retention strength for surgical implantation similar to or better than the 2 commercial products. Tissue regeneration was induced with multilayered smooth muscle cells and collagen fibres on both sides of the patch, along with a mature endothelial layer and tissue connections containing vasa vasorum across the patch in the aorta and inferior vena cava. Inflammatory reactions were minimal, and no calcium deposition occurred. The molecular weight of PLLA was reduced to half at 12 months after implantation.

Conclusions: The SHF may solve the drawbacks of the existing products. Further studies of the expandability of the SHF patch after degradation of PLLA are warranted.
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http://dx.doi.org/10.1093/ejcts/ezy045DOI Listing
August 2018

Pseudoaneurysm of the external iliac artery is a rare late complication after total hip arthroplasty.

J Vasc Surg Cases Innov Tech 2017 Sep 18;3(3):149-151. Epub 2017 Jul 18.

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College Hospital, Osaka, Japan.

Vascular injury as a delayed complication of total hip arthroplasty (THA) is rare. We present a case of pseudoaneurysm of the external iliac artery due to chronic irritation from a prominent bone spicule occurring 2 years after revision THA. We successfully managed the patient with open repair, and there has been no sign of recurrence in the 2 years since the previous surgery. This report suggests that patients who have undergone THA should be followed up carefully and assessed for vascular injuries even after a substantial time.
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http://dx.doi.org/10.1016/j.jvscit.2017.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764856PMC
September 2017

Development of a new surgical sheet containing both silk fibroin and thermoplastic polyurethane for cardiovascular surgery.

Surg Today 2018 May 18;48(5):486-494. Epub 2017 Dec 18.

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.

Purpose: The surgical sheets that are currently used for congenital cardiovascular surgery have several drawbacks, including material deterioration, calcification, and pseudo-intimal proliferation resulting in hemodynamic disturbance. The aim of this study was to evaluate a newly developed sheet made from a combination of silk fibroin (SF) and a synthetic polymer, thermoplastic polyurethane (TPU), for surgical use.

Methods: The hybrid SF/TPU sheet was a non-woven fabric with nanofibers that was made using the electrospinning method. The mechanical properties of the SF/TPU sheet were characterized. To determine its biocompatibility, part of the wall of the canine descending aorta was replaced with a SF/TPU sheet as a patch. The patches were removed after 3 months and a histological examination was performed.

Results: The flexibility, water permeability, and suture retention strength of the SF/TPU sheet were excellent and equivalent to those of existing sheets. The SF/TPU sheet had excellent handling properties and fit well into the vascular wall without needle hole bleeding. The histological examination revealed that the intimal tissue was restored well over the intraluminal surface of the explanted SF/TPU sheet, the absence of calcium deposition, and minimal inflammatory reaction, without signs of degradation.

Conclusion: The SF/TPU sheet had excellent mechanical properties and tissue biocompatibility. These favorable features and possible biodegradability of the SF portion warrant a long-term follow-up study.
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http://dx.doi.org/10.1007/s00595-017-1615-6DOI Listing
May 2018

What can predict and prevent the long-term use of benzodiazepines?

J Psychiatr Res 2018 02 24;97:94-100. Epub 2017 Nov 24.

Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.

Although benzodiazepines (BZDs) are commonly prescribed for insomnia or anxiety, long-term use of BZDs causes serious adverse effects such as daytime drowsiness and cognitive decline. In the current study, we evaluated the predictors and preventers of long-term usage of BZDs from a retrospective survey by utilizing the 12-year prescription record of a university hospital. From the prescription data of 92,005 people, users of BZDs (n = 3,470, male = 39.2%, mean age = 60 ± 17.5) were analyzed. During this period, both the number of prescriptions (2722 in 2004 to 1019 in 2016) and the number of BZDs (1.73 in 2004 to 1.36 in 2016) gradually decreased, although more than half of the patients continued to take BZDs for over three years. High risk factors for long-term use of BZDs include elderly patients (>65 years old), high dosage (>5 mg diazepam per day), psychiatrist-prescribers, and users with polytherapy. Discontinuation is significantly found in users of hypnotic BZDs and alternative psychotropic medical drugs (including antipsychotics, serotonergic drugs, or newer types of sleep medicine). Future studies should focus on elucidating interventions that are more effective against long-term usage of BZDs.
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http://dx.doi.org/10.1016/j.jpsychires.2017.11.012DOI Listing
February 2018

Development of a simple device enabling percutaneous flow regulation for a small vascular graft for a Blalock–Taussig shunt capable of flow regulation: complete translation of an original article originally published in Pediatric Cardiology and Cardiac Surgery (154–159, 2016: vol. 32).

Gen Thorac Cardiovasc Surg 2018 03 9;66(3):145-149. Epub 2017 Nov 9.

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Objectives: The Blalock-Taussig shunt (BTS) operation is a cornerstone as initial palliative surgery for congenital heart disease with severely reduced pulmonary blood flow (PBF). The ideal PBF provided by BTS is crucial for an uneventful postoperative course, since excess PBF results in acute distress of the systemic circulation and insufficient PBF requires another BTS surgery. Therefore, the goal of this study was to develop a simple device to control the shunt graft flow percutaneously using a constrictor balloon connected to a subcutaneous port.

Methods: The device consists of a cylindrical balloon and an anti-bending structure extension connected to the balloon center. A PTFE vascular graft wrapped by the device was connected to a simulated closed circuit to measure the relationship between pressure and blood flow while changing the inner volume of the balloon. In a beagle model of replacement of the right carotid artery, blood flow velocity was measured in the carotid artery after saline injection into the balloon. The blood flow velocity before and after balloon inflation was compared immediately after implantation of the device and at 3 months after implantation.

Results: The device provided good flow control by inflating and deflating the balloon ex vivo and in vivo for up to 3 months in a canine model with a small graft wrapped with the device.

Conclusions: The simple device developed in this study may enable regulation of PBF through a small vascular graft and help to prevent severe morbidity and mortality in the clinical setting of BTS.
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http://dx.doi.org/10.1007/s11748-017-0860-3DOI Listing
March 2018

[Localized Nodular Pulmonary Amyloidosis after Resection of Lung Cancer;Report of a Case].

Kyobu Geka 2017 Nov;70(12):1044-1047

Department of Thoracic Surgery, Hokusetsu General Hospital, Takatsuki, Japan.

A 79-year-old man had undergone endoscopic colorectal resection for colon cancer and partial resection of right S2 for lung cancer in 2007. Two years later, enlargement of a small nodule in the right S10 detected by chest computed tomography was noted. Partial lung resection was performed in April 2009, and the pathological diagnosis was localized nodular pulmonary amyloidosis.
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November 2017

[Three Surgical Cases of Quadricuspid Aortic Valve].

Kyobu Geka 2017 Sep;70(10):811-815

Department of Cardiovascular Surgery, Osaka Medical College, Takatsuki, Japan.

Quadricuspid aortic valve is a rare congenital disease. We experienced 3 surgical cases of quadricuspid aortic valve. Patient 1 was a 72-year-old man who was noted to have a quadricuspid aortic valve associated with aortic regurgitation and an ascending aortic aneurysm(51 mm in diameter). He underwent replacement of the aortic valve and the ascending aorta. Patient 2 was a 71-year-old man with severe aortic stenosis, regurgitation, and coronary triple vessel disease. He underwent aortic valve replacement and coronary artery bypass grafting. Preoperative echocardiography revealed no abnormalities in the number of valve leaflets, but quadricuspid aortic valve was identified during surgery. Patient 3 was a 79-year-old man with severe aortic regurgitation, who underwent aortic valve replacement. In all patients, the 4 valve cusps were approximately of the same size. Multi-detector computed tomography is useful for evaluation of valve morphology. Indication of prophylactic ascending aorta replacement in patients with aortic dilatation requires further study.
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September 2017

[Concomitant Operations for Thoracic Aortic Aneurysm and Myasthenia Gravis;Report of a Case].

Kyobu Geka 2017 Aug;70(9):791-793

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Japan.

A 77-year-old man, who had been under medical treatment for myasthenia gravis without thymoma, was diagnosed with aortic arch aneurysm. He underwent total aortic arch replacement and total resection of the thymus through median sternotomy. His symptoms relating to myasthenia gravis dramatically disappeared after the surgery. The serum anti-acetyl chorine receptor antibody decreased from 2.7 to 0.7 nmol/l (N<0.2) with the reduction of oral predonisolone from 12.5 to 5 mg/day at 4 years after the surgery. The concomitant operations significantly improved his quality of life.
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August 2017

Fast and slow Ca-dependent hyperpolarization mechanisms connect membrane potential and sleep homeostasis.

Curr Opin Neurobiol 2017 06 30;44:212-221. Epub 2017 May 30.

Department of Systems Pharmacology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113-0033, Japan; Laboratory for Synthetic Biology, RIKEN Quantitative Biology Center, 1-3 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address:

Several lines of evidence indicate that the sleep-wake state of cortical neurons is regulated not only through neuronal projections from the lower brain, but also through the cortical neurons' intrinsic ability to initiate a slow firing pattern related to the slow-wave oscillation observed in electroencephalography of the sleeping brain. Theoretical modeling and experiments with genetic and pharmacological perturbation suggest that ion channels and kinases acting downstream of calcium signaling regulate the cortical-membrane potential and sleep duration. In this review, we introduce possible Ca-dependent hyperpolarization mechanisms in cortical neurons, in which Ca signaling associated with neuronal excitation evokes kinase cascades, and the activated kinases modify ion channels or pumps to regulate the cortical sleep/wake firing mode.
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http://dx.doi.org/10.1016/j.conb.2017.05.007DOI Listing
June 2017

Capillary Degeneration and Right Ventricular Remodeling Due to Hypoxic Stress with Sugen5416.

Curr Vasc Pharmacol 2017 ;15(6):589-598

Laboratory of Cardiovascular Pharmacotherapy and Toxicology, Osaka University of Pharmaceutical Sciences, 4-20-1 Nasahara, Takatsuki, Osaka 569-1094. Japan.

Background: Sugen5416 (semaxinib) is an inhibitor of the vascular endothelial growth factor (VEGF) receptor. A rat model of Pulmonary Arterial Hypertension (PAH), created with Sugen5416 and chronic hypoxia, is known to have similar histological findings to those of PAH patients.

Objective: To evaluate the pathophysiological mechanisms of cardiac remodeling due to hypoxic stress with Sugen5416 in vivo.

Methods: Male Sprague-Dawley rats were exposed to hypoxia (10 ± 1% O2) for 2 weeks after a single injection of Sugen5416 (SU-hypoxia group) or the vehicle (V-hypoxia group).

Results: Hypoxia elevated right ventricular (RV) systolic pressure and caused RV remodeling on Day 14. By electron microscopy, metamorphosis of capillaries with endothelial cell occlusive degeneration was observed in the RV myocardium of the SU-hypoxia group from Day 3. After reoxygenation, progressive RV remodeling with extensive degeneration of cardiomyocytes was observed in the SUhypoxia group, associated with a significant increase of oxidative stress and TUNEL-positive cells in both RV and left ventricular myocardium on Day 84. The expression of VEGF mRNA in the RV myocardium was significantly suppressed in the SU-hypoxia group on Day 3, whereas delayed activation of VEGF/extracellular signal-regulated kinase (ERK) signaling pathway on Day 14 were observed.

Conclusion: Capillary degeneration and activation of VEGF/ERK signaling pathway might be crucial to accelerate the cardiac remodeling due to hypoxic stress with Sugen5416.
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http://dx.doi.org/10.2174/1570161115666170427154217DOI Listing
May 2018

Extramedullary Plasmacytoma Arising From the Anterior Mediastinum.

Ann Thorac Surg 2017 May;103(5):e393-e395

Department of Thoracic Surgery, Osaka Medical College Hospital, Takatsuki, Japan.

Plasmacytomas are a localized proliferation of plasma cells in the bone marrow and soft tissue. Extramedullary plasmacytomas are rare and typically solitary plasma cell neoplasms originating from extraosseous organs and tissues. A 31-year-old woman was referred to our hospital with a rapidly growing abnormal shadow on a chest roentgenogram. Chest computed tomography showed that the lesion was located in the anterior mediastinum. She underwent surgery, and the tumor was diagnosed as an extramedullary plasmacytoma. She remains well 2 years postoperatively without recurrence. An extremely rare case of an anterior mediastinal extramedullary plasmacytoma is presented.
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http://dx.doi.org/10.1016/j.athoracsur.2016.10.064DOI Listing
May 2017

IgG4-positive cell infiltration in various cardiovascular disorders - results from histopathological analysis of surgical samples.

BMC Cardiovasc Disord 2017 02 3;17(1):52. Epub 2017 Feb 3.

Department of Cardiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686, Japan.

Background: The diagnosis of Immunoglobulin G4 (IgG4)-related disease (IgG4-RD), in general, depends on serum IgG4 concentrations and histopathological findings; therefore, diagnosis of IgG4-RD in cardiovascular organs/tissues is often difficult owing to the risk of tissue sampling.

Methods: Prevalence of IgG4-positive lymphoplasmacytic infiltration in 103 consecutive cardiovascular surgical samples from 98 patients with various cardiovascular diseases was analyzed immunohistochemically.

Results: The diagnoses of the enrolled patients included aortic aneurysm (abdominal, n = 8; thoracic, n = 9); aortic dissection (n = 20); aortic stenosis (n = 24), aortic regurgitation (n = 10), and mitral stenosis/regurgitation (n = 17). In total, 10 (9.7%) of the 103 specimens showed IgG4-positive cell infiltration with various intensities; five of these were aortic valve specimens from aortic stenosis, and IgG4-positive cell infiltration was present at >10 /HPF in three of them. In one aortic wall sample from an abdominal aortic aneurysm, various histopathological features of IgG4-RD, such as IgG4-positive cell infiltration, obliterating phlebitis, and storiform fibrosis, were observed.

Conclusions: IgG4-positive cell infiltration was observed in 9.7% of the surgical cardiovascular specimens, mainly in the aortic valve from aortic stenosis and in the aortic wall from aortic aneurysm. Whether IgG4-positive cell infiltration has pathophysiological importance in the development or progression of cardiovascular diseases should be investigated in future studies.
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http://dx.doi.org/10.1186/s12872-017-0488-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291949PMC
February 2017

Primary Leiomyosarcoma in the Inferior Vena Cava Extended to the Right Atrium: A Case Report and Review of the Literature.

Case Rep Oncol 2016 Sep-Dec;9(3):599-609. Epub 2016 Oct 12.

Department of Cardiology, Osaka Medical College, Osaka, Japan.

A 38-year-old woman had developed an abdominal distention, lower extremity edema, and dyspnea. Imaging examination revealed a large mass in the right atrium which was connected to lesions within the inferior vena cava. Although complete resection of the mass was not possible, partial surgical tumor resection was performed to avoid pulmonary embolization and circulatory collapse. Leiomyosarcoma was diagnosed histologically, and chemotherapy (doxorubicin) followed by radiotherapy was started. By reviewing papers published in the past 10 years that included 322 patients, we also discuss the clinical presentations and prognosis of leiomyosarcoma in the inferior vena cava.
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http://dx.doi.org/10.1159/000450598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118828PMC
October 2016

Bronchial artery aneurysm suggested to be caused by metalic tracheal stent migration.

Surg Case Rep 2016 Dec 5;2(1):125. Epub 2016 Nov 5.

Department of Thoracic Surgery, Osaka Medical College Hospital, 2-7 Daigaku-cho, Takatsuki, 569-8686, Japan.

Occurrence of bronchial artery aneurysm is rare, and it has been detected in less than 1 % of all selective bronchial arteriography cases. Here, we present a case of a bronchial artery aneurysm caused by a tracheal stent migration. A 59-year-old man was operated on for esophageal cancer, where an esophageal-tracheal fistula occurred 1 week after operation. Surgical repair of the esophageal-tracheal fistula was performed using a muscle flap, but this not results in fistula closure. Consequently, a self-expanding covered metallic tracheal stent was implanted for rescue, and this resulted in fistula closure. After 1 year, there was frequent hemoptysis caused by migration of the stent. He was referred to our hospital where removal of the stent was planned. A sudden occurrence of massive bleeding from trachea occurred, and extracorporeal membrane oxygenation (ECMO) was used. Although removal of tracheal stent was performed successfully, the patient subsequently died from multi-organ failure. Post-mortem autopsy revealed that the massive bleeding is originated from the rupture of a bronchial artery aneurysm.
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http://dx.doi.org/10.1186/s40792-016-0247-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097054PMC
December 2016