Publications by authors named "Yasuhiko Kawaguchi"

20 Publications

  • Page 1 of 1

Functional and clinical anatomy of the obturator externus muscle: Cadaveric studies and clinical findings for total hip arthroplasty in the posterior approach.

J Orthop 2021 May-Jun;25:93-97. Epub 2021 Apr 21.

Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.

Repairing released posterior soft tissues is important in preventing dislocation after total hip arthroplasty (THA) via the posterior approach. We clarify the functional and the clinical anatomy of obturator externus. We performed cadaveric studies and investigated clinically in primary THA cases. The location, trajectory, and size of the muscular tendon was recorded. The trajectory of the obturator externus ran orthogonal to the femoral axis with the hip in 90° flexion whereas that of the obturator internus muscle ran parallel. Because the trajectory of obturator externus and the obturator internus differ, their functions also differ.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jor.2021.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102206PMC
April 2021

A Five-Year-Old Slipped Capital Femoral Epiphysis Treated With Dynamic Single Screw Fixation.

Cureus 2021 Jan 29;13(1):e12992. Epub 2021 Jan 29.

Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, JPN.

Slipped capital femoral epiphysis (SCFE) commonly occurs during puberty. Onset of SCFE at either less than 10 years old or over 16 years is defined as atypical. As in our patient, atypical onset at less than 10 years occurred in 9%, and the age of onset has been decreasing in recent years and that the probability of concomitant obesity is particularly high in young patients without obvious underlying disease or background factors. In the treatment of SCFE, preventing further slipping and permitting femoral bone growth by physeal closure is difficult, especially for young patients. We adopted 'dynamic single screw fixation' using SCFE short thread screw for continuous fixation without disturbing the growth of proximal femur or damaging to growth plate. Refixation was necessary once. The screw worked for 7 years 4 months while physeal closure was avoided. At the 10-year follow-up, her growth had stopped. She had no problem clinically, no increase in the posterior sloping angle (PSA), and no obvious growth disturbance of the femur.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.12992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916986PMC
January 2021

Reply: Surgical repair of thoracoabdominal aortic aneurysm accompanied by Leriche syndrome using a quadrifurcated graft without a distal anastomosis.

J Card Surg 2021 03 2;36(3):1170-1171. Epub 2021 Feb 2.

Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.15367DOI Listing
March 2021

Stent graft collapse caused by acute aortic dissection after endovascular repair for thoracoabdominal aortic aneurysm repair.

J Vasc Surg Cases Innov Tech 2020 Dec 2;6(4):509-510. Epub 2020 Sep 2.

Department of Cardiovascular Surgery, Nagoya Heart Center, Aichi, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvscit.2020.08.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588798PMC
December 2020

Clinical results of a short stem with flat tapered wedge design in primary total hip arthroplasty for hip dysplasia in Asians.

J Orthop Surg (Hong Kong) 2020 Sep-Dec;28(3):2309499020956742

Department of Orthopaedic Surgery, 12839The Jikei University School of Medicine, Tokyo, Japan.

Background: Cementless femoral reconstruction is challenging in hip dysplasia due to deformity of the proximal femur causing insufficient stem fixation and/or inadequate neck anteversion. Strategies to address these problems include the use of a modular stem or a distal fixation stem, but both stems have some characteristic disadvantages.

Methods: We studied the postoperative clinical outcomes in primary total hip arthroplasty in 257 hips using the flat tapered wedge short femoral stem for hip dysplasia in an Asian population (postoperative follow-up period: 2 years to 6 years and 11 months; mean 4 years and 5 months). We took advantage of the characteristic of high flexibility in stem placement because of its low volume, positioning it while performing some varus/valgus and rotational alignment adjustments.

Results: Favorable clinical functional outcomes were obtained, including the radiographic outcome of biological fixation achieved in all stems. Regarding complications, there was no case of split fracture of the femoral calcar region during stem insertion, and the rate of postoperative dislocation was also low at 0.4% (1 case). In the pre- and postoperative computed tomography measurements, the variability in stem anteversion postoperatively was significantly reduced compared to preoperative anatomical anteversion.

Conclusion: This flat-shaped short low-volume stem likely has high flexibility in positioning in cases of hip dysplasia and can be easily positioned to avoid fractures while still achieving secure fixation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2309499020956742DOI Listing
October 2020

Surgical repair of thoracoabdominal aortic aneurysm accompanied by Leriche syndrome using a quadrifurcated graft without a distal anastomosis.

J Card Surg 2020 Nov 13;35(11):3166-3168. Epub 2020 Aug 13.

Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan.

Background: The coexistence of Leriche syndrome and thoracoabdominal aortic aneurysm is rare and challenging for surgeons especially if there are no distal anastomosis sites.

Case Report: A 56-year-old man with past medical histories of coronary artery bypass grafting and total arch replacement was planned to the surgery for thoracoabdominal aneurysm. His abdominal aorta was occluded just below the renal arteries and his terminal aorta, iliac and femoral arteries were hypoplastic. Right internal thoracic artery and visceral arteries provided collateral blood supply to the legs. The aneurysm was successfully repaired using a quadrifurcated graft without distal anastomoses.

Conclusion: A quadrifurcated graft can be a therapeutic option for repair of thoracoabdominal aneurysm accompanied by Leriche syndrome without distal anastomosis sites.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.14907DOI Listing
November 2020

[Cardiac Surgery for Mitral Regurgitation Associated with Essential Thrombocythemia].

Kyobu Geka 2020 May;73(5):353-357

Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.

An 80-year-old woman with essential thrombocythemia was diagnosed with severe mitral regurgitation and moderate tricuspid regurgitation. Preoperatively, she had been treated with hydroxycarbamide and low-dose aspirin since her platelet count was high( 96.2×104/μl). After the platelet count was reduced to 46.2×104/μl, she underwent mitral valve repair and tricuspid valve annuloplasty. Atypical heparin resistance was noted intraoperatively. After initial heparin infusion, the activated clotting time(ACT) increased as expected. However, it decreased after initiation of cardiopulmonary bypass, despite additional heparin infusion and heparin concentration maintenance. A correlation between platelet factor 4 and heparin resistance was suggested. On discharge, she had no complications. We should consider the possibility of heparin resistance in essential thrombocythemia even when platelet count is adequately controlled.
View Article and Find Full Text PDF

Download full-text PDF

Source
May 2020

Aortic Valve Replacement by a Transaxillary Anterior Minithoracotomy Approach.

Ann Thorac Surg 2020 09 18;110(3):e237-e239. Epub 2020 Apr 18.

Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan.

A modified transaxillary approach for aortic valve disease to obtain the same exposure as the anterior minithoracotomy approach and to preserve the pectoralis major muscle is presented. When the patient's right shoulder is adducted horizontally, or the right arm is flexed anteriorly 90 degrees and adducted to the left, the right axilla comes close to the chest midline. That means that a right anterior thoracotomy can be made through the right axilla when the arm position is adjusted appropriately. The modified new approach is safe and faster than the conventional transaxillary approach, and it provides cosmetic advantages to the patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2020.03.046DOI Listing
September 2020

Successful Endovascular Repair for Abdominal Aortic Aneurysm Presenting as Aortoduodenal Syndrome.

Ann Vasc Dis 2020 Mar;13(1):81-85

Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan.

Aortoduodenal syndrome is a rare duodenal obstruction caused by an abdominal aortic aneurysm. Current treatment involves open aneurysmal repair according to the theory that this procedure releases the duodenum from mechanical compression. However, the mechanism of duodenal blockage remains unclear and reports of endovascular aneurysm repair (EVAR) for aortoduodenal syndrome are quite rare. We report our successful case of EVAR for aortoduodenal syndrome without aneurysmal shrinkage and discuss the mechanism of duodenal obstruction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3400/avd.cr.19-00092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7140162PMC
March 2020

Double right coronary arteries arising from two separate ostia.

Asian Cardiovasc Thorac Ann 2020 May 8;28(4):224-225. Epub 2020 Apr 8.

Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0218492320919466DOI Listing
May 2020

Thoracic endovascular aneurysm repair to treat recurrent lower limb ischemia secondary to occlusion of axillofemoral bypass.

Int J Surg Case Rep 2020 28;68:190-192. Epub 2020 Feb 28.

Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan.

Introduction: A case of malperfusion in which the patient presented with aortic dissection is presented.

Presentation Of Case: A 69-year-old man with an acute aortic dissection (Stanford type B) had lower limb ischemia. Axillary-femoral bypass was performed, and his lower limb ischemia improved. Eight months after the onset of acute aortic dissection, he again had lower limb ischemia. Contrast-enhanced computed tomography showed axillary-femoral bypass occlusion and true lumen collapse, compressed by the increased false lumen pressure in the aorta. Thoracic endovascular aortic repair (TEVAR) was performed for entry closure. His lower limb ischemia was improved by TEVAR.

Discussion: One of the complications of type B aortic dissection is malperfusion. Endovascular therapy is a first step in treating the malperfusion of type B aortic dissection. It is important to seal the entry for the treatment of malperfusion.

Conclusion: If there is an entry, it is important to seal it for the treatment of malperfusion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijscr.2020.02.053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090095PMC
February 2020

How to anastomose a patch to avoid residual leak in the infarct exclusion method.

J Card Surg 2020 Mar 30;35(3):659-661. Epub 2020 Jan 30.

Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan.

Background And Aim: Postinfarction ventricular septal defect is a potentially lethal complication of acute myocardial infarction for which surgical repair is mandatory. The infarct exclusion method has contributed to improving surgical outcomes, but a certain percentage of residual leakage continues to be reported. We considered possible mechanisms of residual leakage and modified the sewing method to overcome these mechanisms.

Method: A bovine pericardial patch and a Teflon felt strip between the patch and endocardium to achieve good fit were used. The patch and felt were anchored with U stay sutures and reinforced with a running suture.

Results: Use of the modified method in seven cases showed improved outcomes. Only one patient had trivial leakage, compared to nine cases using the older method; six of nine patients had residual leaks, including three minor ones.

Conclusions: Our method is a rational approach that effectively reduces residual leakage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.14442DOI Listing
March 2020

A mycotic aortic aneurysm treated by thoracic endovascular aneurysm repair.

J Surg Case Rep 2019 Nov 4;2019(11):rjz288. Epub 2019 Nov 4.

Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan.

An 88-year-old man was admitted with general fatigue. Computed tomography (CT) showed a descending aortic aneurysm. The laboratory data indicated severe infection. Despite negative blood cultures, broad-spectrum intravenous antibiotic therapy was started. Though antibiotic therapy was continued for about 2 weeks, the aneurysm extended 20 mm. Thoracic endovascular aortic repair was performed, and antibiotic therapy was continued for 4 weeks after the procedure, followed by oral antibiotics for 1 year. CT showed regression of the aneurysm 15 months after reconstruction. Antibiotic therapy, preoperatively and postoperatively, is important for a mycotic aortic aneurysm.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jscr/rjz288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827553PMC
November 2019

Early and long-term results of surgery for secondary mitral regurgitation with a damaged heart.

J Card Surg 2019 Oct 3;34(10):919-926. Epub 2019 Jul 3.

Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan.

Background: Surgery for secondary mitral regurgitation is still controversial, especially when the left ventricle is damaged. The Mitra Clip has been shown to be safe and effective for certain patient groups but does not offer superior control of mitral regurgitation compared with the surgery. If performed safely, the surgery can provide greater benefits over the long-term. The objective of this study was to retrospectively investigate the early and long-term results of mitral valve surgery for secondary mitral valve regurgitation with a damaged, dilated left ventricle.

Methods: Patients with ejection fraction <40% and left ventricular end-diastolic/systolic diameter >50/40 mm who underwent mitral valve surgery for secondary mitral regurgitation were investigated retrospectively.

Results: The mean age of the 80 identified cases was 65.7 years, and 63 patients were male. Preoperative echocardiograms showed a mean ejection fraction of 25.2% and mean left ventricular diameters in diastole/systole of 64.5/56.9 mm, respectively. Mitral valve replacement was performed in 39 cases, and mitral valve plasty in 41 cases. The most common concomitant procedures were coronary artery bypass grafting and tricuspid valve surgery (41.3% each). Mitral regurgitation improved significantly from 3.5 to 0.83, and no operative or in-hospital deaths were encountered. Long-term results showed actual 1-, 3- and 5-year survival rates of 93.1%, 80.0%, and 64.7%, respectively (mean follow-up, 1264 days).

Conclusions: Early results of this study were good and long-term results were acceptable. Our results suggest that mitral valve surgery is feasible for secondary mitral valve regurgitation even in dilated, damaged hearts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.14147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6851538PMC
October 2019

A drainage catheter tangled around a closed left atrial appendage.

Gen Thorac Cardiovasc Surg 2019 Aug 17;67(8):726-727. Epub 2019 May 17.

Department of Cardiovascular Surgery, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan.

A 70-year-old man underwent cardiac surgery including left atrial appendage closure. A pigtail catheter was inserted into the pericardial sac because of delayed tamponade. Removal of the catheter was planned for 2 days after drain insertion. However, the resistance was high and pulsatile. The patient was transferred to the catheterization laboratory and a guide wire was inserted through the catheter, revealing the catheter route around the left atrial appendage. The wire was exchanged for a stiff wire to uncurl the catheter as much as possible, then the catheter was removed. The left atrial appendage does not usually represent an obstacle to catheter removal because it is soft and shrinkable. However, once the left atrial appendage becomes closed off, it can become hard, unshrinkable and an obstacle that might be caught by the drainage catheter.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11748-019-01138-yDOI Listing
August 2019

Diagnosis and treatment of slipped capital femoral epiphysis: Recent trends to note.

J Orthop Sci 2018 Mar 1;23(2):220-228. Epub 2018 Feb 1.

Department of Orthopaedic Surgery, The Jikei University School of Medicine, Japan.

Slipped capital femoral epiphysis (SCFE) is not frequently encountered during routine practice and diagnosis and treatment are often delayed. It is important to understand symptoms and imaging features to avoid delayed diagnosis. After the diagnosis is made correct classification of the disease is required. The classification should be based on the physeal stability in order to choose safe and effective treatment. However, surgeons should bear in mind that the assessment is challenging and actual physeal stability is not always consistent with the stability predicted by a clinical classification method.

Treatment Of Stable Scfe: Closed reduction is not indicated for stable SCFE, where continuity between the epiphysis and metaphysis has not been disrupted. Treatment method(s) is (are) chosen from in-situ fixation, osteotomy and femoroacetabular impingement treatment. A single screw fixation is often used to fix the epiphysis and the dynamic method is considered especially for young patients. Traditional three-dimensional trochanteric osteotomies have been associated with procedural complexity and uncertainty. A simpler osteotomy method using an updated imaging analysis technology should be considered. Modified-Dunn procedure is indicated for a severe stable SCFE. However, caution is required because recent studies have reported a high rate of complications including postoperative femoral head avascular necrosis (AVN) and hip instability when this method is indicated for stable SCFE.

Treatment Of Unstable Scfe: Treatment of unstable SCFE is difficult and complication rate is high. Most of unstable SCFE patients were previously treated with closed method and it was difficult to predict an occurrence of postoperative AVN. However, treatment of unstable SCFE has gradually changed in recent years and many studies have shown that physeal hemodynamics can be assessed during treatment. Preoperative assessments include contrast-enhanced MRI and bone scintigraphy. Intraoperative assessments include confirmation of bleeding after drilling the femoral head and monitoring the intracranial pressure by laser doppler flowmetry. It is expected that postoperative AVN can be prevented in many cases by performing the treatment while assessing the intraoperative physeal hemodynamics. Open surgeries have begun to be indicated in the treatment of unstable SCFE through either of anterior approach or (modified) Dunn procedure. The authors expect that recent improvements in assessment of physeal hemodynamics and open treatment method provide improved clinical outcomes in the treatment of SCFE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jos.2017.12.009DOI Listing
March 2018

Treatment for unstable slipped capital femoral epiphysis: Current status and future challenge in Japan.

J Orthop Sci 2016 Nov 6;21(6):847-851. Epub 2016 Sep 6.

Department of Orthopaedic Surgery, The Jikei University Daisan Hospital, Japan.

Background: Treatment for unstable slipped capital femoral epiphysis (SCFE) is challenging and controversial. For many years, the debate centered around closed treatments and especially the pros and cons of manual reduction and its concrete procedure. However, recent studies reported on open treatments such as open reduction through an anterior approach and modified Dunn procedure. Being in a period of such transition, we investigated the current status and future challenge of treatment for unstable SCFE.

Methods: A questionnaire survey of medical institutions specializing in pediatric hip disorders across Japan was conducted. Survey items were the accurate diagnosis of physeal stability, the pre- and intra-operative evaluation of epiphyseal hemodynamics, and current treatment strategy.

Results: Survey responses returned from 29 out of 40 participant institutions (response rate: 73%) revealed that 55% of the institutions evaluated physeal stability based on clinical findings of ambulation capability in accordance with the Loder classification. Another 38% diagnosed physeal stability comprehensively by combining the Loder classification and imaging findings. Epiphyseal hemodynamics was assessed preoperatively in 18% of the institutions, effectively using angiography, contrast-enhanced magnetic resonance imaging (MRI), and bone scintigraphy. Intraoperative assessment was performed in 13% based on the bleeding through a drilling hole on the articular surface and observation of the cancellous bone color during open surgeries. As a treatment strategy, 52% of the institutions used in-situ fixation, while another 38% used manual reduction and internal fixation. On the other hand, open reduction was used at 3 institutions (the remaining 10%): the modified Dunn procedure at 2 institutions and arthrotomy at 1 institution.

Conclusion: Treatment for unstable SCFE remains controversial, but closed treatments without hemodynamic monitoring is no longer the center of the controversy. Today, the topic of the discussion is shifting toward how to correlate hemodynamic findings with treatment procedures and the indications for open treatments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jos.2016.07.024DOI Listing
November 2016

[Myocardial Ischemia in Acute Type A Aortic Dissection; Coronary Artery Dissection and Functional Ischemia].

Kyobu Geka 2016 Apr;69(4):292-7

Department of Cardiovascular Surgery, shizuoka Municipal Hospital, Shizuoka, Japan.

Myocardial ischemia due to acute type A dissection is a fatal complication. This study was undertaken to evaluate the surgical results of acute type A aortic dissection with myocardial ischemia. Between 1986 and 2014, 364 patients were treated for acute type A dissection in our hospital. Twenty-four patients were underwent myocardial revascularization. Preoperative coronary artery stent placement was involved in 2, coronary-artery bypass grafting (CABG) 18 (right 12, left 4, both 2), reCABG 2, and Carrel patch with coronary orifice restoration 2. Seven of CABG group had no symptom of myocardial ischemia, but right coronary artery was circumferentially detached from the intimal ostia. Hospital mortality was 20.1% in patients who underwent CABG. Sixteen patients with significant electrocardiogram ischemic change were not undertaken with CABG, because coronary artery was not involved by dissection. In these cases, acute aortic valve regurgitation, loss of backward pressure from distal aorta, or valve formation by intimal tear in ascending aorta might decrease diastolic pressure at aortic root and make myocardial ischemia.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2016

A modified S-ROM stem in primary total hip arthroplasty for developmental dysplasia of the hip.

J Arthroplasty 2013 Dec 21;28(10):1741-5. Epub 2013 May 21.

Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.

This study examined the clinical outcome of 220 hips in 196 Asian patients who underwent primary total hip arthroplasty (THA) for treatment of developmental dysplasia of the hip (DDH) using a modified S-ROM modular (S-ROM-A) stem designed for Asians, after 2-5 years (mean, 3.3 years) of follow-up. The stem was placed so that the anteversion angle of the neck was decreased against the sleeve in 56% of the hips and increased in 18% of the hips. Bone ingrown fixation was achieved in 99.5% of the hips on X-ray at final follow-up. There were 2 (0.9%) dislocations postoperatively. In primary THA for treatment of DDH accompanied by femoral rotational deformity, the freely-rotatable modular stem provided favorable short-term outcomes by affording both morphological and functional advantages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2013.04.041DOI Listing
December 2013

Dumbbell-shaped osteochondroma of the fifth rib causing spinal cord compression.

J Orthop Sci 2009 May 5;14(3):336-8. Epub 2009 Jun 5.

Department of Orthopaedic Surgery, The Jikei University School of Medicine, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa-shi, Chiba 277-8567, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00776-008-1323-6DOI Listing
May 2009