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11. Poster Session 3

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Fabbri, G. M. T., primary, Baldasseroni, S., additional, Panuccio, D., additional, Zoni Berisso, M., additional, Scherillo, M., additional, Lucci, D., additional, Di Pasquale, G., additional, Mathieu, G., additional, Burazor, I., additional, Burazor, M., additional, Perisic, Z., additional, Atanaskovic, V., additional, Erakovic, V., additional, Stojkovic, A., additional, Vogtmann, T., additional, Schoebel, C., additional, Sogorski, S., additional, Sebert, M., additional, Schaarschmidt, J., additional, Fietze, I., additional, Baumann, G., additional, Penzel, T., additional, Mornos, C., additional, Ionac, A., additional, Cozma, D., additional, Dragulescu, D., additional, Mornos, A., additional, Petrescu, L., additional, Pescariu, L., additional, Brembilla-Perrot, B., additional, Khachab, H., additional, Lamberti, F., additional, Bellini, C., additional, Remoli, R., additional, Cogliandro, T., additional, Nardo, R., additional, Bellusci, F., additional, Mazzuca, V., additional, Gaspardone, A., additional, Aguinaga Arrascue, L. 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J., additional, Gibson, D., additional, Pisapia, A., additional, Wazni, O., additional, Natale, A., additional, Arujuna, A., additional, Karim, R., additional, Rinaldi, A., additional, Cooklin, M., additional, Rhode, K., additional, Razavi, R., additional, O'neill, M., additional, Gill, J., additional, Kusa, S., additional, Komatsu, Y., additional, Kakita, K., additional, Takayama, K., additional, Taniguchi, H., additional, Otomo, K., additional, Iesaka, Y., additional, Ammar, S., additional, Reents, T., additional, Fichtner, S., additional, Wu, J., additional, Zhu, P., additional, Kolb, C., additional, Hessling, G., additional, Deisenhofer, I., additional, Gilbert, G., additional, Mohanty, P., additional, Cunningham, J., additional, Metz, T., additional, Horton, R., additional, Tao, S., additional, Yamauchi, Y., additional, Okada, H., additional, Maeda, S., additional, Obayashi, T., additional, Isobe, M., additional, Chan, J., additional, Johar, S., additional, Wong, T., additional, Markides, V., additional, Hussain, W., additional, Konstantinidou, M., additional, Wissner, E., additional, Fuernkranz, A., additional, Yoshiga, Y., additional, Metzner, A., additional, Kuck, K.- H., additional, Ouyang, F., additional, Kettering, K., additional, Gramley, F., additional, Mollnau, H., additional, Weiss, C., additional, Bardeleben, S., additional, Biasco, L., additional, Scaglione, M., additional, Caponi, D., additional, Di Donna, P., additional, Sergi, D., additional, Cerrato, N., additional, Blandino, A., additional, Gaita, F., additional, Fiala, M., additional, Wichterle, D., additional, Sknouril, L., additional, Bulkova, V., additional, Chovancik, J., additional, Nevralova, R., additional, Pindor, J., additional, Januska, J., additional, Choi, J. I., additional, Ban, J. E., additional, Yasutsugu, N., additional, Park, J. S., additional, Jung, J. S., additional, Lim, H. E., additional, Park, S. W., additional, Kim, Y. 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E., additional, Yaegashi, T., additional, Furusho, H., additional, Kato, T., additional, Chikata, A., additional, Takashima, S., additional, Usui, S., additional, Takamura, M., additional, Kaneko, S., additional, Chudzik, M., additional, Mitkowski, P., additional, Przybylski, A., additional, Lewek, J., additional, Smukowski, T., additional, Maciag, A., additional, Castrejon Castrejon, S., additional, Perez-Silva, A., additional, Estrada, A., additional, Doiny, D., additional, Ortega, M., additional, Lopez-Sendon, J. L., additional, Merino, J. L., additional, O'mahony, C., additional, Coats, C., additional, Cardona, M., additional, Garcia, A., additional, Calcagnino, M., additional, Lachmann, R., additional, Hughes, D., additional, Elliott, P. M., additional, Conti, S., additional, Pruiti, G. P., additional, Puzzangara, E., additional, Romano, S. A., additional, Di Grazia, A., additional, Ussia, G. P., additional, Tamburino, C., additional, Calvi, V., additional, Radinovic, A., additional, Sala, S., additional, Latib, A., additional, Mussardo, M., additional, Sora, S., additional, Paglino, G., additional, Gullace, M., additional, Colombo, A., additional, Ohlow, M.- A. G., additional, Lauer, B., additional, Wagner, A., additional, Schreiber, M., additional, Buchter, B., additional, Farah, A., additional, Fuhrmann, J. T., additional, Geller, J. C., additional, Nascimento Cardoso, R. M., additional, Batista Sa, L. A., additional, Campos Filho, L. F. C., additional, Rodrigues, S. V., additional, Dutra, M. V. F., additional, Borges, T. R. S. A., additional, Portilho, D. R., additional, Deering, T., additional, Bernardes, A., additional, Veiga, A., additional, Gartenlaub, O., additional, Goncalves, A., additional, Jimenez, A., additional, Rousseauplasse, A., additional, Deharo, J. C., additional, Striekwold, H., additional, Gosselin, G., additional, Sitbon, H., additional, Martins, V., additional, Molon, G., additional, Ayala-Paredes, F., additional, Sancho-Tello, M. J., additional, Fazal, I. A., additional, Brady, S., additional, Cronin, J., additional, Mcnally, S., additional, Tynan, M., additional, Plummer, C. J., additional, Mccomb, J. M., additional, Val-Mejias, J. E., additional, Oliveira, R. M., additional, Costa, R., additional, Martinelli Filho, M., additional, Silva, K. R., additional, Menezes, L. M., additional, Tamaki, W. T., additional, Mathias, W., additional, Stolf, N. A. G., additional, Misawa, T., additional, Ohta, I., additional, Shishido, T., additional, Miyasita, T., additional, Miyamoto, T., additional, Nitobe, J., additional, Watanabe, T., additional, Kubota, I., additional, Thibault, B., additional, Ducharme, A., additional, Simpson, C., additional, Stuglin, C., additional, Gagne, C. 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P., additional, Louis-Simonet, M., additional, Hugli, O., additional, Yersin, B., additional, Schlaepfer, J., additional, Mischler, C., additional, Pruvot, E., additional, Occhetta, E., additional, Frascarelli, F., additional, Burali, A., additional, and Dovellini, E., additional

Published
2011
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24. Flow velocity of central retinal artery and retrobulbar vessels during cardiovascular operations

Author

Medicine, Hiroshima University School of, Hiroshima, From the First Department of Surgery, Japan., Orihashi, K., Matsuura, Y., Sueda, T., Shikata, H., Morita, S., Hirai, S., Sueshiro, M., and Okada, K.

Abstract

Objective: Both blood flow monitoring and pressure monitoring are necessary to avoid inadequate cerebral perfusion during cardiovascular operations. Inasmuch as transcranial Doppler ultrasonography does not provide a consistently good signal, especially during cardiopulmonary bypass, we examined the blood flow through the central retinal artery, which has proved to reflect an obstruction of the carotid artery. Method: Twenty-eight consecutive cases were examined with a 5 or 7.5 MHz conventional echocardiographic probe. Correlation between the maximal velocity at the central retinal artery and systolic blood pressure was examined. The blood flow of the central retinal artery and retrobulbar vessels was examined during selective or retrograde cerebral perfusion or intraaortic balloon pumping. Results: Blood flow could be clearly visualized but disappeared below a certain pressure in every case. With data from 478 measuring points, systolic blood pressure correlated with maximal velocity ( r = 0.6902, p < 0.0001). The blood pressure-axis intercept, known as ''critical closing pressure,'' was 35.8 +/- 14.8 mm Hg, varying among individuals and bilateral eyes. Pulsatility index increased after cardiopulmonary bypass (1.095 +/- 0.245 to 1.525 +/- 0.268, p < 0.0001). Patency of the circle of Willis was confirmed by the blood flow during anastomosis of the ipsilateral artery. During retrograde cerebral perfusion, blood flow was detectable at the retrobulbar vessels. During intraaortic balloon pumping, the central retinal artery flow was augmented on inflation of the balloon. Conclusion: Orbital vessel monitoring provides the critical closing pressure of the central retinal artery and confirms patency of the circle of Willis. The eye can be ''an acoustic window'' into intracranial blood flow during cardiovascular surgery. (J Thorac Cardiovasc Surg 1997;114:1081-7)

Published
1997
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32. Post-traumatic diaphragmatic herniation of the liver, examined by positron emission tomography: case report

Author

Chatani Naru, Hirai Shinji, Mitsui Norimasa, Hamanaka Yoshiharu, Orihashi Kazumasa, Sato Katsutoshi, and Nishisaka Takashi

Subjects
Diaphragmatic herniation, Positron emission tomography: PET, Blunt trauma, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract We present a case of post-traumatic diaphragmatic herniation of the liver, which mimicked an intrathoracic tumor. After an automobile accident, the patient underwent thoracotomies for hemothorax and lung cancer in the right chest. Seven months later, computed tomography (CT) demonstrated a round tumor in the thorax adjacent to the right diaphragm with a higher density than the liver parenchyma. An intrathoracic tumor including a primary or metastatic lung cancer was suspected. However, positron emission tomography (PET) showed that the uptake of fluorine-18-fluorodeoxyglucose (FDG) was identical to that in the liver, and the tumor appeared to be contiguous with the liver. Thus, we suspected liver herniation. Core needle biopsy revealed liver cells without neoplastic tissue. Upon surgical exploration, herniation of the liver was found and repaired. PET was helpful in providing morphological and functional information leading to accurate diagnosis of liver herniation in this unusual case.

Published
2011
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37. Foundational Image Analyses for Ultrasonographic Screening of Abdominal Aortic Aneurysm.

Author

Orihashi K

Abstract

Objectives: With improved surgical outcomes for non-ruptured abdominal aortic aneurysm (AAA), the primary objective has shifted toward the detection of asymptomatic AAA. Since ultrasonographic visualization from the anterior abdominal wall is often obstructed by intestinal gas, utilizing additional bilateral posterior approaches via the retroperitoneal tissue may be beneficial. This study investigates the feasibility of assessment using three approaches through computed tomography (CT) data analyses. Methods: The study included 27 surgical patients with AAA (AAA group) and 37 patients with other atherosclerotic diseases (non-AAA group). CT data were analyzed to locate the infrarenal aorta relative to the navel, availability of acoustic window, depth of the aorta, and assessment of aneurysmal aorta using three approaches. Results: The "AAA area" for ultrasonographic screening may be set at 0-4 cm above the navel. An acoustic window was unavailable in 8.1% of AAA cases and 7.4% of non-AAA cases in the anterior approach; however, it was available in the posterior approach. Although the depth of the aorta was greater in obese patients, it remained within 20 cm. Conclusion: Ultrasonographic screening is feasible by incorporating posterior approaches in cases where anterior visualization is difficult, enhancing the detection of asymptomatic AAA., (@ 2024 The Editorial Committee of Annals of Vascular Diseases.)

Published
2024
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38. Effectiveness of rigid plate fixation for sternal closure in patients with a high risk of deep sternal wound infection.

Author

Nakamura H, Miura Y, Yoshida K, Edo N, Saito R, and Orihashi K

Subjects
Humans, Male, Female, Aged, Retrospective Studies, Middle Aged, Tomography, X-Ray Computed, Risk Factors, Aged, 80 and over, Treatment Outcome, Surgical Wound Infection prevention & control, Surgical Wound Infection etiology, Bone Plates, Sternotomy adverse effects, Sternum surgery, Sternum diagnostic imaging
Abstract

Objective: Median sternotomy is a standard approach in cardiovascular surgery, and wire fixation is commonly used for sternal closure. However, postoperative intermittent stress on the sternum can lead to sternal breakdown, potentially resulting in deep sternal wound infection (DSWI). Sternal closure with rigid plate fixation was recently reported to be effective for preventing DSWI and promoting sternal healing. We investigated the effectiveness of a rigid plate fixation system in patients at a high risk of developing DSWI., Methods: This retrospective observational study evaluated the incidence of DSWI and the progression of postoperative sternal fusion observed on computed tomography. Forty-eight patients at a high risk of DSWI who underwent sternal closure with a rigid plate fixation system between 2020 and 2023 were assessed., Results: Among the 48 patients, 1 (2.1%) developed DSWI requiring surgical treatment. Sternal fusion improved over time, with significant progression observed during the follow-up period compared with the early postoperative period. Additionally, patients who did not show sternal fusion in the early postoperative period showed progressive fusion during follow-up., Conclusions: The rigid plate fixation system prevents sternal displacement and may be beneficial in preventing DSWI by maintaining and promoting sternal fusion in high-risk patients., Competing Interests: Declaration of conflicting interestsThe authors declare that there are no conflicts of interest.

Published
2024
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39. Triplet-Triplet Annihilation-Based Photon Upconversion with a Macrocyclic Parallel Dimer.

Author

Mulyadi CH, Uji M, Parmar B, Orihashi K, and Yanai N

Abstract

The integration of multiple chromophore units into a single molecule is expected to improve the performance of photon upconversion based on triplet-triplet annihilation (TTA-UC) that can convert low energy photons to higher energy photons at low excitation intensity. In this study, a macrocyclic parallel dimer of 9,10-diphenylanthracene (DPA) with a precisely parallel orientation, named MPD-2, is synthesized, and its TTA-UC properties are investigated. MPD-2 shows a green-to-blue TTA-UC emission in the presence of a triplet sensitizer, platinum octaethylporphyrin (PtOEP). Compared to monomeric DPA, MPD-2 results in an enhancement of the spin statistical factor of TTA and a decrease in the excitation light intensity due to the intramolecular TTA process. The obtained structure-property relationship provides important information for the further improvement of TTA-UC properties., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Co-published by University of Science and Technology of China and American Chemical Society.)

Published
2024
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41. Comprehensive Treatment of Total Arch Replacement in a Patient With Liver Cirrhosis: A Case Report.

Author

Nakamura H, Miura Y, Yoshida K, Saito R, and Orihashi K

Abstract

A 78-year-old woman with liver cirrhosis due to chronic hepatitis C visited our department for treatment of a thoracic aortic aneurysm. Her Child-Pugh classification was class A, and her model for end-stage liver (MELD) disease score was 8. As she also had thrombocytopenia associated with splenomegaly and esophageal varices, endoscopic injection sclerotherapy and partial splenic embolization were performed before total arch replacement surgery for treating esophageal varices to reduce the bleeding risk during transesophageal echocardiography and for thrombocytopenia, respectively. After endoscopic injection sclerotherapy and partial splenic embolization, the platelet count increased; hence, total arch replacement surgery was performed. By combining partial splenic embolization and endoscopic injection sclerotherapy, we were able to safely perform transesophageal echocardiography and total arch replacement surgery in the perioperative period., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Nakamura et al.)

Published
2024
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42. Significant thrombus in saccular aneurysm in a patient with polycythemia: a case report.

Author

Mitsuishi A, Nakamura H, Miura Y, Miyata T, Orihashi K, Yoshida K, and Araki K

Subjects
Male, Humans, Aged, Polycythemia complications, Aortic Aneurysm complications, Aortic Rupture complications, Thrombosis complications, Thrombosis surgery, Thromboembolism complications, Aortic Aneurysm, Abdominal complications
Abstract

Background: Morphologically, the risk of aortic aneurysm rupture is mainly evaluated based on its type (e.g., fusiform or saccular) and diameter. Based on the finite element analysis, peak wall stress has been identified as a more sensitive and specific predictor of rupture in recent years. Moreover, in finite analysis, the neck of aneurysm is the highest peak wall stress and is associated with the rupture point., Case Presentation: A saccular aortic aneurysm (84 mm) was incidentally detected during preoperative examination for chronic empyema in a 74-year-old male patient with a history of polycythemia. Aortic arch graft replacement using an open stent was performed., Conclusions: Morphologically, this case was associated with a very high risk of rupture; nevertheless, it did not rupture. In this case, a mural thrombus (likely formed due to polycythemia) covered the neck of aneurysm that is experiencing the highest peak wall stress and is associated with the rupture point. The mural thrombus decreased peak wall stress and could reduce the risk of rupture even for huge saccular aneurysms. Furthermore, the mural thrombus was fully occupied in aneurysms, such as during coil embolization. Thus, polycythemia could decrease the risk of rupture of huge saccular aneurysms., (© 2024. The Author(s).)

Published
2024
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43. Decision making of iatrogenic coronary embolism after SAVR: a case report.

Author

Mitsuishi A, Orihashi K, Miura Y, and Saito R

Subjects
Aged, 80 and over, Female, Humans, Aortic Valve surgery, Constriction, Pathologic complications, Decision Making, Iatrogenic Disease, Treatment Outcome, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications, Coronary Artery Disease surgery, Embolism complications, Percutaneous Coronary Intervention
Abstract

Background: Acute coronary artery obstruction is a rare but lethal complication of surgical aortic valve replacement (SAVR), which may be caused by embolization of resected native tissue such as calcium plaque, thrombus, or perivalvular aortic tissue like fat embolus. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the main treatment modalities. PCI is less invasive, but it is difficult to determine its feasibility intraoperatively., Case Presentation: We report an 86-year-old woman who had asymptomatic severe aortic stenosis. She had scleroderma with an intractable left leg ulcer and bilateral leg varices. Considering the possibility of the spread of infection from the leg wound, SAVR was performed via right anterior thoracotomy to avoid complications such as mediastinitis. Coronary artery occlusion was suspected after weaning of cardiopulmonary bypass in the operation room due to asynergy with ST elevation and new severe mitral regurgitation. Transoesophageal echocardiography (TEE) helped diagnose coronary obstruction by embolus based on the degree of stenosis and the movement of the stenosis site. Percutaneous catheter intervention was performed successfully to restore coronary perfusion., Conclusion: TEE facilitated the diagnosis of coronary artery stenosis caused by an embolus and helped in determining the feasibility of percutaneous catheter intervention, thus allowing us to choose PCI over CABG as a less invasive surgery. This is especially invaluable in cases where obtaining a saphenous graft for CABG is difficult or where CABG would have required conversion from minimally invasive surgery (anterolateral approach) to median sternotomy., (© 2024. The Author(s).)

Published
2024
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44. Blood flow evaluation of reconstructed gastric tube in esophageal surgery using near-infrared imaging and retrospective time-intensity curve analysis.

Author

Yamamoto N, Kitagawa H, Orihashi K, Yokota K, Namikawa T, and Seo S

Subjects
Humans, Retrospective Studies, Indocyanine Green, Anastomotic Leak diagnostic imaging, Anastomotic Leak etiology, Anastomotic Leak surgery, Anastomosis, Surgical methods, Stomach diagnostic imaging, Stomach surgery, Stomach blood supply, Esophagectomy methods
Abstract

Purpose: Near-infrared fluorescence imaging using indocyanine green (ICG-NIFI) can visualize a blood flow in reconstructed gastric tube; however, it depends on surgeon's visual assessment. The aim of this study was to re-analyze the ICG-NIFI data by an evaluator independent from the surgeon and feasibility of creating the time-intensity curve (TIC)., Methods: We retrospectively reviewed 97 patients who underwent esophageal surgery with gastric tube reconstruction between January 2017 and November 2022. From the stored ICG videos, fluorescence intensity was examined in the four regions of interest (ROIs), which was set around the planned anastomosis site on the elevated gastric tube. After creation the TICs using the OpenCV library, we measured the intensity starting point and time constant and assessed the correlation between the anastomotic leakage., Results: Postoperative leakage occurred for 12 patients. The leakage group had significantly lack of blood flow continuity between the right and left gastroepiploic arteries (75.0% vs. 22.4%; P < 0.001) and tended to have slower ICG visualization time assessed by the surgeon's eyes (40 vs. 32 s; P = 0.066). TIC could create in 65 cases. Intensity starting point at all ROIs was faster than the surgeon's assessment. The leakage group tended to have slower intensity starting point at ROI 3 compared to those in the non-leakage group (22.5 vs. 19.0 s; P = 0.087)., Conclusion: A TIC analysis of ICG-NIFI by an independent evaluator was able to quantify the fluorescence intensity changes that the surgeon had visually determined., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2024
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45. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection.

Author

Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, and Ueda Y

Subjects
Humans, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm therapy, Aortic Dissection diagnosis, Aortic Dissection therapy
Published
2023
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46. Surgical ligation level of the bronchial artery influences tissue oxygen saturation of the bronchus and the incidence of postoperative bronchofistula after pulmonary lobectomy.

Author

Yamamoto M, Anayama T, Okada H, Miyazaki R, and Orihashi K

Abstract

Background: Lobectomy, or the removal of a lobe of the lung, is the most commonly performed lung cancer surgery. One of the most severe postoperative complications is a bronchial stump fistula, which often occurs following a right lower lobectomy. During lymph node dissection, the bronchial arteries, which supply blood to the bronchus, are cut. Subsequently, reduced blood supply to the bronchus may result in bronchofistula. We investigated the relationship between the level of the surgical ligation of the bronchial arteries and the decrease in blood flow at the bronchial stump during a right lower lobectomy. This study aimed to clarify the relationship between the anatomical amputation level of the bronchial artery and the decrease in tissue oxygen saturation at the bronchial stump, allowing us to identify a surgical procedure that reduces the risk of a bronchopleural fistula following pulmonary lobectomy and an appropriate bronchial artery amputation site that could be used in future lobectomies., Methods: We developed a new system (micro-tissue oxygen saturation) that enabled the semi-quantification of the oxygen saturation of thin tissues in pinpoint during video-assisted thoracic surgery. Changes in the blood flow at the bronchial stump were examined during lymph node dissection and bronchial artery amputation using a biological pig lobectomy model., Results: The regional oxygen saturation level at the bronchial wall was 95.5%±1.0% in normal conditions. A gradual decrease in regional oxygen saturation was observed, as the cutting point of the bronchial artery was moved higher. When the bronchial artery coursing into the middle lobe bronchus was preserved, the blood flow in the bronchus was preserved at 82.8%±1.3%. When the branches of the bronchial arteries running both inside and outside of the intermediate bronchial trunk were cut at high positions, regional oxygen saturation level decreased to 55.7%±1.2%., Conclusions: The preservation of at least one bronchial artery at the level of the middle lobe bronchus minimizes the reduction of tissue oxygen saturation at the lower lobe bronchial stump. The ligation of bronchial arteries at a higher position results in desaturation <60%, which may increase the risk of bronchial stump fistula., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-1057). The authors have no conflicts of interest to declare., (2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Published
2021
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47. The accuracy of cone-beam computed tomography and augmented fluoroscopy-guided bronchoscopic marking of multiple small-sized pulmonary nodules in a hybrid operating room: a retrospective cohort study.

Author

Anayama T, Yamamoto M, Hirohashi K, Miyazaki R, Okada H, Doi A, and Orihashi K

Abstract

Background: For the minimally invasive excision of small-sized pulmonary nodules, bronchoscopic markings are increasingly being performed owing to advancements in video-assisted thoracic surgery (VATS). Hybrid operating room equipment is utilized for bronchoscopic VATS markings. We aimed to compare the marking accuracy between bronchoscopic VATS and other marking techniques such as computed tomography-guided percutaneous marking and conventional X-ray fluoroscopy-guided bronchoscopic marking., Methods: Patients with small-sized pulmonary nodules scheduled to undergo VATS were enrolled in the study. A mixture of 50 to 100 µL of diluted indocyanine green and iopamidol was injected adjacent to the pulmonary nodules as a VATS marker. Patients receiving each of the three image-guided techniques were categorized into group A (computed tomography-guided percutaneous injection), group B (X-ray fluoroscopy-guided virtual bronchoscopy-assisted bronchoscope injection), and group C (cone-beam computed tomography and augmented fluoroscopy-guided virtual bronchoscope-assisted bronchoscopic injection in the hybrid operating room). VATS marking accuracy and procedural complications were compared among the three groups., Results: In total, 61 patients with 73 pulmonary nodules were eligible for analysis. VATS marking was successful for 15/16 nodules in group A, 28/30 nodules in group B, and 25/27 nodules in group C. Marking accuracy was 5.75±4.59, 15.00±14.02, and 6.05±6.11 (mm), respectively. Multiple markings were successful in 0/1 (0%), 5/6 (83.3%), and 5/5 (100.0%) nodules in groups A, B, and C, respectively. A small pneumothorax occurred in 3/15 (20.0%) patients in group A., Conclusions: The cone-beam computed tomography and augmented fluoroscopy-guided bronchoscopic approach performed in a hybrid operating room is accurate and equivalent to the computed tomography-guided percutaneous approach, and it enables the VATS marking of multiple pulmonary nodules without causing a secondary pneumothorax., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-781). The authors have no conflicts of interest to declare., (2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Published
2021
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48. Fluorescence visualization of the intersegmental plane by bronchoscopic instillation of indocyanine green into the targeted segmental bronchus: determination of the optimal settings.

Author

Anayama T, Hirohashi K, Miyazaki R, Okada H, Yamamoto M, and Orihashi K

Subjects
Bronchi diagnostic imaging, Fluorescence, Humans, Pneumonectomy, Indocyanine Green, Lung Neoplasms surgery
Abstract

Objective: To determine the appropriate amount of indocyanine green for bronchial insufflation., Methods: We enrolled 20 consecutive patients scheduled for anatomical segmentectomy in the Kochi Medical School Hospital. After inducing general anesthesia, 6 to 60 mL of 200-fold-diluted indocyanine green (0.0125 mg/mL) was insufflated into the subsegmental bronchi in the targeted pulmonary segmental bronchus. The volume of the targeted pulmonary segments was calculated using preoperative computed tomography. Fluorescence spread in the segmental alveoli was visualized using a dedicated near-infrared thoracoscope., Results: The targeted segment was uniformly visualized by indocyanine green fluorescence in 16/20 (80.0%) cases after insufflating indocyanine green. A receiver operating characteristic curve indicated that the area under the curve was 0.984; the optimal cut-off volume of diluted indocyanine green for insufflation was 8.91% of the calculated targeted pulmonary segment volume., Conclusions: The setting for indocyanine green insufflation was optimized for near-infrared fluorescence image-guided anatomical segmentectomy. By injecting the correct amount of indocyanine green, fluorescence-guided anatomical segmentation may be performed more appropriately.

Published
2021
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49. Preoperative AminoIndex Cancer Screening (AICS) abnormalities predict postoperative recurrence in patients undergoing curative resection for non-small cell lung cancer.

Author

Higashiyama M, Miyazaki R, Yamamoto H, Anayama T, Kikuchi S, Hirohashi K, Okami J, Maniwa T, Kimura T, Orihashi K, and Imamura F

Subjects
Adenocarcinoma of Lung pathology, Adenocarcinoma of Lung surgery, Adult, Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell surgery, Female, Follow-Up Studies, Humans, Lung Neoplasms pathology, Lung Neoplasms surgery, Male, Middle Aged, Neoplasm Recurrence, Local blood, Neoplasm Recurrence, Local epidemiology, Postoperative Complications blood, Postoperative Complications epidemiology, Preoperative Care, Prognosis, Retrospective Studies, Survival Rate, Amino Acids blood, Biomarkers, Tumor blood, Carcinoma, Non-Small-Cell Lung surgery, Early Detection of Cancer methods, Neoplasm Recurrence, Local diagnosis, Pneumonectomy mortality, Postoperative Complications diagnosis
Abstract

Background: AminoIndex™ Cancer Screening (AICS (lung)) was developed as a screening test for lung cancer using a multivariate analysis of plasma-free amino acid (PFAA) profiles. According to the developed index composed of PFAA, the probability of lung cancer was categorized into AICS (lung) ranks A, B, and C in order of increasing risk. The aim of the present study was to investigate the relationship between the preoperative AICS (lung) rank and surgical outcomes in patients who underwent curative resection for non-small cell lung cancer (NSCLC)., Methods: Preoperative blood samples were collected from 297 patients who underwent curative resection for NSCLC between 2006 and 2015. PFAA concentrations were measured. The relationship between the preoperative AICS (lung) rank and clinicopathological factors was examined. The effects of the preoperative AICS (lung) rank on postoperative outcomes were also analyzed., Results: The AICS (lung) rank was A in 93 patients (31.3%), B in 82 (27.6%), and C in 122 (41.1%). The AICS (lung) rank did not correlate with any clinicopathological factors, except for age. Based on follow-up data (median follow-up period of 6 years), postoperative recurrence was observed in 22 rank A patients (23.7%), 15 rank B (18.3%) and 49 rank C (40.2%). In the univariate analysis, preoperative AICS (lung) rank C was a worse factor of recurrence-free survival (p = 0.0002). The multivariate analysis identified preoperative AICS (lung) rank C (HR: 2.17, p = 0.0005) as a significant predictor of postoperative recurrence, particularly in patients with early-stage disease or adenocarcinoma., Conclusion: Preoperative AICS (lung) rank C is a high-risk predictor of postoperative recurrence in patients undergoing curative resection for NSCLC.

Published
2020
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50. Intraoperative Transesophageal Echocardiography for Coronary Artery Assessment.

Author

Kondo N, Hirose N, Kihara K, Tashiro M, Miyashita K, and Orihashi K

Abstract

Background: In surgical aortic valve replacement (SAVR), coronary arteries are routinely assessed by transesophageal echocardiography (TEE) to prevent undesirable complications. This study evaluated the capabilities and pitfalls of TEE assessment. Methods and Results: Of 147 consecutive SAVR patients undergoing aortic stenosis, the TEE records for 130 patients, in which the procedures were conducted by a single examiner, were analyzed retrospectively regarding data acquisition and the accuracy of detecting an anomalous origin, high or low takeoff, ostial diameter, and short left main truncus (LMT). The left and right coronary arteries could be visualized in every patient. A left coronary ostium >5 mm was found in 33 patients (25.4%). TEE revealed an anomalous origin in 2 patients (1.5%) that had not been diagnosed, but missed it in another patient. High takeoff was noted in 11 patients (8.3%), often associated with aortic disease necessitating aortic repair. In one such patient, occlusion of the right coronary artery was detected, necessitating coronary revascularization. Short LMT was found in 15 patients (11.8%) but misdiagnosed due to artifact in 1. During selective cardioplegia, malperfusion of the left anterior descending artery due to deep cannula placement was detected. Conclusions: TEE provides fairly accurate assessment in SAVR, including detection of undiagnosed pathologies or pitfalls related to coronary arteries, although misdiagnosis due to artifacts should be kept in mind., Competing Interests: None declared., (Copyright © 2020, THE JAPANESE CIRCULATION SOCIETY.)

Published
2020
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