Affiliation 【 display / non-display 】

Affiliation 【 display / non-display 】

• Sapporo Medical University   CardioVascular Surgery   Associate Professor  

Papers 【 display / non-display 】

Papers 【 display / non-display 】

• Right External Iliac Artery Resection and Reconstruction Because of Cecum Cancer Invasion: A Case Report.

  Tomohiro Nakajima, Yutaka Iba, Masayuki Ishii, Maho Toyota, Koichi Okuya

  Cureus   17 ( 5 ) e84916  2025.05  [International journal]

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  This report describes the case of a 69-year-old female patient. At the age of 68, she was diagnosed with cecum cancer, and infiltration of the right external iliac artery was detected. Owing to arterial infiltration, surgical resection was considered inappropriate, and a future risk of intestinal obstruction in the cecum region was anticipated. Therefore, a laparoscopic ileum-transverse colon bypass was performed. Subsequently, chemotherapy with the FOLFOXIRI (folinic acid, fluorouracil, oxaliplatin and irinotecan) regimen plus bevacizumab was administered for five months. Contrast-enhanced computed tomography revealed reduced infiltration of the right external iliac artery, prompting plans for ileocecal resection with combined resection of the right external iliac artery and iliopsoas muscle. After resection of the intestine, preserving the bypass site and tissue mobilization except the right external iliac artery infiltration site, systemic heparinization was performed. An 8 mm artificial vessel was then interposed to reconstruct the right external iliac artery using an end-to-end anastomosis technique. Lower extremity blood flow was unremarkable, and the postoperative course was uneventful. The patient was discharged on postoperative day 10 without complications.

  DOI PubMed

• Spontaneous Forearm Hemorrhage in a Patient With Polycystic Kidney Disease: A Case Report.

  Tomohiro Nakajima, Akihiro Tabata

  Cureus   17 ( 4 ) e81864  2025.04  [International journal]

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  The patient is a 73-year-old woman. She had a brain hemorrhage at 53 years of age and underwent craniotomy and hematoma removal. At 55 years of age, she was treated for multiple renal cysts. An infection has spread to the existing renal cyst. The patient's renal function gradually deteriorated, and she underwent hemodialysis at 56 years of age. At 58 years of age, an internal shunt was created using an autologous blood vessel in the left elbow fossa. Thereafter, she was hospitalized six times because of a cyst infection and received antibiotic treatment. At 72 years of age, she experienced a brain hemorrhage and received conservative treatment at our hospital. Presently, she presented with swelling in the left forearm. Upon further examination, bleeding was found in the left forearm muscles. Hemostatic surgery was performed under general anesthesia. Here, we report a rare case of forearm hemorrhage in a patient with comorbid cystic kidney disease.

  DOI PubMed

• Effects of temperature on transient neurologic dysfunction after total arch replacement.

  Keitaro Nakanishi, Hiroshi Sato, Yutaka Iba, Ayaka Arihara, Shuhei Miura, Tsuyoshi Shibata, Jyunji Nakazawa, Tomohiro Nakajima, Takeo Hasegawa, Nobuyoshi Kawaharada

  General thoracic and cardiovascular surgery   73 ( 3 ) 155 - 163  2025.03  [Domestic journal]

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  OBJECTIVES: The relationship between cooling status during aortic surgery with hypothermic circulatory arrest and postoperative neurologic dysfunction remains unknown. In the present study, we evaluated the effect of cooling status on transient neurologic dysfunction after total arch replacement. METHODS: We studied patients who underwent elective total arch replacement with hypothermic circulatory arrest and antegrade selective cerebral perfusion from December 2011 to January 2021. Changes in tympanic temperature trends recorded during surgery were plotted. Several parameters, including the nadir temperature, cooling speed, and degree of cooling (cooling area, or the area under the curve of inverted temperature trends from cooling to rewarming as calculated by the integral method), were analyzed. The relationships between these variables and transient neurologic dysfunction were evaluated. RESULTS: Transient neurologic dysfunction was observed in 33 (14.5%) of the 228 included patients. In the transient neurologic dysfunction group, the cooling area was larger (2417.3 vs. 1920.8 °C min; P < 0.001) and the cooling speed was higher (0.68 vs. 0.51 °C/min; P < 0.001) than in the non-transient neurologic dysfunction group. A multivariate logistic model revealed that both the cooling area (odds ratio = 1.13 per 100 °C min; P < 0.001) and cooling speed (odds ratio = 3.69 per °C/min; P = 0.041) were independent risk factors for transient neurologic dysfunction. CONCLUSIONS: Both the cooling area, which indicates the degree of cooling, and cooling speed had significant relationships with transient neurologic dysfunction after total arch replacement. Together, these findings indicate that overcooling and rapid cooling may contribute to brain injury.

  DOI PubMed

• Unsuccessful Thrombin Injection for Right Femoral Artery Pseudoaneurysm: A Case Report.

  Tomohiro Nakajima, Yu Iwashiro, Tsuyoshi Shibata, Yutaka Iba, Nobuyoshi Kawaharada

  Cureus   17 ( 3 ) e80640  2025.03  [International journal]

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  A 33-year-old man was brought to the emergency department after sustaining multiple traumas. The interventional radiology team performed vascular embolization via a 6 Fr sheath inserted into the right common femoral artery due to suspected bleeding from the duodenum. The man underwent multidisciplinary management. On day 3 after injury, contrast-enhanced computed tomography (CT) revealed a pseudoaneurysm in the right common femoral artery, the radiology team opted for thrombin injection therapy, and the patient was monitored. No swelling was initially observed. However, repeat contrast-enhanced CT demonstrated a pseudoaneurysm on postinjury day 9, indicating that thrombin treatment had failed. Vascular surgery was considered, and emergency surgical intervention was performed on the same day. A pseudoaneurysm and a 6 Fr sheath puncture site were identified through a right inguinal incision, and hemostasis was achieved. The postoperative course was uneventful, and the patient was transferred for rehabilitation on postoperative day 19 following pseudoaneurysm repair. This case involved the development of a femoral artery pseudoaneurysm following endovascular treatment for multiple traumas. Although the interventional radiology team performed a local thrombin injection, the treatment ultimately failed, necessitating vascular surgery intervention. The patient underwent open surgical repair without complications. With the increasing use of local thrombin injection for pseudoaneurysms, careful post-treatment monitoring is essential, and surgical intervention should be considered at an appropriate time if necessary.

  DOI PubMed

• Unraveling Novel Subsets of Lymphocytes Involved in Sac Expansion in the Tertiary Lymphoid Structure Within an Abdominal Aortic Aneurysm.

  Itaru Hosaka, Ippei Ikegami, Takuma Mikami, Tatsuya Sato, Toshifumi Ogawa, Kei Mukawa, Marenao Tanaka, Keisuke Endo, Yukinori Akiyama, Akihito Ohkawa, Junji Nakazawa, Tsuyoshi Shibata, Tomohiro Nakajima, Yutaka Iba, Chikara Shiiku, Satoshi Sumino, Ryuji Koshima, Kenichi Takano, Shingo Ichimiya, Nobuyoshi Kawaharada, Masato Furuhashi

  Journal of the American Heart Association   14 ( 6 ) e040279  2025.02  [International journal]

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  BACKGROUND: Chronic inflammation is involved in the development of abdominal aortic aneurysm (AAA). A tertiary lymphoid structure (TLS) within vascular lesions has recently been focused on for its role in modulation of inflammation in local tissues. We aimed to elucidate the relationships between TLS and pathophysiology of AAA. METHODS: Abdominal aortic samples obtained from 37 patients with AAA (men/women: 34/3, age: 72.8±9.9 years) and 15 autopsied patients who died from non-aortic events (men/women: 11/4, age: 65.5±9.8 years) were investigated. RESULTS: TLSs in AAA lesions were confirmed by focal infiltration of CD3-positive cells surrounding germinal center-like structures containing CD20-positive cells between the tunica adventitia and tunica media layers. The formation of a TLS was significantly more prevalent in AAA patients than in autopsied patients. The number of TLSs in AAA lesions was positively correlated with sac diameter (r=0.357, P=0.035) and the amount of intraluminal thrombosis (r=0.466, P=0.005). T cells and B cells were predominant cellular populations among CD45+ cells in AAA lesions. There was a significantly positive correlation between the proportions of interfollicular T follicular helper (CD3+CD4+CD45RA-CXCR5+PD-1+) cells and double negative B (CD3-CD19+IgD-CD27-) cells, and they were positively correlated with sac diameter, intraluminal thrombosis, and serum lipids. Deposited single-cell RNA-sequencing data for AAA showed that T follicular helper cells and double negative B cells were associated with lipid metabolism, T cell activation/proliferation and inflammation. CONCLUSIONS: The formation of a TLS in AAA lesions is associated with sac diameter and intraluminal thrombosis in connection with interfollicular T follicular helper cells and double negative B cells, which may contribute to the pathophysiology of AAA and might be novel therapeutic targets for the development of AAA.

  DOI PubMed

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Misc 【 display / non-display 】

Misc 【 display / non-display 】

• 手術ハイリスク患者のComplex aortic aneurysmに対するPhysician modified inner branched endovascular repairの早期成績

  柴田 豪, 伊庭 裕, 中島 智博, 仲澤 順二, 大川 陽史, 保坂 到, 在原 綾香, 對馬 慎吾, 川原田 修義

  日本外科学会定期学術集会抄録集 ( (一社)日本外科学会 )  123回   SF - 5  2023.04

• 胸腹部大動脈瘤術後対麻痺の経過中に生じた大腿骨近位部周囲Neurogenic heterotopic ossificationの経験

  保坂 到, 伊庭 裕, 對馬 慎吾, 柴田 豪, 仲澤 順二, 中島 智博, 川原田 修義

  日本心臓血管外科学会雑誌 ( (NPO)日本心臓血管外科学会 )  52 ( 2 ) 128 - 132  2023.03

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  症例は生来著患のない59歳男性.検診で高血圧症を指摘され近医を受診した.精査のCT検査でCrawford II型相当の胸腹部大動脈瘤が指摘され,精査加療目的に当科紹介となった.手術侵襲を低減させる目的で,一期目に全弓部置換術,二期目に胸部ステントグラフト内挿術,三期目にIII型相当の胸腹部置換術を行う計画的分割手術を施行した.三期目の胸腹部置換術後に対麻痺を認め種々の支持療法にても改善を得られず,下肢麻痺および膀胱直腸障害が残存した.リハビリ施行ののち術後67日目に回復期病院に転院となった.転院後褥瘡形成や反復する尿路感染を認め抗生剤加療が開始されていたが改善に乏しく,またCT上両側大腿骨周囲に血腫形成と異所性骨化を認め,集学的治療が必要と判断され転院後約4ヵ月で当院へ再入院となった.臨床経過および画像所見から術後対麻痺に合併したNeurogenic heterotopic ossificationと診断した.褥瘡および尿路感染に対する抗生剤加療を継続すると同時に,強度に留意しながらリハビリを継続することで異所性骨化の増悪を認めず経過した.入院後44日目に皮弁を施行し,79日目に再転院となった.Neurogenic heterotopic ossification自体の病態生理は不明な点が多く治療法も定まったものはないが,術後対麻痺を合併した症例においてはNeurogenic heterotopic ossificationが生じるリスクにより術後のリハビリ自体が制限され,手術侵襲からの回復やADL維持を困難にさせる可能性が考えられた.リスク因子に対する適切な予防マネージメントを講じ,早期発見に務めることが重要と考えられた.(著者抄録)

• Analysis of the Relationship between Blood Flow, Function, and CHA2D2-VASc Score in the LAA and LA Using 4D Flow MRI(タイトル和訳中)

  大川 陽史, 伊庭 裕, 中島 智博, 柴田 豪, 保坂 到, 在原 綾香, 對馬 慎吾, 川原田 修義

  日本循環器学会学術集会抄録集 ( (一社)日本循環器学会 )  87回   PJ020 - 3  2023.03

• 体外循環中ヘパリン濃度測定による抗凝固管理下で開心術を施行した抗リン脂質抗体症候群合併の1例

  梅田 璃子, 中島 智博, 伊庭 裕, 保坂 到, 大川 陽史, 安田 尚美, 柴田 豪, 仲澤 順二, 川原田 修義

  日本心臓血管外科学会雑誌 ( (NPO)日本心臓血管外科学会 )  52 ( 1 ) 9 - 13  2023.01

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  症例は72歳女性.2014年より全身性エリテマトーデス,抗リン脂質抗体症候群(antiphospholipid antibody syndrome;APS)加療のために通院中であった.2020年にリウマチ性重症僧帽弁狭窄症(mitral valve stenosis;MS)により労作時息切れが出現し,あわせて発作性心房細動と冠動脈狭窄を指摘され,手術の方針となった.手術は僧帽弁置換術+三尖弁輪形成術+冠動脈バイパス+肺静脈隔離術+左心耳閉鎖術を行った.APSによる活性化凝固時間(active clotting time;ACT)延長に対する対策として,術中の人工心肺における抗凝固管理は,HMS PLUSを用いて血中ヘパリン濃度指標下に抗凝固管理を行った.周術期に出血性合併症や血栓塞栓症は認めず,術後23日目に自宅退院した.今回,APL患者の人工心肺を用いた開心術において,目標ヘパリン濃度を3.5U/mlに設定しHMS PLUSによるヘパリン濃度測定下に抗凝固管理を行い,合併症なく経過したため報告する.(著者抄録)

• 外科手技のラーニングカーブには何が影響を与えるのか? 医学生を対象とした前向き介入研究

  仲澤 順二, 對馬 慎吾, 保坂 到, 大川 陽史, 柴田 豪, 中島 智博, 伊庭 裕, 川原田 修義

  北海道外科雑誌 ( 北海道外科学会 )  67 ( 2 ) 182 - 182  2022.12

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