Acta Med Okayama
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The right lateral decubitus position is a risk factor for postoperative pulmonary embolism. We examined postural changes of femoral vein velocity in order to elucidate the mechanism. Thirty patients scheduled for general thoracic surgery were enrolled in this study. ⋯ The maximum diameters of the right femoral vein in the right lateral decubitus position and the left femoral vein in the left decubitus position were significantly larger than those in the other positions. The venous velocity of the right femoral vein in the right lateral decubitus position was significantly smaller than that in the supine position, while the velocity of the left femoral vein in the left lateral decubitus position was not significantly decreased. We speculate that the decreased venous velocity of the right femoral vein in the right lateral decubitus position could result in a deep venous thromboembolism in the right leg, making this position a possible risk factor for postoperative pulmonary embolism.
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We describe a successful case of surgical treatment for anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome with severe left ventricular dysfunction. Because of the severe left ventricular dysfunction, we planned to use an extracorporeal membrane oxygenation for heart support until a satisfactory recovery had been established. The left ventricular function significantly recovered in a few days, and the patient could be discharged without any complications.
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Right pleural effusion was diagnosed in a 36-year-old woman with right upper quadrant pain and fever. Enhanced pelvic computed tomography performed because of irregular genital bleeding revealed the pelvic inflammatory disease. Upon further questioning, the patient confirmed that she had recently undergone therapy for Chlamydia trachomatis infection. ⋯ Right pleural effusion may be caused by inflammation of the diaphragm associated with perihepatitis. Once chlamydial infection reaches the subphrenic liver, conditions in the closed space between the liver and diaphragm due to inflammatory adhesion may be conductive to chlamydial proliferation. The possibility of FHCS should be considered in patients and carefully distinguished from other abdominal diseases.
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A 52-year-old obese woman was admitted to our institution for evaluation of dyspnea and pulmonary hypertension (PH). Polysomnography revealed severe obstructive sleep apnea (OSA) with an apnea hypopnea index of 99.8. ⋯ To our knowledge, this is the most severe case of OSA-associated PH (approximately70 mmHg) reported to date, and it was successfully treated with nocturnal CPAP. This case demonstrates that OSA should be considered and polysomnography performed in all patients with PH, irrespective of severity, and that nocturnal CPAP has therapeutic effects on both OSA and daytime PH.
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This study was carried out to determine whether an extracorporeal membrane oxygenation (ECMO) support could be sufficiently conducted by the right ventricle alone from the viewpoint of the hemodynamics and blood gas state. Six infant dogs underwent a bypass between the left pulmonary artery and left atrium with an in-line oxygenator after a left pneumonectomy. Partial ECMO support was conducted simply by opening the circuit, and total ECMO support was conducted by ligating the right pulmonary artery. ⋯ The results suggest the possibility of using the pumpless ECMO support. However, the flow resistance of the membrane oxygenator proved to still be too high for use in a total pumpless ECMO. Further studies on long-term ECMO and the development of a membrane oxygenator with a considerably low flow-resistance are needed.