[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Sep 1989
[Prevention of spinal cord ischemia after cross-clamping of the thoracic aorta--monitoring of spinal cord perfusion pressure and somatosensory evoked potentials].
The pressure difference between the mean distal aortic pressure (MDAP) and the cerebrospinal fluid pressure (CSFP), defined as the spinal cord perfusion pressure (SCPP), as well as somatosensory evoked potentials (SEP) were monitored intraoperatively to detect and prevent intraoperative spinal cord ischemia in 24 patients who required cross-clamping of the descending thoracic aorta. A temporary axillo-femoral shunt, utilizing a 10 mm woven Dacron tube graft, was employed in 10 patients and partial cardiopulmonary bypass was employed in fourteen. Ischemic SEP changes were seen in six patients. ⋯ These four patients recovered without any neurological deficit. In the other 18 cases without ischemic SEP change, SCPP was kept at more than 40 mmHg during aortic cross-clamping. We conclude that the SCPP should be maintained at more than 40 mmHg during aortic occlusion, and increased to more than 60 mmHg when ischemic SEP changes occur, by increasing MDAP and/or withdrawing cerebrospinal fluid in order to prevent postoperative paraplegia.
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Nihon Kyobu Geka Gakkai Zasshi · Sep 1989
Case Reports[A case report of early valve replacement surgery in infective endocarditis with mycotic cerebral aneurysm].
Mycotic cerebral aneurysm is a relatively infrequent complication of infective endocarditis. However, rupture and intra-cranial hemorrhage involves so high a mortality that few patients can be saved from this condition. We reported a 22-year-old woman with mitral regurgitation and ruptured mycotic cerebral aneurysm caused by infective endocarditis. ⋯ Mitral valve was replaced with a Björk-Shiley prosthetic valve 48 hours after the craniotomy. The postoperative course was uneventful and no neurological deficit was found. This report indicates that valve replacement surgery can be successfully performed only 48 hours after craniotomy without any bleeding complications.
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Nihon Kyobu Geka Gakkai Zasshi · Aug 1989
[Clinical study on stab wounds of chest--factors that may influence their mortality].
Stab wounds of the chest occupy an important position in penetrating thoracic injuries in Japan. A retrospective review of 117 patients with stab wounds of the chest admitted to our hospital over the past 12 years (from 1975 to 1987) revealed some factors that might influence their mortality. Seven patients died from trans-diaphragmatic injuries of intra-abdominal organs. ⋯ Survival rate in the DOA patients with stab wounds of the chest was higher than that in the DOA patients with blunt thoracic injuries. ERT for cardiac insufficiency following stab wounds of the chest was thought an effective procedure for surviving. Survival rate of the patients with cardiac stab wounds was 63.6 per cent.
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From 1985 to 1987, we had 4 patients with infected emphysematous bulla, three males and one female ranging from 18 to 61 years of age. The male patients had been suffering from emphysematous bullae and had complications stemming from the resulting infection. In the female case, the infection occurred at the pneumatocele which had grown at pneumonia was caught during steroid therapy for SLE. ⋯ The therapeutic combination of percutaneous drainage with a small caliber tube and washing of infected emphysematous bulla is available for therapy or preoperative treatment for the following reasons: First of all, especially in patients who have remarkably disturbed pulmonary function, it can be performed safely and pt's symptoms and the general condition of the patient improves rapidly. The second reason is that, in some particular cases, it achieves the remarkable shrinkage and closure of infected emphysematous bulla. The third reason is that, the patients experience minimum pain with the use of a small caliber drainage tube.
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Nihon Kyobu Geka Gakkai Zasshi · Jun 1989
[The results of surgical treatment of total anomalous pulmonary venous return in neonates].
By the time, the results of surgical treatment for total anomalous pulmonary venous return have been unsatisfactory. From 1981, we changed a surgical procedure fro Gersony-Malm procedure to the posterior approach method, and a surgical technique from the deep hypothermia and the circulatory arrest to the moderate hypothermia and the pump perfusion. Consequently, the results of surgical treatment was improved. ⋯ There were four hospital deaths (22.2%). The causes of deaths were pulmonary hypertension in two, low cardiac output in one, and intracranial bleeding in one. From the results of our institution, we concluded that the primary factors determining the outcome were the condition of the patients prior to repair and the severity of pulmonary hypertension.