[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Apr 1989
[Phrenic nerve conduction disorder after open heart surgery--electrophysiological study].
In 32 consecutive adult patients undergoing heart surgery, the induced diaphragmatic muscle action potential was measured. Phrenic nerve conduction disorder was defined as disappearance of muscle action potential (Edi) and conduction time (CT). Phrenic nerve conduction disorder was observed in 10 patients (31%); 8 patients on the left side and 2 patients on both sides. ⋯ In the conduction disorder group, incidence of atelectasis, diaphragm elevation and pleural effusion as documented by chest roentgenographic findings were higher than those of non-conduction disorder group (p less than 0.01). Moreover, the lowest temperature of the myocardium during operation was significantly (p less than 0.05) lower for conduction disorder group as compared to non-conduction disorder group. We believed that it is necessary to develop a innovative method for preventing the phrenic nerve from cold injury.
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Nihon Kyobu Geka Gakkai Zasshi · Feb 1989
Case Reports[The diagnostic value of computed tomography during lymphangiography on the postoperative chylothorax in lung cancer].
A successfully operated case of postoperative chylothorax in a lung cancer was reported, under the diagnosis of computed tomography during lymphangiography demonstrating the disruption of the thoracic duct. The computed tomography during lymphangiography is considered to be very useful for deciding the surgical indication of postoperative chylothorax and prompt surgical treatment is recommended when the main truncus of the thoracic duct is lacerated.
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Nihon Kyobu Geka Gakkai Zasshi · Feb 1989
Comparative Study[Noninvasive and quantitative evaluation of pulmonary regurgitation by pulsed Doppler echocardiography--a study in patients with tetralogy of Fallot after corrective surgery].
A noninvasive and quantitative evaluation of pulmonary regurgitation (PR) using pulsed Doppler echocardiography (PDE) was performed in 25 patients with tetralogy of Fallot (TOF) after corrective surgery. Considering a possibility of the presence of the difference in regurgitant flow velocity in pulmonary artery, four sampling points for detecting the pulmonary regurgitant flow were designed as follows: point 0 was positioned at the right ventricular outflow tract; point 1, at the pulmonary annulus; point 2, at mid-portion of the pulmonary trunk; point 3, at bifurcation of the pulmonary artery. The values of maximum Doppler shift determined by analysing the sonograms recorded at point 1, 2 and 3 were examined in comparison with the grades of PR estimated by pulmonary arteriography and the results obtained were as follows. ⋯ In a prospective study in a separate group of other 7 patients, the grade of PR estimated by PDE corresponded well with these of pulmonary arteriography, with a significant Spearman rank correlation coefficient (rs = 0.90, p less than 0.01). An experimental study using a dog with surgically induced PR of different grades confirmed the presence of higher Doppler shift in pulmonary artery corresponding to the grade of PR. These results indicated the usefulness of a newly proposed method evaluating PR by PDE applying a concept of Windkessel model for PR regurgitant flow.
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Nihon Kyobu Geka Gakkai Zasshi · Jan 1989
Comparative Study[Surgical treatment of postinfarction ventricular septal perforation--the difference between a cardiogenic shock group and a congestive heart failure group].
Twelve patients with postinfarction ventricular septal perforation (VSP) were divided into 2 groups based upon the preoperative status and the time interval between the operation and the occurrence of VSP after acute myocardial infarction (AMI). Group I were in cardiogenic shock unresponsive to either pharmacologic supports or IABP, and needed an emergency repair of VSP. The other group (group II) were in congestive heart failure responding to some extent to pharmacologic supports and IABP, and VSP of this group was repaired on the elective or semiemergency basis. ⋯ In group I, the right heart failure remained and was prolonged even after surgery reflected by the RAP/LAP ratio over 1 and finally resulting in MOF. To improve surgical results in group I, the operation should be undertaken on the emergency basis before MOF is completed, and patch reconstruction of the left ventricular free wall is recommended in patients with a wide AMI and a high positioned anterior septal perforation. When RV failure is dominant, not only a LV assist device but also a RV assist device may also improve the results.
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Nihon Kyobu Geka Gakkai Zasshi · Jan 1989
[Postoperative bronchopleural fistula--diagnostic significance of masked cases and results of early re-operation].
We studied recent-day cases of postoperative bronchopleural fistula from 1982 to 1985. And in 1985, postoperative chest X-ray films were intensively compared with previous ones. Radiological signs for bronchopleural fistula and/or alveolar fistula such as increases in air content and/or falls in air-fluid level of pleural space were seen in 11 (7.1%) of 155 pulmonary resection cases in 1985. ⋯ On the bronchoscopic examination, bronchopleural fistulas were mainly located at the side of the residual lobe on the stump. Bronchopleural fistula cases which were re-operated for re-amputation, re-suture, and coverage of the stump within 48 hours, were all cured. So we concluded early re-operation is the best choice for bronchopleural fistula patient, because of short administration, no cosmetical problems and no disadvantage for lung function.