Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Thoracic aortic dissection complicating autosomal dominant polycystic kidney disease; report of a case].
A 55-year-old man underwent aortic valve replacement for aortic valve insufficiency 12 years ago. At that time, autosomal dominant polycystic kidney disease was diagnosed. Subsequently, renal failure developed gradually. ⋯ However, the patient recovered uneventfully, without requiring dialysis. Aortic dissection can occur as a complication in patients with autosomal dominant polycystic kidney. Strict control of blood pressure is therefore essential in such patients.
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In March 2007, under the guidance of the Ministry of Health, Labour and Welfare, a committee released Japanese guidelines for cardiopulmonary bypass (CPB) with the purpose to standardize CPB hardware and software for patient's safety and education of medical personnel. In April 2007, the Japanese Society of Extra Corporeal Technology in Medicine (JaSECT) released recommendations concerning safety devices for cardiopulmonary bypass. An on-site training session for CPB troubles was held at the 38th annual meeting of Japanese Society for Cardiovascular Surgery in February 2008 as a measure to ensure safety of CPB. ⋯ Of the 7 certified or uncertified perfusionists who participated, only one certified perfusionist made an effort to accomplish the recommendation. CPB accidents are rare, but as a medical team, tragedies such as death and life-threatening complication due to CPB accident should be prevented at all costs. We believe that the 1st step to prevent CPB incident is to read and understand the CPB guidelines thoroughly, and to accomplish the "required" items listed in the recommendations.
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Eighty-six cases of small peripheral lung cancer without contact with the chest wall on computed tomography (CT) scans were studied on the presence of radiological pleural indentation and pathological pleural invasion. Twenty-three tumors in 44 cases with pleural indentation were found to reach the pleura histologically, but only one in 42 cases without pleural indentation. ⋯ Pleural indentations were more frequently seen in small adenocarcinomas of low ground-glass opacity (GGO) ratio or Noguchi's type C. Small lung nodules with pleural indentation had better be removed as early as possible because of the possibility of pleural invasion and pleural dissemination.
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In this review, the author summarizes the recent development in the anesthesia methods, anesthetics, and anesthesia-related technology including intraoperative monitors and anesthesia medical information systems. Modern anesthesia workstations have features called fresh gas decoupling systems to prevent excess inspiratory volume and pressures that may induce barotraumas or volutrauma to the patients' lungs. Compared to volatile inhalational anesthetics, intravenous anesthetics might have several advantages. ⋯ In addition, newly designed anesthesia medical information system is under development. All of the advancement in anesthesia technologies facilitates advanced and complicated procedures in the thoracic surgery. It is hoped such advancement of anesthesiology will play roles in better treatment and outcome in patients undergoing respiratory and thoracic surgical procedures.
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The development of the computer technology brought reform in the field of medical equipment. Originally the mechanical ventilator was an instrument only as for running by pressure and the tool that let you breathe. However, it has a function to assist a measurement (tidal volume, peek pressure, etc.) and to wean from a ventilator. ⋯ After the operation without the complication, it seems that there is not the special administration. However, special respiratory management is necessary in case of chronic respiratory failure and acute lung injury, acute respiratory distress syndrome. Therefore I introduce a method to use a respirator after an operation in our institution.