Kyobu geka. The Japanese journal of thoracic surgery
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High-resolution manometry (HRM) has significant contribution in the field of esophageal motility disorders recently. The development of HRM has categorized various esophageal motility disorders focusing on patterns of esophageal motor function. Additionally, the Chicago classification criteria are widely used for manometric diagnosis. ⋯ First the lower esophageal sphincter (LES) function, and subsequently the esophageal pressure patterns are used to make a diagnosis. The hierarchical flow-chart has 4 groups; (1) incomplete LES relaxation( achalasia or esophagogastric junction outflow obstruction), (2) major motility disorders, (3) minor motility disorders, (4) normal esophageal motility. HRM is the gold standard for diagnosis of esophageal motility disorders.
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Mechanical ventilation is a useful treatment option for respiratory insufficiency following thoracic and cardiovascular surgery. Ventilation mode is classified as volume-controlled-ventilation(VCV) and pressure-controlled ventilation(PCV). Non-invasive ventilation(NIV) without tracheal intubation has been recently developed and is effective in patients with chronic obstructive pulmonary disease (COPD) exacerbation. ⋯ According to the protocol published from Japanese Society of Intensive Care Unit, Japanese Society of Respiratory Care Medicine, and Japan Academy of Critical Care Nursing, both spontaneous awakening trial(SAT) and spontaneous breathing trial(SBT) are recommended at the weaning from mechanical ventilation. I herein describe the utility of mechanical ventilation in patients with major pulmonary resection, myasthenia gravis, lung transplantation, and cardiac surgery, for each. We should understand not only the utility but also the non-physiological condition during mechanical ventilation.
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Case Reports
[Pneumothorax Caused by Multiple Pulmonary Metastases of a Uterine Endometrial Stromal Sarcoma;Report of a Case].
A 53-year-old woman who had undergone hystero-oophorectomy for uterine endometrial stromal sarcoma in our hospital 9 months previously was referred to our hospital because of bilateral pneumothorax. Chest computed tomography scan on admission revealed multiple thin-walled cavity nodules in both lung and a bilateral pneumothorax, suggesting pulmonary metastases of the uterine endometrial stromal sarcoma. We surgically treated the pneumothorax and diagnosed the nodules as metastatic lesions. They were pathologically diagnosed as metastatic uterine endometrial stromal sarcoma.
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A 59-year-old man consulted our hospital because of an abnormal shadow on a chest computed tomography, located in the right lower lobe. Fluorodeoxyglucose-positron emission tomography showed abnormal uptake in the tumor suggesting lung cancer and right lower lobectomy was performed. ⋯ Immunohistochemical staining was positive for TTF-1, CK-7 and CK-20. Postoperative screening of the abdomen revealed no suspicious primary lesion in the colon and the tumor was diagnosed as a pulmonary enteric adenocarcinoma.
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Perioperative right heart failure(RHF) is an important problem, especially in the field of heart failure surgery. Right ventricular performance is determined by the combination of preload, contractility, heart rate, rhythm and afterload. ⋯ Concomitant tricuspid annulus plasty may be effective for selected patients. In this review, we show the factors determining the performance of right ventricle, and then summarize the etiology and management strategies of perioperative RHF.