Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Extensive traumatic pneumomediastinum. without injuries of organs in the thorax: report of a case].
A 57-year-old man was accidentally hit by concrete blocks weighing 3 tons on his right side, and was admitted to a hospital. The radiologic findings taken immediately after trauma demonstrated pneumo-mediastinum, subcutaneous emphysema with multiple rib fractures and right clavicle fracture. At computed tomography (CT) scan 16 hours after trauma, pneumomediastinum and subcutaneous emphysema turned out to be worsened with an increased bilateral pleural effusion. ⋯ The chest cavities and mediastinum were washed well with 3 liters of saline solution. The patient had a good course after surgery without any complications, and was discharged at the 18th hospital day. Mediastinal drainage by an emergency operation should always be a choice to a patient having a progressively worsening pneumomediastinum which might cause tachycardia, low blood pressure, and severe dyspnea due to compression of blood vessels and trachea.
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A 77-year-old woman had an ascending aortic aneurysm and aortic regurgitation due to aortitis syndrome. Computed tomography showed that ascending aorta was 55 mm in diameter and had severe calcification between the ascending aorta and distal aortic arch involves neck vessels. ⋯ No adverse event occurred after the operation and the patient was discharged on the 28th postoperative day. The open stent implantation was useful for the treatment of the aneurysm in high risk patients.
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Chronic obstructive pulmonary disease (COPD) is defined by the presence of airflow limitation, measured by the forced expiratory volume in 1 second (FEV1) after the administration of bronchodilator. Here the beta2-reversibility is defined by postbronchodilator FEV1-prebronchodilator FEV1 > 12% of pre-bronchodilator FEV1. The simple classification of disease severity into 4 stages is recommended based postbronchodilator FEV1. ⋯ Treatments including inhaled glucocorticosteroids are recommended to only severe COPD patients with the FEV1 < 50% predicted and to those who repeat exacerbations. Inhaled bronchodilators and systemic glucocorticosteroids are effective treatments for exacerbations of COPD. Noninvasive intermittent positive pressure ventilation in acute exacerbations reduces mortality, decreases the need for invasive mechanical ventilation and intubation, and decreases the length of hospital stay.
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Case Reports
[Mitral valve repair with anterior leaflet augmentation for rheumatic mitral valve disease].
A 74-year-old male with congestive heart failure was referred to our hospital, and massive mitral regurgitation as well as aortic stenosis and regurgitation were detected by echocardiography. His mitral valve was successfully repaired with anterior leaflet augmentation with the equine pericardial patch followed by aortic valve replacement. ⋯ The patient recovered uneventfully and was discharged on the 19th postoperative day. At 2 years and 2nd month after the operation, he is well without limitation of daily activities and any evidence of mitral regurgitation.
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Patients with mitral regurgitation are increasing while those with mitral stenosis are decreasing. In addition, percutaneous transluminal mitral commissurotomy (PTMC) technique has dramatically reduced surgical indication of mitral stenosis. ⋯ In this context, feasibility of mitral valve repair, in other words, the skill and experience of the surgeon becomes very important. In this paper, we described issues about the timing and indication of mitral valvular surgery based on "American College Cardiology/American Heart Association (ACC/AHA) 2006 practice guidelines for the management of patients with valvular heart disease".