Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Emergent endovascular stent-graft treatment for traumatic injury of descending aorta; report of a case].
A 71-year-old man was transfered to our hospital with acute aortic rupture due to a hit in the back by a log. Chest computed tomography (CT) demonstrated dissecting aneurysm of thoracic descending aorta, mediastinal hematoma, rib fracture and pulmonary contusion, We performed emergent endovascular stent-graft placement with local anesthesia successfully. The post operative course was uneventful. Chest CT scan after four months showed disappearance of aneurysm and hematoma.
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Thoracoscopy has been recently established as an indispensable technique for diagnosis and treatment of respiratory diseases. Although, thoracoscopy is usually applied under general anesthesia by a surgeon, it can also be applied by a chest physician under local anesthesia if the target is limited to pleural diseases. The main objective of medical thoracoscopy under local anesthesia is to establish a diagnosis of pleural effusions by means of observation and biopsy in the thoracic cavity. ⋯ These 3 diseases are the diseases with which medical thoracoscopy is most useful because they can be reliably diagnosed by biopsies and because early diagnosis and early treatment are essential. In case of the pneumothorax, treatment with bulla looping or cauterization may be possible, but we do not treat pneumothorax with medical thoracoscopy because it is impossible to approach and find air leaks of lesions located in or near blind spots such as the apex or mediastinal part In case of acute emphysema, it is important to release adhesions and perform effective drainage using thoracoscopy as soon as possible since deposition of fibrin tends to form quickly compartments that make drainage difficult. Scince medical thoracoscopy under local anesthesia is rapid, easy, safe, and well-tolerated procedure with an excellent diagnostic yield, it is recommended as a diagnostic procedure for cases with pleural diseases.
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Cardiac auscultation remains the most important method of screening for valvular heart diseases. Echocardiography is recommended for symptomatic patients or even asymptomatic patients with heart murmurs. Echocardiography is one of the most important examinations for the diagnosis and assessment of severity of valvular heart diseases. ⋯ The mitral valve area can also be derived from Doppler echocardiography with the diastolic pressure half-time method. In addition to semiquantitative assessment of the severity of aortic or mitral regurgitation by color flow jet area by Doppler echocardiography, quantitative measurement of regurgitant volume, regurgitant fraction, and regurgitant orifice area can be performed. Indirect measures of severity of aortic regurgitation are helpful, using the rate of decline in regurgitant gradient measured by the slope of diastolic flow velocity, or using the degree of reversal in pulse wave velocity in the descending aorta
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Transesophageal echocardiography (TEE) is an essential tool for all the cardiovascular surgeries. It has many roles intraoperatively including confirmation of preoperative diagnosis, guiding cannulation for cardiopulmonary bypass, monitoring myocardial contractility as well as loading conditions, helping the surgeon to evacuate residual intracardiac air after cardiotomy, and ensuring successful surgical results after coming off from cardiopulmonary bypass. Since TEE probe is placed very close to the left atrium, much more detailed images of the heart can be obtained by TEE than by transthoracic echocardiography. ⋯ The amount and quality of information which can be obtained from TEE are heavily operator-dependent. Therefore, continuous efforts to improve the skill and quality assurance are mandatory. An annual qualifying exam for TEE is available from the Japanese Society of Cardiovascular Anesthesia.
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Endobronchial ultrasound (EBUS) is a promising new modality first introduced in the early 1990s. The radial probe EBUS was initially developed seeking for high resolution imaging of processes within the airway wall and also outside the airways. The radial probe EBUS guided transbronchial needle aspiration (TBNA) has increased the yield of TBNA of mediastinal lymph nodes. ⋯ It is especially useful for lymph node staging of lung cancer patients with a high diagnostic yield. EBUS-TBNA can also be used for the diagnosis of mediastinal tumors or mediastinal lymphadenopathy which may be very difficult to diagnose by other minimal-invasive modalities. EBUS-TBNA is a novel approach that is safe and has a good diagnostic yield.