Kyobu geka. The Japanese journal of thoracic surgery
-
Case Reports
[Pulmonary metastasis of uterine leiomyosarcoma 8 years after hysterectomy; report of a case].
A 57-year-old woman, who had undergone hysterectomy for uterine leiomyosarcoma 8 years ago, was admitted to our hospital for pulmonary tumors on chest X-ray. Two tumors were recognized on each side at left and right lung field by computed tomography (CT). ⋯ The histologic findings showed that those tumors were metastases of uterine leiomyosarcoma. This case suggests that the long term follow-up is necessary in the case of uterine leiomyosarcoma after operation.
-
We present a case of acute pulmonary embolism (APE) after cesarean section. A cesarean section was performed on a 27-year old woman with normal course. However, one day after operation, she suddenly developed syncope and dyspnea. ⋯ She was consulted to our hospital for treatment. Soon after her arrival, we treated her for both APE and cardiogenic shock. The combined with antithrombotic therapy using heparin sodium, was successfully treated the patient from cardiogenic shock due to APE with right ventricular dysfunction after cesarean section.
-
Our basic strategy for spinal cord protection during thoracoabdominal aortic surgery has been established since August 1994 such as: 1) distal aortic perfusion using partial cardiopulmonary bypass (32-34 degrees C), 2) multi-segmental sequential clamping, 3) deep hypothermic circulatory arrest when sequential clamping is impossible, 4) evoked spinal cord potential-guided reconstruction of the critical intercostal arteries (preoperative evaluation using multi-detector row computed tomography), 5) cerebrospinal fluid drainage, and 6) administration of naloxone hydrochloride and methylprednisolone. In this paper, we analyzed clinical outcome of thoracoabdominal aortic surgery according to this strategy. ⋯ Our strategy for spinal cord protection during thoracoabdominal aortic surgery could provide acceptable clinical outcome and seemed justified.
-
Spinal cord injury such as paraparesis and paraplegia remains one of the major concerns in surgery on the thoracoabdominal aortic aneurysm (TAAA). We utilize spinal cord protection including cerebrospinal fluid drainage (CSFD), adjuncts of aortic distal perfusion, reconstruction of the intercostal or lumbar arteries and deep hypothermia in TAAA repair. This report describes the results of surgical treatment for TAAA including postoperative neurological outcome. ⋯ This clinical experience demonstrates that current technical strategies enable patients to undergo TAAA repair with acceptable early survival. However, despite aggressive spinal cord protection, few patients suffered from postoperative spinal cord injury. Future research should focus on spinal cord protection in patients with TAAA.
-
Deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest has been used for protection of the spinal cord during operations for thoracoabdominal aortic aneurysm (TAAA) in our hospital. We examined the effect of this adjunct this time. We studied 15 patients who were operated using deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest among 19 patients with the TAAA who we performed the operations from 1995 through 2003. ⋯ Duration of spinal cord ischemia to the intercostal arteries were reconstructed was from 25 to 104 (50.5 +/- 24) minutes. We recognized nerve disorder in 6 cases in progress after operation, and respiratory organs management period and a hospitalization period became long, but the hospitalization death was 3 cases, and, as for the paraplegia was no case, 12 patients were discharged in good condition. The deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest was regarded as a useful adjunct for prevention of the paraplegia.