Kyobu geka. The Japanese journal of thoracic surgery
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The evaluation of cerebral perfusion during off-pump coronary bypass grafting (OPCAB) has not been clarified. The aim of this study was to investigate the predictive value of neurobiochemical markers of brain damage and cerebral perfusion with respect to the neuropsychological outcomes after OPCAB. ⋯ Intraoperative continuous cerebral oxygen desaturation monitoring seems to be useful monitor for neuropsychological outcomes after OPCAB.
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This article deals with a 7-year endeavor to reform the board certification system of surgical specialty and subspecialty, outlining of 29 meetings of the surgical subspecialty board in Japan. The surgical societies are responsible to constantly improve the quality of the surgical training programs and qualification systems so that the board certified surgeons are accepted and treated as true surgical specialists in this country.
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Lobectomy by video-assisted thoracoscopic surgery (VATS) is gradually being performed more frequently because of advantages regarding pain and pulmonary function. Complications sometimes occur during or after VATS lobectomy. The purpose of this study was to analyze the incidence and the causes of the complications. ⋯ Postoperative morbidity was 22.9%. A surgical operation without any good direct or thoracoscopic view or the use of a thoracoscopic tool without knowledge of the directions on its use should be avoided. The VATS approach should be replaced by open thoracotomy if there are DHA.
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Case Reports
[Emergent ascending and arch replacement for acute type A aortic dissection with anomalies of the aortic arch].
We experienced 4 cases that had to be performed emergent ascending and arch replacement for acute type A aortic dissection with anomalies of the aortic arch (aberrant right subclavian artery in 2 case and isolated left vertebral artery in 2 cases). As for the aberrant right subclavian artery, preoperative diagnosis is possible by CT scan. We must not overlook aberrant right subclavian artery in order to prevent brain complication in emergency arch replacement for acute type A aortic dissection. For the isolated left vertebral artery, incision of the aortic arch is recommended for its reconstruction.
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Case Reports
[Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries].
Patients with tetralogy of Fallot (TOF), pulmonary atresia (PA), and major aortopulmonary collateral artery (MAPCA) usually need some staged surgical procedures. There is no clear consensus to the initial procedure and also the most proper initial procedure is different in each case. We report here a case of 6-year-old girl with TOF, PA, and MAPCA. ⋯ Her pulmonary artery got good growth after the palliative surgery. Five years later she underwent complete repair after two other surgeries and 1 interventional embolization. RVOTR is a useful procedure for pulmonary artery growth, but it should be well considered that what size of RVOTR is needed in each case.