Kyobu geka. The Japanese journal of thoracic surgery
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Comparative Study
[Diagnosis of mediastinal lymph node metastasis in primary lung cancer: comparing CT scan and mediastinoscopy].
In 105 patients with primary lung cancer who were operated on, the rate of diagnosis of mediastinal lymph node metastasis was determined, and the results of CT scanning and mediastinoscopy were compared. The rate of accuracy of mediastinoscopy was 93.8%, considerably higher than that of CT, which was less than 85%. ⋯ In the 9 patients who were proved by mediastinoscopy to have contralateral lymph node metastasis, the rate of accuracy of CT was only 44%. Mediastinoscopy was very effective in the diagnosis of mediastinal lymph node metastases from primary lung cancers.
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Review Case Reports
[A case of chronic traumatic dissecting aneurysm of the thoracic aorta].
A case of chronic traumatic dissecting aneurysm was reported. A 61-year-old man was admitted to our hospital for multiple trauma caused in traffic accident. ⋯ Replacement of thoracic aorta was performed after 33 months from the traffic accident, for enlargement of dissecting lumen accompanied with hoarseness. The postoperative course was uneventful and the patient returned to his daily life successfully.
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A 25-year-old man of Marfan syndrome with chronic stage aortic dissection of Stanford type A underwent concomitant graft replacement of the total aortic root and transverse aortic arch. The surgical procedure were performed with an aid of extracorporeal circulation, blood cardioplegia, using the techniques of "open distal anastomosis" under the deep hypothermic circulatory arrest and continuous retrograde cerebral perfusion for cerebral protection during circulatory arrest. ⋯ There were no neurological complications. In the case of Marfan syndrome, type A aortic dissection involving aortic arch should be treated by concomitant graft replacement of the total aortic root and the transverse aortic arch in order to reduce the late risk of aortic dissection or annular dilatation.
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Successful repair of blunt traumatic rupture of ventricle due to traffic accident is reported. Patient was a 73-year-old woman who was driving and had seated with seatbelts at the traffic accident. Arriving at our hospital, her blood pressure was under 50 mmHg and she had clouding of consciousness, although no brain injury was recognized. ⋯ The pericardiectomy was performed immediately, then blood pressure was improved to 70 mmHg. The ruptures of right ventricle were repaired without cardiopulmonary bypass via median sternotomy. Post-operative course was without trouble and patient was discharged within 2 weeks.
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Late hemodynamics following corrective surgery for congenital heart diseases were evaluated in 65 patients. The patients were divided into 4 groups due to the operative procedures including closure of ventricular septal defect (VSD group = 15 patients), repair of tetralogy of Fallot (TOF group = 20), Mustard operation (Mustard group = 19) and Fontan operation (Fontan group = 11). The postoperative period was 3.8 +/- 3.8, 1.0 +/- 0.1, 5.7 +/- 4.3 and 3.2 +/- 4.9 years in VSD, TOF, Mustard and Fontan groups, respectively. ⋯ Ejection fraction (EF) of the systemic ventricle (left ventricle) in VSD, TOF and Fontan groups were 0.66 +/- 0.06, 0.65 +/- 0.07 and 0.63 +/- 0.08, respectively. In Mustard group, EF of the systemic ventricle (right ventricle) was 0.56 +/- 0.12 and significantly less than left ventricular EF in the other 3 groups. The hemodynamic characteristics after these operative procedures should be considered for patient management.