Kokyu to junkan. Respiration & circulation
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A case is reported of adult respiratory distress syndrome(ARDS) combined with barotrauma due to positive end-expiratory pressure (PEEP) therapy. The patient was a 32-year-old woman with fulminant hepatitis, type B, who died of ARDS 22 days after the onset of the illness. ⋯ The emphysematous lesion seen in this case was peculiar and not like any type of of ordinary pulmonary emphysema. Judging from the strange, sharply demarcated emphysematous lesion with marked destruction of alveolar structure, and the good preservation of the alveolar structure in the edematous lesion, the emphysematous lesion might be barotrauma which was induced by PEEP therapy on top of pneumonia.
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The method of measuring cardiac output with transesophageal pulsed Doppler two-dimensional echocardiography was developed and validated by comparison with the thermodilution technique in 65 adult patients. With the use of transesophageal four-chamber view, the Doppler sample volume was placed in the center of the mitral ring and the mitral flow velocity-time integral was obtained through planimetric measurements of the mitral flow velocity curve. The diameter of the mitral valve anulus was measured at the time of peak rapid filling flow velocity, and the cross-sectional area of the mitral valve anulus was calculated, assuming a circular shape. ⋯ MFVI [cm].heart rate [bpm].10(-3), where MFVI is mitral flow velocity-time integral, and D is the diameter of the mitral valve anulus. There was a weak correlation between thermodilution and Doppler measurements of cardiac output (r = 0.64, p less than 0.01), while a good correlation was observed between percent changes in thermodilution-derived cardiac output and those in Doppler-determined cardiac output (r = 0.92, p less than 0.01) during different loading conditions. It has been suggested that this method may be useful for assessing relative changes in cardiac output during short time periods.
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Case Reports
[Extraction of embolised catheter fragments using percutaneous technique: report of 3 cases].
Three cases are presented in which a basket catheter was used to retrieve broken central venous catheters successfully from the right side of the heart. Case 1: A 71-year-old female, in whom an IVH catheter was accidentally cut, and a fragment of which migrated into the pulmonary artery, was presented. Case 2: A 63-year-old male, fell into a restless state and pulled out the IVH catheter by himself, leaving a broken piece of catheter. ⋯ We succeeded in removing the fragmented catheters by using basket catheters. They were inserted into the right heart transvenously, through a Fr. 8 sheath introducer (98cm long) under fluoroscopic control. We discussed the method and problems involved in removing intracardiac foreign bodies.
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A 72-year-old woman had experienced palpitation and fatigue during exertion for two months and was referred to our hospital from her nearby hospital. On physical examination, a systolic murmur was heard in the left fourth intercostal space. A chest X-ray film showed cardiac enlargement (CTR 64%). ⋯ There were several cysts in the mass. Pathological examination showed myxomatous tissue. In this case, TEE was the most valuable means for evaluation of the right atrial mass.