[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Aug 1997
Case Reports[Clipping of the thoracic duct with video-assisted thoracic surgery in the treatment of chylothorax after pulmonary resection].
We describe a procedure for video-assisted thoracoscopic clipping of the thoracic duct to treat postoperative chylothorax. This technique was successfully performed on a 62-year-old man who developed chylothorax following right lower lobectomy and partial resection of the 11th and 12th vertebral bodies for squamous cell lung cancer. Because conservative therapy for 7 days failed to reduce the amount of pleural effusion, we performed thoracoscopic examination of the thoracic duct and found a site leaking chylous fluid. ⋯ Generally, chylothorax complicating pulmonary resection has been managed by medical treatment first, followed by surgical intervention in case that fail to respond to initial therapy. The newly designed video-assisted thoracic surgery procedure reduces the trauma, shortens the drainage period and hospital stay, and provides better exposure of the thoracic duct. We believe that this procedure can be carried out shortly after the occurrence of chylothorax.
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Nihon Kyobu Geka Gakkai Zasshi · Jul 1997
Case Reports[Monitoring for spinal cord ischemia by the use of the motor evoked potentials, the evoked spinal cord potential and the segmental evoked spinal cord potential during thoracoabdominal aortic surgery--a case report].
A 55-year-old woman, who was detected an enlargement of the aorta with body CT, was admitted to our hospital. Preoperative examination revealed that the aneurysm was expanded from ascending aorta to the abdominal aorta above the celiac artery. She underwent total arch replacement using elephant trunk technique. ⋯ During the operation, the monitor showed no remarkable change, even while the aorta was cross clamped. Her postoperative course was uneventful without any spinal cord damage. Combined use of MEP, ESCP, and S-ESCP was useful for monitoring spinal cord injury during thoracoabdominal aneurysmal repair.
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Nihon Kyobu Geka Gakkai Zasshi · Jun 1997
Randomized Controlled Trial Clinical Trial[Clinical evaluation of heparin concentration and activated clotting time monitoring (HEPCON HMS) system].
The HEPCON HMS system provides both activated clotting time (ACT) and accurate whole blood heparin concentration measurements. We evaluated the impact of heparin and protamine administration using this system on the incidence and treatment of bleeding after performing a cardiopulmonary bypass. Patients were randomly divided into two groups. ⋯ There were no statistical differences in the coagulation factor, the postoperative chest tube drainage or the blood products used between the two groups. Patients in Group H received a higher dosage of heparin and a lower dosage of protamine compared with Group A. By facilitating the maintenance of a therapeutic heparin concentration and by determining an appropriate protamine dosage, the HEPCON HMS system may be useful in managing extracorporeal circulation.
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Nihon Kyobu Geka Gakkai Zasshi · Jun 1997
Case Reports[A case of total arch replacement for traumatic aortic arch rupture].
We report a case of aortic arch rupture due to blunt chest trauma. A 64-year-old woman was crushed under a wood when she was working. On her arrival to our hospital, she was in shock state due to cardiac tamponade. ⋯ As the intimal disruption was found to be extended to three fourths of the circumference of aortic arch, total arch replacement was performed. In this case, the TEE was useful for the immediate diagnosis of the aortic rupture. This was the first successful case of total arch replacement for a traumatic arch rupture.
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Nihon Kyobu Geka Gakkai Zasshi · Apr 1997
Case Reports[A successful surgical case report of impending rupture of the true thoraco-abdominal aortic aneurysm induced by thrombosed-type acute aortic dissection (Stanford type A)].
Impending rupture of the true aneurysm of the thoraco-abdominal aorta induced by acute aortic dissection (Stanford type A) is very rare, and decision making of the therapeutic plain is difficult. A 88-year-old woman manifested severe back pain with hypotension. ⋯ Under the diagnosis of impending rupture of the thoraco-abdominal aortic aneurysm induced by acute aortic dissection (Stanford type A), graft replacement of the thoraco-abdominal aortic aneurysm and pericardial drainage were successfully performed. Two months later, computed tomographic examination revealed disappearance of the thrombosed false lumen in the ascending aorta.