開心術前後における身体組成変動

Lean body mass decreases after a major operation such as open-heart surgery, which leads to postoperative complications, as a drastic loss of muscle mass is related to infections and longer hospital stays. The purpose of this study was to examine changes in lean body mass and muscle mass including body composition the perioperative phase until discharge in patients undergoing open-heart surgery. Body fluids, fat and lean body mass in 17 patients were determined before and 1 week after surgery, and at discharge using bioelectrical impedance analysis. In addition, the levels of hemoglobin, albumin, and C-reactive protein in blood were measured. Cardiac rehabilitation consisted of early mobilization and aerobic bicycle exercise was subsequently performed after confirmation of independent walking for 200 meters. Early mobilization after surgery was assisted by physical therapists experienced in cases of cardiovascular surgery. Early mobilization required no more than 3 delayed days and no major complications until discharge in any of the patients. Weight and body mass index were significantly lower at discharge than before and 1 week after surgery, while lean body mass, muscle mass, total body water, intracellular fluid, body protein, and body cell mass values were significantly lower at discharge than before surgery. The changes in body composition seen after cardiac surgery until discharge indicated continuous catabolic reactions in our patients and some cytokines have been suggested to influence this phenomenon. After receiving open-heart surgery, it is important for patients to receive nutritional therapy and begin resistance exercise as soon as possible. Aerobic exercise should produce muscle protein synthesis and increase muscle mass under adequate nutritional support including specific amino acid supplements. Our findings indicate that muscle mass and nutritional status should be monitored after discharge and followed consistently in patients after open-heart surgery

Radiation Dose Reduction During EVAR: Results from a Prospective Multicentre Study (The REVAR Study).

OBJECTIVE To evaluate radiation exposure in standard endovascular aneurysm repair (EVAR) using intra-operative guidance with pre-operative computed tomographic angiography (CTA) fusion and strict ALARA guidelines in a modern hybrid room. MATERIAL AND METHODS Between February and November 2016, consecutive patients with AAA undergoing EVAR with a bifurcated device in a hybrid room under fusion imaging guidance were prospectively enrolled in six aortic centres from the United States (n = 1), Europe (n = 4), and Japan (n = 1). Demographic data including body mass index (BMI), indirect dose area product (DAP), cumulative air kerma (CAK), variables influencing dose delivery, and contrast media volume were collected. RESULTS 85 patients (90.4% males) were included. The median age was 75 (IQR 69-81), with a median BMI of 27.4 (IQR 24.7-30.6). Median DAP and CAK were 14.7 (IQR 10.0-27.7) Gy·cm and 107 (IQR 68.0-189.0) mGy, respectively. The median contrast volume was 47 mL (IQR 35-70) (equivalent to 14.1g of iodine [IQR 10.5-21.0]). Median DAP per centre was 28.1 (n = 16, IQR 12.6-47.1), 15.9 (n = 11, IQR 11.9-22.5), 14.2 (n = 12, IQR 10.9-25.7), 20.2 (n = 18, IQR 7.0-39.5), 10.3 (n = 27, IQR 8.2-14.7) and 26.5 (n = 1) Gy·cm. In multivariable analysis, collimation was the only factor that was significantly associated with DAP reduction, (coefficient = -0.014 per percentage of collimation, 95% CI -0.019 to -0.008, p < .001). CONCLUSIONS With adherence to the ALARA principle and routine application of fusion imaging guidance for EVAR, low radiation exposure compared with the published literature can be achieved in a real world setting