キョウブ ダイドウミャク ジンコウ ケッカン チカン ジュツゴ ニ カッケツ トケツ オ キタシタ サイシュジュツ ショウレイ ノ セイセキ

【緒言】胸部大動脈疾患に対する人工血管置換術後に、喀血・吐血を来して再手術を要した症例の背景、予後を報告する。【症例】当院で2012年1月から2020年12月までに、喀血・吐血を主訴に胸部大動脈手術を行った24例中、人工血管置換術後の19例（喀血11、吐血8）を対象とした。【結果】年齢中央値73歳（49 - 88歳）、男性12例、女性7例、17例は緊急で手術を行った。初回手術からの間隔は中央値435日（55 - 1883日）であり、初回手術は上行置換1例、下行置換7例、弓部置換11例であった。手術適応は人工血管感染11例、仮性動脈瘤7例、急性大動脈解離1例であった。感染症例の内、9例に大動脈食道瘻を認めた。今回手術は、下行置換6例、胸腹部置換1例、弓部置換3例、ステントグラフト8例、自己弁温存基部置換術１例であった。全体の在院死亡は6例（32%）、生存者の術後滞在期間の中央値は101日であった。大動脈食道瘻を来した症例のうち6例は、2期的に食道抜去も施行し、その在院死亡は33%であった。一方、食道抜去を施行しなかった3例の在院死亡は67%であった。感染の有無で2群に分け検討したところ、在院死亡に統計学的有意差は認めなかった（p=0.147）。Kaplan-Meier法による全体の3年生存率は22.8%と不良であり、感染を認めた群では2年生存率9%と極めて不良であった。【結論】胸部人工血管置換後に喀血・吐血を来した症例の中でも、人工血管感染を生じた症例の予後は極めて不良であった。特に大動脈食道瘻を認めた場合は、食道抜去が必要であると考えられる。Introduction:We report the conditions and outcomes of patients suffering thoracic aortic disease, who developed hematemesis and hemoptysis and required reoperation.Patients: From January 2012 to December 2020, 19 patients (11 hemoptysis, 8 hematemesis) who had previous thoracic aortic surgery required reoperation with the main complaint of hemoptysis and hematemesis. Results:The median age was 71.5 years; there were 7 females, and 17 urgent cases. The median interval since the previous surgery was 435 days (55 to 1883 days), and the previous surgeries were 1 ascending aorta replacement, 7 descending aorta replacements, and 11 total arch replacements. The indications for reoperation were infection in 11 cases, pseudoaneurysm in 7 cases, and acute aortic dissection in 1 case. Aortoesophageal fistula was found in 9 of the infected cases. The surgical actions were 6 descending aorta replacements, 1 thoracoabdominal aorta replacement, 3 total arch replacements, 8 stent grafts, and 1 valve-sparing root reconstruction. Only one patient, who suffered aortic rupture due to dissection, died within 30 days. Six of the cases with aortoesophageal fistula also underwent esophagectomy in the second phase. There were 6 in-hospital mortality cases (32%), and the median length of stay after surgery for survivors was 101 days. The patients were divided into two groups according to the presence of infection, but the difference in-hospital mortality (infection (-): 13%, (+): 45%, p = 0.147) was not statistically significant. The 3-year survival rate by the Kaplan-Meier method was 23% overall, but the 2-year survival rates were 9% in the infected group and 53% in the non-infected group (Log-rank p= 0.167). Conclusion:Among the patients developing hemoptysis and hematemesis after previous thoracic aortic surgery, the cases of graft infection had extremely poor prognosis. Especially when aortoesophageal fistula is found, it is necessary to consider esophagectomy immediately

サイセンタン ノ サンジゲン イメージング システム : シンゾウ ケッカン ゲカ ニオケル Virtual Reality ギジュツ ノ ユウヨウセイ

滋賀医科大学心臓血管外科では医療用画像を三次元構築し、臓器を立体表示するVirtual Reality (VR) 技術を用いて心臓血管系の3D解析研究を進めている。VRでは臓器の内腔を可視化することができ、また3D構築した画像に直接介入し、従来の2D解析では評価困難であった複雑な構造も術者の視点で直観的に計測できるという利点がある。あらゆる医療画像データを三次元化し, かつ直感的な立体計測が可能なVR技術は, これまでの診断精度を上回る形態学的な情報を臨床医に提示し得ると考えられる。特に外科医にとって有用な手術支援VR画像は, 難易度が高い手術の治療成績を向上させる可能性が高い。Adequate preoperative planning may facilitate successful procedures in cardiovascular surgery. We have newly developed a system the Vesalius 3D suite, combining three-dimensional (3D) image-processing software with an optic-tracking spatial navigation, allowing quick, accessible 3D image interpretation for virtual reality (VR) exploration and measurement of complex anatomy. In this review, we present a novel method of virtual imaging analysis for preoperative planning and simulation in cardiovascular operation using this 3D-VR system. Based on unimodal or multimodal medical imaging data, DICOM data sets can be reconstructed for 3D visualization. Virtually reconstructed images can be viewed on stereoscopic 3D display, revealing each patient’s specific anatomy and the internal structures in exquisite detail. Highly accessible 3D interpretation promptly permits precise and intuitive measurements of repair-relevant anatomical parameters including geometrically complex shapes. This technology may promote understanding of form and function in the cardiovascular system, and facilitate operative procedures in more challenging cases. Furthermore, this system can be especially valuable for any surgeon to gain experience in practicing for rarely-performed procedures or uncommon patient-specific preoperative surgical simulations

Evaluation of Geenius HIV-1/2 Confirmatory Assay for the confirmatory and differential diagnosis of HIV-1/HIV-2 in Japan and reliability of the Geenius Reader in the diagnosis of HIV-2

Abstract Background NEW LAV BLOT I and II (LAV I and LAV II), they were only option for human immunodeficiency virus (HIV) confirmatory test, following HIV screening test using HIV Ag/Ab combination test in Japan. We evaluated the performance of Geenius HIV-1/2 Confirmatory Assay (Geenius), both as a confirmatory test and for differentiation between HIV-1 and HIV-2, in comparison with LAV I and LAV II. Methods Eighty-nine HIV-1-positive plasma specimens, one anti-HIV-1 low-titer performance panel, 10 seroconversion panels, and two anti-HIV-1/2 combo performance panels were tested. The results were read with the Geenius Reader and by visual reading. Results All 89 HIV-1-positive plasma specimens were identified as HIV-1-positive using Geenius; this 100% success rate was superior to that with LAV I (95.5% using WHO criteria, 98.9% using CDC criteria). The HIV-1-positive specimens showed low cross-reactivity with HIV-2 lines in Geenius. The sensitivity of Geenius for HIV-1 detection was the same as or greater than that of LAV I, but less than that of Genscreen HIV Ag-Ab ULT, in our analysis of the commercial performance and seroconversion panels. In contrast, five of the 13 HIV-2-positive specimens that had been identified as HIV-positive untypable by visual reading because of their cross-reactivity to HIV-1 lines were successfully identified by the Geenius Reader as HIV-2-positive with cross-reactivity. Conclusions Geenius provides strong performance for HIV confirmatory tests and HIV-1 differentiation tests. However, when visual reading is used, its performance in HIV-2 differentiation is less reliable. Because HIV-2 infection has been sporadically reported in Japan, the use of the Geenius Reader is preferable to ensure more reliable HIV-1/HIV-2 differentiation