Endovascular Stent-Graft Placement for Vascular Failure of the Thoracic Aorta

It still remains undetermined whether endovascular stent-graft placement (ESGP) is the optimal initial treatment for elective cases of thoracic aortic disease because of unknown long-term results. However, it is also recognized that ESGP contributes to better outcome as an initial treatment for aortic emergency, such as rupture, aortic injury, and complicated acute type B aortic dissection. Despite the fact that most patients are elderly, early mortality rates of ESGP are reportedly around 10% in cases of ruptured degenerative thoracic aortic aneurysm. Postoperative morbidity is also superior in ESGP compared with conventional open repair. Postoperative paraplegia has rarely occurred with ESGP. In cases of blunt aortic injury (BAI), other complications may also be present because of other serious injuries. ESGP has changed the surgical strategy for BAI and partially resolved some of the clinical dilemmas. Early mortality rate is almost zero when a stent graft can be placed before re-rupture. While BAI is a very good indication for ESGP, young patients need careful management and attention because of the unknown long-term outcome. In cases of complicated acute type B aortic dissection, the two main determinants of death, shock from rupture and visceral ischemia, could be managed by ESGP with or without conventional endovascular interventions. Recent reports disclosed less than 10% early mortality with ESGP for complicated acute aortic dissection. Even if the possibility of endotension remains, ESPG seems to be beneficial for these critical patients as the preferable initial treatment. The importance of close follow-up should be stressed to avoid some devastating late complications following ESGP

ファロー四徴症に対する直視下右室流出路拡大術の検討

Fourteen cases of TOF were performed on the RVOT construction without closure of the VSD which was called central palliation. The cases consisted of an equal number of males and females. These patients ranged in age from six to forty-five years. Before central palliation, initial palliative shunt was carried out in five cases. The remaining nine cases were provided with the central palliation as the initial surgery. Twelve cases showed the ratio of PA/AO below one fourth or the ratio of RPA/AO below 0.3. Two cases showed an abnormal right coronary traversing the right ventricle. Resection of the abnormal right ventricle muscle band and pulmonary valvuloplasty were performed in nine cases (group A) and the placement of a patch graft was done in five cases (group B). Arterial oxygen saturation was increased in both groups postoperatively. The postoperative hematocrit was decreased in both groups. Postoperative PA/AO ratio became 1/3 in group A and 1/2.3 in group B, respectively. Symptomatic improvement was good, especially in group B. The preoperative state of group B patients was classified as NYHA functional class IV. After central palliation, four cases changed to NYHA functional class II and one case could not be located during the follow up period. Determination of the proper time for central palliation correction remains a problem that must be solved in the future. The time necessary for total correction will be about three or four years with occasional observation and follow up

Successful treatment of severe accidental hypothermia with cardiac arrest for a long time using cardiopulmonary bypass - report of a case

Accidental hypothermia is defined as an unintentional decrease in body temperature to below 35°C, and cases in which temperatures drop below 28°C are considered severe and have a high mortality rate. This study presents the case of a 57-year-old man discovered drifting at sea who was admitted to our hospital suffering from cardiac arrest. Upon admittance, an electrocardiogram indicated asystole, and the patient's temperature was 22°C. Thirty minutes of standard CPR and external rewarming were ineffective in raising his temperature. However, although he had been in cardiac arrest for nearly 2 h, it was decided to continue resuscitation, and a cardiopulmonary bypass (CPB) was initiated. CPB was successful in gradually rewarming the patient and restoring spontaneous circulation. After approximately 1 month of rehabilitation, the patient was subsequently discharged, displaying no neurological deficits. The successful recovery in this case suggests that CPB can be considered a useful way to treat severe hypothermia, particularly in those suffering from cardiac arrest

ケイブ コユウ カンカク トレーニング ガ ジュウシン ドウヨウ ニ オヨボス エイキョウ ニ ツイテ ノ ケンキュウ

PURPOSE: The purpose of this study was to investigate the effectiveness of cervicocephalic kinesthetic training on postural stability and neck joint position sense in healthy young adults. METHOD: 33 subjects were recruited for this study and randomly divided into training （n＝16） and control groups （n＝17）. The training group performed cervicocephalic kinesthetic training for 5 minutes per day for 10 days and the control group performed the same training but with eyes closed to eliminate visual feedback. All training sessions for both groups were performed under supervision. Pre and post cervical joint position sense and sensory organization testing （SOT） were measured on both groups. RESULT: Significant differences were found in cervical joint position sense and SOT condition 6 in the training group. No significant differences were found in SOT condition1-5 in both groups and cervical joint position in the control group. CONCLUSION: The improvements of postural stability and cervical joint position sense after 10 days of cervicocephalic kinesthetic training suggest that cervical joint position sense may may be beneficial for postural stability in healthy young adults

先天性心疾患に対する三尖弁置換術の長期予後

Fourteen cases of isolated TVR (Tricuspid valve replacement) for congenital heart disease were studied. The purpose of this communication is to review the long-term prognosis of isolated TVR for congenital heart disease. Eight were Ebstein\u27s anomaly, 3 were tricuspid regurgitation (TR) after closure of ventricular septal defect (VSD). Three other cases were TR after radical surgery of Tetralogy of Fallot, VSD associated with two chambered right ventricle and VSD with right ventricular infundibular stenosis, respectively. The operative mortality rate was 7.1% and the actuarial survival curves for the 14 patients are shown to be 92.9% for the 1st year, 60.4% as 5 years and 60.4% after 20 years. One patient died on the second day after TVR due to a complete A-V block. The causes of late death included pulmonary embolism, sudden death, cardiac failure and sepsis, respectively. One case of Ebstein\u27s anomaly was performed for the re-TVR 19 years 8 months postoperatively due to a thrombosed valve. One of 5 porcine xenograft valve cases which was replaced 9 years 9 months ago is scheduled to undergo cardiac catheterization because of a systolic murmur and hepatomegaly. The other 7 cases followed up from 1 year 3 months to 18 years 1 month remained in NYHA functional class I in 6 cases and class II in 1 case. Periodic check up of the prosthetic valve by UCG and the monitoring of arrhythmia are essential as well as the application of antiplatelet agents to prevent thrombosis

Shortening of CPR time before the defibrillation worsens the outcome in out-of-hospital VF patients

Objective: To investigate the influence of cardiopulmonary resuscitation (CPR) time before the first defibrillation. Methods: The present study retrospectively analyzed the Utstein template records from April 1, 2002 to June 30, 2005. Patients who had out-of-hospital witnessed cardiac arrest caused by cardiac disease and who presented with ventricular fibrillation (VF) as the initial cardiac rhythm were included in the study. Before April 1, 2003, the emergency medical technician (EMT) needed to obtain telephone permission before attempting defibrillation, and CPR was continued until permission was received (CPR first). On and after April 1, 2003, the EMT was immediately able to attempt a defibrillation without obtaining permission (Shock first). Results: In 143 patients who had out-of-hospital witnessed VF, 43 patients and 100 patients were treated with the CPR first strategy and the Shock first strategy, respectively. The duration of CPR before the first defibrillation was longer in the CPR first group than that in the Shock first group. The CPR first group showed a higher rate of favorable neurological outcome 30 days after (28% vs. 14%, P = .048) and 1 year after cardiac arrest (26% vs. 11%, P = .033) than those of the Shock first group. In the patients with witnessed VF, a stepwise multiple logistic-regression analysis showed the CPR first strategy to improve the neurological outcome. Conclusions: In patients with out-of-hospital witnessed VF, sufficient CPR before the first defibrillation is considered to improve the neurological outcome in comparison to the performance of immediate defibrillation