キュウセイ ダイドウミャク カイリ ヤマガタケン ニオケル セイレキ 2000ネン ノ ケイケン

Objective: Prefectural clinico-epidemiological survey of acute aortic dissection has not been widely carried out.　Methods: We collected data of all patients with acute aortic dissection in Yamagata Prefecture, and retrospectively reviewed their primary treatments throughout 2000.　Results: There were 71 patients with an acute aortic dissection and an incidence calculated from this number was 5.7 per 100,000 people per year. Patient\u27s age was 23-92(69+14) years. Male and female ratio was 44/27. Stanford type A aortic dissection was 35 patients and B 35. Complications of acute aortic dissection were shock in 12, cardiac tamponade in 16, rupture in 5, abdominal ischemia in 8, limb ischemia in 6 and brain infarction in 2. Two patients were in cardiac pulmonary arrest on arrival. Overall inhospital mortality was 13%, except for 2 patients. In Stanford A type aortic dissection, surgery was done in 21 and mortality was 9.5%; among those not receiving surgery mortality was 29%. In Stanford type B aortic dissection, death occurred in 2 patients out of 5 after emergency operation, and no putients out of 30 who were medically treated.　Conclusion: Incidence of acute aortic dissection calculated from this survey was 5.7 per 100,000 people per year in Yamagata Prefecture. Seven of 71(10%) died in the acute phase. Operative mortality for Stanford type A aortic dissection was 9.5%, while that of medical management was 29%. Operative mortality for Stanford type B aortic dissection was high, but medical treatment had no mortality. More aggressive treatment would improve initial results of acute aortic dissection.　Key words : acute aortic dissection, incidence, mortality, Yamagat

Assessment of the intrapulmonary ventilation-perfusion distribution after the Fontan procedure for complex cardiac anomalies: Relation to pulmonary hemodynamics

AbstractIn 12 patients who underwent the Fontan procedure for complex cardiac anomalies, lung scanning with xenon-133 was performed to assess the intrapulmonary ventilation-perfusion distribution, and comparison was made with a control group. All data were then analyzed in relation to either pre- or postoperative pulmonary hemodynamic data. In ventilation scans, the intrapulmonary distribution in the right lung was almost normal.In perfusion scans, an abnormal increased upper to lower lobe perfusion ratio greater than the normal value found in the control group was noted in seven patients (58.3%). There was a significant correlation (p < 0.02) between the upper to lower lobe perfusion ratio and postoperative pulmonary vascular resistance. Furthermore, this perfusion ratio correlated inversely with the preoperative (p < 0.005) and postoperative (p < 0.02) right pulmonary artery area index, defined as the ratio of cross-sectional area to the normal value. Of five patients with < 90% arterial oxygen saturation, four showed an abnormal distribution of pulmonary blood flow greater than the normal perfusion ratio. No patient had evidence of a pulmonary arteriovenous fistula by the echocardiographic contrast study.These results suggest that abnormal distribution of pulmonary blood flow to the upper lung segment may develop in patients after the Fontan procedure, and that insufficient size of the pulmonary artery before operation and the consequent postoperative elevation of pulmonary vascular resistance may be responsible for this perfusion abnormality

ドッキョウ イカ ダイガク デ ハジメテ ノ ノウシ カラノ ゾウキ テキシュツ ジュツ ノ マスイ ケイケン

獨協医科大学で初めての脳死下臓器摘出術の麻酔を経験した.ドナーは50歳代の女性で,くも膜下出血による脳死であり,麻酔および摘出術は特に問題なく終了した.臓器摘出術の麻酔管理の主な要点は,各摘出臓器の機能を最大限に維持するための適切な循環および呼吸管理である.本症例におけるわれわれの経験は近い将来,獨協医科大学で行われるであろう臓器摘出術及び移植術の麻酔管理に有益な情報になると考えられた.We report the anesthetic management of the first case ofthe brain death for organ donation in Dokkyo Medical University.The donor was brain death after subarachnoidhemorrhage. Anesthesia and surgical procedure were doneuneventfully. The aims of anesthetic management are tomaintain optimal organ perfusion. We believe that this firstexperience will be helpful for the anesthetic management ofthe organ transplantation patient in the future of DokkyoMedical University

Figure 6.2.7: Measured results.

r and domino level converter. Figure 6.2.6: Chip micrograph. Figure 6.2.4: Sparse radix-4 carry tree. # ## ################ ################# # ### ####### # ### ####### # ### ####### # ### ####### # ### ####### # ### ####### # ### ####### # ### # ### # ### ####### ## ## ## ## ## ## ## ## # ### # ### # ### # #### ### # ## ########## ################ ########### ############ ############ ######## ######## #################### ## #### ###### ###### ###### ###### ###### ### ### # # ##### ##### ### #### ######### ### ########## ####### ### ### ### ### ####### ### ### ####### #### #### #### ##### ####### ### ###### ### # # ##### ### ## ## ## ### ### ### ### ### ### ### ### ### ### ### ### ### ### ############ ################################ #### . 2003 IEEE International Solid-State Circuits Conference 0-7803-7707-9/03/$17.00 2003 IEEE ISSCC 2003 / SESSION 6 / LOW-POWER DIGITAL TECHNIQUES