肺疾患による二次性肺高血圧症に対する体外式人工呼吸の効果

博士(医学) 乙第2930号(主論文の要旨、要約、審査結果の要旨、本文)，著者名:Yoko Sato・Noriyuki Saeki・Takuma Asakura・Kazutetsu Aoshiba・Toru Kotani，タイトル:Effects of extrathoracic mechanical ventilation on pulmonary hypertension secondary to lung disease，掲載誌:Journal of Anesthesia(0913-8668)，巻・頁・年:30巻4号 p.663～370(2016)，著作権関連情報:© The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).，DOI:10.1007/s00540-016-2172-7博士(医学)東京女子医科大

Laryngocele: a rare complication of surgical tracheostomy

BACKGROUND: A laryngocele is usually a cystic dilatation of the laryngeal saccule. The etiology behind its occurrence is still unclear, but congenital and acquired factors have been implicated in its development. CASE PRESENTATION: We present a rare case of laryngocele occurring in a 77-year-old Caucasian woman. The patient presented with one month history of altered voice, no other associated symptoms were reported. The medical history of the patient included respiratory failure secondary to childhood polio at the age of ten; the airway management included a surgical tracheostomy. Flexible naso-laryngoscopy revealed a soft mass arising from the posterior pharyngeal wall obscuring the view of the posterior commissure and vocal folds. The shape of the mass altered with respiration and on performing valsalva maneuver. A plain lateral neck radiograph revealed a large air filled sac originating from the laryngeal cartilages and extending along the posterior pharyngeal wall. The patient was then treated by endoscopic laser marsupialization and reviewed annually. We discuss the complications of tracheostomy and the pathophysiology of laryngoceles and in particular the likely aetiological factors in this case. CONCLUSION: A laryngocele presenting in a female patient with tracheostomy is extremely rare and has not been to date reported in the world literature. A local mechanical condition may be the determinant factor in the pathogenesis of the disease

Negative-Pressure Ventilation in Neuromuscular Diseases in the Acute Setting

Mechanical ventilation started with negative-pressure ventilation (NPV) during the 1950s to assist patients with respiratory failure, secondary to poliomyelitis. Over the years, technological evolution has allowed for the development of more comfortable devices, leading to an increased interest in NPV. The patients affected by neuromuscular diseases (NMD) with chronic and acute respiratory failure (ARF) may benefit from NPV. The knowledge of the available respiratory-support techniques, indications, contraindications, and adverse effects is necessary to offer the patient a personalized treatment that considers the pathology's complexity

Sleep disordered breathing and its treatment in children

The establishment of a dedicated paediatric sleep unit over the past three years has allowed detailed investigation of a large number of children with sleep associated upper airway obstruction. This thesis explores the characteristics of upper airway obstruction and sleep associated breathing control abnormalities, in children who have been investigated in that unit. The "unit" began with three or four people performing children’s sleep studies at the Sleep Unit (for adults) at RPAH; the results presented here include those studies. The methods used in this thesis have evolved through practical experience acquired in caring for children with breathing disorders in sleep. This thesis is presented in two parts. The studies in the first section provide an overview of the presentation and treatment of the syndrome of obstructive sleep apnoea (OSA) as it occurs in infants and children. The second section is a more detailed exploration of OSA and its treatment in achondroplasia. These latter studies provide further insights into the disorder in this specific group, and therefore into some aspects of OSA in the broader population of children

陽・陰圧体外式人工呼吸器(RTX[○!R])が排痰困難に有効であった特発性肺線維症の一例

今回、特発性肺線維症(IPF)の急性増悪をきたした患者に対し、陽・陰圧体外式人工呼吸器(RTX[○!R])が有効であった症例を経験した。本人の主訴として呼吸困難と排痰困難の自覚症状があったが、RTX[○!R]の排痰モードおよびコントロールモードの使用により呼吸筋疲労の軽減や排痰の介助に効果が認められた。また、医師・看護師・理学療法士などがチームとなって積極的に関わることができ、患者の満足感もえられた。Article信州大学医学部附属病院看護研究集録 37(1): 46-49(2008)departmental bulletin pape

The effects of one year of nocturnal cuirass-assisted ventilation in chest wall disease

The effects of one year of nocturnal cuirass-assisted ventilation in chest wall disease. W.J.M. Kinnear, S. Hockley. J. Harvey, J .M. Shneerson . ABSTRACT: The effects of one year of nocturnal cuirass-assisted ventilation using individually des. igned cuirass respirators have been investigated in twentyfive patients with chest wall disease. After one year, 22 (88%) of the patients were alive. Daytime arteri al blood gases had improved. Functional residual capacity (FRC) had increased but there was no significant change in other lung volumes. M aximum inspiratory pressure (MIP) improved in the subjects with a scoliosis but not in those with a thor.acoplasty or neuromuscular disease. Maximum expiratory pressure (MEP) was unchanged. Maximum volunta ry ventilation (MVV), the ventilatory response to carbon dioxide and six minute walking distance bad all increased. There was no improvement in respiratory symptoms, but a decrease in depression scores and in the time taken to complete a trail test. The mean (so) number of days spent in hospital over the year was 21.5 (15.1) per patient, with patients consulting their general practitioners less frequently than in the year prior to commencing nocturnal cuirass-assisted ventilation. The cost of commencing a patient on domiciliary nocturnal cuirassassisted ventilation is estimated as £2470, and of maintaining them at home for one yea r as £3302