ABSTRACT
A Case of abdominal aortic occlusion caused by acute aortic dissection (DeBakey's type III b) is reported. A 59-year-old woman was admitted with sudden onset back pain and sensory disturbance of bilateral lower extremities. The pulsations of bilateral femoral arteries were absent. CT and aortogram revealed dissection of the thoracic descending aorta and infrarenal aortic occlusion. Since ischemic change had progressed, bilateral axillofemoral bypass was performed for limb salvage, and the symptoms improved rapidly. Axillofemoral bypass is an easy and safe procedure even in the acute phase of aortic dissection. It provides fast reperfusion, and so is considered to be useful to preventing myonephrotic metabolic syndrome MNMS.
ABSTRACT
A Pulmonary arterial flow-directed catheter (Oxymetry 93A-741-7.5F), combining the fiberoptic reflectometric system of continuous measurement of mixed venous blood oxygen saturation (SvO<sub>2</sub>) was used for hemodynamic measurements including thermodilution cardiac output estimation and hemoglobin value in 21 cases of open heart surgery. Immediately after open heart surgery there was low correlation between Hb (hemoglobin value) and SvO<sub>2</sub> (r=0.513, <i>p</i><0.05). However there was no correlation between SvO<sub>2</sub> and cardiac function (pulmonary capillary wedge pressure and cardiac index). With almost normal Hb (10-13g/dl) the average cardiac index (CI) in cases of SvO<sub>2</sub> less than 60% was 2.47<i>l</i>/min/m<sup>2</sup> which was significantly lower than those with SvO<sub>2</sub> more than 60% (<i>p</i><0.01). With normal CI (2.5-4.0<i>l</i>/min/m<sup>2</sup>) the average Hb in cases of SvO<sub>2</sub> less than 60% was 7.40g/dl which was significantly lower than those of more than 60% (<i>p</i><0.01). This study suggested that there is low cardiac function or severe anemia in the state of SvO<sub>2</sub> less than 60%.
ABSTRACT
We studied the effects of granulocytic elastase (GEL) and fibronectin (FN) on the coagulation and fibrinolytic system when using cardiopulmonary bypass (CPB). Blood sampling was performed before CPB (Pre), just after CPB (Post) the 1st postoperative day (PD1) and the second postoperative day (PD2). Laboratory parameters were GEL, FN, fibrinogen (Fib), prothrombin time (PT), fibrin degradation products (FDP), D dimer (D-D), α2 plasmin inhibitor plasmin complex (PIC) and antithrombin III (AT III). The level of GEL was highest and that of FN was lowest at Post. The levels of Fib, PT and AT III were lowest and that of PIC was highest just after CPB. The levels of FDP and D-D were highest on PD1. The levels of GEL and D-D correlated just after CPB and on PD1 and PD2. The level of GEL correlated with that of PIC on PD1. These results demonstrated that the level of FN decreased with CPB. And it was expected that CPB time affected the level of GEL. The levels of GEL affects D-D and PIC which are fibrinolysic factors particularly related to secondary fibrinolysis.
ABSTRACT
The patient was a 43-year-old male who presented with heart murmur. Echocardiography, chest CT, and cardiac catheterization data showed extracardiac extension of an aneurysm of the noncoronary sinus, compressing the right atrium, right ventricular outflow tract, and superior vena cava. Severe aortic regurgitation was also recognized. The aneurysm was incised under extracorporeal circulation. The orifice of the aneurysm was closed, and the elongated annulus of the noncoronary sinus was corrected with woven Dacron patch. Mild aortic regurgitation was shown on postoperative aortogram, and the case is being carefully followed up.
ABSTRACT
Aortic valve replacement was carried out for aortic regurgitation in Behçet's disease. A prosthetic valve was fixed using reinforced felt-strip mattress sutures. Difficulty to ensure adequate myocardial protection due to ostial stenosis in the right coronary artery resulted in the occurrence of intraoperative myocardial infarction. Right ventricular assist with the help of a centrifugal pump was employed to obtain successful recovery from right cardiac failure. It was noted that at operation attention should have been paid to the aortic valve and also to abnormalities of the coronary artery and that control of the inflammatory reaction by steroids was essential before and after the operation.
ABSTRACT
Fifteen patients were operated on infective endocarditis (IE). We studied indication for operation, operative methods and results. There were 13 male and 2 female patients and the mean age of these patients was 48.5 years. 8 cases were inactive IE and 3 of them were prosthetic valve endocarditis (PVE). The patients consisted of 4 cases of aortic valve regurgetation, 2 cases of mitral valve regurgetation, 3 cases of PVE and 3 cases of VSD. <i>Casual bacteria</i> were positive for blood culture in 5 cases. The following bacteria findings were found: <i>Streptcoccus viridans</i> in 3 patients, <i>gram-negative bacteria</i> and <i>Staphylococcus</i> each in one case. Valve cultures were positive in 3 cases: There were <i>gram-positive bacteria</i> in 2 patients and <i>Enterococcus</i> in one case. Vegetations were present in all native valves and the echocardiogram was useful for these findings. There were 3 perioperative deaths (20%) and 2 of those patients were active PVE. All patients with IE who develop progressive congestive heart failure and cerebral emboli should have prompt valve relacement. In paticular active PVE still has high mortality rate.
ABSTRACT
Sixty-two embalmed cadavers of elderly Japanese individuals, ranged in age from 44-98 years (48 males, 14 females), were completely dissected, and the weights of skin plus subcutaneous adipose tissue (SSATW) and Triceps Surae Muscle (TSMW) determined. Then subcutaneous adipose tissue free weight (SSATFW) was determined by subtracting SSATW from body weight (BW) .<BR>SSATW and percentage of SSATW relative to BW in females (8.9 kg, 19.8%) were larger than those in males (6.1 kg, 12.7%) . On the other hand, TSMW and percentage of TSMW relative to BW in males (313.6 g, 0.65%) were larger than those in females (210.6g, 0.49%) . BW, SSATFW, TSMW were highly correlated (p<0.01) with each other in males. However, in females, TSMW was not significantly correlated (p>0.05) with those variables. The slopes of regression lines for SSATW against BW and SSATFW for females were about twice as steep as those for males.<BR>From these results, it was suggested that females carried a higher proportion of their adipose tissue externally than males and relationship between muscle weight and inner adipose tissue weight in females was more variable than in males.