ABSTRACT
A 76-year-old man who suffered from consistent back pain was admitted for anti-hypertensive therapy to strictly manage the early thrombosed acute type A aortic dissection (AAAD). On admission, his blood pressure could not be controlled well ; soon he complained of recurrent severe back pain. The second thoracoabdominal enhanced computed tomography revealed the progression of AAAD from DeBakey type II to type I with thrombosed pseudolumen at the descending thoracic aorta ; therefore, emergent surgical intervention by primary central repair was conducted. Paraplegia was diagnosed eight hours after surgery, then cerebrospinal fluid drainage and intravenous administration of Naloxone were started immediately followed by keeping the systemic blood pressure more than 120 mmHg. However, paraplegia had never improved and been persistent with neurological deficit of the lower extremities. We herein report a complicated surgical case of an AAAD patient with paraplegia and review the complex clinical settings.
ABSTRACT
The method of cardioplegic myocardial protection is often controversial for re-cardiotomy after a coronary artery bypass grafting (CABG). A 69-year-old woman with a history of three previous surgeries consisting of closed mitral commissurotomy (CMC), dual valve replacement (DVR), and CABG underwent mitral valve replacement (MVR) and CABG for perivalvular leakage (PVL). As a result, the bilateral coronary ostium and the bypass graft to the right coronary artery (RCA) were totally occluded. The left internal thoracic artery (LITA) graft to the left anterior descending (LAD) coronary artery was the only inflow to the left coronary artery system and the right coronary artery system developed collateral inflow. Cardioplegia was carried out by performing a temporary anastomosis graft on the saphenous vein graft (SVG) in the left anterior descending coronary artery and a new bypass graft in the RCA was used for the administration of cardioplegic solution with no complications. There are various strategies for cardioplegic myocardial protection. The best method should be selected depending on the patient characteristics and condition.
ABSTRACT
[Objective]It is important for students to learn in school education how to prevent medical accidents caused by deep insertion of a needle. Also, it is essential in safe acupuncture treatment that students are always reminded there are individual variations in subcutaneous structure and to confirm the position of the needle tip in the subcutaneous tissue. To recognize the acupuncture needle tip, muscle twitch induced by electrical stimulation through the acupuncture needle tip was felt with fingers of training students. <BR>[Methods]To prevent accidental pneumothorax, acupuncture training was performed in the upper and lower extremities. After the class, we conducted a questionnaire investigation with the students.<BR>[Result]As the result, students realized that the position of the needle tip which they assumed is different from the real position in subcutaneous tissue.<BR>[Discussion]Without knowing the precise position of the acupuncture needle tip, a desirable effect is not provided, and furthermore, a medical accident may be caused. It is important to confirm the position of the acupuncture needle tip with consideration to individual variation for safe and effective acupuncture treatment. <BR>[Conclusion]We concluded that the skill to prick and insert the acupuncture needle to the correct position is so important in preventing medical accidents that training to learn correct needle tip position should be given in acupuncture education.
ABSTRACT
We studied the appearance of pleural effusion and inflammatory reactions after endovascular grafting in cases of aortic dissection. From December 1995 to January 2000, 16 patients with chronic double-barrel type aortic dissection (DeBakey type III b) were treated by endovascular grafting. In all cases, enhanced computed tomography (CT) of the chest was examined before operation and at about the 7th postoperative day (POD). Patients were divided into 3 groups. Group P: patients who had pleural effusion before the operation. Group E: patients who had new pleural effusion after the operation. Group N: patients who did not have any pleural effusion. In each group, onset of dissection, patient's age, maximum diameter of dissecting aorta, period of postoperative fever (above 37.0°C), and WBC counts and CRP value at POD 1, 3, 7 and 14 were compared. Four patients were in group P, 4 patients were in group F, and 8 patients were in group N. Period between onset and operation was 41.6±34.6 months in group P, 18.2±27.3 months in group E and 7.3±11.6 months in group N. There was no relation between the effusion and the period after onset. Postoperative fever continued for 5.0±2.0 days in group P, 13.5±2.6 days in group E and 2.5±0.3 days in group N. The period of fever of group E was significantly longer than in group N and P (p<0.01). WBC showed a peak on the first POD in each group. CRP showed a peak value on POD 3 in group P and N. There was no significance among the 3 groups about WBC and CRP, but group E showed slightly high CRP values on POD 7 and 14. No patient had complications regarding respiratory function. After endovascular grafting for aortic dissection, postoperative pleural effusion appeared in 25% of patients. They had prolonged postoperative fever, but there was no respiratory function complication. Endovascular grafting is a minimally invasive procedure with regard to respiratory function.
ABSTRACT
A 40-year-old man was admitted because of prolonged fever after extraction of teeth. Infective endocarditis, congestive heart failure and hepatorenal failure were diagnosed in a series of examinations. Electrocardiograms showed complete atrio-ventricular block and QT prolongation. After continuous hemodiafiltration (CHDF) and high doses of antimicrobials promptly initiated for the treatment of multiple organ failure, the aortic valve with regurgitation and vegetation was replaced with an artificial valve. Serious arrhythmias occurred after the operation, which disappeared by the administration of antiarrhythmic agents. In cases of infective endocarditis with multiple organ failure, preoperative intensive treatment such as CHDF in combination with high doses of antimicrobials and surgical intervention represent a good strategy for successful outcome.