Résumé
Complete circulatory arrest with profound hypothermia has been an indispensable adjunct to the safe management of selected giant intracranial aneurysms. For the conduct of cardiopulmonary bypass, there are usually two kinds of methods, open and closed chest methods. We could manage one case of huge intracranial aneurysm that was successfully operated under circulatory arrest using the closed chest method, especially with percutaneous insertion of arterial and venous cannulas for cardiopulmonary bypass.
Sujets)
Anévrysme , Artères , Circulation sanguine , Pontage cardiopulmonaire , Cathéters , Hypothermie , Anévrysme intracrânien , ThoraxRésumé
BACKGROUND: Thoracic sympathicotomy has been used safely and successfully to manage palmar hyperhidrosis. The preoperative and postoperative recording of Sympathetic Skin Responses(SSR) was performed for objective evaluation and follow-up of thoracic sympathicotomy in hyperhidrosis patients, and also for ascertaining the clinical usefullness of SSR. MATERIAL AND METHOD: The recording of SSR was performed on 15 patients suffering from palmar hyperhidrosis with Medelec Sapphire Plus electromyogragh before and after thoracic sympathicotomy. Eletrical stimuli on the right median nerve was made in patients in supine position and results were recorded on right and left palms with soles at the same time by 4 channels. Skin temperatures were also monitored simultaneously. T2,3 sympathicotomy was performed with VATS in every patients. SSR was done in 2 patients one month later. RESULT: Clinically, all patients had symptomatic improvement with satisfaction. Postoperative complication was small amount of residual pneumothorax in 5 patients but it was absorbed sponteneously. There was no recurrence during follow-up period and ten patients(66%) complained compensatory hyperhidrosis. After operation, SSR change was shown in every 15 patients. Abolition of SSR on both palms was achieved in 12 patients(80%) and on both soles in 6 patients. In the other 3 patients, the latencies were significantly delayed and the amplitudes were significantly reduced at both palms and soles. In two patients who were examined at one month later after operation, similar results with postoperative SSRs were shown. The skin temperature on preoperative both palm and sole were lower than normal temperature, and those on postoperative both palm and sole were increased. Those had statistical significance(p<0.05), and the temperature on the palm was increased higher that than on the sole. CONCLUSION: After thoracic sympathicotomy was performed on palmar hyperhidrosis patients, an increment of skin temperatures and SSR changes were achieved at both palms and soles of all patients. Palmar SSRs were completely abolished in 12 patients(80%), and similar results of postoperative SSRs were achieved. The recording of SSR may be useful to easily and objectively assess the completeness of sympathicotomy and the follow-up of recurrence in hyperhidrosis patients.
Sujets)
Humains , Oxyde d'aluminium , Études de suivi , Hyperhidrose , Nerf médian , Pneumothorax , Complications postopératoires , Récidive , Température cutanée , Peau , Décubitus dorsal , Système nerveux sympathique , Chirurgie thoracique vidéoassistéeRésumé
We report a case of a resection of very large intracavitary metastatic malanoma causing obstruction of the right ventricular inflow and outflow tract of the heart. A 49-year-old woman with dyspnea and generalized edema was seen. Echocardiography reveal an intra cavitary mass occupying the entire right ventricle and pericardial effusion. The lesion was palliatively resected using a cardiopulmonary bypass and was confirmed as a malignant melanoma. The patient is alive and improved symptomatically 30days after the operation.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Pontage cardiopulmonaire , Dyspnée , Échocardiographie , Oedème , Coeur , Tumeurs du coeur , Ventricules cardiaques , Mélanome , Métastase tumorale , Épanchement péricardiqueRésumé
BACKGROUND: This study is to suggest the optimal method as a treatment for the patent ductus arteriosus in the premature infants. MATERIAL AND METHOD: Between April 1994 and April 1997, 45 premature infants with evidence of a hemodynamically significant patent ductus arteriosus associated with cardiopulmonary compromise underwent indomethacin therapy, surgical treatment, or both. Thirty-nine infants received indomethacin and twelve infants among them were surgically ligated because of indomethacin failure(5) or complications(7). Six infants, who weighed less than 1,500 gm at birth, were referred for primary surgical ligation because of contraindication to indomethacin therapy. RESULT: The failure rate of indomethacin therapy was 43%(17/39) and the complications(13/39, 33%) to the indomethacin were associated with a high morbidity and mortality. Among the infants who underwent ligation, there were no failures and complications related to the operation. This data suggests that in the premature neonate with a hemodynamically significant PDA, (1) indomethacin therapy is associated with a high failure rate and significant complications, (2) surgical duct closure is associated with minimal morbidity. CONCLUSION: Although the results of this study cannot suggest the optimal management for PDA in premature infants, primary surgical ligation may be considered. However, long-term studies will be needed to confirm this later.
Sujets)
Humains , Nourrisson , Nouveau-né , Persistance du canal artériel , Indométacine , Prématuré , Ligature , Mortalité , ParturitionRésumé
Renal cell carcinoma involves the inferior vena cava (IVC) in approximately 5-10% of the patients. Presently surgical extirpation is the only form of therapy that can result in cure. Circulatory arrest with cardiopulmonary bypass is an operative technique that recently has been used to assist in resection of tumors that extend into the vena cava above the level of hepatic veins. We performed removal of tumor thrombi of IVC in 4 patients. All of them who had the renal cell carcinormas with infrahepatic vena caval extension were performed by standard surgical technique without cardiopulmonary bypass. But in one patient, inferior vena caval thrombectomy was done using circulatory arrest because of the recurred extension of the tumor thrombi within the vena cava above the insertion of the hepatic vein. All patients were recovered without any significant problems.
Sujets)
Humains , Néphrocarcinome , Pontage cardiopulmonaire , Veines hépatiques , Tumeurs du rein , Thrombectomie , Veine cave inférieureRésumé
Intrathoracic teratoma is mainly found on the anterior mediastinum. For teratoma of the pleura, one case was described. We have presented what we believe to be the first report of a teraroma of the pleura, which was mainly composed of neuroglial cells and was accompanied with lymph node metastasis.
Sujets)
Noeuds lymphatiques , Médiastin , Métastase tumorale , Névroglie , Plèvre , TératomeRésumé
Though leiomyomas are the commonest benign tumors in the esohpagus, the vast majority of the leiomyomas of alimentary tract occurs outside the esophagus. Leiomyoma is mostly solitary, and multiple lesions are rare. Diffuse esophageal leiomyomatosis is a very rare disease, which is the condition having diffuse thickening of esophageal musculature and with or without discrete lesion. We are reporting a typical case of diffuse leiomyomatosis of the esophagus in a 37-year-old woman successfully resected.
Sujets)
Adulte , Femelle , Humains , Tumeurs de l'oesophage , Oesophage , Léiomyome , Léiomyomatose , Maladies raresRésumé
Mechanical complications of acute myocardial infarction which may lead to heart failure or shock include ruptute of left ventricular free wall, ventricular septum and papillary muscle. The clinical characteristics of these lesions vary conservative management alone has high mortality rate, for which reason surgical repair of these defects are essential. Structural defects including rupture of the left ventricular free wall, ventricular septum, and papillary muscle, accout for 5% to 20% of all deaths from acute myocardial infarction. Among these, ventricular septal defects occur in approximately 1% of all myocardial infarction, and account for up to 2% of deaths subsequent to myocardial infarction. Rupture of the ventricular septum following acute myocardial infarction(AMI) is associated with high mortality rate, as 54% of the patients succumb within two weeks, 87% within two months and 92.5% during the first year. We experienced two cases of postinfarct ventricular septal defects(VSD) which had been repaired within 1 week after AMI due to progressive deterioration of patients` conditions, and were to be reoperated because of repeated septal ruptures in postoperation period and development of cardiogenic shock.
Sujets)
Humains , Défaillance cardiaque , Communications interventriculaires , Infarctus , Mortalité , Infarctus du myocarde , Muscles papillaires , Rupture , Choc , Choc cardiogénique , Septum interventriculaireRésumé
No abstract available.