[Spontaneous rupture of the thoracic aorta diagnosed rupture of the acute stanford type B aortic dissection at preoperation; report of a case].

BACKGROUND: Spontaneous rupture of the thoracic aorta is extremely rare. It is very difficult to diagnose it preoperatively. CASE: A 71-year-old woman suffered the sudden onset of severe chest and back pain and was admitted to our hospital. Enhanced computed tomography (CT) showed mediastinal hematoma and apparent aortic dissection in the aortic arch and descending aorta. We diagnosed the rupture of Stanford type B dissection and performed an emergency operation. 20 mm tear was found in the intima of lesser curvature of aortic arch and 5 mm perforation was found in the adventitia of this part. There was no flap or false lumen suggestive of a dissection nor was there aortic aneurysm. Total aortic arch replacement was performed. RESULT: The surgery was followed by an uneventful postoperative course. CONCLUSION: A case of spontaneous rupture of the thoracic aorta which was diagnosed the rupture of Stanford type B dissection preoperatively was successfully treated.

[Preoperative respiratory training for a patient with chronic obstructive pulmonary disease undergoing redo mitral valve replacement].

The patient is a 76-year-old woman. She had undergone double valve replacement for rheumatic mitral and aortic valve regurgitation at the age of 64. She was diagnosed with chronic obstructive pulmonary disease (COPD) at 73 years old (Hugh-Jones class IV) . She was admitted to our hospital because of severe hemolytic anemia at 76 years old. Perivalvular leakage of mitral prosthetic valve was noted by transesophageal echocardiography. Preoperative respiratory physiotherapy was performed (breath muscle training, expectoration of sputum training, a therapeutic exercise, and Souffle training) for 3 weeks, because she was a high risk patient for postoperative respiratory complications. Her respiratory function (vital capacity, FEV1.0) was improved. Re-replacement of the mitral valve was performed using On-X valve 23 mm. She was extubated on the 1st postoperative day, and her postoperative course was uneventful. Preoperative respiratory physiotherapy might be very important for patients with COPD to prevent post operative pulmonary complications.

Experiments on the quick-relief medical communications via the Japan's domestic communication satellite CS-2 for the case of disasters and emergencies.

Experiments on the quick-relief medical communications via the CS-2 satellite were carried out by using two types of 30/20 GHz small transportable earth stations whose antenna diameters are 1 and 2 m. As the terminal equipments, FM-SCPC systems with a one-telephone-equivalent channel were prepared for the transmission of voice, color freezed picture (9.6 kbps), supersonic echo signal and heart sound from a electrocardiograph. Signals from various medical equipments were transmitted by an FM-SCPC system from Simizu harbour (1 m station) to Tokyo transportable station (2 m), assuming that a person was injured in the ship and the ship came alongside the pier. Transmitted materials are mainly various kinds of pictures of affected parts, X-ray films and electrocardiograph with breathing sounds. It was found possible to send various medical information mentioned above via CS-2 by the 30/20 GHz simple communication systems with one-telephone-equivalent channel. Doctors suggested it would be possible to judge very well about the patients' emergency conditions and to give quick consult with inevitable treatment procedures for them. However, a few problems were found in the Hi-Fi reproduction of original colors and in the transmission of heart sounds in the very low frequency band less than 300 Hz.