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101.
Shunya Shindo Kouji Ogata Seiichiro Katahira Keiji Iyori Tadao Ishimoto Masahiro Kobayashi Osamu Suzuki Kihachiro Kamiya Yusuke Tada 《Surgery today》1997,27(1):76-79
Delayed manifestation of aortic stenosis caused by abdominal blunt trauma is rare. We report herein the case of a 67-year-old man who was taken to a nearby hospital after being crushed between a heavy truck and a wall. An emergency laparotomy was performed, revealing only a mesenteric tear which was repaired. He was discharged after an uneventful postoperative course; however, 1 month later he began to experience intermittent claudication, and presented to our hospital in December 1994, 1 year after the first operation. Angiography and enhanced computed tomography (CT) demonstrated infrarenal abdominal aortic dilatation with distal stenosis. Both the dilated and stenotic lesions were resected and bypass surgery was performed. Pathologic examination demonstrated that the intima had been lacerated circumferentially and everted distally, causing the aortic stenosis. To our knowledge, this is the first case of the delayed manifestation of traumatic aortic stenosis to be documented in Japan. The etiology of this rare complication of blunt trauma is described in this report. 相似文献
102.
J. W. Ross 《International urogynecology journal》1997,8(3):146-152
Pelvic organ prolapse remains a difficult problem for pelvic reconstructive surgery. Before new surgical procedures can be
developed a good understanding of pelvic anatomy is necessary. It is widely held that the etiology of pelvic organ prolapse
is secondary to stretch neuropathy following childbirth and chronic cough or constipation. Several transvaginal and transabdominal
procedures have been developed over the years. With the increasing use of laparoscopy, a new variation on existing culdeplasty
techniques has been developed. Following anatomical principles, the apical vault repair reestablishes the pericervical ring
at the vaginal apex. The incorporation of pubocervical fascia, uterosacral-cardinal ligament and the rectovaginal fascia provides
a strong anchor for the vaginal apex. In addition, the repair should help prevent future transverse cystocele, rectocele,
enterocele and apical vault prolapse. Early outcome studies suggest that the apical vault repair should be used routinely
with laparoscopic urethropexy, laparoscopic hysterectomy and the repair of pelvic organ prolapse. Good apical vault support
is considered the cornerstone of pelvic reconstruction. 相似文献
103.
104.
Masahiro Tsuboi Hisao Asamura Tsuguo Naruke Haruhiko Nakayama Haruhiko Kondo Ryosuke Tsuchiya 《Surgery today》1997,27(11):1074-1076
A video-assisted right upper lobectomy was successfully performed on a 58-year-old man with an anomalnous segmental pulmonary
vein. The tumor was a peripherally located adenocarcinoma. The anomalous vein behind the right main bronchus was identified
and safely divided. This case emphasized that to perform this procedure successfully, (1) a careful preoperative evaluation
of the anatomy, including the presence of any possible vascular and/or bronchial anomalies, is necessary, and (2) if any anatomical
structures cannot be determined intraoperatively, a conversion into an open procedure must immediately be undertaken. 相似文献
105.
Toshifumi Murashita Keishu Yasuda Yoshiro Matsui Norihiko Shiiya Shigeyuki Sasaki Makoto Sakuma 《Surgery today》1997,27(4):368-372
A successful replacement of the aorta from the ascending aorta to the supraceliac abdominal aorta in one operation is herein reported. The patient was 66-year-old woman who had DeBakey type I chronic aortic dissection with a pre-disseminated intravascular coagulation (DIC) condition. The image diagnosis revealed a markedly enlarged false lumen with a narrow true lumen in the ascending aorta extending to the diaphragm level while below the diaphragm level, the aortic dilatation was mild. The operation was performed through both a thoracoabdominal incision and a median sternotomy to expose the whole thoracic aorta, and the aorta was replaced from the ascending aorta to the supraceliac abdominal aorta. Selective cerebral perfusion was used for cerebral protection and this was a useful adjunct since no time limitations were thus required during repair of the aortic arch. Although the patient developed several complications postoperatively, she eventually recovered and was discharged from the hospital without any neurological disorders. 相似文献
106.
目的:临床观察纵隔镜检查在胸部疑难疾病诊断中的作用。方法:使用德国STORZ公司生产的纵隔镜,对17例临床不能确诊的影像学检查发现的纵隔肿物或淋巴结施行标准的经颈纵隔镜检查术。结果:本组均获得了明确的病理诊断,其中良性病变88.2%(15/17),包括结节病9例,淋巴结结核5例,巨大淋巴结增生症1例,而2例恶性肿物均为肺小细胞未分化癌。结论:纵隔镜对原因不明的纵隔肿物或结节的诊断有着重要意义,可使一些结节病或淋巴结结核的患者得到及时正确的诊断,使这部分患者避免了盲目的试验性放、化疗或开胸探查所带来的痛苦。 相似文献
107.
108.
Mariko Kobayashi Yukihiro Takahashi Makoto Ando Naoki Wada Masamitsu Murata Toshio Kikuchi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2005,53(12):635-637
A 6 month-old male infant (weight: 4.5 kg) with congenital aortic stenosis underwent aortic valve replacement with a pulmonary
autograft (Ross procedure). The right ventricular outflow tract (RVOT) was reconstructed with a polytetrafluoroethylene (PTFE)-valved
equine pericardial conduit. At the age of 5, re-RVOT reconstruction with an equine pericardial patch bearing a PTFE monocusp
was required because of severe pulmonary stenosis resistant to 2 attempts of percutaneous transluminal pulmonary valvotomy.
Currently, at the age of 8, the degree of aortic regurgitation is trivial and the pulmonary autograft is free of functional
deterioration despite somatic growth. 相似文献
109.
Ryo Aeba Toshiyuki Katogi Kenichi Hashizume Yoshimi Iino Kiyoshi Koizumi Kentaro Hotoda Shinya Inoue Hideki Matayoshi Akihiro Yoshitake Ryohei Yozu 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2003,51(7):302-307
OBJECTIVE: Severe aortic arch obstruction including an interrupted aortic arch in congenital complex heart anomalies remains a challenge in surgical management. METHODS: Treatment and outcomes in 75 consecutive patients who underwent an aortic arch repair as the first step of the staged repair protocol between 1975 and 2000 were reviewed. Their ages at repair ranged from 1 day to 8.5 months. RESULTS: Cross-sectional postoperative follow-up data were available in all the patients. The follow-up period ranged from 0 to 27.6 years (mean: 7.3 +/- 7.3 years). There were 20 postoperative hospital deaths (27%) and 7 late deaths. The Kaplan-Meier estimate of survival was 81.3% +/- 4.5% at 1 month, 68.0% +/- 5.4% at 1 year, 65.0% +/- 5.5% at 5 years, 63.1% +/- 5.7% at 10 years, 63.1% +/- 5.7% at 20 years. By Cox regression analysis, body weight of 2.5 kg or less is the only independent determinant of postoperative mortality (p = 0.04, multivariable odds ratio: 2.50, [95% confidence interval: 1.02-6.1]). The aortic arch morphology, the primary cardiac lesion, or date of operation did not reach a statistically significant level to show correlation with mortality. Reintervention to reconstruct the aortic arch was performed at 9 occasions in 8 of the 55 patients who survived the primary operation (14.5%). The Kaplan-Meier estimate of the reintervention-free rate was 91.3% +/- 4.2% at 5 years, 85.5% +/- 5.6% at 10 years, 75.6% +/- 8.2% at 20 years. Using multivariable Cox regression analysis, interrupted aortic arch (versus aortic coarctation) was the only independent predictor of a shorter time to reintervention (p = 0.001, multivariable odds ratio: 16.1, [95% confidence interval: 3.2-80.2]). CONCLUSIONS: The staged repair protocol was associated with significant limitations in patient survival and with the development of recurrent aortic arch obstruction. Thus, a primary repair protocol may serve as an alternate approach, especially in patients with low weight or with an interrupted aortic arch. 相似文献
110.