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1.
Artigo em Inglês | MEDLINE | ID: mdl-32349413

RESUMO

The present study examined whether a culture-based virtual reality (VR) training program is feasible and tolerable for patients with amnestic mild cognitive impairment (aMCI), and whether it could improve cognitive function in these patients. Twenty-one outpatients with aMCI were randomized to either the VR-based training group or the control group in a 1∶1 ratio. The VR-based training group participated in training for 30 min/day, two days/week, for three months (24 times). The VR-based program was designed based on Korean traditional culture and used attention, processing speed, executive function and memory conditions to stimulate cognitive function. The adherence to the culture-based VR training program was 91.55% ± 6.41% in the VR group. The only adverse events observed in the VR group were dizziness (4.2%) and fatigue (8.3%). Analysis revealed that the VR-based training group exhibited no significant differences following the three-month VR program in Korean Mini-Mental State Examination (K-MMSE) scores, working memory functions such as performance on the digit span test, or in Stroop test performance and word fluency. We conclude that although the 12-week culture-based VR training program did not improve cognitive function, our findings revealed that the culture-based VR training program was feasible and tolerable for participants with aMCI.

2.
Korean J Thorac Cardiovasc Surg ; 52(6): 392-399, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31832375

RESUMO

Background: The surgical strategies for carotid endarterectomy (CEA) vary in terms of the anesthesia method, neurological monitoring, shunt usage, and closure technique, and no gold-standard procedure has been established yet. We aimed to analyze the feasibility and benefits of CEA under regional anesthesia (RA) and CEA under general anesthesia (GA). Methods: Between June 2012 and December 2017, 65 patients who had undergone CEA were enrolled, and their medical records were prospectively collected and retrospectively reviewed. A total of 35 patients underwent CEA under RA with cervical plexus block, whereas 30 patients underwent CEA under GA. In the RA group, a carotid shunt was selectively used for patients who exhibited negative results on the awake test. In contrast, such a shunt was used for all patients in the GA group. Results: There were no cases of postoperative stroke, cardiovascular events, or mortality. Nerve injuries were noted in 4 patients (3 in the RA group and 1 in the GA group), but they fully recovered prior to discharge. Operative time and clamp time were shorter in the RA group than in the GA group (119.29±27.71 min vs. 161.43±20.79 min, p<0.001; 30.57±6.80 min vs. 51.77±13.38 min, p<0.001, respectively). The hospital stay was shorter in the RA group than in the GA group (14.6±5.05 days vs. 18.97±8.92 days, p=0.022). None of the patients experienced a stroke or restenosis during the 27.23±20.3-month follow-up period. Conclusion: RA with a reliable awake test reduces shunt use and decreases the clamp and operative times of CEA, eventually resulting in a reduced length of hospital stay.

3.
Korean J Thorac Cardiovasc Surg ; 52(5): 372-375, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31624716

RESUMO

A 55-year-old man was admitted to the trauma center after a car accident. Cardiac tamponade, traumatic aortic injury, and hemoperitoneum were diagnosed by ultrasonography. The trauma surgeon, cardiac surgeon, and interventional radiologist discussed the prioritization of interventions. Multi-detector computed tomography was carried out first to determine the severity and extent of the injuries, followed by exploratory sternotomy to repair a left auricle rupture. A damage control laparotomy was then performed to control mesenteric bleeding. Lastly, a descending thoracic aorta injury was treated by endovascular stenting. These procedures were performed in the hybrid-angio room. The patient was discharged on postoperative day 135, without complications.

6.
J Korean Med Sci ; 34(30): e198, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31373183

RESUMO

BACKGROUND: Accurate volume measurement is important in the management of patients with congestive heart failure or renal insufficiency. A bioimpedance analyser can estimate total body water in litres and has been widely used in clinical practice due to its non-invasiveness and ease of results interpretation. To change impedance data to volumetric data, bioimpedance analysers use equations derived from data from healthy subjects, which may not apply to patients with other conditions. Bioelectrical impedance vector analysis (BIVA) was developed to overcome the dependence on those equations by constructing vector plots using raw impedance data. BIVA requires normal reference plots for the proper interpretation of individual vectors. The aim of this study was to construct normal reference vector plots of bioelectrical impedance for Koreans. METHODS: Bioelectrical impedance measurements were collected from apparently healthy subjects screened according to a comprehensive physical examination and medical history performed by trained physicians. Reference vector contours were plotted on the RXc graph using the probability density function of the bivariate normal distribution. We further compared them with those of other ethnic groups. RESULTS: A total of 242 healthy subjects aged 22 to 83 were recruited (137 men and 105 women) between December 2015 and November 2016. The centers of the tolerance ellipses were 306.3 Ω/m and 34.9 Ω/m for men and 425.6 Ω/m and 39.7 Ω/m for women. The ellipses were wider for women than for men. The confidence ellipses for Koreans were located between those for Americans and Spaniards without overlap for both genders. CONCLUSION: This study presented gender-specific normal reference BIVA plots and corresponding tolerance and confidence ellipses on the RXc graph, which is important for the interpretation of BIA-reported volume status in patients with congestive heart failure or renal insufficiency. There were noticeable differences in reference ellipses with regard to gender and ethnic groups.


Assuntos
Composição Corporal/fisiologia , Impedância Elétrica , Insuficiência Cardíaca/diagnóstico , Insuficiência Renal/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Adulto Jovem
7.
JMIR Mhealth Uhealth ; 7(6): e13381, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215513

RESUMO

BACKGROUND: Little is known of the effect of wearable devices on metabolic impairments in clinical settings. We hypothesized that a wearable device that can monitor and provide feedback on physical activity may help resolve metabolic syndrome. OBJECTIVE: This study aimed to examine the objective effects of the use of these devices on metabolic syndrome resolution. METHODS: Patients diagnosed with metabolic syndrome were recruited. Participants were prescribed regular walking using a wearable device (Coffee WALKIE +Dv.3, GC Healthcare CI, Korea) on their wrist for 12 weeks. Participants received self-feedback on the amount of their exercise through an app on their mobile phone. The information on physical activities of the participants was uploaded automatically to a website. Thus, a trained nurse could provide individuals with feedback regarding the physical activity via telephone consultation on alternate weeks. Blood pressure (BP), body composition, fasting plasma glucose, and lipid profiles were recorded. The primary outcome was metabolic syndrome resolution. The secondary outcome was an improvement in the components of metabolic impairment. RESULTS: Of the 53 participants recruited, 20 participants with a median age of 46 (range 36-50) years completed the trial. There was no significant difference in the amount of calorie expenditure at weeks 4, 8, and 12. After 12 weeks, metabolic syndrome was resolved in 9 of 20 participants (45%), and the mean number of metabolic impairment components per person decreased from 3.4 to 2.9. Particularly, the mean systolic and diastolic BP decreased from mean 136.6 (SD 18.5) mm Hg to mean 127.4 (SD 19.5) mm Hg and from mean 84.0 (SD 8.1) mm Hg to mean 77.4 (SD 14.4) mm Hg (both P=.02), respectively. CONCLUSIONS: This study found that a 12-week intervention via feedback, based on a wearable physical activity monitor, helped metabolic syndrome patients to be more engaged in regular walking and it improved impaired metabolic components, especially in BP. However, some practical challenges regarding patients' adherence and sustained engagement were observed.


Assuntos
Exercício Físico/psicologia , Retroalimentação , Síndrome Metabólica/terapia , Dispositivos Eletrônicos Vestíveis/normas , Adulto , Feminino , Humanos , Masculino , Síndrome Metabólica/psicologia , Pessoa de Meia-Idade , Aplicativos Móveis/normas , Aplicativos Móveis/estatística & dados numéricos , Projetos Piloto , República da Coreia , Dispositivos Eletrônicos Vestíveis/estatística & dados numéricos
8.
Am J Emerg Med ; 37(8): 1600.e1-1600.e3, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31029522

RESUMO

Intrathoracic omental herniation (ITOH) is the herniation of the omentum through the esophageal hiatus without herniation of the stomach. It is a rare disease and serious complications due to ITOH have not been reported in the literature. Here, we reported the case of 47-year old man who presented to the emergency department with dyspnea and chest pain. Enhanced computed tomography (CT) demonstrated a large retrocardiac mass and ITOH was suspected. During the observation period in the emergency department, the patient's condition rapidly deteriorated. Follow-up CT showed large parapneumonic effusion and empyema. Emergency surgery was performed and the omental sac was removed. The patient's vital signs were restored and his symptoms were relieved. He was discharged on hospital day 15 without complications. Emergency physicians should be aware that severe complications of ITOH could develop and that if the patient's symptoms and vital signs worsen, emergency surgery should be considered.


Assuntos
Empiema/etiologia , Hérnia Hiatal/complicações , Omento , Doenças Peritoneais/etiologia , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Peritoneais/cirurgia , Resultado do Tratamento
9.
Asian J Surg ; 42(1): 106-111, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29249391

RESUMO

BACKGROUND/OBJECTIVES: The natural history of type II endoleaks (T2ELs) is still not completely understood; however, it is widely accepted that those associated with aneurysmal sac growth are harmful. We aimed to review our experience with T2ELs in endovascular aneurysm repair (EVAR). METHODS: We retrospectively reviewed electronic medical records of all patients who underwent EVAR for infrarenal-type abdominal aortic aneurysms (AAAs) at a single institution from August 2007 to November 2015. Demographic and clinical data were collected. Preoperative contrast computed tomography scans were reviewed to determine aneurysm morphology (the maximum AAA diameter, number of lumbar arteries that enter the AAA sac, size of the inferior mesenteric artery (IMA), proximal neck diameter, proximal neck angle, existence of thrombosis, presence of atheroma, and existence of rupture). RESULTS: Sixty-two patients underwent EVAR; the follow-up duration was 35.82 ± 31.89 months. There were statistically significant differences in female sex (P = .040), number of lumbar arteries on preoperative computed tomography scans (P = .010), and non-smoking status (P = .031) between patients with and without T2ELs. There were statistically significant differences in the maximum AAA diameter (P = .034) and size of the IMA (P = .043) between patients with and without secondary intervention in T2EL. There was one mortality after EVAR but no mortality associated with T2ELs. CONCLUSIONS: A more judicious approach that considers risk factors of T2ELs is needed before EVAR. The risk of secondary intervention in patients developing a T2EL after EVAR could increase with the maximum AAA diameter ≥7 cm or IMA ≥3 mm.


Assuntos
Aneurisma da Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/cirurgia , Endoleak/etiologia , Procedimentos Endovasculares , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Tomografia Computadorizada por Raios X
10.
Cardiol J ; 26(6): 653-660, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30009375

RESUMO

BACKGROUND: This study aimed to evaluate the effect of adenosine on epicardial coronary artery diameter during ergonovine provocation testing. METHODS: A total of 158 patients who underwent an ergonovine provocation test with intracoronary adenosine injection between 2011 and 2014 were selected. Patients were divided into four groups based on the severity of percent diameter stenosis following intracoronary ergonovine administration: Group 1, induced spasm < 50%; Group 2, 50-89%; Group 3, 90-99%; and Group 4, total occlusion. RESULTS: Spasm positivity was observed in 44 (27.8%) cases in the study population (mean age, 57.4 ± ± 10.7 years). Intracoronary adenosine increased the diameter of the ergonovine-induced epicardial artery by 0.51 ± 0.31 mm, 0.73 ± 0.39 mm, 0.44 ± 0.59 mm, and 0.01 ± 0.04 mm in Groups 1, 2, 3, and 4, respectively. Subsequent administration of nitroglycerin further increased vessel diameter by 0.49 ± 0.28 mm, 0.93 ± 0.68 mm, 2.11 ± 1.25 mm, and 2.23 ± 0.69 mm in Groups 1, 2, 3, and 4, respectively. The ratios of adenosine-induced diameter to reference diameter were significantly lower in patients with spasm positive results (0.68 [0.59-0.76] vs. 0.18 [0.00-0.41], p < 0.001 in the study population; 0.60 [0.54-0.67] vs. 0.40 [0.27-0.44], p < 0.001 in Group 2) with the best cut-off value of 0.505 (sensitivity 0.955, specificity 0.921). CONCLUSIONS: Intracoronary administration of adenosine dilated the ergonovine-induced vasoconstricted epicardial coronary artery. The ratio of adenosine-induced diameter to reference diameter was significantly lower in patients with spasm positive results.

11.
Thorac Cardiovasc Surg ; 66(8): 697-700, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29605961

RESUMO

BACKGROUND: In patients with parapneumonic empyema, decortication is usually preferred to ensure functional lung re-expansion. However, there could be patients exhibiting incomplete postoperative lung expansion and inadequate drainage despite decortication. Therefore, we evaluated factors affecting postoperative lung expansion in patients undergoing decortication. METHODS: A total of 221 patients with pyogenic empyema who underwent video-assisted thoracoscopic surgery (VATS) between January and October 2016 in our hospital were reviewed in terms of surgical success. The following factors were evaluated: age; the time between identification of a localized effusion and surgical referral; chest tube drainage durations; any underlying morbidity preoperative blood culture data; and the thickness of the visceral pleura. RESULTS: Several factors that significantly prolonged the postoperative time to lung expansion were evident in patients with diabetes mellitus (DM) and bacteremia; postoperative chest tube drainage was significantly longer in those with DM (p = 0.009) and bacteremia (p = 0.01); and postoperative hospitalization time was significantly longer in patients with bacteremia (p = 0.01). The thickness of the visceral pleura was strongly correlated with postoperative chest tube drainage duration and postoperative hospitalization time (Pearson correlation coefficient, r = 0.245, p = 0.00). CONCLUSIONS: In patients with DM, bacteremia, or thickened pleura, the time to lung expansion after operation was longer. Therefore, stricter pre- and post-operative control of blood-sugar levels and adequate antibiotics are required to facilitate postoperative lung re-expansion. In patients with thickened pleurae, prolonged chest tube placement is unavoidable.


Assuntos
Drenagem , Empiema Pleural/cirurgia , Pulmão/fisiopatologia , Pleura/cirurgia , Derrame Pleural/cirurgia , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tubos Torácicos , Criança , Pré-Escolar , Drenagem/efeitos adversos , Drenagem/instrumentação , Empiema Pleural/diagnóstico por imagem , Empiema Pleural/microbiologia , Empiema Pleural/fisiopatologia , Feminino , Humanos , Tempo de Internação , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pleura/diagnóstico por imagem , Pleura/microbiologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/microbiologia , Derrame Pleural/fisiopatologia , Recuperação de Função Fisiológica , República da Coreia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
12.
Cardiovasc Intervent Radiol ; 41(6): 972-975, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29546455

RESUMO

Blunt abdominal aortic injury (BAAI) is extremely rare. Three known treatments of BAAI exist: medical treatment, conventional surgical treatment, and endovascular treatment. Outcomes of medical and conventional surgical treatments, such as bypass graft, thrombectomy, and intimal suture, were not satisfactory. A 47-year-old man presented with multiple injuries after a high-speed vehicular accident. He was diagnosed with the traumatic aortic injury to be an intra-mural hematoma in the bifurcation of the terminal aorta. Endovascular repair with a kissing stent was performed after exploratory laparotomy. At 12 months postoperatively, the kissing stents were patent and intact, and there was no late complication. The findings indicate that the kissing stent could be useful for the treatment of BAAI in the terminal aorta.


Assuntos
Acidentes de Trânsito , Procedimentos Endovasculares/métodos , Stents , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Aorta Abdominal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem
13.
Korean J Thorac Cardiovasc Surg ; 50(6): 443-447, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29234611

RESUMO

Background: The inferior vena cava filter (IVCF) is very effective for preventing pulmonary embolism in patients who cannot undergo anticoagulation therapy. However, if a filter is placed in the body permanently, it may lead to other complications. Methods: A retrospective study was performed of 159 patients who underwent retrievable Cook Celect IVCF implantation between January 2007 and April 2015 at a single center. Baseline characteristics, indications, and complications caused by the filter were investigated. Results: The most common underlying disease of patients receiving the filter was cancer (24.3%). Venous thrombolysis or thrombectomy was the most common indication for IVCF insertion in this study (47.2%). The most common complication was inferior vena cava penetration, the risk of which increased the longer the filter remained in the body (p=0.032, Exp(B)=1.004). Conclusion: If the patient is able to retry anticoagulation therapy and the filter is no longer needed, the filter should be removed, even if a long time has elapsed since implantation. If the filter cannot be removed, it is recommended that follow-up computed tomography be performed regularly to monitor the progress of venous thromboembolisms as well as any filter-related complications.

14.
Ann Thorac Surg ; 104(6): e413-e415, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29153807

RESUMO

A 72-year-old man previously treated for an abdominal aortic aneurysm (AAA) was diagnosed with the 70-mm-sized type IIIb aortic dissection. Endovascular repair was considered, but there was no stent graft passing through the 8-mm iliac graft that was used for open repair of the AAA. We sealed the 5-mm-sized intimal tear site, using an Amplatzer Vascular Plug, which successfully repaired. The patient was discharged and had no complications. Serial follow-up computerized tomography scans showed that the vascular plug was positioned without migration, and the size of the aorta decreased.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Prótese Vascular , Procedimentos Endovasculares , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Doença Crônica , Humanos , Masculino
15.
Korean J Thorac Cardiovasc Surg ; 50(4): 263-269, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28795031

RESUMO

BACKGROUND: Endovascular aneurysm repair (EVAR) has dramatically changed the management of abdominal aortic aneurysms (AAAs) as the number of open aneurysm repairs have declined over time. This report compares AAA-related demographics, operative data, complications, and mortality after treatment by open aneurysm repair or EVAR. METHODS: We retrospectively reviewed 136 patients with AAAs who were treated over an 8-year time period with open aneurysm repair or EVAR. RESULTS: The mean age of the EVAR group was higher than that of the open repair group (p=0.001), and hospital mortality did not differ significantly between groups (p=0.360). However, overall survival was significantly lower in the EVAR group (p=0.033). CONCLUSION: Although EVAR is the primary treatment modality for elderly patients, it would be ideal to set slightly more stringent criteria within the anatomical guidelines contained in the instructions for use of the EVAR device when treating younger patients.

16.
J Trauma Acute Care Surg ; 83(5): 903-907, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28806284

RESUMO

BACKGROUND: We report our experience with extracorporeal cardiopulmonary resuscitation (ECPR) in patients with rupture of heart and major vessels caused by severe chest trauma. METHODS: From April 2015 to May 2016, 10 patients with suspected injuries to the heart and major vessels after focused assessment with sonography in trauma or computed tomography were selected from patients admitted at a Level I trauma center presenting with cardiac tamponade and tension hemothorax due to severe chest trauma. Patients were divided as follow: group A (n = 3), patients without cardiac arrest before entering the operating theatre; group B (n = 5), patients with cardiac arrest for whom ECPR was applied, and group C (n = 2), patients with cardiac arrest for whom ECPR was not applied. RESULTS: All patients underwent exploratory thoracotomy or sternotomy. Injuries included cardiac chamber ruptures (n = 8), lesions in the internal mammary arteries (n = 1), and lesions of the bronchial arteries (n = 1). In group B, extracorporeal membrane oxygenation (ECMO) was initiated and circulation was restored promptly with adequate extracorporeal blood flow in all five cases. These patients were weaned off ECMO uneventfully after controlling the bleeding in the operating theatre. Mean ECMO time was 142 ± 48.2 minutes. Conversely, both patients in group C died, one due to low cardiac output on postoperative day 1, and the other due to multiple-organ failure on postoperative day 7. CONCLUSION: ECPR may be an option to rescue and stabilize patients with cardiac arrest due to severe chest trauma. LEVELS OF EVIDENCE: Therapeutic/Care Management, Level V.


Assuntos
Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/terapia , Traumatismos Cardíacos/complicações , Adulto , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/terapia , Países em Desenvolvimento , Feminino , Parada Cardíaca/etiologia , Traumatismos Cardíacos/diagnóstico por imagem , Hemotórax/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Ruptura , Traumatismos Torácicos/complicações , Adulto Jovem
17.
Korean J Thorac Cardiovasc Surg ; 50(1): 41-43, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28180102

RESUMO

A 38-year-old female patient with a history of tetralogy of Fallot repair at 10 years of age underwent pulmonary valve replacement with a mechanical prosthesis, tricuspid annuloplasty, and right ventricular outflow tract cryoablation due to pulmonary regurgitation, tricuspid regurgitation, and multiple premature ventricular contractions with sustained ventricular tachycardia. After surgery, she had an uneventful postoperative course with arrhythmia monitoring. She was discharged without incident, and a follow-up Holter examination showed a decrease in the number of ventricular ectopic beats from 702 to 41.

18.
Catheter Cardiovasc Interv ; 89(2): 219-225, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-27535003

RESUMO

OBJECTIVES: The aim of this study was to explore the effect of one stenosis in a daughter artery on the fractional flow reserve (FFR) of another stenosis parallels in side branch. BACKGROUND: The impact of one stenosis on the FFR of another parallel stenosis has not been evaluated. METHODS: The proximal segments of the left anterior descending (LAD) and left circumflex (LCX) arteries were exposed and encircled with a Teflon pledget complex in seven swine (55-70 kg). Five degrees of stenosis (to approximate angiographic diameter stenoses of 0%, 25%, 50%, 75%, and 100%) were made by tightening the pledgets. FFR was evaluated simultaneously in the LAD and the LCX with two pressure wires in each coronary artery. A mixed-effects linear model was used to evaluate the association between the FFR values. RESULTS: A total of 115 paired FFR values were obtained. The FFR of the LAD and LCX were not significantly associated with each other (F = 0.237 and P = 0.627 for the LCX FFR to predict the LAD FFR; F = 0.541 and P = 0.463 for the LAD FFR to predict the LCX FFR). CONCLUSIONS: The individual FFR values of each parallel stenosis in the LAD and the LCX were not significantly influenced by each other. This relationship was independent of the mean aortic pressure and heart rate. © 2016 Wiley Periodicals, Inc.


Assuntos
Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Animais , Aorta/fisiopatologia , Pressão Arterial , Cateterismo Cardíaco , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Modelos Animais de Doenças , Frequência Cardíaca , Modelos Lineares , Masculino , Modelos Cardiovasculares , Análise Multivariada , Índice de Gravidade de Doença , Suínos
19.
ASAIO J ; 63(1): 99-103, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28033203

RESUMO

Anesthetic management of critical airway stenosis is often very challenging. Extracorporeal membrane oxygenation (ECMO) may provide adequate respiratory support when conventional approaches fail. We report our experience of ECMO support for critical airway surgery. Between April 2012 and March 2015, nine patients underwent ECMO-supported airway operation. The reason for surgery was tracheal stenosis in nine patients, and tracheomalacia, tracheal tumor, and external tracheal compression by mediastinal mass in one patient each. Resection and end-to-end anastomosis was performed in four patients; the remainder underwent diverse procedures, including tracheoplasty, tracheal ballooning, tracheostomy, and debulking of mediastinal mass. Extracorporeal membrane oxygenation support was sufficient for gas exchange during surgery and six patients were successfully weaned off intraoperatively. The median time on ECMO was 2.42 hours (range: 14.43-216 hours). No ECMO-related complications occurred. The median intensive care unit stay, median hospital stay, and mean follow-up period were 2 days (range: 1-61 days), 33 days (range: 9-303 days), and 17.1 ± 10.8 months, respectively. The rate of freedom from reintervention was 71.4%; the mean survival rates over 1 and 2 years were 76.2% and 63.5%, respectively. Our experience indicates that ECMO is a feasible and safe method for critical airway surgery.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Adolescente , Adulto , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos Retrospectivos
20.
Ann Vasc Dis ; 9(4): 295-299, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28018501

RESUMO

Background: Carotid endarterectomy (CEA) is the standard treatment modality for the prevention of stroke in patients with carotid stenosis. This study reports our experiences during CEA with routine awake tests under regional anesthesia (RA) combined with light sedation by dexmedetomidine infusion. Materials and Methods: We retrospectively reviewed 23 patients who had undergone CEA between April 2013 and June 2015. All patients underwent the awake test during CEA with cervical plexus block and light sedation by continuous dexmedetomidine infusion. Results: Mean operation and clamp times were 108.5 ± 20.1 min and 30.1 ± 6.9 min, respectively. Selective shunt placement was performed in three patients (13.0%). There were no cases of perioperative stroke, myocardial infarction, or death. There were no occurrences of residual stenosis, thrombosis, or dissection. One patient had a hypoglossal nerve injury but fully recovered before discharge. Mean (± standard deviation) hospital stay was 7.5 ± 2.6 days. There were no incidences of death, stroke, or restenosis during a mean follow-up period of 9.2 ± 8.8 months. Conclusions: RA with dexmedetomidine infusion appears to be a safe and feasible option. A lower shunt placement rate and favorable patient outcomes were observed following the awake test during CEA.

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