Hiroshi Ikuta

Surgical treatment of patients with psychiatric disorders: A review of 21 patients

Between January 1985 and September 1994, 21 patients with psychiatric disorders underwent various forms of surgery at our hospital. There were 12 men and 9 women with an average age of 57.6 years. The coexisting psychiatric disorders were schizophrenia in 15 patients, depression in 2, dementia in 2, mental retardation with epilepsy in 1, and Parkinsons disease in 1. All the patients had been receiving neuroleptic medications for a long period. The indications for surgery were: cholelithiasis in 6 patients, acute appendicitis in 4, perforation of the small intestine in 3, incarceration of an inguinal hernia in 2, and esophageal cancer, stomach cancer, bleeding from a gastric ulcer, perforation of a duodenal ulcer, strangulating ileus, and burns in 1 patient each, respectively. All of the patients who underwent elective surgery were given epidural anesthesia with or without general anesthesia. Antipsychotic medications were given until just prior to surgery and recommenced concurrent with the first meal. Abnormal behavior was observed in 11 patients (52.4%) postoperatively, but all the patients were discharged in accordance with recovery from their surgical disorder. Intra- and postoperative hypotension resistant to intravenous catecholamine administration was recognized in 9 patients (42.9%), and this peculiar complication should be borne in mind when patients with psychiatric disorders require surgical management.

SURGICAL OPERATION OF 12 PATIENTS WITH PSYCHIATRIC DISEASE

In a 4-year period from April, 1988 to March, 1992, we performed surgical operation for 12 patients with psychiatric disease. There were 8 men and 4 women, with an average age of 56.5 years. These patients have been troubled with various psychiatric diseases, such as shizophrenia in 7 cases, dementia, mania and depression, Parkinsons disease, mental disorder by methanphetamine and alcholism in each one case, for 3 months to 35 years before the operation. Operations were performed emergently in 5 cases (41.7%) and under general anesthesia in 10 cases (83.3%), Catecholamine-resistant hypotention, suspected to be induced by long-term medication of antipsychotic drugs, was observed in 5 cases (41.7%) in the period of intra-and postoperative stages. Antipsychotic drugs were given until the day before operation, and restarted with meals in all cases. However strange and disquieting behaviors were observed in 6 cases (50%) postoperatively, all of them could be discharged from the hospital with recovery of their surgical diseases. In the management of surgical psychiatric patients, causion should be exersized to the possible occurrence of intra-and postoperative catecholamine-resistant hypotension.

Laser Application in the Fields of Cardiovascular Surgery; Experimental and Clinical Studies

Recently, several kinds of lasers have been widely employed in the fields of medicine and surgery. However, laser applications are very rare in the field of cardiovascular surgery throughout the world. By the way, surgical treatment for ischemic heart disease has been widely performed in Japan. Especially aortocoronary bypass (A-C bypass) for these patients has been down as a popular surgical intervention.