Shuichi Matsuno

Handlebar hernia with intra-abdominal extraluminal air presenting as a novel form of traumatic abdominal wall hernia : Report of a case

An 18-year-old male was admitted to our Emergency Department with a traumatic abdominal wall hernia (TAWH) of the left lower quadrant (LLQ) after suffering hypogastric blunt injury and urogenital lacerations in a motorcycle accident. Upright chest X-ray showed a small amount of right infradiaphragmatic free air, and a computed tomographic (CT) scan demonstrated an abdominal wall hernia. At surgery, no impairment was found in the digestive tract, and an abdominal herniorrhaphy was performed. It is suggested that the free air had passed through a connection between the scrotal laceration and the contralateral abdominal defect via the subcutaneous space and was palpated as emphysema. This is a new type of TAWH, which suggests that blunt abdominal trauma may result in negative pressure in the subcutaneous and peritoneal cavity, and this could reflect the pathophysiology of TAWH.

Clinical significance of reverse redistribution phenomenon after coronary artery bypass grafting

The reverse redistribution (RR) phenomenon is a decrease in thallium 201 uptake during redistribution compared with 201Tl uptake immediately after exercise. We evaluated RR in 23 patients after coronary artery bypass grafting. Postoperative RR was present in 48% and was significantly more common in patients with a history of myocardial infarction (62%). The patients were classified according to the presence (+) or absence (-) of RR. An analysis of left ventricular wall motion showed significant improvement after coronary artery bypass grafting in the RR+ group (n = 12) but not in the RR- group (n = 11). Quantitative myocardial viability was evaluated using the defect volume ratio, mean defect severity, and defect severity index. The preoperative defect volume ratio was higher in the RR+ group than in the RR- group (p < 0.05). In the RR- group, no improvement in these indices was observed after operation. In contrast, the RR+ group showed significant improvement in all three indices (p < 0.05). These results indicate that after coronary artery bypass grafting, an adequate blood supply to the remaining myocardium may induce RR. This phenomenon, therefore, may be a significant indicator of postoperative myocardial viability.

New modification of the Damus-Kaye-Stansel operation

We report a successful modification of the Damus-Kaye-Stansel operation for transposition of the great arteries when the coronary arteries are unsuitable for transfer. The procedure includes creation of a neoaorta with end-to-end anastomosis of the proximal pulmonary artery to the distal ascending aorta and creation of an aortopulmonary window between the proximal great arteries. A valved conduit is interposed between the right ventricle and the distal pulmonary artery.

Spinal Cord Damage after Aorto-bifemoral Bypass Operation.

腹部大動脈手術時の脊髄障害は希だが, 患者の quality of life の上からも重大な合併症である. 今回, われわれは腹部大動脈・腸骨動脈領域の閉塞性動脈硬化症術後に右下肢麻痺を発症した1例を経験した. 症例は59歳の男性. 左総腸骨動脈, 右外腸骨動脈の閉塞性動脈硬化症に対する腹部大動脈・両側大腿動脈バイパス術後に右側の第2腰髄 (L2) から第1仙髄 (S1) にかけての運動および痛覚麻痺が出現した. 脊髄障害は内科的治療などによりS1は改善したもののL2-L5は改善せず, 患者は術後3か月目に退院した. 腹部大動脈-大腿動脈バイパス術において, 粥状硬化の強い腹部大動脈に対する side clamp は腰動脈の開口部を閉塞させる可能性があり, 脊髄障害発症の危険性を高めると考えられる.