Yoshitaka Uchiyama

An aberrant left subclavian artery aneurysm with right aortic arch: Report of a case

The case of a 41-year-old man who developed an aneurysm in his aberrant left subclavian artery is described. The patient had a right aortic arch. After a successful aortosubclavian artery bypass, symptoms due to brain ischemia disappeared. This is a very rare disease that is sometimes associated with an aortic anomaly, therefore the optimal therapeutic procedure need to be carefully selected, including the operative indications and approach.

Successful application of an omental pedicle flap in delayed repair of a perforated esophageal diverticulum: Report of a case

Mediastinitis resulting from a perforated esophageal diverticulum is a potentially fatal complication and the surgical treatment of persistent esophagomediastinal fistula may be difficult. In this report, we describe the successful application of an omental pedicle flap in the delayed repair of a perforated esophageal diverticulum. A 53-year-old man presented with chest and back pain and a diagnosis of perforated esophageal diverticulum was subsequently confirmed. After receiving conservative treatment, he was referred to our department and underwent surgical repair 6 months following the onset of the perforation. Through a right thoracotomy, the mucosal layer of the esophagus around the diverticulum was sutured, and an omental pedicle flap was used to cover the suture line and obliterate the fistulous tract. His postoperative course was uneventful and the suture line healed well. The successful treatment of this patient reinforces our belief that wider application of the omental pedicle flap can be expected in the field of thoracic surgery.

A case of antiarrhythmic agent-induced atrioventricular and intraventricular conduction disturbance in chronic hemodialysis patients after CABG

抗不整脈剤であるpilsicainide hydrochlorideの催不整脈作用により房室および心室内刺激伝導障害を起こした1例を経験し, 血液吸着および血液透析による同剤の除去効果についての知見を得たので報告する. 症例は57歳男性, 慢性腎不全に対して血液透析中であったが, 不安定狭心症のため冠動脈バイパス術を施行した. 術後心室性期外収縮に対しmexilletine, disopyramideを使用したが効果がなく, pilsicainide hydrochloride (150mg) を開始した. 不整脈は消失したが, 開始後5日目に突然心電図変化 (PQ延長, QRS幅の増大) が出現し, pilsicainide hydrochlorideの催不整脈作用による房室および心室内刺激伝導障害と診断した. 投薬を中止するとともに緊急の血液吸着と血液透析を施行し, 血中濃度 (有効血中濃度: 0.2-0.9μg/ml) は4.74μg/mlから3.96μg/mlまで減少した. その後合計6回の血液透析を施行し, 発症後14日目の透析後の血中濃度は0.38μg/mlまで減少した. 心電図変化も改善し, 血中濃度と心電図上のPQ時間, QRS幅との間には有意な相関を認めた. Pilsicainide hydrochlorideに対する血液吸着および6回の透析による平均除去率はそれぞれ13.7%, 23.9%で開始後120分でのクリアランスはそれぞれ37.6ml/min, 84.1ml/minであった. また膜前後の血中濃度差から算出した実際の除去量は血液吸着では31mg, 4回目の透析時は8.3mgであり, 各時点における循環血液中の含有量をほぼ除去できたと判断された.