悪性腫よう術後に発症した心因性健忘（解離性記憶障害）の症例 (original) (raw)

術前塞栓術と直達術により治療を行ったくも膜下出血発症の成人・後頭蓋窩pial AVFの1例

Surgery for Cerebral Stroke, 2015

The incidence of pial arteriovenous fistulas (pAVFs) is low, and most cases are treated by interrupting the shunt via endovascular or direct surgery. In the present report, we describe a very rare case of pAVF and discuss the treatment and pathological findings of such cases in the literature. A 63-year-old woman presented with a sudden headache and vomiting. Computed tomography (CT) indicated the presence of a subarachnoid hemorrhage, but she was treated conservatively. The hematoma size gradually decreased and her neurological findings remained unchanged. Angiography indicated the presence of pAVF. The fistula was fed by small branches of the common trunk between the right anterior inferior cerebellar artery and posterior inferior cerebellar artery, and drained into the varix. Feeder occlusion was performed through Histoacryl infusion under local anesthesia. One day after embolization, the patient underwent right suboccipital craniotomy, and the pAVF was extirpated by electrocoagulation. Postoperative angiography indicated that the fistula had disappeared. She was discharged without any new neurological deficits. Thus, pAVF was treated in a more safe and reliable manner with combined therapy as compared to one-staged therapy.

重度のえん下障害で発症し対照的な経過を辿った延髄外側症候群の２例

The Japanese Journal of Rehabilitation Medicine, 2004

Severe dysphagia occurs in over 50% of lateral medullary syndrome (LMS) cases, and the prognosis varies greatly among individuals. Predicting the prognosis of the dysphagia from data acquired at the acute phase is very important in selecting both the type and duration of dysphagia treatment. Here we examined whether radiological findings and severity of dysphagia in the acute phase could accurately predict prognosis and treatment required. We experienced 2 cases of LMS in which magnetic resonance imaging in the acute phase showed medullary lesions on the ipsilateral side of the medulla in each patient. Videofluorograhic examination of swallowing revealed severe dysphagia with an absence of the swallowing reflex. Both patients received swallowing therapy, including thermal stimulation, supraglottic swallow, and the Mendelsohn maneuver. While dysphagia was significantly improved one month post onset in one patient, the loss of swallowing reflex continued for more than one year in the other patient. These findings indicate that radiological data and severity of dysphagia in the acute phase cannot accurately predict the prognosis of dysphagia in LMS patients.

急性A 型大動脈解離術後，人工心肺離脱不能症例に対してVeno-Arterial Extracorporeal Membrane Oxygenation を使用し救命した1 例

日本血管外科学会雑誌, 2013

We report here a case of acute aortic dissection (Stanford Type A) with severe aortic regurgitation (AR) successfully treated by postoperative ECMO (extracorporeal membrane oxygenation). The patient was a 52-year-old man who was transferred to our hospital after complaining of chest-back pain. An emergent operation was performed after diagnosis of a type A acute aortic dissection with severe AR. We performed ascending aortic replacement under hypothermia arrest and retrograde cerebral perfusion. ECMO became necessary, because of postoperative acute respiratory failure. We used axillary artery cannulation with a graft anastomosis for inflow perfusion in ECMO because of central support with antegrade flow and excellent upper body oxygenation. During ECMO, anticoagulation with nafamostat mesilate was used to control bleeding complications. Postoperative bleeding decreased gradually and the patient was successfully weaned from ECMO 65 hours after the operation with no neurological complications. The recovery was uneventful, and at discharge the patient was able to walk out of the hospital without assistance. In this case, V-A ECMO with axillary arterial perfusion was performed successfully after acute aortic dissection, with no cerebral complications. Moreover, we reported that nafamostat mesilate was effective in preventing bleeding during ECMO.

腹部大動脈瘤ステントグラフト内挿術後に発症したコレステロール塞栓症の１例

Japanese Journal of Cardiovascular Surgery, 2010

We report a case of cholesterol crystal embolism(CCE)after endovascular aortic repair for abdominal aortic aneurysm(AAA). A 68-year-old man with AAA underwent endovascular aortic repair. He complained of left lower abdominal pain after the operation. Abdominal CT showed renal infarction on postoperative day 10. Renal dysfunction developed after postoperative day 17. A biopsy of the renal infarct lesion demonstrated characteristic cholesterol clefts in the small arteries. We diagnosed CCE. Steroid therapy was administered and the patient's condition improved remarkably. Diagnosis of CCE is difficult and its prognosis still remains poor. Therefore, we should keep this unusual complication in mind.