1/2. Hemodynamic changes after resection of thoracic duct for en bloc resection of esophageal cancer.An en bloc resection of esophageal cancer is one of the most radical forms of esophagectomy, and includes the resection of the thoracic duct, but a relatively high hospital mortality rate has been reported. There is very little knowledge on the pathophysiological changes after resection of the thoracic duct. We examined 24 patients who underwent en bloc resection. Some patients developed severe tachycardia or shock postoperatively which subsided after a massive infusion of plasma. Analysis of the fluid balance revealed that much more fluid was necessary during surgery and the postoperative 24 h than in patients treated by a standard esophagectomy. Postoperative lymphangiography or CT revealed abnormal collateral lymphatics around the kidneys or in the pelvic cavity. This suggests the development of the lymphaticovenous shunts, which differed depending on the anatomy of each patient. One patient with chronic hepatitis developed uncontrollable ascites. These are important findings which can hopefully reduce the high rate of hospital death after this operation.- - - - - - - - - - ranking = 1keywords = section (Clic here for more details about this article) |
2/2. Severe von Willebrand's disease during labor and delivery.In pregnant women with severe von Willebrand's disease, the prepartum period should include monitoring for a rise in factor viii-related activities (factor viii coagulant activity [factor viii:C], factor viii-related antigen [VIII R:Ag], and factor viii ristocetin cofactor [factor viii R:Cof]). Two women whose pregnancies were so monitored were delivered of normal infants: one by cesarean section and one by vaginal delivery. The failure of factor viii:Ag or factor viii R:Cof to rise above the level of 50% at term in the woman who delivered vaginally predicted hemostatic difficulty during the postpartum period. She was, therefore, treated with cryoprecipitate. In the woman who gave birth by cesarean section, although all factor viii-related activities rose into the normal range, the additional surgical trauma anticipated in cesarean section prompted the use of cryoprecipitate as well.- - - - - - - - - - ranking = 16.191791061253keywords = cesarean section, delivery, section (Clic here for more details about this article) |