記述言語：日本語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study investigates short-term outcomes following surgical interventions for atrial fibrillation (Af), including the Cox-maze Ⅳ procedure (maze procedure) and pulmonary vein isolation (PVI), performed concurrently with other cardiac surgeries. Additionally, we aim to determine the indications for surgical intervention for Af. METHOD: We retrospectively studied a total of 1,580 patients, out of which 274 had preoperative Af, that underwent cardiac surgery between January 2015 and April 2023. Patients who underwent emergency surgery, died in the hospital postoperatively, or received pacemaker implantation were excluded. Patients were first divided into two groups:the intervention group (n=135, 53.6%) and the non-intervention group( n=117, 46.4%), further categorized by whether they were in sinus rhythm at discharge. The intervention group was then subdivided into the maze procedure group( n=54), and the PVI group (n=76). RESULTS: Within the maze procedure group, significant differences were observed between the sinus rhythm and non-sinus rhythm groups in terms of age, preoperative Af duration, and aortic valve intervention status. In the PVI group, patients with persistent Af, longer preoperative Af duration, and larger left atrium diameter( LAD) were less likely to return to sinus rhythm. Smaller LAD was also a significant factor for returning to sinus rhythm in the non-intervention group. Multivariate analysis for all patients revealed that an LAD smaller than 50 mm was the strongest predictor for returning to sinus rhythm post operation( p<0.01). CONCLUSION: For patients with persistent Af, the maze procedure is favored over PVI as a surgical intervention. When LAD exceeds 50 mm, the likelihood of returning to sinus rhythm is diminished.

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記述言語：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00349&link_issn=&doc_id=20231229040004&doc_link_id=issn%3D0021-5252%26volume%3D77%26issue%3D1%26spage%3D4&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0021-5252%26volume%3D77%26issue%3D1%26spage%3D4&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：北海道外科学会  

急性心筋梗塞後の合併症として左心室瘤は通常慢性期に左室形成術を施行するが,心破裂や乳頭筋断裂による重症僧帽弁閉鎖不全症等併発した場合,手術時期の適切な判断に苦慮する。今回,急性心筋梗塞後,心破裂と乳頭筋断裂による重症僧帽弁閉鎖不全を併発した左心室瘤に対して僧帽弁置換術(MVR)と左室形成術を段階的に施行し,良好な治療成績が得られた一例を経験したので報告する。74歳男性が熱発後,下肢の脱力が出現し,他院へ救急搬送され,冠動脈造影検査で右冠動脈#3の完全閉塞を認める下壁梗塞として保存的に加療していたが,左心室瘤,oozing型心破裂,乳頭筋断裂による僧帽弁閉鎖不全症を発症し,手術目的に当科転院し,救命目的に心膜開窓ドレナージ術を施行した。その後,循環動態が安定したため,僧帽弁置換術を施行した。しかし,術後4ヵ月で心室瘤の拡大傾向を認めたため,当科で左室形成術(David-Komeda式)を施行し,術後経過は良好で術後16日目に前医へ転院となった。(著者抄録)

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記述言語：日本語   出版者・発行元：北海道外科学会  

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記述言語：英語  

Although total arch replacement would be performed in a patient with acute type A aortic dissection and concomitant aortic aneurysm in the distal aortic arch, total arch replacement may be too invasive in elderly patients with significant morbidities. A 92-year-old female with acute type II DeBakey aortic dissection and concomitant distal aortic arch aneurysm was successfully treated with hemi-arch replacement followed by thoracic endovascular aortic repair. Hybrid two-stage repair of DeBakey type II aortic dissection complicated by distal arch aneurysm using thoracic endovascular aortic repair after hemi-arch replacement may be effective.

DOI： 10.1093/jscr/rjad648

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記述言語：日本語   出版者・発行元：北海道外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cases that are inoperable owing to poor preoperative conditions are sometimes encountered. However, there are some cases that are led to radical treatment by performing bridge therapy. Here, we presented a case of a patient with complex cardiac disease in an inoperable state who underwent bridging therapy that led to successful surgical treatment. A 73-year-old male who received hemodialysis treatment and had severe aortic valve stenosis and coronary artery disease planned surgical treatment. However, he was deemed inoperable owing to his low cardiac function and hemodynamic instability. Therefore, to escape from a fatal condition, we first performed balloon aortic valvuloplasty and percutaneous coronary intervention as palliative procedures. Subsequently, his cardiac function and hemodynamic stability remarkably improved; therefore, after 1 month, we performed a successful radical surgical treatment. Even in inoperable patients, bridging therapy leading to radical treatment is possible.

DOI： 10.59958/hsf.5779

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記述言語：英語  

Acute coronary syndrome with cardiogenic shock is a life-threatening condition, but with planned staged treatment combined with coronary revascularization and mechanical circulatory supports its management is increasingly possible. Here, we present our successful life-saving case. A 76-year-old male patient was diagnosed with ST-elevation myocardial infarction with cardiogenic shock due to severe stenosis of the left main coronary artery based on the severe triple vessel disease. We initially introduced Impella CP and performed a percutaneous coronary intervention without stenting on the patient. We maintained hemodynamics with Impella CP and performed coronary artery bypass grafting after a week. Intraoperatively, Impella CP was left to function as a left ventricular vent. The patient required upgrading to Impella 5.5 plus veno-arterial extracorporeal membrane oxygenation postoperatively, but his condition gradually improved, all mechanical circulatory supports could be weaned off, and he eventually survived.

DOI： 10.1093/jscr/rjad631

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語  

Driveline infection (DLI) is treated by local irrigation via driveline exit site (DLES) and surgical debridement is considered in patients with deep DLI. We describe three cases of deeply progressed superficial DLI that were considered to require surgical debridement but could be treated with a unique catheter cleaning method using intravenous indwelling catheter, a cotton swab with 10% silver nitrate solution and a monofilament nylon thread. Case 1 was a 60-y-old man with ischemic cardiomyopathy with left ventricular assist device implantation 2 y before. Daily bedside debridement with 10% silver nitrate solution was performed via the DLES. Case 2 was a 43-y-old man with ischemic cardiomyopathy who had recurrent DLI with methicillin-resistant Staphylococcus aureus, and case 3 was a 49-y-old woman with hypertrophic cardiomyopathy, who also showed improvement in their DLI with Pseudomonas aeruginosa. These cleaning methods may be useful for the deeply progressed superficial DLI.

DOI： 10.1093/jscr/rjad443

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記述言語：英語  

Minimally invasive direct coronary artery bypass is preferred due to its less invasive nature; however, it carries the risk of graft failure owing to inherent technical challenges. We present a case where minimally invasive direct coronary artery bypass grafting was performed and graft failure was detected via coronary angiography 3 days post-operation. Successful percutaneous coronary intervention was subsequently performed on the failed graft itself to salvage myocardial cellular damage. Consequently, the combination of minimally invasive direct coronary artery bypass and percutaneous coronary intervention, both less-invasive revascularization approaches, effectively achieved the primary treatment objective.

DOI： 10.1093/jscr/rjad420

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記述言語：日本語   出版者・発行元：北海道外科学会  

症例は19歳男性,フットサルのサークル活動中に意識消失し,心肺停止となった。ただちに心肺蘇生が行われ,自動体外式除細動器(AED)で計2回除細動を行ったところ自己心拍が再開した。AEDの初期波形は心室細動であった。冠動脈コンピュータ断層撮影では右冠動脈(RCA)が左冠動脈洞より起始し,上行大動脈と肺動脈の間を走行しており,右冠動脈左冠動脈洞起始症と診断され手術を実施する方針となった。術式は右内胸動脈-RCAの冠動脈バイパス術(CABG)及びRCA根部離断を行った。術後経過は良好であり,術後11日目に独歩退院となった。術後約1年経過した現在,自制内ではあるが運動は再開できており,経過は良好である。冠動脈起始異常症の術式選択に関する一定のガイドラインは存在せず,またその解剖学的多様性から,術式は多岐にわたる。本症例のように,左右冠動脈起始部が近接している場合,CABG+異常起始冠動脈根部離断術は有効な選択肢となり得る。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01375&link_issn=&doc_id=20230731050010&doc_link_id=%2Fdc7hksrg%2F2023%2F006801%2F011%2F0042-0045%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2023%2F006801%2F011%2F0042-0045%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10047-023-01398-9

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ehjcr/ytad080

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：北海道外科学会  

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記述言語：日本語   出版者・発行元：北海道外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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掲載種別：研究論文（学術雑誌）  

<h4>Background</h4>No study has examined the association of the calcification of abdominal artery orifices with nonocclusive mesenteric ischemia (NOMI) in dialysis patients undergoing cardiac surgery. Thus, this study aimed to determine whether calcification of abdominal blood vessel orifices in hemodialysis patients may be a risk factor for NOMI and examine the long-term survival of dialysis patients after undergoing cardiac surgery.<h4>Methods</h4>From April 2014 to September 2020, 100 dialysis patients underwent cardiac surgery at our hospital. The calcification of the celiac artery (CA) and superior mesenteric artery (SMA) was evaluated by computed tomography, and the degree of orifice stenosis was graded as follows: patent, 0; partial occlusion, 1; and complete occlusion, 2.<h4>Results</h4>Eight patients experienced NOMI, and all of them died. SMA calcification scores were not significantly different between the NOMI and non-NOMI groups (1.38±0.52 vs. 1.13±0.69; P = 0.247). However, the average CA orifice calcification score was significantly greater in the NOMI group than in the non-NOMI group (1.63±0.52 vs. 1.15±0.65; P = 0.039), and the SMA+CA orifice calcification scores were significantly different between the groups (3.00±0.76 vs. [non-NOMI] 2.25±1.18; P = 0.028). In all patients, the 30-day and in-hospital mortality rates were 13% and 18%, respectively. All patients were completely followed up with a mean follow-up period of 604±585 days. Kaplan-Meier survival curves showed that patients with SMA and CA calcification tended to have a shorter overall survival than patients without calcification; however, no significant difference was noted.<h4>Conclusions</h4>The calcification of CA and/or SMA orifices was associated with postoperative NOMI and poor long-term survival among dialysis patients undergoing cardiac surgery.

DOI： 10.1532/hsf.4859

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.xjtc.2022.09.011

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掲載種別：研究論文（学術雑誌）  

Vascular tissue engineering has shown promising results in "healthy" animal models. However, studies on the efficacy of artificial grafts under "pathological conditions" are limited. Therefore, in this study, we aimed to characterize the performance of polyvinyl alcohol (PVA)-coated poly-ε-caprolactone (PCL) grafts (PVA-PCL grafts) under diabetic conditions. To this end, PCL grafts were produced <i>via</i> electrospinning and coated with the hydrophilic PVA polymer, while a diabetic rat model (DM) was established <i>via</i> streptozotocin injection. Thereafter, the performance of the graft in the infrarenal abdominal aorta of the rats was evaluated <i>in vivo</i>. Thus, we observed that the healthy group showed CD31 positive/αSM positive cells in the graft lumen. Further, the patency rate of the PVA-PCL graft was 100% at 2 weeks (<i>n</i> = 7), while all the DM rats (<i>n</i> = 8) showed occluded grafts. However, the treatment of DM rats with neutral protamine Hagedorn insulin (tDM) significantly improved the patency rate (100%; <i>n</i> = 5). Furthermore, the intimal coverage rate corresponding to the tDM group was comparable to that of the healthy group at 2 weeks (tDM <i>vs.</i> healthy: 16.1% <i>vs.</i> 14.7%, <i>p</i> = 0.931). Therefore, the present study demonstrated that the performance of the PVA-PCL grafts was impaired in DM rats; however, insulin treatment reversed this impairment. These findings highlighted the importance of using a model that more closely resembles the cases that are encountered in clinical practice to achieve a clinically applicable vascular graft with a small diameter.

DOI： 10.1039/d2bm00531j

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Postoperative atrial fibrillation is a poor prognostic factor associated with increased mortality rates. Patients experiencing significant pericardial effusion develop postoperative atrial fibrillation; however, little is explored about the association between postoperative atrial fibrillation and post-cardiotomy pericardial effusion. This retrospective, single-center study included adult patients who underwent cardiovascular surgery via median sternotomy from January 2016 to December 2019. Patients who underwent routine postoperative computed tomography at 7 ± 3 days after surgery (n = 294) were included. Pericardial effusion was measured at the thickest point. Patients were classified into those with (n = 127) and without (n = 167) postoperative atrial fibrillation. The association of pericardial effusion with other factors was evaluated. A possible confounder-adjusted logistic regression analysis after multiple imputation was performed to obtain odds ratios for postoperative atrial fibrillation using previously published risk factors. Age, intraoperative bleeding volume, and pericardial effusion size were all significantly higher in the group with postoperative atrial fibrillation. Multivariate logistic regression after multiple imputation revealed that age, intraoperative bleeding volume, and postoperative pericardial effusion were significantly associated with postoperative atrial fibrillation. Our findings suggest that post-cardiotomy pericardial effusion is associated with postoperative atrial fibrillation. However, the causality remains unknown, making further studies mandatory.

DOI： 10.1007/s10554-022-02560-9

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press ({OUP})  

DOI： 10.1093/jscr/rjac129

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier {BV}  

DOI： 10.1016/j.xjtc.2021.08.049

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掲載種別：研究論文（学術雑誌）  

Hypothermic circulatory arrest (HCA) is an essential procedure during aortic surgery to protect organs; however, hypothermia is believed to cause coagulopathy, which is a major fatal complication. This study aimed to clarify the impact of hypothermia on coagulation by eliminating clinical biases in vitro. In the hypothermic storage study, blood samples from five healthy volunteers were stored at 37 ℃ (group N) for 3 h or at 20 ℃ for 2 h, followed by 1 h of rewarming at 37 ℃ (group H). Thromboelastography was performed before and after 3 h of storage. In the mock circulation loop (MCL) study, blood samples were placed in the MCL and (a) maintained at 37 ℃ for 4 h (group N, n = 5), or (b) cooled to 20 ℃ to simulate HCA with a 0.1 L/min flow rate for 3 h and then rewarmed to 37 ℃ (group H, n = 5). The total MCL duration was 4 h, and the flow rate was maintained at 1 L/min, except during HCA. Blood samples collected 15 min after the beginning and end of MCL were subjected to standard laboratory tests and rotational thromboelastometry analyses. Hypothermia had no impact on coagulation in both the hypothermic storage and MCL studies. MCL significantly decreased the platelet counts and clot elasticity in the INTEM and EXTEM assays; however, there was no effect on fibrinogen contribution measured by FIBTEM. Hypothermia does not cause irreversible coagulopathy in vitro; however, MCL decreases coagulation due to the deterioration of platelets.

DOI： 10.1007/s10047-022-01324-5

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掲載種別：研究論文（学術雑誌）  

<h4>Objective</h4>To identify whether preoperative magnetic resonance imaging findings of the brain can predict postoperative delirium in patients who undergo arch replacement for aneurysms.<h4>Methods</h4>Overall, 193 patients who underwent aortic replacement for the first time at a single institution between April 2014 and September 2020 were enrolled in this retrospective study. After we excluded patients with acute aortic dissection, no preoperative magnetic resonance imaging findings of the brain, and postoperative cerebral infarction, 50 patients were included and divided into 2 groups, according to their confusion scale results: postoperative delirium (group D) and nonpostoperative delirium (group ND). Preoperative magnetic resonance imaging findings of the brain were classified into lacunar stroke, periventricular hyperintensity, and deep subcortical white matter hyperintensity groups; the latter 2 groups were further classified based on the Fazekas scale, grade 0 to 3.<h4>Results</h4>There were 23 patients (46%) in group D and 27 (54%) in group ND. The mean age was significantly greater in group D than in group ND (75 vs 70 years; <i>P</i> = .007). The mean operative time was significantly longer in group D than in group ND (447 vs 384 minutes; <i>P</i> = .024). As for preoperative magnetic resonance imaging findings of the brain, there were significantly more lacunar stroke cases in group D than in group ND (<i>P</i> = .027). In multivariable logistic regression with stepwise selection, high-grade periventricular hyperintensity was significantly related to postoperative delirium (odds ratio, 9.38; 95% confidence interval, 1.55-56.56; <i>P</i> = .015).<h4>Conclusions</h4>Silent cerebral ischemia detected by preoperative magnetic resonance imaging of the brain was a significant risk factor for postoperative delirium.

DOI： 10.1016/j.xjon.2022.02.026

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掲載種別：研究論文（学術雑誌）  

Background and objective Postcardiotomy cardiogenic shock (PCS) is one of the most critical conditions observed in cardiac surgery. Recently, the early initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been recommended for PCS patients to ensure end-organ perfusion, especially in high-volume centers. In this study, we investigated the effectiveness of earlier initiation of VA-ECMO for PCS in low-volume centers. Methods We retrospectively assessed patients admitted in two of our related facilities from April 2014 to March 2019. The patients who underwent VA-ECMO during peri- or post-cardiac surgery (within 48 hours) were included. We divided the patients into two groups according to the timing of VA-ECMO initiation. In the early initiation of VA-ECMO group, the "early ECMO group," VA-ECMO was initiated when patients needed high-dose inotropic support with high-dose catecholamines, such as epinephrine, without waiting for PCS recovery. In the late initiation of VA-ECMO group, the "late ECMO group," VA-ECMO was delayed until PCS was not controlled with high-dose catecholamines, with the intent of avoiding severe bleeding complications. Results A total of 30 patients were included in the analysis (early ECMO group/late ECMO group: 19/11 patients). Thirty-day mortality in the entire cohort was 60% (n=18), and there was no significant difference between the two groups (early ECMO group/late ECMO group: 64%/55%, p=0.712). Thirteen and six patients died without being weaned off in the early ECMO (43%) and late ECMO groups (55%), respectively; there was no significant difference between the two groups (p=0.696). The median duration of ECMO support was five days (IQR: 1.5-6.5). Conclusions The early initiation of ECMO did not contribute to patients' 30-day outcomes in low-volume centers. To improve outcomes of ECMO therapy in patients with PCS, centralization of low-volume centers may be required.

DOI： 10.7759/cureus.22474

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掲載種別：研究論文（学術雑誌）  

<h4>Backgrounds</h4>Minimally invasive mitral valve surgery (MIMVS) in patients with a small body presents surgeons with a technically difficult surgical maneuver. We hypothesized that physique might negatively influence the safety and technical complexity of MIMVS.<h4>Methods</h4>One hundred and twenty-one patients underwent MIMVS in our institution between May 2014 and April 2020. These patients were categorized into two groups. The first group was the small physique group (<i>n</i> = 20) consisting of patients with a stature <150 cm. The second group was the normal physique group (<i>n</i> = 101) consisting of patients with a stature >150 cm. The primary endpoint was freedom from death and major adverse cardiovascular and cerebrovascular events (MACCE). The secondary endpoint was freedom from moderate or severe mitral regurgitation.<h4>Results</h4>Cardiopulmonary bypass time (130 ± 29 vs. 156 ± 55 min, <i>p</i> = 0.02) and aortic cross-clamp time (75 ± 27 vs. 95 ± 39 min, <i>p</i> = 0.03) were significantly shorter in the small physique group. Both in the early and midterm periods, there was no significant difference in the mortality (early, 5.0 vs. 1.0%, <i>p</i> = 0.30. midterm, 5.0 vs. 1.0%, <i>p</i> = 0.09), MACCE (early, 5.0 vs. 6.9%, <i>p</i> = 0.65. midterm, 5.0 vs. 5.9%, <i>p</i> = 0.93) and the residual MR (early, 0 vs. 1.0%, <i>p</i> = 0.66. midterm, 5.0 vs. 4.9%, <i>p</i> = 0.93) between the two groups.<h4>Conclusions</h4>Small physique is not a hurdle for MIMVS in terms of the safety of the operation.

DOI： 10.3389/fsurg.2021.746302

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.xjtc.2022.01.015

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Korean Society for Thoracic and Cardiovascular Surgery  

DOI： 10.5090/jcs.21.048

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

DOI： 10.1007/s11748-021-01605-5

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press ({OUP})  

DOI： 10.1093/jscr/rjab094

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掲載種別：研究論文（学術雑誌）  

<h4>Background</h4>In adult patients with primary or recurrent coarctation of the aorta (CoA), extra-anatomic bypass grafting (EABG) has been widely used as a surgical treatment option. However, there have been few reports on pseudoaneurysms (PAs) of the distal anastomotic sites after extra-anatomic bypass for CoA.<h4>Case presentation</h4>A 51-year-old man with hemoptysis was transferred to our hospital. Twenty years ago, he had undergone EABG from the ascending to the descending aorta (ascending-to-descending EABG) for CoA with right aortic arch. Eight years ago, he underwent thoracic endovascular aortic repair (TEVAR) for the ruptured PA on the distal anastomotic site of the EABG. Contrast-enhanced computed tomography scans revealed recurrent ruptured PA on the distal anastomotic site of the EABG. Therefore, we decided to replace the descending aorta, followed by end-to-side anastomosis of the EABG to the replaced descending aorta. However, due to massive adhesion of the lung to the EABG and PA, we performed transection of the descending aorta to decompress the PA. The postoperative course was uneventful, and the patient is doing well 5 months after surgery.<h4>Conclusions</h4>Aortic transection between the CoA and the distal anastomosis site may be a useful additional procedure in patients previously treated with TEVAR for PAs in the distal anastomosis site after EABG.

DOI： 10.1186/s40792-021-01136-4

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press ({OUP})  

DOI： 10.1093/jscr/rjab001

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本人工臓器学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press ({OUP})  

DOI： 10.1093/jscr/rjaa333

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掲載種別：研究論文（学術雑誌）  

Secondary aortoenteric fistula or erosion (SAEFE), an abnormal connection between the aorta and gastrointestinal tract, is a rare but critical complication after abdominal aortic aneurysm repair. Most SAEFEs occur between the aorta or proximal graft anastomosis and the duodenum, and occurrence between the iliac graft and small intestine is rare. Standard SAEFE management involves graft removal and extra-anatomical bypass. However, this is extremely invasive and has a high mortality rate. We encountered a rare case of SAEFE with no sign of infection, which was successfully treated by ligating the iliac graft to reduce mechanical pulsatile stress and bleeding following the retroperitoneal approach.

DOI： 10.3400/avd.cr.20-00094

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press ({OUP})  

DOI： 10.1093/jscr/rjaa263

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier {BV}  

DOI： 10.1016/j.avsg.2019.10.067

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s11748-019-01118-2

Scopus

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/icvts/ivx046

Scopus

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10047-017-0951-z

Scopus

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記述言語：日本語   出版者・発行元：北海道外科学会  

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記述言語：日本語   出版者・発行元：公益社団法人 日本理学療法士協会  

【目的】<BR> 一般に，同じ運動を繰り返すことでそのパフォーマンスが向上することはよく知られている．我々，理学療法士もリハビリテーションの場面において，何度も動作を繰り返すことでその動作能力を向上させるよう治療する．立位から全身を用いるリーチ動作も繰り返し行うことでそのパフォーマンスが向上することは知られているが，正確で素早いリーチを行うためには，より適切な推進力や動作の安定性といった姿勢の制御が必要になる．その推進力や安定性は姿勢筋の活動により得られるが，動作を繰り返すことにより姿勢制御にも動作を効率よく行うための変化が生じるのかどうかはよくわかっていない．よって，今回，動作を繰り返すことで姿勢制御に関わる姿勢筋の活動がどのように変化するかを調べた． <BR><BR>【方法】<BR> 対象は右利きの健常成人10名とした．被験者は床反力計の上で静止立位を保ち，音刺激後，右手指をできるだけ素早く肩の高さに位置する直径2cmの目標物にリーチを行った．目標物までの距離はファンクショナルリーチテストにより被験者毎に決定した．リーチ動作は休憩を取りつつ50回繰り返し行った．身体各部位に反射マーカーを取りつけ3次元動作解析機により各セグメントの位置や関節角度，体重心の変位を求めた．左右の前脛骨筋，腓腹筋，大腿直筋，大腿二頭筋から筋活動を記録した．右手部のマーカーが動き出した時間をリーチ開始時間とし，開始時間から右手の加速度が最大になる時間までの筋活動量（加速期：推進力のための活動）と右手の速度が最大になった時間からリーチ終了時間までの筋活動量（減速期：姿勢保持のための活動）を求めた．リーチ動作の1～10回の平均値と41～50回のそれとを比較することで，繰り返しによる運動と姿勢筋活動の変化を調べた．<BR><BR>【結果と考察】<BR> リーチ動作を繰り返し行うことでリーチの運動時間は短縮した．これに伴い，加速期に右前脛骨筋の活動量の増大が認められた．しかしながら，この期間の腓腹筋の活動は減少した．これは，全身を動かすリーチ動作の推進力を効率よく得るために，姿勢の制御を変化させた結果だと考えられる．一方，リーチの減速期には両腓腹筋の筋活動量が繰り返しにより増大したが，両前脛骨筋と左大腿二頭筋の活動量は減少した．このことは，主に，腓腹筋がリーチ動作のブレーキングに使われ，パフォーマンスを向上させるための姿勢の安定性を供給していると考えられる．これらのことから，リーチ動作を繰り返し行うことでそのパフォーマンスが向上し，それと同様に，姿勢の制御に関わる下肢筋の筋活動にもリーチ動作向上のための変化が生じることが明らかとなった．

DOI： 10.14900/cjpt.2007.0.a0848.0

CiNii Books

CiNii Research

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記述言語：日本語   出版者・発行元：公益社団法人 日本理学療法士協会  

【目的】<BR> リーチ動作は日常的に利用される重要な動作であり、体重心の大きな移動を伴う動作であることから、臨床でもFunctional Reach Test（FRT）などのバランス評価や訓練に多く用いられている。また、運動療法では動作のパフォーマンスを向上させるために反復練習を行うことが多く、その効果も多く示されている。正確なパフォーマンスには、動作前に発生する予測的な姿勢制御による姿勢の安定性や推進力が必要になる。予測的姿勢制御（anticipatory postural adjustment; APA）とは、自発運動や予測可能な外乱が加えられた状況で運動に先行して出現し、身体の動揺を最小限に抑え姿勢を安定化させるために働く。これは姿勢筋活動や足圧中心（COP）の移動として観察される。APAの変化が動作を反復することで生じるパフォーマンスに影響を与えている可能性があると考えられるが、それについては調べられていない。よって今回は、リーチ動作を反復して行ったときのパフォーマンスとAPAの変化の関係について、特に姿勢筋活動に着目して調べた。<BR>【方法】<BR> 対象は10名の健常成人とした。リーチ動作は施行毎に数十秒の休憩をはさみつつ50回行った。肩幅に開脚した安静立位を保ち、音刺激後にできるだけ素早く右手指で目標点へ正確にリーチさせた。目標点は直径2cmで右肩峰の高さとし、FRTの距離に設置した。また目標点を3N以上の圧で触れた施行は失敗とした。リーチ動作の計測には、筋電計、床反力計、3次元動作解析機を用いた。導出筋は、両側の前脛骨筋、腓腹筋、大腿直筋、大腿二頭筋とした。各関節運動の記録のため、全身27箇所にマーカーを付け6台のカメラを使用した。リーチ動作の開始は右手部マーカーが動き出した時間とし、リーチ動作の終了は手指が目標点に到達した時間とした。反復リーチ動作のパフォーマンス及び予測的な姿勢筋活動について、1～10回目と41～50回目を比較検討した。<BR>【結果と考察】<BR> リーチ動作の1～10回目と41～50回目の平均値を比較すると、動作の成功率の増加と動作時間の短縮が認められたため、反復によりリーチ動作のパフォーマンスは向上したと考えられる。一方、音刺激から動作開始までの時間は延長した。予測的な姿勢筋活動として、前脛骨筋・大腿直筋は興奮、腓腹筋は抑制を示し、それらの筋活動は反復に伴いより早期に出現した。また、動作開始前のCOP後方移動も筋活動と同様に反復に伴いより早期に出現した。このように、APAに要する時間を十分に取ることで、正確で素早い動作の準備を確実に行うことが可能と考えられる。これらの結果より、予測的な姿勢筋活動がリーチ動作のパフォーマンスに影響を与えることが示唆された。<BR>

DOI： 10.14900/cjpt.2007.0.a0849.0

CiNii Books

CiNii Research

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