A 75-year-old male patient had stable angina pectoris After coronary angiography we decided to perform a coronary artery bypass graft surgery. Twenty years ago the patient underwent radical cystectomy and bilateral ur...A 75-year-old male patient had stable angina pectoris After coronary angiography we decided to perform a coronary artery bypass graft surgery. Twenty years ago the patient underwent radical cystectomy and bilateral ureterosigmoidostomy because of bladder cancer After that, his micturition was via the rectum. We did not experience that before. As is known, monitoring of urine output is very important after cardiac surgery The patient was consulted with an urologist for how to monitor urine output in him. Transrectal catheterization was recommended for our follow-up, but before the catheterization bowel cleansing is necessary. Four-vessel on-pump coronary artery bypass graft surgery was performed without any problem. Peroperative urine volume and arterial blood gas results were normal. Urine output is a sensitive variable reflecting the patient's effective blood volume and tissue perfusion. Urinary catheterization is a standard for all cardiac surgeries and it allows the patients' urine to drain freely from the bladder for collection. Monitoring of urine output in patients with ureterosigmoidostomy is impossible by standard urinary catheterization method. In this casewe performed transrectal catheterization for Urine flow follow-up. Urine flow follow-up is essential after the open-heart surgery and it can be measured in different ways, as in our case.展开更多
The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy(PD);that is,en bloc resection using a non-touch isolation technique.We have been developing isolated PD for pancreatic cancer since 1981,w...The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy(PD);that is,en bloc resection using a non-touch isolation technique.We have been developing isolated PD for pancreatic cancer since 1981,when we developed an antithrombogenic bypass catheter for the portal vein.In this operation,the first and most important step is the use of a mesenteric approach instead of Kocher’s maneuver.The mesenteric approach allows dissection from the non-cancer infiltrating side and determination of cancer-free surgical margins and resectability,followed by systemic lymphadenectomy around the superior mesenteric artery.This approach enables early ligation of the inferior pancreatoduodenal artery and mesopancreas excision.The mesopancreas is the second portion of the pancreatic head nerve plexus.Isolated PD is the ideal surgery for pancreatic head cancer from both surgical and oncological viewpoints.In patients with resectable pancreatic head cancer,isolated PD using the mesenteric approach is suspected to have a higher survival rate than conventional PD using Kocher’s maneuver.The precise surgical techniques of the mesenteric approach are herein described.展开更多
文摘A 75-year-old male patient had stable angina pectoris After coronary angiography we decided to perform a coronary artery bypass graft surgery. Twenty years ago the patient underwent radical cystectomy and bilateral ureterosigmoidostomy because of bladder cancer After that, his micturition was via the rectum. We did not experience that before. As is known, monitoring of urine output is very important after cardiac surgery The patient was consulted with an urologist for how to monitor urine output in him. Transrectal catheterization was recommended for our follow-up, but before the catheterization bowel cleansing is necessary. Four-vessel on-pump coronary artery bypass graft surgery was performed without any problem. Peroperative urine volume and arterial blood gas results were normal. Urine output is a sensitive variable reflecting the patient's effective blood volume and tissue perfusion. Urinary catheterization is a standard for all cardiac surgeries and it allows the patients' urine to drain freely from the bladder for collection. Monitoring of urine output in patients with ureterosigmoidostomy is impossible by standard urinary catheterization method. In this casewe performed transrectal catheterization for Urine flow follow-up. Urine flow follow-up is essential after the open-heart surgery and it can be measured in different ways, as in our case.
文摘The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy(PD);that is,en bloc resection using a non-touch isolation technique.We have been developing isolated PD for pancreatic cancer since 1981,when we developed an antithrombogenic bypass catheter for the portal vein.In this operation,the first and most important step is the use of a mesenteric approach instead of Kocher’s maneuver.The mesenteric approach allows dissection from the non-cancer infiltrating side and determination of cancer-free surgical margins and resectability,followed by systemic lymphadenectomy around the superior mesenteric artery.This approach enables early ligation of the inferior pancreatoduodenal artery and mesopancreas excision.The mesopancreas is the second portion of the pancreatic head nerve plexus.Isolated PD is the ideal surgery for pancreatic head cancer from both surgical and oncological viewpoints.In patients with resectable pancreatic head cancer,isolated PD using the mesenteric approach is suspected to have a higher survival rate than conventional PD using Kocher’s maneuver.The precise surgical techniques of the mesenteric approach are herein described.
