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uring abdominal aortic surgery, dynamic changes occur in the circulation of the pelvic area, but until now there was no method of evaluating them. Recently, near-infrared spectroscopy (NIRS) 1 has been used to evaluate muscle deoxygenation 2,3 and various vascular diseases, 4-7 including intermittent claudication accompanying arteriosclerosis obliterans. [8][9][10][11] In this study we examined how NIRS of the buttocks might reflect changes in the arterial flow of the pelvic area during aortic surgery, and tried to evaluate the circulatory changes caused by abdominal aortic clamping and reperfusion of individual distal arteries. MethodsWe studied 22 patients who underwent aneurysmectomy and prosthetic graft replacement for abdominal aortic aneurysm (AAA). The patients comprised 21 men and 1 woman, aged 73±6 years. Twenty-one of the patients underwent bifurcated graft replacement, and 1 underwent a straight graft replacement. The patients who received bifurcated grafts were divided into groups A and B. Group A comprised 17 patients who underwent reconstruction of the bilateral common iliac artery and ligation of the inferior mesenteric artery (IMA) in the usual manner. Patients who first underwent reconstruction of the left common iliac artery were classified as group A•I (6 cases) and those who first underwent reconstruction of the right common iliac artery were classified as group A•II (11 cases). Group B comprised 4 patients who underwent other patterns of arterial reconstruction for extended iliac aneurysms. The NIRS probe was mounted on the center of the left buttock (approximately 5 cm cranial to the center of the large gluteal muscle) during the AAA repair operation. Measurements were taken using a NIRS oxygen electrode monitor (OMRON HEO-200). Changes in oxy-and deoxy-hemoglobin (Hb) concentration after clamping of the abdominal aorta were measured. We focused mainly on changes in oxy-Hb. Oxy-and deoxy-Hb concentrations changed proportionately in all cases. The recovery time (RT) was defined as the interval from aortic declamping (or declamping of the main artery feeding the left buttock) to the point where the oxy-and deoxy-Hb curves crossed over. The mean changes in Hb values and RTs were expressed as the mean ± SD. ResultsDistinct types of circulatory changes in the gluteal muscles were detected by NIRS. In all cases the Hb values reflected decreased arterial flow because of aortic clamping During abdominal aortic surgery, dynamic changes occur in the pelvic circulation. Near-infrared spectroscopy (NIRS) was used in this study to evaluate arterial flow in the buttocks as a monitor of arterial flow in the pelvic area during abdominal aortic surgery. Twenty-two patients who underwent abdominal aortic aneurysmectomy comprised the study group. The NIRS probe was mounted on the left buttock during surgery, and the changes in oxy-and deoxy-hemoglobin (

From 1973 to March 1989, surgical resection was performed in 83 stage IIIB non-small-cell lung cancer patients (81% of all admitted stage IIIB patients). There were 2 operative deaths (2.3%), and complete resection was accomplished in 33 patients. The five-year survival rate of the patients undergoing complete resection was 25%, whereas that of the incomplete resection group was nil (p less than 0.05). Among the 26 patients with invasion of mediastinal structures who underwent complete resection, 3 patients survived for over five years. Two had squamous-cell carcinoma and one had adenocarcinoma, and their tumors involved the left atrium, pulmonary arterial trunk, and superior vena cava, respectively. Among the 6 patients with T4 lesions due to carinal invasion, two patients (one with mucoepidermoid carcinoma and one with squamous-cell carcinoma) have survived for over 8 and 4 years, respectively, after complete resection. There were no long-term survivors among the patients with malignant pleural effusion. Pleuropneumonectomy did not improve survival. Extended lymph-node dissection for N3 disease was only commenced in recent years, so it is not yet clear whether it will affect the survival rate or not. However, 6 out of 19 patients who underwent extended lymph-node dissection including the contralateral lymph-node compartments are still alive, with 23 months being the longest survival. To date, there are 6 three-year survivors among our present series of stage IIIB patients who underwent operative treatment. From these results, it can be concluded that stage IIIB patients should not be uniformly excluded from consideration for surgery, but rather should be evaluated with regard to the possibility of performing complete resection.

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This report describes a case of traumatic incomplete rupture of the ventricular septum, a rare complication caused by blunt chest trauma. Although a serial ECG progressed its course similar to acute anteroseptal myocardial infarction in this case, there was little clinical clue of septal tear. The diagnosis was established by transthoracic echocardiography. The authors chose a conservative line of management rather than surgical repair for incomplete septal rupture because of the patent's stable clinical course and hemodynamic status. A sequence of echocardiography during a 32-day stay in the hospital showed no change in the extent of incomplete septal rupture, septal structure, systolic function, and shape of left ventricle and also obtained no evidence of shunting through the rupture. In conclusion, echocardiography is a useful investigation to make a diagnosis as well as for follow-up in case of incomplete ventricular septal rupture. A close follow-up of incomplete septal rupture with serial echocardiography should be performed, because several cases of delayed ventricular septal rupture following blunt chest trauma have been reported.