JA Clinical Reports最新文献_第2页

Intraoperative hemodynamic collapse revealing undiagnosed pheochromocytoma in a patient with neurofibromatosis type 1 and severe cervical deformity: a case report on perioperative management. 1型神经纤维瘤病伴严重颈椎畸形患者术中血流动力学崩溃显示未确诊嗜铬细胞瘤：围手术期处理1例报告。

IF 1.2

JA Clinical Reports Pub Date : 2026-05-11 DOI: 10.1186/s40981-026-00860-w

Riko Ideyama, Chikashi Takeda, Yohei Chiwata, Yui Takei, Figwang Fang, Akiko Hirotsu, Moritoki Egi

{"title":"Intraoperative hemodynamic collapse revealing undiagnosed pheochromocytoma in a patient with neurofibromatosis type 1 and severe cervical deformity: a case report on perioperative management.","authors":"Riko Ideyama, Chikashi Takeda, Yohei Chiwata, Yui Takei, Figwang Fang, Akiko Hirotsu, Moritoki Egi","doi":"10.1186/s40981-026-00860-w","DOIUrl":"10.1186/s40981-026-00860-w","url":null,"abstract":"Background: Patients with neurofibromatosis type 1 (NF1) have a 0.1-5.7% incidence of pheochromocytomas. Blood pressure control is difficult in cases of undiagnosed pheochromocytomas without preoperative treatment.Case presentation: A 39-year-old woman with NF1 and severe cervical deformity presented with progressive quadriplegia and underwent urgent halo-vest placement. A large adrenal mass was incidentally detected on preoperative computed tomography (CT) scans; however, no further examination was performed because the patient had no symptoms suggestive of pheochromocytoma and her cervical spinal condition was considered urgent. When hemodynamic instability occurred during surgery, pheochromocytoma was suspected, and the diagnosis was confirmed postoperatively. Fourteen months later, the tumor was safely resected using strict preoperative management with metyrosine and alpha-blockers and a careful surgical plan.Conclusions: This case highlights the importance of thorough preoperative screening and the role of anesthesiologists in detecting pheochromocytomas in asymptomatic patients with NF1 who present with intraoperative hemodynamic instability.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-term pulmonary function after intrathoracic versus extrathoracic LVAD Implantation: perioperative implications at one year. 胸腔内与胸腔外LVAD植入后的长期肺功能：一年围手术期的影响。

IF 1.2

JA Clinical Reports Pub Date : 2026-05-02 DOI: 10.1186/s40981-026-00859-3

Kimito Minami, Tatsutoshi Shimatani, Masahiro Kazawa, Naoki Tadokoro, Satsuki Fukushima, Takuma Sato, Yasumasa Tsukamoto, Muneyuki Takeuchi

{"title":"Long-term pulmonary function after intrathoracic versus extrathoracic LVAD Implantation: perioperative implications at one year.","authors":"Kimito Minami, Tatsutoshi Shimatani, Masahiro Kazawa, Naoki Tadokoro, Satsuki Fukushima, Takuma Sato, Yasumasa Tsukamoto, Muneyuki Takeuchi","doi":"10.1186/s40981-026-00859-3","DOIUrl":"10.1186/s40981-026-00859-3","url":null,"abstract":"Background: Patients undergoing durable left ventricular assist device (LVAD) implantation frequently require prolonged perioperative respiratory support. However, the long-term pulmonary consequences of different surgical pump placement strategies remain unclear. We investigated longitudinal pulmonary function changes following intrathoracic versus extrathoracic LVAD implantation.Methods: This single-center retrospective cohort study included patients who underwent LVAD implantation and completed pulmonary function testing (PFT) preoperatively and at 1 year postoperatively. Intrathoracic HeartMate 3 recipients were compared with extrathoracic HeartMate II recipients. Linear mixed-effects models assessed longitudinal changes in forced vital capacity (FVC), percent predicted FVC (%FVC), forced expiratory volume in 1 s (FEV₁), and percent predicted FEV₁ (%FEV₁), adjusting for age, sex, body surface area, and surgery era.Results: Among 190 patients (intrathoracic, n = 76; extrathoracic, n = 114), greater declines in FVC, %FVC, and FEV₁ were observed at 1 year in the intrathoracic group. Significant time-by-placement interactions were identified for FVC (P = 0.010), %FVC (P = 0.010), and FEV₁ (P = 0.011), whereas %FEV₁ showed comparable trends between groups. Smaller body surface area and female sex were independently associated with lower lung volumes, whereas the apparent association with female sex was largely explained by body size.Conclusions: Intrathoracic LVAD implantation was associated with greater restrictive changes in pulmonary function at one year. These findings suggest that surgical pump positioning and patient body size may influence long-term respiratory trajectories and may be relevant for perioperative planning and postoperative follow-up.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation of the reliability of large language models for ASA-PS classification in cardiovascular surgery: a pilot study. 心血管外科ASA-PS分类大语言模型的可靠性评估：一项初步研究。

IF 1.2

JA Clinical Reports Pub Date : 2026-04-15 DOI: 10.1186/s40981-026-00858-4

Keisuke Iwabu, Takashi Juri, Shogo Tsujikawa, Hideki Hino, Yusuke Funai, Koichi Suehiro, Takashi Mori

{"title":"Evaluation of the reliability of large language models for ASA-PS classification in cardiovascular surgery: a pilot study.","authors":"Keisuke Iwabu, Takashi Juri, Shogo Tsujikawa, Hideki Hino, Yusuke Funai, Koichi Suehiro, Takashi Mori","doi":"10.1186/s40981-026-00858-4","DOIUrl":"10.1186/s40981-026-00858-4","url":null,"abstract":"BACKGROUND: Large language models (LLMs) have shown promising performance for ASA Physical Status (ASA-PS) classification, but prior work suggests reduced agreement in high-risk patients. We evaluated LLM reliability for ASA-PS classification in cardiovascular surgery. RESULTS: Thirty-two anonymized cases were rated by two residents, two board-certified cardiovascular anesthesiologists, and four LLM modes (ChatGPT: GPT-5.2 Instant and GPT-5.2 Thinking; Gemini: Gemini 3 Fast and Gemini 3 High Thinking); all LLM assessments were zero-shot. Overall agreement across evaluators was moderate (intraclass correlation coefficient [ICC] 0.49–0.52); agreement between each LLM and specialists was good (ICC 0.61–0.65). Exact-match to a five-specialist consensus was 42.2% for residents versus 59.4–75.0% for LLMs; classifications outside the range of ratings assigned by individual specialists were rare (0–3.1%). CONCLUSIONS: In cardiovascular surgery, contemporary LLMs showed good concordance with cardiovascular anesthesiologists and exceeded resident agreement with expert consensus, supporting prospective multicenter validation as adjuncts for ASA-PS assessment and training. ","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13194820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inhaled nitric oxide stabilizes acute right ventricular failure due to hypercapnia in abdominal compartment syndrome: a case report. 吸入一氧化氮稳定由高碳酸血症引起的急性右心室衰竭腹腔隔室综合征：1例报告。

IF 1.2

JA Clinical Reports Pub Date : 2026-04-14 DOI: 10.1186/s40981-026-00857-5

Yusuke Takei, Yuna Sato, Hidehisa Saito, Hirona Nishimaki, Shoma Tanaka, Hiroaki Toyama, Yutaka Ejima, Masanori Yamauchi

{"title":"Inhaled nitric oxide stabilizes acute right ventricular failure due to hypercapnia in abdominal compartment syndrome: a case report.","authors":"Yusuke Takei, Yuna Sato, Hidehisa Saito, Hirona Nishimaki, Shoma Tanaka, Hiroaki Toyama, Yutaka Ejima, Masanori Yamauchi","doi":"10.1186/s40981-026-00857-5","DOIUrl":"10.1186/s40981-026-00857-5","url":null,"abstract":"BACKGROUND: Inhaled nitric oxide is a selective pulmonary vasodilator commonly used to treat pulmonary hypertension and right ventricular failure. However, its effectiveness in treating right ventricular failure secondary to hypercapnia caused by abdominal compartment syndrome has not been well described. CASE PRESENTATION: This case describes a patient who developed severe hypercapnia and acute right ventricular failure due to abdominal compartment syndrome following massive intraoperative hemorrhage. Elevated intra-abdominal pressure impaired the respiratory mechanics, resulting in alveolar hypoventilation, hypercapnia, and acute pulmonary hypertension. Respiratory and circulatory failures progressively worsened. Administration of inhaled nitric oxide was associated with a rapid improvement in right ventricular afterload surrogates, leading to improved right ventricular output and enhanced carbon dioxide elimination, with concomitant improvement in systemic hemodynamics. DISCUSSION: Inhaled nitric oxide may serve as an effective rescue therapy for hypercapnia-induced pulmonary hypertension and acute right ventricular failure associated with abdominal compartment syndrome. ","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147673482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Successful use of transesophageal echocardiography for minimally invasive cardiac surgery after esophagectomy with gastric tube reconstruction via the retrosternal route: a case report. 经食管超声心动图成功应用于经胸骨后途径胃管重建食管切除术后微创心脏手术1例报告。

IF 1.2

JA Clinical Reports Pub Date : 2026-03-26 DOI: 10.1186/s40981-026-00855-7

Kanon Yokoi, Sakurako Kitade, Shoko Maruyama, Takayuki Yoshida

{"title":"Successful use of transesophageal echocardiography for minimally invasive cardiac surgery after esophagectomy with gastric tube reconstruction via the retrosternal route: a case report.","authors":"Kanon Yokoi, Sakurako Kitade, Shoko Maruyama, Takayuki Yoshida","doi":"10.1186/s40981-026-00855-7","DOIUrl":"10.1186/s40981-026-00855-7","url":null,"abstract":"BACKGROUND: The use of transesophageal echocardiography (TEE) after esophagectomy remains controversial. Herein, we describe a case in which TEE use was safe and effective during cardiac surgery after esophagectomy with retrosternal gastric tube reconstruction. CASE PRESENTATION: A 71-year-old man, who had undergone esophagectomy with retrosternal gastric tube reconstruction, was scheduled for removal of a left atrial myxoma via right anterior thoracotomy under cardiopulmonary bypass. A multiplane TEE probe was smoothly inserted into the gastric tube, providing echocardiographic images similar to those acquired by transthoracic echocardiography via the parasternal and subcostal windows. TEE monitoring helped confirm the positions of the devices placed in the great vessels, tumor location, absence of residual air or leakage, and normal heart function. No complications related to the TEE were observed. CONCLUSIONS: Intraoperative TEE monitoring is a feasible option even in patients who have undergone esophagectomy with retrosternal gastric tube reconstruction. ","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reconsidering arm positioning during pediatric general anesthesia based on natural sleep posture. 基于自然睡眠姿势重新考虑小儿全麻时手臂的定位。

IF 1.2

JA Clinical Reports Pub Date : 2026-03-25 DOI: 10.1186/s40981-026-00854-8

Keisuke Yoshida, Yuko Matsumoto, Tatsumi Yakushiji, Takayuki Hasegawa, Satoki Inoue

引用次数: 0

Cardiac herniation six years after thoracoscopic thymectomy: a case report. 胸腔镜胸腺切除术后6年心脏疝1例。

IF 1.2

JA Clinical Reports Pub Date : 2026-03-24 DOI: 10.1186/s40981-026-00856-6

Yusei Ishizuka, Taiichiro Hayashida, Tomoaki Yoshii, Maiko Hasegawa-Moriyama

{"title":"Cardiac herniation six years after thoracoscopic thymectomy: a case report.","authors":"Yusei Ishizuka, Taiichiro Hayashida, Tomoaki Yoshii, Maiko Hasegawa-Moriyama","doi":"10.1186/s40981-026-00856-6","DOIUrl":"10.1186/s40981-026-00856-6","url":null,"abstract":"BACKGROUND: Cardiac herniation is a rare but potentially fatal complication that may occur after surgery involving pericardial incision or resection. Most cases develop intraoperatively or in the early postoperative period, and delayed-onset cases after minimally invasive thoracic surgery have not been reported. CASE PRESENTATION: A 48-year-old woman developed left shoulder pain and nausea six years after thoracoscopic thymectomy for myasthenia gravis. Electrocardiography indicated ST-segment elevation myocardial infarction. Computed tomography of the chest showed cardiac herniation into the left thoracic cavity and coronary angiography revealed stenosis corresponding to the hernial defect. The patient was diagnosed with coronary artery compression due to cardiac herniation and underwent hernia reduction and coronary artery bypass grafting. The postoperative course was uneventful. CONCLUSIONS: Cardiac herniation may occur even long after minimally invasive thoracic surgery and should be considered in patients presenting with chest symptoms or hemodynamic instability. ","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Remimazolam-based anesthesia with intraoperative motor evoked potential monitoring in a patient with Leigh syndrome undergoing scoliosis surgery: a case report. 雷马唑仑麻醉伴术中运动诱发电位监测的Leigh综合征脊柱侧凸手术患者一例报告。

IF 1.2

JA Clinical Reports Pub Date : 2026-02-13 DOI: 10.1186/s40981-026-00851-x

Takahiro Kuwabara, Takahiro Tamura, Masashi Takakura, Tasuku Fujii, Kanako Ozeki, Koichi Akiyama

{"title":"Remimazolam-based anesthesia with intraoperative motor evoked potential monitoring in a patient with Leigh syndrome undergoing scoliosis surgery: a case report.","authors":"Takahiro Kuwabara, Takahiro Tamura, Masashi Takakura, Tasuku Fujii, Kanako Ozeki, Koichi Akiyama","doi":"10.1186/s40981-026-00851-x","DOIUrl":"10.1186/s40981-026-00851-x","url":null,"abstract":"BACKGROUND: We present a case of scoliosis surgery performed under general anesthesia with remimazolam in a 16-year-old patient with Leigh syndrome (LS), a subtype of mitochondrial encephalomyopathy. Anesthetic management in such patients is challenging because of the risks of malignant hyperthermia with inhalational agents and propofol infusion syndrome, and because many of these patients present with impaired consciousness and respiratory compromise, anesthetic management becomes extremely difficult. To date, very few reports have described remimazolam use in LS, and none have described cases requiring intraoperative motor-evoked potential (MEP) monitoring. CASE PRESENTATION: A patient diagnosed with LS at 7 months of age underwent corrective scoliosis surgery. Anesthesia was induced and maintained using remimazolam supplemented with opioids and muscle relaxants. Some intraoperative MEP signals were attenuated but remained monitorable. The patient was extubated with flumazenil and admitted to the intensive care unit, where a transient decrease in oxygenation was observed. However, the patient recovered without any complications and was discharged uneventfully. CONCLUSION: Remimazolam may be a feasible anesthetic option for patients with LS undergoing surgery requiring MEP monitoring. However, its use should be carefully determined based on factors such as the patient’s age, level of consciousness, respiratory function, and history of epilepsy. ","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146179999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intraoperative detection and management of cerebral malperfusion in acute aortic dissection using regional cerebral oxygen saturation monitoring: case report. 局部脑氧饱和度监测术中发现和处理急性主动脉夹层脑灌注不良1例。

IF 1.2

JA Clinical Reports Pub Date : 2026-02-10 DOI: 10.1186/s40981-026-00853-9

Shinnosuke Miura, Hiroya Tsujimoto, Ayami Shimomiya, Kenji Yoshitani

{"title":"Intraoperative detection and management of cerebral malperfusion in acute aortic dissection using regional cerebral oxygen saturation monitoring: case report.","authors":"Shinnosuke Miura, Hiroya Tsujimoto, Ayami Shimomiya, Kenji Yoshitani","doi":"10.1186/s40981-026-00853-9","DOIUrl":"10.1186/s40981-026-00853-9","url":null,"abstract":"Background: Cerebral malperfusion during acute aortic dissection (AAD) surgery is a life-threatening event requiring prompt detection and intervention. We report a case of intraoperative extension of dissection into the brachiocephalic artery (BCA) detected by regional cerebral oxygen saturation (rSO₂) monitoring before cardiopulmonary bypass.Case presentation: A 78-year-old man undergoing emergency total aortic arch replacement showed a sudden bilateral rSO₂ decline after anesthesia induction, corresponding to BCA extension on transesophageal echocardiography. rSO₂ recovered during selective cerebral perfusion but fell again during CPB weaning. Carotid duplex ultrasonography revealed collapse of the right common carotid artery due to false lumen expansion compressing the true lumen. Reanastomosis of the BCA restored cerebral oxygenation.Conclusion: This case highlights the utility of multimodal monitoring-rSO₂ trends, transesophageal echocardiography, and carotid duplex ultrasonography-for detecting and managing cerebral malperfusion during AAD surgery. Early identification allows timely surgical revision and may improve neurological outcomes.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Unexpected vascular structure during rectus sheath block in a cirrhotic patient. 肝硬化患者直肌鞘阻滞时意外血管结构。

IF 1

JA Clinical Reports Pub Date : 2026-02-06 DOI: 10.1186/s40981-026-00848-6

Tatsumi Yakushiji, Jun Honda, Keisuke Yoshida, Satoki Inoue

引用次数: 0