心筋梗塞のコントロールモデル

今日はまた動物実験の日でした。多少早めに研究所に行くと、たまたまいつもより早く豚が既に麻酔されていました。助手をしてくれる医学生はまだ来ていませんでした。彼らは来るのかなと多少不安な気持ちで始めていたら続々と仲間がやってきてくれて、安心。

医学生は全部で１５人くらいこの実験の担当でいるのですが、実際には数人しか合ったことがありません。名目上、今日が最終日だと言うのに。

ところで昨日も実験したのですが、心筋梗塞がやや大きかったようで、最終目的まで到達せずに失ってしまいました。その教訓から、これまで以上に出来上がる心筋梗塞の範囲を厳密に想定しながら実験を進めました。何カ所か面倒な操作があるのですが、今日は、機材も新しいことも幸いして全て完璧でした。とうとう最終日でマスターしたって感じです。

始まりも早かったことと、スムーズに実験が終了したので、午後からの手術にも参加できました。今日は冠動脈バイパス術＋僧帽弁形成術で、教授の助手にはまた例の、いつも病棟にいる彼でした。

術中、人工心肺への脱血不良がしばしば問題になり、珍しく教授が技師にきれています。さらに助手の彼も椅子に座りながらの助手で、教授の手順を理解していないため、やりにくそうです。教授はかなりきれた後、やり場がないのか、僕に英語でいろいろ喋ってきます。普段はドイツ語だけなのに。

教授が降りた後は、自然と僕が手術を引き継ぎました。
どこの国でもいろいろあるのでしょう。ただ日本と違うところはみんな自分の意見を言うので、手術中であっても教授にも反論します。技師は人工心肺の操作は完璧だと。吻合中に糸がもつれても、助手はほかの方法がいいのではないかと言っているし。

言葉が全部分かったら、結構大変かもしれません。

Small incision

Minimal invasive cardiac surgery is one of a mainstream all over the world.

It is expressed variously way. Some surgeons persist in short operation tiem or little amount of bleeding, some surgeons encourage to avoid cardiopulmonary bypass, i.e. off pump bypass being famous in Japan to be anatstomosed on beating condition, and some surgeons prefer to perform it via small incision resulting from using a robot at the end of it.

The bypass surgery was performed today via less than a 15cm of very small incision and done completed arterial graft revascularization.
As to bypass surgery, I think novel operations are created in Japan because there are high competitions to gather patients from cardiologists. I have, however, never seen such a small incision in Japan.

Although it demands the operator to be higher skill, I did not feel it was too difficult today. It took more time than usual, but an operation performed by skillful operator always seems not challenging but ordinary or if anything easiy. It must be important.

Anyhow it was interesting and the patient would be happy. I would like to try it someday.

しばしば変更される手術予定

Image it!
After an operation schedule is fixed, can you change it easily?

It is difficult in Japan to excuse a patient and their family except for emergency. If I have to change it due to doctor preference or something, I have to say so sorry many times to all concerns.

I do not know why, but operation schedule is very changeable in AKH. I may have seldom seen the day when all operations go through as same as that of operative program. It would be happy someday, but worse someday.

By the way, recently my wife made a lot of nice Japanese friends in Vienna, which is also my pleasure and allow me a kind of relax. Their chat or communications will provide her much fun and discover something her new in Vienna. These also must be grate fortune in our family.

No call

I was waiting for a pager call from the operation room.
I was supposed to get the call, when the operation stating time was decided which the professor was performing. Unfortunately I did not have any call today.




If someone tolds to me that he does not know what I need to know, I should ask another one about the same thing, because the answer is often different depending on the person, in this country. In this meaning, even if you are said “impossible or No”, you can try to ask another people. I guess you can get good results or what you have wanted.

I met the professor directly by chance; he said to me “where were you? I was looking for.” It was very sorry for me that I did not get any call. There must have been some mistakes in telephone operator.

I realize to do confirm every things by myself.

We will maybe have another operation. I am still waiting next call whether the operation is performed today or not. It is still 16 hour, but it is dark outside.

Every day I learn something new.

Emergency

Of course we have a lot of emergency cases.

I realized the difference of hospital system between Japan and AKH with enough co medical staffs, anesthesiologists and independent surgeons.

If you have an emergency operation on Sunday night in Japan, I think it would be performed by one independent surgeon, but here it could be done by a couple of or more if needed.

Every surgeons have own their way and judgment, if assistant surgeons regard re-CPB should be needed, they will do soon alone. Moreover their surgical technique is also perfect, as like they can do operation as an independent operator.

I may have never seen such a quick and reasonable judgment and surgical recover technique conducted by a young assistant in Japan, providing me astonished.

I am sure I will study something.