The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 12 , Issue 4
Showing 1-17 articles out of 17 articles from the selected issue
  • M. M. R. Bhuiyan, Kembu Nakamoto, Taku Okamoto, Ayanori Sugita, Kotaro ...
    1998 Volume 12 Issue 4 Pages 454-460
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    The effect of the thromboxane A2 synthetase inhibitor, OKY-046 on pulmonary flushing and preservation of lung was studied using an ex vivo perfused rabbit model. The grafts were divided into the following groups : Group 1) flushed in vivo with modified EP4 solution (50 ml /kg) alone (n=10); and Group 2 flushed in vivo with modified EP4 solution (50 ml/kg) containing OKY-046 (0.1 mmol) (n=10). After preservation for 18 hours at 8t, the function of preserved grafts was examined for 60 seconds with autologous blood using an ex vivo perfusion system.
    During flushing, the mean (± SD) pulmonary artery pressure (PAP) was significantly lower (p<0.005) in Group 2 (9.5±0.33 cmH2O) than in Group 1 (10.7±1.0 cmH2O). During reperfusion, the mean (± SD) PAP for Group 2 was significantly lower than that for Group 1 at each time point (p<0.01-0.04). During the 60 seconds of reperfusion, a direct significant correlation was found between time (X) and PAP (Y) in Group 2 (Y= -0.058, X +21.0 ; r= 0.486, p< 0.01). In the functional assessment of grafts, the mean (± SD) wet/dry weight ratio of reperfused lung for Group 2 (5.62 ± 0.27) was significantly lower than for Group 1 (6.47 ± 0.33) (p<0.001). The mean (±SD) pO2 of reperfused lung for Group 2 (144.6 ± 8.1 torr) was significantly higher than that for Group 1 (97.0±25.2 torr) (p<0.001).
    The results of the present study show a significant effect of modified EP4 solution containing OKY-046 on lung preservation. There findings indicate a potential approach to ameliorate the effects of ischemia-reperfusion injury.
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  • alternative procedure for bronchoplasty
    Mitsunori Ohta, Osamu Kuwahara, Hajime Maeda, Keiji Inada
    1998 Volume 12 Issue 4 Pages 461-467
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Generally, bronchial anastomosis of sleeve lobectomy is performed so as to obtain cartilage -to-cartilage approximation of the bronchial edges, carefully avoiding telescoping. But there is always a size discrepancy between the two bronchial stumps, so that the bronchus naturally telescopes to a depth of one cartilage when the interrupted sutures are placed around the cartilages.
    From 1991 to 1997, we carried out a telescoping bronchial anastomosis for 13 patients with lung cancer and one with neurofibroma. Five of them underwent preoperative irradiation (mean dose : 42 Gy) and chemotherapy. Six modes of bronchoplasty were carried out without anastomotic complications, such as granulation, narrowing or separation. Major complications including empyema and chylothorax were successfully managed by conservative and operative therapy.
    Telescoping bronchial anastomosis is safe as a conventional procedure and can be considered one of the procedures for bronchoplasty.
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  • results and consideration
    Takahiro Mukaida, Shingo Ichiba, Motoi Aoe, Kazunori Okabe, Motohiro Y ...
    1998 Volume 12 Issue 4 Pages 468-473
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We have previously reported on our work in cryopreserved tracheal allotransplantation. This paper reviews the most recent results and points up consideration in clinical application.
    Results : (1) The simple method that we have developed for tracheal cryopreservation without using a programed freezer is easy, inexpensive, highly mobile, and useful in clinical application. (2) Allogenic epithelia in grafts showing the donor phenotype were depleted within about 20 of after transplantation. Epithelia migrated gradually from the anastomotic site, and regenerated epithelia showing the recipient phenotype covered the allograft within about 50 days of transplantation. (3) Long-term cryopreservation exceeding one month reduced MHC class II expression in tracheal allografts.
    Consideration : (1) What is the tolerable time after death for using grafts from donors whose hearts have stopped ? (2) What is the time limit on cryopreservation of tracheal grafts ?
    We have studied these two consideration, and have almost solved the technical problems involved. We therefore expect that clinical application of cryopreserved tracheal allotransplantations will become possible in the near future.
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  • Makoto Nonaka, Mitsutaka Kadokura, Noboru Tanio, Shigeru Yamamoto, Dai ...
    1998 Volume 12 Issue 4 Pages 474-481
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    After right upper (RU) lobectomy the orifice of the middle lobe bronchus (RMLB) is round in some cases but is deformed in others. To analyze the cause of the deformity, we measured the conjugate and transversal axis and areas of the orifice of the RMLB by bronchofiberscopic measurement. In group A (n=6), the orifice of the RMLB was round before and after the RU lobectomy. In group B (n=5), the orifice was round before the surgery but was deformed afterwards. In group B, the conjugate-to-transversal axis (c/t) ratios were lower and the anastomotic lines of the right upper lobe were 1-3 rings apart from the bifurcation when compared with group A. In group C (n=3), the orifice was semicircular before and after the surgery, but in group D (n=9), the orifice was deformed after the surgery. In group C, the c /t ratios were higher than in group D. When the orifice was semicircular before the RU lobectomy, the deformity of the orifice of the RMLB was common after the surgery. And when the c/t ratios were lower than 45% (50mm2) before the surgery, these cases had severe stenosis (35mm2, c/t ratios <0.3) after the surgery (n=4, group D).
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  • Keiji Kushibe, Kunimoto Nezu, Takashi Tojo, Makoto Takahama, Shigeki T ...
    1998 Volume 12 Issue 4 Pages 482-487
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Thoracoscopic wedge resection was performed for cT1NOMO lung cancer in high-risk patients who were unable to undergo standard thoracotomy. The distance from the pleura to the tumor, as assessed by CT scans, was 2cm or less. The twelve patients studied met one or more of the following criteria : FEV1.0 of less than 800 ml ; ejection fraction of less than 0.3; or age of more than 80 years with poor performance status. Chest tubes were removed at 2 to 10 days after operation (mean, 5.4±3.1 days). Four patients had prolonged air leakage lasting for more than 7 days. Three of these four patients had COPD. No major complications occurred. Patients were discharged at 6 to 19 days after surgery (mean, 12±3.8 days). Actuarial survival at 5 years was 63.7% with a mean follow up of 34 months. Two patients died of recurrent disease (one of local recurrence, one of brain metastasis) and one died of respiratory failure (COPD) 3 years later after surgery. We conclude that thoracoscopic wedge resection is useful for cT1NOMO lung cancer in high-risk patients who were unable to undergo standard thoracotomy.
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  • Yuichi Ono, Takao Tsushima, Seiji Takahashi, Hanako Oide, Ikko Ichinos ...
    1998 Volume 12 Issue 4 Pages 488-493
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We investigated the influence of lobectomy on right ventricular function by pulsed Doppler echocardiogram. This study included 26 patients who underwent either lobectomy or bilobectomy at our institute. The parameters which included the right ventricular (RV) inflow pattern at the tricuspid orifice and the RV ejection pattern at the RV outflow tract were investigated by pulsed Doppler echocardiogram. The following results were obtained. (1) The parameter of the acceleration time (AT ; time beginning of RV ejection to peak velocity, msec) that shows the RV afterload shortened at the postoperative day 1 of the pulmonary resection compared with the preoperative value (144±26 vs 117±21, p<0.001). It was thought that RV afterload was increased after the lobectomy. (2) The parameter of the deceleration half time (DHT, the time interval required to decrease the velocity from its peak to one half which obtained from RV early diastolic filling, msec) lengthened not only at the POD 1 but also at the POD 14 (pre : 112±16, POD 1 : 122±21, POD 14 : 122±15, p<0.05 vs pre). The parameter of DC (the deceleration of the early rapid filling of the RV inflow Doppler pattern) decreased after the lobectomy. The results of both DHT and DC revealed that right ventricular diastolic dysfunction has occurred after the lobectomy.
    Supraventricular tachyarrhythmias are noted as one of the several cardiac complications developing after pulmonary resection. We must carry out a further examination of the relation between the postoperative tachyarrhythmia and right ventricular dysfunction in the future.
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  • Nobuhiro Fujita, Kazuro Sugi, Toshiki Tanaka, Takahisa Matsuoka, Kouic ...
    1998 Volume 12 Issue 4 Pages 494-498
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    The validity of the target area identified with Xe-133 single photon emission computed tomography (SPECT) for lung volume reduction surgery in 10 patients with non-bullous emphysema was tasted, based on post-operative improvement of respiratory function, oxygenation of the arterial blood, and functional capacity. After a 6-min inhalation of 133 Xe gas, equilibrium and subsequent wash-out SPECT images were acquired every 30 seconds for 6 to 7 minutes during spontaneous breathing. The patients underwent unilateral thoracoscopic volume reduction, and abnormal Xe retention area (WO3) at 3 minutes after start of spontaneous breathing was resected as the target area. Forced expiratory volume in one second and partial oxygen pressure of the arterial blood improved from 646±50mL/sec to 763±68 mL/sec (p=.029) and 71.4±3.7 mmHg to 77.8±2.6 mmHg (p.069), respectively. 6-minutes walk distance significantly increased from 293± 44 m to 359±51 m (p=.013), postoperatively. The resection of the target area identified with Xe-133 SPECT resulted in significant improvement of respiratory function, oxygenation ability, and functional capacity, suggesting the validity of the decision to use the target area using Xe-133 SPECT.
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  • Takuya Morita, Shuichi Tachibana, Manpei Kawakami, Tatsuhiko Orino, Ke ...
    1998 Volume 12 Issue 4 Pages 499-505
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Thymic cyst is a relatively rare mediastinal tumor. Six cases of thymic cyst were treated in our institution and the intracystic fluids were studied. The 6 cases accounted for 5.2% of all mediastinal tumors and 35% of congenital cysts. Five of the 6 patients had no symptoms and one had chest oppression. There were no associated diseases such as myasthenia gravis. CT scan showed a homogeneous water density area which was demonstrated as a low intensity area on Tl-weighted and high intensity on T2-weighted MR images. Thallium scintigram showed a defect at the site of the lesion. All the 6 cases underwent surgical resection without cyst recurrence. All surgical specimens were histologically diagnosed as thymic cysts. Analysis of the intracystic fluid revealed a high titer of CAl25, a low titer of total protein and LDH, and uniform titer of sodium. These results indicated that percutaneous aspiration might be useful for diagnosis and therapy of a thymic cyst if it has no sign of malignancy.
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  • Satoshi Hirata, Eiji Yatuyanagi, Kousuke Yamazaki, Yasukazu Sugimoto, ...
    1998 Volume 12 Issue 4 Pages 506-510
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Serum interleukin-6 (IL-6) and acute phase reactant levels of 30 patients with lung cancer and 37 patients with other diseases were measured during the perioperative period. Eight patients with lung cancer who had received a preoperative administration of methylprednisolone (250 mg/body, MP group) were compared with a no administration group (non MP group); levels of IL-6 and other factors were measured in order to determine the effect of the steroid.
    Peak levels of IL-6 and CRP of patients with no complications occurred on the 1st and 3rd post operative days. However, these levels were significantly lower in VATS procedures than in the conventional thoracotomy group. The peak levels of IL-6 and CRP of MP group were significantly lower than those of the non MP group.
    These results suggest that serum IL-6 measurement during the perioperative period may be useful and the preoperative administration of the steroid methylprednisolone can control excessive reactions after chest surgery.
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  • Katsuo Usuda, Yasuki Saito, Satomi Takahashi, Masashi Handa, Hiroyuki ...
    1998 Volume 12 Issue 4 Pages 511-518
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Bronchial fistula after pulmonary resection for lung cancer is one of the most distressful complications for thoracic surgeons. To clarify effective methods and indications of conservative therapies for empyema due to bronchial fistula after pulmonary resection for lung cancer, we examined the clinical courses and therapies of 9 cases who suffered from empyema due to bronchial fistula after pulmonary resection for lung cancer between January, 1991 and December, 1995. Seven of the 9 patients underwent right lower lobectomy, 1 left lower lobectomy and 1 right upper sleeve lobectomy (one stoma type). Concerning dissection of lymph nodes, 8 patients underwent R2b dissection and 1 R1 dissection. In 6 patients (67%), the empyemas had healed by conservative therapies 14 to 67 days (mean 31.5 days) after confirmation of bronchial fistulas. All the healed cases met the following requirements : (1) A residual lobe is expected to expand. (2) Necrosis of bronchial stump is narrow. (3) There is no or only slight aspiration pneumonia in the contralateral lung. Empyema due to bronchial fistula after pulmonary resection for lung cancer can be healed by conservative therapies consisting of tube drainage (affected side below), postural drainage, effective antibiotics and intravenous hyperalimentation. In the other 3 patients (33%), wide ischemia led to bronchial necrosis from the bronchial stump to central bronchus, and aspiration pneumonia of the contralateral lung was severe. Conservative therapies were not effective and surgical procedures were indicated.
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  • Katsunari Matsuoka, Masatoshi Ito, Youichiro Ueno, Jun Isobe, Takanobu ...
    1998 Volume 12 Issue 4 Pages 519-523
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We present a case report of fungal osteomyelitis after aspergillus empyema. At first, 68-years male was admitted to our hospital complaining for cough and sputum. Chest X-ray film and CT demonstrated an air space with niveau in the right side of chest. As Aspergillus fumigatus was cultured from his sputum and pleural effusion, the diagnosis of aspergillus empyema was confirmed. After lung decortication, open thoracotomy, and omentopexy was performed, he left hospital. After 4 month from discharge, he was consulted to our hospital again complaining for lower limb paralysis. Myelography and MRI revealed infected osteomyelitis of the lumbar spine. Penicillium sp. was cultured from resected specimen, and it was diagnosed as fungal osteomyelitis after treatment of aspergillus empyema.
    Although fungal osteomyelitis are rare now, most of them occured in immunocompromised hosts and there may be increased incidence of fungal osteomyelitis due to the increasing frequency of immunosuppression associated conditions including chemotherapy, organ transplantation, AIDS, and postoperative condition.
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  • Shinji Kosaka, Naoyuki Ikegami, Tadashi Matsukura, Jiro Tamada
    1998 Volume 12 Issue 4 Pages 524-528
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 68-year old woman admitted with complaint of cough with purulent sputum and appetite loss. At the admission, chest X-ray film showed air-fluid level in the left thorax. Open drainage was performed because of the patient's poor general condition on admission. Four months later, when she was in better condition, left pleuropneumonectomy was performed.
    After operation, fluid obtained by thoracocentesis was purulent and grew a pure culture of Aspergillus terreus. Ten mg of amphotericin-B was infused in empyema space once a week. One month later, pleural fluid became serous and grew neither fungus nor bacterium. At present, 7 years after operation, she is alive without recurrence of empyema.
    Concentration of amphotericin-B in the pleural fluid, checked twice in the course, was found in relatively high level.
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  • Hiroaki Meguro, Ritsu Kohiyama, Norifumi Abe, Nobuyuki Takemoto, Michi ...
    1998 Volume 12 Issue 4 Pages 529-534
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 56-year-old male underwent left upper lobectomy with radical lymph node dissection (R2 a) for lung cancer located in the left S3.
    Intraoperative finding revealed that the left lung was almost non-lobulated, but the ramification of the pulmonary vein seemed to be normal.
    On the 2nd post operative day, congestion of the left lower lobe appeared and gradually increased.
    On pulmonary angiography, contrast medium remained in the left pulmonary artery and hardly shifted to the pulmonary venous phase.
    We concluded it might be the failure of irrigation in the residual left lower lobe and performed completion left pneumonectomy. Then the patient recovered uneventfully. The resected specimen revealed a defect of the left inferior pulmonary vein, and proved that a drainage vein from lower lobe joined to the upper pulmonary vein inside the left lung and single pulmonary vein drained into the left atrium.
    Though the cases of single pulmonary vein are very rare in the literature, if lobectomy is done with standard transection of the pulmonary vein in such a case, residual lung may become congested, and completion pneumonectomy will be needed.
    During operation, it should be carefully confirmed whether the superior and inferior pulmonary veins are separate or not.
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  • Susumu Kawano, Makoto Odaka, Hisashi Shioya, Hiroshi Takeyama, Tadashi ...
    1998 Volume 12 Issue 4 Pages 535-538
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 44-year-old woman with several episodes of right pneumothorax related to onset of menstruation was reported. Thoracoscopic surgery revealed the presence of many small perforations in the central tendon of the right diaphragm.
    Partial resection of the diaphragm including the lesions was performed under small thoracotomy assisted by thoracoscopy. Histological findings of the resected diaphragm showed stromal endometriosis surrounded by hemosiderin pigment deposits. Our case may give support to Maurer's hypothesis.
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  • Shigeto Takeshima, Koji Sensaki, Tsutomu Marui, Masazumi Watanabe, Yui ...
    1998 Volume 12 Issue 4 Pages 539-542
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 32-year-old female who had an intrapulmonary needle was reported. She was referred to our hospital because of an abnormality on chest roentgenogram. A long thin piece of metal was seen on the left upper field of the lung which we diagnosed as an intrapulmonary needle. We removed the needle with a partial pulmonary resection under fluoroscopic guidance through a lateral thoracotomy. As the needle was rusty, it was broken into 3 pieces by the intraoperative maneuver in spite of our careful procedure. The length of the needle was about 3.5 cm and we guessed it to be a sewing needle. She had acupuncture therapy for lumbago when she was 25 year old. However, the relationship between the therapy and this was not clear. Postoperative course was uneventful. Since intrapulmonary metal could induce inflammation in future, an intrapulmonary needle was an indication for operation. Additionally, as the needle could be rusty and fragile due to its long-time retention in the lung, operation should be performed with caution under fluoroscopic guidance to avoid leaving any piece of the needle behind.
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  • Yoshinobu Hattori, Shuichiro Sugimura, Tadasi Iriyama, Kouji Watanabe, ...
    1998 Volume 12 Issue 4 Pages 543-548
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 51-year-old man was referred for evaluation of an abnormal upper mediastinal shadow on routine chest roentgenogram. Laboratory data including thyroid hormone, parathyroid hormone and tumor markers were normal except liver function. CT and MRI showed a 3-cm cystic mass attached to the right side of the trachea. Axillo-anterior thoracotomy was performed and the mass was removed. Parathyroid hormone content in the serous fluid within the cyst was 24000 pg/mKouseikai Takai Hospital. Histopathologic examination revealed a parathyroid cyst, and the tumor was diagnosed as a nonfunctioning parathyroid cyst.
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  • Norio Yamaoka, Yoshitaka Uchiyama, Akihiro Nakamura, Masafumi Morinaga ...
    1998 Volume 12 Issue 4 Pages 549-556
    Published: May 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Three cases of severe tracheal stenoses were treated using extracorporeal membrane oxygenation with a veno-venous bypass (V-V ECMO). Case 1 was a 78-year-old male admitted for severe dyspnea due to stenotic trachea with primary lung cancer invasion. Immediately, left pneumonectomy was carried out by V-V ECMO using a circuit of percutaneous cardiopulmonary support system (PCPS). Case 2 was a 57-year-old female admitted for dyspnea due to severe tracheal stenosis 3 mm in diameter by tracheal tuberculosis. Immediately, an expanding metallic stent was inserted to the trachea using V-V ECMO. In spite of the lack of lung ventilation for 20 minutes during the treatment, the oxygen saturation of arterial blood was maintained at 100%, and hemodynamics was stable. The trachea was dilated after placement of the stent, and the symptom resolved. Case 3 was a 74-year-old male admitted for dyspnea due to severe tracheal stenosis by esophageal cancer invasion. Dumon stent was inserted to the trachea using V-V ECMO, the trachea was dilated after placement of the stent, and the symptom resolved. These three cases had no complications during or after these treatments. These results indicated that V-V ECMO using PCPS was a very useful, powerful and satisfactory method in the treatment of tracheal stenosis during the lack of lung ventilation.
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