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Volume 66 (2015)
- Issue 6 Pages 365-
- Issue 5 Pages 299-
- Issue 4 Pages 245-
- Issue 3 Pages 191-
- Issue 2 Pages 57-
- Issue 1 Pages 1-
Volume 66, Issue 6
Displaying 1-8 of 8 articles from this issue
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Original
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Yasunori Sakuma, Osamu Shiono, Masanori Komatsu, Yoichi Ikeda, Nobuhik ...2015 Volume 66 Issue 6 Pages 365-372
Published: 2015
Released on J-STAGE: December 25, 2015
JOURNAL RESTRICTED ACCESSLaryngotracheal separation is very useful as a procedure that can completely prevent aspiration in intractable aspiration pneumonia. We have been performing laryngotracheal separation at our hospital as a method that is noninvasive and can preserve laryngeal function. We performed laryngotracheal separation on 7 cases and tracheal flap method B-type on 7 other cases. The patients' ages ranged from 7 months to 69 years. The operative times were 143±39 minutes (mean ± standard deviation) in the laryngotracheal separation cases, and a significantly shorter 103±23 minutes in the tracheal flap method B-type cases. The cannula was removable in all adult cases except 2 that required respiratory equipment, and was retained in both cases of child patients. Postoperative complications were observed in 2 cases; in 1 case, death resulted from aggravated heart failure, and the other case required a second operation owing to suture-related complications. The tracheal flap method is a noninvasive operation similar to surgical closure of the larynx in that it can be performed under local anesthesia. It is superior as it requires less time and results in fewer complications such as suture imperfections. Based on our findings, we believe that the tracheal flap method should be chosen as a preferred method of surgical intervention to prevent aspiration.View full abstractDownload PDF (804K) -
Hiroki Takahashi, Takashi Tsubuku, Michiya Matsumura, Yasushi Furuta2015 Volume 66 Issue 6 Pages 373-379
Published: 2015
Released on J-STAGE: December 25, 2015
JOURNAL RESTRICTED ACCESSSurgical closure of the larynx is a very effective treatment for intractable aspiration due to cerebrovascular disorders or progressive neuromuscular disease. We performed the glottic closure procedure with removal of both thyroid and cricoid cartilage and insertion of a sternohyoid muscle flap on 20 patients (15 male, 5 female ; median age of 68.5 years) between March 2010 and July 2014. In all cases, surgery was safely performed under general anesthesia, although the preoperative physical status was severe (ASA class 3) in 12 of the 20 patients. Closure of the larynx was achieved in all cases and no surgical site infection was observed. Fifteen of the 20 cases did not require any tracheal cannula. Stoma stenosis or mismatch between stoma and tracheal cannula occurred in 3 cases, for which stomaplasty was performed. The frequency of sucking sputum markedly decreased in 7 cases that had undergone tracheostomy before this procedure. In conclusion, the glottic closure procedure is a safe and secure approach for patients with intractable aspiration, and it is applicable even in those in severe physical condition. Size adjustment between the tracheostoma and the cannula is necessary in patients who require a ventilator.View full abstractDownload PDF (376K) -
Yutaka Tokairin, Yasuaki Nakajima, Kenro Kawada, Yutaka Miyawaki, Taku ...2015 Volume 66 Issue 6 Pages 380-384
Published: 2015
Released on J-STAGE: December 25, 2015
JOURNAL RESTRICTED ACCESSIt is very difficult to perform complete upper mediastinal dissection for cervical esophageal cancer in the normal cervical surgery view. If we can develop a method to perform upper mediastinal dissection, including the left recurrent nerve lymph nodes (106recL), then it would be possible to perform minimal invasive surgery without any sternal splitting incision or esophagectomy under right thoracotomy. Here we describe a new method for performing complete dissection of the upper mediastinal lymph nodes for cervical esophageal cancer under pneumomediastinum using cadavers. First, a left cervical collar incision, measuring about 4 cm in length, was made and open surgery on the left side was subsequently changed to the pneumomediastinum method after identifying the left recurrent nerve. An Alexis wound retractor was placed and deployed, and a single-port laparoscopic access device was then attached. Pneumomediastinum was then established and the 106recL lymph nodes were dissected along the left common carotid artery, subclavian artery, thoracic duct and the left recurrent nerve. Finally, the esophageal wall was divided from the membranous trachea. Pneumomediastinum can create a good view to enable complete dissection of the upper mediastinum lymph nodes. This method does not require the transthoracic approach, and for this reason it is considered to be a useful modality based on our experience.View full abstractDownload PDF (2473K) -
Makoto Miyamoto, Tomofumi Sakagami, Masao Yagi, Eri Miyata, Koichi Tom ...2015 Volume 66 Issue 6 Pages 385-390
Published: 2015
Released on J-STAGE: December 25, 2015
JOURNAL RESTRICTED ACCESSWe examined the factors affecting recurrent nerve paralysis (RNP) after esophagectomy for esophageal cancer among our patients from January 2011 to December 2013. We excluded patients who had RNP before surgery, those whose recurrent laryngeal nerve was cut during surgery, and those who underwent tracheostomy before extubation. We evaluated the vocal fold movement of 59 patients with laryngeal fiberscopy after esophagectomy. In almost all cases of RNP, the paralysis was in the median position. RNP was observed in 49.2% (29 of 59 patients) of the cases during extubation. Of the 29 patients, 18 (62.1%) improved while the remaining underwent no change. We compared the patients with and without RNP, and considered factors behind the occurrence of postoperative RNP. We analyzed factors including age, preoperative serum albumin, location of carcinoma, staging, surgical method (right transthoracic subtotal esophagectomy or using thoracoscope), lymph node dissection (2-field or 3-field), surgical time, amount of bleeding, intubation time and pathological metastasis (to #106). None of the above factors were found to affect the occurrence of RNP. In addition, all factors exhibited no significant association with RNP in multiple regression analysis. Comparison between patients whose RNP improved and those whose RNP remained showed a significant difference in preoperative BMI. Occurrence of RNP is higher in patients who are over 70 years old. We should exercise greater care in the performance of surgery on elder patients.View full abstractDownload PDF (295K) -
Masahiro Haraguchi2015 Volume 66 Issue 6 Pages 391-399
Published: 2015
Released on J-STAGE: December 25, 2015
JOURNAL RESTRICTED ACCESSThe aim of this study was to analyze passive motion around pharyngeal structures using dynamic magnetic resonance imaging (MRI). We conducted a preliminary study involving 30 healthy volunteers who underwent dynamic MRI. Consecutive MRI axial images were obtained by examining the plane parallel to the hard palate at the level of the anterior inferior corner of C2. The area differences in pharyngeal frame during pharyngeal swallowing were measured as a motion index of pharyngeal contraction rate (PCR). Age, body mass index (BMI), tonsillar area (TA), displacement of the bilateral external carotid arteries (ECA) as well as increase in parapharyngeal area were calculated at rest and at maximum pharyngeal contraction. In most participants, the bilateral ECAs were anterointernally displaced by pharyngeal contraction. A weak negative correlation was found between age and PCR (r=-0.21, r2=0.045, p=0.26), with no significant difference. There were moderate negative correlations between BMI and PCR (r=-0.52, r2= 0.27, p<0.05) and between TA and PCR (r=-0.55, r2=0.30, p<0.05). There were moderate positive correlations between ECA displacement and PCR (r=0.45, r2=0.21, p<0.05) and between increase in parapharyngeal area and PCR (r=0.54, r2=0.29, p<0.05). These results revealed that pharyngeal contraction creates passive motion around pharyngeal structures toward the pharyngeal air space.View full abstractDownload PDF (1633K) -
Sunao Tanaka, Shigeru Kikuchi, Atushi Ohata, Masafumi Ohki2015 Volume 66 Issue 6 Pages 400-405
Published: 2015
Released on J-STAGE: December 25, 2015
JOURNAL RESTRICTED ACCESSIn Japan, several types of tracheostomy tube are available, and physicians determine which to employ based on their personal experience. A recent addition to the market is the Bivona®, a silicone tracheostomy tube incorporating stainless-steel spiral reinforcement. We experimentally evaluated the usefulness of the Bivona® compared to conventional silicone tracheostomy tubes and polyvinyl chloride tubes based on flexibility of shape and change in ventilation volume under various bending conditions. The silicone tracheostomy tubes were shown to be more flexible than polyvinyl chloride tubes, and the Bivona® was the most flexible. With the Bivona®, only when flexed between 30 and 60 degrees was there no attenuating change in ventilation volume. The attenuating rate of ventilation volume was significant with conventional silicone tracheostomy tubes and minimal with polyvinyl chloride tubes, while the Bivona® demonstrated the smallest change. These results indicate that the Bivona® offers outstanding flexibility and stable ventilation volume, thereby enabling non-invasive and secure respiratory management of infants wearing tracheostomy tubes.View full abstractDownload PDF (2389K) -
Yutaka Tokairin, Yasuaki Nakajima, Kenro Kawada, Yutaka Miyawaki, Taku ...2015 Volume 66 Issue 6 Pages 406-410
Published: 2015
Released on J-STAGE: December 25, 2015
JOURNAL RESTRICTED ACCESSIt is very difficult to perform complete upper mediastinal dissection for cervical esophageal cancer in the normal cervical surgery view. If we can develop a method to perform upper mediastinal dissection, including the left recurrent nerve lymph nodes (106recL), then it would be possible to perform minimal invasive surgery without any sternal splitting incision or esophagectomy under right thoracotomy. We herein describe a new method for performing complete dissection of the upper mediastinal lymph nodes for cervical esophageal cancer under pneumomediastinum. Case report : The patient was a 57-year-old male with a preoperative diagnosis of cervical esophageal cancer (Ce type 4 cT3 cN0 cM0 cStage II). CT revealed the 106recL lymph node to be enlarged to 8 mm in diameter, but no accumulation at the 106recL lymph node was seen on PET. A pathological examination was thus considered to be necessary. We dissected the upper mediastinal lymph nodes under pneumomediastinum. The left recurrent nerve and the ramus cardiacus of the sympathetic nerve were identified and exposed, and then the 106recL lymph nodes were dissected. It was possible to detect the recurrent nerve above the aortic arch. This method does not require the transthoracic approach, and thus it is considered to be a useful modality based on our experience.View full abstractDownload PDF (2976K)
Case Report
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[in Japanese]2015 Volume 66 Issue 6 Pages 411-413
Published: 2015
Released on J-STAGE: December 25, 2015
JOURNAL RESTRICTED ACCESSDownload PDF (234K)
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