胸部外科
Volume 60, Issue 2, 2007
Volumes & issues:
-
胸部外科の指針
-
-
大動脈弁狭窄に対する弁置換術後の心機能
60巻2号(2007);View Description Hide DescriptionTo prevent patient-prosthesis mismatch(PPM)after aortic valve replacement(AVR), we set up our original standard criteria for the selection of the size of the prosthetic valve. We also routinely perform supra-annular enlargement in patients with small aortic annuli. The objective of this study was to assess the impact of our procedure on the postoperative cardiac function of patients suffering from aortic stenosis(AS).We retrospectively reviewed 102 consecutive surgical patients with AS from 1999 to 2004. The patients were classified into the following 3 groups based on the sizes of their prosthesis(group S:19 mm prosthesis, n=34;group M:21 mm prosthesis, n=51;and group L:>23 mm prosthesis, n=17). Cardiac function was evaluated using echocardiography preoperatively, immediately postoperatively, and 6 months after the operation. There were no hospital deaths during the study period. A favorable hemodynamic outcome of all 3 groups was achieved. Our surgical strategy for AS was thought to be useful to prevent PPM after AVR.
-
-
今月の臨床
-
-
院外心肺停止後蘇生患者に対する緊急CABG
60巻2号(2007);View Description Hide DescriptionWe report a case of emergent coronary artery bypass grafting(CABG)in a survivor of an out-of-hospital cardiac arrest. A 64-year-old male driver lost consciousness and collapsed in a rice paddy field. A bystander placed him in a car and immediately started cardiopulmonary resuscitation after confirming the presence of pulselessness and apnea. Emergency medical service providers performed a defibrillation of ventricular fibrillation by using an automated external defibrillator(AED), and the patient was transferred to the critical care center in our hospital. Coronary angiography revealed a thrombus in the left main trunk(LMT), total occlusion of the left anterior descending artery(LAD)and the right coronary artery(RCA), and 90% stenosis of the left circumflex artery(Cx). Since the patient recovered consciousness 1 hour after admission and did not undergo any critical trauma, an on-pump CABG was performed for 3 vessels. He was discharged on the postoperative day 23, and he resumed a normal life. -
気管支内神経鞘腫
60巻2号(2007);View Description Hide DescriptionBenign endobronchial tumors are rare, and among these endobronchial neurinoma is extremely rare. We describe a case of endobronchial neurinoma successfully treated with left lower lobectomy. A 58-year-old man presented with an 8-month history of cough. During this period he was repeatedly treated with antibiotics for pneumonia of the left lower lobe. Chest X-ray showed atelectasis of the left lower lobe. Computed tomography(CT)of the chest showed a mass in the left main and lower lobe bronchi. Broncho scopy revealed the mass almost completely obstructing the left main bronchus. Although transbronchial biopsy was inconclusive and yielded necrotic tissue with Aspergillus hyphae, lung cancer was highly suspected based on clinical and radiographic findings. He underwent left lower lobectomy and was discharged 14 days after surgery in good condition. Pathological diagnosis was an endobronchial neurinoma 4 cm in size arising from the left basal bronchus. On immunohistochemical staining, the tumor was positive for S-100 protein and negative for α-smooth muscle actin. He took itraconazole at a daily dose of 200 mg orally for 6 months. He remains well 52 months after surgery without any evidence of recurrence.
-
-
今月の話題
-
-
Leriche 症候群を伴う冠状動脈病変に対するH グラフトを用いた低侵襲血行再建術
60巻2号(2007);View Description Hide DescriptionWe present a case of Leriche syndrome, requiring coronary revascularization and both lower extremities. Leriche syndrome shows high aortic occlusion, which has occasionally large collateral pathways from the internal thoracic artery(ITA)to the femoral artery via superior and inferior epigastric arteries. Usual usage of ITA may lead to deterioration of blood supply to lower extremities at surgical coronary revascular-ization. H-graft minimally invasive direct coronary artery bypass(MIDCAB), which puts arterial graft horizontally between in situ left ITA(LITA)and left anterior descending(LAD)through small incision approach, enables surgical LAD revascularization and keeps blood supply to lower extremities. H-graft MIDCAB contributed to two-stage surgery in a patient with Leriche syndrome complicated with coronary artery disease. -
癌性限局性胸膜腫瘍
60巻2号(2007);View Description Hide DescriptionWe report a 58-year-old male with localized pleural adenocarcinoma, the origin of which was not identified. The disk-shaped pleural tumor was 8×6×2 cm in size and involved the left upper chest wall including the ribs. A fine needle biopsy showed adenocarcinoma, but whole body survey revealed no neoplasm other than the chest wall tumor. The left chest wall resection was followed by the left pleuropneumonectomy, because a few disseminations were identified in the visceral pleura. Pathological examinations showed no primary tumor in the lung. Immunohistochemical examinations suggested that micro-adenocarcinoma originating the subpleural lung invaded chest wall. It may be possibly a subtype of pseudomesotheliomatous adenocarcinoma. The patient has no recurrent tumor 1 year after the operation.
-
-
臨床経験
-
-
ねじ込み固定型心内膜双極ペーシングリードの心外膜心房リードとしての利用法
60巻2号(2007);View Description Hide DescriptionGood performance was observed over 10 years after implantation of bipolar epicardial atrial pacing using an active fixation bipolar endocardial lead in 3 pediatric patients with congenital heart block. The bipolar endocardial lead which was supposed to be fixed transvenously was implanted on the atrial surface by first screwing the lead’s helix into the myocardium. The catheter was then laid down on the atrial surface, and both electrodes were wrapped by the atrial tissue. The good performance of this pacing lead seemed to depend on stable positioning of the electrode. This lead is superior to the commercially available, and steroid eluting epicardial bipolar pacing lead, on the point of its small size in head and body, and could be applied to dual chamber pacing in smaller children. -
乳腺紡錘細胞癌の興味ある肺転移例
60巻2号(2007);View Description Hide DescriptionWe experienced a case of interesting pulmonary metastasis from spindle cell carcinoma of the breast. A 68-year-old female who had undergone a radical mastectomy 32 months earlier was admitted to our hospital for the pulmonary tumor in the left S10 in January 2005. Pathological study of the breast tumor revealed mixture of carcinomatous portion and sarcomatoid portion with spindle cells. Because of the presence of transitional areas from one portion to the other, the tumor was diagnosed as spindle cell carcinoma of the breast. Partial resection of the left lower lobe was performed. Pathological examination of the pulmonary tumor revealed that the tumor was composed of the component similar to carcinomatous element of the breast cancer. In June 2005, She was admitted to our hospital again for the pulmonary tumor in the right S7. Partial resection of the right lower lobe was performed. The tumor was composed of both carcinomatous and sarcomatoid elements. After operation, as she complained of epigastralgia, a gastroscopic examination was perfomed. It showed 2 white polypi of the stomach. The biopsy specimen of the polypi were composed of the tumor similar to the sarcomatoid element of the breast cancer. She died of widespread metastasis 43 months after mastectomy. -
気管支形成を施行した若年者粘表皮癌
60巻2号(2007);View Description Hide DescriptionA 17-year-old man in whom mucoepidermoid carcinoma of the left upper lobe bronchus was successfully treated by bronchoplasty. The patient has been suffered from relapsing respiratory infections over the past 2 years. Bronchoscopic examination revealed a tumor at the orifice of the left upper lobe bronchus. Thus, left upper sleeve lobectomy was carried out. The tumor was 18×15×14 mm in size and obstructed left upper bronchus with mucoid impaction peripherally. Hystological examination confirmed a diagnosis of low grade malignant mucoepidermoid carcinoma without lymph node metastasis. The patient has been well and free from recurrence for 4 years postoperatively.
-
-
症例
-
-
単冠状動脈症に対するOPCAB の1 例
60巻2号(2007);View Description Hide DescriptionA 55-year-old male with single coronary artery complicated by angina pectoris was referred to our department for coronary artery bypass grafting(CABG). Coronary arteriography could not identify the left coronary orifice. Right coronary arteriography showed that the circumflex branch (Cx) followed the course of the normal right coronary artery(RCA),and the left anterior descending branch(LAD) followed the Cx. Other findings included 90% stenosis in #4 posterior descending(PD)of RCA. Off-pump CABG was successfully performed to D1 with the left internal thoracic artery graft and to #4PD with the radial artery graft. -
心不全を契機に発見された成人期心室中隔欠損の1 例
60巻2号(2007);View Description Hide DescriptionA 68-year-old woman was admitted because of face edema and dyspnea. Echograpy revealed ventricular septal defect(Kirklin Ⅳ).The pulmonary to systemic blood flow ratio was 3.73, and shunt ratio was 74% . Angiography showed mid-muscular defect with aditional defects. Left ventriculotomy was selected. The ventricular septal defect was 13 mm in diameter at mid-muscular portion and was closed with bovine pericardium. Postoperative course was uneventful. We think that the ventricular septal defect was recurrence after spontaneous closure of ventricular septal defect because the patient had no symptoms in childhood despite of large defect. -
外傷性心室中隔穿孔の1 例
60巻2号(2007);View Description Hide DescriptionWe report a 67-year-old female patient with ventricular septal perforation after weak blunt chest trauma. She tumbled down on a frozen street. Approximately 1 week later, the patient was aware of shortness of breath on exertion. On admission, holosystolic murmur was detected on chest wall and routine electrocardiogram examination showed ST-T change which suggested myocardial ischemia. Acute myocardial infarction and ventricular septal defect with left-to-right shunt was suspected. The echocardiography and cardiac catheterization revealed the muscular type ventricular septal perforation near the apex with large left-to-right shunt flow(82% shunt ratio). The congestive heart failure was controlled successfully by conservative medical treatment. Surgical repair was scheduled on the 28th day after initial chest trauma because of large left-to-right shunt. A hole of about a diameter of 2 cm with fibrous edge of the muscular septum was closed through a left ventriculotomy using a Dacron patch under cardiopulmonary bypass. Postoperative course was uneventful and the patient was discharged without symptoms of congestive heart failure. -
僧帽弁後尖より発生した乳頭状線維弾性腫の1 例
60巻2号(2007);View Description Hide DescriptionPapillary fibroelastoma is a rare benign tumor arising from the cardiac endothelium. In this report, we describe the surgical treatment for mitral valve papillary fibroelastoma with hypothyroidism. A 69-year-old woman was admitted to our hospital for the treatment of cardiac tamponade. Echocardiography revealed massive pericardial effusion and a small tumor attached to the posterior mitral leaflet. We drainaged the pericardial effusion, and found that the cause of pericardial effusion was hypothyroidism. After controling the thyroid function, open heart surgery was performed. We excised the tumor including a part of the posterior mitral leaflet, and mitral valve plasty was done. Both the surgical and histological findings showed papillary fibroelastoma, and the postoperative course was uneventful. To avoid embolic complications, early surgical intervention is recommended. -
両側部分肺静脈還流異常の1 例
60巻2号(2007);View Description Hide DescriptionWe have experienced a case of bilateral partial anomalous pulmonary venous connection with a fossa ovalis type of atrial septal defect and pulmonary stenosis. The right upper pulmonary vein returned to the superior vena cava and the left upper pulmonary vein returned to the left innominate vein via the vertical vein. The atrial septal defect was enlarged and the right upper pulmonary vein was baffled into the left atrium with an equine pericardial patch. The left upper pulmonary vein was divided and anastomosed to the left atrial appendage. Pulmonary commissurotomy was also done for concomitant pulmonary stenosis. Postoperative course of the patient was excellent with constantly normal sinus rhythm. Angiography 2 weeks after operation showed no evidence of pulmonary venous obstructions on both sides. -
胸膜発生巨大孤立性線維性腫瘍の1 例
60巻2号(2007);View Description Hide DescriptionAn 81-year-old male appealed against a feeling of dyspnea, and consulted the hospital. The giant tumor discovered in the thorax and it was enlarging gradually for 7 years. The tumor shadow with a diameter of about 15 cm was noted in right lower lung field on the chest X-ray. A definite diagnosis was not obtained by the needle biopsy. The tumor was found to exist between upper lobe and lower lobe and pressed lower lobe at surgery. The tumor was completely excised with partial resection of the collapsed lower lobe. The tumor was 1,050 g in weight and 18 cm in maximum diameter. Pathological examination showed the irregular and plan-like arrangement of the spindle-shape cell. Immunohistochemical study revealed positive findings for bcl-2 and CD34, negative findings for desmin, ketatin, and α-actin. The tumor was diagnosed as malignant solitary fibrous tumor of the pleura due to highly atypical nuclear finding with an abundant nuclear fission or histology. -
降下性壊死性縦隔炎に対する頚部切開および胸腔鏡下ドレナージの1 例
60巻2号(2007);View Description Hide DescriptionA case of a 55-year-old man with descending necrotizing mediastinitis(DNM)after a tooth removal was reported. Chest computed tomography(CT)showed a fluid collection in the right thorax, in the cervical region and in the mediastinum. The patient underwent cervical drainage and thoracoscopic pleural dissective drainage. The cervical and right anterior thoracic drain was removed on the 6th day and posterior drain was removed on the 8th day after the operation. The patient was discharged on the postoperative day 13, and showed no recurrence. -
心横隔膜角発生のCastleman 病の1 例
60巻2号(2007);View Description Hide DescriptionWe report the first case of Castleman disease arising from cardiophrenic angle. The patient was referred to our hospital to treat his mediastinal tumor. Computed tomography(CT)showed a well-enhanced mass arising from the right cardiophrenic angle. We speculated the tumor to be a Castleman disease or hemangioma. Right thoracotomy was performed, and the tumor was removed after the ligation of the feeding artery and drainage vein. The histological findings of the tumor led to a diagnosis of Castleman disease hyaline vascular type.
-
-
日本胸部外科学会発の医療政策―施設集約化は是か非か
-
-
-
まい・てくにっく
-
-
-
1枚のシェーマ
-
-
-
日本胸部外科学会 夫人の会日記
-
-
-
書評
-
-