Volume 63,
Issue 10,
2010
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胸部外科の指針
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Source:
胸部外科 63巻10号, 843-848 (2010);
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Median full-sternotomy carries a risk of sternal infection and lethal mediastinitis in cardiac surgery.We performed open-heart surgery through partial median sternotomy in 5 patients with tracheostomy.Coronary artery bypass grafting( CABG) was performed in 3 patients, aortic valve replacement in 1, andmitral valve replacement in 1. No operative deaths or complications related to wound infection occurred.Partial sternotomy represents a safe alternative in cardiac surgery in patients with tracheostoma.
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今月の臨床
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Source:
胸部外科 63巻10号, 849-852 (2010);
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Recently, postoperative adjuvant chemotherapy is very popular for completely resected non-small-celllung cancer patients, but cisplatin-based regimens are not safety and tolerable for outpatients. In thisstudy, gemcitabine plus carboplatin regimen is selected as more safety and feasible for outpatient chemotherapy, and scheduled bi-weekly administration to reduce hematological toxity, especially thrombocytopenia.Twenty patients with completely resected non-small-cell lung cancer (pStage IA〜IIIB)administered gemcitabine 1,000 mg/m2 and carboplatin area under the curve (AUC) 3 bi-weekly for 8times at outpatient chemotherapy center except that 1st treatment was done with short stay in hospital.Of 20 patients, 13( 65%) completed the 8 times bi-weekly treatment and 7 patients incompleted becauseof neutropenia in 2, anemia in 1, liver dysfunction in 3, interstitial pneumonia suspected in 1. Relativedose intensity was 79%. Seven patients had grade 3/4 neutropenia, 2 had grade 3 thrombocytopenia, 2had grade 3 anemia, and 2 had grade 3 liver dysfunction. Hematological toxity, especially thorombocytopeniaare less than standard administration of gemcitabine and carboplatin regimen, so we conclude thatthis regimen is feasible in outpatient adjuvant chemotherapy for completely resected non-small-cell lungcancer.
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今月の話題
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Source:
胸部外科 63巻10号, 853-856 (2010);
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A 37-year-old woman underwent semi-emergency mitral valve plasty for severe mitral regurgitationand congestive heart failure. Although repair was successfully performed and the left ventricular functionwas maintained, refractory pulmonary hypertension precluded cessation of cardiopulmonary bypass.Inhalation of nitric oxide was ineffective, and assist circulation was required. All data obtained from theSwan-Ganz catheter and other routine monitors were devastating, and the patient showed no clinicalrecovery in the early postoperative period. However, transesophageal echocardiography (TEE) performedon the 2nd postoperative day (POD) revealed much better filling of the left heart and thepatient was weaned from assist circulation on the 4th POD. Pulmonary vascular disease was denied histologically.Late cardiac catheterization disclosed normal pulmonary artery pressure and resistance.TEE played a key role during very complicated postoperative management. Monitoring of the left atrialpressure might be necessary in cases that require assist circulation due to pulmonary vasoconstriction
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Source:
胸部外科 63巻10号, 857-861 (2010);
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This is a case of a 72-year-old male whose chest computed tomography (CT) revealed a 2.0×1.6 cmanterior mediastinal solid tumor during follow-up of an abnormal shadow of the lung. The tumorincreased its size during preoperative follow-up, and multilocular cyst was also observed. Radical thymectomywas performed, and histopathologically the tumor was diagnosed as thymic basaloid carcinoma. Thymic basaloid carcinoma is a rare tumor and is often associated with multilocular thymic cyst.There are only 32 cases reported both locally and internationally. Surgical resection is the general treatmentfor this disease. Adjuvant radiotherapy can be considered in cases of incomplete resection andinvasive tumor. In our case, no recurrence of the tumor was noted 12 months post-operative. Generally,the malignancy of thymic basaloid carcinomas are regarded as low-grade compared with other thymiccarcinomas, however, since mortality and recurrence have been reported, careful follow-up is required.
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手術の工夫
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Source:
胸部外科 63巻10号, 864-866 (2010);
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Aortopulmonary window (APW) is a rare congenital heart defect that requires urgent repair, as itcan lead to rapid development of pulmonary hypertension. A 6-day-old boy with a total-defect APW wastransferred to our hospital and underwent definitive repair on the 15th day after birth. The ascendingaorta and pulmonary trunk were divided to create a larger tissue margin on the aortic side for the nextseam. Then, the aortic window was sutured and closed directly, while the large pulmonary defect wasreconstructed with a fresh autologous pericardial patch. Although peritoneal dialysis was briefly requiredfor acute renal failure due to low output syndrome, his condition improved and he was discharged 22days after surgery. Six years later, he remains well, without complications or need for medication.
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術前・術後管理
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Source:
胸部外科 63巻10号, 867-869 (2010);
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Vacuum-assisted closure( VAC) therapy is increasingly applied for patients with wound dehiscence ormediastinitis caused by surgical site infection (SSI) after open-heart surgery. We have used wall suctionfor such cases in the past. But this method was an obstacle for improvement of the quality of life(QOL) of the patient. Since the S-B Vac is portable, this equipment may allow wound healing withoutdecreasing QOL. Here, we report a case in which VAC therapy was performed using the S-B Vac.
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臨床経験
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Source:
胸部外科 63巻10号, 871-874 (2010);
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Tumors of the pulmonary artery( PA) are rare and their prognosis is poor. Proper diagnosis is oftendelayed or made post mortem despite diagnostic advances. Although the only treatment of choice isradical surgical resection, local recurrences are soon recognized after the operation. There is no standardregimen of perioperative additional therapy, and its effectiveness is still unknown. We report a caseof an 80-year-old male whose PA was almost completely obstructed by the intimal sarcoma. It wasresected and reconstructed with autologous pericardial roll. His postoperative course was uneventful.
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Source:
胸部外科 63巻10号, 875-878 (2010);
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Pulmonary hamartoma is most common benign tumor of the lung and is not recognised as having acharacter of malignant transformation. So, longtime radiological observation is not uncommon forpatients with diagnosis of pulmonary hamartoma from computed tomography (CT) finding. Althoughpulmonary hamartoma does not transform to malignancy, high frequency of coexistence hamartoma andlung cancer has been reported. We experienced 14 cases of resected pulmonary hamartoma, and 3 ofthem had lung cancer, showing that 21.4% of pulmonary hamartoma coexisted with lung cancer.Patients with pulmonary hamartoma should undergo sufficient evaluations for malignancy.
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Source:
胸部外科 63巻10号, 879-882 (2010);
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We report a 70-year-old man who suffered from right anterior chest wall tumor. Physical examinationrevealed an elastic hard mass at the right 4th rib measured 6 cm in diameter. Chest X-ray and computedtomography (CT) revealed enhanced mass and destruction of the 4th rib. As needle aspirationcytology did not define the diagnosis, we performed a chest wall resection and reconstruction. Histologicaldiagnosis of the tumor was plasmacytoma (IgG lambda type). Five months after the operation, thetumor recurred at the right anterior chest wall. Radiotherapy was performed with dose of 50 Gy. Fourteenmonths after the operation, the tumor recurred at the lower sternum, and the chemotherapy wasperformed using ranimustine, vincristine, melpharan and dexamethasone. He is doing well 2 years and 9months after surgery without signs of progressive disease or conversion to myeloma.
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Source:
胸部外科 63巻10号, 883-885 (2010);
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We report a case of delayed massive hemothorax, a 72-year-old women, due to diaphragmatic injuryby multiple lower rib fracture on 4th day aftrer traffic injury. We tried to stop bleeding by transcatheterarterial embolization, but the control of bleeding was difficult, necessitating the emergency surgery.The diaphragmatic injury about 3 cm diameter was found, and was sutured with absorption thread. Thepost operative course was uncomplicated. Patient was discharged on 51th day after injury.Careful observation is important for delayed hemothorax after lower rib fracture.
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症例
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Source:
胸部外科 63巻10号, 899-902 (2010);
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A 91-year-old man was transferred to our hospital because of severe chest pain. Chest computedtomography( CT) scan showed impending rupture of the true aneurysm of the aortic arch. The patientunderwent emergent graft replacement of the total aortic arch. He was extubated on the 1st postoperativeday, and received continuous hemodiafiltration (CHDF) for oliguria. However, he recovered fromoliguria and renal dysfunction. He discharged at the 67th postoperative day.
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Source:
胸部外科 63巻10号, 903-905 (2010);
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We operated on an advanced aged patient who presented with acute aortic dissection( DeBakey typeII).The patient was a 97-year-old female who was admitted to our hospital due to chest pain. We initiallyadministered conservative medical therapy as far as possible. However, due to the continuing chest painand the fact that the diameter of the aneurysm was quite large and the risk of a rupture was high, wetherefore decided to operate on the ascending graft replacement using retrograde cerebral perfusion onthe 8th day from onset. Sufficiently controlling the bleeding proved to be difficult because the site ofcannulation on the right atrium was fragile and it therefore tended to split easily. The postoperativecourse was uneventful except for the fact that it took the patient longer than usual to wake up fromanesthesia.As far as could be determined based on an extensive search of the pertinent literature, this appears tobe the most advanced aged case of an operation for acute aortic dissection ever reported in Japan.
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Source:
胸部外科 63巻10号, 906-909 (2010);
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A 66-year-old man was referred to our hospital for surgical treatment for aortic regurgitation. Transthoracicechocardiography revealed the diagnosis of aortic regurgitation due to quadricuspid aorticvalve. During operation, we confirmed that the aortic valve consisted of 4 leaflets with almost same size(Hurwitz and Roberts classification type A). We performed valve replacement because each leaflet hasdegenerative change. The patient’s postoperative course was uneventful and discharged the hospitalwithout complications.Congenital quadricuspid aortic valves are rare, and patients with this disease are frequently operatedbecause of aortic regurgitation. Presently, common operative procedure is aortic valve replacement,although in the future valvuloplasty should be investigated.
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Source:
胸部外科 63巻10号, 911-914 (2010);
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Bronchial carcinoids are relatively rare, low-grade malignancies. Here we report a case of a bronchialcarcinoid found by repeated pneumonia in the lingular division of the left lung. A 34-year-old man wasreferred to our hospital because of an abnormal shadow detected in an annual checkup. A chest computedtomography( CT) showed an infiltrative shadow in the lingular division. Two months later, a follow-up CT showed the shadow had remarkably improved. Two years after the 1st detection, an annualcheckup revealed an abnormal shadow in the same lesion again. A chest CT showed not only an infiltrativeshadow in the lingular division, but also a solid mass with calcification in the lingular bronchus. Abronchoscopy revealed an obstruction of the left upper lobe bronchus by a vascularized polypoid tumor.A transbronchial biopsy indicated a presence of a carcinoid, and a resection of the left upper lobe wasperformed. A histopathological examination showed that it was a typical carcinoid. The patient hasbeen free of recurrence for 2 years since surgery. This is a case with repeated pneumonia and atelectasiscaused by a bronchial carcinoid.
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Source:
胸部外科 63巻10号, 915-918 (2010);
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A 69-year-old man and a 53-year-old man with lung cancer of left upper lobe underwent pulmonaryresection. A preoperative chest computed tomography( CT) scan showed the left superior and inferiorpulmonary veins forming a common trunk. In the former case, the common trunk was misidentified asthe superior pulmonary vein. The latter was recognized preoperatively by using 3-dimensional CT, andsuccessfully performed left superior segmentectomy. This variation type is surgically important becauseof a potential risk of intraoperative bleeding and damage to pulmonary circulation during pulmonaryresection.
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Source:
胸部外科 63巻10号, 919-921 (2010);
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31-year-old man who complained of chest pain due to chest wall wound caused by tumble. He tookchest X-ray examination and suggested of having mediastinal tumor. Computed tomography( CT) scanrevealed 3.0 cm mass in diameter with irregular shaped calcification and lobulated cystic lesion (size:21×17×41 mm). The mediastinal tumor was totaly removed by surgical operation. No invasive portionwas observed between mediastinal pleura and solid tumor. Pathological examination revealed that tumorwas composed of mucoepidermoid carcinoma of the thymus and postoperative adjuvant radiotherapywas performed. The patient have survived without disease for 3 years after surgery.
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Source:
胸部外科 63巻10号, 922-925 (2010);
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The patient was a 70-year-old woman who visited our hospital due to right chest pain. Chest computedtomography (CT) and magnetic resonance imaging (MRI) revealed an abscess in the chest wallwhich was diagnosed as tuberculous abscess by a bacterial examination of needle aspiration. In spite ofanti-tuberculosis chemotherapy, the abscess was ruptured on day 15 after starting treatment, and a radicalresection of the abscess was performed after 10-days conservative treatment. Skin over the abscessand a part of right 7th and 8th rib were also resected. Postoperative anti-tuberculosis chemotherapywas added and no relapse was seen for 40 months postsurgery.
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連載 ●知っておきたい文献管理のコツ(第5回)●
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Source:
胸部外科 63巻10号, 893-897 (2010);
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With recent advances in reference management software, bibliographic data can be down-loadeddirectly from PubMed and other databases. And then, the down-loaded full text of an article is immediatelyprinted out. However, it is still a hassle to store, organize and search hard copies accumulated inpiles.
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まい・てくにっく
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Source:
胸部外科 63巻10号, 862-863 (2010);
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1枚のシェーマ
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Source:
胸部外科 63巻10号, 870-870 (2010);
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画像診断Q&A
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Source:
胸部外科 63巻10号, 886-891 (2010);
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胸部外科医の散歩道
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Source:
胸部外科 63巻10号, 892-892 (2010);
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書評
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Source:
胸部外科 63巻10号, 898-898 (2010);
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Source:
胸部外科 63巻10号, 910-910 (2010);
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