RESUMEN

UNLABELLED: Pure red cell aplasia (PRCA) and myasthenia gravis (MG) are respectively combined with thymoma, however, these 3 complications are extremely rare coexisted as a clinical triad. A 73-year-old female with mediastinal tumor found in 2000 was pointed out anemia in June 2002. As PRCA was diagnosed by the bone marrow examination, blood transfusion had been performed. By a chest computed tomography (CT), a thymoma in size of 7 x 5 cm in diameter was recognized in the anterior mediastinum. The serum level of anti-acetylcholine receptor antibody was elevated to be 35 nmol/l. MG was simultaneously diagnosed with a decreased power of neck muscle. The extended thymectomy was performed in August 2002, and pathological diagnosis disclosed a 'type AB' by World Health Organization (WHO) classification. After the operation, the decreased power of neck muscle had been improved, however, PRCA had not been remitted in the early-postoperative term. Blood transfusion had been required (2-4 units/1-2 weeks) for the postoperative 7 months' term. A cyclosporin (250 mg/day) as an adjuvant therapy was administered in April 2003. One month later, the patient's serum level of Hb had been over 10 g/dl without blood transfusion. The patient has been followed up with reducing the dose of cyclosporin. CONCLUSIONS: Surgery for a thymoma combined with PRCA and MG was effective for MG but not for PRCA in an early-postoperative term, however, a multimodality therapy with immunosuppressant as a postoperative adjuvant should bring a favorable outcome to patient's clinical data, and the postoperative long-observation must be critical in this case.

Asunto(s)

Miastenia Gravis/complicaciones , Aplasia Pura de Células Rojas/complicaciones , Timectomía , Timoma/cirugía , Neoplasias del Timo/cirugía , Anciano , Terapia Combinada , Femenino , Humanos , Timoma/complicaciones , Timoma/patología , Neoplasias del Timo/complicaciones , Neoplasias del Timo/patología

RESUMEN

The disclosed 5-year survival rate for lung cancer in the Internet website represents a various difference by each institution. The better inferiority of the survival has been listed in a table to compare with other institutions and has been reported in magazines and media with a lack of an enough inspection, i.e., with a sufficient considering of a risk adjustment such as patient's background, operative policy, postoperative adjuvant therapy, and statistical background. We report our outcome of the surgical treatment for primary lung cancer. Of 875 patients treated for lung cancer in our department for 23 years between January 1980 and December 2002, 115 patients containing of 42 cases in 1997 and of 48 ones in 1992 and of 25 ones in 1987 were selected and the accumulated survival analysis was treated by Kaplan-Meier method. Eighty males and 35 females were between 15 and 80-year-old (average 63.2 +/- 11.4). The pathological classification was adenocarcinoma (n=69), squamous cell carcinoma (n=32), and others (n=14). The operative procedures were pneumonectomy (n=14), bilobectomy (n=12), lobectomy (n=85), and wedge resection (n=4). The survival time was from 29 days to 182 months (median survival time was 1471+/- 1180 days, the averaged time was 49 months). The 5-year survival rate was 41.4 +/- 9.1% (n=25) in 1987, 35.6 +/- 6.2% (n=48) in 1992, and 56.0 +/- 7.0% (n=42) in 1987, respectively (log-rank test, p = 0.2555). The 10-year survival rate was 24.1 +/- 7.9% in 1987 and 8.5 +/- 3.6% in 1992, respectively. The 5-year survival rate was as follows: IA 81.0 +/- 8.6% (n=20), IB 73.7 +/- 10.1% (n=19), IIA 57.1 +/- 18.7% (n=7), IIB 55.6 +/- 16.6% (n=9), IIIA 28.6 +/- 7.6% (n=35), IIIB 15.4 +/- 10.0% (n=13), IV 16.7 +/- 10.8% (n=12), respectively. The 5-year survival rate was as follows: male 42.8 +/- 5.3% (n=80), female 63.2 +/- 7.3% (n=35), respectively (p = 0.0147). In regard to the histological classification, the 5-year survival rate was as follows: adenocarcinoma 47.2 +/- 5.9% (n=69), squamous cell carcinoma 50.8 +/- 8.9% (n=32), respectively (p = 0.9012). As a rule of the disclosure on the internet website, we report our survival data by accompanying with minimum parameters such as, patient's background, pathological types, gender, pathological stages, and mean survival rate with standard error. When we compare the 5-year survival rate with other institutes, in considering of a risk adjustment, we would carefully have to estimate the determined survival rate with a standard error.

Asunto(s)

Internet , Neoplasias Pulmonares/mortalidad , Adenocarcinoma/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Femenino , Humanos , Japón/epidemiología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Tasa de Supervivencia

RESUMEN

Type I neurofibromatosis (NF-I), also referred to as von Recklinghausen's disease, is an autosomal dominant disease characterized by neurofibromas and abnormal cutaneous pigmentation (café-au-lait spot). We studied retrospectively the 8 cases operated in our hospital between January 1979 to December 2002, which were complicated with von Recklinghausen's disease and a thoracic surgical disease. The patients were 6 males and 2 females and the age from 16 to 70 (the averaged age was 36 +/- 22). The thoracic diseases were consist of mediastinal tumors (n = 7) and esophageal cancer (n = 1). The operative procedures were tumorectomy (n = 6), subtotal esophagectomy (n = 1), and pericardial cystectomy (n = 1). The mediastinal tumors were neurofibroma (n = 3), malignant schawannoma (n = 1), ganglioneurinoma (n = 2), and pericardial cyst (n = 1). Malignant neoplasms were recognized in 2 cases (25%). The postoperative survival was 10 months for malignant schwannoma, and 8 months for esophageal cancer, and the others were alive. For 1 case of neurofibromas, there was observed to be the reoperated one after the postoperative recurrence. von Recklinghausen's disease are apt to be complicated with thoracic surgical neoplasms, it should be required a careful and systemic exploration especially for malignant neoplasms.

Asunto(s)

Neurofibromatosis 1/complicaciones , Enfermedades Torácicas/cirugía , Adolescente , Adulto , Anciano , Neoplasias Esofágicas/cirugía , Femenino , Humanos , Masculino , Neoplasias del Mediastino/cirugía , Persona de Mediana Edad , Estudios Retrospectivos

RESUMEN

Mucormycosis is an extremely rare case of pulmonary mycosis, its prognosis is very poor, and known as an opportunistic infection among immunocompromised hosts accompanied with other primary chronic disease. We report here a case of bilateral lower lobectomies carried out by two-stage operation for pulmonary mucormycosis combined with diabetes mellitus (type I) and severe resistance to an antimycobiotics under biblicographical considerations. A 36-year-old female was diagnosed as a diabetes mellitus (type I), and has been administrated with an insulin injection in 1989 at the age of 22-year-old. The patient was suffered a dry cough in June and the bilateral abnormal shadows were pointed out by the chest X-ray film in November, 2002. By transbronchial lung biopsy, Mucor fungus was confirmed in grannulomatous lung specimen. Intravenous injection of amphotericin B could not be continued due to the unavoidable side-effects from this agent. As the lung mass shadow was enlarged increasing and strongly suggested an abscess, formation in its focus, and then the left lower lobectomy was performed as the first step of surgical treatment and the right lower lobectomy was done on the postoperative forty-fourth day as the second step. The postoperative prognosis was considerably uneventful. After bilateral lower lobectomies, the patient could try a walk and go upstairs with a moderate dyspnea. A possible surgical resection should be conducted for the pulmonary mucormycosis, when the medicinal therapy showed an uneffectiveness and/or an infectious lesion was shown as restricted lesion.

Asunto(s)

Enfermedades Pulmonares Fúngicas/cirugía , Mucormicosis/cirugía , Neumonectomía/métodos , Adulto , Diabetes Mellitus Tipo 1/complicaciones , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/patología , Mucormicosis/patología

RESUMEN

UNLABELLED: We report a case of thymothymectomy for the thymoma with pure red cell aplasia (PRCA). A 31-year-old male with a general fatigue had a severe anemia (hemoglobin 3.1 g/dl) since November 1997. By the bone marrow examination, PRCA was diagnosed and treated with blood transfusion and immunosuppressive drug (cyclosporin: CYA) administration but anemia had not been improved. The chest computed tomography displayed a 3 cm in a diameter of thymoma located in the anterior mediastinum. The extended thymothymectomy had been performed in February 1998, pathological detection disclosed Masaoka classification stage I, type AB was diagnosed due to the World Health Organization (WHO) classification. PRCA had not obtained an immediate remission during the postoperative-early term, while, adjuvant therapy (CYA 300 mg/day) has been continued and it brought a complete remission of PRCA in August 2001 (after the postoperative 3 years and 6 months later). CONCLUSIONS: Even though only thymothymectomy for thymoma with PRCA showed no effectiveness for the postoperative-early remission of PRCA, however, the combination of thymectomy and the postoperative adjuvant therapy (CYA) should bring a better outcome, and the continuous follow-up would be required for a long postoperative term.

Asunto(s)

Aplasia Pura de Células Rojas/etiología , Timectomía , Timoma/cirugía , Neoplasias del Timo/cirugía , Adulto , Ciclosporina/administración & dosificación , Humanos , Inmunosupresores/administración & dosificación , Masculino , Aplasia Pura de Células Rojas/tratamiento farmacológico , Inducción de Remisión , Timoma/complicaciones , Neoplasias del Timo/complicaciones

RESUMEN

AIMS: The prognosis of non-small cell lung cancer with pathologic mediastinal lymph node involvement (pN2) is poor, we wished to study the expression of p53, bcl-2 by immunohistochemistry in a series of such patients. METHODS: Clinicopathologic factors were investigated in relation to prognosis in 60 patients with resected pN2 non-small cell lung cancer. RESULTS: The 5-year survival rate was 21.7%. Positive staining for p53, and bcl-2 was found in 29/60 and 12/60, respectively. Patients with bcl-2 positive tumor had a more favorable survival than those with bcl-2 negative tumor (P=0.0054). The expression of p53 was not related to patients' survival. Multivariate analysis showed that Bcl-2 expression and single N2 station were independent prognostic factors. CONCLUSIONS: Patients with bcl-2 positive tumors may comprise a favorable prognostic subgroup in pN2 non-small cell lung cancer.

Asunto(s)

Biomarcadores de Tumor/análisis , Carcinoma de Pulmón de Células no Pequeñas/química , Neoplasias Pulmonares/química , Proteínas Proto-Oncogénicas c-bcl-2/análisis , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Proteína p53 Supresora de Tumor/análisis

RESUMEN

The association of mast cells with tumor angiogenesis was investigated in patients with esophageal squamous cell carcinoma. Surgical specimens from 48 patients with esophageal squamous cell carcinoma were studied. Mast cells in tumor sections were stained with Alcian blue and safranin O. The number of mast cells was counted under light microscopy and the average count recorded. To highlight the microvessels, endothelial cells were stained with anti-human factor VIII antibody. Microvessel density was also counted. We found a significant correlation between mast cell count and microvessel density in patients with esophageal squamous cell carcinoma. Double staining of the microvessels revealed highly angiogenic areas densely populated with mast cells. There appears to be a direct correlation between the number of mast cells and tumor angiogenesis in patients with esophageal squamous cell carcinoma.

Asunto(s)

Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Mastocitos/citología , Adulto , Anciano , Anciano de 80 o más Años , Recuento de Células , Esófago/irrigación sanguínea , Humanos , Masculino , Mastocitos/patología , Microcirculación , Persona de Mediana Edad , Neovascularización Patológica

RESUMEN

BACKGROUND: We assessed the nm23-H1 gene product expression and its relationship with lymphatic and blood vessel invasion in patients with esophageal squamous cell carcinoma. METHODS: Formalin-fixed and paraffin-embedded tissue sections from 45 patients who were treated surgically were used in this study. Pathologists graded lymphatic and blood vessel invasion in each of the tissue samples. Expression of nm23-Hl gene product was determined using a specific monoclonal antibody. RESULTS: Expression of nm23-H1 gene product was present in 17 (37.8%) cases. We found an inverse correlation between nm23-H1 gene product expression and lymphatic vessel invasion, whereas no correlation between nm23-H1 gene product expression and blood vessel invasion. Overall survival rate was not different between nm23-H1 gene product positive and negative patients (p = 0.21). However, reduced expression of nm23-H1 gene product was associated with shorter overall survival in patients with involved lymph nodes (p < 0.05), but not in patients without involved lymph nodes (p = 0.87). CONCLUSIONS: In patients with esophageal squamous cell carcinoma, there appears to be an inverse relationship between nm23-H1 gene product expression and lymphatic vessel invasion. Furthermore, nm23-H1 gene product expression might be a prognostic marker in patients with involved lymph nodes. Our data does not demonstrate any correlation between nm23-H1 gene product expression and blood vessel invasion.

Asunto(s)

Carcinoma de Células Escamosas/metabolismo , Neoplasias Esofágicas/metabolismo , Neoplasias Esofágicas/patología , Proteínas de Unión al GTP Monoméricas/biosíntesis , Nucleósido-Difosfato Quinasa , Factores de Transcripción/biosíntesis , Biomarcadores de Tumor/biosíntesis , Biomarcadores de Tumor/genética , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Neoplasias Esofágicas/genética , Femenino , Fijadores , Formaldehído , Regulación Neoplásica de la Expresión Génica/genética , Humanos , Metástasis Linfática/genética , Masculino , Persona de Mediana Edad , Nucleósido Difosfato Quinasas NM23 , Invasividad Neoplásica/genética , Invasividad Neoplásica/patología , Neoplasias de Tejido Vascular/genética , Neoplasias de Tejido Vascular/secundario , Adhesión en Parafina , Distribución Aleatoria , Análisis de Supervivencia

RESUMEN

A 67-year-old male underwent a right upper lung lobectomy for lung cancer in January 1993. Follow-up chest X-rays revealed a progressive and rapidly growing intrathoracic mass in the right thorax. The mass, however, did not resemble a tumor recurrence, and the patient complained only of shortness of breath. Computerized tomography and magnetic resonance imaging confirmed the presence of the intrathoracic mass and its associated compression of the residual lung. A right thoracotomy was performed in January 1998, and a mass found arising from the sympathetic nerve trunk was resected. Microscopic examination revealed stellate or spindle-shaped cells in myxoid stroma with sparsely distributed collagen fibers. Immunohistochemically, the cells were positive for neuron-specific enolase, and the tumor was identified as neurofibroma. The patient did not suffer from von Recklinghausen's disease, and there was no family history of the disease. After resection of the neurofibroma, the compressed lung was able to re-expand, and the patient's shortness of breath disappeared. At one year postoperative, the patient remains well, and there is no evidence of recurrence.

Asunto(s)

Neurofibroma/patología , Neoplasias del Sistema Nervioso Periférico/patología , Neumonectomía , Neoplasias Torácicas/patología , Anciano , Humanos , Masculino , Neurofibroma/cirugía , Neoplasias del Sistema Nervioso Periférico/cirugía , Complicaciones Posoperatorias , Neoplasias Torácicas/cirugía

RESUMEN

We report herein the rare case of an 8-year-old boy in whom an inflammatory pseudotumor of the upper lobe bronchus of the right lung was successfully treated by bronchoplasty. A bronchoscopy was initially performed to investigate the cause of pulmonary atelectasis in the right upper lobe, which revealed a tumor in the right main bronchus. Thus, a thoracotomy followed by bronchotomy of the right main bronchus was carried out. The tumor was seen to have polypoid protrusion into the right main bronchus at the orifice of the upper lobe. A bronchoplasty with a wedge resection of the right main bronchus and right upper lobectomy was carried out, effectively preserving right pulmonary function. Histological examination confirmed the diagnosis of an inflammatory pseudotumor. The patient had an uneventful postoperative course and has been free of recurrence for 3 years since his operation.

Asunto(s)

Bronquios/cirugía , Enfermedades Bronquiales/cirugía , Granuloma de Células Plasmáticas/cirugía , Biopsia con Aguja , Enfermedades Bronquiales/diagnóstico , Enfermedades Bronquiales/patología , Broncoscopía/métodos , Niño , Estudios de Seguimiento , Granuloma de Células Plasmáticas/diagnóstico , Granuloma de Células Plasmáticas/patología , Humanos , Masculino , Neumonectomía/métodos , Resultado del Tratamiento

RESUMEN

For an inoperative critical airway obstruction (bilateral bronchial stenoses) from a carcinomatous carina due to the mediastinal lymphnodal metastasis from uterine cancer, we succeeded in improving the patient's severe dyspnea by the combination of bilateral bronchial stent dilatation and a percutaneous cardiopulmonary support (PCPS) system. The imminent airway stenosis with severe dyspnea may have a high risk of asphyxia and contact-flooding during implanting of the stent. By the novel use of PCPS in advance for blood-oxygenation as a respiratory support, we could safely perform the interventional therapy of bronchial expandable metallic stents, and the patient obtained a good quality of life without dyspnea until she died of systemic metastatic cachexia. This technique may possibly be approved as an option for temporary remission therapy of a critical airway obstruction.

Asunto(s)

Obstrucción de las Vías Aéreas/terapia , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/secundario , Neoplasias Pulmonares/complicaciones , Cuidados Paliativos/métodos , Stents , Obstrucción de las Vías Aéreas/etiología , Angioplastia Coronaria con Balón/instrumentación , Angioplastia Coronaria con Balón/métodos , Broncoscopía , Cateterismo/instrumentación , Terapia Combinada , Resultado Fatal , Femenino , Humanos , Neoplasias Pulmonares/secundario , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Neoplasias Uterinas/patología , Neoplasias Uterinas/radioterapia

RESUMEN

A retrospective evaluation on the usefulness of the pedicled omental graft (POG) in treating problems associated with thoracic surgery is reported. The omentum has been long used to manage numerous intra-abdominal problems because of its excellent blood supply that could limit the spread of infection. The POG finds even greater application in extraperitoneal use because it is able to extend to all areas of the thorax. In this study, we reviewed 25 patients with omentopexy cases in our thoracic surgery unit over the last 19 years. Indications and usage of the POG were divided into two categories. As a preventive measure, the POGs were used to wrap tracheal and bronchial anastomoses. As a corrective treatment, the POGs were used to wrap perforated esophageal lesions and bronchial stumps and cover postoperative bronchial and pulmonary fistulas, repair chest walls, fill empyema cavities, and control osteomyelitis in the sternum and ribs. Uneventful and successful treatments were obtained in 22 cases (88%). Two patients died due to multiple organ failure followed by sepsis, and another due to respiratory failure. The POG was considered to be effective and useful in treating both potential and existing conditions often encountered in thoracic surgery.

Asunto(s)

Epiplón/cirugía , Colgajos Quirúrgicos , Procedimientos Quirúrgicos Torácicos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

BACKGROUND: A prospective study on the vasodilatory effect of prostaglandin E1 on blood flow to the gastric tube after esophagectomy is reported. METHODS: Twelve patients with thoracic esophageal cancer who underwent esophagectomy were enrolled in this study. In all patients, the esophagogastrostomy was performed in the cervical region, and the stomach was used for reconstruction. Immediately after the creation of the gastric tube, baseline blood flow was measured at the oral end, in the center, and at the pyloric ring of the gastric tube using a laser Doppler flowmeter. The prostaglandin E1 group (n = 6) was then infused with prostaglandin E1 until postoperative day 2; the control group (n = 6) received saline. At +5 minutes and +40 minutes after administration, blood flow was again measured at the same three sites. RESULTS: The control group did not show a significant increase of blood flow to any site over time. For the prostaglandin E1 group, blood flow at +40 minutes increased from the baseline measurements significantly at a rate of 63%, 39%, and 36%, respectively. CONCLUSIONS: Prostaglandin E1 has a characteristic vasodilating effect on the area of impaired microcirculation of the gastric tube, thereby increasing blood flow to the affected area.

Asunto(s)

Alprostadil/farmacología , Esofagoplastia , Vasodilatadores/farmacología , Adulto , Anciano , Neoplasias Esofágicas/cirugía , Esofagectomía , Femenino , Humanos , Masculino , Microcirculación/efectos de los fármacos , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Prospectivos , Estómago/irrigación sanguínea

RESUMEN

BACKGROUND: Although extensive studies on the detailed mechanisms of ischemia-reperfusion injury have been conducted, the implication of the fibrinolytic system has not been known. To determine the role of the fibrinolytic system in ischemia-reperfusion injury, we used tranexamic acid, a synthetic specific plasmin and tissue-type plasminogen activator inhibitor, to suppress fibrinolytic activity in a rabbit lung ischemia-reperfusion model. METHODS: New Zealand White rabbits were randomly divided into two groups: a simple ischemia group and a group injected with tranexamic acid before left hilar occlusion. After 2 hours of warm ischemia, plasma was collected from pulmonary vessels. Fibrin zymography was used to ascertain fibrinolytic activity, and enzyme-linked immunosorbent assay was used to determine soluble thrombomodulin levels as a marker for endothelial cells damage. Changes in left pulmonary function including arterial oxygen tension, peak airway pressure, and pulmonary vascular resistance were recorded during reperfusion after the 2 hours of warm ischemia. RESULTS: Fibrinolytic activity and soluble thrombomodulin levels increased in the vessels of the ischemic lung, indicating endothelial cell injury. The increased fibrinolytic activity and the rise in soluble thrombomodulin were suppressed by the preadministration of tranexamic acid, resulting in remarkably improved pulmonary function during reperfusion. After 2 hours of reperfusion, the wet-to-dry weight ratios and histological studies showed reduced pulmonary edema in the group that had received tranexamic acid. CONCLUSION: These findings suggest that the fibrinolytic system is involved in the onset mechanism of ischemia-reperfusion injury through induced endothelial cell damage and increased vascular permeability.

Asunto(s)

Antifibrinolíticos/uso terapéutico , Fibrinólisis/efectos de los fármacos , Isquemia/fisiopatología , Circulación Pulmonar/fisiología , Daño por Reperfusión/fisiopatología , Ácido Tranexámico/uso terapéutico , Animales , Isquemia/sangre , Isquemia/tratamiento farmacológico , Isquemia/patología , Pulmón/patología , Pulmón/fisiopatología , Masculino , Edema Pulmonar/prevención & control , Conejos , Daño por Reperfusión/sangre , Daño por Reperfusión/patología , Pruebas de Función Respiratoria , Trombomodulina/sangre

RESUMEN

We examined the efficacy of rinsing isolated lungs subjected to prolonged hypothermic storage with a high colloidal osmotic pressure solution prior to ex vivo blood reperfusion in order to preserve physiologic functions, suppress peroxidation of mitochondrial membranes, and inhibit infiltration of neutrophils. Isolated rabbit lungs were flushed with a Rinse-1 solution (289 mOsm/kg H2O) to remove remaining blood and immersed in physiologic saline at 8 degrees C for 24 hr. The control group received blood reperfusion immediately after storage; the Rinse-1 group was rinsed with Rinse-1 solution before blood reperfusion and the Rinse-2 group with Rinse-2 solution (312 mOsm/kg H20) including deferoxamine. Reperfused blood was passed through an artificial membranous lung to reduce oxygen tension (PO2) to the venous level, and time-dependent changes in airway pressure (AWP), pulmonary artery pressure (PAP), and PO2, as a measure of gas-exchange capability were examined. We estimated the lipid peroxide level in mitochondrial membranes as thiobarbituric acid-reactive substances (TBARS), i.e., malonedialdehyde, and neutrophil infiltration into lung tissue by measuring myeloperoxidase activity after 60 min of blood reperfusion. The PO2 was significantly higher in both rinsed groups compared with the control, while neither AWP nor PAP was significantly different in the three treatment groups. Both mitochondrial TBARS and myeloperoxidase activity were significantly higher in the control group compared with either rinsed group. These results indicate that rinsing stored lungs with a solution of high colloidal osmotic pressure prior to blood reperfusion was effective in preserving physiologic function and inhibiting neutrophil infiltration. Addition of deferoxamine was markedly effective in reducing TBARS formation and lessening reperfusion injury of stored lungs.

Asunto(s)

Deferoxamina/uso terapéutico , Pulmón , Preservación de Órganos/métodos , Daño por Reperfusión/prevención & control , Animales , Presión Sanguínea/fisiología , Coloides , Deferoxamina/química , Hipotermia Inducida , Peróxidos Lipídicos/metabolismo , Pulmón/irrigación sanguínea , Pulmón/efectos de los fármacos , Pulmón/fisiología , Masculino , Mitocondrias/efectos de los fármacos , Mitocondrias/metabolismo , Concentración Osmolar , Oxígeno/sangre , Presión Parcial , Peroxidasa/metabolismo , Arteria Pulmonar/fisiología , Conejos , Respiración/fisiología , Sustancias Reactivas al Ácido Tiobarbitúrico/metabolismo

RESUMEN

A 59-year-old female was admitted with massive hematemesis and melena. A hematological examination revealed that the red blood cell count was 1.31 x 10(6)/mm3, Hb 3.4 g/dl, and Hct 12%. No source of bleeding was found by an emergency endoscopic examination of the esophagus, stomach and duodenum, or by superior mesenteric angiography. At laparotomy a right common iliac arterio-intestinal fistula was found. The microscopic examination of this part of the ileum, including the fistula, revealed the presence of tubercular peritonitis. An extra-anatomic bypass graft using a prosthetic graft was performed between the left and right femoral arteries because reconstruction of the right common iliac artery was impossible.

Asunto(s)

Fístula/etiología , Enfermedades del Íleon/etiología , Arteria Ilíaca , Fístula Intestinal/etiología , Peritonitis Tuberculosa/complicaciones , Tuberculoma/complicaciones , Prótesis Vascular , Femenino , Fístula/cirugía , Humanos , Enfermedades del Íleon/cirugía , Fístula Intestinal/cirugía , Persona de Mediana Edad

RESUMEN

A successful treatment of coronary arteriovenous fistula with intraoperative echocardiogram and Symbas procedure is presented. The patient, a 2-year-old male, had been suffering from concealed congestive heart failure from his birth. The cardiac catheterization and angiogram revealed coronary arteriovenous fistula from LAD to right ventricle with large coronary aneurysm. In the operation, no fistula vessels were noted on the cardiac surface. Then, the intraoperative echocardiography was performed, and the fistula pour into right ventricle with aneurysm was found in the myocardium. The fistula was closed with Symbas procedure, and excellent closure could be checked with the intraoperative echocardiogram, too. After this operation, he got well under anticoagulant treatment with "ticlopidine".

Asunto(s)

Malformaciones Arteriovenosas/cirugía , Anomalías de los Vasos Coronarios/cirugía , Enfermedades en Gemelos , Malformaciones Arteriovenosas/diagnóstico , Preescolar , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico , Ecocardiografía , Humanos , Periodo Intraoperatorio , Masculino , Gemelos Dicigóticos

RESUMEN

One-year-old girl was admitted because of recurrent pneumonia and pectus excavatum. Chest X-ray showed hyperlucency at the upper lung field and infiltrated shadow at the lower field of the left lung. Bronchoscopy and bronchograms revealed marked collapse in a long segment of the left main bronchus during expiration. CT scan showed an emphysematous change and a giant bulla of left lung. Angiogram showed right aortic arch. Sternoturnover was performed at 5 years of age for pectus excavatum. After 10 months, left pneumonectomy was performed for bronchomalacia and lobar emphysema. Pathologic findings of the bronchus revealed that the rings were flattened, while the cartilage was microscopically normal.

Asunto(s)

Aorta Torácica/anomalías , Bronquios/anomalías , Tórax en Embudo/complicaciones , Enfisema Pulmonar/complicaciones , Bronquios/cirugía , Preescolar , Femenino , Tórax en Embudo/cirugía , Humanos , Neumonectomía , Enfisema Pulmonar/cirugía

RESUMEN

The study population consisted of 42 patients with squamous cell carcinoma and 46 patients with adenocarcinoma of stage I, 12 patients with squamous cell carcinoma and 7 patients with adenocarcinoma of stage II lung cancer who underwent curative surgical resection. Local recurrence and metastasis was not significant in both histological types in stage I, II. Lung and bone metastasis was dominant in the both cases of squamous cell carcinoma, adenocarcinoma and brain metastasis in the cases of adenocarcinoma. Concerning the period to first recurrence following the operation, the recurrences of stage I squamous cell carcinoma occurred 28% within 1 year after surgery, 28% during 1-2 years after surgery and those of stage II squamous cell carcinoma occurred 11% within 1 year. On the other hand, the recurrences of stage I adenocarcinoma occurred 25% within 1 year, 31% during 1-2 years, 25% over 2 years after surgery and those of stage II adenocarcinoma occurred 13% within 1 year. In the cases with squamous cell carcinoma, the 5-year survival rate (56%) of stage I was not significant compared with those (59%) of stage II. On the other hand, in the adenocarcinoma, the 5-year survival rate (54%) of stage I was significantly better than those (29%) of stage II (p less than 0.05).

Asunto(s)

Adenocarcinoma/cirugía , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia/patología , Adenocarcinoma/patología , Adenocarcinoma/secundario , Neoplasias Óseas/secundario , Neoplasias Encefálicas/secundario , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/secundario , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/patología , Metástasis Linfática , Estadificación de Neoplasias

RESUMEN

Omentum is now not only policeman of the abdomen but also of the thorax. We applied omental pedicle flap in the management of 14 patients with thoracic surgery including chest wall reconstruction, empyema, thoracic skeletal infection and tracheobronchial problems. Especially, tracheobronchial reconstruction using omental pedicle flap for the patient combined with lung cancer (T4N2M0 STAGE IIIB) and asthma under steroid therapy was reported. The case was 71-year-old man with complaint of hemosputum. He had 5-6 year history of bronchial asthma with disturbed pulmonary function of % VC 44%, FVC1.0% 37%. Bronchoscopic study revealed the tumor invading the right side of trachea originating from right upper bronchus with histological diagnosis of moderately differentiated squamous cell carcinoma. Preoperatively, he experienced a heavy asthma attack which was controlled by steroid administration. Following extended right sleeve upper lobectomy, we applied omental pedicle flap around the reconstructed portion for the protection of infection, impaired wound healing due to postoperative steroid therapy and strong tension at anastomoses. Postoperative course was satisfactory. We suggest omental pedicle flap is an effective surgical armamentarium in the management of tracheobronchial surgery for the patient with strong anastomotic tension, immunocompromised condition, preoperative irradiation at bronchial stump and use of drug causing delayed wound healing (steroid, anticancerous drug etc).

Asunto(s)

Bronquios/cirugía , Epiplón/cirugía , Colgajos Quirúrgicos , Tráquea/cirugía , Anciano , Anastomosis Quirúrgica , Humanos , Masculino