Kyobu geka. The Japanese journal of thoracic surgery

Publications in this journal

• Article: [Simplified Aortic Root Replacement in the Era of Complex Operation.]

  Tsutomu Sugimoto, Kazuo Yamamoto, Yuki Okamoto, Takashi Wakabayashi, Kaori Kato, Shinya Mimura, Shinpei Yoshii
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  ABSTRACT: Objectives:The purpose of the present study is to assess the clinical results of aortic root replacement using the Carbo-Seal composite graft( CS) compared with the other type of homemade composite grafts. Fifty-nine patients who underwent aortic root replacement between January 1998 to December 2010 were retrospectively analyzed. Twenty-six received homemade composite graft( group 1;1998 ~ 2005) and 33 received CS( group 2;2005 ~ 2010).Results:The duration of operation was longer in group 1:469.2±143.5 min versus 380.3±153.9 min (p=0.03). Although there was no statistically significant difference, group 2 had a higher complex operation rate compared with group1(23.1% versus 45.5%, p=0.07). Overall hospital mortality was 11.5% in group1 versus 3.0% in group2. Prevalence of major complication was significantly lower in group 2 (46.2% versus 18.2%, p=0.02).Requirement of intraoperative blood transfusion (group 1;1,130.8±854.7 ml versus group 2;598.2±836.4 ml) and amount of blood loss in the 1st 12 hours post operation (group 1;628.3±474.6 ml versus group 2;447.8±253.2 ml) were significantly lower in group 2. By univariate analysis, duration of operation, duration of cardio-pulmonary bypass (CPB), blood transfusion, acute dissection were independent risk factors and CS use was negative risk factor for major events. Aortic root replacement with use of CS can be performed with a relatively low early mortality and morbidity. Because a complicated operation is increasing in recent years, use of CS graft may simplify a Bentall operation.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):360-365.
• Article: [Combined Surgical and Endovascular Treatment( Hybrid-procedure) of Thoracoabdominal Dissecting Aneurysm.]

  Satoru Otani, Tsuyoshi Yamamoto, Yuki Yamada, Noriaki Kuwada
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  ABSTRACT: A 50-year-old man was admitted because of enlargement in diameter of the descending thoracoabdominal aorta. Seven years previously, he had undergone Bentall operation and graft replacement of the aortic arch due to an acute dissecting aneurysm, and he had also received graft replacement of the descending aorta due to a rupture of dissecting aneurysm 2 years before. The surgical stress of conventional repair under left lateral thoracotomy and laparotomy was considered to be excessive, and the 3-dimensional computed tomography (3D-CT) image revealed the reconstruction of intercostals artery was difficult. Hence, extra-anatomic bypasses were created to perfuse the visceral and renal vessels, and endovascular thoracic stent-grafts were deployed into the false lumen, because of the severe narrowing of the true lumen( hybrid-procedure). The postoperative course was uneventful and the patient was discharged on postoperative 30 days. Hybrid-procedure of aortic aneurysm is feasible, and may be an alternative to standard open procedures in high-risk patients and emergency cases.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):379-382.
• Article: [Open Heart Surgery using Cardiopulmonary Bypass in a Patient with Heparin-induced Thrombocytopenia(HIT).]

  Hiroshi Furukawa, Toshio Konishi, Mutsumu Fukata, Hiroshi Okada, Naoko Sakagami, Kenji Kurosaki
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  ABSTRACT: Heparin-induced thrombocytopenia (HIT) is a life-threatening side effect of heparin therapy. We report an open heart surgery with cardiopulmonary bypass( CPB) using argatroban as an anticoagulant for a patient with HIT. A 72-year-old male with a history of percutaneous coronary intervention 5 years ago, was admitted to our hospital due to congestive heart failure and heparin 10,000 units/day was administered. At 10th hospital day, his platelet count was significantly decreased and antibodies positive for type II HIT was found, so he was diagnosed HIT. Echocardiogram and coronary angiography revealed severe functional mitral regurgitation and coronary stenosis. At 24th hospital day we performed coronary artery bypass grafting( CABG) and mitral valve replacement (MVR) with CPB using argatroban as an anticoagulant. During CPB, we monitored the activated clotting time (ACT) to adjust the dose of argatroban. Though the surgical procedure itself was uneventful. We required about 4 hours to achieve adequate hemostasis after CPB. Postoperative course was uneventful.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):383-386.
• Article: [Intrathoracic Washing with Urokinase was Effective for Empyema with Atelectasis.]

  Kiyohiro Fujiwara, Shinya Kobayashi, Nobuhiro Fujioka, Kanako Teramoto, Takefumi Itoh, Hiroko Sugimura, Yuichi Takezawa
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  ABSTRACT: A 60-year-old man had a medical examination because of fever in the emergency hospital and had a diagnosis of pneumonia and was treated, but he was admitted to our hospital 2 days later because there was not the improvement of his symptom. The chest computed tomography(CT)image showed multilocular pleural effusions and lower lobe atelectasis with the air bronchogram on the left side. We diagnosed the case as empyema and inserted a catheter, but drainage was very few and injected 60,000 urokinase units for 3 days from the next day. We removed a drain 2 days after the 3rd infusion, and the pleural thickening became mild, and atelectasis was gradually improved in the chest CT image, and the inflammatory reaction was reduced, too. The intrathoracic washing with urokinase was thought to be effective for empyema with atelectasis.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):391-393.
• Article: [The Research Purposes and Design of Clinical Database.]

  Suguru Okubo, Hiroaki Miyata, Ai Tomotaki, Noboru Motomura, Arata Murakami, Minoru Ono, Tadashi Iwanaka
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  ABSTRACT: We discussed clarification of research purposes and designing of data collection form in large clinical databases. Research purposes are 1)assessment of healthcare quality, 2)evaluation of diagnosis and treatment, and 3)evaluation of health policy. In designing clinical databases, the researchers should consider the following themes;assurance of clinical utility, international collaboration, alleviation of data entry burden and assurance of scientific accuracy.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):401-405.
• Article: [Axillo-axillary Bypass for Coronary-subclavian Steal Syndrome.]

  Yasuyuki Sasaki, Hidekazu Hirai, Mitsuharu Hosono, Yasuyuki Bito, Atsushi Nakahira, Yasuo Suehiro, Daisuke Kaku, Yuko Okada, Shigefumi Suehiro, Shigeru Harada
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  ABSTRACT: We describe a case of coronary-subclavian steal syndrome in a 77-year-old man who presented with progressive coronary ischemia 8 years after coronary artery bypass grafting with an in-situ left internal thoracic artery graft. Coronary and left subclavian artery angiogram revealed completely patent internal thoracic artery graft and 90% stenosis in the proximal left subclavian artery. We performed axilloaxillary artery bypass using expanded polytetrafluoroethylene (ePTFE)[8 mm] graft. No coronary ischemia was noted postoperatively. Axillo-axillary artery bypass grafting was effective for coronarysubclavian steal syndrome.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):371-373.
• Article: [Foreign Body Granuloma with Positive 18-Fluorodeoxyglucose Positoron Emission Tomography( FDGPET)3 Years after Thymectomy.]

  Yasoo Sugiura, Masafumi Kawamura, Etsuo Nemoto, Shizuka Kaseda
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  ABSTRACT: A seventies year-old woman underwent thymo-thymectomy through a median sternotomy for type B2 thymoma. Annual screening with fluorodeoxyglucose positron emission tomography (FDG-PET) and computed tomography( CT) did not show any abnormality until 3 years after surgery, when a FDG-positive lesion, 1.5 cm in diameter, was found in the top of the anterior mediastinum. The lesion was resected under the diagnosis of thymoma recurrence, but was pathologically diagnosed as a foreign body granuloma including a suture thread. False-positive results with FDG-PET are related to FDG-uptake by inflammatory cells (e.g. macrophages and lymphocytes in the granuloma). Although FDG-PET is useful for diagnosing the postoperative recurrence of tumors, it should be noted that a foreign body granuloma and local recurrence of tumor have similar growth rates and both appear positive on FDGPET.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):387-390.
• Article: [Development of Hemostatic Sealant for Arterial Anastomosis;Clinical Application.]

  Shigeki Morita, Takehisa Matsuda, Masataka Eto, Shinichiro Oda, Ryuji Tominaga
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  ABSTRACT: For the purpose of examining the clinical applicability of a newly developed surgical sealant, animal experiments were performed, and clinical trial was followed. In animal experiments, several animal models, including carotid artery anastomosis model and coronary artery bypass grafting model were undertaken. In each model, complete hemostasis of the anastomoses using four simple interrupted sutures, was obtained. In addition, elastomeric property of the sealant prevented thinning of the arterial wall. The clinical trial performed in patients with thoracic aortic surgery showed significantly better hemostasis even under heparinized condition. Based on these excellent results, clinical usage of the sealant was approved.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):395-400.
• Article: [An Adult Case of Tricuspid Valve Endocarditis with Ventricular Septal Defect;Report of a Case.]

  Takashi Kajiwara, Masahiro Oe, Satoshi Fujita, Hideki Tatewaki, Koji Fukae
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  ABSTRACT: A 50-year-old man was admitted to hospital because of an elevated fever. He had been diagnosed with ventricular septal defect in his childhood, but surgery had not been recommended. An echocardiogram showed vegetations on the tricuspid valve, severe tricuspid regurgitation and perimembranous ventricular septal defect. He was diagnosed with infective endocarditis( IE) and treated with antibiotics and diuretics. Five serious dental caries, which had probably caused IE, were found and extracted before surgery. After 4 weeks of medical treatment, we performed tricuspid valve repair and closed the ventricular septal defect. The postoperative course was uneventful. He has been free from any complication for over 3 years.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):415-418.
• Article: [Staged Operation of Aortic Valve Stenosis with Concomitant Sigmoid Colon Cancer by Minimally Invasive Cardiac Surgery;Report of a Case.]

  Hiroyuki Kawaura, Noboru Ishikawa, Yasuyuki Kondou, Hirofumi Iizuka, Masaomi Fukuzumi, Kazuto Maruta, Tadashi Omoto, Kimiyasu Yamazaki, Masahiko Murakami
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  ABSTRACT: Severe aortic stenosis was found by preoperative echocardiography in a 79-year-old female patient with sigmoid colon cancer. Staged operation was planned. First, bioprosthetic aortic valve replacement was performed by minimally invasive cardiac surgery. She underwent concomitant colostomy to avoid malnutrition which may have occurred in case of colon obstruction. On 25th day after cardiac surgery, curative sigmoidectomy was performed. One year after the operation, she is doing well without any major complications.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):419-422.
• Article: [Very Elderly Case of Spontaneous Esophageal Rupture Successfully Treated by Conservative Treatment;Report of a Case.]

  Kenichi Tazawa, Kenta Sukegawa, Yasunori Tsuchiya, Fuminori Yamagishi, Yutaka Shimada, Kazuhiro Tsukada
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  ABSTRACT: A 94-year-old female patient presenting with vomiting and hematemesis, was transferred to our hospital. On a chest computed tomography (CT) image, mediastinal emphysema was seen with a little amount of bilateral pleural effusion, therefore, a diagnosis of spontaneous esophageal rupture was made. It took 6 hours to make a definite diagnosis of this disease, and conservative therapies were done including administration of antibiotics and proton-pump inhibitor. The patient was able to drink water on 4th hospital day, and was discharged on 19th hospital day. At about 2 months after the onset, a gastrointestinal fiberscope showed just only scar at the lower thoracic esophagus.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):431-433.
• Article: [Thoracoscopic Surgery for Traumatic Mediastinal Hematoma.]

  Masahiro Mizumoto, Hiroyuki Oizumi, Hirohisa Kato, Mitsuaki Sadahiro
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  ABSTRACT: We report a rare case of traumatic mediastinal hematoma treated by thoracoscopic surgery. A 78-year-old man accidentally fell down from the roof, and he was urgently transferred to our hospital. Soon after the arrival, he showed breathlessness followed by cardiopulmonary arrest, necessitating tracheal intubation and resuscitation. Computed tomography (CT) showed a large cervical hematoma extending to the tracheal bifurcation level of mediastinum, causing tracheal obstruction. Five days later, the large mediastinal hematoma was removed by thoracoscopic surgery. The patient recovered without any complications after our treatments.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):374-378.
• Article: [Catamenial Pneumothrax Treated in Portable Pneumothorax Drainage Kit;Report of a Case.]

  Shoji Nakata, Hisayuki Murata, Yasuhiro Mishima, Tatsuya Andoh
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  ABSTRACT: A 37-year-old woman visited our hospital for right pneumothorax and was treated using a portable thoracic drainage kit(Thoracic Egg). A month later, she had relapse of right pneumothorax with onset of a menestration. Catamenial pneumothorax was diagnosed clinically and the surgical treatment and a hormone therapy were recommended. But she refused our proposal and desired a treatment using Thoracic Egg again. Thereafter, she relapsed pneumothorax 3 times, and was treated by rest or using Thoracic Egg. A Thoracic Egg was useful for management of spontaneous pneumothorax, but there is no report concerning the catamenial pneumothorax. Thoracic Egg may be a choice of treatment for catamenial pneumothorax of minor or moderate grade.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):423-425.
• Article: [Solitary Pulmonary Lesion Developed after the Resection of Primary Lung Cancer.]

  Hiroshi Saito, Munehisa Takata, Noriyoshi Yashiki
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  ABSTRACT: The purpose of this study was to evaluate the characteristics of solitary pulmonary lesion developed after the resection of primary lung cancer and the outcome. Between 1990 and 2011, 1,004 patients underwent complete resection for primary lung cancer in our hospital and we retrospectively analyzed 53 patients with a history of primary lung cancer resection who had a solitary pulmonary lesion. Pulmonary resections were performed in 43 patients. Wedge resection and segmentectomy were performed in 42( 98%) of them. There was no operative death. The diagnosis was 2nd primary lung cancer in 28 patients, recurrent lesion in 9, and benign lesions in 6. Malignant tumor ratio of resected cases was 86%.Other unresected 10 cases were not diagnosed historogically and 9 of them underwent radiation therapy. The 5-year survival rate was 57.3% in those with 2nd primary lung cancer, 55.5% in those with recurrent lesion, and 64.3% in those with undiagnosed-unresected lesions( no significant difference). It is important to take a surgical approach for a diagnosis and to treat with standard therapy for both 2nd primary lung cancer and recurrent lesion. Sublobar resection may be adequate. In patients with a undiagnosed nodule who were not able to have 2nd surgery, radiation therapy may be permitted and effective.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):351-357.
• Article: [Management of Cardiopulmonary Bypass during Cardiac Surgery for Patients with Heparin-induced Thrombocytopenia.]

  Taichi Kondo, Masanori Hirota, Joji Hoshino, Yasuhisa Fukada, Tadashi Isomura
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  ABSTRACT: We experienced 4 cases of open heart surgeries under preoperative diagnosis of heparin-induced thrombocytopenia(HIT). We performed operation with argatroban instead of heparin. The argatroban was administered intravenously with a bolus of 100 μg/kg. After activated clotting time(ACT)reached over 200 seconds, continuous infusion of argatroban was started, 1~2 μg/kg/min until the level of ACT over 250 in the case of off-pump coronary artery bypass grafting(OPCAB), with 6~10 μg/kg/min, or the level of ACT over 400 with the use of cardiopulmonary bypass (CPB). All cases required more than 60 minutes to achieve the target ACT level after starting the argatroban. In 1 case it was impossible to achieve target level of ACT by argatroban alone, and heparin was used concomitantly. In 1 case there was a complication of membrane occlusion of CPB. Open cardiac surgery with the use of argatroban required specific care for coagulation to complete operation.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):366-369.
• Article: [Successful Repair of Descending Aortic Aneurysm with Narrowed Elephant Trunk after Total Arch Replacement;Report of a Case.]

  Ken Nakamura, Tetsuro Uchida, Yoshiyuki Maekawa, Masahiro Mizumoto, Atsushi Yamashita, Cholsu Kim, Yukihiro Yoshimura, Mitsuaki Sadahiro
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  ABSTRACT: A 40-year-old man had undergone total arch replacement using the elephant trunk technique. Three years after the initial operation, stenosis of the elephant trunk due to enlargement of a false lumen was detected. Replacement of the descending thoracic aorta was performed. A narrow segment of the elephant trunk was compressed by old hematoma and lapped around the connective tissue. A new graft was anastomosed to the narrow segment of the elephant trunk in an end-to-side fashion. Postoperative course was uneventful, and he was discharged 18 days after the operation.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):411-414.
• Article: [Delayed Laryngeal Nerve Paralysis after Lung Cancer Surgery;Report of a Case.]

  Fumiaki Watanabe, Shuhei Kogure, Naoki Yamamoto, Tarou Fujii, Uhito Yuasa, Toshiya Tokui
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  ABSTRACT: A 75-year-old woman with mesopharyngeal adenocarcinoma underwent left upper lobectomy for lung adenocarcinoma. Before the operation, computed tomography showed no stricture of the trachea, and laryngoscope showed no abnormality of vocal cord. Spiral tube( 7.5 mm I.D.) was used insted. One lung ventilation was achieved using balloon. It took 4 hours and 3 minutes to finish the surgical procedure. After extubation in the operation room, we did not recognize the breathing abnormality and laryngeal nerve palsy. 4 days after the operation, stridor was noticed, and laryngoscopic examination revealed stenosis of glottis due to bilateral laryngeal nerve paralysis. We performed the emergent tracheotomy. 7 days after the operation, nerve paralysis improved.
  Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):427-430.
• Article: [Development of elastameric sealant designed for arterial field].

  Takehisa Matsuda, Nobuyuki Nakajima
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  ABSTRACT: The development of a reliable surgical sealant specific for arterial tissues has been long awaited. In this article, first the "ideal" adhesion mechanism formulated from biomechanical concept is proposed for ensured hemostasis in dissected arteries with pulsatile flow. An urethane prepolymer prepared along the design criteria is viscous liquid. Due to its high water absorbility and high reactivity with water, the sealant applied to vascular tissues becomes an elastomer within several minutes. When the sealant was applied to dissected canine abdominal arteries with 3 stay sutures, followed by declamping 5 minutes, neither bleeding nor detrimental effect on tissue morphogenesis was observed. This sealant is being ready to the market.
  Kyobu geka. The Japanese journal of thoracic surgery 04/2013; 66(4):315-9.
• Article: [Outcome of pulmonary resection for metastases from hepatocellular carcinoma].

  Takeshi Oyaizu, Osamu Araki, Yoko Karube, Makio Hayama, Norio Seki, Satoru Kobayashi, Masayuki Chida
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  ABSTRACT: Because pulmonary metastasis is considered to be systemic spread of hepatocellular carcinoma( HCC),indication of pulmonary resection as a treatment for it is not well-described. We retrospectively reviewed clinical records of the patients who underwent pulmonary resection for metastases from HCC in our hospital. Seven patients, 6 men, 1 woman, and the mean-age 65.4 year-old, underwent pulmonary resection from April in 2001 to March in 2010. During the same period, we carried out pulmonary resection for 122 patients with metastases from other malignant diseases. Therefore, pulmonary resection for HCC metastases accounted for 5.4% of the total pulmonary metastasectomy. One of the 7 patients, a 70 year-old man, survives for 69 months after right middle lobectomy for solitary HCC metastasis. Other 6 patients with multiple pulmonary metastases or with increased level of alpha-fetoprotein (AFP) before pulmonary resection died of systemic recurrence. The mean survival time of 7 patients was 20 months and was 11.8 months except the long-time survivor. From our results, patients with multiple pulmonary metastases from HCC or with increased serum level of AFP before surgery should be carefully selected as candidates for pulmonary metastasectomy.
  Kyobu geka. The Japanese journal of thoracic surgery 04/2013; 66(4):302-4.
• Article: [Stump recurrence after pulmonary metastasectomy from colorectal cancer].

  Yoshihiko Kanai, Sayaka Mitsuda, Tomoyuki Nakano, Tetsuya Endo, Yasuhiro Tezuka, Noriko Saito, Shinichi Otani, Hiroyoshi Tsubochi, Shinichi Yamamoto, Kenji Tetsuka, Tsuyoshi Hasegawa, Shunsuke Endo
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  ABSTRACT: Pulmonary metastasectomy with wedge resection is an ideal procedure in terms of less invasiveness and preservation of respiratory function, while local recurrence is a major problem. The goal of this study was to verify risk factors of stump recurrence after pulmonary metastasectomy from colorectal cancer. Pulmonary metastasectomies including 112 operations for 131 lesions in 85 patients with colorectal cancer were performed in our department since March, 2005 until the end of 2010. In our cases, stump recurrence significantly occurred in patients who underwent wedge resection than segmentectomy or lobectomy. Stump recurrence developed in 14 operations among 62 wedge resections (recurrence rate:23%). Diameter more than 10 mm and distance between pleura and deepest end of the tumor (depth value) more than 14 mm were risk factors as stump recurrence. Tumor diameter and depth value can be a decisional factor for wedge resection in pulmonary metastasectomy in the colorectal cancer patients.
  Kyobu geka. The Japanese journal of thoracic surgery 04/2013; 66(4):284-7.