Yukihito Saito

Kansai Medical University, Moriguchi, Osaka-fu, Japan

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Publications (33)40.43 Total impact

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    ABSTRACT: Pneumothorax is a common disease worldwide, but surprisingly, its initial management remains controversial. There are some published guidelines for the management of spontaneous pneumothorax. However, they differ in some respects, particularly in initial management. In published trials, the objective of treatment has not been clarified and it is not possible to compare the treatment strategies between different trials because of inappropriate evaluations of the air leak. Therefore, there is a need to outline the optimal management strategy for pneumothorax. In this report, we systematically review published randomized controlled trials of the different treatments of primary spontaneous pneumothorax, point out controversial issues and finally propose a three-step strategy for the management of pneumothorax. There are three important characteristics of pneumothorax: potentially lethal respiratory dysfunction; air leak, which is the obvious cause of the disease; frequent recurrence. These three characteristics correspond to the three steps. The central idea of the strategy is that the lung should not be expanded rapidly, unless absolutely necessary. The primary objective of both simple aspiration and chest drainage should be the recovery of acute respiratory dysfunction or the avoidance of respiratory dysfunction and subsequent complications. We believe that this management strategy is simple and clinically relevant and not dependent on the classification of pneumothorax.
    Interactive Cardiovascular and Thoracic Surgery 11/2012; · 1.11 Impact Factor
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    ABSTRACT: OBJECTIVES Opportunities to treat multifocal lung cancers, mostly adenocarcinoma, are increasing due to the development of imaging technologies. The optimal therapy modality to treat multifocally growing lung cancers remains obscure. To determine the features of multifocal lung cancers, we retrospectively reviewed patients with multiple lung lesions. METHODS Clinical, pathological and genetic characteristics of 31 patients with multifocal lesions were compared with those of patients who had had radical lung resection for solitary lung cancer. Gene mutation analyses for EGFR, KRAS and P53 were performed on three tumours of each of the patients who had four or more lesions. RESULTS Of the 31 patients, 17 had double tumours, 4 had triple tumours and 10 had 4 or more lesions. Patients with four or more lesions were significantly more likely to be females and never smokers. All of the histologically confirmed tumours of the cases with four or more lesions were adenocarcinoma in situ or lepidic predominant adenocarcinoma. The number of lesions in the right upper lobes when compared with the right lower lobes was significantly higher in patients with four or more lesions than in patients with double or triple lesions (P = 0.013). Five of the 12 tumours were positive for the EGFR mutation L858R in exon 21. No KRAS mutation was found. CONCLUSIONS Lesions in patients with multifocal adenocarcinoma are more frequently in the right upper lobes. Genetic analysis suggested that the specific EGFR mutation L858R in exon 21 might be the main factor contributing to lung carcinogenesis in multiple lung cancers. Further investigation of the right upper lobe in those patients compared with the lower lobes might provide more insights into lung carcinogenesis.
    Interactive Cardiovascular and Thoracic Surgery 06/2012; 15(4):627-32. · 1.11 Impact Factor
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    ABSTRACT: Postoperative pneumonia is a serious complication following pulmonary resection. Aspiration of oesophageal reflux contents is known to cause pulmonary complications in patients with a history of gastrectomy. In this study, we compared the incidence of postoperative pneumonia in patients with or without previous gastrectomy. A retrospective review was conducted of clinical charts for patients who underwent radical pulmonary resection for non-small cell lung cancer from January 2006 to December 2010. Pneumonia was diagnosed with chest computed tomography findings in all cases. A total of 333 patients underwent pulmonary resections during the study period. Twenty-seven patients (8.1%) had a history of gastrectomy. Eight patients (2.2%) had postoperative pneumonia. All eight patients who developed postoperative pneumonia did not have pneumonia before pulmonary resection. Of the aforementioned 27 patients, five (18.5%) developed pneumonia postoperatively, whereas only three of 325 patients who did not have a history of gastrectomy (0.9%) had pneumonia (P < 0.001). In multivariate analysis, a history of gastrectomy had the highest impact on the odds ratio (8.81) for postoperative pneumonia. A significantly higher incidence of postoperative pneumonia was found in patients with a history of gastrectomy. Prophylactic treatment, such as premedication with ranitidine, should be considered in those patients.
    Interactive Cardiovascular and Thoracic Surgery 03/2012; 14(6):750-3. · 1.11 Impact Factor
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    ABSTRACT: We report the case of a 66-year-old woman with neurofibromatosis type 1 who developed chest wall bleeding with severe scoliosis and a giant intrathoracic meningocele. She was brought to the emergency department with acute-onset of left-sided chest pain and clinical signs of hypovolemia. Bleeding control was difficult in the first operation because the tissue was friable and there were multiple subcutaneous bleeding points. During the first operation, the patient developed disseminated intravascular coagulation, which required immediate management; therefore, the surgery was aborted and a repeat surgery was performed later to stop the bleeding. The major cause of bleeding was presumed to be the mechanical stretching of the intercostal arteries and branches of the internal thoracic artery secondary to the severe deformity of the thoracic vertebra and ribs. The massive bleeding remained as a hematoma and did not lead to development of hemothorax. This was believed to be because the giant intrathoracic meningocele supported the expansion of the hematoma and prevented the perforation of the visceral pleura. After the second operation, the hematoma shrunk gradually; however, the patient required ventilatory support because the decrease in the size of the hematoma was accompanied by the expansion of the meningocele.
    Interactive Cardiovascular and Thoracic Surgery 02/2011; 12(2):328-30. · 1.11 Impact Factor
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    ABSTRACT: Primary spontaneous pneumothorax is one of the most common diseases. To prevent recurrent pneumothorax after video-assisted thoracoscopic surgery, various methods of pleural covering with biodegradable polymers have been devised. In addition, using fibrin sealant should be avoided as far as possible because of its infectious aspect. Thus, we devised the covering with forceps-assisted polymeric biodegradable sheet and endostapling method in response to these demands. With this novel technique, we used non-woven polyglycolic acid (PGA) NEOVEILĀ® sheet (Gunze, Ayabe, Japan). A 5-mm cut was made in the center of the PGA sheet, which was then guided over the apical bulla with a lung forceps. The bulla was then pulled through the cut hole with the lung forceps, in a manner similar to the way a cape is worn through the head. To avoid stapling failure caused by wrinkling of the PGA sheet, we moistened the sheet with a few drops of saline before endostapling. The diseased lung tissue was resected by endostapling across the PGA sheet. After firing the endostapler, we could perform a sealing test by inflating the lung to detect persistent air leaks. This is a simple and reliable technique of staple-line reinforcement without fibrin glue.
    Interactive Cardiovascular and Thoracic Surgery 11/2010; 12(2):103-5. · 1.11 Impact Factor
  • Yukihito Saito, H Kaneda, T Maniwa, T Saito, K Minami
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    ABSTRACT: Video-assisted thoracic surgery (VATS) lobectomy is defined as a video-assisted procedure using anatomic dissection with individual ligation of the vessels and bronchi. VATS lobectomy can offer several advantages, including decreased pain, and decreased inflammatory response. The patient is placed in the lateral decubitus position. A 12-mm port is inserted in the 7th intercostal space at the midaxillary line. A 8-cm utility incision is created in the axilla at the 4th intercostal space for upper or middle lobectomy. For lower lobectomy, a 8-cm utility incision is created in the auscultatory triangle at the 5th intercostal space. A 12-mm incision is frequently placed near the utility incision in the 6th intercostal space, particularly when using retraction for improved exposure or for insertion of added instrumentation. We performed the hilar vessel ligation using endoscopic ligation forceps SAITO model (Japan patent no. 4148324). We reported approaches and techniques in our hospital for the patients who underwent VATS lobectomy based on the surgical databases from the Division of Thoracic Surgery at the Kansai Medical University Hirakata Hospital during the period from January 5, 2006 through August 31, 2008.
    Kyobu geka. The Japanese journal of thoracic surgery 05/2009; 62(4):289-94.
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    ABSTRACT: The prognostic importance of bronchioloalveolar carcinoma in comparison to the invasive subtypes needs to be studied, although the natural history of a pure bronchioloalveolar carcinoma is still unclear. We report the appearance of a pure ground-glass opacity that demonstrates rapid progression into a solid component in the central area, pathologically revealing a minimally invasive papillary adenocarcinoma. Considering the findings of previous reports, as well as our case, we need to pay careful attention to the follow-up of a patient who has even a pure ground-glass opacity when the patient had a history of an invasive lung cancer. We need also to perform curative surgery with optimal timing.
    General Thoracic and Cardiovascular Surgery 05/2009; 57(4):224-7.
  • Tomohiro Maniwa, Hiroyuki Kaneda, Yukihito Saito
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    ABSTRACT: Pulmonary fistulas caused by tumours are very fragile and difficult to suture directly. It is impossible to close pulmonary fistulas with tissue sealants when massive air leakage occurs in the low pressure of the respiratory tract. A 73-year-old man with a pneumothorax caused by lung cancer had suffered a persistent massive air leakage for more than one month. We used a fibrin glue-soaked polyglycolic acid (PGA) sheet for sealing the complicated fistula. In addition, the visceral pleura of the fistula was wrapped with the pedicle of an intercostal muscle (ICM) flap to prevent massive air leakage. The pneumothorax did not reappear after surgery. Thus, a fibrin glue-soaked PGA sheet covered with an ICM flap was effective for sealing an intractable air-leaking fistula caused by lung cancer.
    Interactive Cardiovascular and Thoracic Surgery 04/2009; 8(6):697-8. · 1.11 Impact Factor
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    ABSTRACT: Recently, nuclear genes encoding two mitochondrial complex II subunit proteins, SDHD and SDHB, have been found to be associated with the development of familial pheochromocytomas and paragangliomas (hereditary pheochromocytoma/paraganglioma syndrome: HPPS). Growing evidence suggests that the mutation of SDHB is highly associated with abdominal paraganglioma and the following distant metastasis (malignant paraganglioma). In the present study, we report the case of a novel SDHB mutation (L157X) in a Japanese patient with abdominal paraganglioma following malignant lung metastasis. In addition, we identified an asymptomatic carrier of the SDHB mutation in this family.
    Endocrine Journal 04/2009; 56(3):451-8. · 2.23 Impact Factor
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    ABSTRACT: Contralateral pneumothorax is a severe complication after pneumonectomy. We evaluated the mediastinal shift and the residual lung in patients who had undergone pneumonectomy to predict the incidence of contralateral pneumothorax. We evaluated 21 cases of pneumonectomy performed from 1996 to 2006. For this study, we excluded patients with recurrent neoplasm, empyema, or hemothorax. We reviewed the computed tomography (CT) results of 13 patients who had undergone pneumonectomy to compare the bullae in the residual lungs, carina shifts, and herniation of the residual lungs before and after pneumonectomy. When evaluating the degree of herniation 4-6 cm below the carina, the anterior and posterior pulmonary hernias were classified as grade A, B, or C. We also investigated the preoperative respiratory function in all 13 patients. Results. Two patients suffered contralateral pneumothorax after left pneumonectomy. Both patients who suffered contralateral pneumothorax after pneumonectomy had bullae. The percentage forced expiratory volume in 1 s (FEV(1.0%)) was <70% in these two patients. Carina shifts and lung herniation were found to be greater after left pneumonectomy than after right pneumonectomy. The bullae in the lung and obstructive pulmonary disease are associated not only with spontaneous pneumothorax but also with contralateral pneumothorax after pneumonectomy. Lung herniation and mediastinal shift are greater after left pneumonectomy than after right pneumonectomy, which may be related to contralateral pneumothorax after pneumonectomy.
    General Thoracic and Cardiovascular Surgery 01/2009; 57(1):28-32.
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    ABSTRACT: An intercostal muscle (ICM) flap is used to buttress the bronchial stump or bronchial anastomosis during thoracic surgery for airway reconstruction. Such flaps sometimes show ossification after surgery. Previous reports have suggested that such ossification requires a functional periosteum and good vascularization. We examined the background of ICM flap ossification and its relationship with complications and pain after surgery. We surveyed the clinical records of 47 patients who underwent bronchial stump reinforcement with an ICM flap during thoracic surgery at Kansai Medical University Hospital between January 2003 and December 2005. We reviewed the post-surgical chest computed tomography (CT) scans of 42 patients, and examined the degree of ICM ossification. We classified patients into two groups: those with ossification of the ICM flap (O group) and those without (non-O group). We compared the two groups for age, gender, the site of ICM flap placement, disease, type of lymph node dissection, and pretreatment. We also compared the two groups for pain levels and complications after surgery. Eight (19%) of the 42 patients showed ossification of the ICM after surgery. There were statistically significant differences between the O and non-O groups in gender (p=0.029), lymph node dissection (p=0.024) and pain levels after surgery (p=0.034). There were no complications attributable to ICM ossification in this series. Ossification of an ICM flap may be related to gender, lymph node dissection and pain after surgery. Ossification does not cause any complication after surgery when an ICM is used to reinforce bronchial stumps.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2009; 35(3):435-8. · 2.40 Impact Factor
  • The Journal of The Japanese Association for Chest Surgery. 01/2009; 23(7):977-980.
  • The Journal of thoracic and cardiovascular surgery 11/2008; 139(2):e14-6. · 3.41 Impact Factor
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    ABSTRACT: We reviewed our experience from 1990 to 2005 to examine whether control of myasthenia gravis (MG) with steroid therapy before surgery could stabilize postoperative respiratory conditions, compared with the nonsteroid treatment. Records of 43 consecutive patients with MG who underwent extended thymectomy at Kansai Medical University Hospital were retrospectively reviewed. Two groups, a steroid group (n = 28) and a nonsteroid group (n = 15) were compared. In the steroid group, steroid doses ranged from 10 to 100 mg every other day, or 40-60 mg daily. The patients showed significantly less thymus hyperplasia in the pathological findings (P = 0.023). Whereas 3 of 28 (7%) in the steroid group suffered respiratory insufficiency within 3 days of surgery, 5 of 15 (33%) in the nonsteroid group exhibited the same problem (P = 0.030). Univariate analysis showed that steroid treatment was the only significant factor (P = 0.041) affecting respiratory insufficiency. Patients in the steroid group achieved palliation of MG more quickly after surgery than patients in the nonsteroid group (86% vs. 57% within 6 months, P = 0.059; 84% vs. 42% within 1 year, P = 0.042). The control of myasthenia gravis with steroid therapy before surgery seems to stabilize postoperative respiratory status without having adverse effects on surgical infection.
    General Thoracic and Cardiovascular Surgery 04/2008; 56(3):114-8.
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Journal of Bronchology & Interventional Pulmonology. 03/2008; 15(2):71-72.
  • The Journal of The Japanese Association for Chest Surgery. 01/2008; 22(2):146-150.
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    ABSTRACT: The aim of this study was to determine whether walking at 4 h after surgery as a more aggressive way to proceed with early mobilization could be a safe approach compared with the patients who walked the day after surgery. We encouraged patients who had lobectomy for non-small-cell lung cancer at Kansai Medical University Hospital to walk at 4 h after surgery and start pulmonary rehabilitation between January 2003 and June 2005. A group of 36 patients walked at 4 h after surgery. We retrospectively reviewed the postoperative courses of the patients and compared them with 50 patients who walked the next day during the same period. No patient had major trouble with chest drainage tube, and no patients fell when walking at 4 h. Amount of drainage, changing rates of the heart load during the walking, and pain scores after walking did not show significant differences in patients walking at 4 h and those walking the next day. Although four patients who walked the next day had an arterial oxygen partial pressure/inspired oxygen concentration ratio of <300 on day 3, none in the patients walking at 4 h had a ratio below this level. Among the patients walking at 4 h, 24 (67%) needed oxygenation for less than 2 days compared with 17 (34%) of the patients walking the next day. Walking at 4 h after lobectomy in patients with non-small-cell lung cancers is a safe approach to starting pulmonary rehabilitation after surgery.
    General Thoracic and Cardiovascular Surgery 01/2008; 55(12):493-8.
  • The Journal of The Japanese Association for Chest Surgery. 01/2008; 22(2):226-230.
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    ABSTRACT: Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the joints of the axial skeleton. Pleuropulmonary involvement is an uncommon, late event in the course. A 53-year-old man who had a diagnosis of ankylosing spondylitis since he was 40 years old developed a bilaterally repeated and refractory spontaneous pneumothorax. He was treated successfully with surgery to the left pneumothorax that had been refractory to conservative chest tube drainage and chemical pleurodesis. During the second episode of right-side pneumothorax, he developed severe respiratory insufficiency because of his coexisting restrictive lung disease. He was successfully treated with chemical pleurodesis to the right pneumothorax. In our experience, prophylactic treatment such as surgery and pleurodesis should be considered for patients with ankylosing spondylitis during the first episode of pneumothorax.
    General Thoracic and Cardiovascular Surgery 07/2007; 55(6):266-9.
  • Journal of Thoracic Oncology - J THORAC ONCOL. 01/2007; 2.