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ABSTRACT: A new liquid-liquid blood gas exchange system was investigated using a venovenous low flow extracorporeal circuit. A 2 m2 hollow fiber dialyzer served as the interface of the blood and oxygen carrier (a 38 percent FC-43, perfluorocarbon emulsion in a buffered electrolyte solution), which was continuously recycled through a bubble oxygenator. Experiments were performed on five mongrel dogs under general anesthesia. Upon the arrest of spontaneous ventilation, the dogs' lungs were inflated with 50% oxygen gas under a positive pressure of 10 cmH2O. After 10 min of apnea the dogs' PaO2 decreased to 37 +/- 14 mmHg, and the extracorporeal circulation was started at 10 ml/min/kg b./w. At 15 min the PaO2 had risen to 80 +/- 41 mmHg and at 30 min to 121 +/- 17 mmHg. The oxygen transfer was 8.3 +/- 2.3 ml/min. The extracorporeal circulation was continued 5h, when PaO2 reached 156 +/- 90 mmHg, and PaCO2 148 +/- 43 mmHg, then stopped. Fifteen minutes later, the PaO2 had returned to 32 +/- 10 mmHg. These findings indicate that our blood gas exchange system can supply a sufficient amount of oxygen to the body under apnea with continuous positive airway pressure.
The International journal of artificial organs 12/1994; 17(11):609-15. · 1.86 Impact Factor
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ABSTRACT: Superior vena cava (SVC) syndrome is caused by several diseases, although to our knowledge, a bullous lesion has not been reported previously. In the present case, severe pleural adhesion prevented the expanding bulla from stretching the visceral pleura and from compressing the residual lung, subsequently causing compression of the SVC and thus SVC syndrome.
Chest 03/1994; 105(2):611-2. · 5.25 Impact Factor
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ABSTRACT: A 70-year-old woman with leiomyosarcoma, followed up for 5 years as tuberculoma, is described. The tumor, in the left lower lobe, had enlarged from 1.5 x 1.5 cm to 3.4 x 3.4 cm in 5 years, and doubling time was calculated to be 540 days. Another tumor (1.8 x 1.8 cm) was also recognized in the right lower lobe at the later time. Since not only a benign tumor but metastatic disease was suspected, thoracotomy was performed, and the intraoperative pathologic diagnosis was leiomyosarcoma. However, only partial lung resection was performed because of the low growth rate of the tumor, the patient's advanced age, limited lymphatic metastasis and favorable prognosis with only partial resection. DNA analysis of the tumor based on flow cytometry showed a diploid pattern, and this was thought to account for the long doubling time of the tumor. The postoperative course was satisfactory without any signs of recurrence at the operation site.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 12/1992; 40(11):2066-9.
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ABSTRACT: Bioabsorbable PGA non-woven fabric sheets were used to treat 103 patients who underwent pulmonary surgery in three hospitals, and their handleability, applicability, drainage time after surgery and subsequent side effects were studied. For suture reinforcement, these sheets showed satisfactory handleability, applicability and effectiveness for hemostasis and prevention of air leakage at the suture sites. Since this material has good compatibility with fibrin glue, use of these two materials in combination reduced both the operation time and postoperative drainage period. For small fistula and pleural defects, attachment of the sheets with fibrin glue to create an artificial pleura was sufficient for prevention air leakage without suturing. No side effects or complications were observed, and the postoperative courses of all 103 patients were uneventful. These findings suggest that PGA sheets are acceptable for suture reinforcement in the pulmonary surgery, and that when used with fibrin glue, can simplify surgery for emphysematous lung disease and shorten the period of postoperative air leakage.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 11/1992; 40(10):1828-31.
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ABSTRACT: The effects on gas exchange of superimposition of high-frequency oscillation (HFO) (40 Hz) on conventional mechanical ventilation were investigated in mongrel dogs with eucapnic gas exchange on conventional mechanical ventilation (CMV). The dogs were anesthetized, paralyzed, and ventilated with CMV until stable. Oscillation was then superimposed for 15 min, followed by CMV alone for a further 30 min. During HFO superimposed on CMV (CMV-HFO), the arterial carbon dioxide tension (PaCO2) increased from 43.6 +/- 1.2 mm Hg to 47.2 +/- 1.4 mm Hg (p less than 0.02), whereas the arterial oxygen tension (PaO2) did not change at all. The change was inhibited completely by administration of intravenous cromolyn sodium (CS) (6 mg/kg/min). The mean pulmonary arterial pressure (mPAP), cardiac output (CO), pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance (PVR) did not change during the experiment. These results demonstrate that CMV-HFO appears to cause CO2 accumulation and eliminates the impaired O2 transfer, and that these effects are inhibited completely by CS administration.
Chest 10/1992; 102(3):931-4. · 5.25 Impact Factor
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ABSTRACT: Mediastinal shift and overinflation of the residual lung after pneumonectomy are well known, and sometimes cause pulmonary insufficiency. However, most of such cases occur after surgery in childhood or adolescence. We present a 49-year-old woman who had dyspnea and severe overinflation of the residual lung after left pneumonectomy. She had undergone pneumonectomy at the age of 33 years. Dyspnea on exertion occurred 4 years later, and became much more severe 9 years later (H-J IV degrees). Computed tomography showed that the postpneumonectomy space and completely disappeared and the right lung was overinflated to the left posterior axillary line. Low vital capacity with high residual volume and low maximal ventilatory volume were detected by pulmonary function test. Pulmonary function after pneumonectomy is difficult to predict because mediastinal shift and overinflation of the residual lung may occur. To avoid this, prosthesis plombage for the postpneumonectomy space is necessary.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 10/1992; 40(9):1749-51.
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ABSTRACT: A 37-year-old man was admitted because of miliary tuberculosis. However, his fever and general condition did not improve with chemotherapy. Six months later, paraplegia occurred following sudden radicular back pain without any alteration of segmental sensation. There were no abnormal findings on X-ray films of the thoracic and lumbar vertebrae. Examination by magnetic resonance imaging revealed that the contents of a cold tuberculous abscess in the right chest wall had drained into the epidural space through the intervertebral foramen. Drainage of the chest wall abscess and laminectomy were performed. Further investigation showed that this case did not belong to the usual type of atypical spinal tuberculosis reported previously.
Nihon Kyōbu Shikkan Gakkai zasshi 04/1992; 30(3):500-2.
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ABSTRACT: A case of primary paraganglioma of the lung in a 48-year-old woman is presented. She was found to have a coin lesion in lower lobe on routine radiography. Results of bronchoscopic examination were negative, and exploratory right thoracotomy was performed. At operation, non-invasive encapsulated tumor found in posterior basal segment of the right lower lobe was enucleated. Histological analysis of the resected tumor proved to be compatible with pulmonary paraganglioma. Pulmonary paraganglioma is said extreme rare, and so only 21 cases were previously reported in the literature including this case.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 04/1992; 40(3):435-9.
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Chest 03/1992; 101(2):590-1. · 5.25 Impact Factor
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ABSTRACT: Intubation of the left main bronchus via a tracheostomy tube was performed in a patient with local recurrence of lung cancer associated with invasion and obstruction of the left main bronchus after right sleeve pneumonectomy. The result was satisfactory not only for preventing asphyxia, but also for maintaining the patency of the airway after extubation of the endotracheal tube.
Chest 01/1992; 100(6):1735-7. · 5.25 Impact Factor
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ABSTRACT: Of 354 thoracotomies, 114 cases involved intraoperative cytopathologic evaluation. The study included 86 men and 28 women, and 184 specimens were examined. Smears were taken from the lung lesion or lymph node and the chest wall or bronchial stump by imprint or needle aspiration. Intraoperative evaluations were compared with histologic findings. In 85 cases not diagnosed as malignant preoperatively, malignancy was confirmed in 97.6 percent of cases and histologic type in 71.8 percent. In the 28 cases diagnosed as malignant preoperatively, there was only one false-negative. The most important finding during thoracotomy is whether a lesion is malignant or not. The time required to obtain a pathologic diagnosis also is important. We are able to obtain the results of a cytologic diagnosis within 10 min. Cytologic diagnosis of malignancy during thoractomy may be a feasible and convenient method of diagnosis, especially where malignancy is suspected.
Chest 12/1990; 98(5):1156-8. · 5.25 Impact Factor
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ABSTRACT: In order to elucidate the therapeutic mechanisms of low dose-long term erythromycin (EM) therapy in patients with diffuse panbronchiolitis (DPB), the authors evaluated the effect of in vitro EM treatment on neutrophil (PMN) oxygen radicals production. EM has potent capacity to suppress PMN chemiluminescence (CL) induced by the N-formyl Met-leu-phe (FMLP), opsonized zymosan, and calcium ionophore A23187 stimulation. In marked contrast, phorbol myristate acetate (PMA)-induced PMN CL were much less affected by EM treatment. The suppressive activity of EM was dependent on the EM concentration and at a EM concentration of 25 micrograms/ml, FMLP-induced PMN CL were suppressed by 45.3 +/- 5.6% (n = 7), but PMA-induced CL were suppressed only marginally, 11.9 +/- 3.7% (n = 7). The onset of inhibitory activity of EM is rapid and at 5 min., 60.1% of the maximum suppression at 60 min. was observed. This EM-induced suppression was found to be reversible and dependent on the EM-pretreatment temperature since the suppressive activity of EM were observed only at 37 degrees C but not at 0 degrees C. These results suggest that actively transported intracellular EM exerts its suppressive activity by inhibiting the process of Ca++ transfer or Ca++ utilization by cells. In addition, these results were consistent with the concept that EM might act as an anti-inflammatory agent in chronic bacterial airway infections such as bronchiectasis and DPB where the PMN appear to play an important role in the generation of airway destruction.
Nihon Kyōbu Shikkan Gakkai zasshi 09/1990; 28(8):1066-71.
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ABSTRACT: A new type of bioabsorbable pledget made from non-woven fabric of polyglycolide (PGA) fibers has been developed. After the in vivo implantation test using dogs, samples were subject to clinical evaluations in pulmonary operations in four hospitals. The total number of trial cases was 50; in 11 cases pledgets were used for repair of the bronchus and in 39 cases for lung fistulas or defects of the pleurae. Compared with the conventional nonabsorbable pledgets, these PGA pledgets showed satisfactory results. In particular, for cases of emphysematous pulmonary diseases the application of the PGA pledgets and non-woven fabrics made the post-operative air-leakage duration short. In all these 50 cases neither side effect nor complication was observed. This evaluation suggests that PGA pledgets and non-woven fabric are an acceptable and even better alternative to conventional nonabsorbable pledgets for the pulmonary surgery.
The Thoracic and Cardiovascular Surgeon 05/1990; 38(2):81-5. · 0.88 Impact Factor
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ABSTRACT: Coin lesions in the thoracic cavity, skin, muscle and connective tissue are clearly observed by computed tomography (CT). However, it is very difficult to detect abnormal shadows in the ribs by thoracic CT at the mediastinal level. We describe 3 cases of pulmonary nodules that were not detected by CT at the mediastinal or lung field level, however, but could be detected at the bone level. When pulmonary nodules cannot be detected by thoracic CT at the mediastinal or lung field level, it is recommended to change the window to the bone level.
Nihon Kyōbu Shikkan Gakkai zasshi 07/1989; 27(6):754-9.
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[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 08/1988; 36(7):1180-4.
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Kyobu geka. The Japanese journal of thoracic surgery 05/1988; 41(4):291-4.
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[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 05/1988; 36(4):574-7.
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[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 07/1987; 35(6):913-7.
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Nihon Kyōbu Shikkan Gakkai zasshi 03/1987; 25(2):203-9.
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[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 03/1987; 35(2):232-6.
