[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Dec 1992
[Distribution of thymic tissue in the mediastinal adipose tissue removed at the thymectomy in 47 patients with myasthenia gravis].
In this report, the distribution of thymic tissue in the mediastinal adipose tissue was examined histologically in 54 patients with myasthenia gravis underwent extended thymectomy. In fourty-seven of 54 patients, the mediastinal adipose tissues were removed from 6 different parts adjacent to the thymus, i.e., right upper, right middle, right lower, left upper, left middle, and left lower, respectively. Upper area means of around the upper pole of thymus, middle area means of around hilum and lower area means of around from lower pole of thymus to diaphragma. ⋯ There were no significant differences in the prevalences among sex, Osserman type, duration of the disease, pre-operative treatment and histological findings or removal thymus. There were significant differences in the prevalence of all according to the proportion of thymic tissue in the thymus (0.01 < P < 0.05). In conclusion, it is suggested that for the removal of all thymic tissue, the sufficient procedure required utmost care especially to the left middle area around thymus.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nihon Kyobu Geka Gakkai Zasshi · Dec 1992
Review Case Reports[A rare case of mediastinal neuroblastoma with pectus excavatum in a 4-month-old boy--a surgical report].
Screening of neuroblastoma is commonly performed on 6-month-old infants; therefore, its discovery in children younger than that age is extremely rare. However, a 4-month-old boy with pectus excavatum was found to also have mediastinal neuroblastoma after close examination. This 7 kg child had no apparent symptoms, yet revealed an egg-sized shadow along the right atrium in the chest X-ray film, and along the right side of the vertebrae on CT. ⋯ After conducting a post-operative chemotherapy (Jame's protocol), no evidence of recurrence was observed at 33 months after surgical treatment. We summarized the previously reported seven surgically treated cases of Stage I mediastinal neuroblastoma at less than 12 months of age. Among the 2500 pectus excavatum surgeries that have been held at our department, non has been found to have mediastinal neuroblastoma.
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Nihon Kyobu Geka Gakkai Zasshi · Aug 1992
Review Case Reports[Coarctation of aorta with right aortic arch and anomalous left subclavian artery].
The occurrence of coarctation in patients with right aortic arch is extremely rare. We have encountered a 21-year-old man with anomalous left subclavian artery. He was diagnosed when he was 13. ⋯ Clinical studies revealed no vascular ring and no other anomalies were found in this patient. An attempt at treatment was made with extra anatomical bypass grafting from the ascending aorta to the descending aorta. No pressure difference due to coarctation remained after operation.
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Nihon Kyobu Geka Gakkai Zasshi · Aug 1992
[Reinfusion of autologous platelet-rich plasma improves hemostasis after cardiopulmonary bypass].
Although it is reported that postoperative bleeding is reduced by reinfusing autologous platelet-rich plasma (PRP) after cardiopulmonary bypass (CPB), the effect of PRP on hemostasis is not reported in detail. We prepared PRP and fresh whole blood (WB) from the blood of seven patients each prior to their undergoing CPB, and reinfused them autologously to the patients intravenously after the CPB was terminated. In this article, the effect on hemostasis of autologous PRP and WB was described. ⋯ The platelet counts increased from 4.3 +/- 1.4 x 10(4)/mm3 to 14.1 +/- 1.6 x 10(4)/mm3 after PRP reinfusion and the platelet aggregation rates increased significantly (p less than 0.01) after PRP reinfusion compared to WB transfusion. The activities of coagulation factors VII-X also increased significantly (p less than 0.05) after reinfusion of PRP when compared to transfusion of WB. The activated partial thromboplastin time decreased to 1.2 times the baseline in the PRP group but remained 1.5 times the baseline in the WB group (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Nihon Kyobu Geka Gakkai Zasshi · Jun 1992
[Experimental and clinical study of cardiopulmonary hemodynamics under one-lung ventilation during transthoracic esophagectomy].
Cardiopulmonary hemodynamics in pre- and postoperative period after transthoracic esophagectomy under one-lung ventilation (OLV) was investigated in experimental and clinical studies. In experimental study, 30 mongrel dogs were assigned to one of the groups: Group 1 (n = 10): 2 hour right thoracotomy alone under one (n = 5)- or two-lung ventilation (TLV) (n = 5), Group 2 (n = 10): thoracotomy + esophagectomy, Group 3 (n = 10): esophagectomy + right thoracic vagotomy. For further evaluation of the effect of vagotomy on increase of extravascular lung water (EVLW) on 3rd POD, the following 2 groups were designed as Group 4-1) (n = 5): thoracotomy + right thoracic vagotomy and Group 4-3) (n = 5): esophagectomy + left thoracic vagotomy. ⋯ Cardiopulmonary parameters and postoperative complications were not different between OLV and TLV groups in clinical study. In conclusion, OLV is a desirable procedure, not only for good exposure of the operative filed, but also for its safety regarding the cardiopulmonary hemodynamics. Transthoracic esophagectomy plus vagal branch denervation, which is necessary for aggressive lymphadenectomy around the trachea, increases EVLW and subsequent pulmonary edema compared with thoracotomy alone.