Predicting the response to lung volume reduction surgery using scintigraphy.

This study was conducted to evaluate the use of quantitative scintigraphy with a newly designed marker to assess and predict the efficacy of lung volume reduction surgery in treating emphysema. In a series of 50 patients with severe emphysema who underwent the operation, ventilation/perfusion scintigraphy was performed and 2 markers of area ratio and lung uniformity were measured before and 6 months after surgery. The markers were correlated with the results of pulmonary function tests.

New strategy for treatment of MRSA mediastinitis: one-stage procedure for omental transposition and closed irrigation.

Mediastinitis due to methicillin-resistant Staphylococcus aureus is a devastating potential complication of cardiac surgery. We treated 4 patients with this condition using a new technique. First we performed an early radical removal of infected tissue and omental transposition with direct primary closure of the sternum and closed continuous irrigation with saline/vancomycin hydrochloride; that was followed by an administration of intravenous antibiotics.

Noninvasive evaluation of internal thoracic artery and left anterior descending coronary artery anastomotic sites using transthoracic Doppler echocardiography: comparison with coronary arteriography.

Objectives: This study was designed to evaluate anastomotic sites located between the internal thoracic artery and left anterior descending coronary artery using transthoracic Doppler echocardiography, and then to clarify the accuracy of those results by comparison with coronary arteriographic findings.

Methods: We examined 35 consecutive patients who had undergone bypass surgery. The echocardiographic examinations were performed within approximately 1 week of follow-up coronary arteriography, which occurred at 4.

Occult gallbladder carcinoma diagnosed by a laparoscopic cholecystectomy.

Purpose: A laparoscopic cholecystectomy (LC) has become a common treatment modality. The incidence of occult gallbladder carcinoma (GC) diagnosed by LC has increased; however, the effects of a radical second operation after LC have not yet been demonstrated. In this study we examine the outcome of such further surgical intervention.

Advantage of earlier thoracoscopic clipping of thoracic duct for post-operation chylothorax following thoracic aneurysm surgery.

We report that an earlier thoracoscopic clipping of the thoracic duct was advantageous in a case of post-operation chylothorax that occurred following thoracic aneurysm surgery. A 61-year-old man developed chylothorax on postoperative day 2 following graft replacement of the descending thoracic aorta using a left-sided thoracotomy. Since a replaced graft infection is lethal, earlier thoracoscopic clipping of the thoracic duct through the right side chest wall was indicated.

[Choroid plexus carcinoma of the foramen Luschka: a case report].

Choroid plexus carcinoma(CPC) is a rare intracranial neoplasm that usually arises in the supra-tentorial region of infants. We report an adult case of CPC that arose in the foramen Luschka. A 61-year-old woman presented with a 10-year history of dysarthria.

Less invasive needle thoracoscopic laser ablation of small bullae for primary spontaneous pneumothorax.

Objective: The purpose of this study was to establish a new surgical technique of thoracoscopic laser ablation for the patients of primary spontaneous pneumothorax (PSP) with small bullae, by using endoscopic equipment with a 2-mm diameter.

Method: According to the size of a bulla identified by high-resolution computed tomography (HRCT), we have a protocol to determine an indication; the conventional video-assisted thoracic surgery (VATS) procedure by both stapler bullectomy and laser ablation to visceral pleura surrounding the bulla (bullae size: greater than 2 cm), or a new VATS procedure using needle shaped thoracoscopy and endoscopic equipment with a 2-mm diameter (needle VATS) by laser bulla ablation alone (bullae size: less than 2 cm).

Results: The conventional VATS was performed in 54 patients and needle VATS in 60 patients.

Bone and soft tissue tumours of the foot: review of 83 cases.

Purpose: To review cases of bone and soft tissue tumours of the feet managed at the Hyogo College of Medicine, Nishinomiya and Takarazuka Municipal Hospital, Takarazuka, Japan.

Methods: Retrospective analysis of 83 patient records treated for bone and soft tissue tumours of the feet between 1974 and 2000.

Results: There were 33 benign bone tumours, one primary malignant bone tumour, and 2 metastatic bone cancer.

New operative method for a giant bulla: sutureless and stapleless thoracoscopic surgery using the Ligasure system.

Thoracoscopic bullectomy performed with staplers is the main treatment for giant bullae in many institutions. However, there are certain problems associated with the increasing use of stapling devices. In response, we have applied a new operative method in which we excised a bulla with an ultrasonic-driven scalpel and successfully sealed the cut ends using the LigaSure Vessel Sealing System, a new bipolar system developed by Valleylab Inc.

Intrathoracic extramedullary hematopoiesis arising in marble bone disease. Clarifying the genetic disease mechanism.

We report a man with intrathoracic extramedullary hematopoiesis accompanied by marble bone disease who underwent thoracoscopic resection safely and definitively, followed by a radionuclide scan. Although intrathoracic extramedullary hematopoiesis is almost always accompanied by hemolytic anemia, this man's hematological data normalized. A consensus on the tumor genesis mechanism has yet to be reached, but the existence of marble bone disease in our case throws new light on the genetic mechanism in intrathoracic extramedullary hematopoiesis.

[A case of rectal cancer with multiple liver metastases that responded dramatically to pharmacokinetic modulating chemotherapy/CPT-11 therapy].

A 67-year-old male patient suffering from rectal cancer complicated by multiple hepatic metastases underwent low anterior resection, cholecystectomy and hepatic arterial cannulation. He was treated postoperatively with arterial infusion pharmacokinetic modulating chemotherapy (PMC) and venous infusion CPT-11 (modified PMC). After three courses of modified PMC, a complete response (CR) of the hepatic metastatic lesions was noted.

Headache associated with postpartum cerebral angiopathy: monitoring with transcranial color-coded sonography.

We report a case of postpartum cerebral angiopathy with headache; a rare entity that affects women within the early postpartum period. Cerebral angiography revealed multiple segmental narrowings of major cerebral arteries. The patient was monitored with transcranial color-coded sonography of the middle cerebral artery.

[A case of hepatic metastasis from rectal carcinoma successfully treated with pharmacokinetic modulating chemotherapy (PMC)-CPT-11 therapy].

We performed PMC-CPT-11 therapy (modified pharmacokinetic modulating chemotherapy plus irinotecan, or modified PMC) in a case of sigmoid colon cancer with local invasion and multiple hepatic metastases. This regimen combined PMC therapy which includes Hartmann's operation, simple hysterectomy and postoperative 5-fluorouracil (5-FU), with intravenous irinotecan, or CPT-11. The multiple hepatic metastatic lesions disappeared after surgery and no local recurrence has been found since.

An analysis of video-assisted thoracoscopic resection for mediastinal masses in 150 cases. An overview of the pansternal approach, histology, and complications.

Background: To clarify the usefulness of the diagnosis and treatment of mediastinal masses, by video-assisted thoracoscopic surgery (VATS), we performed a retrospective multi-institutional study to delineate the type of approach, histopathology, and complications associated with these entities.

Methods: We analyzed 150 patients who underwent the VATS procedure at several institutions between 1991 and 1999.

Results: VATS resections were performed using various combinations of the "pansternal approach.

[Successful thoracoscopic resection of pulmonary arterio-venous fistula].

A 65-year-old female was admitted for further examination of an abnormal shadow on a chest roentgenogram. Chest computed tomography revealed a lobular nodule with blood vessels, which was diagnosed as pulmonary arterio-venous fistula (PAVF). Thoracoscopic resection was performed under general anesthesia.

Videoendoscopic surgery combined with a minimal sternotomy for removing a thyroid tumor extending into the mediastinum. A case report.

We report the case of a 55-year-old man with a giant goiter descending to the mediastinum. Video-endoscopic surgery combined with a minimal sternotomy was performed to remove a thyroid tumor. In the course of our dissection of the subplatysmal space, an endoscopic approach was applied to avoid incisions of the neck.

Minimally invasive surgery for lung cancer with coronary artery disease.

We report a 69-year-old woman with lung cancer and severe stenosis in the left anterior descending coronary artery. To perform a curative operation for the lung cancer without myocardial infarction, minimally invasive direct coronary artery bypass and left lower lobectomy with video-endoscopic assistance were performed simultaneously. There was no major complication, and she was discharged at 14 days after the operation.

Peritoneal shunt tube placement performed using an endoscopic threaded imaging port. Technical note.

The authors used an endoscopic threaded imaging port that originally was developed for laparoscopy to access the peritoneal cavity, and applied this device to the placement of a peritoneal shunt tube in patients suffering from hydrocephalus. Using this system, the peritoneum can be opened quickly under direct vision by using an endoscope through a small skin incision. The peritoneal cavity is secured by replacing the cannula with a polyvinyl chloride (PVC) tube.

Scalp marking for a craniotomy using a laser pointer during preoperative computed tomographic imaging: technical note.

Objective: The preoperative localization of superficial intracranial lesions is often necessary for accurate burr hole placement or craniotomy siting. It is not always easy, however, to localize the lesions over the scalp working only from computed tomographic images. We developed a simple method for such localization using a laser pointer during the preoperative computed tomographic examination.

Treatment of atrial fibrillation using the Maze procedure: the Japanese experience.

The results of a questionnaire survey show that surgical treatment for atrial fibrillation (AF) has been performed in more than 2,500 patients in Japan. The methods of treatment used were the Cox-Maze-II procedure, the Cox-Maze-III procedure, the Kosakai-Maze procedure, the left atrial Maze procedure, the right atrial Maze procedure, compartment operation, radial operation, and other modifications. The success rates of the right atrial Maze procedure and compartment operation for AF associated with congenital heart disease were approximately 50%.

Immunohistochemical study of insulin-like growth factor II (IGF-II) and insulin-like growth factor binding protein-2 (IGFBP-2) in choroid plexus papilloma.

Insulin-like growth factor-II (IGF-II), a mitogen for various kinds of cells, has been shown to be secreted from the choroid plexus in animals. Insulin-like growth factor binding protein-2 (IGFBP-2), one of the six carrier proteins for IGFs, is also thought to be released from the choroid plexus, bind to IGF-II in the cerebrospinal fluid (CSF) and modulate the action of this growth factor. Little is known about the expression and localization of these substances in human choroid plexus and choroid plexus papillomas.

[Laparoscopic resection of ovarian cysts: precautions and improvements in the procedure and application of the mini-laparotomy].

We previously devised and reported a laparoscopic resection of benign ovarian cysts. In the present paper, we report precautions and improvements in the procedure and the application of the mini-laparotomy. 1.

[Laparoscopy-guided extraperitoneal resection of ovarian cysts: surgical procedure, indications and limitations].

We designed a new surgical method for the treatment of benign ovarian cysts. We have previously reported that, with our laparoscopy-guided method, the cyst wall is pulled outside the abdominal cavity after evacuation of the cyst contents, and resection is performed by the same method as during laparotomy. The preoperative assessment and surgical findings were investigated in 16 subjects, 5 with simple cysts, 2 with para-ovarian cysts, 2 with chocolate cysts, 5 with dermoid cysts and 2 with mucinous cysts.