Experimental Study on Healing Process in Bronchial Anastomosis -Especially Availability of Omental Wrapping and Pericardial Covering-

on the basis of the findings in relation to restoration and recanalization of the bronchial arteries. Restoration of the bronchial artery in the bronchial anastomotic sites was experimentally tested in regard to wrapping with pedicled omentum (Group II) and pedicled pericardium (GroupIII) in comparison with non-wrapping (Group I) on mongrel dogs. The grades of recanalization of the bronchial artery, which had been interrupted by bronchial sleeve resection, were assessed by means of postmortem bronchial angiography and healing process in anastomotic sites were evaluated by bronchoscopic and histologic examinations during a period from the 3rd day to 7th month following sleeve anastomosis between the left main and the lower bronchus on dogs. The results were as follows 1) Regeneration and recanalization of the bronchial artery are achieved on Day 7 after operation by using omentopexy procedure, whereas there are evidenced on Day 14 or later in either non-wrapping or pedicled pericardial covering. 2) Arterial blood supply to the bronchial wall distal to the anastomotic site is observed on Day 3 of the earliest time period following surgery by using omentopexy procedure, showing an arterial connection with the celiac artery, which becomes manifest within at least 3 or 4 days after performing bronchoplasty. 3) There is no difference in development of the bronchial arterial circulation in the bronchus at periphery between the procedures of non covering in bronchial anastomotic site and covering with the pedicled pericardium. The new growing arterial blood flow increased on Day 7 in the both procedures following bronchoplasty. 4) A new growing bronchial artery throughout the bronchial wall is completed on Day 14, demonstrating no differences in time periods between non-covering and wrapping groups

Bronchoplastic procedure with pulmonary angioplasty for lung cancer

Seventy-one patients with primary bronchogenic carcinoma Underwent bronchoplastic procedures (48 sleeve lobectomies and 23 wedge resection) from 1969 to 1986. In 16 patients the bronchoplasty with concomitant resection of pulmonary artery was performed. There were 48 squamous cell carcinomass, 13 adenocarcinomas, six large cell and four small cell carcinomas. There was no nodal metastasis in 26 patients (36.6%), 27 patients (38.0%) had mediastinal nodes involvement. Pathological stages of the disease were as follows : Stage I , one patients ; Stage II, 13 patients ; Stage III, 41 patients ; and Stage IV, one patient. Five year survival rate was 25.4%. Survival rates on the basis of nodal involvement indicate 44.1% at five years for patients without nodal metastasis and 18.4% for those with nodal involvement. Ten patients complained difficulty in expectoration after surgery, and frequent therapeutic bronchofiberscopy was necessary. Four patients had an early bronchial fistula. Bronchial stenosis or obstruction due to formation of suture granulation occurred in six patients, and local recurrence at bronchial suture line was observed in six patients. Three patients with resection of the pulmonary artery had vascular complications. In two patients obstruction of the pulmonary artery due to formation of thrombus occurred, and in one patient pulmonary artery was twisted. Bronchoplastic procedure can be perfomed safely, but if angioplasty of the pulmonary artery was concomitantly performed, it shoule be done carefully to prevent vascular distortion or stenosis. Since the description of bronchoplastic procedures by Paulson and Shaw in 1955 and Price Thomas in 1956, many reports have documented on the merits of these procedures. Sleeve lobectomy for lung cancer is an alternative to pneumonectomy, when the tumor extends into main bronchus. This operative procedure benifits the patients by conservation of lung tissues for whom pneumonectomy is not indicated because of poor pulmonary reserve. This report summarized our 17 years\u27 experience in lobectomy with bronchoplastic procedures and angioplasty of the pulmonary artery

Rupture of the major bronchi following closed injury to the chest

Rupture of the major bronchi following closed injury to the chest is comparatively rare. However, an increasing incidence of this condition is to be expected as the number of automobile accidents continued to rise. During the past 25 years we have had experiences with the management of four cases of traumatic rupture of the bronchus due to non-penetrating trauma. These cases are described here

Surgical treatment of bronchogenic carcinoma in patients over the age of 80 years old

From 1979 to 1986, pulmonary resection for bronchogenic carcinoma were performed in twelve patients over age 80. There were ten men and twowomen. The ages of the patients were 81 in three, 82 in three, 83 in four and 84 in two. The histologic cell types were adenocarcinoma in seven patients, squamous cell carcinoma in four, and large cell carcinoma in one. Eight patients were Stage I (T1 N0 M0 4 and T2 N0 M0 4) 3 were Stage III (T2 N2 M0 2 and T3 N1 M0 1) and one was Stage VI. The operative procedures undertaken were lobectomy in 5, segmentectomy in 3 and wedge resection in 4. Mediastinal nodes dissection was performed in 6 patients. There were ten curative resection and 2 were incurative. No operative deaths occured. 6 patients had dies, 2 of their disease, 2 of gastric cancer and 2 of other disease 5-50 months after operation. 6 patients are alive and well without disease 10-54 months after surgery. The results of this report indicate that pulmonary resections can be performed safely with low mortality and longterm survival in the patients over the age of 80. Because pulmonary resection for bronchogenic carcinoma remains the only effective form of therapy, the decision on whether to perform a pulmonary resections in patients over age 80 should be based not on age but on the patient\u27s cardiovascular status and pulmonary reserve

Thymectomy for myasthenia gravis

The effect of thymectomy on elimination of a myasthenic symptom was clinically evaluated. The operative approach was primarily extended thymectmy of choice via midsternotomy in all but one of transcervical approaches. Most of them belonged to Osserman II b and II a of the disease type. Thirteen cases were in combination with thymoma and thirty-five were not in combination. Thymectomy yields a 53.8% effectiveness rate for patients with thymoma and a 65.7% for patients without thymoma. There was no defenitive relationship between the operation effectiveness and the suffering duration of time. However, aggravation and no improvement of a clinical sign after thymectomy were observed in patients with a severe or moderate degree of germinal center formation

Surgery for older patients with advanced esophageal cancer involving the adjacent organs.

The treatment for thirty three advanced carcinoma of thoracic esophagus with cancer infiltrations to the adjacent organs were clinically analysed. The most affected organs were the aorta, followed by the trachea and bronchus. Clinical features are that two or three organs are affected at the same time and only one organ involvement is rare in frequency. Furthermore, nodal involvement is commonly accompanied and is spreading to the mediastium and abdomen. Surgical outcome of combined resection with involved organs is now unsatisfactory. In contrast, to relieve severe symptoms and to ensure the quality of life, aggressive combined resection is indispensable. It is assumed that further advances in improvement of potent anticancer drugs and surgical techniques may lead to prolonged survival of advanced esophageal cancer patients

Lung Preservation Using Cadaver Perfusion

Cadaver perfusion of in vivo lung storage method is evaluated with respect to time course of ischemic damage to lungs subsequently charged with providing total pulmonary function in comparison with survival and histological derangement of a lung. It, however, is limited within 2 hours due to failure of extracorporeal circulation with core cooling to 15°c by which splanchnic pooling causes reduced venous return. However, cadaver perfusion is useful to minimize an ischemic damage to a lung as a method of in vivo preservation

Benefit from omentopexy on bronchial wound healing in performing concurrent esophagectomy

The healing process of bronchial wound was compared among wrapping tissues such as pedicled omentum, pericardium, and parietal pleura in terms of the degrees of revascularization of the bronchial artery interrupted by bronchoplasty itself by microangiography, including the circumstances of performing a procedure of esophagectomy. The development of neovascularity was marked and facilitated by omentopexy. The procedure of wrapping by pedicled pericardium and pleura was not so useful for promoting neovascularity as would be expected, and it was almost the same as non-wrapping one. Meanwhile, recanalization by wrapping with free pleura was delayed. When esophagectomy was combined with bronchoplasty, revascularization was apparently retarded. In conclusion, wound healing at bronchial anastomosis was markedly impaired so that omentopexy was recommended for facilitating wound healing at anastomosis

Surgery for Stage I Lung Cancer

The surgical outcome for 209 early lung cancers was clinically evaluated. 1) Most (93%) of Stage I cancers were composed of pT1N0 and pT2N0 while 6.3 % was pT1N0. 2) Even in early cancer, nodal involvement and distant metastasis occurred and these related closely to their prognoses. 3) Reoperation should be indicated for recurrence with a 10 month or more time interval from the first operation and should be recommended, if possible. Advances in diagnostic technique for lung cancer have been achieved. As a consequence, early lung cancer has become clinically detected and the surgical curability has been improved with time. This study was undertaken to evaluate surgical treatment for stage I lung cancer patients