Long-term effectiveness of right septal pacing vs. right apical pacing in patients with atrioventricular block

AbstractBackgroundLong-term right ventricular apical (RVA) pacing increases the risk of heart failure (HF) by inducing ventricular dyssynchronization. Although recent studies suggest that right ventricular septal (RVS) pacing results in improved short-term outcomes, its long-term effectiveness remains unclear.Methods and resultsThis study investigated 149 consecutive patients who underwent implantation of a dual chamber pacemaker for atrioventricular block with either RVS-pacing between July 2007 and June 2010 or RVA-pacing between January 2003 and June 2007. The endpoint was defined as death and hospitalization due to heart failure (HF). The rates of mortality and hospitalization due to HF were significantly lower in the RVS-pacing group than that in the RVA-pacing group (event free RVS: 1 year, 98% and 2 years, 98%; RVA: 1 year, 85% and 2 years, 81%; p<0.05). None of the patients died from HF in the RVS-pacing group, while 4 patients died from HF in the RVA-pacing group within 2 years after pacemaker implantation. The paced QRS interval was significantly shorter with RVS pacing than with RVA pacing at different times after pacemaker implantation (RVS: immediately 157.8±24.0ms, after 3 months 157.3±17.5ms, after 6 months 153.6±21.7ms, after 12 months 153.6±19.4ms, after 24 months 149.3±24.0ms vs. RVA: immediately 168.3±23.7ms, after 3 months 168.7±26.0ms, after 6 months 168.0±22.8ms, after 12 months 171.2±22.3ms, after 24 months 176.1±25.5ms; p<0.05).ConclusionsRVS pacing is feasible and safe with more favorable clinical benefits than RVA pacing

Patient Satisfaction after Endoscopic Thoracic Sympathectomy for Palmar Hyperhidrosis

Endoscopic thoracic sympathectomy (ETS) for palmar hyperhidrosis was performed using a 3-mm small endoscope at our hospital, and we conducted a questionnaire for the purpose of studying the conditions and satisfaction after surgery. The subjects were comprised of 50 patients, of which 35 patients (75%) answered the survey. The average age of the respondents was 27 years old (range: 12?62 years old) including 13 males and 22 females and the average postoperative observation period was 33 months (1?114 months). The results showed the good effects of surgery in all of the patients for palmar sweating while patient satisfaction was 79.4 points, which concluded that ETS was sufficiently accepted as treatment for palmar hyperhidrosis. However, compensatory sweating (CS) developed in 97.1% of the patients, and 82.9% answered that they were disturbed because it was more than they had expected. This result makes us realize further the importance of preoperative informed consent for CS. The problem of palmar hyperhidrosis is very serious for patients, and hence it is important to give treatment with a thorough understanding of the effectiveness and problems of ETS for palmar hyperhidrosis according to the analytical results of this questionnaire

Bilateral Multiple Pulmonary Sclerosing Hemangioma in a Young Male Patient

The patient was a 24-year-old male who visited our University Hospital complaining of chest pain, and chest computed tomography revealed multiple bilateral nodules. The chest pain disappeared almost immediately, but the tumor underwent no changes during the 3 years of follow-up observations. We used a thoracoscope to perform a partial lung resection of a nodule that reached a maximum diameter of 9 mm for the purpose of obtaining a definite diagnosis. From the pathological findings, the patient was diagnosed to have pulmonary sclerosing hemangioma in which circular tumor cells lacking nuclear atypia rose to papillary hyperplasia. The mindbomb homolog-1 positive rate (MIB-1 index) of the tumor cells was less than 1%, and it is believed to have a poor proliferation activity. Pulmonary sclerosing hemangioma is predominantly found in cases of middle-aged female patients and occurs unilaterally. Cases of bilateral multiple forms in young males are extremely rare. Some cases of enlargement, metastasis and relapse have also been reported, so in the future, careful follow-up is required

Thoracoscopic Resection of an Anterior Mediastinal Bronchogenic Cyst

We report a very rare case of anterior mediastinal bronchogenic cyst, successfully resected by thoracoscopic surgery. A 78-year-old female was noted as having an abnormal shadow on her chest X-ray during a routine medical checkup. Chest CT revealed a cystic tumor in the anterior mediastinum. A thymic cyst was suspected after a detailed examination and thoracoscopic surgery was performed. A cystic tumor containing yellowish-white mucus measuring 46 × 33 × 19 mm in size was successfully removed. Calcification was also observed in the cyst wall. Pathologically, the tumor was characterized by a ciliated columnar epithelial lining, and was subsequently diagnosed as a bronchogenic cyst. Although they may be rare, bronchogenic cysts should also be considered in the evaluation of cystic tumors in the anterior mediastinum

Inflammatory Pseudotumor of the Lung Identified by 18F-Fluorodeoxyglucose Positron Emission Tomography: A Patient Report

The patient was a 71-year-old man with an abnormal shadow on chest X-ray. Computed tomography (CT) of the chest showed a tumor of 38 mm in size in the upper lobe of the left lung S3. A CT-guided lung biopsy was performed, but no malignancy was observed. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed a high FDG uptake in the tumor: the maximum and mean values of the standard FDG uptake in the early phase were 7.3 and 5.3, respectively, and those in the latter phase, 8.3 and 5.9, respectively. The hilar and mediastinal lymph nodes also showed positive for high FDG uptakes. We strongly suspected lung cancer, and performed a left upper lobectomy by video-assisted thoracic surgery. The pathological diagnosis was an inflammatory pseudotumor of the lung: it is a rare disease but often requires differentiation from lung cancer. Literature has been few on FDG-PET about inflammatory pseudotumor of the lung. Differentiation of the disease from lung cancer was especially difficult in the present patient, because both lymph nodes and the tumor showed high FDG uptakes

An Autopsy Case of Acute Pulmonary Embolism after Lung Cancer Surgery

The patient was a 77-year-old female who had difficulty breathing at 48 h after undergoing a right upper lobectomy for lung cancer and experienced sudden cardiopulmonary arrest. Emergency resuscitation was performed, and she was therefore put under artificial respiration, but she died 15 h after resuscitation. A pathological autopsy was performed upon obtaining informed consent from the family. An examination of the lungs in which the right upper lobectomy was performed detected multiple embolisms blocking the bilateral main pulmonary arteries to the periphery, and the cause of death was established as acute pulmonary embolism. The rate of occurrence of fatal pulmonary embolism after surgery is assumed to be 0.08%, but the rate of occurrence after thoracic surgery shows a high rate of 0.34%. It is important to implement early detection and the early treatment of pulmonary embolism that occurred by misfortune while also reviewing all risk assessments and preventive measures established under the medical guidelines in order to prevent such cases from becoming fatal

Video-Assisted Thoracic Surgery (VATS) for Stabbing Thoracic Injury

The patient was a 30-year-old male who was found after he had stabbed himself in the left side of the chest and collapsed. He was brought to our hospital to undergo immediate drainage of the thoracic cavity. The chest X-ray and chest computed tomography findings showed that the knife was situated from the left cardiac border toward the proximity of the diaphragm, thus resulting in hemopneumothorax. The patient’s vital signs were stable, and we believed that it was important to avoid secondary injury when removing the knife from the thoracic cavity. Therefore, we performed video-assisted thoracic surgery (VATS). We resected the considerably crushed lung and sutured the lacerated myocardium by VATS. The postoperative course was good. We believe that VATS for thoracic injury can be an effective surgical option if a patient’s vital signs are stable

Neurogenic Dumbbell Tumor Resected by Combined Posterior and Thoracoscopic Approaches

The patient was a 51-year-old female with a chief complaint of numbness of the right thigh. A dumbbell tumor compressing the 11th thoracic spinal cord was present in the posterior mediastinum on chest computed tomography and myelography. In surgery, the tumor in the spinal canal was resected by a posterior approach, and the residual tumor was completely excised by thoracoscopic surgery. The tumor measured 78 48 mm, and histopathologically diagnosed as schwannoma. The surgical procedure for neurogenic dumbbell tumors should be decided based on Eden’s classification. For types II and III, such as this patient, excision of the tumor in the spinal canal should be performed to avoid spinal cord damage, followed by thoracoscopic complete resection. Thoracoscopic surgery was applicable even though the tumor was large