A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green

ObjectivePulmonary segmentectomy has been recognized as an operative option for complete resection of early-stage lung cancer in patients with poor pulmonary function. However, identification of anatomic pulmonary segments is sometimes difficult in patients with emphysema. We developed an intraoperative method for identifying intersegmental planes of the lung with high-sensitivity infrared fluorescence imaging after transbronchial injection of indocyanine green.MethodsThe study included 10 patients with early-stage lung cancer who underwent thoracoscopic segmentectomy. Under general anesthesia, indocyanine green was injected into the bronchus of target pulmonary segments. The target segments of the lung were identified using the indocyanine green fluorescence endoscope (Hamamatsu Photonics, Hamamatsu, Japan). The intersegmental lines and planes were identified and allowed removal of the segments. To evaluate operative outcomes, we compared the indocyanine green injection group with a retrospective control group with 10 matched-pair patients who underwent traditional thoracoscopic segmentectomy.ResultsAccurate, real-time intraoperative detection of indocyanine green with an infrared thoracoscope was confirmed. Sparing of intersegments was safely performed using both staples and electric cautery. Furthermore, infrared thoracoscopy allowed visualization of any residual portion of resected segments after segmentectomy. There was no difference between the experimental indocyanine green and control groups in terms of operative time, duration of postoperative chest drainage, or postoperative complications. Length of stay was shorter in the indocyanine green group than in the control group (P = .055).ConclusionsTransbronchial indocyanine green injection into the relevant bronchus with the use of an infrared thoracoscope allows identification of intersegmental lines and planes during thoracoscopic segmentectomy

Home-based subcutaneous immunoglobulin after switch from intravenous immunoglobulin improved quality of life in pediatric patient with common variable immunodeficiency: A case report

　Common variable immunodeficiency (CVID) is one of the primary immunodeficiency. Regular immunoglobulin G (IgG) replacement therapy is often performed for patients with CVID.　We experienced a patient who was hospitalized in our hospital for repeated pneumonia and diagnosed CVID at the age of 10 years. He had often been absent from school due to infectious diseases. We were administered intravenous IgG (IVIG) two times and his serum level of IgG became over 1,000 mg/dL. Afterward, he was affected the hand-foot-and-mouth disease one week after discharge. At that time, his IgG level decreased to 751 mg/dL. To maintain stable IgG trough levels, we introduced subcutaneous IgG (SCIG). Since then, his IgG levels remained around 1,000 mg/dL, he has lived without suffering from infectious diseases.　There are some reports that IVIG and SCIG were compared and SCIG was able to obtain a stable IgG trough levels to prevent infection. In addition, because our patient is a mother and child family, it was difficult to visit the outpatient department frequently, so it was desirable to infuse at home.　We experienced a patient who had a stable trough levels with SCIG and improved quality of life, so we report this case with literature reviews

Long-term survival with RAS-associated autoimmune leukoproliferative disorder with somatic KRAS mutation:A case report

　RAS -associated autoimmune leukoproliferative disorder (RALD) is a recently reported rare nonmalignant autoimmune disorder. The characteristic clinical findings of RALD include monocytosis, leukocytosis, lymphoproliferation, and autoimmune phenomena. RALD is defined by somatic mutations in KRAS or NRAS . It is a new disease that was reported by Niemela and Takagi in 2011. The prognosis and incidence are currently unknown and the treatment strategy has not yet been established.　Here we describe the long-term survival of a patient with who displayed a somatic KRAS G12D mutation. His clinical features and labolatory data were overlapped with juvenile myelomonocytic leukemia and chronic myelomonocytic leukemia. Mercaptopurine hydrate, hydroxycarbamide and azacitizine were administered to control white blood cell count and improve clinical symptoms. He had a long survival time without hematopoietic stem cell transplantation

経皮経食道胃管ドレナージ術(PTEG-Drainage)で長期間QOLの改善が得られた在宅医療の1治験例

我々は1994年より経皮経食道胃管挿入術(percutaneous trans-esophageal gastro-tubing; PTEG)を考案開発し,在宅医療に応用してきた.今回術後癌性腹膜炎の患者の腸管減圧に対し,PTEGを用いた在宅医療を試み,長期間のQOLの改善が得られたので報告する.症例は62歳男性.1997年12月3日下行結腸癌で左半結腸切除術(D3)を施行した.病理診断はtub_1, P_0 H_0 M_0 ss n_2でstage IIIb であった.以後テガフールウラシル450mg/dayの内服で外来通院したが,腸閉塞を繰り返すため1998年9月25日再開腹手術で癒着剥離術を施行し,その際腹膜播種を確認した.以後徐々に経口摂取不良となり,1999年4月12日在宅医療を目標として中心静脈カテーテルを留置して,在宅中心静脈栄養法(HPN)を行っていたが,消化管通過障害による嘔吐頻回となり再入院となった.イレウス管を挿入留置することにより症状軽決したが,イレウス管による咽頭部痛が強いため抜去となった.患者の在宅医療への移行にあたり,腸管減圧目的のPEGの実施は癌性腹膜炎のため困難と判断して,5月26日にPTEGを施行した.また疼痛管理はインフューザーを用いて塩酸モルヒネの持続投与を開始し,栄養管理はHPNにより行うことで,PTEG挿入後第7病日目に退院となった.以後当院在宅医療支援・推進部との連携で在宅医療を続けていたが,全身状態が徐々に悪化し10月18日,PTEG施行後第145病日目に在宅死となった.PTEG挿入留置中は明らかなチューブトラブルなどの合併症は認めず,鼻腔や咽頭の疼痛や違和感などを認めず自然な感覚で飲水が可能で,4カ月以上に渡り著明なQOLの改善を在宅で得ることが可能であった.本法は末期癌患者の在宅医療において,非常に有効な治療手段の一つと考えられた.We invented percutaneous trans-esophageal gastro-tubing (PTEG) on 1994. And we tried to make PTEG suitable for home care for feeding and drainage cases. This case report presents a less invasive method of esophagostomy and simple and easy maintenance for home care. PTEG allows the surgeon to create an esophagostomy safely and simply even in cases with complications that would make it difficult to create a percutaneous endoscopic gastrostomy (PEG). There were no major complications, such as leakage, infection or bleeding. And the maintenance of PTEG is simple and easy. This case with terminal stage colon cancer was treated with PTEG for drainage, improving the patient\u27s quality of life (QOL) at home for the long term

経皮経食道胃管ドレナージ術(PTEG-Drainage)で長期間QOLの改善が得られた在宅医療の1治験例

我々は1994年より経皮経食道胃管挿入術(percutaneous trans-esophageal gastro-tubing; PTEG)を考案開発し,在宅医療に応用してきた.今回術後癌性腹膜炎の患者の腸管減圧に対し,PTEGを用いた在宅医療を試み,長期間のQOLの改善が得られたので報告する.症例は62歳男性.1997年12月3日下行結腸癌で左半結腸切除術(D3)を施行した.病理診断はtub_1, P_0 H_0 M_0 ss n_2でstage IIIb であった.以後テガフールウラシル450mg/dayの内服で外来通院したが,腸閉塞を繰り返すため1998年9月25日再開腹手術で癒着剥離術を施行し,その際腹膜播種を確認した.以後徐々に経口摂取不良となり,1999年4月12日在宅医療を目標として中心静脈カテーテルを留置して,在宅中心静脈栄養法(HPN)を行っていたが,消化管通過障害による嘔吐頻回となり再入院となった.イレウス管を挿入留置することにより症状軽決したが,イレウス管による咽頭部痛が強いため抜去となった.患者の在宅医療への移行にあたり,腸管減圧目的のPEGの実施は癌性腹膜炎のため困難と判断して,5月26日にPTEGを施行した.また疼痛管理はインフューザーを用いて塩酸モルヒネの持続投与を開始し,栄養管理はHPNにより行うことで,PTEG挿入後第7病日目に退院となった.以後当院在宅医療支援・推進部との連携で在宅医療を続けていたが,全身状態が徐々に悪化し10月18日,PTEG施行後第145病日目に在宅死となった.PTEG挿入留置中は明らかなチューブトラブルなどの合併症は認めず,鼻腔や咽頭の疼痛や違和感などを認めず自然な感覚で飲水が可能で,4カ月以上に渡り著明なQOLの改善を在宅で得ることが可能であった.本法は末期癌患者の在宅医療において,非常に有効な治療手段の一つと考えられた.We invented percutaneous trans-esophageal gastro-tubing (PTEG) on 1994. And we tried to make PTEG suitable for home care for feeding and drainage cases. This case report presents a less invasive method of esophagostomy and simple and easy maintenance for home care. PTEG allows the surgeon to create an esophagostomy safely and simply even in cases with complications that would make it difficult to create a percutaneous endoscopic gastrostomy (PEG). There were no major complications, such as leakage, infection or bleeding. And the maintenance of PTEG is simple and easy. This case with terminal stage colon cancer was treated with PTEG for drainage, improving the patient's quality of life (QOL) at home for the long term