Less Invasive Surgery under VATS for Synchronous Bilateral Lung Cancers

A patient with synchronous bilateral lung cancer is described. She was successfully treated with less invasive surgery by right S10 wedge resection using Video-assisted thoracic surgery (VATS) and left S6 segmentectomy. We judged she had synchronous primary lung cancers in the bilateral lung by histological study. She has remained well for 31 months. VATS is an effective approach for multicentric primary lung cancers and minimize the surgical stress of the simultaneous resection of bilateral tumor

Effect of Platelet-Activating Factor Antagonist (TCV-309) on Survival in the Canine Double Lung Transplantation Model

Fourteen adult mongel dogs were subjected to sequential double lung transplantation. The animals were assigned randomly to three experimental groups. Four dogs served as the control group (no treatment). Four other dogs were flushed with 4°C University of Wisconsin (UW) solution (UW flush group). The remaining six dogs were treated with platelet-activating factor antagonist (TCV-309) (PAF- antagonist group). None of the animals in the control group or the UW flush group survived more than 6 hours after transplantation. In contrast, all of the dogs in the PAF- antagonist group were extubated. The mean survival in this group was 5.2 days. PAF-antagonist (TCV-309) preserved lung function and improved survival in the canine sequential double lung transplantation model

An Experimental Study of Canine Isolated Double Lung Transplantation

The isolated double lung transplantation was performed in 8 adult mongrel dogs using transverse sternotomy in 6 and bilateral thoracotomy in 2 dogs. The first four dogs recieved donor lungs flushed with 4℃ UW solution. Isolated double lung transplantation was completed in 5 dogs ; in the other 3, procedure was not completed because of intraoperative cardiac arrest or massive bleeding. Two dogs with the double lung graft were sacrificed because of severe pulmonary edema, and 3 dogs died of cardiac failure 1 to 6 hours after the operation. We conclude that isolated double lung transplantation can be performed in dogs. However, survival time is limited because of progressive lung edema or cardiac failure

Surgical Experience with Pulmonary Thromboembolism

Surgical experience with acute pulmonary thromboembolism was reported and reviewed in the pathogenesis and surgical indication. A past history which underwent surgery for lung cancer was particular to this patient, suggesting a presence of tumor embolism. In conclusion, pulmonary thromboembolism is not necessarily related to preceding deep thrombophlibitis and drug therapy should be prescribed as soon as a diagnosis was made. In drug therapy was ineffective in alleviating their complaints, surgical indication should be taken into consideration. The aid of the support by extracorporeal circulation is of great use in the gain of dry operative field

Clinical Significance of Combined Resection with Tracheobronchial Trees for Advanced Esophageal Cancers

It was confirmed that combined resection of the trachea and the bronchus is feasible and available for advanced cancer patients on the basis of 9 patients of our clinical experience. However, meticulous postoperative cares are necessary for prevention of fatal outcome of postoperative complicatios. Anatomical drawback of tracheobronchoplastic operation is able to be overcome in combination with the procedure of omentopexy which facilitates neovascularity to the reconstructed trachea and bronchus

Class II MHC Antigen Expression in Bronchial Lavage Cells in a Canine Lung Allograft Model using FK506 Immunosuppression

Footnotes: Katsunobu Kawahara, MD., The First Department of Surgery, Nagasaki University School Medicine, Sakamoto-machi 7-1 #852, Nagasaki, Japan, TEL 0958-47-2111, FAX 0958-47-5034 Abbreviations: MHC: Major histocompatibility antigens, CsA: Cyclosporine A, BAL: Bronchoalveolar lavage, APC: Antigen presenting cell To assess the effect of FK506 on class II MHC antigen expression on lymphocytes recovered from bronchoalveolar lavage (BAL) in dogs following left lung allotransplantation, flow cytometric anlysis with OKIa-1 monoclonal antibody was performed. Dogs were divided into two groups: Group 1 (n = 6), control group (dogs without surgery); Group 2 (n = 23), dogs recieving left lung allotransplantation and immunosuppression using FK506 (0.1mg/kg/day intramuscularly). No significant difference existed in the percentage of OKIa-1 positive lymphocytes recovered from control animals (31.2 ± 11.2%) vs. normal allografts in Group 2 (34.8 ± 8.5%, n = 16). With rejection, however, the percentage of OKIa-1 positive lymphocytes increases significantly in Group 2: 56.2 ± 10.3% in mild rejection (n = 6) and 91.4 ± 4.3% in moderate or severe rejection (n = 4) (p < 0.01). Chest radiographs appeared normal in allografted lungs with histologically mild rejection. The percentage of the OKIa-1 positive lymphocytes in BAL did not significantly change during the first, second, or third week following transplantation, ((32.2 ± 6.4 (n = 5), 36.4 ± 4.2 (n = 4), and 35.8 ± 12.3 (n = 7), respectively)) in the allografted lungs without rejection. FK506 does not affect the class II MHC antigen expression of lymphocytes recovered from BAL in canine allografted lungs without rejection. Furthermore, this compound does not change in class II antigen expression seen with allograft rejection

Local Recurrence in the Pectoralis Major Muscle Following Modified Radical Mastectomy for Breast Cancer

Local recurrence in the pectoralis muscle after modified radical mastectomy for breast cancer is rare. We encountered a 53-year-old woman who developed a small nodule on her right antero-lateral chest wall after modified radical mastectomy. Excision biopsy of the mass lesion was performed, and pathological examination revealed a local recurrence in the pectoralis major muscle. Resection of the pectoralis major and minor muscles, subclavicular lymph nodes dissection and postoperative radiation therapy were performed. After operation, no local recurrence appeared, but the patient died of multiple liver and bone metastases two and a half years later

Results of Surgical Treatment for Small Cell Lung Cancers

We analyzed the data for patients with small cell lung cancer, especially as regards comparison of the results of surgical treatment before and after the introduction of multimodal chemotherapy treatments. Sixty cases with small cell lung cancer were admitted in our department between January, 1955 and December, 1993. Among them, 38 cases underwent pulmonary resection. To evaluate the efficacy of the multimodal treatment including cisplatin with surgical therapy, patients were devided whether pulmonary resection was performed before 1983 (Group A) or after 1984 (Group B). There were no differences in sex and stage between two groups, but ages and operative proceduress were significantly different (p <0.05). Ages were older in Group B (65.5 years) than in Group A (58.1 years) and operations were lesser in Group B (lobectomy or segmentectomy 87.0 %) than in Group A (pneumonectomy or bilobectomy 53.5 %). The operative mortality rates were 13.3 % (2/15) in Group A and 4.3 % (1/23) n Group B. Survival rate at 3 years of Group A was only 6.7 % and no patients survived more than 4 years. While, survival rates of Group B at 3 and 5 years were 24.2 %. The 5 years survival rate of patients with Stage I and II of Group B was 46.9 % and that of Stage III and IV was 8.5%. It is concluded that surgical resection of limited small cell lung cancer (Stage I and II) with intensive chemotherapy is an efficient therapeutic approach

The Efficacy of Polydioxanone Monofilament Absorbable Suture for Tracheal Anastomosis

To evaluate the efficacy of polydioxanon absorbable suture for tracheal anastomoses, we performed an experimental study using dose. Eight adult mongrel dogs underwent sleeve resection of the mediastinal trachea. A length of ten to twelve cartilage rings was resected. An end-to-end anastomosis was performed using either interrupted or continuous running 4-0 polydioxanone (PDS) suture. There was no detectable difference bronchoscopically, microangiografically, or histologically, in tracheal anastomotic healing between interrupted suture and continuous running suture. The inflammatory tissue response was mild and disappeared 3 weeks after surgery. The breaking strength, however, was greater in dogs in which interrupted sutures were used than in those with a continuous running sutures. We conclude that PDS is a useful suture material for tracheal anastomoses and that interrupted sutures are stronger and possibly safer than a continuous running suture for end-to-end anastomosis following sleeve resection of the trachea