RESUMO
A 20-year-old male was clinically diagnosed as having a mediastinal non seminomatous germ cell tumor because of the elevation of the serum AFP and a large mass lesion in the anterior mediastinal and right thoracic cavity. After 3 courses of chemotherapy with cisplatin (CDDP) and etoposide (VP-16), the serum level decreased to normal range. But, the mediastinal mass enlarged after chemotherapy due to hemorrhage. The tumor was completely removed with sternotomy and right thoracotomy. Postoperative course was uneventful, and he has been free of recurrence for 2 years.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Mediastino/cirurgia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Pneumonectomia/métodos , Adulto , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Etoposídeo/administração & dosagem , Humanos , Masculino , Neoplasias do Mediastino/tratamento farmacológico , Neoplasias do Mediastino/patologia , Invasividade Neoplásica , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/patologia , Terapia de Salvação , Esterno/cirurgia , Toracotomia/métodos , Resultado do TratamentoRESUMO
A 44-year-old male was admitted to our hospital owing to severe dyspnea of sudden onset. Chest X-ray disclosed bilateral giant bullae. His pulmonary function was severely depressed. VC (%) was 2.61 l (66.3%) and FEV1% (%) was 1.47 l (64.5%). Indication of surgical repair of giant bullae are; space occupying lesion more than 25-50% in 1 thorax, progressive dyspnea, enlargement over time irrespective of symptoms, and expectation that re-expand the normal lung. He was conducted two-staged bullectomy using video-assisted thoracoscopic surgery (VATS) with small incisions. First operation was performed to left lung. Pulmonary function improved. VC (%) increased 3.02 l (76.8%) and FEV1% (%) 2.36 l (76.6%). After second operation, which was performed to right lung, VC (%) was 2.40 l (60.5%) and FEV1% (%) was 2.21 l (92.1%). Hugh-Jones grade improved class IV to class I. Postoperative course was uneventful and he was discharged 15 days after second operation. Two-staged bullectomy was appropriate in this case, because he might have suffered from re-expansion pulmonary edema after first surgery. The extent of recovery of pulmonary function was unpredictable. And performing right lung bullectomy just after the left bullectomy may be dangerous, because the patient have to receive anesthesia with his resected left lung. There is some possibility that patient who has bilateral giant bullae shows severe dyspnea during the progress, care should be taken to conduct operation as soon as possible.
Assuntos
Pneumonectomia/métodos , Enfisema Pulmonar/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Dispneia/etiologia , Seguimentos , Humanos , Masculino , Enfisema Pulmonar/complicações , Enfisema Pulmonar/fisiopatologia , Testes de Função Respiratória , Fatores de Tempo , Resultado do TratamentoRESUMO
A 40-year-old female was admitted because of abnormal chest shadows. Chest CT and pulmonary angiography revealed bilateral multiple arteriovenous fistulas in the right S5a, S5b and left S5, S9. Fistula excision and bilateral partial resection of lung were performed through median sternotomy in one stage. This surgical options allows entire removal of the fistulas as well as preservation of lung function.
Assuntos
Fístula Arteriovenosa/cirurgia , Artéria Pulmonar , Procedimentos Cirúrgicos Pulmonares/métodos , Veias Pulmonares , Esterno/cirurgia , Adulto , Fístula Arteriovenosa/complicações , Feminino , Humanos , Artéria Pulmonar/cirurgia , Veias Pulmonares/cirurgia , Telangiectasia Hemorrágica Hereditária/complicaçõesRESUMO
PURPOSE: We investigated in detail the state of internal iliac artery (IIA) aneurysms over the midterm after the exclusion procedure. METHODS: From January 1990 to December 1998, 29 patients underwent the exclusion procedure for IIA aneurysms. The medical records of 27 survivors were retrospectively reviewed, and 30 excluded aneurysms of these patients were followed up with computed tomography scanning over the midterm. RESULTS: In the immediate postoperative period, 26 aneurysms were completely thrombosed, and four were incompletely thrombosed. In the midterm, 24 aneurysms were completely thrombosed (complete group), and six were incompletely thrombosed (incomplete group). No aneurysms expanded or ruptured during the follow-up period from 6 to 98 months (mean, 26 months). The size of the excluded aneurysm decreased in 22 of 24 aneurysms in the complete group, but no change in size was noted in the six aneurysms in the incomplete group. The preoperative size of the IIA aneurysm in the incomplete group was significantly larger than that in the complete group (P =.0047). The size of two aneurysms in the incomplete group was smaller than 3.0 cm. The aneurysms in the incomplete group extended significantly deep into the pelvis as compared with those in the complete group (P =.0008). CONCLUSIONS: The exclusion of IIA aneurysm did not reliably result in thrombosis of the aneurysm. For IIA aneurysms extending deeply into the pelvis, even if the size of the aneurysm is smaller than 3.0 cm, the exclusion procedure should not be performed.
Assuntos
Aneurisma/cirurgia , Artéria Ilíaca/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Aneurisma/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Falha de TratamentoRESUMO
PURPOSE: The purpose of this study was to compare the midline retroperitoneal approach with the midline transperitoneal approach for abdominal aortic aneurysm (AAA) repair with respect to operative details, gastrointestinal complications, and wound complications. METHODS: From January 1990 through January 1998, 128 patients underwent elective aortic reconstruction for infrarenal AAA. Of these, 64 patients (the transperitoneal group) underwent conventional transperitoneal midline aortic exposure, whereas the remaining 64 patients (the retroperitoneal group) underwent retroperitoneal midline exposure of the aneurysm. RESULTS: Preclamp time, that is, the time from skin incision to aortic clamping, was significantly shorter in the transperitoneal group than in the retroperitoneal group (P <.001). However, the midline retroperitoneal approach was associated with decreased incidence of ileus (P <.01), earlier resumption of oral intake (P <.01), and decreased wound pain (P <.01), in comparison with the transperitoneal approach. Furthermore, there was no incidence of wound complications such as abdominal bulge or wound pain in any of the patients in the postoperative period or over the long term. CONCLUSIONS: The midline retroperitoneal approach for AAA was associated with fewer postoperative gastrointestinal and wound complications than the midline transperitoneal approach. Over the long term, there was no wound complication such as abdominal bulge and wound pain in any of the patients.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Idoso , Humanos , Peritônio , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
We describe herein the postoperative renal functions of patients who required a suprarenal aortic cross-clamp during abdominal aortic surgery. Seven patients required a unilateral suprarenal aortic cross-clamp (group A) and six patients required a bilateral suprarenal clamp (group B). Eighty-three patients who required an infrarenal aortic clamp were assigned to group C. Renal hypothermia with renal perfusion or topical cooling during suprarenal clamp was not performed. No hospital deaths were encountered. In group B, the postoperative creatinine and blood urea nitrogen (BUN) levels remained statistically significantly higher than that of group C until the seventh postoperative day. The postoperative renal dysfunction (serum creatinine level >2.0 mg/dl) was 28.6% in group A and 50% in group B, while it was only 8.4% in group C, although no patient required either temporary or permanent hemodialysis. The postoperative peak BUN over 30 min suprarenal clamp was significantly higher than that within 30 min. In summary, the postoperative renal function was impaired after an extended bilateral suprarenal clamp. These findings suggest that if prolonged renal ischemia is thus expected, then renal preservation should be considered.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Rim/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Idoso , Aorta Abdominal , Aneurisma da Aorta Abdominal/fisiopatologia , Estudos de Casos e Controles , Constrição , Feminino , Humanos , Isquemia/fisiopatologia , Rim/irrigação sanguínea , Masculino , Período Pós-Operatório , Fatores de TempoRESUMO
A 61-year-old man was diagnosed with severe aortic valve stenosis with left ventricular outflow tract pressure gradient due to systolic anterior movement of the mitral valve and a large poststenotic dilation of the ascending aorta. He underwent successful aortic root replacement and concomitant septal myectomy.
Assuntos
Estenose da Valva Aórtica/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Aorta/patologia , Aorta Torácica/cirurgia , Estenose da Valva Aórtica/etiologia , Implante de Prótese Vascular/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Dilatação Patológica/complicações , Septos Cardíacos/cirurgia , Doenças das Valvas Cardíacas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/etiologiaRESUMO
A 28-year-old Marfan's syndrome woman was referred to our hospital because of sudden chest and back pain. She had received replacement of the descending and ascending aorta for acute aortic dissection previously in other two institutions. CT scan revealed the massive mediastinal hematoma and hemothorax which suggested ruptured dissecting aneurysm of the transverse arch. Emergent total arch replacement, re-ascending replacement and aortic root plasty successfully weve performed. She recovered uneventfully although she had residual thoracoabdominal dissecting aneurysm. It was suggested that total arch replacement should be performed for Stanford A type dissection in Marfan's syndrome.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Síndrome de Marfan/complicações , Adulto , Dissecção Aórtica/etiologia , Aorta/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/etiologia , Ruptura Aórtica/etiologia , Feminino , HumanosRESUMO
A 66-year-old man was admitted to our hospital as a result of an abnormal shadow which was observed on his chest X-ray. A chest CT scan and chest MRI revealed an upper mediastinal tumor. The tumor was located in the retrotracheal region and resected completely following a thoracotomy. Histological examination of the tumor revealed follicular adenoma of the thyroid gland. Complete mediastinal goiter is a relatively rare lesion, with only 59 cases (including our case) in Japan prior to 1997. Only two cases were reviewed, in which the tumors were located in the retrotracheal region, out of the 59 cases in Japan.
Assuntos
Adenoma/complicações , Bócio Subesternal/diagnóstico , Neoplasias da Glândula Tireoide/complicações , Idoso , Bócio Subesternal/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Radiografia TorácicaRESUMO
We screened a chemical library of 2000 compounds for inhibitors of hepatitis C virus (HCV) serine proteinase using an in vitro screening method measuring the hydrolysis of the peptide substrate. Three compounds were found to be the most potent inhibitors (IC50 < 10(-5) M). Two of them had a similar structure, that of halogenated benzanilide, and were not inhibitory for common serine proteinases. They inhibited the enzyme non-competitively with the substrate. Together with the result of the analogous compounds in the chemical library, the presumed structural requirements of the inhibition are pointed out.
Assuntos
Serina Endopeptidases/metabolismo , Inibidores de Serina Proteinase/farmacologia , Proteínas não Estruturais Virais/antagonistas & inibidores , Sequência de Aminoácidos , Humanos , Dados de Sequência Molecular , Estrutura Molecular , Peptídeos , Proteínas Recombinantes de Fusão/antagonistas & inibidores , Inibidores de Serina Proteinase/síntese químicaRESUMO
A series of pyrrole butyric acid derivatives was synthesized and evaluated for inhibitory activity on human and rat steroid 5 alpha-reductase in vitro and ex vivo. 3-Benzoyl-4-alkylpyrrole-1-butyric acids and 1-methyl-2-alkyl-3-benzoylpyrrole-5-butyric acid derivatives were effective inhibitors. Structure activity relationships were evaluated among the 37 compounds synthesized. Compound 37 (HQL-1069) shows potent inhibitory activities against both rat and human 5 alpha-reductase.
Assuntos
Inibidores de 5-alfa Redutase , Inibidores Enzimáticos/síntese química , Inibidores Enzimáticos/farmacologia , Pirróis/síntese química , Pirróis/farmacologia , Animais , Fibroblastos , Humanos , Técnicas In Vitro , Espectroscopia de Ressonância Magnética , Masculino , Conformação Molecular , Próstata/efeitos dos fármacos , Próstata/enzimologia , Ratos , Ratos Wistar , Relação Estrutura-AtividadeRESUMO
PURPOSE: This study was performed to evaluate the effects of a residual dissection on coagulation, fibrinolysis, and platelet function after surgical treatment of acute type A aortic dissection. METHODS: Between 1987 and 1995, 48 consecutive patients underwent emergency surgery for acute type A aortic dissection. Thirty-five of 41 survivors were followed-up for periods ranging from 6 to 112 months (median, 30.3 months). These survivors were classified into three groups by computed tomographic scanning and angiography. Fifteen patients had no residual dissection (group I). Of the 20 patients who had residual dissection, nine had an enlarged aorta greater than 45 mm in maximal diameter (group II), and 11 had an aorta less than 45 mm in maximal diameter (group III). For all patients, blood samples were collected for coagulation, fibrinolysis, and platelet function studies on the same day that the computed tomographic scanning had been performed. RESULTS: beta-thromboglobulin, thrombin-antithrombin III complex, D-dimer, and alpha 2 plasmin inhibitor-plasmin complex concentrations were significantly higher in group II than in the other two groups. Strong correlations between the maximal diameter of the dissected aorta and beta-thromboglobulin, thrombin-antithrombin III complex, D-dimer, and plasmin inhibitor-plasmin complex concentrations were evident. In contrast, correlations between the length of the dissected aorta and coagulation/fibrinolysis measurements were weak. CONCLUSIONS: Our findings suggest that the coagulopathy worsened in proportion to the degree of dilatation of the dissected aorta.
Assuntos
Aneurisma Aórtico/sangue , Aneurisma Aórtico/cirurgia , Dissecção Aórtica/sangue , Dissecção Aórtica/cirurgia , Coagulação Sanguínea , alfa 2-Antiplasmina , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Angiografia Digital , Antifibrinolíticos/análise , Antitrombina III/análise , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aortografia , Plaquetas/fisiologia , Coagulação Intravascular Disseminada/complicações , Tratamento de Emergência , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinolisina/análise , Fibrinólise , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Hidrolases/análise , Tomografia Computadorizada por Raios X , beta-Tromboglobulina/análiseRESUMO
BACKGROUND: Thromboangiitis obliterans (TAO) is an occlusive arterial disease and a separate disease entity from atherosclerosis. It occurs mainly in the small and medium-sized vessels. Although the cause of TAO is unknown, systemic factors (immunological or humoral) may be involved in addition to abnormal peripheral microcirculation. Endothelium is now recognized as an important factor in the maintenance of microvascular circulation and the inhibition of platelet aggregation. This study examines the possible impairment of endothelium-dependent vasodilation in the peripheral vasculature of patients with TAO. METHODS AND RESULTS: Forearm blood flow (FBF) changes induced by the endothelium-dependent vasodilator acetylcholine, the endothelium-independent vasodilator sodium nitroprusside, and occlusion-induced reactive hyperemia were measured plethysmographically in eight patients with TAO and in eight healthy control subjects matched for age and smoking status. The increase in FBF response to intra-arterial acetylcholine infusion was lower in patients with TAO than in healthy control subjects (peak FBF, 22.9 +/- 2.9 versus 14.1 +/- 2.8 mL/min per dL of tissue volume; P < .01). In contrast, there was no significant difference in the increase in FBF response to sodium nitroprusside infusion between the two groups (peak FBF 13.1 +/- 4.0 versus 16.3 +/- 2.5 mL/min per dL of tissue volume; P = NS). In the case of reactive hyperemia, there were no significant differences between the two groups at any time points of hyperemia (peak FBF, 32.9 +/- 4.0 versus 31.4 +/- 3.3 mL/min per dL of tissue volume; P = NS). CONCLUSIONS: These results indicate that peripheral endothelium-dependent vasodilation is impaired in the nondiseased limb of patients with TAO. This type of vascular dysfunction may contribute to such characteristics as segmental proliferative lesion and thrombus formation in the peripheral vessels of patients with TAO.
Assuntos
Endotélio Vascular/fisiologia , Tromboangiite Obliterante/fisiopatologia , Vasodilatação , Acetilcolina/farmacologia , Adulto , Feminino , Antebraço/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/efeitos dos fármacosRESUMO
A 20-year-old man underwent total cavopulmonary shunt for univentricular heart type A (A.L.L.) with hemiazygos connection six years ago. Four years later, his condition deteriorated with easy fatigue and cyanosis. Cardiac catheterization showed recanalization of ligated SVC. Chest CT showed tight adhesion between the chest wall and the ascending aorta. We approached the heart through left anterolateral thoracotomy in order to avoid injury of the aorta and the ventricle during redo median sternotomy. Total cavopulmonary connection with intraatrial conduit was performed under circulatory arrest and retrograde cardioplegia without aortic cross clamp. His postoperative course was satisfactory. Left thoracotomy was useful for total cavopulmonary connection following total cavopulmonary shunt associated with postoperative adhesion.
Assuntos
Derivação Cardíaca Direita , Comunicação Interventricular/cirurgia , Adulto , Parada Cardíaca Induzida , Humanos , Masculino , Reoperação , Toracotomia/métodosRESUMO
A 48-year-old male presented with a rare subclavian artery aneurysm associated with absence of the ipsilateral internal carotid artery. The aneurysm was resected and replaced with a Gore Tex artificial graft. Computed tomography, angiography and cerebral blood flow findings suggest that defect of the right internal carotid artery occurred in the developmental stage. There was no past history of trauma, nor histological evidence of inflammatory or sclerotic changes in the aneurysmal wall. The two vascular lesions may have been influenced by a synchronous causative factor in his developmental stage.
Assuntos
Aneurisma/complicações , Artéria Carótida Interna/anormalidades , Artéria Subclávia , Aneurisma/diagnóstico , Aneurisma/cirurgia , Angiografia , Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/patologia , Artéria Subclávia/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We describe herein the case of a patient in whom a median sternotomy was successfully employed for mediastinal drainage in the treatment of descending necrotizing mediastinitis (DNM). Although most reports describe cervical or thoracotomy approaches, our experience strongly suggests that median sternotomy is a satisfactory alternative approach for treatment of this disease.
Assuntos
Mediastinite/cirurgia , Esterno/cirurgia , Adulto , Infecções por Bacteroides/diagnóstico por imagem , Infecções por Bacteroides/cirurgia , Celulite (Flegmão)/complicações , Celulite (Flegmão)/cirurgia , Drenagem , Humanos , Masculino , Doenças Mandibulares/complicações , Doenças Mandibulares/cirurgia , Mediastinite/diagnóstico por imagem , Necrose , Abscesso Periodontal/complicações , Abscesso Periodontal/cirurgia , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Fibrilação Atrial/cirurgia , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
A 26-year-old male was clinically diagnosed as having a anterior mediastinal yolk sac tumor because of the elevation of the serum AFP (26,765 ng/ml) and a large mass lesion (13 x 12 x 8 cm) in the anterior mediastinum and right thoracic cavity. After three courses of chemotherapy with CDDP and VP-16, the mediastinal mass reduced in size significantly but the serum AFP level did not reach within normal range. We suspected that the tumor took a resistance to drugs, accordingly the operation was performed. The tumor was completely removed and there were small viable foci of the tumor in part of the tumor. The histological examination revealed the findings of yolk sac tumor. After the operation, the serum AFP level decreased within normal range. He is alive without evidence of recurrence during 18 months after operation. It was noticed that the serum AFP is a useful indicator for determining the chance of operation after chemotherapy.
Assuntos
Tumor do Seio Endodérmico/cirurgia , Neoplasias do Mediastino/cirurgia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/administração & dosagem , Terapia Combinada , Tumor do Seio Endodérmico/tratamento farmacológico , Etoposídeo/administração & dosagem , Humanos , Masculino , Neoplasias do Mediastino/tratamento farmacológico , Cuidados Pré-Operatórios , alfa-Fetoproteínas/análiseRESUMO
A case of catamenial pneumothorax associated with diaphragmatic endometriosis was reported. A 43-year-old woman had 4 times-recurrent pneumothorax on right side for recent 5 months. Each onset was related to the beginning of menses. Right thoracotomy revealed the presence of multiple darkly-pigmented spots and several pinhole like perforations in the central tendon of diaphragm. The area showing these lesions were considered to be the focal region, and this part of diaphragm was excised. Histology showed the stromal endometriosis surrounded by hemosiderin pigment deposits. The patient has been asymptomatic for 4 years after operation. Our case may give support to Maurer's hypothesis. Surgeons should be aware of the importance of carefully inspecting the diaphragm during operation.