Recovery of respiratory muscle strength, physical function, and dyspnoea after lobectomy in lung cancer patients undergoing pulmonary rehabilitation: A retrospective study.

OBJECTIVE: To characterise changes in respiratory muscle strength, physical function, and dyspnoea in patients who underwent pre- and post-operative exercise intervention following lobectomy for non-small-cell lung cancer (NSCLC). METHODS: This retrospective study included NSCLC patients who underwent lobectomy via video-assisted thoracoscopic surgery (VATS) or posterolateral thoracotomy (PLT) and pre- and post-operative exercise intervention consisting of breathing, flexibility, resistance, aerobic exercises, coughing/huffing techniques, and early mobilisation. Maximum mouth inspiratory (Pimax) and expiratory pressures (Pemax), 6-min walk distance (6MWD), quadriceps force (QF), and modified Medical Research Council (mMRC) dyspnoea scale were evaluated preoperatively, at hospital discharge, and post-lobectomy 1 and 3 months. RESULTS: Data from 41 patients were analysed. At hospital discharge, the Pimax, Pemax, 6MWD, and mMRC dyspnoea scores were lower than pre-operatively; QF remained unchanged; Pimax and 6MWD recovered to pre-operative values at post-lobectomy 1 month; and Pemax and mMRC dyspnoea scores recovered at 3 months. During sub-analysis, Pimax and mMRC dyspnoea scores in the VATS (n = 24) and PLT groups (n = 17) recovered to pre-operative values at post-lobectomy 1 and 3 months. CONCLUSION: After lobectomy, respiratory muscle strength, physical function, and dyspnoea in patients who underwent exercise intervention returned to pre-operative values at post-lobectomy 3 months.

[Corticospinal Tract Mapping by Calculating the Ratio of Subcortical to Cortical Stimulation Intensity:A Technical Note].

OBJECTIVE: Motor evoked potentials(MEPs)have been developed and utilized as safe surgical procedures. A correlation between the threshold intensity of direct stimulation MEPs and the distance of the corticospinal tract(CST)has been already established. However, MEPs are affected by anesthesia and patient-related conditions. Here, we describe a unique technique to avoid these effects. METHOD: When tumors developed in proximity to the CST, the transcortical MEP monitoring was done by placing grid electrodes on the primary motor cortex continuously while direct subcortical MEP mapping was conducted with a monopolar probe. The ratios of the subcortical to the transcortical stimulation intensity were calculated. The point at which the ratios reached 50% was defined as the surgical excision limit. DISCUSSION: MEPs are affected by anesthesia, paralysis, body temperature, and other factors. By measuring the ratio of the cortical stimulation intensity instead of the absolute value of the white matter stimulation intensity, various affecting factors can be avoided, and more accurate monitoring can become possible. CONCLUSION: By calculating the ratio of subcortical to cortical stimulation intensity, the corticospinal tract mapping is less likely to be influenced by the stimulation condition or facility setup, and this warrants further investigation.

Genioglossus muscle activity during sniff and reverse sniff in healthy men.

NEW FINDINGS: What is the central question of this study? Maximal sniff nasal inspiratory and reverse sniff nasal expiratory pressures are measured as inspiratory and expiratory muscle strength, respectively. Is the genioglossus muscle activated during short maximal inspiratory and expiratory efforts through the nose? What is the main finding and its importance? Genioglossus muscle activity occurred with inspiratory muscle activity during a maximal sniff and with expiratory muscle activity during a maximal reverse sniff. These results indicate that genioglossus muscle activity is closely related to the generation of maximal sniff nasal inspiratory and reverse sniff nasal expiratory pressures. ABSTRACT: Maximal sniff nasal inspiratory pressure (SNIPmax ) is widely used to assess inspiratory muscle strength. The sniff nasal inspiratory pressure (SNIP) is lower in patients with neuromuscular disease with bulbar involvement compared with those without, possibly owing to impaired upper airway muscle function. However, the degree to which the genioglossus (GG) muscle, one of the upper airway muscles, is activated during inspiratory and expiratory efforts through the nose remains unclear. Therefore, we examined GG activity during short and sharp inspiratory and expiratory efforts through the nose, i.e. sniff and reverse sniff manoeuvres. In eight normal young subjects, we inserted fine wire electrodes into the GG muscle, parasternal intercostal and scalene (inspiratory) muscles and transversus abdominis (expiratory) muscle. We assessed EMG activity of each muscle and measured SNIP and reverse sniff nasal expiratory pressure (RSNEP) during sniffs and reverse sniffs from low to high intensities in the sitting position. The highest SNIP and RSNEP were analysed as SNIPmax and maximal RSNEP (RSNEPmax ), respectively. In each subject, GG EMG activity increased linearly with increasing SNIP and RSNEP. The SNIPmax and RSNEPmax were -85.1 ± 15.9 and 83.2 ± 24.2 cmH2 O, respectively. Genioglossus EMG activity varied with EMG activity of the parasternal intercostal and scalene muscles during generation of SNIPmax and with EMG activity of the transversus abdominis muscle during RSNEPmax . Genioglossus EMG activity during generation of SNIPmax was higher than during RSNEPmax (62.9 ± 31.1% EMG of SNIPmax , P = 0.012). These results suggested that GG activity was closely related to the generation of both SNIPmax and RSNEPmax .

Aminophylline increases respiratory muscle activity during hypercapnia in humans.

BACKGROUND: Theophylline is an old drug traditionally used as a bronchodilator, although it was recently shown to possess anti-inflammatory properties, enhance the actions of corticosteroid actions, and stimulate the respiratory neuronal network. Theophylline has been recognized as an important drug for not only asthma but also corticosteroid-insensitive chronic obstructive pulmonary disease (COPD). To clarify the role of theophylline in hypercapnic ventilatory responses in humans, we analyzed the effects of aminophylline administered at the usual clinical therapeutic doses on ventilation and augmentation of respiratory muscle contractility in room air and under 3 conditions of hypercapnia. STUDY DESIGN: We performed electromyography (EMG) of the parasternal intercostal muscle (PARA) and transversus abdominis muscle (TA) in 7 healthy subjects and recorded both ventilatory parameters and EMG data in room air and under 3 conditions of hypercapnia before (control) and during aminophylline administration. RESULTS: Before aminophylline administration (control), hypercapnic stimulation elicited ventilatory augmentation in a hypercapnia intensity-dependent manner. Ventilatory parameters (tidal volume, frequency of respiration, and minute ventilation) showed significant increases from lower PaCO2 levels during aminophylline administration when compared with the corresponding values before aminophylline administration. EMG activity of both PARA and TA increased significantly at each level of hypercapnia, and those augmentations were shown from lower PaCO2 levels during aminophylline administration. CONCLUSION: Aminophylline administered at the usual clinical therapeutic dose increases ventilation and EMG activity of both inspiratory and expiratory muscles during hypercapnia in healthy humans.

Interhemispheric Acute Subdural Hematoma Secondary to Falx Meningioma: A Case Report.

This report describes an unusual case of falx meningioma associated with acute subdural hematoma, which is a rare presentation. A 76-year-old woman presented with right-sided hemiparesis and a known falx meningioma that had rapidly increased in volume over the previous year. Computed tomography revealed interhemispheric and left-hemispheric acute subdural hematomas. Preoperative embolization and surgical tumor removal were performed to improve the symptoms, and pathological examination of the tumor revealed transitional meningioma (WHO Grade I). The patient's paresis symptoms improved postoperatively. This report provides valuable insights into the management and outcomes of falx meningioma with acute subdural hematoma, suggesting aggressive surgery to improve postoperative recovery.

Angiotensin-converting enzyme inhibition curbs tyrosine nitration of mitochondrial proteins in the renal cortex during the early stage of diabetes mellitus in rats.

Experiments were performed to evaluate the hypothesis that ACE (angiotensin-converting enzyme) inhibition (enalapril) suppresses 3-NT (3-nitrotyrosine) production in the renal cortex during the early stage of Type 1 DM (diabetes mellitus) in the rat. Enalapril was administered chronically for 2 weeks to subsets of STZ (streptozotocin)-induced DM and vehicle-treated sham rats. O(2)(-) (superoxide anion) and NO(x) (nitrate+nitrite) levels were measured in the media bathing renal cortical slices after 90 min incubation in vitro. SOD (superoxide dismutase) activity and 3-NT content were measured in the renal cortex homogenate. Renal cortical nitrated protein was identified by proteomic analysis. Renal cortical production of O(2)(-) and 3-NT was increased in DM rats; however, enalapril suppressed these changes. DM rats also exhibited elevated renal cortical NO(x) production and SOD activity, and these changes were magnified by enalapril treatment. 2-DE (two-dimensional gel electrophoresis)-based Western blotting revealed more than 20 spots with positive 3-NT immunoreactivity in the renal cortex of DM rats. Enalapril treatment blunted the DM-induced increase in tyrosine nitration of three proteins ACO2, GDH1 and MMSDH (aconitase 2, glutamate dehydrogenase 1 and methylmalonate-semialdehyde dehydrogenase), each of which resides in mitochondria. These data are consistent with enalapril preventing DM-induced tyrosine nitration of mitochondrial proteins by a mechanism involving suppression of oxidant production and enhancement of antioxidant capacity, including SOD activation.

Sniff and reverse-sniff nasal respiratory pressures after exacerbation of chronic obstructive pulmonary disease: A single-center prospective study.

BACKGROUND: and objective: This study examined the validity of sniff nasal inspiratory (SNIP) and reverse-sniff nasal expiratory pressures (RSNEP) for estimating respiratory muscle strength and for predicting poor life expectancy following exacerbation in patients with chronic obstructive pulmonary disease (COPD). METHODS: This prospective study included patients who were admitted for COPD exacerbation and underwent rehabilitation. At hospital discharge, SNIP, RSNEP, and maximum mouth inspiratory (MIP) and expiratory pressures (MEP) were measured, and the body mass index, degree of airflow obstruction, dyspnea, and exercise capacity (BODE) index was calculated by evaluating body mass index, forced expiratory volume in 1 s (FEV1), the Modified Medical Research Council Dyspnea Scale, and 6-min walk distance. RESULTS: Data from 43 patients (mean age 76.8 years, FEV1 42.8 % predicted) were analyzed. SNIP and RSNEP were moderately correlated with MIP and MEP, respectively. Bland-Altman plot means of SNIP (48.3 ± 17.5) and RSNEP (44.7 ± 23.8 cmH2O) were lower than those of MIP (54.8 ± 19.9) and MEP (76.4 ± 31.2 cmH2O), respectively, and the SNIP-MIP and RSNEP-MEP 95 % limits of agreement were wide. Logistic regression showed that SNIP and RSNEP were significantly associated with BODE score ≥7 (poor life expectancy), and predictive accuracy was 81.4 % when combining SNIP ≤49 and RSNEP ≤42 cmH2O. CONCLUSION: After exacerbation in patients with COPD, SNIP and RSNEP are useful indicators that complement MIP and MEP. Furthermore, a combined SNIP and RSNEP test may be beneficial in predicting poor life expectancy.

A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization.

Objective: In-stent thrombosis (IST) is a known complication after stent-assisted coil (SAC) embolization. We report a case of mechanical thrombectomy using a stent retriever (SR) for IST and share our experience with this treatment to prevent a poor outcome in future cases. Case Presentation: The patient was a 62-year-old man. SAC embolization for an unruptured left internal carotid artery (ICA) aneurysm was performed. Three weeks after discharge, right hemiparesis and aphasia developed. Magnetic resonance imaging (MRI) demonstrated cerebral infarction in the left middle cerebral artery (MCA) territory and the left ICA was occluded. His relatives told us that the patient discontinued taking antiplatelet drugs. IST was diagnosed and emergency thrombectomy was performed. First, we tried to introduce an aspiration catheter or balloon catheter into the occluded lesion, but they were unable to be sufficiently inserted to the distal site. Therefore, we used a SR even though it carried a risk of friction on the deployed stent. The occluded artery was finally recanalized using the SR, but the stent became shortened. For the treatment strategy, sufficient medication (antithrombogenic agents and edaravone) should be administered first, followed by mechanical treatment. In mechanical treatment, thrombus fragmentation with a guidewire or balloon and aspiration should be attempted first. New aspiration catheters to carry the devices to the far distal site easily are now available. Conclusion: SRs cannot be utilized for thrombectomy with a stent. In emergency situations, careful consideration during troubleshooting rather than using a SR is needed.

Results of Mechanical Thrombectomy 6 Hours after Stroke Onset: Analysis of Multiple Stroke Centers in Fukushima Prefecture.

Objective: The purpose of this study was to examine the efficacy and safety of mechanical thrombectomy in patients with acute occlusion of a large cerebral artery in the anterior circulation beyond 6 hours of the time last known to be well using the real-world clinical data collected from non-urban areas of Japan. Methods: We analyzed a retrospective multicenter database collected at 10 thrombectomy capable primary stroke centers in Fukushima Prefecture. In all, 188 patients were presenting a large cerebral artery occlusion in the anterior circulation, that is, internal carotid and middle cerebral artery (M1 and M2 segment). In all, 158 patients received mechanical thrombectomy within 6 hours from symptom onset (early time window), and 30 patients exceeded 6 hours (late time window). We compared the patient background, outcomes, and safety variables between the two groups. The modified Rankin Scale (mRS) score of 0-2 at 90 days after treatment and the incidence of symptomatic intracranial hemorrhage were compared between groups to evaluate treatment efficacy and safety. Results: There was no significant difference in the proportion of mRS score 0-2 at 90 days after treatment (51.3 vs. 46.7%: P = 0.644). However, symptomatic intracranial hemorrhage was more frequent in the late time window group (7.0 vs. 16.7%: P = 0.081). Symptomatic intracranial hemorrhage was a significant factor of a poor functional outcome in the late time window group (P = 0.022). Conclusion: This study reflects the real-world results of mechanical thrombectomy in the non-urban areas of Japan. The treatment efficacy in the late time window patients was equivalent to that in the early time window patients. On the other hand, the incidence of symptomatic intracranial hemorrhage showed a trend to high in patients beyond 6 hours, which was a significant factor related to a poor functional outcome.

Comparison between quantitative computed tomography, scintigraphy, and anatomical methods for prediction of postoperative FEV1 and DLCO: effects of chronic obstructive pulmonary disease status and resected lobes.

BACKGROUND: Postoperative assessment of pulmonary function is important for estimating the risk of thoracic surgery and long-term disability following pulmonary resection, including predicted postoperative (ppo) forced expiratory volume (FEV) in one second (ppoFEV1) and percent predicted lung diffusion capacity for carbon monoxide (ppo%DLCO) estimation. The ppo values were compared using four different estimation methods between chronic obstructive pulmonary disease (COPD) and non-COPD patients and according to the resected lobe. METHODS: This prospective study included 59 eligible patients requiring single lobectomy and succeeded in performing pulmonary function tests at 3 and 12 months after lobectomy. The ppoFEV1 and ppo%DLCO were compared with poFEV1 and po%DLCO obtained at 3 and 12 months after lobectomy. The ppo values were estimated using the four usual methods: the 19-segment anatomical technique (S), perfusion scintigraphy (Q), quantitative CT (CT), and quantitative CT with low attenuation volume (CTLAV) subtraction. RESULTS: For non-COPD and COPD patients, the smallest mean difference between ppo and po values was observed by S for FEV1 and %DLCO. Based on the resected lobe, the smallest mean difference was observed by (I) Q for right upper lobectomy (RUL) excluding %DLCO at 12 months by S, (II) S for left upper lobectomy (LUL), (III) CT and CTLAV for right lower lobectomy (RLL), and (IV) CT and CTLAV for left lower lobectomy (LLL) at 12 months. The ppo values calculated by S for RUL (FEV1 at 3 and 12 months and %DLCO at 3 months) and by all four methods for LLL (FEV1 and %DLCO at 3 months) were smaller than the po values. CONCLUSIONS: The S method is adequate for calculating ppoFEV1 and ppo%DLCO when patients are classified as non-COPD and COPD. However, S sometimes overestimates the ppoFEV1 and ppo%DLCO when patients are classified according to the resected lobe. The CTLAV method may be the method of choice instead of S for calculating ppoFEV1 and ppo%DLCO in patients who undergo lung lobectomy despite the presence or absence of airflow limitation.

A simple, noninvasively determined index predicting hepatic failure following liver resection for hepatocellular carcinoma.

BACKGROUND: A novel index, the serum aspartate aminotransferase activity/platelet count ratio index (APRI), has been identified as a biochemical surrogate for histological fibrogenesis and fibrosis in cirrhosis. We evaluated the ability of preoperative APRI to predict hepatic failure following liver resection for hepatocellular carcinoma. METHODS: Potential preoperative risk factors for postoperative hepatic failure (hepatic coma with hyperbilirubinemia, four patients; intractable pleural effusion or ascites, 30 patients; and variceal bleeding, one patient) as well as APRI were evaluated in 366 patients undergoing liver resection for hepatocellular carcinoma. Prognostic significance was determined by univariate and multivariate analyses. RESULTS: Hepatic failure developed postoperatively in 30 patients, causing death in four. APRI correlated with histological intensity of hepatitis activity and degree of hepatic fibrosis, and was significantly higher in patients who developed postoperative hepatic failure than in others without failure. Risk of postoperative hepatic failure increased as the serum albumin concentration and platelet count decreased and as indocyanine green retention rate at 15 min, aspartate and alanine aminotransferase activities, and APRI increased. Only APRI was an independent preoperative factor on multivariate analysis. Of the four patients who died of postoperative hepatic failure, three had an APRI of at least 10. CONCLUSIONS: Preoperative APRI independently predicted hepatic failure following liver resection for hepatocellular carcinoma. Patients with an APRI of 10 or more have a high risk of postoperative hepatic failure.

Reconstruction of hepatic veins by anastomosis with suprahepatic IVC in the posterior mediastinum in living donor liver transplantation for Budd-Chiari syndrome.

In living donor liver transplantation for Budd-Chiari syndrome, it is necessary to eliminate interference with outflow from the liver without the replacement of the involved retrohepatic segment of the inferior vena cava. A 34-year-old female patient underwent living donor liver transplantation for Budd-Chiari syndrome. During surgery, the fibrous tissue surrounding the recipient inferior vena cava was dissected after removal of the recipient liver. The diaphragm was dissected and mobilized from the inferior vena cava on the cranial side to expose the intact inferior vena cava in the posterior mediastinum. The left and middle hepatic veins in the graft liver were anastomosed to a horizontal anastomotic orifice prepared in the anterior wall of the intact inferior vena cava in the posterior mediastinum. Anticoagulant therapy was begun after liver transplantation. Dynamic computed tomography after living donor liver transplantation demonstrated patent hepatic veins. The patient has been doing well, without any episode of thrombosis or occlusion of the graft hepatic veins at 1 year and 6 months after liver transplantation.

Huge liver abscess radiologically mimicking cystadenocarcinoma.

A 72-old-year Japanese man was incidentally found to have out liver dysfunction on serum examination and a cystic tumor in the liver. Dynamic computed tomography revealed a solitary cystic tumor 14 cm in diameter with multiple septa. The cyst wall was occasionally irregular with hyperarterial inflow. After admission, he suffered from fever and right upper abdominal pain. We suspected cystadenocarcinoma with intraluminal infection. Percutaneous transhepatic drainage was performed. However, neither cytologic examination nor culture test was positive. The cystic tumor had been decreasing in size, and hepatic resection performed. Macroscopically, the tumor was a gray-yellow solid tumor with a fine boundary between tumor and liver parenchyma, and the cystic lesion collapsed. Microscopically, the tumor consisted of hepatic infarction, degenerated Glisson's sheath, and chronic inflammation, and chronic liver abscess was diagnosed. Most cases of bacterial liver abscess can be diagnosed because progression is accompanied by typical signs. However, it is difficult to diagnose liver abscess in the chronic phase because chronic liver abscesses exhibit various features on imaging series without typical signs or symptoms. When atypical liver cyst is found, the possibility of liver abscess in chronic phase should be considered.

Separate demonstration of arterial- and venous-phase by 3D-CT angiography for brain tumors using 64-multidetector row CT: 3D-CT arteriography and 3D-CT venography.

We assessed the usefulness of the separate demonstration of the arterial- and venous phase on 3D-CT angiography (3D-CTA) using a 64-multidetector row CT (MDCT) scanner for the surgery of brain tumors. Nineteen patients with meningiomas (n=11), schwannomas, metastatic brain tumors (n=2 each), glioblastoma multiforme, malignant lymphoma, craniopharyngioma, and embryonal carcinoma (n=1 each) underwent scanning on a 64-MDCT scanner. After dynamic CT scanning to determine the scan timing for the arterial- and venous-phase, we individually scanned the arterial- and venous phase for 4 sec after injecting a nonionic contrast medium. Using the CT threshold setting and subtraction and cutting techniques, we produced individual 3D-CT images of the arteries, veins, tumors, and bones. The operators subjectively assessed the usefulness of these images in comparison with 3D-CTA. We separately demonstrated the arterial- and venous phase on 3D-CTA covering the entire head in all 19 cases. The 3D-CT arteriographs, 3D-CT venographs, and the fused 3D-CT images facilitated our understanding of the 3D anatomic relationship among the tumor, arteries, veins, and bony structures. In 14 of 19 cases our method provided the surgically valuable findings; the information on the anatomical relation between tumor and the surrounding arteries and veins (in 13 cases) the identification of anatomical course of the encased vessels (in one), and feeding arteries and draining veins (in one), and discrimination between the venous sinus and tumor (in one). The anatomical information yielded by our technique makes safer surgery possible. If more detailed information which 3D-CTA cannot provide is required, our method should be performed.

Intraoperative Fluorescence Cerebral Angiography by Laser Surgical Microscopy: Comparison With Xenon Microscopy and Simultaneous Observation of Cerebral Blood Flow and Surrounding Structures.

BACKGROUND: Laser surgical microscopes should enable uniform illumination of the operative field, and require less luminous energy compared with existing xenon surgical microscopes. OBJECTIVE: To examine the utility of laser illumination in fluorescence cerebral angiography. METHODS: Fluorescein sodium (fluorescein) was used as a fluorescent dye. We first compared the clarity of cerebral blood flow images collected by fluorescence angiography between the laser illumination and xenon illumination methods. We then assessed use of the laser illuminator for simultaneous observation of blood flow and surrounding structures during fluorescence angiography. Furthermore, the study was designed to evaluate usefulness of the thus determined excitation light in clinical cases. RESULTS: Fluorescence angiography using blue light laser for excitation provided higher clarity and contrast blood flow images compared with using blue light generated from a xenon lamp. Further, illumination with excitation light consisting of a combination of 3 types of laser (higher level of blue light, no green light, and lower level of red light) enabled both blood flow and surrounding structures to be observed through the microscope directly by the surgeon. CONCLUSION: Laser-illuminated fluorescence angiography provides high clarity and contrast images of cerebral blood flow. Further, a laser providing strong blue light and weak red light for excitation light enables simultaneous visual observation of fluorescent blood flow and surrounding structures by the surgeon using a surgical microscope. Overall, these data suggest that laser surgical microscopes are useful for both ordinary operative manipulations and fluorescence angiography.

Glutamine synthetase protects the spinal cord against hypoxia-induced and GABA(A) receptor-activated axonal depressions.

BACKGROUND: We investigated the effects of exogenous GS on hypoxia- and GABA(A) receptor-induced axonal depression in neonatal rats. METHODS: To assess the effects of GS on spinal cord axons, CAPs were recorded. Hemicords were exposed to hypoxia by 30-minute superfusion with Ringer's solution saturated with 95% N(2) and 5% CO(2) followed by 60-minute exposure to 95% N(2) and 5% CO(2) gassing (N(2) gassing phase) and then 90 minutes of resuperfusion with oxygenated Ringer's solution (resuperfusion phase). Exogenous high GS (15 U) or low GS (1.5 U) was delivered during the N(2) gassing phase. The effects of GS on GABA(A) receptor-induced axonal depression were analyzed with oxygenated isolated dorsal columns. RESULTS: The high GS significantly reduced the decline in the CAP amplitudes during the N(2) gassing and resuperfusion phases (P = .0185) compared to the hypoxia control. The low GS treatment showed a trend toward recovery during the N(2) gassing and resuperfusion phases, but the effect was not significant (P = .3953). In isolated dorsal columns, GS significantly reduced the CAP amplitude depression induced by GABA(A) receptor agonist. CONCLUSIONS: Our findings suggest that GS had dose-dependent protective effects on the spinal cord against hypoxia-induced axonal depression. It may inhibit the depression of CAP amplitudes by blocking GABA(A) receptors.

Convenience of a tape-guiding technique in different types of hepatectomy.

BACKGROUND/AIMS: The liver hanging maneuver is widely used in right lobectomy to resect huge tumors and harvest living donors. The convenience of tape assistance in other types of hepatectomy is not well known. METHODOLOGY: Tape-guiding technique (TGT) was applied in 30 hepatectomies of different type between April 2003 and April 2006. The indications were liver carcinoma in 22 and living-donor in 8. Hepatectomies included right lobectomy, 14; left lobectomy with caudate lobectomy, 8; left lobectomy without caudate lobectomy, 2; lateral segmentectomy, 3; central bisegmentectomy, posterior segmentectomy, and superior dorsal partial resection, 1 each. A tape was placed in front of the inferior vena cava for right hepatectomy and left hepatectomy with caudate lobectomy. In other hepatectomies, the tape was positioned to be the target of parenchymal dissection. RESULTS: TGT was successfully performed in all 30 cases. Tape facilitated dissection by helping the surgeon maintain orientation, and traction on the tape flattened the parenchyma, making it easier to identify and manage vessels and ducts. With an assistant holding the tape, the surgeon's left hand was free, and ligation and suturing was easier and more secure. CONCLUSIONS: The TGT is a convenient technique that is applicable to different types of liver resection.

Postoperative pulmonary function changes according to the resected lobe: a 1-year follow-up study of lobectomized patients.

BACKGROUND: Pulmonary function and patient complaints appear to improve up to 12 months after lobectomy but long-term prospective studies based on clinical data are scarce. Improvement in pulmonary function may depend on the area and extent of the resection and the time from the operation. This prospective study aimed to determine pulmonary function changes according to the resected lobe. METHODS: This prospective study included 59 patients requiring single lobectomy. Total volume and low-attenuation volume (LAV) for each lobe and the entire lungs were calculated based on helical computed tomography images. Vital capacity (VC), forced expiratory volume in one second (FEV1), percent FEV1 (%FEV1), percent lung diffusion capacity for carbon monoxide (%DLco), %DLco divided by the alveolar volume (%DLco/VA), modified Medical Research Council (mMRC) grades, and COPD Assessment Test (CAT) scores were compared at 3, 6, and 12 months after surgery. RESULTS: VC was higher at 12 months than at 3 months after right upper lobectomy (RUL) or right lower lobectomy (RLL). FEV1 and %FEV1 were higher at 12 months than at 6 months after left lower lobectomy (LLL). %DLco was higher at 12 months than at 3 months after RUL or left upper lobectomy (LUL). DLco/VA, mMRC grades, and CAT scores did not change significantly in the period from 3 to 12 months after any lobectomy procedure. Compared to the predicted postoperative values, the observed values of VC for RUL, RLL, and LUL; FEV1 for RLL; %FEV1 for RLL and LUL; %DLco for LUL; and %DLco/VA for all lobectomy procedures were higher at 12 months. CONCLUSIONS: Improvements in pulmonary function and symptoms varied according to the resected lobe. Some of the observed pulmonary function values were higher than the predicted postoperative values. Pulmonary function changes may be related to the location, volume, and extent of emphysematous changes.

Confirmation of blood flow in perforating arteries using fluorescein cerebral angiography during aneurysm surgery.

OBJECT: The authors performed fluorescein cerebral angiography in patients after aneurysm clip placement to confirm the patency of the parent artery, perforating artery, and other arteries around the aneurysm. METHODS: Twenty-three patients who underwent aneurysm surgery were studied. Aneurysms were located in the internal carotid artery in 12 patients, middle cerebral artery in six, anterior cerebral artery in three, basilar artery bifurcation in one, and junction of the vertebral artery (VA) and posterior inferior cerebellar artery in one. After aneurysm clip placement, the target arteries were illuminated using a beam from a blue light-emitting diode atop a 7-mm diameter pencil-type probe. In all patients, after intravenous administration of 5 ml of 10% fluorescein sodium, fluorescence in the vessels was clearly observed through a microscope and recorded on videotape. RESULTS: The excellent image quality and spatial resolution of the fluorescein angiography procedure facilitated intraoperative real-time assessment of the patency of the perforating arteries and branches near the aneurysm, including: 12 posterior communicating arteries; 12 anterior choroidal arteries; four lenticulostriate arteries; three recurrent arteries of Heubner; three hypothalamic arteries; one ophthalmic artery; one perforating artery arising from the VA; and one posterior thalamoperforating artery. All 23 patients experienced an uneventful postoperative course without clinical symptoms of perforating artery occlusion. CONCLUSIONS: Because the fluorescein angiography procedure described here allows intraoperative confirmation of the patency of perforating arteries located deep inside the surgical field, it can be practically used for preventing unexpected cerebral infarction during aneurysm surgery.