ABSTRACT
OBJECTIVES: The presence of collateral network circulation to the spinal cord, which is reflected in the repair of a descending thoracic aortic aneurysm (dAo) and a thoraco-abdominal aortic aneurysm (TAAo), has been demonstrated in clinical and animal experimental data. The latissimus dorsi muscle (LDM) including the thoracodorsal artery might be one of the major sources of this collateral network. The objective of this study was to evaluate the impact on spinal cord safety of a left anteroaxillary thoracotomy with minimal muscle division including preservation of the LDM in surgery for dAo and TAAo. METHODS: Sixty-nine patients [64 (23-85) years old; 56 men] who underwent surgical repair for dAo and TAAo were divided into 2 groups: 29 [65 (23-84) years old] with an anteroaxillary thoracotomy with LDM preservation (PL group) and 40 [61 (28-85) years old] with a lateral thoracotomy without LDM preservation (NL group). RESULTS: Aortic repairs were performed at the dAo in 30 patients including 14 in the PL group vs 16 in the NL group and at the TAAo in 39 patients including 15 in the PL group vs 24 in the NL group. There were 2 (2.9%) 30-day deaths; 2 (7.9%) in the PL group vs none in the NL group (P = 0.173). No strokes occurred. In patients with a femoro-femoral partial cardiopulmonary bypass with mild hypothermia, the incidence of loss of signal of motor-evoked potentials (>50%) was significantly lower in the PL group; 5.6% vs 31.8% (P = 0.039). The frequency of signal reduction of the remaining motor-evoked potential after surgery was also significantly lower in the PL group: 3.7% vs 25% (P = 0.040). Subsequently, the rate of spinal cord complications were lower in the PL group: 3.4% vs 12.5% (P = 0.188). CONCLUSIONS: The left anteroaxillary thoracotomy with minimal incision of the muscles including the LDM might have potential advantages for spinal cord protection via preserved intramuscular collateral circulations to the spinal cord in dAo/TAAo open repairs.
ABSTRACT
BACKGROUND: Mammography and physical examination (PE) are the recommended modalities for breast-cancer screening for women 40 years and older in Japan. Mammography, however, cannot detect lesions in dense breast tissue, which is common in Japanese women. Breast screening by ultrasound (US) is popular in Japan. We studied which modality or combinations of modalities optimize breast cancer detection for Japanese women. METHODS: From April 1993 through March 2005 we found 97 breast cancers in 9,082 women by screening examinations with mammography, US, and PE. We compared the detection rates of these three modalities for breast cancer. RESULTS: The detection rates of mammography, US, and PE for breast cancer were 83.5 (81 of 97 cancers), 75.3 (73 of 97 cancers), and 60.8% (59 of 97 cancers), respectively. The detection rates of the combinations of mammography and US, mammography and PE, and US and PE were 99.0 (96 of 97 cancers), 88.7 (86 of 97 cancers), and 81.4% (79 of 97 cancers), respectively. Ultrasonography detected 15% of the mammographically occult breast cancers. CONCLUSION: Screening with the combination of mammography and US significantly increases the detection rate of breast cancer. These results suggest that screening with mammography and US would optimize cancer detection in Japanese women.
