Laparoscopic cholecystectomy with two original lifting bars.

BACKGROUND: This study aimed to evaluate the efficacy of laparoscopic cholecystectomy (LC) in which the abdominal wall is lifted with two original lifting bars, especially for patients with cardiopulmonary disease. METHODS: We developed our original lifting bar. It consisted of a bent stainless steel rod 5 mm in diameter. We used two lifting bars to get a better surgical field. We performed LC on many cardiopulmonary-compromised patients. RESULTS: Since 1994, we have performed 250 LCs with good results using the two-bar method. No severe complication occurred in any LC using the two-bar method. Only two cases were converted to conventional open surgery. CONCLUSION: By traction to the teres ligament, the liver is lifted to the median abdominal wall. As a result, the surgeon can get a suitable surgical in field in which manipulate the inferior surface of the liver. Our lifting method is suitable for cardiopulmonary-compromised patients.

[Chylothorax resulting from malignant non Hodgkin's lymphoma].

We report a case of chylothorax with malignant non-Hodgkin's lymphoma. A 51-year-old man was admitted to our hospital with a chief complaint of dyspnea on March 18, 1995. An x-ray film of the chest revealed a large right pleural effusion. Biochemical tests of the pleural fluid revealed chyle. CT scans of abdomen and chest showed retroperitoneal and mediastinal tumors. Examination of biopsy specimens of the retroperitoneal tumor showed non-Hodgkin's lymphoma (diffuse small cell type, B cell). Treatment with chemotherapy (CHOP, ProMACE-CytaBOM) resulted in complete remission. The chylothorax disappeared after chemotherapy. Only 21 cases of malignant lymphoma with chylothorax have been reported in Japan to date, but their numbers are gradually increasing. We must consider malignant lymphoma in patients with chylothorax.