Degree of severity of pectus excavatum and pulmonary function in preoperative and postoperative periods.

Pulmonary function was evaluated in 138 patients with pectus excavatum, paying particular attention to the degree of severity of chest deformity. We defined the severity of deformity quantitatively based upon a computed tomographic index obtained from a computed tomogram. We recognized a positive relationship between computed tomographic index (x) and percent vital capacity (y), as follows: y = 137x + 58 (n = 138, r = 0.61, p < 0.05). Pulmonary function tests were performed from 2 to 42 months postoperatively. Vital capacity decreased about 10% from the baseline value during the initial 2 months after surgical treatment and recovered to the preoperative level by 1 year after surgery. At 42 months after surgical correction, the pulmonary function was maintained at the baseline level and the severity of deformity was significantly improved. Surgical procedures for the treatment of pectus excavatum--sternocostal elevation and sternal turnover--resulted in an excellent cosmetic result but did not importantly affect respiratory function.

[Antibiotic concentration during extracorporeal circulation (author's transl)].

In open surgery, ampicillin (Solcillin) or cephacetrile (Celtol), 2 g for patients weighing 20 kg or more, and 1 g for those below 20 kg, was administered, and the antibiotic concentrations in blood and urine were estimated during extracorporeal circulation, from the time of operation to the admission in an intensive care unit (Group A). In other group, a total circulation volume of 0.3 mg/ml of the antibiotic was administered, based on body weight of patients and priming volumes (Group B). In Group A, blood concentration of antibiotics was so variable that it was difficult to decide additional dosage. In Group B, comparatively definite concentrations were estimated in each case. In extracorporeal circulation for a long time, it is preferable to maintain the blood concentration of antibiotic at 50 micrograms/ml, by additional antibiotic administration 90 approximately 120 minutes after the beginning of the extracorporeal circulation. In patients with preoperative subacute bacterial endocarditis, the blood concentration should be kept over 100 micrograms/ml during extracorporeal circulation.

[The surgical management of renal cell carcinoma involving the right atrium].

Between January 1985 and November 1992, 12 patients with renal cell carcinoma involving the inferior vena cava were evaluated and treated at this hospital. In 4 of the 12 patients (33%), the tumors extended into the right atrium. These 4 patients underwent radical nephrectomy with tumor thrombus extraction. Of the 4 patients one had metastases to regional lymph nodes, but no patient had distant metastases. We used a cardiopulmonary bypass and a right atriotomy in all patients for the removal of thrombus under direct vision. We also performed in the intra-operative transesophageal ultrasonography for monitoring of intra-atrial thrombus. The average blood loss during operation was 10,430 ml. One of these patients died in the postoperative period and the other patient died from inferior vena caval emboli without long term sequelae. However, the remaining 2 patients of this group are free of disease, with a mean follow-up of 21 months. Although the numbers are small, these results suggest that patients with intra-atrial tumor thrombus had a worse prognosis than those with other types of vena cava tumor thrombus. One reason for this poor prognosis is due to the complicated surgical management and we believe that a complete removal of tumor thrombus and a complete vascular control are key points of this operation.

[Conservative treatment of postoperative chylothorax in a patient with chronic traumatic aneurysm of thoracic aorta].

A 66-year-old male was admitted to our hospital because of a chronic traumatic aneurysm of the thoracic aorta caused by a traffic accident 5 years earlier. Although he had been treated successfully by patch closure under extracorporeal circulation, chylothorax gradually manifested 9 days after the operation. The fact that our conservative treatment resulted in complete recovery from chylothorax, strongly suggested that progress of nutriology was a contributing factor.

[A case of bilateral coronary artery fistulae into main pulmonary artery].

A case of coronary-pulmonary artery fistulae was presented with the review of the literature. A 46-year-old man was admitted to our department with an ischemic change in leads III, a VF on ECG. Although he had no complaint, the exercise ECG showed significant depression of ST segment in leads II, III, V4, V5. Coronary angiography revealed fistulae from left anterior descending branch to main pulmonary artery, and also from right coronary artery to main pulmonary artery. No coronary organic narrowing were found. Ligation of the fistulae was performed and postoperative course was uneventful.

[A case report of coronary artery bypass surgery (3-SVG) in 80-year-old woman with acute respiratory failure].

A successful operation for a patient of unstable angina with hypoxia is reported. A 80-year-old woman was admitted with severe chest oppression. The selective coronary angiogram revealed 3-vessel disease. Symptoms were uncontrolled by medical therapy. Aorto-coronary bypass surgery (with 3-saphenous vein grafts) was followed by excellent post-operative course. The patient has been asymptomatic for more than 1 year after operation.

[Extracorporeal systemic hyperthermia and cis-diamminedichloroplatinum for treatment of patients with advanced cancer].

Extracorporeal systemic hyperthermia was effective in removing pleural effusion or ascites and for pain relief in patients with advanced cancer. The administration of cisplatin was combined with hyperthermia. Partial remission was noted in 18% of the cases. With the use of cisplatin dosage over 1 mg/kg, approximately 50% of cases showed effective results. Cisplatin dosage should be 1.6mg/kg or more when combined with hyperthermia. Renal failure was the most common complication.

[The use of direct current in the local destruction of cancer tissues].

Two platinum electrodes were inserted into malignant cancer tissue. One electrode was positive or anode, and the other was negative or cathode. Five to thirty milliamperes were employed between two electrodes. The tissue impedance was initially 600 ohms and decreased to 300 ohms in 30 minutes following the start. Marked acidosis was obtained around the anode, while strong alkalosis was created around the cathode. Cancer tissues of 2cm in diameter around the electrode became necrotic in 60 min. This principle was applied for the local destruction of cancer tissues. Repeated use of direct current seemed to be effective in decreasing the cancer volume around electrodes. For more complete destruction of the cancer tissues, bleomycin was injected intravenously in experimental animals. Since the agent was positively charged, it was easily drawn toward the negative electrode. Direct current was applied following the bleomycin injection, and animal tissues around electrodes were examined. The drug was found to accumulate around the cathode in 6 out of eleven cases. The use of direct current might be helpful in accumulating anti-cancer drugs in malignant tissue.

[Peri- and postoperative management in one staged operation of cardiac disease combined with pectus excavatum].

Patients with pectus excavatum occasionally have coexisting surgical heart disease. During a 10-year period up to the end of 1988, we surgically treated a total of 2015 cases of pectus excavatum, including 12 cases with one staged operation for pectus excavatum and heart disease. Proving the advantage of our one staged operation for the coexisting diseases we studied data resulting from the perioperative management in the group of one staged operations (n = 5), and in the other group of single valve replacement (n = 10). Operative time, amount of operative blood loss and total amount of transfused blood, were 433 +/- 66 min. (mean +/- SD), 3180 +/- 1867 ml and 4836 +/- 2247 ml, in the former group (n = 5), respectively. These data were almost similar to those in the latter group (n = 10). Postoperative ventilatory support time and ICU stay time also showed little difference between two groups. We conclude these data supports our previous report that one staged operation has no perioperative disadvantage in the surgical treatment of patients with both cardiac disease and pectus excavatum.

[A case of aortitis syndrome with anastomoses from left coronary artery to bronchial artery].

We reported a case of aortitis syndrome with about 10-year course from onset. The patient was a 44-year old female suffering from a cardiac failure. The angiogram revealed presence of aortic regurgitation, The angiogram revealed presence of aortic regurgitation, pulmonary vascular lesions, anastomosis from left coronary artery to bronchial artery and hypervascularity of bronchial artery. We considered the anastomosis from left coronary artery to bronchial artery as a collateral blood flow for the ischemic lesions of the lung. We abandoned aortic valve replacement because of the severe pulmonary vascular lesions and of the pulmonary dysfunction.