Akihiko Takeshi

Giant Solitary Fibrous Tumor of the Pleura Causing Respiratory Insufficiency: Report of 3 Cases

We present 3 cases of solitary fibrous tumors (SFTs) occupying entire hemithorax and resulting in respiratory insufficiency. All patients were treated by complete resection, resulting in immediate re-expansion of the lungs and recovery from respiratory insufficiency. Although, two patients remain alive without recurrence, one patient had pleural recurrences three times over a 20-year period, all of which were treated by surgical resection. All of the primary tumors exhibited areas of hypercellularity, hemorrhage, or necrosis. All of the recurrent tumors in the recurrent case displayed large areas of hypercellularity, similar to the part of primary tumor. Although, the MIB-1 index in primary tumors was less than 5%, the index of the recurrent tumors increased up to 11% with repeated recurrence. Giant SFTs usually display hypercellularity, hemorrhage, or necrosis. Tumors with hypercellularity could recur. MIB-1 index could display malignant characteristics of recurrent tumors. Long-term follow-up for more than 10 years after surgery is necessary, particularly for tumors with areas of hypercellularity.

Triple-layer sealing with absorptive mesh and fibrin glue is effective in preventing air leakage after segmentectomy: results from experiments and clinical study

OBJECTIVES Fibrin glue in combination with polyglycolic acid (PGA) mesh is effective in preventing air leakage after segmentectomy, but we frequently experienced air leakage with single-layer application. To investigate improved usage, we compared the sealing effect among single-, double- and triple-layer PGA mesh and fibrin glue in both experimental and clinical segmentectomy. METHODS Ex vivo pig lungs were used for experiments. As a model of segmentectomy, the lateral segment of the left lung was removed using electrocautery. As a model of peripheral lung defect, peripheral lung tissue was resected with scissors. The inter-segmental plane and the peripheral lung defect were sealed using one of the following four methods: (i) fibrin glue alone (Group 1, n = 8), (ii) single-layer with PGA mesh and fibrin glue (Group 2, n = 8), (iii) double-layer (Group 3, n = 8) and (iv) triple-layer (Group 4, n = 8). The seal-breaking pressures among them were compared. In clinical segmentectomy, the periods of chest-tube drainage were compared retrospectively between 17 patients treated by the single-layer and 17 treated by the triple-layer method. RESULTS In experimental segmentectomy, the seal-breaking pressure in the triple-layer (100 ± 25 cmH2O) was significantly higher than those in the other methods (26 ± 17, 48 ± 12 and 69 ± 19 cmH2O in the Groups 1, 2 and 3, respectively, P < 0.001-0.05), while there were no significant differences among other methods. For peripheral lung defect, the seal-breaking pressures did not differ among the methods. In clinical segmentectomy, the mean chest-drainage period with the triple-layer was 2 ± 0.9 days, which was significantly shorter than 3.6 ± 2.8 days with the single-layer (P = 0.009). CONCLUSIONS Stronger sealants are required to prevent air leakage from inter-segmental planes than from peripheral lung. To prevent air leakage after segmentectomy, triple-layer PGA mesh and fibrin glue is recommended.

Pulmonary embolism by a foreign body that migrated in the inferior vena cava during lumbar spine surgery

A 72-year-old man was referred to our department for evaluation and treatment of pulmonary embolism by a foreign body. He underwent lumbar spine surgery for spinal canal stenosis. The surgeons noticed a piece of rubber catheter used to cover a tip of surgical suction was missing during procedures. Lumbar spinal X-ray taken in the operation room revealed the foreign body just anterior to the lumbar spine. The piece of catheter was thought to have migrated in the inferior vena cava …