Katsuyuki Kusajima

Contralateral Lung Injury Associated With Single-Lung Ischemia-Reperfusion Injury

BACKGROUND There have been very few studies on the effect of single-lung ischemia-reperfusion on the function of the contralateral lung. This study was designed to clarify the effect. METHODS Fifteen mongrel dogs were divided into two groups. In group 1 (n = 7), the left lung was subjected to ischemia without ventilation for 90 minutes, and then reperfused. In group II (n = 8), the lung was not subjected to ischemia, and was ventilated during the 90-minute ischemia of group I. Arterial blood gas, hemodynamics, extravascular lung water, and airway pressure were measured. Pulmonary biopsy was performed to evaluate adenine nucleotide levels. The protein concentration and phosphorous concentration of phospholipids in bronchoalveolar lavage fluid were measured. RESULTS Group I, with perfusion and ventilation of the right lung alone, was significantly inferior to group II with respect to arterial blood gas, right pulmonary compliance, extravascular lung water of the right lung, and the protein concentration in the bronchoalveolar lavage fluid of the right lung after the 90-minute period. CONCLUSIONS These results indicate that 90 minutes of warm ischemia and reperfusion of the left lung caused deterioration of not only the left but also contralateral right pulmonary function.

Simultaneous Cardiac Operations With Pulmonary Resection for Lung Carcinoma

OBJECTIVES A procedure remains to be established for managing patients with both cardiac and pulmonary diseases requiring surgical interventions. We review our experience with 6 patients having cardiac disease and lung cancer surgically treated simultaneously to determine whether simultaneous surgery is safe and effective. METHODS Subjects were 6 men with a mean age of 64 +/- 10 years undergoing cardiac surgery combined with pulmonary lobectomy from January 1986 through June 2000. Cardiac procedures consisted of coronary artery bypass in 3, coronary artery bypass plus left ventricular aneurysm repair, aortic valve replacement, and minimally invasive direct coronary artery bypass surgery in 1 patient each. All underwent lobectomy. RESULTS No early deaths occurred. Bleeding complications occurred in 2 patients and lymph node dissection was incomplete in 3. Two died of carcinoma-related events, 1 at 28 and the other at 84 months after surgery. One died suddenly from a cardiac-related event 42 months after surgery. Only 1 patient is currently alive and disease-free at 104 months after surgery. CONCLUSION Simultaneous surgery can be conducted with acceptable mortality. The occurrence of bleeding complications and incomplete lymph node dissection, however, indicates combined procedures only in patients requiring simultaneous surgery due to their disease or unable to tolerate a second operation.

Influence of oxygen in inflation gas during lung ischemia on ischemia-reperfusion injury

OBJECTIVES Previous studies have reported that hyperinflation during lung ischemia improves pulmonary function after reperfusion. However, it has not been clarified whether hyperinflation itself or oxygen in inflation gas causes good pulmonary function. The aim of this study is to evaluate the effect of oxygen in pulmonary inflation gas during lung ischemia on ischemia-reperfusion injury. METHODS Twenty-one mongrel dogs were randomly divided into three groups: the lung during a 90-minute period of warm ischemia was inflated to 30 cm H2O with 100% oxygen in group A and 100% nitrogen in group B; it was not inflated in group C. Pulmonary function and hemodynamics were measured before ischemia and 1, 2, and 3 hours after reperfusion. Total protein and phosphorus of phospholipid in bronchoalveolar lavage fluid were measured 210 minutes after reperfusion. Adenine nucleotide levels in lung tissue were estimated 210 minutes after reperfusion. RESULTS No significant differences in pulmonary function and hemodynamics were noted between group A and group B, but these two groups had significantly better pulmonary function and hemodynamics than group C. No significant differences were detected in the concentrations of total protein and phosphorus of phospholipids in bronchoalveolar lavage fluid and in adenine nucleotide levels of lung tissue after reperfusion among the three groups. CONCLUSIONS The results indicate that pulmonary inflation during warm ischemia improves pulmonary function and hemodynamics after reperfusion in this model. The effect is caused by inflation itself and is not due to oxygen as a metabolic substrate during warm ischemia.

Twenty‐Seven‐Year Follow‐up of Arrhythmogenic Right Ventricular Dysplasia

OBATA, H., et al.: Twenty‐Seven‐Year Follow‐up of Arrhythmogenic Right Ventricular Dysplasia. This case report describes clinical features, especially of surface ECG changes, observed for 27 years in a patient with arrhythmogenic right ventricular dysplasia (ARVD). The course of this patient was characterized by progressive deterioration of right ventricular function and progression of delayed potentials (so‐called epsilon waves) following QRS complexes. However, the relation between ventricular arrhythmias and ECG changes or the degree of right ventricular abnormality was difficult to discern.

The reinforcement of tracheoplasty with a self-fascia lata andGelatin-Resorcin-Formal (GRF) glue

We examined the efficacy of protecting the suture line in tracheoplasty by using a self-fascia lata and Gelatin-Resorcin-Formal (GRF) glue. Fifteen dogs underwent a resection of four rings of the trachea and reconstruction, and we then observed them for one month; group A (n=5) without reinforcement, group B (n=5) with a self-fascia-lata spread with GRF glue, and group C (n=5) with only a self-fascia-lata. In the reinforced dogs (group B, three cases, and group C, five cases), in which the continuity of the suture line had been conserved, eight cases were resistant to pressures of from 240 mmHg to 300 mmHg, and two cases (both in group B) which had a partial discontinuity of the suture line were resistant to the same pressure of 160 mmHg. But in the five dogs without reinforcement (group A), four died from infection due to leakage of the trachea within 2 weeks; only one that had a continuity of the suture line survived and was resistant to pressure of 300 mmHg. These results show that a reinforcement of tracheoplasty using a self-fascia lata and GRF glue is useful for preventing air leakage from the suture line.

Combined Medical and Surgical Treatment for Pulmonary Mucormycosis

A 40-year-old woman with primary pulmonary mucormycosis was successfully treated with combination therapy involving administration of amphotericin B and surgery.

Treatment of Subglottic Stenosis in a Child Utilizing a Costal Cartilage Graft

A nine-year old girl with severe subglottic stenosis secondary to an emergency tracheostomy is presented. Several conservative managements had no significant effect. The patient, however, was successfully extubated by surgical reconstruction with a costal cartilage graft. One year postoperatively, follow up showed no evidence of upper respiratory obstruction or interference with laryngeal growth. Management of severe subglottic stenosis in children is discussed and the usefulness of an autogenous graft for reconstruction of the larynx and upper trachea in the above-mentioned case is documented.

A case of Stanford type A acute aortic dissection associated wih a distal aoric arch atherosclerotic aneurysm

We report a rare case of Stanford type A acute aortic dissection associated with a distal aortic arch atherosclerotic aneurysm. A 71-year-old female was referred to us with the diagnosis of thrombosed Stanford type A acute aortic dissection, however on the next day transesophageal echocardiography revealed the false lumen has been recanalized. In the operation, there was a distal aortic arch atherosclerotic aneurysm which was unidentified at the preoperation. It is very rare that the dissection originated from atherosclerotic aneurysm and proceeded to proximal and distal portion of the aorta.

Clinical Experience of Gelatin-Impregnated Branched Vascular Graft(Gelseal) in Total Aortic Arch Replacement.

ゼラチン被覆 (Gelseal®) 4分枝付き人工血管を用いた弓部大動脈瘤手術を1996年4月より12月までに9例に施行し, その操作性, 手術成績および問題点について検討を行った. ゼロポロシテイーであるこの人工血管は preclotting の必要がないうえ, 分枝作成の煩わしさもなく, 特に緊急手術時など人員および時間の制約のある場合に有用であると思われた. 手術成績は, 死亡例なく, 急性I型大動脈解離の1例に術後に対麻痺を認めたが, 全例軽快退院し, 良好な結果を得た. しかし, 術後1か月で20%程度のグラフト径の拡大を認めており, 今後の厳重な経過観察を要すると思われた. また, 術後2週目にCRPおよび白血球値の再燃を認めた. 同時期に穿刺を要した心嚢液および胸水の貯留を1例ずつにみたが, グラフトとの関連は不明であった.