Kazuya Nakaoka

Functional indications for bullectomy of giant bulla.

Nineteen patients with giant bulla were followed for more than 1 year after bullectomy. They were divided into two groups according to their postoperative symptoms. Group 1 consisted of 16 patients who had no problems in their postoperative clinical course, while Group 2 included 3 patients who complained of severe dyspnea at 5 to 6 years of follow-up. Prior to operation, the forced expiratory volume in 1 sec over vital capacity (FEV1%) was 66.8 +/- in Group 1 and 27.6 +/- 5.4% in Group 2. Differences in preoperative and postoperative FEV1% were statistically significant within Group 1 and between the two groups. Postoperative FEV1% (Y) correlated significantly with preoperative FEV1% (X) (Y = 0.74X + 25.4; r = 0.836; p less than 0.001). Thus, we were able to predict the postoperative FEV1% from the preoperative value. Regional ventilation over volume was computed from the washout curve of xenon 133 after reaching equilibrium with rebreathing in a closed circuit (V/V dynamic). Group 2 had significantly lower regional ventilation over volume in all regions, both before and even after bullectomy, compared with normal subjects or Group 1 patients. Preoperative V/V dynamic was below 0.5 in all regions of Group 2. Furthermore, postoperative V/V dynamic (Y) correlated significantly with preoperative V/V dynamic (X) in the upper region (Y = 0.46X + 0.40; r = 0.638; p less than 0.02) and in the lower region (Y = 0.72X + 0.33; r = 0.869; p less than 0.001). We conclude that functional indications of bullectomy for giant bulla are that FEV1% should be greater than 40%, and that regional V/V dynamic should be greater than 0.5. On the other hand, symptomatic and functional improvement following bullectomy was reduced in patients whose FEV1% was less than 35% in whose V/V dynamic was remarkably disturbed in all regions of the involved hemithorax.

Postoperative preservation of pulmonary function in patients with chronic empyema thoracis: a one-stage operation

Twenty-two patients with chronic empyema thoracis underwent decortication. In 11 of them, simple decortication achieved sufficient reexpansion of the lung. In the other 11 patients, our new method was indicated because the pleural space was not closed completely by simple decortication. In our procedure, the parietal wall is collapsed, without rib resection, to contact the surface of the decorticated lung. All 11 patients had a one-stage cure. Two of these 11 patients had bronchopleural fistula. The preoperative and postoperative percentage of vital capacity, percentage of forced expiratory volume in 1 second, arterial oxygen tension, alveolar-arterial oxygen pressure difference, and xenon 133 radiospirometry revealed that pulmonary function was well preserved in patients treated by our method as well as in those undergoing simple decortication. The alveolar-arterial oxygen pressure difference during oxygen inhalation improved significantly (p less than 0.05) after operation compared with the preoperative values in both groups. From the pulmonary function studies, we conclude that our method achieves results comparable with those of simple decortication for the treatment of chronic empyema thoracis. Our procedure is indicated in patients for whom it is thought simple decortication will not lead to primary cure of empyema.

A Case of Pulmonary Carcinosarcoma.

症例は62歳, 男性.検診にて, 胸部異常陰影を指摘され来院.胸部X線写真にて右肺門部に腫瘤陰影を認めた.気管支鏡下の擦過細胞診にて腺癌と診断され, 手術を施行した.主病変は, S1に存在したが, 肺内転移を認め, 右肺全別術を施行した.術後病理組織診断にて, 肺癌肉腫と診断された.組織学的に肉腫成分が, 線維肉腫と粘液肉腫の2成分より構成されている点と転移様式が, 癌腫と肉腫で異なる, 即ち, 腺癌は, リンパ行性転移と血行性転移, 肉腫成分は血行性転移のみで, しかも粘液肉腫が主体である点より, 本症例は, 稀な症例と考えられた.

133Xe-Radiospirometry and lung cancer-A tentative nomogram to detect subsegmental obstructions.

例の原発性肺癌症例を用いて, 133Xe Radiospirometryを行い, 患側の換気分布比 (V%), 肺容量分布比 (V%) および肺血流分布比 (Q%) を測定し, これらパラメ-タ-から肺癌による閉塞亜区域枝の数を予測するノモグラムを試作した.一方気管支造影所見から閉塞亜区域枝数を実測した.各パラメーターで予測された閉塞亜区域枝数と実測した数値の相関性はそれぞれ推計学的に有意 (p<0.001) で, V%ではr=0.838, V%ではr=0.834, Q%ではr=0.846であった.我々が試作したノモグラムの問題点について論じた.