Koh-ichi Sakasegawa

The use of a dumon stent for the treatment of a bronchopleural fistula

We report the successful management of a bronchopleural fistula with bronchial stent placement combined with irrigation of the empyema cavity. A bronchopleural fistula occurred in a 67-year-old man after a right upper lobectomy for lung cancer. Resuturing of the bronchial stump plus omental wrapping and subsequent closure of the open stump with a pedicled flap of intercostal muscle were not effective. Consequently, we placed a Dumon stent in the right main bronchus to close the stump.

Clinical Experience with Temporary Vena Cava Filters

An experience with temporary filter placement, which seems to be safe and effective for temporarily preventing pulmonary embolism, is reported. Since October 1997, six patients had temporary filters. There were two men and four women, with a mean age of 37 years. Three filters were placed at the infrarenal inferior vena cava, two at the suprarenal inferior vena cava, and one at the superior vena cava. All filters were placed before various surgical interventions. During filter placement, anticoagulation therapy was routinely performed. There were no complications at and during filter placement. No pulmonary emboli occurred during surgical intervention. All filters were successfully removed, two of which were exchanged for permanent filters. All patients are alive and well without recurrent deep vein thrombosis and/or pulmonary emboli during a follow-up period of 11 to 25 months. Although this experience is small, temporary filter placement is safe and effective for short-term prevention of pulmonary emboli even in older patients or those with malignant disease. Veins of the upper part of the body may be more favorable than the femoral vein for insertion of a temporary filter. Temporary filters can be safely placed not only at the infrarenal inferior vena cava, but also at the suprarenal inferior vena cava or superior vena cava.

Ruptured thymoma causing mediastinal hemorrhage resected via partial sternotomy

A case of a ruptured thymoma causing mediastinal hemorrhage and hemothorax that was electively resected by a partial sternotomy approach is presented. This case and others previously reported illustrate that a sudden onset of dyspnea and chest pain accompanied by acute mediastinal widening on chest roentgenogram in a previously healthy patient should suggest the diagnosis of a ruptured thymoma. An upper part sternotomy approach may be as safe and effective as a less invasive surgical procedure in resection of noninvasive thymomas, even if dense tumor adhesion exists.

Intrathoracic cooling of cadavers before lung transplantation using cold air: an experimental study.

Objective. In an attempt to identify an effective method of harvesting adequately functioning donor lungs from a cadaver, we devised an intrathoracic cooling method utilizing cold air that resulted in successful experimental lung transplantation. Methods. The lungs of donor mongrel dogs were inflated with 100% oxygen after death. The animals in group I (n=5) were left at room temperature for 2 hr, whereas those in group II (n=5) were left for 2 hr with their left thoraces filled with cold air cooled by dry ice. The lungs were subsequently flushed with cold Euro‐Collins solution, harvested, and stored inflated in a cold saline solution for a further 2 hr. Left lung allotransplantation was then performed. Transplanted left lung function was examined by inducing occlusion of the native right bronchus and pulmonary artery for 10 min while the left lung was ventilated with 100% oxygen. Results. There was a slow decline in intrathoracic, lung surface, and endobronchial temperatures toward room temperature in group I. In contrast, all three temperatures dropped to approximately 10°C within 30 min in group II. In group I, all recipient dogs died immediately after occlusion was induced, whereas four of the five dogs in group II survived to show satisfactory lung function. Conclusions. (1) Intrathoracic topical cooling of a cadaver by cold air is efficacious in decreasing lung temperature and thus preserving lung tissue function. (2) Transplantation of cadaver lungs harvested using this novel method might be clinically feasible.

Balloon catheter for cyst aspiration in a thoracoscopic resection of mediastinal cysts.

Abstract In a thoracoscopic resection of mediastinal cysts, aspiration of the cyst contents at the beginning of the procedure is often helpful because it allows the cyst to be more easily grasped and manipulated. Spillage of the cyst contents into the thoracic cavity may, however, occur during aspiration when an ordinary aspiration needle is used. If the cyst contents are infective, then a subsequent contamination of the thoracic cavity may develop. We therefore use a specially designed double-balloon catheter for aspiration to minimize spillage of the cyst contents into the thoracic cavity. We describe herein the usefulness of this aspiration technique.