Masafumi Hioki

Successful Combined Operation for Mitral Stenosis and Atrial Fibrillation

Simultaneous surgical treatment of mitral stenosis and atrial fibrillation was performed. The patients postoperative course was uneventful, the rhythm changed to sinus rhythm, and the patient was discharged on the 21st postoperative day in stable condition.

Resection of Sternal Tumors and Reconstruction of the Thorax: A Review of 15 Patients

PurposeWe report our experience of resecting sternal tumors, followed by reconstruction of the skeletal and soft-tissue defects, and discuss the usefulness of sandwiched Marlex and stainless-steel mesh.MethodsFifteen patients underwent resection of a sternal tumor and chest wall reconstruction with autologous bone grafts, sandwiched Marlex and stainless-steel mesh or a titanium plate, and musculocutaneous flaps. The sternal tumors were from locally recurrent breast carcinoma in ten patients, metastasis from other organs in three, and primary chondrosarcoma in two.ResultsAll patients were extubated without paradoxical respiration just after surgery. There was no operative mortality. A wound infection developed in the acute phase after a sandwiched Marlex and stainless-steel mesh reconstruction in one patient. A second repair with Marlex and stainless-steel mesh was required in two patients; for flail chest after an autologous bone graft in one; and following re-recurrence of breast carcinoma in another patient who had undergone a musculocutaneous flap repair. No signs of breakdown, dislodgment, severe depression, or deformity were seen in any of the six patients who underwent reconstruction with Marlex and stainless-steel mesh during a median follow-up period of 56 months.ConclusionsWide resection of sternal tumors provides good local control. Reconstruction with Marlex and stainless-steel mesh seems to be the most effective technique for repairing a wide anterior chest wall defect.

Left retroperitoneal approach using a retractor to repair abdominal aortic aneurysms: a comparison with the transperitoneal approach.

Abstract.Abstract.Purpose: The purpose of this study was to compare the effectiveness of the retroperitoneal approach (RP) using a Thompson retractor with the conventional transperitoneal approach (TP), to repair infrarenal abdominal aortic aneurysms (AAA).Methods: A total of 91 consecutive patients were divided into two groups; group A (n= 21) underwent surgery using the TP, and group B (n= 70) underwent surgery using the RP with a Thompson retractor.Results: There were no significant differences in the operation time, aortic cross-clamp time, incidence of postoperative cardiac events, or the development of wound complications; however, a significantly higher rate of postoperative respiratory complications and ileus was observed in group A. Moreover, oral feeding was commenced later and the hospital stay was prolonged in group A (P < 0.01).Conclusion: These findings clearly demonstrate that our RP method, especially when using a Thompson retractor, is a preferable alternative to TP for AAA surgery.

Characteristics of Multiple Primary Malignancies Associated with Lung Cancer by Gender

Background: There are gender differences in multiple primary malignancies associated with lung cancer (MPMLC) in terms of clinical characteristics. However, the importance of these differences in the management of patients has not been clarified. Objective: Differences in characteristics affected by gender were investigated in MPMLC to identify factors important for the proper management of the patients. Methods: Univariate and multivariate analyses were performed between 82 male and 34 female patients with MPMLC treated from August 1982 to March 2002. Results: In univariate analysis, the numbers of smokers or ex-smokers, smoking-related cancer and synchronous multiple primary malignancies were significantly increased in males with MPMLC (p < 0.0001, p < 0.05 and p < 0.05, respectively). In multivariate analysis, synchronous multiple primary malignancies and the number of smokers or ex-smokers were significantly different between male and female MPMLC. Gastric, lung and colon cancers were major constituents in male MPMLC, and 40.2% of all malignancies were smoking-related cancers. On the other hand, breast and uterine cancers were major constituents in female MPMLC, and only 20.6% of all MPMLC were smoking-related cancers. Conclusions: Male patients with MPMLC demonstrated significant smoking history and synchronous multiple primary malignancies, indicating the need for different approaches to properly manage and follow up male versus female MPMLC patients.

Resection of sternal metastasis from endometrial carcinoma followed by reconstruction with sandwiched marlex and stainless steel mesh: report of a case.

We report the successful resection of sternal metastasis from endometrial carcinoma, followed by reconstruction of the chest defect, in an 87-year-old woman. We performed subtotal sternectomy and concurrent resection of the ribs and overlying soft tissue. The skeletal defect was then reconstructed with sandwiched Marlex and stainless steel mesh, and soft tissue coverage was accomplished by using a pectoralis major advancement flap. The patient had an uneventful postoperative course with no sign of recurrence during 5 years of follow-up. Thus, reconstruction with Marlex and stainless steel mesh could be an effective technique for preventing paradoxical movement of the thorax and protecting the intrathoracic organs.

Ciprofloxacin Penetration into the Pulmonary Parenchyma in Japanese Patients

PurposeTo assess the degree of penetration of intravenous (i.v.) ciprofloxacin into the lung parenchyma resected for lung carcinoma in Japanese patients.MethodsCiprofloxacin was given i.v. over 1 h to ten Japanese patients with non-small cell lung carcinoma. We took 1 g of normal lung parenchyma and 1 ml of blood serum for analysis when the lung was resected. Ciprofloxacin concentrations were determined by high-performance liquid chromatography.ResultsThe mean time from the end of ciprofloxacin administration to lung resection was 135 ± 55 min (range, 75–223 min). The mean concentrations of ciprofloxacin in the lung parenchyma and blood serum were 4.9 ± 2.0 µg/g (range, 2.1–7.9) and 1.5 ± 0.7 µg/ml (range, 0.8–2.7). The mean tissue per serum concentration ratio was 3.6 ± 2.2 (range, 1.9–8.7).ConclusionThe concentrations of ciprofloxacin in the lung parenchyma after i.v. administration in Japanese patients were above the minimal inhibitory concentration for bacteria from at least 75 min until 4 h later.

Hereditary factors in multiple primary malignancies associated with lung cancer.

PurposeThere are differences between lung cancer alone and multiple primary malignancies associated with lung cancer (MPMLC) in terms of clinical characteristics. However, the importance of these differences has not yet been clarified.MethodsUnivariate and multivariate analyses were performed on 123 patients with MPMLC and 815 patients with lung cancer alone who underwent operative procedures for lung cancer from August 1982 to March 2004.ResultsAge, number of family with a family history of other malignancies except for smoking-related cancers, and pathological early stage of lung cancer were significantly high in patients with MPMLC based on univariate analyses (P < 0.0001, P < 0.05, and P < 0.05, respectively). Age and family history of malignancy were thus found to be significant factors based on a multivariate analysis.ConclusionsMPMLC demonstrated a significant association with advanced age and stronger hereditary factors in comparison with lung cancer alone, indicating the need for different approaches to properly manage and follow up risk patients.

Aneurysm of the left sinus of valsalva causing aortic, mitral regurgitation and myocardial ischemia

An aneurysm of the left sinus of Valsalva producing aortic and mitral regurgitation with myocardial ischemia was treated successfully by reconstructing the left coronary sinus while preserving the aortic cusp combined with coronary artery bypass grafting. Aortic and mitral regurgitation occurred due to distortion of the left aortic cusp by a huge aneurysm that also compressed and obstructed the main trunk of the left coronary artery. The postoperative course was uneventful and follow-up showed aortic and mitral regurgitation to be absent and the coronary graft to be patent. Aortic valve-sparing surgery thus proved to be an appropriate procedure for this case.

Metastatic chest wall tumor suspected to be of lung origin by immunoreactivity for cytokeratin 7 and 20

We report a rare case of unknown primary carcinoma. A 36-year-old man was admitted to the hospital because of a chest wall tumor. Serum carcinoembryonic antigen level was 160 ng/ml. The resected chest wall tumor was pathologically diagnosed as metastatic adenocarcinoma, showing positive immunoreactivity for cytokeratin 7 and negative immunoreactivity for cytokeratin 20, suggesting lung origin. Serum carcinoembryonic antigen level returned to normal limits. Twenty-one months later, a chest X-ray showed a nodular lesion in the left upper lobe and serum carcinoembryonic antigen level increased to 12.3 ng/ml. Left upper lobectomy was performed 23 months after chest wall resection. The resected tumor was pathologically diagnosed as primary lung adenocarcinoma, showing the same immunoreactivity as in the chest wall tumor. The combination of immunohistochemistry for cytokeratin 7 and 20 appeared to be a useful tool in determining the site of origin and helpful for premortem diagnosis of the origin of unknown primary carcinoma.

Enucleation of Esophageal Leiomyoma with Azygos Continuation of the Inferior Vena Cava: Report of a Case

We herein report a rare case of esophageal leiomyoma in an 18-year-old woman with azygos continuation of the inferior vena cava. A submucosal tumor was located in the left wall of the esophagus behind the carina. The enlarged azygos vein made video-assisted thoracic surgery so difficult that conversion to a minithoracotomy and transection of the right superior intercostal vein were necessary to fully visualize the tumor. A pathological diagnosis revealed leiomyoma. Our experience suggests that a transection of the right superior intercostal vein is effective for the proper exposure of an esophageal tumor located behind the carina in a patient with an enlarged azygos vein.