Mayumi Shinonaga

Thoracoscopic stapled bullectomy supported by suturing

In 1985, a thoracoscopic technique for closing bullae with hemostatic clips was developed. However, the method was limited, and therefore clinical application was small. A linear endoscopic stapler (Endo-GIA) was developed in 1990. The advent of the Endo-GIA nearly made thoracoscopic treatment of spontaneous pneumothorax practicable, and ended the use of clipping. In addition, a new operative technique was developed, the 3-cm minithoracotomy bullectomy for the treatment of spontaneous pneumothorax. This technique has now become obsolete. The current method is that of a thoracoscopic stapled bullectomy using the Endo-GIA, supported by suturing. The recurrence rate was 2.7% (1/37) using this method. The one recurrence occurred in a case where no bullae were observed during the operation. Our findings suggest that thoracoscopic stapled bullectomy supported by suturing is a practicable treatment of spontaneous pneumothorax. An economical use of the endoscopic stapler and complementary suturing may be less expensive than using a laser. Pleurodesis should be performed in the patients in whom no distinct bullae are discovered thoracoscopically.

Development of an endocardioscope for repair of an atrial septal defect in the beating heart

The purpose of this study was to evaluate the possibility of surgical treatment of an atrial septal defect in the beating heart without cardiopulmonary bypass. The first step was to develop an endocardioscope that permitted observation of the inside of the beating heart. To visualize the inside of the beating heart, the tip of the endoscope was covered with a glass adapter. The endocardioscope was inserted through the right atrial appendage in eight beagles. The atrial septum, foramen ovale, coronary sinus, tricuspid valve, and chordae tendineae were identified without hemodynamic derangement. The second step was to attempt to close the foramen ovale with clips or staplers. We were able to close the foramen ovale with these devices, but a safer, easier device is needed. The endocardioscope we developed should prove to be a useful tool for minimally invasive surgical treatment of heart diseases, such as atrial septal defect.

The long-term survival rates of patients after repair of abdominal aortic aneurysms

This study was undertaken to examine the longterm survival rates of patients following abdominal aortic aneurysm (AAA) repair in comparison with an age-matched normal population, and to determine by multivariate analysis the factors influencing long-term survival. Of 125 patients who underwent AAA repair prior to July 1986, 13 died during hospitalization. Of these 13 patients, 6 who suffered aneurysmal rupture all died within 30 days. The survival rate of patients with ruptured aortic aneurysms was significantly lower than that of those with nonruptured aneurysms. Of the 112 patients surviving hospitalization, 85 died within 0.48 to 24 years after their operation. The long-term survival rate of patients who had suffered a preoperative cardiovascular event was significantly lower than that of those who had not suffered a preoperative cardiovascular event. The actual survival rate was significantly lower than the expected survival rate. According to a multivariate analysis, the significant predictors of late survival were age, aneurysmal rupture, and chronic renal failure in all the patients, and age, chronic renal failure, and pre- and postoperative cardiovascular events in patients who did not die in hospital. These findings indicate the importance of improving immediate perioperative management of ruptured AAA and that cardiovascular events should be prevented, or treated during long-term follow-up.

Total circular annuloplasty with absorbable suture for the repair of left atrioventricular valve regurgitation in atrioventricular septal defect

To obtain a better control of left atrioventricular valve regurgitation, we applied total circular annuloplasty with the use of absorbable sutures to 14 children with atrioventricular septal defect (six complete forms and eight incomplete forms). In the intraoperative period, a good coaptation of the leaflets was achieved and the regurgitation was minimized or disappeared. Follow-up studies with echocardiography for 13 survivors showed a gradual increase of annular size during the postoperative period. Ten patients of the survivor group (77%) maintained good valvular competency in a long-term period. Total circular annuloplasty is a simple and effective procedure to reduce the regurgitation and prevent the annular dilatation during the immediate postoperative period.

Coexistence of primary pulmonary Hodgkin lymphoma and gastric MALT lymphoma associated with Epstein-Barr virus infection: a case report.

We describe a 66‐year‐old woman with Epstein‐Barr virus‐associated lymphoproliferative disorder with lung and gastric tumors. We identified two lung tumors measuring 13 and 20 mm in diameter that consisted of CD30‐, CD15‐, and CD20‐positive Hodgkin‐ and Reed‐Sternberg‐like cells and heterogeneous cellular infiltrates in a pronounced nodular pattern, with necrosis and vasculitis, diagnosed as nodular sclerosis classical Hodgkin lymphoma. A gastric tumor showed low‐grade extranodal marginal zone B‐cell lymphoma of the mucosa‐associated lymphoid tissue type. Neoplastic cells in all tumors expressed Epstein‐Barr virus‐encoded RNA based on in situ hybridization. The present case is a rare composite lymphoma arising from different extranodal organs, associated with EBV infection. Her medical history included gamma‐knife therapy for clinical diagnosis with a suspicion of cerebral lymphoma.

Posttraumatic Tricuspid Insufficiency Successfully Repaired by Conventional Technique

Abstract  A 22‐year‐old man developed exertional dyspnea 2 years after blunt chest trauma due to a horse kick. Preoperative echocardiography showed severe tricuspid insufficiency (TI) caused by chordal rupture and prolapse of the anterior leaflet. A novel repair technique, the “clover technique,” was applied, but was unsuccessful in this case. The valve was then repaired successfully using conventional techniques, that is, insertion of an artificial chordae, plication of the prolapsing leaflet, and DeVegas annuloplasty. We present here a brief review of posttraumatic TI, and discuss effective and less expensive techniques for repair.

Video-Assisted Thoracic Surgery for Thorascopic Resection of Giant Bulla

This report outlines our experience of 6 patients who underwent video-assisted thoracic surgery (VATS) using a linear endoscopic stapler to remove a giant bulla from the lung. Successful treatment with VATS was carried out in 4 patients, but the procedure needed to be changed to a thoracotomy in 2 patients — in one because of difficulty in single-lung ventilation, and in the other, due to a persistent air leak. Thus, we conclude that giant bulla without any associated severe respiratory failure can be an indication for VATS.

Squamous cell carcinoma of the lung in association with sarcoidosis.

A 76-year-old man who was known to have sarcoidosis, developed a lung tumor. He had previously undergone cardiac and abdominal vascular surgery, at which sarcoidosis was confirmed by lymph node biopsy. A right lower lobectomy was carried out. Postoperative pathology showed limited disease, but cancer recurred 1 year later. Issues regarding the combination of sarcoidosis and a malignant tumor are discussed.

Transcatheter Embolization of Aortopulmonary Collateral Arteries Prior to Intracardiac Repair in Patients with Congenital Heart Disease.

心内修復術前に側副血行路カテーテル塞栓術 (TAE) を施行した先天性チアノーゼ性心疾患7例について検討した. 側副血管は25本 (1症例当り1～5本, 平均3.6本) で, 気管支動脈は7本中7本(100%), 肋間動脈は18本中17本 (94%) の完全閉塞が得られ, 全体では側副血管の25本のうち24本 (96%) の塞栓に成功した. 合併症は1例で金属コイルの大腿動脈への脱落を認め, 外科的に摘出をした. TAE後の5例で体動時のチアノーゼの増強や呼吸困難等の自覚症状が出現し, 1例では低酸素血症増強のため緊急に心内修復術が必要となり, 2例で一過性の発熱が認められた. TAE後, 労作時のチアノーゼ増強等の自覚症状, 更には低酸素血症の危険があることから心内修復術直前の施行が適切と思われた.