Sadanori Takeo

Video-assisted extended thymectomy in patients with thymoma by lifting the sternum

We present use of minimally invasive video thoracoscopic surgery to perform complete extended thymectomy in patients with thymoma. These procedures were performed using a sternum-elevating method that provides a wide field of vision between the sternum and heart. Indications for this method are Masaoka Stage I, II and some Stage III (invasion to the lung and pericardium). This new method may be useful from the standpoint of minimal access, rapid recovery, less pain, and good cosmetic results.

Carcinoma of the thyroid manifested as hyperthyroidism caused by functional bone metastasis.

A rare case of hyperthyroidism in the presence of a functioning bone metastasis secondary to an occult thyroid cancer is reported. A 59-year-old womans pelvic bone metastasis was much too extensive and hypervascular to permit resection. An I-131 scan showed striking activity in the pelvic metastasis, which reflected ectopic excessive production of thyroid hormone by a functioning metastatic thyroid carcinoma. After total thyroidectomy, the patient received I-131 ablation and transcutaneous intra-arterial embolization therapy but her metastasis progressively enlarged. Microscopically, concomitant follicular and papillary cancer was found in close proximity to the thyroid. The patient now has vertebral metastases, and her hyperthyroid state still requires methymazole to prevent thyrotoxicosis.

Prognosis of Arteriosclerosis Obliterans Associated with Diabetes.

糖尿病 (DM) を合併した閉塞性動脈硬化症 (ASO) では, DM非合併例に比べ発症年齢が約5歳若く, 臨床的に重症の傾向を示した. また, 血管造影, 趾尖容積脈波にて末梢動脈の病変が強く, 下肢・足趾切断に至る例が少なくなかった. GHb高値の症例に重症例が多く, DMコントロールの不良は動脈硬化を促進すると考えられた. 一方, DMの治療法, 羅病期間と肢趾切断の割合の間には一定の傾向は認められなかった. これらの結果より, DMをコントロールし, 合併症を軽減させた上で可及的に血行再建術を行い, 少しでも多くの血流を末梢に送るようにすることが治療上重要であると考えた.