Satoru Iwabuchi

Iatrogenic paraplegia caused by surgicel used for hemostasis during a thoracotomy: report of a case.

A 46-year-old Japanese woman underwent a right lower lobectomy through a posterolateral incision made in the fifth intercostal space under general and epidural anesthesia on January 23, 1995. During the procedure, oxidized regenerated cellulose (Surgicel) was used to prevent postoperative rebleeding from the dorsal branch of the fifth intercostal artery. The following day it became evident that complete paraplegia had developed below the Th5 level, the cause of which was revealed by an emergency laminectomy, performed within 20 h after the thoractomy, to be the Surgicel treatment. By 50 days after the operation the patient had begun to show improvement, and was able to move her lower extremities against gravity. Her condition is continuing to improve.

Vasoactive intestinal peptide causes nitric oxide-dependent pulmonary vasodilation in isolated rat lung.

Vasoactive intestinal peptide (VIP) is one of the chief neurotransmitters of nonadrenergic noncholinergic nerve fibers. In this study, we investigated the effect of VIP on the pulmonary circulation in isolated perfused rat lungs. Baseline pressures of the pulmonary artery for the isolated rat lungs were not affected by 3 x 10(-8) M VIP. VIP caused dose-dependent pulmonary vasodilation when the pulmonary vascular bed was constricted with 20 mM KCl. This vasodilative effect of VIP was inhibited by 1 x 10(-6) M L-n omega-nitro-arginine, an endothelium-derived relaxing factor (nitric oxide) inhibitor, and was restored by the addition of 10(-4) M L-arginine, a substrate of nitric oxide. VIP also caused suppression of the ANG II pressor response, and this VIP-induced suppressive effect was reduced when L-N omega-nitro-arginine or 3 x 10(-6) M meclofenamate was added to the perfusate. These results indicate that VIP causes pulmonary vasodilation in isolated rat lung and suggest the possible involvement of NO and/or cyclooxygenase metabolites in VIP-induced pulmonary vasodilation.

Intrapleural rupture of a pulmonary arteriovenous fistula occurring just beneath the pleura: Report of a case

We report herein a rare case of a 21-year-old man with Rendu-Osler-Weber disease, otherwise known as hemorrhagic teleangiectasia, in whom a spontaneous hemothorax occurred following the rupture of one of multiple pulmonary arteriovenous fistulae (PAVF). An emergency life-saving operation was performed which revealed the ruptured fistula lying just beneath the visceral pleura. This case demonstrates that patients in whom a pulmonary angiogram shows an arteriovenous fistula lying just beneath the visceral pleura should undergo prophylactic surgery to avoid a life-threatening emergency, whenever possible.

Familial neurilemmomatosis: report of a case.

We report herein a case of familial neurilemmomatosis seen in a 16-year-old girl and her 38-year-old mother. The girl presented to us with an intrathoracic vagal neurilemmoma, as well as neurilemmomas on the right fifth intercostal nerve and in the serratus anterior muscle. Two years after these tumors were resected, bilateral acoustic neuromas and multiple brain stem tumors appeared. Her mother was being treated simultaneously at another hospital for multiple neurilemmomas, including bilateral acoustic neurilemmomas, suggesting the possibility that neurilemmomatosis is an autosomal dominantly inherited disorder.

Use of the sandwich method with an ultra-high-molecular-weight polyethylene prosthesis and Marlex mesh in sternal reconstruction: Report of a case

A 52-year-old Japanese man with a slow-growing chondroma originating from the sternal bone was referred to our hospital. A subtotal resection of the sternum was performed, hereafter termed the “sandwich method,” and an originally designed prosthesis made from ultra-high-molecular-weight polyethylene and Marlex mesh was used for reconstruction. The postoperative course was uneventful without any symptoms due to paradoxical movement of the chest or regional abscess, and no disturbance in the movement of the upper limbs, such as a surgical sequelae, was observed.

Role of pulmonary intravascular macrophages activation in increased pulmonary microvascular permeability.

Pulmonary intravascular macrophages reside in the alveolar capillaries of sheep lung. We tested the effects of pulmonary intravascular mcrophages activation on pulmonary microvascular permeability.Sheep were divided into 3 groups; latex group, indomethacin group and OKY-046 (thromboxane A2 synthetase inhibitor) group. In each group, we infused latex beads emulsion, 1 μm in diameter, 5.46×1010 beads/kg, intraarterially. In latex group, lymph protein clearance increased significantly during and after the infusion period. In indomethacin group, increases in lymph protein clearance were blocked completely. However, in OKY-046 group, lymph protein clearance increased significantly 3 hours after the infusion period. In each group, peripheral white blood cell counts decreased significantly during the infusion period, and recovered to the baseline valeus after the infusion. Many latex beads were caught by pulmonary intrvascular macrophages selectively.These results suggest that pulmonary intravascular macrophages activation through their phagocytic uptake of microparticles is essential to increase in pulmonary microvascular permeability in sheep.