Shinobu Matsubara

Long-Term Results of Microscopic Lymphatic Vessel-Isolated Vein Anastomosis for Secondary Lymphedema of the Lower Extremities

PurposeTo evaluate the effectiveness of microscopic lymphatic vessel-isolated vein anastomosis in patients with secondary obstructive lymphedema of a lower extremity, refractory to nonoperative management.MethodsNine women suffered from nonpitting edema of one or both legs (11 limbs) after radical hysterectomy with postoperative irradiation for uterine cancer. The indications for this operation were repeated cellulitis and severe nonpitting edema impairing limb function. Under microscopy of 3.2 on average, the identified lymphatic vessels were anastomosed to an isolated saphenous vein using the pull-through technique with modifications.ResultsThe follow-up period ranged from 21 to 87 months and the operation achieved excellent reduction, of more than 5 cm, in six limbs; good reduction, of 2–5 cm, in two limbs; and poor reduction, of less than 2 cm, in three limbs. The frequency of cellulitis decreased from 2.4 infections per patient per year to 0.2 infections per patient per year.ConclusionThese results show that microscopic lymphatic vessel-isolated vein anastomosis is a minimally invasive operation, with good long-term effects, making it the treatment of choice for intractable secondary lymphedema of the lower extremities refractory to physiotherapy.

Clinical Course of Asymptomatic Isolated Distal Deep Vein Thrombosis of the Leg: A Single-Institution Study

Background: The natural history of asymptomatic isolated distal deep vein thrombosis (DVT) of the leg is unclear. This study aimed to describe a 3-month and 1-year clinical course after diagnosis of asymptomatic isolated distal DVT of the leg. Methods: This study included 127 patients with asymptomatic, sonographically proven isolated distal DVT who did not receive anticoagulant therapy and were retrospectively evaluated at our hospital between May 2014 and September 2016. After 3 months and 1 year, the presence or absence of venous thromboembolism recurrence and extension of DVT toward proximal veins was sonographically confirmed. Results: At 3-month and 1-year follow-ups, 125 and 109 patients were observed, respectively. All patients showed no symptoms or findings suspecting venous thromboembolism recurrence during the observation period. However, 43 patients underwent repeat ultrasonic examination, and thrombus extension was confirmed in 2 patients. Conclusions: Asymptomatic isolated distal DVT of the leg showed good prognosis, and thus uniform anticoagulation therapy was considered unnecessary. (This is a translation of Jpn J Phlebol 2018; 29(3): 309–314.)

Thoracoscopic surgery for diagnosis of interstitial pneumonia special reference to medicoeconomical effect

We compared thoracoscopic surgery (TS) and open thoracotomy for the diagnosis of interstitial pneumonia. Intraoperative blood loss and duration of postoperative chest drainage were significantly less with TS than with thoracotomy. The length of postoperative hospital stay and social insurance costs with TS was significantly less than with thoracotomy. These results show that TS for the diagnosis of interstitial pneumonia is superior to open thoracotomy in terms of surgical stress and cost.