Takahiro Homma

Complete thoracoscopic diaphragm plication using carbon dioxide insufflation: report of a case

Diaphragm plication has become the accepted treatment for major respiratory impairment caused by diaphragmatic eventration and paralysis. Various open and minimally invasive plication techniques have been described and while video-assisted thoracoscopic diaphragm plication appears to be a safe and effective alternative to open surgery, the workspace is limited. We describe how we performed complete thoracoscopic diaphragm plication using carbon dioxide (CO2) insufflation for a patient with unilateral diaphragmatic eventration. Using CO2 insufflation seems to dramatically improve the workspace.

Spontaneous Hemothorax Caused by Pulmonary Micro-Venous Hemangioma.

Various etiologies of spontaneous hemothorax have been reported, though the cause remains unidentified in some patients despite an exploratory thoracotomy. We report on an 89-year-old man with spontaneous hemothorax resolved by partial resection of the lung using complete video-assisted thoracoscopic surgery. The histopathologic findings revealed a ruptured micro-venous hemangioma located just below the bleeding visceral pleura. To the best of our knowledge, this is the first report of spontaneous hemothorax caused by a pulmonary micro-venous hemangioma.

Rare Lipomatous Tumor of the Posterior Mediastinum in Children

The mediastinum is a unique anatomic area containing various structures and pluripotent cells, which allow for the development of a range of tumors. We report two pediatric cases of a lipomatous tumor of the posterior mediastinum. Complete surgical excision of the mass in each was achieved through a lateral thoracotomy. Histopathologic findings showed a lipoma in one case and a lipoblastoma in the other. A lipomatous tumor in the posterior mediastinum is extremely rare and preoperative diagnosis is difficult. When an operative plan is being considered, the presence of a potentially malignant tumor should be kept in mind.

A case of acute psittacosis with severe abdominal pain

We report the case of a psittacosis patient with severe abdominal pain who subsequently developed acute respiratory failure. The main symptoms of psittacosis are considered to be upper respiratory inflammation and influenza-like symptoms. However, it should be emphasized that digestive symptoms can be prominent in psittacosis patients. Early diagnosis of this condition is difficult and there is a need for an effective method for rapid diagnosis.

Risk factors of neuropathic pain after thoracic surgery

Background This study aimed to clarify the incidence and risk factors of neuropathic pain after thoracic surgery, focusing especially on patients who underwent complete video-assisted thoracoscopic surgery (VATS). Methods We retrospectively identified 185 patients who underwent thoracic surgery at our hospital over a 2-year period. Logistic regression analysis was used to analyze the association of various factors with postoperative neuropathic pain. Results Forty-eight (25.9%) patients developed postoperative neuropathic pain, and 9 (18.8%) of these patients reported persistent pain 1 year postoperatively. The median interval from surgical treatment to the onset of neuropathic pain was 7 days, and the duration was 50 days. Multivariate logistic regression analysis revealed a significant positive correlation between postoperative neuropathic pain and preoperative use of hypnotic medication [odds ratio (OR), 5.45; 95% confidence interval (CI); 2.52-12.17] and duration of surgery ≥2.5 hours (OR, 2.72; 95% CI, 1.27-6.09), and a significant negative association with the complete VATS approach (OR, 0.18; 95% CI, 0.073-0.42). Conclusions Preoperative use of hypnotic medication, the thoracotomy approach, and duration of surgery ≥2.5 hours are associated with increased risk of neuropathic pain after thoracic surgery. The complete VATS approach could decrease the incidence of postoperative neuropathic pain, regardless of the duration of surgery.

Sternum-splitting anterior approach following posterior decompression and fusion in patients with massive ossification of the posterior longitudinal ligament in the upper thoracic spine: report of 2 cases and literature review

PurposeAnterior approach to the upper thoracic spine is difficult. It is important for spine surgeons to know the indication and the effect of anterior decompression for upper thoracic lesions and also to recognize the complications which are related to the approach with sternotomy. We present two patients for whom we took the sternum-splitting anterior approach for thoracic ossification of the posterior longitudinal ligament (OPLL) following posterior decompression and fusion surgery; the clinical course and surgical outcome are discussed, with particular reference to complication avoidance and also we review the previous literature.MethodsWe present two cases with severe upper thoracic OPLL. The maximum occupying ratio of OPLL against the spinal canal was more than 80% in both cases. Posterior decompression and fusion were not effective and, therefore, anterior surgery with sternotomy was carried out.ResultsCerebrospinal fluid leak was encountered with the removal of OPLL using the anterior approach. Subsequently, a polyglycolic acid sheet was used to cover the defect in the dura matter; a thoracic drainage system with a continuous suction unit was positioned at the surgical wound to avoid fluid retention in the mediastinum. In addition, we facilitated spinal drainage from the lumbar level. These procedures resulted in no complication caused by fluid retention in the mediastinum.ConclusionBoth a safe surgical approach and preventive measures to alleviate postoperative complications are mandatory in difficult cases with thoracic OPLL.