Résumé
Recurrent hyperhidrosis after thoracic sympathectomy is an uncomfortable condition, and compensatory hyperhidrosis (CH) is one of the most troublesome side effects. Here, we describe two patients with recurrent palmar hyperhidrosis (PH) and CH over the whole body simultaneously. They were treated with bilateral T4 sympathetic clipping and reconstruction of the sympathetic nerve from a T5 to T8 sympathetic nerve graft, which was transferred to the resected T3 sympathetic bed site. They reported improvements in sweating and were fully satisfied with the results. Our method can be considered as an alternative approach for patients with recurrent PH and CH.
Sujets)
Adulte , Femelle , Humains , Mâle , Hyperhidrose/chirurgie , Récidive , Thermographie , Thoracoscopie , Résultat thérapeutiqueRésumé
Coronary artery disease has historically been a contraindication to lung transplantation. We report a successful combined bilateral lung transplantation and off-pump coronary artery bypass in a 62-year-old man. The patient had a progressive decline in lung function due to idiopathic pulmonary fibrosis and a history of severe occlusive coronary artery disease.
Sujets)
Humains , Adulte d'âge moyen , Pontage aortocoronarien , Pontage coronarien à coeur battant , Maladie des artères coronaires , Fibrose pulmonaire idiopathique , Transplantation pulmonaire , PoumonRésumé
PURPOSE: We investigated the relationship between various parameters, including volumetric parameters, and tumor invasiveness according to the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification. MATERIALS AND METHODS: We retrospectively reviewed 99 patients with completely resected stage IA lung adenocarcinoma. The correlation between several parameters [one-dimensional ground glass opacity (1D GGO) ratio, two-dimensional (2D) GGO ratio, three-dimensional (3D) GGO ratio, 1D solid size, 2D solid size, and 3D solid size] and tumor invasiveness according to IASLC/ATS/ERS classification was investigated using receiver operating characteristic (ROC) analysis. Adenocarcinoma in situ and minimally invasive adenocarcinoma were referred to as noninvasive adenocarcinoma. RESULTS: The areas under the curve (AUC) to predict invasive adenocarcinoma for the 1D, 2D, and 3D GGO ratios were 0.962, 0.967, and 0.971, respectively. The optimal cut-off values for the 1D, 2D, and 3D GGO ratios were 38%, 62%, and 74%, respectively. The AUC values for 1D, 2D, and 3D solid sizes to predict invasive adenocarcinoma were 0.933, 0.944, and 0.903, respectively. The optimal cut-off values for 1D, 2D, and 3D solid sizes were 1.2 cm, 1.5 cm2, and 0.7 cm3, respectively. The difference in the ROC curves for 3D GGO ratio and 3D solid size was significant (p=0.01). CONCLUSION: Computed tomography image-related parameters based on GGO were well correlated with and predictive of invasiveness according to IASLC/ATS/ERS classification. 3D GGO ratio was more strongly correlated with pathologic invasiveness than 3D solid size.
Sujets)
Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Adénocarcinome/imagerie diagnostique , Aire sous la courbe , Imagerie tridimensionnelle , Tumeurs du poumon/imagerie diagnostique , Invasion tumorale , Stadification tumorale , Valeur prédictive des tests , Courbe ROC , Études rétrospectives , Tomodensitométrie , Charge tumoraleRésumé
Postpneumonectomy syndrome (PPS) is a rare late complication of pneumonectomy. It occurs more often in children than in adults, and is characterized by respiratory failure resulting from bronchial compression caused by severe mediastinal shift. Various methods have been used to treat PPS, including aortopexy and the insertion of plastic balls, silastic implants, and saline-filled breast prostheses. We describe two cases of PPS corrected with tissue expanders after right pneumonectomy in patients with esophageal atresia.
Sujets)
Adulte , Enfant , Humains , Région mammaire , Atrésie de l'oesophage , Matières plastiques , Pneumonectomie , Prothèses et implants , Insuffisance respiratoire , Expanseurs tissulairesRésumé
BACKGROUND: The use of video-assisted thoracic surgery (VATS) to perform major pulmonary resection with systematic node dissection (SND) for lung cancer by is commonly used in clinics. However, the feasibility of SND by VATS remains controversial. Video-assisted mediastinal lymphadenectomy (VAMLA) increases the quality of mediastinal lymph node staging in lung cancer. The video-mediastinoscope allows systematic lymphadenectomy by bimanual preparation. This study was conducted to assess safety and usefulness and clinical feasibility of VAMLA expanding Linder-Dahan mediastinoscope with VATS lobectomy for left sided lung cancer. MATERIAL AND METHOD: Between February 2004 to April 2008, a total 50 patients who underwent VATS lobectomy for left sided lung cancer were analyzed retrospectively. Thirty patients (group A) underwent VAMLA followed by VATS lymphadenectomy and 20 patients (group B) underwent VATS lymphadenectomy for SND. RESULT: There were no statistical differences in operation times, chest tube indwelling times, or hospital days between the 2 groups. The number of dissected total nodes (p=0.001) and N2 nodes (p=0.013) were higher in group A than in group B, but there was no difference in N1 nodes. Postoperative complications included 2 prolonged air leakages (> or =10 days) in each group, one pneumonia in group A, and one vocal cord palsy in group B. There were no early operative mortalities. CONCLUSION: Mediastinal staging of resectable lung cancer is performed by VAMLA. This new technique is the basis for VATS lobectomy particularly for left-sided lung cancer, because a higher percentage of mediastinal lymph nodes undergo complete resection using VAMLA.
Sujets)
Humains , Drains thoraciques , Poumon , Tumeurs du poumon , Lymphadénectomie , Noeuds lymphatiques , Médiastinoscopes , Médiastinoscopie , Pneumopathie infectieuse , Complications postopératoires , Études rétrospectives , Chirurgie thoracique vidéoassistée , Paralysie des cordes vocalesRésumé
Rhabdomyoma has been reported to be the most common type of cardiac tumors in fetuses and children, and multiple cardiac rhabdomyomas almost certainly signify the association with tuberous sclerosis. We report here on a case of Tetralogy of Fallot (ToF) that was associated with multiple rhabdomyomas and tuberous sclerosis. A two-year-old boy, who had undergone systemic-pulmonary shunt during the neonatal period, received total correction of his ToF after the complete regression of the cardiac tumor. The postoperative course was uneventful, and he has been follow-up for 2 months. The boy is currently in an excellent condition.
Sujets)
Enfant , Humains , Foetus , Études de suivi , Tumeurs du coeur , Rhabdomyome , Tétralogie de Fallot , Complexe de la sclérose tubéreuseRésumé
A 57-year-old man with dyspnea was transferred to our institution. Echocardiography demonstrated grade III aortic valve regurgitation with a bicuspid aortic valve. The preoperative coronary angiography showed a left single coronary artery. Replacement of the aortic valve was performed. Ventricular fibrillation developed during weaning the patient of cardiopulmonary bypass after aortotomy repair. An anomalous origin of the coronary arteries is usually an incidental finding. However, in patients who are undergoing aortic valve replacement, a single coronary artery can significantly complicate the procedure. If this is present, then it is imperative that the precise anatomy be clearly identified and the required procedure should be modified to avoid injury to these vessels.
Sujets)
Humains , Adulte d'âge moyen , Valve aortique , Prémolaire , Pontage cardiopulmonaire , Coronarographie , Vaisseaux coronaires , Dyspnée , Échocardiographie , Valvulopathies , Résultats fortuits , Fibrillation ventriculaire , SevrageRésumé
Apoptosis is a normal physiological process. Morphological studies have shown that cells die by physiological mechanisms after undergoing characteristic changes termed 'apoptosis' or 'programmed cell death'. Several genes were known to participate in the apoptotic process including p53 as a proapoptic gene and Bcl-2 as an antiapoptic gene. It was also known that there are certain gender differences in the cerebrovascular accidents and their effect on tissue damage. The purpose of this study is to evaluate how the apoptotic genes are expressed in delayed focal cerebral infarction and peri-infarct area in male and female adult rats by comparing the immunoexpression of p53 and Bcl-2 and p53:Bcl-2 ratio at delayed focal cerebral infarction between both sexes. In sixteen adult Spraugue-Dawley rats (nine males and seven females), the right MCA and both CCA were ligated for thirty minutes to make a delayed focal cerebral infarction in right frontal lobe. Their brains were taken at seventy two hours after the operation. And then the brains were prepared for immunohistochemical stains for apoptosis, p53 and Bcl-2 proteins. The infarction volume of male rats (11.3 mm3) was larger than that of female rats (7.3 mm3) (p<0.01). In male group, the width (micrometer2) of the apoptotic area (46.4 micrometer2) was significantly larger than those in female group (38.9 micrometer2) (p<0.005). The p53 : Bcl-2 ratio was significantly higher in male group (3.23) compared with female group (2.18) (p<0.01). As a result, the p53:Bcl-2 ratio seemed to be related to the gender differences in neuronal apoptosis after delayed focal cerebral infarction.