[Posterior mediastinal hemangioma with extramedullary haematopoieisis].

We report a very rare coexistence of posterior mediastinal hemangioma with extramedullary haematopoieisis. A 69-year-old woman was detected to have an abnormal mass on the chest radiograph during a routine medical examination. No disorders were found by hematologic exams before and after surgery. Chest computed tomography (CT) revealed a well circumscribed posterior mediastinal tumor measured 32×11 mm in diameter, located on paravertebral space. The most likely diagnosis was a benign neurogenic tumor and we were planning to remove this tumor by video-assisted thoracic surgery (VATS) via a right transthoracic approach. Thoracoscopic finding revealed that this tumor was brownish and soft, such as hemangioma. Initially, incisional biopsy was done to obtain definitive diagnosis. Since intraoperative microscopic examination of the biopsy specimen revealed extramedullary haematopoieisis, we obtained another larger samples and finished the operation. Interestingly, the postoperative final histological diagnosis was mediastinal hemangioma with extramedullary haematopoieis.

[Tracheoplasty for tracheal cuff stenosis post long-term tracheostomy].

We encountered a case of tracheal stenosis post tracheostomy, so-called cuff stenosis. A 43-year-old man with ventricular septal defect (VSD) was treated by oral endotracheal intubation because of heart-failure and pneumonia, and tracheostomy was performed. He was placed on artificial ventilation for almost 3 months. Four months after discharge, he complained of dyspnea and was treated by oral endotracheal intubation again. At that time bronchofiberscopy demonstrated severe circumferential stenosis of the trachea 4 cm from the tracheostomy spot and that was compatible with the cuff site. Although the stenotic portion was dilated by an endotracheal tube, 47-days after dilation, the portion was restenosed to almost 7 mm in diameter. Therefore, surgical treatment was necessary and tracheoplasty was performed by end-to-end suture after 2 cm (4 ring) resection of trachea. Tracheoplasty is the most reliable method of treating cuff stenosis after tracheostomy.

[Effect of nicardipine cardioplegia on A-V conduction system in coronary bypass surgery].

The effect of diltiazem and nicardipine cardioplegia on A-V conduction system was analyzed in 75 patients undergoing coronary bypass operation. The dose of these drugs into the crystalloid cardioplegia was 10 micrograms/kg in nicardipine group (n = 29) and 100 micrograms/kg in diltiazem group (n = 46). Among these patients, there was no operative death and no patient required IABP after surgery and there was no difference on the post operative CK-MB level, on the cardiac index and on the pulmonary pressure between two groups. The number of patients who had complete A-V block after release of aortic cross clamping was significantly smaller in nicardipine group than in diltiazem group: 45.7% in diltiazem group vs. 6.9% in nicardipine group at 30 minutes and 21.7% vs. 6.9% at 60 minutes. We conclude that the suppressive effect on A-V conduction system was significantly lower in nicardipine cardioplegia than in diltiazem cardioplegia in the patients undergoing coronary bypass operation.

[Location of PERIFIX SOFT epidural catheter investigated by X-ray].

It is known that the course of catheter placement is related to the firmness of catheter. This paper reports the results of roentgenographic analysis of the location of catheters (20G PERIFIX SOFT catheter-B. Braun Melsungen-blind tip with three side holes) inserted into the lumbar epidural space in 20 patients. Epidural catheterization was performed in patients on the lateral decubitus position. The epidural space was identified by the loss of resistance technique with a 17 gauge Tuohy needle, with median approach. Post-operatively, the injection of 0.5 ml radiopaque solution (Iopamidol) through the catheter was made. A-P X-ray film showed that 70 per cent of epidural catheters were inserted straightly cephalad. It has been reported that the optimum hardness and blind tip of the catheter are required for the good epidural placement. PERIFIX SOFT epidural catheter showed the good result for this purpose. From the recent anatomical observation by MRI, epi-dural space takes various figures depend on the location. Since posterior median part is the widest part in lumbar region, catheter placement should be done in this area. This will increase the success of straight placement of the epidural catheter.

[A study to predict the clinical efficacy of house dust mite immunotherapy in bronchial asthmatics].

To predict the clinical efficacy of house dust mite immunotherapy (IT), clinical factors before IT were analyzed in relation to clinical efficacy in bronchial asthmatics treated by standard IT method. In 111 asthmatics treated by IT, 88 cases (80%) obtained favorable results over a one-year period, while only 39% of asthmatics without IT showed clinical improvement (p < 0.05, chi 2 test). Factors including severity, skin test threshold, age, age at which IT was started, duration of asthma, onset of asthma, FEV1.0% and serum IgE levels before IT were analyzed. Severity showed the most significant influence on clinical efficacy (r = 0.412, p < 0.01). A study to determine whether some specific criteria could be used to predict the clinical efficacy of IT was then carried out. Using multivariate analysis with the factors above mentioned, the clinical efficacy ranging from deteriorated to good response could be expressed as a formula with a multi-regression coefficient of 0.56, p < 0.05. Moreover, the application of linear discriminating analysis gave an 80% true positive discriminating rate in 75 asthmatics. In both methods, severity seemed to be the most important factor, skin test threshold next and FEV1.0% third. The other factors were not significant. Hopefully, the use of this formula in clinical practice will improve the efficacy of IT, thus providing further therapeutic benefits to bronchial asthmatics.

[Chemotherapy of advanced bone and soft tissue sarcoma].

The primary site of metastasis of bone and soft tissue sarcoma is the lung. Control of these sarcomas depends upon the prevention and treatment of their pulmonary metastasis. The introduction of a chemotherapy consisting mainly of Adriamycin and high-dose methotrexate dramatically improved the prognosis of osteosarcoma. However the effectiveness of chemotherapy has not yet been duplicated in soft tissue sarcomas except some childhood sarcomas. We analyzed the clinical data for pulmonary metastasis of osteosarcomas and soft tissue sarcomas. Based on these analyses, we tried to clarify the nature of pulmonary metastasis of these sarcomas and to evaluate its response to treatment, that this would yield clues to future treatment of these sarcomas.