ABSTRACT
A 56-year-old woman was admitted to our hospital with the chief complaint of left back pain. We detected left pleural effusion on chest X-ray and performed chest drainage. No malignant cells were detected in the effusion. Chest CT demonstrated a tumor shadow over the left diaphragm and left pleural effusion 6 months later. She underwent en bloc resection of the tumor and left diaphragm. Histological evaluation revealed malignant fibrous histiocytoma (MFH). Recurrent tumors were found in the abdomen 8 months after the operation, and she underwent resection of the abdominal recurrent tumors. Histological evaluation of the recurrent tumors also showed MFH. The patient died 28 months after the first operation.
Subject(s)
Diaphragm , Histiocytoma, Benign Fibrous/surgery , Muscle Neoplasms/surgery , Diaphragm/surgery , Female , Histiocytoma, Benign Fibrous/diagnosis , Humans , Middle Aged , Muscle Neoplasms/diagnosisABSTRACT
We analyzed pulmonary functions and rib cage-phrenic motions on 296 cases of chronic empyema patients who had surgical treatment. Pulmonary functions were better preserved in patients with a single step than in those with multi-step operations, and in those who had more than five operations the impairment was inevitable. Both %VC and rib cage-phrenic motions improved by decortication, and by air-plombage, but in those who developed multi-rib fractures after the latter procedure, ipsilateral chest wall motion almost disappeared. Since some restriction of rib cage-phrenic motion is inevitable after the surgery, we have developed a cuirass respirator which can synchronize with the respiration to assist the movement of the chest wall. The results attained so far are satisfactory.
Subject(s)
Postoperative Complications/therapy , Respiratory Insufficiency/therapy , Tuberculosis, Pulmonary/surgery , Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Physician's Role , Ventilators, MechanicalABSTRACT
Anterolateral multiple rib fractures near xiphoid process impaired mechanical linkage which resists distortion between pulmonary (upper) and abdominal (lower) rib cage resulting in flail chest. Repair of fractured ribs with ceramic pins improved phase shift between the diaphragm and the rib cage and the amplitude of the injured rib cage motion, and decreased rib cage distortion. Asymmetrical motion of lower rib and upper abdomen which suggested impairment of the diaphragm action on the abdominal rib cage was found in three patients whose emphysematous bullae were located in the middle and lower lung fields, and disappeared after bullectomy. To control the pressure in the pleural cavity after pneumonectomy from excessive negative pressure to atmospheric pressure with SF6 improved pulmonary function. Chest wall function can be preserved on the basis of functional anatomy and physiology of the chest wall.
