Diaphragmatic repair of hepatic hydrothorax with VATS after abdominal insufflation with CO(2).

Hepatic hydrothorax is defined as the presence of a significant pleural effusion that develops in a patient with cirrhosis of the liver who does not have an underlying cardiac or pulmonary disease. There have been few published case reports dealing with hepatic hydrothorax treated surgically. Recently, we treated a patient with refractory hepatic hydrothorax by directly suturing the diaphragmatic defect during VATS. During surgery, the diaphragmatic defect was identified by using abdominal insufflation with CO(2) . The defect was sutured and the diaphragm was covered by polyglycolic acid felt and fibrin glue. After surgery, the patient's pleural effusion improved, his postoperative course was uneventful and he did not require a drainage tube at discharge.

Thoracoscopic one window plus puncture method for spontaneous pneumothorax.

AIM: The aim of this article is to present a new method for treating spontaneous pneumothorax, the one window plus puncture method (1WP) in which a thin endoscope is used. METHODS: With the patient in the lateral position and under one-lung ventilation, a one-window working port was created on the ventral side. An introducer was inserted on the dorsal side, and the operation to treat spontaneous pneumothorax was performed under observation with a thin endoscope, that was 2 mm to 3 mm in diameter. RESULTS: This study enrolled 540 patients, in whom thoracoscopic surgery was performed in order to treat spontaneous pneumothorax during the period from 1995 to 2004. The cases were divided into two groups: the first group comprised 324 cases (TWM group) in which surgery was performed by the two windows method (TWM), and the second group comprised 216 cases (1WP group) in which surgery was performed by the one window plus puncture method (1WP) using a thin endoscope. After surgery the two groups were compared. The TWM group consisted of 282 males and 42 females, and the patients' mean age was 32+/-14.5 years (range: 15 to 76 years). The 1WP group consisted of 202 males and 14 females, and the patients' mean age was 21.6+/-6.1 years (range: 15 to 48 years). The mean interval between hospital admission and surgery was 1.5+/-2.8 days in the TWM group and 0.9+/-1.5 days in the in the 1WP group. The mean interval between surgery and hospital discharge was 3.3+/-2.5 days in the TWM group and 2.3+/-0.7 days in the 1WP group. There was a postoperative recurrence in 13 (4%) of the cases in the TWM group, and reoperation was performed in 8 of them; and there was a recurrence in 7 (3.2%) of the cases in the 1WP group, and reoperation was performed in all of them. Thoracoscopic surgery using the thin endoscope was esthetically superior, surgical invasion was minor, and the patients were able to return to their daily lives sooner. CONCLUSIONS: A thoracoscopic surgery performed aggressively to treat spontaneous pneumothorax made it possible for the patients to return to their daily lives sooner. As thoracoscopic surgery by the 1WP method eliminates the access site on the dorsal side, used in the TWM, and utilizes only a 2 mm to 3 mm puncture, it is a more esthetic procedure, similar in terms of appearance to inserting a pleural drain without performing surgery.

Immunohistochemical study of glutathione-related enzymes and proliferative antigens in lung cancer. Relation to cisplatin sensitivity.

BACKGROUND: With resected tumor tissue from 84 patients with lung cancer, the expression of glutathione peroxidase (GPX), glutathione reductase (GR), proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR) was examined in relation to cisdiamminedichloroplatinum (CDDP) sensitivity. METHODS: The CDDP sensitivity was assessed from an increase of cells in the S-phase or G2M-phase by a DNA histogram after the tumor cells were incubated in a CDDP solution. The expression of GPX, GR, PCNA, and EGFR for each tumor was studied with an indirect immunoperoxidase technique on paraffin-embedded tissues. RESULTS: The percentage of patients sensitive to CDDP according to the histologic type was 86% for small cell carcinomas, 40% for large cell carcinomas, 31% for squamous cell carcinomas, and 6% for adenocarcinomas. There was an inverse relationship between CDDP sensitivity and the frequency of GPX and GR expression, and both were significantly different among histologic types. The GPX and GR expression was significantly lower in the CDDP-sensitive group than in the resistant group (P < 0.01). However, the expression of PCNA and EGFR was significantly lower in the sensitive group in non-small cell carcinomas and squamous cell carcinomas (P < 0.05). CONCLUSIONS: From the above findings, an immunohistochemical study of these antigens may be useful for predicting CDDP sensitivity in lung cancer.

Prognostic implications of DNA histogram, DNA content, and histologic changes of regional lymph nodes in patients with lung cancer.

Forty-six cases of resected lung cancer, including 20 cases at Stages I and II and 26 cases at Stage III (N2), were subdivided into two groups: a good prognosis group with a longer survival period and a poor prognosis group in which the patients died earlier of the cancer. From paraffin-embedded lymph node tissues of these patients, the authors examined DNA histogram pattern and DNA content, using flow cytometry, and histologic hyperplasia of germinal center and paracortical area; they also evaluated their correlation with the prognosis. In the good prognosis group at Stages I and II, paracortical hyperplasia (PH) of the lymph nodes was observed significantly more frequently. In the good prognosis group at Stage III, the incidence of PH, G2M phase in the DNA histograms, and DNA content were all significantly higher. DNA content was positively correlated with the grade of PH.

[Traumatic transection of the left main bronchus and laryngeal fracture resulting from blunt trauma--a successful case of emergency operation].

A 18-year-old female, who had incomplete transection of the left main bronchus and laryngeal fracture, due to blunt trauma, is reported. Chest X-ray on admission showed subcutaneous emphysema extending to the cervical soft tissues and marked pneumomediastinum. Bronchoscopic examination revealed disruption of the left main bronchus, leaving only the membranous portion. An emergency operation was performed 5 hours after the injury. A week later, bronchoscopic reexamination revealed tracheal stenosis just below the vocal cord, due to fracture of the cricoid and thyroid cartilages, which was enlarged to a certain extent by laryngoscopic intervention under cooperation of the laryngologist. The patient's postoperative course was uneventful, and two months later, was well with tracheostomy.

Relation of ABH blood group antigen expression to prognosis in lung carcinoma.

The ABH blood group antigens were studied in resected specimens from patients with lung cancer employing monoclonal antibodies against A, B and H antigens by the immunoperoxidase technique. There were no differences between paraffin-processed and fresh-frozen materials in detectability of ABH antigens. Comparing specimens at operation with those at autopsy from the same patient, the loss of A and B antigens in the latter was demonstrated more frequently than H antigen. Concerning the relation between the prognoses and the expression of ABH antigens, the group with good prognosis preserved more ABH antigens than that with poor prognosis. In contrast, the group with poor prognosis showed less ABH antigens. There were also statistical differences in antigen detectability and prognosis, particularly in stage 1 patients, adenocarcinomas and well-differentiated lung cancers.