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1.
Minerva Surg ; 76(6): 592-597, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34047529

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with a high incidence of postoperative pulmonary complications (PPCs). When untreated COPD is found before lung cancer surgery, we have been actively intervening therapeutically with inhaled long-acting muscarinic antagonist (LAMA)/long-acting ß2-agonist (LABA) combinations. We investigated the efficacy of preoperative LAMA/LABA treatment. METHODS: We reviewed data from 261 patients who underwent pulmonary resection for primary lung cancer. Of these, 59 patients showed unrecognized obstructive ventilatory impairment on respiratory function testing. We administered inhaled drugs for 38 patients, of whom 22 patients treated with LAMA/LABA combinations and diagnosed with COPD were retrospectively analyzed regarding improvement of respiratory function and postoperative course. RESULTS: Median duration of LAMA/LABA treatment was 19.5 days (interquartile range (IQR), 10.5-28.3 days). Percentage predicted vital capacity (%VC) (pretreatment: 95.6%, IQR 91.9-111.7 vs. posttreatment 102.8%, IQR 92.3-113.0), forced expiratory volume in 1 s (FEV1) (1.76 L, 1.43-2.12 vs. 2.00 L, 1.78-2.40), forced VC (FVC) (2.96 L, 2.64-3.47 vs. 3.22 L, 2.95-3.74) and percentage predicted FEV1 (80.1%, 68.4-97.0 vs. 91.6%, 80.3-101.9) were all significantly improved (P<0.05 each). FEV1/FVC tended to be improved, but not significantly. No significant difference in improvement of respiratory function was seen between short-term (≤2 weeks) and normal-term (>2 weeks) treatment. PPCs occurred in 4 of 22 patients (18.2%), showing no significant difference compared to patients with COPD previously treated with inhaled drugs (2/20; 10.0%). CONCLUSIONS: Respiratory function is improved by preoperative LAMA/LABA treatment even in the short term. Starting treatment allows even COPD patients diagnosed on preoperative screening to experience the same frequency of PPCs as previously treated patients.


Assuntos
Neoplasias Pulmonares , Doença Pulmonar Obstrutiva Crônica , Agonistas de Receptores Adrenérgicos beta 2 , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Agonistas Muscarínicos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos
2.
J Rural Med ; 14(1): 73-77, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31191769

RESUMO

Objectives: Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for surgical site infections (SSIs). However, few studies have evaluated the rate of nasal carriage of MRSA and its effect on SSIs in patients undergoing general thoracic surgery. We investigated the importance of preoperative screening for nasal carriage of MRSA in patients undergoing general thoracic surgery. Patients and Methods: We retrospectively analyzed 238 patients with thoracic diseases who underwent thoracic surgery. We reviewed the rates of nasal carriage of MRSA and SSIs. Results: Results of MRSA screening were positive in 11 of 238 patients (4.6%), and 9 of these 11 patients received nasal mupirocin. SSIs occurred in 4 patients (1.8%). All 4 patients developed pneumonia; however, MRSA pneumonia occurred in only 1 of these 4 patients. No patient developed wound infection, empyema, and/or mediastinitis. SSIs did not occur in any of the 11 patients with positive results on MRSA screening. Conclusions: The rates of nasal carriage of MRSA and SSIs were low in this case series. Surveillance is important to determine the prevalence of MRSA carriage and infection in hospitals, particularly in the intensive care unit. However, routine preoperative screening for nasal carriage of MRSA is not recommended in patients undergoing general thoracic surgery.

3.
Eur J Cardiothorac Surg ; 49(4): 1063-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26324682

RESUMO

OBJECTIVES: Video-assisted thoracoscopic surgery (VATS) lobectomy is classified into hybrid VATS (direct and video vision) and thoracoscopic VATS (video vision only). In this study, the outcomes of hybrid VATS and thoracoscopic VATS for clinical stage I lung cancer were compared using a propensity score-matching analysis. METHODS: Hybrid and thoracoscopic VATS were performed in 178 and 76 patients, respectively. Propensity scores were calculated using logistic regression analysis and matched within a score of ±0.03 for age, sex, size of tumour, Charlson comorbidity index, preoperative therapy, percent vital capacity, forced expiratory volume in 1 s, clinical stage, pathological stage and histology. RESULTS: In the non-matched analysis, the results for hybrid and thoracoscopic VATS, respectively, were as follows: mean age, 69 ± 9 and 66 ± 10 years (P = 0.04); tumour size, 24 ± 10 and 20 ± 7 mm (P < 0.01); 2-deoxy-2 [F-18]fluorodeoxyglucose positron emission tomography SUV, 5.6 ± 4.4 and 3.6 ± 3.2 (P < 0.01); clinical stage (IA/IB), 130/48 and 69/7 (P < 0.01); pathological stage (IA/IB/IIA and IIB/IIIA and IIIB), 89/56/15/18 and 57/14/2/3 (P < 0.01); postoperative complications, 66 (37.1%) and 16 (21.1%; P = 0.01); respiratory complications, 32 (18.0%) and 6 (7.9%; P = 0.04); 5-year overall survival (OS), 77.0 and 88.8% (log-rank P = 0.045); and 5-year disease-free survival (DFS), 67.2 and 81.1% (log-rank P = 0.02). In 66 matched cases, the results for hybrid and thoracoscopic VATS, respectively, were as follows: mean operative time, 245 ± 96 and 285 ± 85 min (P = 0.01); blood loss, 95 ± 100 and 86 ± 123 ml (P = 0.67); mean duration of drainage, 3.6 ± 2.7 and 3.2 ± 2.2 days (P = 0.37); postoperative complications, 21 (31.8%) and 14 (21.2%; P = 0.17); respiratory complications, 11 (16.7%) and 5 (7.6%; P = 0.11); 5-year OS, 72.5 and 86.0% (log-rank P = 0.25); and 5-year DFS, 68.4 and 77.2% (log-rank P = 0.17). CONCLUSIONS: In this single-institution, propensity score-matched study, hybrid VATS showed a shorter operative time and similar outcomes compared with thoracoscopic lobectomy for clinical stage IA lung cancer.


Assuntos
Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Pneumonectomia/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida/métodos , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Idoso , Estudos de Coortes , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Pneumonectomia/mortalidade , Pontuação de Propensão , Análise de Sobrevida , Cirurgia Torácica Vídeoassistida/mortalidade
4.
Surg Today ; 46(2): 183-7, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25700843

RESUMO

PURPOSE: We herein investigated the influence of smoking on changes in the levels of perioperative oxidative stress after pulmonary resection. METHODS: A total of 31 patients with primary lung cancer who underwent curative pulmonary lobectomy were analyzed prospectively. The degree of perioperative oxidative stress was evaluated based on the serum levels of derivatives of reactive oxygen metabolites (d-ROM) and biological antioxidant potential (BAP). The patients were divided into two groups: group A (smoking < 40 pack-years) and group B (smoking ≥ 40 pack-years). The d-ROM and BAP measurements were obtained preoperatively, postoperatively and on the first, second, third and fifth postoperative days. RESULTS: In all 31 cases, the d-ROM values were higher on the third and fifth postoperative days than preoperatively. The extent of change in the d-ROM levels was greater in group A than in group B on the second, third and fifth postoperative days (1.05 ± 0.159 vs. 0.920 ± 0.205, p = 0.008; 1.20 ± 0.233 vs. 1.02 ± 0.186, p = 0.032; 1.34 ± 0.228 vs. 1.07 ± 0.200, p = 0.003, respectively). In contrast, there were no significant differences in the BAP values. The maximum increase in the d-ROM level and decrease in the BAP level negatively correlated with the amount of smoking (|r| = 0.428, p = 0.016 and |r| = 0.357. p = 0.049, respectively). CONCLUSIONS: Surgical stress associated with pulmonary lobectomy induces oxidative stress. In addition, smoking reduces the oxidative stress reaction, and the degree of this change is correlated with the amount of smoking.


Assuntos
Estresse Oxidativo , Período Perioperatório , Pneumonectomia , Fumar , Idoso , Idoso de 80 Anos ou mais , Antioxidantes/análise , Biomarcadores/sangue , Humanos , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Espécies Reativas de Oxigênio/sangue , Fumar/sangue , Fumar/fisiopatologia , Fatores de Tempo
5.
Eur J Cardiothorac Surg ; 46(3): 375-9; discussion 379, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24562008

RESUMO

OBJECTIVES: Recently, lung segmental resection has been increasingly performed in patients with lung cancer. In this study, the results of radical segmentectomy (RS) and palliative segmentectomy (PS) were compared retrospectively. METHODS: Segmentectomy was performed to remove a primary lung cancer in 87 cases. RS was performed for pure ground-glass opacity (GGO), >50% GGO and diameter less than 2 cm and less than 10 mm solid tumours. PS was performed in patients with poor lung function or relapse, or at high risk for surgery. A total of 84 cases, excluding 3 cases of relapse, were investigated. RESULTS: The pathological stage of RS was IA in 32 (94.1%) and IB in 2 (5.9%). The pathological stage of PS was IA in 23 (46.0%), IB in 15 (30.0%), IIA in 5 (10.0%), IIB in 1 (2.0%), IIIA in 4 (8.0%) and IV in 2 (4.0%). The preoperative characteristics of RS were compared with those of PS for pathological stage I. The mean age was significantly lower for RS cases (67.4 ± 9.9 years) than for PS cases (73.0 ± 9.0 years; P = 0.013). Tumour size was significantly smaller in RS cases (14.7 ± 4.6 mm) than in PS cases (22.0 ± 8.9 mm; P < 0.001). The tumour standardized uptake value of 18F-fluorodeoxyglucose positron emission tomography was significantly lower in RS cases (1.2 ± 1.6) than in PS cases (6.0 ± 6.1; P < 0.001). Serum carcinoembryonic antigen level was lower in RS cases (2.8 ± 1.8 ng/ml) than in PS cases (4.9 ± 5.0; P = 0.019). The mean duration of drainage was shorter in RS (2.5 ± 0.7 days) than in PS (3.9 ± 2.6 days; P = 0.004). Postoperative complications occurred in 6 RS cases (17.6%) and 12 PS cases (29.3%). Overall 5-year survival was higher in RS (100%) than in PS (66.2%; P = 0.003). Five-year disease-free survival was higher in RS (100%) than in PS (66.2%; P = 0.002). Recurrence was detected in 6 PS patients; 10 PS cases showed tumour with GGO and survived without recurrence. CONCLUSIONS: Our RS is feasible for stage I lung cancer with specific computed tomography features, such as small size, GGO or peripheral location.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Animais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Estudos Retrospectivos , Análise de Sobrevida
6.
Gen Thorac Cardiovasc Surg ; 62(1): 53-7, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23990049

RESUMO

OBJECTIVE: We analyze the safety and efficacy of one-stage bilateral pulmonary resections for pulmonary metastases via a bilateral approach. METHODS: We retrospectively analyzed 154 cases with pathologically verified pulmonary metastases which underwent curative pulmonary resection. Intraoperative and perioperative variables were evaluated. RESULTS: One hundred and thirty cases underwent unilateral pulmonary metastasectomy (group U), and the other 24 cases with bilateral pulmonary metastases underwent one-stage bilateral pulmonary resections (group B). Operation time in group B was significantly longer than in group U (354 ± 132 vs. 203 ± 110 min; p < 0.001), but was not longer than double that in group U (407 ± 219 min; p = 0.540). Operative blood loss was not significantly greater in group B than group U (113 ± 158 vs. 76 ± 138 ml; p = 0.069). Neither duration of postoperative hospital stay nor incidence of postoperative complications differed between the two groups. Hospitalization costs in group B were significantly greater than in group U (257 ± 120 × 10(4) vs. 168 ± 69.2 × 10(4) yen; p < 0.001), but they were significantly less than double those in group U (336 ± 138 × 10(4) yen; p < 0.001). CONCLUSIONS: We consider one-stage bilateral pulmonary metastasectomy to be safe for bilateral pulmonary metastases. Moreover, it may offer an economic benefit by avoiding the expenses associated with a two-stage operation.


Assuntos
Neoplasias Pulmonares/secundário , Pneumonectomia/métodos , Idoso , Feminino , Hospitalização/economia , Humanos , Tempo de Internação , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Interact Cardiovasc Thorac Surg ; 16(4): 423-5, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23315184

RESUMO

Lung segmental resection is of two types: a simple type with resection of only one intersegmental plane, such as lingual or superior segmentectomy; and a complicated type with resection of two or more intersegmental planes, such as anterior segmentectomy. We present a method of identifying the intersegmental plane by physiological function. First, we cut the segmental pulmonary artery and vein. The entire lobe is then inflated with pure oxygen for 5 min. Immediately after oxygen inflation, the segmental bronchus is deflated and stapled. After a couple of minutes, the intersegmental plane is easily detected. In 117 patients who underwent segmentectomy, mean blood loss was 122 ± 193 ml and mean duration of drainage was 3.5 ± 4.8 days. Postoperative complications related to operative procedures occurred in 14 cases (12.0%). Our method of detecting intersegmental planes is convenient and useful for subsegmental resection, particularly for complicated-type cases.


Assuntos
Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida , Idoso , Eletrocoagulação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Artéria Pulmonar/cirurgia , Veias Pulmonares/cirurgia , Grampeamento Cirúrgico , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Ultrassônicos
8.
Gen Thorac Cardiovasc Surg ; 61(6): 359-61, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22865281

RESUMO

Segmental resection is a useful procedure to preserve respiratory function. We report a case of lower apical segmentectomy for relapse after initial video-assisted left upper lobectomy to avoid completion pneumonectomy. After 4 years of follow-up, the patient is doing well with no evidence of disease.


Assuntos
Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia/cirurgia , Pneumonectomia/métodos , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Pessoa de Meia-Idade , Reoperação , Cirurgia Torácica Vídeoassistida
9.
Eur J Cardiothorac Surg ; 41(6): e161-5, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22504895

RESUMO

OBJECTIVES: Postoperative acute exacerbation (PAE) of idiopathic pulmonary fibrosis (IPF) is a serious complication that is hard to treat. Therefore, it is important to manage IPF patients in such a way as to avoid PAE. Conversely, the relationship between postoperative acute lung injury and perioperative fluid administration has been reported. Herein, we analyse the perioperative risk factors of PAE of IPF, including fluid management. METHODS: Fifty-two patients diagnosed as having clinical IPF who underwent pulmonary resection (segmentectomy, lobectomy or bilobectomy) for primary lung cancer were analysed retrospectively. Preoperative predictive factors and perioperative management items, especially fluid management, were evaluated. RESULTS: The incidence of PAE of IPF was 13.5% (7 of 52 patients). Six patients (85.7%) died of respiratory failure induced by uncontrollable PAE of IPF. Upon univariate analysis, the amount of the intraoperative fluid infused (ml/kg/h), the intraoperative fluid balance (ml/kg/h) and the preoperative C-reactive protein (CRP) level were found to be significantly higher in IPF patients who developed PAE than in those who did not. A multivariate logistic regression analysis showed that the intraoperative fluid balance and the preoperative CRP were prognostic factors for PAE of IPF [P = 0.026, odds ratio (OR) = 1.312 and P = 0.048, OR = 1.280, respectively]. CONCLUSIONS: To prevent PAE of IPF, intraoperative management that minimizes intravenous fluid administration is essential. Moreover, caution is particularly important in patients with preoperative evidence of inflammation.


Assuntos
Fibrose Pulmonar Idiopática/prevenção & controle , Cuidados Intraoperatórios/métodos , Neoplasias Pulmonares/cirurgia , Equilíbrio Hidroeletrolítico/fisiologia , Doença Aguda , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Feminino , Hidratação/efeitos adversos , Hidratação/métodos , Humanos , Fibrose Pulmonar Idiopática/etiologia , Cuidados Intraoperatórios/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Prognóstico , Estudos Retrospectivos , Fatores de Risco
12.
Gen Thorac Cardiovasc Surg ; 59(4): 297-300, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21484560

RESUMO

We report two cases of pulmonary epithelioid hemangioendothelioma (PEH). Both patients presented with multiple bilateral pulmonary nodules, <10 mm diameter, on computed tomography (CT). Multiple pulmonary metastases were considered, but no primary malignant lesion was detected by other imaging modalities including (18)F-fl uorodeoxyglucose positron emission tomography ((18)F-FDG-PET)/CT. Moreover, the nodules did not show increased uptake of (18)F-FDG. We performed pulmonary wedge resections by video-assisted thoracoscopic surgery (VATS). Histological and immunohistochemical analysis revealed PEH in both. Positivity for the monoclonal antibody MIB-1 in the tumor cells was 5% in the fi rst case and 5%-10% in the second case. Slow tumor progression was detected with CT in the second case. Although (18)F-FDG PET/CT is effective for screening other malignant lesions, it does not appear to be of direct use in the diagnosis and surgical planning of PEH. Pathological diagnosis by VATS is the most effective method. MIB-1 positivity should be analyzed as to whether it is a prognostic factor of PEH.


Assuntos
Hemangioendotelioma Epitelioide , Neoplasias Pulmonares , Nódulos Pulmonares Múltiplos , Adulto , Idoso , Anticorpos Antinucleares , Anticorpos Monoclonais , Biópsia , Feminino , Fluordesoxiglucose F18 , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/cirurgia , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/diagnóstico , Nódulos Pulmonares Múltiplos/cirurgia , Pneumonectomia/métodos , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
13.
J Heart Lung Transplant ; 27(6): 642-8, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18503964

RESUMO

BACKGROUND: Graft damage due to acute rejection has been reported as one of the risk factors in the chronic stage of cardiac and renal allografts. This study was designed to elucidate the histologic changes of grafts after ongoing acute allograft rejection was discontinued in models of lung re-isotransplantation. METHODS: WKAH rat lungs were orthotopically transplanted into F344 recipients. Three days (3A group) and 5 days (5A group) after the first allotransplantation, the grafts were re-isotransplanted back into the WKAH rats (3RA and 5RA groups, respectively). Five days (5I group) after the first isotransplantation, the grafts were re-isotransplanted back into the WKAH rats (5RI group). The grafts were removed 30 and 60 days after re-isotransplantation and assessed histologically. RESULTS: Typical acute allograft rejection developed in the 3A and 5A groups, and the changes were reduced after re-isotransplantation, although they remained significantly greater in the 5RA group than in the 3RA and 5RI groups. For intimal hyperplasia, the graft score 60 days after re-isotransplantation in the 5RA group was significantly higher than in the 5RI and 3RA groups. The changes in airway inflammation were significantly greater in the 5RA group than in the 3RA and 5RI groups at 60 days. Peribronchiolar fibrosis was significantly more frequent in the 5RA and 3RA groups than in the 5RI group. CONCLUSIONS: Acute rejection and airway inflammation corresponded to the magnitude of rejection before retransplantation. Significant intimal hyperplasia developed in severe acute rejection, and peribronchiolar fibrosis occurred after the first acute rejection.


Assuntos
Rejeição de Enxerto/patologia , Transplante de Pulmão/patologia , Transplante Homólogo/patologia , Túnica Íntima/patologia , Animais , Modelos Animais de Doenças , Fibrose/etiologia , Hiperplasia , Ratos , Ratos Endogâmicos F344 , Reoperação , Fatores de Risco , Fatores de Tempo
14.
J Hepatobiliary Pancreat Surg ; 14(6): 582-5, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18040625

RESUMO

We describe a patient who underwent pulmonary resection three times for metastatic lung cancer from hepatocellular carcinoma (HCC). A 56-year-old man, who had a past history of right hepatic lobectomy for HCC, was referred to our department with an abnormal finding on chest computed tomography (CT). Chest CT showed three abnormal shadows, in the right upper lobe (S3b), right middle lobe (S5), and right lower lobe (S10), respectively, and there was no evidence of intrahepatic recurrence. He underwent surgical resections (right upper lobectomy and partial resections) for the metastatic lung cancer from HCC. Subsequently, 12 and 16 months after the first pulmonary resection, metastatic lung cancer recurred, in right S6 and S9, respectively. Because there was no evidence of intrahepatic recurrence and because of the feasibility of curative resection, we performed partial pulmonary resections. He had no postoperative morbidity, and is alive with no evidence of disease 60 months after the first pulmonary resection. Twelve cases of repeat pulmonary resections for metastatic lung cancer from HCC have been reported in the literature, and the authors of these reports described that repeated pulmonary resections for metastatic lung cancer from HCC resulted in long-term survival. Repeat pulmonary resections for metastatic lung cancer from HCC can be an effective treatment for patients with such metastases.


Assuntos
Carcinoma Hepatocelular/secundário , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Carcinoma Hepatocelular/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reoperação , Tomografia Computadorizada por Raios X
15.
Surg Today ; 37(8): 704-7, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17643220

RESUMO

We herein report a rare case of ectopic pancreatic acinar cell carcinoma (ACC) which presented as a submucosal tumor of the pylorus. A 73-year-old man came to our hospital presenting with epigastralgia. Esophago-gastroduodenal endoscopy showed no mucosal lesions, but a submucosal tumor was observed around the pylorus. Abdominal computed tomography revealed two round masses. One was located in the pylorus, while the other was found between the portal vein and the inferior vena cava. An examination of a biopsy specimen was inconclusive. We diagnosed a gastrointestinal stromal tumor or malignant lymphoma preoperatively, and decided to perform an operation in order to confirm the diagnosis and select the optimal treatment. Intraoperatively, the mass in the pylorus invaded the pancreatic head, and the lymph node in the hepatoduodenal ligament was swollen. We performed a pancreaticoduodenectomy as a radical excision. The resected specimen showed the 7.6 x 4.9-cm size tumor to mainly originate from the pylorus. Histopathologically, the tumor was identified as pancreatic ACC with lymph node metastasis. The tumor cells were labeled by immunohistochemical staining for alpha1-antitrypsin. Because of the tumor location, we considered the tumor to have originated from the ectopic pancreatic tissue in the stomach. This is only the second case of ACC originating from an ectopic pancreas reported in the literature.


Assuntos
Carcinoma de Células Acinares/patologia , Neoplasias Pancreáticas/patologia , Piloro/patologia , Neoplasias Gástricas/secundário , Idoso , Carcinoma de Células Acinares/etiologia , Carcinoma de Células Acinares/cirurgia , Humanos , Masculino , Neoplasias Pancreáticas/cirurgia , Piloro/cirurgia , Neoplasias Gástricas/patologia
16.
J Surg Res ; 124(2): 312-7, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15820263

RESUMO

BACKGROUND: The purpose of the present study is to examine whether sonoporation with doxorubicin enhances suppression of intimal hyperplasia (IH) in a vein graft model. MATERIALS AND METHODS: After the administration of 1.5 mg/kg doxorubicin intravenously, the right external jugular vein of six rabbits was exposed at 2 W/cm2 and 1 MHz of ultrasound for 2 min (Sonoporation group). Tissue doxorubicin concentration was measured. In 48 rabbits, the right common carotid artery was ligated after performing a vein graft bypass. The animals were divided into the following four groups: the C0 group (surgical procedure only); the C0S (sonoporation without doxorubicin); the C1 (doxorubicin administration only); the C1S (sonoporation with doxorubicin). Twenty-four grafts were subjected to Elastic van Gieson staining for morphometric analysis 4 weeks after the operation; others were subjected to TdT-mediated X-dUTP nick end-labeling for detection of apoptic cells and to staining with a monoclonal antibody against the proliferating cell nuclear antigen for assessment of cell proliferation 1 week after. RESULTS: The tissue doxorubicin concentration was significantly higher in the Sonoporation group than in the Control group. Compared with the C0 group, IH was not suppressed in the C1 group but was significantly suppressed in the C1S group. Sonoporation with doxorubicin administration suppressed IH significantly (C1 group versusC1S group: P < 0.05). Cell apoptosis was induced and cell proliferation was suppressed significantly in the C1S group. CONCLUSIONS: Sonoporation with doxorubicin suppressed IH of the vein graft. Sonoporation may be effective in coronary or peripheral revascularization using vein grafts.


Assuntos
Antibióticos Antineoplásicos/farmacocinética , Doxorrubicina/farmacocinética , Veias Jugulares/patologia , Veias Jugulares/transplante , Ultrassom , Anastomose Cirúrgica , Animais , Antibióticos Antineoplásicos/efeitos adversos , Apoptose , Artéria Carótida Primitiva/cirurgia , Divisão Celular , Doxorrubicina/efeitos adversos , Hiperplasia , Marcação In Situ das Extremidades Cortadas , Injeções Intravenosas , Masculino , Coelhos , Túnica Íntima/patologia
17.
Ann Vasc Surg ; 19(1): 108-12, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15714378

RESUMO

In a case of thrombosed abdominal aortic aneurysm, intraluminal and intrathrombotic pressures were simultaneously measured 3 cm distal to the left renal vein level (#1), at the inferior mesenteric artery level (#2) (3 cm distal to #1), 3 cm distal to #2 (#3), and at the aortic bifurcation level (#4) (3 cm distal to #3). The intraluminal pressure (at #1) was 154/72 (101) mmHg, and the intrathrombotic pressures at #2, #3, and #4 were 138/77 (100), 137/74 (97), and 135/68 (96) mmHg, respectively. The percentages of the systolic and mean intrathrombotic pressures to the intraluminal pressure were 90% and 99% at #2, 89% and 96% at #3, and 88% and 95% at #4, respectively. The mural thrombus of an aneurysm does not significantly decrease the pressure on the aneurysmal wall, even in a thrombosed aneurysm.


Assuntos
Aneurisma da Aorta Abdominal/fisiopatologia , Pressão Sanguínea/fisiologia , Trombose/fisiopatologia , Idoso , Artéria Femoral/fisiopatologia , Humanos , Artéria Ilíaca/fisiopatologia , Masculino , Artéria Mesentérica Inferior/fisiopatologia , Veias Renais/fisiopatologia
18.
J Vasc Surg ; 39(5): 1125-7, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15111873

RESUMO

The first case of an aneurysm of the femoral artery occupationally exposed to a vibratory tool is described. A 72-year-old man with a right common femoral artery aneurysm had had an occupational history of putting a "breaker," which breaks concrete into pieces by means of powerful vibration, on the right groin for more than 10 years. The patient underwent aneurysmectomy and graft replacement, with reconstruction of the deep femoral artery. Pathologic examination of the resected aneurysm revealed fibrosis and lipid deposition in the intima, well-maintained elastic fibers without disruption in the media, and thickened adventitia, in place of the typical findings of atherosclerosis.


Assuntos
Aneurisma/etiologia , Transtornos Traumáticos Cumulativos/cirurgia , Artéria Femoral , Doenças Profissionais/etiologia , Vibração/efeitos adversos , Idoso , Aneurisma/cirurgia , Humanos , Masculino , Doenças Profissionais/cirurgia , Fatores de Tempo
20.
Ann Thorac Surg ; 76(4): 1298-301, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14530037

RESUMO

A 68-year-old man with aortic arch aneurysm was referred to our department. Preoperative carotid echography and magnetic resonance angiography revealed occlusion of the left internal carotid artery. Single-photon emission computed tomography scanning indicated that cerebral blood flow was decreased and reactivity to acetazolamide was reduced in the left temporal lobe. A successful superficial temporal artery-middle cerebral artery anastomosis was first made by neurosurgeons. A postoperative single-photon emission computed tomography scan showed that cerebral blood flow and reactivity to acetazolamide were remarkably improved. Two months after the anastomosis, the aortic arch aneurysm was successfully repaired.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Revascularização Cerebral , Artéria Cerebral Média/cirurgia , Artérias Temporais/cirurgia , Acetazolamida , Idoso , Aorta Torácica , Artéria Carótida Interna , Estenose das Carótidas/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada de Emissão de Fóton Único
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