[A case of catamenial hemoptysis (pulmonary endometriosis) cured by VATS lobectomy].

We report here a case in which for hemoptysis during menstruation (catamenial hemoptysis) right middle lobectomy was performed thoracoscopically under a preoperative diagnosis of pulmonary endometriosis with a successful outcome. The patient was a 27-year-old housewife who from the age of 24 years experienced hemoptysis during menstruation, and was diagnosed as having pulmonary endometriosis on the basis of detailed examinations including bronchoscopy and chest CT. From the age of 26 years hormone therapy was administered, but the hemoptysis recurred with the menstruation following its cessation. After admission to this department bronchoscopy performed at the time of menstruation revealed bleeding from right B4 while chest CT showed an abnormal shadow in right S4 b. Right middle lobectomy was then performed thoracoscopically under a diagnosis of right middle lobe endometriosis. In the resected specimen findings of pulmonary hemosiderosis, granulomatous phlebitis and micrometastases from a thyroid cancer were noted. The postoperative course was favorable with no further episodes of hemoptysis occurring. In this case histological proof of endometriosis could not be obtained, but the diagnosis of pulmonary endometriosis was strongly suggested by the clinical course and objective findings such as pulmonary hemosiderosis.

An experimental study on spinal cord ischemia during cross-clamping of the thoracic aorta: the monitoring of spinal cord ischemia with motor evoked potential by transcranial stimulation of the cerebral cortex in dogs.

The usefulness of spinal motor evoked potential by transcranial stimulation of the motor cortex (MEPT) in detecting spinal ischemia and predicting postoperative neurological dysfunction was evaluated using a model of spinal ischemia. Group 1 was comprised of 11 dogs used for measuring the basic wave form of spinal MEPT. The normal spinal MEPT response curve consists of two major peaks: peak I and peak II. The latency of peak I and peak II at T13-L1 was 6.0 +/- 0.6 and 7.1 +/- 0.6 msec, and the amplitude, 3.3 +/- 1.6 and 6.1 +/- 2.6 microV, respectively. Group 2 was comprised of six animals subjected to spinal ischemia, in which a time-related deterioration of the MEPT as well as evoked spinal cord potential (ESP) was demonstrated. The time taken until the loss of peak I and peak II was 19.2 +/- 5.3 and 21.7 +/- 6.2 min, respectively, while the time taken until the loss of ESP was 36.7 +/- 14.0 min. In group 3, comprised of seven animals, the aorta was unclamped and the animals were allowed to recover when the spinal MEPT had disappeared. Four had paraparesis immediately after the operation, two had a normal gait, one died, and one developed spastic paraplegia after 24 h. We concluded that the change in spinal MEPT during spinal ischemia occurred earlier than the change in ESP, and that the loss of MEPT suggested irreversible spinal cord damage.

[A review of post-operative multiple organ failure in peripheral arterial diseases].

Two-hundred- and-fifty-one patients of peripheral arterial diseases underwent 281 operations for past 11 years in our institute, and multiple organ failure (MOF) occurred in 10 patients (4.0%). These patients were reviewed and were compared with in other diseases. Survival rate was 50% and all the patients with 4 or more organ disorders died. Incidence and survival rate were not significantly different from operative time, blood loss and blood transfusion. Significant difference was observed between elective operation (3.0%) and emergent operation (20.0%). Compared with other diseases, MOF occurred more rarely in peripheral arterial diseases than in aortic aneurysms, but occurred 1.4 times of digestive diseases. While the gastro-intestinal bleeding as the initial failure organ occurred more frequently in peripheral arterial diseases than in other diseases, heart and respiratory failures were rare. MOF occurred after peripheral arterial intervention as well as other abdominal and thoracic surgery. To avoid MOF it is important to avoid MOF that the emergent surgery should be kept out and that general status, especially the grade of diabetes mellitus should be evaluated sufficiently.

[Surgical treatment and result of high aortic occlusion].

Twenty-one patients with high aortic occlusion treated at our institution from 1967 to 1986 were reviewed. There were seventeen men aged from 39 to 78 (mean age: 61.0) underwent surgical intervention. All patients presented clinical manifestations of vascular insufficiency of the lower limbs; rest pain in eleven patients, intermittent claudication in nine and the others. Sexual impotence was present in eight patients. Renal artery involvement was seen in one case, and renovascular hypertension was observed in this patient. Hypertension and ischemic heart disease were present in twelve cases, cerebrovascular insufficiency in one case, diabetes mellitus in three cases. The following surgical treatments were performed; end-to-end Y-shaped Dacron graft implantations from the infrarenal abdominal aorta to the common femoral arteries in six patients, onlay V-shaped Dacron graft implantations in three patients, axillofemoral extra-anatomic bypass in four patients, and amputation only in one. The hospital mortality was 18% (3/17). Twelve patients discharged from the hospital are followed up (average period was 118 months), but the follow up was lost in two patients. There were two late deaths, which course was not related to operations. The prognosis of high aortic occlusion after anatomic bypass is good, thus it was concluded that anatomic bypass with Y-shaped or V-shaped Dacron graft was recommended and extra-anatomic bypass might be performed only in a high risk patient.