Kyobu geka. The Japanese journal of thoracic surgery最新文献

We report a case of diaphragmatic eventration treated by a combination of thoracoscopy and laparoscopy. A 49-year-old man was taken by ambulance to our hospital for emergency with a chief complaint of epigastric tightness and left-sided abdominal distention. A chest X-ray showed elevation of the left diaphragm, and diaphragmatic eventration was suspected, resulting in an initial visit to our department. A computed tomography (CT) of the thorax and abdomen showed that part of the liver, stomach, spleen, and colon splenic flexure were highly displaced cephalad, and the above symptoms were diagnosed as being caused by diaphragmatic eventration, and surgery was indicated because of the strong symptoms. The surgery was performed laparoscopically first because of the strong gastrointestinal symptoms and for safe thoracic manipulation, the stomach was suture-fixed to the diaphragmatic leg and the splenic flexure of the colon to the lateral abdomen. Next, thoracoscopic surgery was performed. The entire diaphragm was highly relaxed. The diaphragm was repaired first by resection with a stapler, followed by additional plication. The postoperative course was good, and the above symptoms disappeared completely.

A 59-year-old woman with a history of aortic dissection that began during pregnancy at the age of 34, which affected the aorta and its branches, underwent multiple surgeries, including aortic root replacement with a mechanical valve, staged total aortic replacement extending to the bilateral iliac arteries, coil embolization of a left internal thoracic artery aneurysm, and bypass surgeries from the brachiocephalic artery to the right common carotid artery and right axillary artery, as well as from the left subclavian artery to the left axillary artery. Following these procedures, genetic testing was performed, leading to a diagnosis of Marfan syndrome. Genetic test identified the mutation c.2677+5 G>A in exon 21 of the FBN1 gene (variant:NM_000138.5). Even if the family history and phenotype do not meet the diagnostic criteria, genetic testing for aortic-related genes can play a supplementary role, leading to early and proactive antihypertensive treatment or surgical interventions to prevent events such as dissection or rupture.

We report two cases complicated with spinal cord injury after the frozen elephant trunk procedure for Stanford type A acute aortic dissection. The two patients experienced dissection from the ascending aorta to the iliac arteries, and posterior false lumens were seen from Th8 to L2 in both cases. After an emergent surgery, both patients showed paraplegia and underwent immediate spinal fluid drainage. Symptoms improved to paraparesis in both patients, who were subsequently transferred to rehabilitation hospital. If a posterior false lumen is present from Th8 to L2, an increased risk of complications by spinal cord injury following the frozen elephant trunk procedure should be considered.

Extracorporeal membrane oxygenation (ECMO) has become an essential therapeutic modality for severe respiratory and circulatory failure. Recent technological advances have lowered the operational threshold for ECMO by enabling safer, more portable, and user-friendly systems. This article reviews the latest developments in ECMO-related technologies from the perspective of practicing clinicians. Key topics include the miniaturization and transportability of devices, improvements in centrifugal pumps and membrane lungs, and the incorporation of real-time monitoring and automatic control. Surface coatings using phosphorylcholine or hydrophilic polymers have enhanced biocompatibility and extended device longevity. Artificial intelligence and deep learning are being explored to assist in real-time decision-making and survival prediction. Furthermore, the potential for long-term implantable oxygenators is gaining attention. Our group has demonstrated prolonged in vivo function of a novel silicone membrane lung with methacryloyloxyethyl phosphorylcholine (MPC) polymer coating in large animal models, achieving thrombosis-free support for up to 100 days. The early conceptual framework for an implantable intrathoracic artificial lung, proposed by Mortensen in 1994, is gradually becoming technically feasible thanks to material and design innovations. These multifaceted advancements promise to broaden the future clinical applications of ECMO and improve outcomes across both acute and chronic indications.

Significant advancements in medical imaging technology have been made over the years. Currently, several commercial post-processing software solutions-such as Synapse Vinsent and Ziostation-are available to facilitate the creation of photorealistic three-dimensional (3D) images. Three-dimensional lung reconstruction with virtual modeling offers the opportunity to visualize tumors within the target segment or lobe and to confirm the bronchovascular anatomy, thereby enabling optimal surgical planning. Cross reality (XR)-which includes virtual reality (VR), augmented reality (AR), and mixed reality (MR)-enables surgeons to interact with computer-generated environments based on reality. In thoracic surgery, XR tools support anatomical assessment, surgical training through lifelike procedural simulations, preoperative planning, and intraoperative guidance. Lung perfusion scintigraphy with single photon emission computed tomography (SPECT-CT) allows for quantification of lobar perfusion during preoperative assessment of lung cancer candidates and provides a more accurate prediction of postoperative residual pulmonary function. Fractional flow reserve computed tomography (FFRCT) analysis is a non-invasive diagnostic tool used to determine the physiological impact of coronary artery disease (CAD) in patients with symptoms suggestive of CAD. The FFRCT has been demonstrated to reduce the necessity for invasive coronary angiography that shows no significant CAD. Coronary computed tomography angiography (CCTA) is a highly sensitive method of evaluating vascular anatomy, coronary plaque, calcification and stenosis. The pericoronary fat attenuation index (FAI), a new imaging biomarker derived from CCTA, assesses vascular inflammation by detecting respective gradients in coronary perivascular adipose tissue attenuation. Several studies have shown that elevated pericoronary FAI is associated with vascular inflammation and increased risk of cardiac events.

While it may seem that there have been no significant changes in the field of cardiopulmonary bypass (CPB) over the past decade, there have been advances in management concepts, such as coagulation management strategies and the use of oxygen delivery index (DO2i) and carbon dioxide (CO2)-derived variables during CPB. It will be important to examine what changes in outcomes are observed as a result of advances in management methods. The development of a variety of monitoring devices is expected if better outcomes are observed as a result of advances in CPB management. In addition, the introduction and study of different perfusion-assist functions are hoped to lead to the automation of operations in CPB.

A 73-year-old man was referred to our hospital for abnormal shadow. Chest computed tomography (CT) showed a tumor with a cavity in S10 of the left lung. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed the accumulation in the tumorous lesion of the cavity wall. Although the culture of the lavage fluid was positive for acid-fast bacilli and polymerase chain reaction (PCR) was positive for M. intracellulare, coexistence of cancer could not be denied. Therefore, he underwent surgery. Histopathological findings showed squamous cell carcinoma adjacent to epithelioid cell granulomatous lesion of nontuberculous mycobacteriosis.

Patients on dialysis with end-stage renal failure often develop pleural effusion, which is typically managed by dehydration. However, distinguishing empyema from pleural effusion is crucial, since empyema may not present with typical symptoms like fever, leading to potential misdiagnosis. This study examines the surgical treatment of empyema in dialysis patients. Between 2021 and 2024, among 404 dialysis patients, 5(1.2%)developed empyema. The patients(4 males, 1 female)had a mean age of 69.8 years, and all had diabetic nephropathy-induced renal failure. Two patients presented with asymptomatic pleural effusion, while three patients had fever and leukocytosis. Two patients had encapsulated effusions requiring early surgery. Surgery was performed in four cases after antibiotic treatment, while one received drainage and antibiotics alone. All underwent thoracoscopic procedures, with one patient requiring fenestration for recurrent multidrug-resistant empyema.

Various types of covering materials, reinforcement materials, and sealants with different compositions and structures are available in the field of thoracic surgery. However, complications such as infection, adhesion, and deformation of the materials, as well as hematoma caused by bleeding, chylothorax from lymphatic leakage, and pneumothorax or empyema due to air leaks, still occur at a certain rate. These issues indicate that the functions of currently available materials do not yet fully meet the needs of thoracic surgeons. In this article, we provide an overview of the classification, characteristics, and limitations of materials currently approved for use in Japan. Furthermore, we introduce recent advances in the development of novel materials-particularly surgical sealants-including an Alaska pollock gelatin sealant that we are co-developing for clinical application. In the development of new materials, improvements in physical properties, along with the availability of different formulations-such as liquid and sheet types-are expected to broaden their clinical applicability. The properties and limitations of each material are closely interrelated, and a thorough understanding of both is essential for optimal material selection and appropriate clinical use.

The patient was a 40-year-old male. His main complaints were fever and heart failure. Methicillin-sensitive Staphylococcus aureus was isolated from the patient's blood culture. He was diagnosed with a left ventricular pseudoaneurysm by contrast-enhanced computed tomography (CT). Severe mitral insufficiency and vegetation on the anterior mitral valve were observed on echocardiography. The patient went into shock and intratracheal intubation was performed. An intraaortic balloon pumping was started, and percutaneous cardiopulmonary support were established for cardiogenic shock. Mitral valve replacement with a mechanical valve and autologous pericardium patch closure were performed in an urgent surgery. Antibiotics were administered until his inflammatory response was negative. The patient had no recurrence of endocarditis or malfunction of the prosthetic valve and no leakage of the patchplasty for two years post-surgery.