Pub Date : 2017-02-20DOI: 10.5761/atcs.oa.16-00164
T. Isaka, H. Nakayama, T. Yokose, H. Ito, K. Katayama, Kouzo Yamada, M. Masuda
INTRODUCTION The efficacy of platinum-based adjuvant chemotherapy (PBAC) for pathological stage II and stage III squamous cell carcinoma (SCC) of the lung was analyzed retrospectively. MATERIALS AND METHODS The prognoses of 94 patients with stage II and stage III SCC with or without PBAC (more than three courses of cisplatin-, carboplatin-, and nedaplatin-based adjuvant chemotherapy) were compared. RESULTS The mean observation period was 46.1 months. PBAC was not administered for the following reasons: 39 (55.7%) patients had comorbidities, 25 (35.7%) were older than 75 years, 19 (27.1%) patients underwent surgery before the approval of PBAC, and 3 (4.3%) patients could not continue PBAC (≤2 cycles) because of adverse events. PBAC patients (n = 24) were significantly younger than non-PBAC patients (n = 70; 66.3 vs 69.6 years old, respectively; p = 0.043). Disease-free survival (DFS) did not differ between PBAC and non-PBAC patients (55.0% and 67.1%, respectively; p = 0.266). PBAC patients tended to have worse overall survival (OS) than non-PBAC patients (56.1% and 70.2%, respectively; p = 0.138). PBAC was not prognostic for OS (hazard ratio (HR), 2.11; 95% confidence interval (CI), 0.82%-5.40%; p = 0.120). CONCLUSION PBAC did not improve the prognoses of patients with pathological stage II or stage III SCC in the single institution experience.
{"title":"Platinum-Based Adjuvant Chemotherapy for Stage II and Stage III Squamous Cell Carcinoma of the Lung.","authors":"T. Isaka, H. Nakayama, T. Yokose, H. Ito, K. Katayama, Kouzo Yamada, M. Masuda","doi":"10.5761/atcs.oa.16-00164","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00164","url":null,"abstract":"INTRODUCTION\u0000The efficacy of platinum-based adjuvant chemotherapy (PBAC) for pathological stage II and stage III squamous cell carcinoma (SCC) of the lung was analyzed retrospectively.\u0000\u0000\u0000MATERIALS AND METHODS\u0000The prognoses of 94 patients with stage II and stage III SCC with or without PBAC (more than three courses of cisplatin-, carboplatin-, and nedaplatin-based adjuvant chemotherapy) were compared.\u0000\u0000\u0000RESULTS\u0000The mean observation period was 46.1 months. PBAC was not administered for the following reasons: 39 (55.7%) patients had comorbidities, 25 (35.7%) were older than 75 years, 19 (27.1%) patients underwent surgery before the approval of PBAC, and 3 (4.3%) patients could not continue PBAC (≤2 cycles) because of adverse events. PBAC patients (n = 24) were significantly younger than non-PBAC patients (n = 70; 66.3 vs 69.6 years old, respectively; p = 0.043). Disease-free survival (DFS) did not differ between PBAC and non-PBAC patients (55.0% and 67.1%, respectively; p = 0.266). PBAC patients tended to have worse overall survival (OS) than non-PBAC patients (56.1% and 70.2%, respectively; p = 0.138). PBAC was not prognostic for OS (hazard ratio (HR), 2.11; 95% confidence interval (CI), 0.82%-5.40%; p = 0.120).\u0000\u0000\u0000CONCLUSION\u0000PBAC did not improve the prognoses of patients with pathological stage II or stage III SCC in the single institution experience.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75043784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-20DOI: 10.5761/atcs.ra.16-00162
M. Sohda, H. Kuwano
The local control effect of esophagectomy with three-field lymph node dissection (3FLD) is reaching its limit pending technical advancement. Minimally invasive esophagectomy (MIE) by thoracotomy is slowly gaining acceptance due to advantages in short-term outcomes. Although the evidence is slowly increasing, MIE is still controversial. Also, the results of treatment by surgery alone are limiting, and multimodality therapy, which includes surgical and non-surgical treatment options including chemotherapy, radiotherapy, and endoscopic treatment, has become the mainstream therapy. Esophagectomy after neoadjuvant chemotherapy (NAC) is the standard treatment for clinical stages II/III (except for T4) esophageal cancer, whereas chemoradiotherapy (CRT) is regarded as the standard treatment for patients who wish to preserve their esophagus, those who refuse surgery, and those with inoperable disease. CRT is also usually selected for clinical stage IV esophageal cancer. On the other hand, with the spread of CRT, salvage esophagectomy has traditionally been recognized as a feasible option; however, many clinicians oppose the use of surgery due to the associated unfavorable morbidity and mortality profile. In the future, the improvement of each treatment result and the establishment of individual strategies are important although esophageal cancer has many treatment options.
{"title":"Current Status and Future Prospects for Esophageal Cancer Treatment.","authors":"M. Sohda, H. Kuwano","doi":"10.5761/atcs.ra.16-00162","DOIUrl":"https://doi.org/10.5761/atcs.ra.16-00162","url":null,"abstract":"The local control effect of esophagectomy with three-field lymph node dissection (3FLD) is reaching its limit pending technical advancement. Minimally invasive esophagectomy (MIE) by thoracotomy is slowly gaining acceptance due to advantages in short-term outcomes. Although the evidence is slowly increasing, MIE is still controversial. Also, the results of treatment by surgery alone are limiting, and multimodality therapy, which includes surgical and non-surgical treatment options including chemotherapy, radiotherapy, and endoscopic treatment, has become the mainstream therapy. Esophagectomy after neoadjuvant chemotherapy (NAC) is the standard treatment for clinical stages II/III (except for T4) esophageal cancer, whereas chemoradiotherapy (CRT) is regarded as the standard treatment for patients who wish to preserve their esophagus, those who refuse surgery, and those with inoperable disease. CRT is also usually selected for clinical stage IV esophageal cancer. On the other hand, with the spread of CRT, salvage esophagectomy has traditionally been recognized as a feasible option; however, many clinicians oppose the use of surgery due to the associated unfavorable morbidity and mortality profile. In the future, the improvement of each treatment result and the establishment of individual strategies are important although esophageal cancer has many treatment options.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78736329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: We performed a retrospective analysis to evaluate the usefulness of positron-emission tomography/computed tomography (PET/CT) findings in the classification and management of anterior mediastinal tumors.
Methods: Between 2006 and 2015, 105 patients with anterior mediastinal tumor received PET/CT. 18F-fluorodeoxyglucose (18F-FDG)-PET images were obtained 60 minutes after the injection of 18F-FDG.
Results: The histological classifications were as follows: thymoma (n = 49), thymic carcinoma (TC) (n = 19), malignant lymphoma (ML) (n = 8), teratoma (n = 7), thymic cyst (n = 14), and others (n = 8). Upon visual inspection (SUV max: >2.0), all of the malignant tumors showed 18F-FDG accumulation (with the exception of one type A thymoma). Two of the 14 thymic cysts and three of the seven teratomas showed slight 18F-FDG accumulation. The SUV max values of the low-grade thymomas, high-grade thymomas, TCs and MLs were 3.14 ± 0.73, 4.34 ± 1.49, 8.59 ± 3.05, and 10.08 ± 2.53, respectively, with significant differences between the low- and high-grade thymomas, and between TCs and MLs. The sensitivity, specificity and accuracy of 18F-FDG in the detection of low-grade thymomas and thymomas with a maximum diameter of ≤50 mm and an SUV max of ≤3.4 were 85%, 48%, and 60%, respectively.
Conclusion: FDG-PET/CT is an objective and useful modality in the differential diagnosis and management of anterior mediastinal tumors.
目的：我们进行了一项回顾性分析，评估正电子发射断层扫描/计算机断层扫描（PET/CT）结果在前纵隔肿瘤的分类和治疗中的作用：2006年至2015年间，105名前纵隔肿瘤患者接受了PET/CT检查。注射18F-脱氧葡萄糖（18F-FDG）60分钟后获得18F-FDG-PET图像：组织学分类如下：胸腺瘤（49 例）、胸腺癌（TC）（19 例）、恶性淋巴瘤（ML）（8 例）、畸胎瘤（7 例）、胸腺囊肿（14 例）和其他（8 例）。经肉眼观察（最大 SUV 值：>2.0），所有恶性肿瘤均显示有 18F-FDG 积累（一个 A 型胸腺瘤除外）。14 个胸腺囊肿中的 2 个和 7 个畸胎瘤中的 3 个有轻微的 18F-FDG 积聚。低级别胸腺瘤、高级别胸腺瘤、TC 和 ML 的 SUV max 值分别为（3.14±0.73）、（4.34±1.49）、（8.59±3.05）和（10.08±2.53），低级别和高级别胸腺瘤之间以及 TC 和 ML 之间差异显著。18F-FDG检测低级别胸腺瘤和最大直径≤50 mm、SUV max≤3.4的胸腺瘤的敏感性、特异性和准确性分别为85%、48%和60%：结论：FDG-PET/CT 是鉴别诊断和治疗前纵隔肿瘤的一种客观而有用的方法。
{"title":"The Usefulness of Positron-Emission Tomography Findings in the Management of Anterior Mediastinal Tumors.","authors":"Akihiko Kitami, Fumitoshi Sano, Shinichi Ohashi, Kosuke Suzuki, Shugo Uematsu, Takashi Suzuki, Mitsutaka Kadokura","doi":"10.5761/atcs.oa.16-00205","DOIUrl":"10.5761/atcs.oa.16-00205","url":null,"abstract":"<p><strong>Purpose: </strong>We performed a retrospective analysis to evaluate the usefulness of positron-emission tomography/computed tomography (PET/CT) findings in the classification and management of anterior mediastinal tumors.</p><p><strong>Methods: </strong>Between 2006 and 2015, 105 patients with anterior mediastinal tumor received PET/CT. <sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>F-FDG)-PET images were obtained 60 minutes after the injection of <sup>18</sup>F-FDG.</p><p><strong>Results: </strong>The histological classifications were as follows: thymoma (n = 49), thymic carcinoma (TC) (n = 19), malignant lymphoma (ML) (n = 8), teratoma (n = 7), thymic cyst (n = 14), and others (n = 8). Upon visual inspection (SUV max: >2.0), all of the malignant tumors showed <sup>18</sup>F-FDG accumulation (with the exception of one type A thymoma). Two of the 14 thymic cysts and three of the seven teratomas showed slight <sup>18</sup>F-FDG accumulation. The SUV max values of the low-grade thymomas, high-grade thymomas, TCs and MLs were 3.14 ± 0.73, 4.34 ± 1.49, 8.59 ± 3.05, and 10.08 ± 2.53, respectively, with significant differences between the low- and high-grade thymomas, and between TCs and MLs. The sensitivity, specificity and accuracy of <sup>18</sup>F-FDG in the detection of low-grade thymomas and thymomas with a maximum diameter of ≤50 mm and an SUV max of ≤3.4 were 85%, 48%, and 60%, respectively.</p><p><strong>Conclusion: </strong>FDG-PET/CT is an objective and useful modality in the differential diagnosis and management of anterior mediastinal tumors.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87279852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-14DOI: 10.5761/atcs.ra.16-00178
B. Martínez-González, C. G. Reyes-Hernández, A. Quiroga-Garza, Víctor E Rodríguez-Rodríguez, C. N. Esparza-Hernández, R. Elizondo-Omaña, S. Guzmán-López
There is a significant variety of vascular conduits options for coronary bypass surgery. Adequate graft selection is the most important factor for the success of the intervention. To ensure durability, permeability, and bypass function, there must be a morphological similarity between the graft and the coronary artery. The objective of this review was to analyze the morphological characteristics of the grafts that are most commonly used in coronary bypass surgery and the coronary arteries that are most frequently occluded. We included clinical information regarding the characteristics that determine the behavior of the grafts and its permeability over time. Currently, the internal thoracic artery is the standard choice for bypass surgery because of the morphological characteristics of the wall that makes less prone to developing atherosclerosis and hyperplasia. The radial and right gastroepiploic arteries are the following second and third best options, respectively. The ulnar artery is the preferred choice when other conduits are not feasible.
{"title":"Conduits Used in Coronary Artery Bypass Grafting: A Review of Morphological Studies.","authors":"B. Martínez-González, C. G. Reyes-Hernández, A. Quiroga-Garza, Víctor E Rodríguez-Rodríguez, C. N. Esparza-Hernández, R. Elizondo-Omaña, S. Guzmán-López","doi":"10.5761/atcs.ra.16-00178","DOIUrl":"https://doi.org/10.5761/atcs.ra.16-00178","url":null,"abstract":"There is a significant variety of vascular conduits options for coronary bypass surgery. Adequate graft selection is the most important factor for the success of the intervention. To ensure durability, permeability, and bypass function, there must be a morphological similarity between the graft and the coronary artery. The objective of this review was to analyze the morphological characteristics of the grafts that are most commonly used in coronary bypass surgery and the coronary arteries that are most frequently occluded. We included clinical information regarding the characteristics that determine the behavior of the grafts and its permeability over time. Currently, the internal thoracic artery is the standard choice for bypass surgery because of the morphological characteristics of the wall that makes less prone to developing atherosclerosis and hyperplasia. The radial and right gastroepiploic arteries are the following second and third best options, respectively. The ulnar artery is the preferred choice when other conduits are not feasible.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80139952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-08DOI: 10.5761/atcs.oa.16-00219
Mingya Wang, Ming Chen, Hushan Ao, Sipeng Chen, Zhifa Wang
OBJECTIVE Blood loss is a predictor of outcomes after coronary artery bypass grafting (CABG). This study investigated the effects of body mass index (BMI) on blood loss, blood transfusion rate, and the variations in coagulation parameters of Chinese patients undergoing CABG. METHODS A total of 1007 Chinese patients who consecutively underwent isolated, primary CABG at Fuwai Hospital from January 1, 2013 to December 31, 2013 were included in this study. They were categorized by BMI into <24 kg/m2 (low and normal weight group), 24≤ BMI <28 kg/m2 (overweight group), and BMI ≥28 kg/m2 (obese group). Following this BMI classification, the quantities of blood lost and recorded transfusions were analyzed. RESULTS Blood loss and transfusion rates were significantly higher in the low and normal weight group compared with the obese group (p <0.01). Chest tube drainage over 24 h, duration of intensive care unit (ICU) stay, and postoperative mechanical ventilation were higher as well (p <0.01). Atrial fibrillation was closely related to blood transfusion (p <0.001). CONCLUSIONS Obesity is a predictor for protection against blood loss and transfusion in Chinese people. Patients with low and normal BMI lost more blood per kg of their weight and had higher total transfused volume during isolated primary CABG. Atrial fibrillation was associated with high blood transfusion.
{"title":"The Effects of Different BMI on Blood Loss and Transfusions in Chinese Patients Undergoing Coronary Artery Bypass Grafting.","authors":"Mingya Wang, Ming Chen, Hushan Ao, Sipeng Chen, Zhifa Wang","doi":"10.5761/atcs.oa.16-00219","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00219","url":null,"abstract":"OBJECTIVE\u0000Blood loss is a predictor of outcomes after coronary artery bypass grafting (CABG). This study investigated the effects of body mass index (BMI) on blood loss, blood transfusion rate, and the variations in coagulation parameters of Chinese patients undergoing CABG.\u0000\u0000\u0000METHODS\u0000A total of 1007 Chinese patients who consecutively underwent isolated, primary CABG at Fuwai Hospital from January 1, 2013 to December 31, 2013 were included in this study. They were categorized by BMI into <24 kg/m2 (low and normal weight group), 24≤ BMI <28 kg/m2 (overweight group), and BMI ≥28 kg/m2 (obese group). Following this BMI classification, the quantities of blood lost and recorded transfusions were analyzed.\u0000\u0000\u0000RESULTS\u0000Blood loss and transfusion rates were significantly higher in the low and normal weight group compared with the obese group (p <0.01). Chest tube drainage over 24 h, duration of intensive care unit (ICU) stay, and postoperative mechanical ventilation were higher as well (p <0.01). Atrial fibrillation was closely related to blood transfusion (p <0.001).\u0000\u0000\u0000CONCLUSIONS\u0000Obesity is a predictor for protection against blood loss and transfusion in Chinese people. Patients with low and normal BMI lost more blood per kg of their weight and had higher total transfused volume during isolated primary CABG. Atrial fibrillation was associated with high blood transfusion.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84962173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-03DOI: 10.5761/atcs.oa.16-00196
A. A. Juhl, Sofie Hody, T. S. Videbaek, T. Damsgaard, P. Nielsen
PURPOSE The present study aimed to compare the clinical outcome for patients with or without muscle flap reconstruction after deep sternal wound infection due to open-heart surgery. METHODS The study was a retrospective cohort study, including patients who developed deep sternal wound infection after open-heart surgery in the Western Denmark Region from 1999 to 2011. Journals of included patients were reviewed for clinical data regarding the treatment of their sternal defect. Patients were divided into two groups depending on whether they received a muscle-flap-based sternal reconstruction or traditional rewiring of the sternum. RESULTS A total of 130 patients developed deep sternal wound infection in the study period. In all, 12 patients died before being discharged, leaving a total of 118 patients for analysis. Of these, 50 (42%) patients received muscle flap reconstruction. Muscle flap recipients had significantly longer total hospital stays (p <0.001). However, after receiving muscle flap reconstruction, patients were discharged after a median of 14 days, with 74% not needing additional surgery. CONCLUSION It is difficult to predict which patients eventually require muscle flap reconstruction after deep sternal wound infection. Although patients receiving muscle flap reconstructions have longer hospital stays, they are quickly discharged after the reconstruction.
{"title":"Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis.","authors":"A. A. Juhl, Sofie Hody, T. S. Videbaek, T. Damsgaard, P. Nielsen","doi":"10.5761/atcs.oa.16-00196","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00196","url":null,"abstract":"PURPOSE\u0000The present study aimed to compare the clinical outcome for patients with or without muscle flap reconstruction after deep sternal wound infection due to open-heart surgery.\u0000\u0000\u0000METHODS\u0000The study was a retrospective cohort study, including patients who developed deep sternal wound infection after open-heart surgery in the Western Denmark Region from 1999 to 2011. Journals of included patients were reviewed for clinical data regarding the treatment of their sternal defect. Patients were divided into two groups depending on whether they received a muscle-flap-based sternal reconstruction or traditional rewiring of the sternum.\u0000\u0000\u0000RESULTS\u0000A total of 130 patients developed deep sternal wound infection in the study period. In all, 12 patients died before being discharged, leaving a total of 118 patients for analysis. Of these, 50 (42%) patients received muscle flap reconstruction. Muscle flap recipients had significantly longer total hospital stays (p <0.001). However, after receiving muscle flap reconstruction, patients were discharged after a median of 14 days, with 74% not needing additional surgery.\u0000\u0000\u0000CONCLUSION\u0000It is difficult to predict which patients eventually require muscle flap reconstruction after deep sternal wound infection. Although patients receiving muscle flap reconstructions have longer hospital stays, they are quickly discharged after the reconstruction.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86241778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-24DOI: 10.5761/atcs.nm.16-00248
M. Yamazaki, H. Kin, Shohei Kitamoto, Shota Yamanaka, H. Nishida, K. Nishigawa, S. Takanashi
Minimally invasive cardiac surgeries for aortic valve replacement (AVR) are still a technical challenge for surgeons because these procedures are undertaken through small incisions and deep surgical fields. Although AVR via vertical infraaxillary thoracotomy can be a cosmetically superior option, a disadvantage of this approach is the distance between the thoracotomy incision and the ascending aorta. Therefore, we devised a technique to perform all manipulations using the fingertips without the aid of a knot pusher or long-shafted surgical instruments. This was achieved by particular placement of several retracted sutures to the right chest wall. We named placement of these sutures the "Stonehenge technique." In conclusion, AVR via vertical infraaxillary thoracotomy with our Stonehenge technique can be safely and simply performed with superior cosmetic advantages.
{"title":"Efficacy of the Stonehenge Technique for Minimally Invasive Aortic Valve Replacement via Right Infraaxillary Thoracotomy.","authors":"M. Yamazaki, H. Kin, Shohei Kitamoto, Shota Yamanaka, H. Nishida, K. Nishigawa, S. Takanashi","doi":"10.5761/atcs.nm.16-00248","DOIUrl":"https://doi.org/10.5761/atcs.nm.16-00248","url":null,"abstract":"Minimally invasive cardiac surgeries for aortic valve replacement (AVR) are still a technical challenge for surgeons because these procedures are undertaken through small incisions and deep surgical fields. Although AVR via vertical infraaxillary thoracotomy can be a cosmetically superior option, a disadvantage of this approach is the distance between the thoracotomy incision and the ascending aorta. Therefore, we devised a technique to perform all manipulations using the fingertips without the aid of a knot pusher or long-shafted surgical instruments. This was achieved by particular placement of several retracted sutures to the right chest wall. We named placement of these sutures the \"Stonehenge technique.\" In conclusion, AVR via vertical infraaxillary thoracotomy with our Stonehenge technique can be safely and simply performed with superior cosmetic advantages.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78360665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.5761/atcs.cr.16-00137
N. Haratake, F. Shoji, Yuka Kozuma, T. Okamoto, Y. Maehara
This report presents a rare case involving a patient with a giant leiomyoma originating from the mediastinal pleura. The patient underwent a medical examination, and chest radiography revealed a giant tumor. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a well demarcated, heterogeneous mass which seemed to originate from the posterior mediastinum. Positron emission tomography (PET) showed the uptake of this tumor with a standardized uptake value of 4.9. We suspected that this tumor was a solitary fibrous tumor, and the patient underwent a surgical resection. Intraoperative exploration revealed a well-encapsulated tumor measuring 15 × 11 cm that appeared to originate from the mediastinal pleura. Immunohistochemical findings revealed a benign leiomyoma. We finally diagnosed the patient with a mediastinal leiomyoma. The present report describes CT, MRI, and PET findings of leiomyoma, and presents a review of relevant literature.
{"title":"Giant Leiomyoma Arising from the Mediastinal Pleura: A Case Report.","authors":"N. Haratake, F. Shoji, Yuka Kozuma, T. Okamoto, Y. Maehara","doi":"10.5761/atcs.cr.16-00137","DOIUrl":"https://doi.org/10.5761/atcs.cr.16-00137","url":null,"abstract":"This report presents a rare case involving a patient with a giant leiomyoma originating from the mediastinal pleura. The patient underwent a medical examination, and chest radiography revealed a giant tumor. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a well demarcated, heterogeneous mass which seemed to originate from the posterior mediastinum. Positron emission tomography (PET) showed the uptake of this tumor with a standardized uptake value of 4.9. We suspected that this tumor was a solitary fibrous tumor, and the patient underwent a surgical resection. Intraoperative exploration revealed a well-encapsulated tumor measuring 15 × 11 cm that appeared to originate from the mediastinal pleura. Immunohistochemical findings revealed a benign leiomyoma. We finally diagnosed the patient with a mediastinal leiomyoma. The present report describes CT, MRI, and PET findings of leiomyoma, and presents a review of relevant literature.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89868784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-23DOI: 10.5761/atcs.oa.16-00179
F. Shoji, S. Takamori, T. Akamine, G. Toyokawa, Y. Morodomi, T. Okamoto, Y. Maehara
BACKGROUND Analog chest drainage systems (ACS) are generally used to monitor postoperative alveolar air leakage (PAL) after lung resection. An electronic digital chest drainage system (DCS) has recently been developed that reportedly has several advantages over the traditional ACS. Here, we report a single institution's experience of PAL management with the DCS. We also sought to establish whether DCS had superior clinical benefits and outcomes compared with ACS. METHODS We enrolled 112 consecutive patients who underwent lung resection and were subsequently managed with DCS. We compared PAL rate, duration of chest drainage, and the incidence of complications with a group of 121 consecutive patients previously managed with ACS after lung resection, using propensity score matching. RESULTS Mean maximum and minimum PAL rates during DCS chest drainage were 48.9 ml/min (range: 2.0-868.6 ml/min) and 0.1 ml/min (0.0-1.2 ml/min), respectively. Mean PAL rate at DCS removal was 1.3 ml/min (0.0-10.0 ml/min). After propensity score matching, mean duration of chest drainage was significantly shorter with DCS than ACS (2.7 days, range: 1-9 days, compared with 3.7 days, range: 1-21 days, respectively; P = 0.031). CONCLUSIONS Managing PAL with DCS after pulmonary resection appears to reduce the duration of chest drainage.
{"title":"Clinical Evaluation and Outcomes of Digital Chest Drainage after Lung Resection.","authors":"F. Shoji, S. Takamori, T. Akamine, G. Toyokawa, Y. Morodomi, T. Okamoto, Y. Maehara","doi":"10.5761/atcs.oa.16-00179","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00179","url":null,"abstract":"BACKGROUND\u0000Analog chest drainage systems (ACS) are generally used to monitor postoperative alveolar air leakage (PAL) after lung resection. An electronic digital chest drainage system (DCS) has recently been developed that reportedly has several advantages over the traditional ACS. Here, we report a single institution's experience of PAL management with the DCS. We also sought to establish whether DCS had superior clinical benefits and outcomes compared with ACS.\u0000\u0000\u0000METHODS\u0000We enrolled 112 consecutive patients who underwent lung resection and were subsequently managed with DCS. We compared PAL rate, duration of chest drainage, and the incidence of complications with a group of 121 consecutive patients previously managed with ACS after lung resection, using propensity score matching.\u0000\u0000\u0000RESULTS\u0000Mean maximum and minimum PAL rates during DCS chest drainage were 48.9 ml/min (range: 2.0-868.6 ml/min) and 0.1 ml/min (0.0-1.2 ml/min), respectively. Mean PAL rate at DCS removal was 1.3 ml/min (0.0-10.0 ml/min). After propensity score matching, mean duration of chest drainage was significantly shorter with DCS than ACS (2.7 days, range: 1-9 days, compared with 3.7 days, range: 1-21 days, respectively; P = 0.031).\u0000\u0000\u0000CONCLUSIONS\u0000Managing PAL with DCS after pulmonary resection appears to reduce the duration of chest drainage.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78077819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-14DOI: 10.5761/atcs.oa.16-00189
S. Lee, Do Hyung Kim, Sang Kwon Lee, Y. Kim, J. Cho, H. I
PURPOSE The choice of surgical repair or conservative treatment for iatrogenic tracheobronchial rupture (ITBR) remains controversial. However, thoracic surgeons consider that surgical repair is an important treatment modality. The purpose of this study was to evaluate the clinical results from the perspective of the surgery-preferred group. METHODS We treated 11 patients (8 women and 3 men; age: 52.6 ± 22.9 years) with ITBR from January 2011 to January 2016. A posterolateral thoracotomy or a trans-tracheal approach was performed according to the mechanism of injury. RESULTS Nine patients underwent surgery, and all patients received primary repair. Five patients received a right posterolateral thoracotomy, whereas one patient received a left posterolateral thoracotomy. No mortality or morbidity related to the surgery was observed. The mechanical ventilation time was 65.9 ± 99.2 hours. The intensive care unit duration was 19.7 ± 33.3 days. Two patients received conservative treatment, and all patients died of another disease that was not related to the conservative treatment. CONCLUSION Our mortality or morbidity due to surgery was not higher than world literature results of conservative treatment. We thought surgery is the primary treatment choice for ITBR in the absence of a good indication for conservative treatment.
{"title":"Does Surgical Repair Still have a Role for Iatrogenic Tracheobronchial Rupture? Clinical Analysis of a Thoracic Surgeon's Opinion.","authors":"S. Lee, Do Hyung Kim, Sang Kwon Lee, Y. Kim, J. Cho, H. I","doi":"10.5761/atcs.oa.16-00189","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00189","url":null,"abstract":"PURPOSE\u0000The choice of surgical repair or conservative treatment for iatrogenic tracheobronchial rupture (ITBR) remains controversial. However, thoracic surgeons consider that surgical repair is an important treatment modality. The purpose of this study was to evaluate the clinical results from the perspective of the surgery-preferred group.\u0000\u0000\u0000METHODS\u0000We treated 11 patients (8 women and 3 men; age: 52.6 ± 22.9 years) with ITBR from January 2011 to January 2016. A posterolateral thoracotomy or a trans-tracheal approach was performed according to the mechanism of injury.\u0000\u0000\u0000RESULTS\u0000Nine patients underwent surgery, and all patients received primary repair. Five patients received a right posterolateral thoracotomy, whereas one patient received a left posterolateral thoracotomy. No mortality or morbidity related to the surgery was observed. The mechanical ventilation time was 65.9 ± 99.2 hours. The intensive care unit duration was 19.7 ± 33.3 days. Two patients received conservative treatment, and all patients died of another disease that was not related to the conservative treatment.\u0000\u0000\u0000CONCLUSION\u0000Our mortality or morbidity due to surgery was not higher than world literature results of conservative treatment. We thought surgery is the primary treatment choice for ITBR in the absence of a good indication for conservative treatment.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83032300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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