Kyobu geka. The Japanese journal of thoracic surgery
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There have been only a few reports about a surgical resection of pulmonary metastasis from malignant head and neck tumors. Here we reviewed the literatures concerning the surgical results of pulmonary metastasectomy from malignant head and neck tumors, and discussed the indication for surgery. The 5-year overall survival after a metastasectomy was approximately 50.0% including all the histological types of head and neck cancer. ⋯ A pulmonary metastasectomy of squamous cell carcinoma is thus justified with the exception of oral cavity origin. Both adenoid cystic carcinoma of salivary glands and thyroid cancer are of low malignant nature, and the progression after occurrence of distant metastases is also very slow. Therefore, the survival benefit by those pulmonary metastasectomy is not evident.
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We examined the efficacy of surgical resection of oral cancer pulmonary metastases. Between April 2001 and October 2010, 12 patients with pulmonary metastases underwent thoracic operations. There were 8 men and 4 women with a median age of 66.5 years (range, 27~76). ⋯ Overall survival rate after metastasectomy was 50% at 3 years. Overall survival rate at 2 years by lobectomy was greater than by partial resection. For patients with oral cancer pulmonary metastasis, surgical resection is the effective treatment option.
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A 73-year-old woman with dyspnea was diagnosed with a left atrial myxoma by echocardiography. Right and left circumflex coronary angiography showed neovascularity in the tumor and the blood flow jet extending from the tumor to the left atrial cavity, which led to the steal phenomenon in the left anterior descending artery. ⋯ Exercise testing would involve risks such as embolism and left ventricular inflow disturbance; furthermore, the presence of concomitant chest symptoms with cardiac myxoma is not rare. Therefore, preoperative coronary angiography would be used for differential diagnosis and for detecting the coronary artery disease, which is reported to be common in patient with cardiac myxomas.
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Prosthetic valve endocarditis(PVE)occasionally evokes sepsis and disseminated intravascular coagulation(DIC). A 46-year-old man developed relapsing active PVE with an annular abscess and suffered from exacerbating sepsis and DIC. ⋯ Accordingly, the abscess cavity was closed by using a homograft anterior mitral leaflet, and the aortic root was replaced with the homograft. He is doing well without an evidence of recurrent endocarditis 18 months after the operation. rTM is a new and promising drug for the treatment of DIC with infective endocarditis.