Kyobu geka. The Japanese journal of thoracic surgery
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The dual puncture is one of the diseaseful complications at the induction of the epidural anesthesia, which causes severe symptoms of intracranial hypotension such as headache and nausea. The clinical courses of 3 patients with the dual puncture symptoms after pulmonary resections were retrospectively reviewed, and the effect of the continuous epidural saline infusion treatment (CESI) for the dual puncture was evaluated. ⋯ In contrast, the symptoms of the others who were treated with the CESI were quickly recovered or were effectively prevented. This report strongly suggested that the CESI was convenient and effective treatment for dual punctune symptoms by suppressing the cerebrospinal fluid leakage by elevation of the fluid pressure in the extradural space.
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Case Reports
[Secondary pulmonary hypertension due to pulmonary tumor thrombotic microangiopathy diagnosed by open lung biopsy].
A 67-year-old woman was admitted with progressive exertional dyspnea. Arterial blood gas analysis showed severe hypoxia. A chest radiograph and a computed tomography showed bilateral interstitial infiltrations and patchy ground-grass opacities. ⋯ Open lung biopsy was performed to establish a definitive diagnosis and to treat the diffuse lung disease. Microscopically, multiple tumor thrombi of mucinous adenocarcinoma were found in small sized pulmonary artery. Primary sites of malignancy has not been found in spite of postoperative examinations.
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The patient was a 76-year-old man. He was referred to our hospital to treat Kommerell's diverticulum and aneurysmal right-sided aortic arch with aberrant left subclavian artery. ⋯ He was discharged uneventfully without any complication. Gull-wing approach method has an advantage of wide surgical field and may be useful for extensive thoracic aortic disease.
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Case Reports
[Pulmonary metastasis fifteen years after hysterectomy for uterine leiomyosarcoma; report of a case].
A 75-year-old woman who had undergone a hysterectomy for uterine leiomyosarcoma 15 years before was noted to have a lung tumor on chest radiography. Chest computed tomography (CT) showed a tumor mass, 3.5 cm in size, in her left lung (S10). ⋯ The histopathological diagnosis was a metastasis of uterine leiomyosarcoma. The disease-free interval for this case was 15 years, which was. to our knowledge, the longest among previous reports of pulmonary metastasis of uterine leiomyosarcoma.
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Acute massive pulmonary thromboembolism (APE) is still associated with a high mortality rate. Furthermore, significantly higher mortality rates are observed in patients who underwent cardiopulmonary resuscitation (CPR) because of severe brain damage or multiple organ failure. We present successfully treated 4 patients who were transferred from outside hospitals under continuous CPR. ⋯ Open pulmonary thrombectomy was successfully performed under on pump beating cardiopulmonary support. All patients dramatically improved and were discharged without any complication. When hemodynamic instability or cardiac arrest occurs in patients with APE, rapid CPR, rapid diagnosis with echocardiography, and quick PCPS establishment are keys in our management strategy.