Kyobu geka. The Japanese journal of thoracic surgery
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Swan-Ganz catheter (SGC : pulmonary artery catheter) was introduced in clinical use by Swan HJ and Ganz W in 1970. Since then, the catheter has been used in many kinds of clinical fields, such as critical care medicine, cardiovascular surgery, anesthesia, and cardiology, because of its useful functions. SGC can easily advance into the pulmonary artery with its flow-directed balloon. ⋯ Although SGC gives full diagnostic and therapeutic information of critically ill patients or cardiac surgical patients, all of the patients can not survive their tough critical clinical situation struggling with complications. Therefore, SGC has to be applied to the patients after thorough consideration whether the patients receive benefit of the catheter or not. Furthermore, the data obtained from SGC must be carefully interpreted to manage the patients.
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We report 3 cases of spontaneous mediastinal emphysema. All patients were young males, and had predisposing episodes for development of spontaneous mediastinal emphysema; sports in 2, loud voice in 1. ⋯ All patients became asymptomatic with mediastinal air reabsorption within a week. We should recognize spontaneous mediastinal emphysema as one cause of chest, back, neck and epigastric pain.
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We performed differential lung ventilation for thoracoscopic esophagectomy. There are 2 tools available for differential lung ventilation: double lumen tube (DLT) and endbronchial blocker tube (blocker). We reviewed the best tube by studying esophageal cancer perioperative findings in thoracoscopic esophagectomy. ⋯ However, lymph node dissection (LND) was difficult in DLT cases and DLT required exchange via a spiral tube for cervical LND. Next, we compared 4 DLTs, and found that the phi con DLT tube was the best because of its pliability. We concluded that the best tube for esophagectomy is a phi con DLT because it allows easy control of the differential lung ventilation and this tube does not interfere with surgery.
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From April 1994 to April 2008, we were started on 313 cases video-assisted thoracic surgery (VATS) operations for primary lung cancer at the thoracic surgical department of Kyoto City Hospital. Exclude cases such as conversion to open surgery, partial resection and double primary cancer, 212 cases were evaluated. Most common surgical approach was 111 lobectomy cases (90%) and pneumonectomy is 3 cases. ⋯ Most common complications were prolonged air leak in 20 cases (9.4%). Five year survival rate were stage IA 87.8%, IB 71.8%, II 52.4%, III 47.8%, IV 33.3%. Our data demonstrate thoracoscopic lobectomy for lung cancer is a safe procedure and excellent prognosis.
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Video-assisted thoracic surgery (VATS) is now commonly used to treat malignant tumors of the lung. Generally, there are 2 styles of VATS: one uses only the view in a monitor and the other makes use of direct vision through an access port. Since both are minimally invasive, the difference is a matter of the surgeon's preference, and it is likely to have no effect on the patient. ⋯ There were no differences in survival, according to surgical approach. Although we have not always adopted VATS for advanced lung cancer, we are using a similar approach to perform any kind of bronchoplasty, pneumonectomy, or extensive resection for lung cancer more effectively. It is a step forward to be able to perform surgery using advanced techniques but, ultimately, it is not the technique that is of primary importance, it is the benefit the patient receives.