Kyobu geka. The Japanese journal of thoracic surgery
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A 51-year-old man underwent a middle-lower lobectomy for squamous cell carcinoma on February 8, 1996. In July, 1997, a computed tomography revealed a mass shadow in the right upper lung field. ⋯ This case was the shortest time to occurrence of second tumor in our metachronous lung cancer cases. We must always give attention to exist second primary lung cancer and double primary lung cancer after resection of primary lung cancer.
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Comparative Study
[Aortic valve operations through an upper partial sternotomy].
The median sternotomy has been accepted as the most common approach to the heart, because this approach is easily opened and closed, and easy access to the entire heart is possible. Following the pioneering work by Cosgrove and colleagues of using a parasternal incision for aortic and mitral valve operations, several reports suggested that modified minimal access procedures are likely to be associated with reduced postoperative discomfort and faster recovery. Since July 1997, we have used an upper partial sternotomy and a limited skin incision for isolated aortic valve replacement (AVR) at our hospital. ⋯ The distance between the transverse sternotomy (lower edge of divided sternum) and the midpoint of aortic valve annulus was correlated with mean duration of cardiopulmonary bypass and cross clamp time. Our experience demonstrates that isolated AVR through an upper partial sternotomy allows the same quality operations as the full sternotomy, although more clinical experience is required to clarify the benefits of this approach. Excellent exposure of the aortic valve through a partial sternotomy may be attained, if an adequate approach can be selected by the position of aortic valve.
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We have experienced a case of mediastinal abscess and tracheal fistula after operation for esophageal cancer and successfully closed by using intercostal muscle pedicle flap. A 61-year-old male underwent esophagectomy for advanced esophageal cancer. ⋯ On the 29th postoperative day, tracheal fistula was detected, and operation was performed in order to close the fistula by using of intercostal muscle pedicle flap. His postoperative course was fair and general condition was improvement, esophageal reconstruction using of free jejunal graft was performed and oral ingestion was started.
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Case Reports
[Two cases of thoracic aneurysm with aberrant origin of the aortic branches: diagnosis and strategy].
We present two cases of thoracic aortic aneurysms with anomalous origin of the aortic arch branches. One was a 72-year-old female with a ruptured descending thoracic aneurysm and aberrant origin of the right subclavian artery. ⋯ Preoperative examinations included angiography, computed tomography (CT), three dimensional enhanced CT (3DCT), digital subtraction angiography (DSA), and magnetic resonance imaging (MRI). Understanding the structure of neck vessels is important in deciding where to clamp or to reconstruct in surgical repair of the aortic arch. 3DCT was the most useful examination for this understanding.
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A 33-year-old male was involved in a single motor vehicle accident and was referred to our hospital 135 minutes after injury. He had a sign of cardiac tamponade and immediately pericardial window was performed at the emergency department, but hypotension went worse. ⋯ Cardiac rupture due to blunt trauma is highly lethal, and prompt diagnosis is necessary for a favorable outcome. A high index of suspicion, avoidance of unnecessary diagnostic studies, and immediate surgical intervention are critical for successful management.