Kyobu geka. The Japanese journal of thoracic surgery
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A 77-year-old male patient underwent laryngo-tracheal anastomosis for subglottic tracheal stenosis. He developed exertional dyspnea 10 month after tracheostomy. Anterior and lateral wall of the cricoid cartilage and the first two tracheal cartilages were resected, preserving the recurrent laryngeal nerves. ⋯ Oral intake was started on the 2nd postoperative day. The patient showed smooth recovery. The important points of this operation are: 1) preoperative evaluation of the residual subglottic space, 2) intraoperative care for preservation of the recurrent nerves, especially at the lateral sides of the crycoid cartilage, and 3) postoperative maintenance of the cervical anterior flexion.
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A case with a bronchial foreign body which had an uncommon way of entry through a wound in the chest wall was described. A 70-year-old man was admitted to our hospital because of productive cough and weight loss. He had been injured by a fragment of a hand grenade which penetrated his anterior chest wall at the front in China 45 years ago. ⋯ Computed tomography of the chest and bronchoscopy demonstrated a steel fragment lodging beside and in the right upper lobe bronchus. Right upper lobectomy was performed, and the patient remains well without any thoracic symptoms one and a half years after the operation. Problems in the treatment of traumatic intrapulmonary foreign bodies were discussed.
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Case Reports
[A case report of a massive pulmonary tumor embolism occurring during surgery for renal cell carcinoma].
A 59-year-old man, who suffered a massive pulmonary tumor embolism during surgery for renal cell carcinoma with vena caval invasion, was treated by emergency pulmonary embolectomy using cardiopulmonary bypass. Renal cell carcinoma occasionally extends into the inferior vena cava (IVC) as a tumor thrombus. ⋯ However, the massive pulmonary tumor embolism is a major potential hazard during radical surgical resection. To prevent intraoperative pulmonary embolisms from occurring, scheduled use of cardiopulmonary bypass with the cooperation of cardiovascular surgeons is recommended.
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Case Reports
[Right-sided patent ductus arteriosus with a right aortic arch and right descending aorta].
We experienced an extremely rare anomaly, i.e. right-sided persistent ductus arteriosus with a right aortic arch and right descending aorta. Reviewing the literature, we found only two cases clinically reported in Japan as far as we know. The diagnosis was established by angiography and MRI. We treated the patient successfully through right thoracotomy.
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We have employed hypothermic retrograde total body perfusion via the caval cannulae as a supportive measures to protect the brain and other systemic organs in operations for aortic arch aneurysms or acute aortic dissection. But occasionally unsatisfactory results ensued, because competent valves located in the internal jugular vein near the jugulo-subclavian junction may block retrograde blood flow to the brain from the caval cannula. To cope with this problem, we designed an easy and safe method to cannulate the internal jugular vein transatrially utilizing guidewire and central venous catheter, and thereafter we have used this technique clinically and obtained good results.