Kyobu geka. The Japanese journal of thoracic surgery
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There are relatively few paraesophageal bronchogenic and esophageal cysts in mediastinal tumors. It is often difficult to distinguish between these cysts. Case 1: 11 year old, male with no symptoms. ⋯ CT and MRI showed a well-defined cystic mass in the posterior mediastinum. The cyst bordered the esophagus, but there was no direct communication between them. The pathological findings showed the presence of a double layer of smooth muscle without cartilage which was diagnosed as an esophageal cyst.
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A 15-month-old girl, who was diagnosed asplenia, underwent Blalock-Taussig shunt using EPTFE tubular graft. Postoperatively, discharge containing high concentrations of protein continued to drain from pleural drainage. On the 23rd postoperative day, extirpation of seroma (4 x 3 x 3 cm) and wrapping of the graft using processed porcine pericardium were performed. ⋯ Pleural effusion persisted with decreasing quantity until the graft was obstructed. Ultimately on the 79th postoperative day, central shunt using Golaski tubular graft was successfully replaced. Thus, the occurrence of seroma should be borne in mind when EPTFE graft is used for shunt operation.
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[Use of airway stent subsequent to endoscopic Nd-YAG laser treatment in central airway obstruction].
Ten cases of central airway obstruction mainly caused by extrinsic compression due to the growth of extratracheal malignant tumors or longitudinal extension of tracheal adenoid cystic carcinomas, underwent palliative intubation subsequent to endoscopic Nd-YAG laser treatment. Mean length of the severe stenosis in these cases was 4.4 cm (3-7 cm). Sole application of endoscopic Nd-YAG laser to the stenosis failed relief of the symptom and an immediate palliative intubation was recommended. ⋯ Therefore, it seemed that, in a palliative treatment of the central airway severe stenosis, usefulness of the combination management of Nd-YAG laser with following temporary intubation was revealed. However, in order to maintain the airway for recurrence of the obstruction, use of indwelling airway stents seemed a better application. The longest period of follow-up in the cases treated by indwelling airway stents was 6 months and one of the cases is a now in comfortable state.
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The neodymium-yttrium-aluminium-garnet laser (Nd-YAG laser) has proved to be useful therapeutic tool for the management of endobronchial lesions. Between February 1983 and January 1991, 16 patients received endobronchial laser therapy at the Nagasaki University Hospital, 7 patients for tracheal stenosis, and 9 for endobronchial obstruction. In 4 patients with tracheal stenosis, the therapy was performed in an emergency. ⋯ One patient died from massive bleeding in the left main stem bronchus. Reobstruction had occurred in 2 patients with cicatricial lesion in right main stem bronchus. In patients with an unresectable malignant lesion, concurrent radiotherapy was needed to prevent the reobstruction.
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[Effect of recombinant human erythropoietin on autologous blood pre-donation in open heart surgery].
We have used recombinant human erythropoietin (EPO) with an autologous blood predonation in open heart surgery looking forward to preventing patient's blood level of hemoglobin and quick recovery in post-operative period. In our results, patient's value of hemoglobin (Hb) and hematocrit (Ht) decreased due to autologous blood predonation. In group A (autologous blood predonation with EPO administration), however, predonated blood volume were larger than in group B (without EPO administration), decreased value of Hb and Ht were smaller than in group B. ⋯ In particular, patients who administered EPO intravenously have showed fair recovery from anemia. EPO is very effective drug to prevent patients from the developing anemia as a complication of autologous blood predonation. We conclude that autologous blood predonation with EPO administration is beneficial method to reduce homologous blood requirement in open heart surgery.