Nishikawa S.,Shizuoka City Shizuoka Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012
The number of lung resection for patients with lung cancer has been increasing lineally for last two decades in Japan. It reached more than 30,000 in 2009. Subsequently those combined with chronic obstructive pulmonary disease (COPD) also have increased. As pulmonary vascular bed has already been lost to some extent due to chronic alveolar destruction, a careful preoperative physiologic assessment according to a guideline by American College of Chest Physicians (ACCP) or European Respiratory Society( ERS)/European Society of Thoracic Surgeons( ESTS) is important to select patients to be underwent lung resection within acceptable risk. The process to evaluate the risk of lung resection for a lung cancer patient has three steps structured by forced expiratory volume in 1 sec( FEV1), diffusion capacitiy for carbon monoxide (DLco), and exercise capacity. We suggested that it would be more practical to add global initiative for obstructive lung disease( GOLD) staging of each patient and distribution of emphysematous lung obtained by functional imaging modarities to the pathway of flow chart of the guideline. Some patients with very low FEV1 demonstrate increase in FEV1 after lung resection by so called lung volume reduction effect. To utilize lots of findings and experiences obtained from lung volume reduction surgery( LVRS) contributes to select patients with lung cancer and COPD and to perform lung resection and perioperative care properly.
Chihara K.,Shizuoka City Shizuoka Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2010
Surgical challenge for tumors arising posterior-apical lung well known as Pancoast tumor and those of the apical lung involving anterior thoracic outlet structures (mainly subclavian vessels) have been continued with seeking the pathway of the proper approaches and the strategy combined modalities as radiotherapy or chemoradiotherapy followed by surgery for these 50 years, and operative outcome have been improved these decades. As complete resection of the tumors is the main factor for operative results, the preoperative evaluation on involved structures and the choice among the different approaches is important. We present our experience for Pancoast tumors with posterior approaches and for cervico-thoracic tumors resected with anterior approaches.
Three-year outcome after percutaneous coronary intervention and coronary artery bypass grafting in patients with triple-vessel coronary artery disease: Observations from the CREDO-Kyoto PCI/CABG registry cohort-2
Tazaki J.,Kyoto University |
Shiomi H.,Kyoto University |
Morimoto T.,Kinki University |
Imai M.,Kyoto University |
And 8 more authors.
EuroIntervention | Year: 2013
Aims: We sought to investigate medium-term outcome of percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in patients with triple-vessel coronary artery disease (TVD). Methods and results: We identified 2,981 patients with TVD (PCI: N=1,825, CABG: N=1,156) among 15,939 patients with first coronary revascularisation enrolled in the CREDO-Kyoto PCI/CABG registry cohort-2. Excess adjusted three-year risk of the PCI group relative to the CABG group for death/myocardial infarction (MI)/stroke was significant (HR 1.47 [95% CI: 1.13-1.92, p=0.004]). Adjusted risk for all-cause death was also significantly higher with PCI as compared with CABG (HR 1.62 [95% CI: 1.16-2.27, p=0.005]), while risk for cardiac death was neutral between the two groups (HR 1.3 [95% CI: 0.81-2.07, p=0.28]). PCI was also associated with a markedly higher risk for any coronary revascularisation. Regarding the analysis stratified by the SYNTAX score, the adjusted HR of PCI relative to CABG for death/MI/stroke was 1.66 (95% CI: 1.04-2.65, p=0.03) in the low-score (<23: N=874, and N=257), 1.24 (95% CI: 0.83-1.85, p=0.29) in the intermediate-score (23-32: N=638, and N=388), and 1.59 (95% CI: 0.998-2.54, p=0.051) in the high-score (≥33: N=280, and N=375) tertiles, respectively. Conclusions: PCI as compared with CABG was associated with significantly higher risk for serious adverse events in TVD patients. © Europa Digital & Publishing 2013. All rights reserved.
Terada T.,Shizuoka City Shimizu Hospital |
Moriki T.,Shizuoka City Shizuoka Hospital
Pathology International | Year: 2010
We herein report a unique monolobar hepatic disease composed of Caroli's disease, peribiliary cysts, ductal plate malformations, peribiliary gland proliferation, hepatolithiasis, and portal phlebosclerosis with thrombi. A 73-year-old man underwent abdominal imaging, which revealed multiple segmental dilations of the left intrahepatic bile ducts. Polycystic kidney diseases were absent. Intrahepatic cholangiocarcinoma was suspected, and extended left lobectomy of the liver was preformed. Grossly, the hepatic left lobe was atrophic, and partly replaced by fibrous tissue. The intrahepatic bile ducts were dilated (Caroli's disease), and showed small calcium bilirubinate hepatoliths. Microscopically, the intrahepatic bile duct showed non-obstructive segmental dilations (Caroli's disease), numerous peribiliary cysts, numerous ductal plate malformations, proliferation of intrahepatic peribiliary glands, and calcium bilirubinate hepatolithiasis. Portal veins showed phlebosclerosis with thrombi. Immunohistochemically, the various biliary epithelial cells were positive for cytokeratin (CK) 7, 8, 18, and 19, and for MUC6 and CD10. They were negative for MUC2 and MUC5AC. The ductal plate malformations were positive for fetal biliary antigen MUC1, but other biliary cell types were negative for MUC1. The present case resembles 'monolobar Caroli's disease'. We believe that the present monolobular liver disease was congenital in origin. © 2010 Japanese Society of Pathology and Blackwell Publishing Asia Pty Ltd.
Chihara K.,Shizuoka City Shizuoka Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2011
We address 3 important keys to obtain successful outcomes in surgery for emphysematous giant bullae. It is the 1st step to select patients who might benefit from bullectomy based on functional imaging. The chest computed tomography (CT) and pulmonary perfusion scintigram provide information regarding with pulmonary vascular beds which could be recruited by bullectomy. In addition, dynamic-magnetic resonance imaging (MRI) during breathing can show a patient with paradoxical inflation of giant bulla during expiration, which means impairment of ventilation of the adjacent normal parenchyma, and is a promising sign for successful outcome of bullectomy. Second, it should be emphasized to perform a proper procedure in bullectomy. If a giant bulla has a wide bottom, it should be recommended to open the bulla and to plicate it by sutures without injury of vessels on the bottom of the bulla rather than simple bullectomy with staples. Finally, it is important to keep inflated lung avoiding atelectasis following operation by minimum pressure of suction. We show here sequential bullectomies on a 41-year-old male with chronic obstructive pulmonary disease (COPD) GOLD IV due to bilateral giant bullae and poor vascular reserve, and address our strategy described above.