Biomedical subjects

F Maitani

Publications and source records attributed to F Maitani.

6 recordsLinked to original sources

PubMed2001

Blunt chest trauma with deep pulmonary laceration.

BACKGROUND: Deep pulmonary laceration (DPL) is rare and its survival rate is low. The present study focused on the prognostic factors of DPL. METHODS: The present study concerned 17 DPL patients treated in Tokai University Hospital between 1988 and 1998. The prognostic factors of DPL were compared with systolic blood pressure (SBP), PaO2, and the volume of intrathoracic blood loss. Characteristic findings of initial chest roentgenograms of DPL were investigated. RESULTS: Eleven patients were saved and 6 patients died. An SBP of less than 80 mm Hg on arrival at the hospital and a blood loss of more than 1,000 mL through the chest tube within 2 hours after arrival were poor prognostic factors. Hypoxemia on arrival was not a poor prognostic factor. Chest roentgenograms showed macular infiltrative shadow with moderate lung collapse and deviation of the mediastinal shadow toward the unaffected side. Selective bronchial occlusion with a Univent prevented suffocation by intrabronchial blood. CONCLUSIONS: Two poor prognostic factors of DPL are SBP less than 80 mm Hg on arrival and blood loss of more than 1,000 mL through the chest tube within 2 hours after arrival.

Accidents, Traffic↗

PubMed2000

Is it permissible to omit mediastinal dissection for peripheral non-small-cell lung cancers with tumor diameters less than 1.5 cm?

BACKGROUND: Recently the pros and cons of limited surgery for small-sized peripheral non-small-cell lung cancers (PNSCLCs), such as omission of mediastinal dissection, etc., have been vigorously debated. We analyzed whether hilar/mediastinal lymph node metastases were present in 30 small-sized PNSCLCs. MATERIAL AND METHODS: In the nine years from 1990 to 1998, 294 lung cancer patients underwent lobectomy or pneumonectomy combined with hilar/mediastinal dissection in the Tokai University Hospital. Thirty of these patients diagnosed as having cT1N0M0 PNSCLC with tumor diameters of 1.5 cm or less by computed tomography, are evaluated in this article. RESULTS: The 30 PNSCLC patients consisted of 14 males and 16 females with a mean age of 61 +/- 9 years. Twenty six patients (87%) had no hilar nor mediastinal lymph node metastases (pN0), one patient (3%) had a hilar lymph node metastasis (pN1), and three patients (10%) had mediastinal lymph node metastases (pN2). CONCLUSIONS: Mediastinal lymph node metastases were histologically observed in 3 (10%) of 30 PNSCLC patients with tumor diameters of 1.5 cm or less. Our results show that mediastinal dissection is still necessary even for small-sized lung cancers.

Carcinoma, Non-Small-Cell Lung↗

PubMed1998

Experience with the two-windows method for mediastinal lymph node dissection in lung cancer.

BACKGROUND: Continuing to refine minimally invasive thoracoscopic surgical procedures, we have established the two-windows method. METHODS: Skin incisions required by this method consist of a 2- to 3-cm skin incision posteriorly, and a 2- to 3-cm skin incision anteriorly in the fourth intercostal space, with the inferior angle of the scapula as the midpoint. We used this method to perform pulmonary lobectomies in combination with thoracoscopy and mediastinal lymph node dissection in 100 consecutive patients with lung cancer (preoperative diagnosis, stage I, T1 N0 M0). RESULTS: The mean operative time was 2 hours 46 minutes, the mean blood loss was 68.2 mL, and the mean number of mediastinal lymph nodes dissected was 24.3. In developing this minimally invasive thoracoscopic procedure, which facilitates mediastinal lymph node dissection, we realized that it is best performed through the fourth intercostal space. Because the tracheal bifurcation can be seen directly below this level, surgical manipulation in this area can be easily performed. This enables the same extent of mediastinal lymph node dissection as that performed during a standard thoracotomy. Another advantage of this method is that a standard posterolateral thoracotomy incision can be made whenever necessary by simply connecting the two incisions. CONCLUSIONS: We believe that the two-windows method is capable of serving as the standard method for the surgical treatment of stage I lung cancer.

Adult↗

PubMed1998

A new device for thoracic access: the Thoraco Holder.

BACKGROUND: We present a novel invention (Thoraco Holder; Fuji Systems Corporation, Tokyo, Japan) for thoracoscopic surgery. Made of silicone, automatically stops bleeding from the chest wall, increases range of motion for manipulation, and decreases postoperative pain. METHODS: Under general anesthesia using the Univent tube (Fuji Systems Corporation, Tokyo, Japan), two Thoraco Holders were used in each of 300 thoracoscopic procedures for lung cancer, mediastinal tumor, pneumothorax, chest trauma, and emphysema, most using the Two Windows Method). RESULTS: No patient experienced more than 10 mL of bleeding from the chest wall. In addition, analgesics were not needed by any patient for over 1 week. No patient experienced trouble caused by the Thoraco Holder. CONCLUSIONS: The Thoraco Holder is made of silicone. Silicone rubber causes less pain postoperatively. The silicone cuff (balloon) causes less bleeding from the chest wall. This Thoraco Holder is useful access for video assisted thoracoscopic surgery.

Endoscopes↗

PubMed1997

[Thoracoscopic unilateral fold plication method in lung volume reduction surgery for diffuse pulmonary emphysema].

We have devised a 'Fold Plication Method', which helps ensure safe and simple lung volume reduction surgery (LVRS) for pulmonary emphysema and prevent air leakage from pulmonary stumps, which is most crucial problem, in addition to postoperative interstitial pneumonia that is occasionally caused by the use of the bovine pericardium. We performed LVRS on seven patients with the disease, using this method and the thoracoscopic surgery, which is based on the 'Two Windows Method' we had previously developed. The operation was performed without observable bleeding within approximately one hour for all patients, who then recovered favorably.

Aged↗

PubMed1996

Thoracoscopic surgery for lung cancer using the two small skin incisional method. Two windows method.

Pulmonary lobectomy and mediastinal lymph node dissection was performed in 25 patients with Stage I lung cancer under thoracoscopic guidance using the two-windows method. A posterior skin incision (3 cm) and lateral skin incision (2 cm) were made in the 4th intercostal space centering on the inferior angle of the scapula. The site closest to the operating surgeon was used for direct vision, while the distant site was used for insertion of the thoracoscope. The mean operative time was 2 hours and 15 minutes, and the mean blood loss was 82.6 ml. The mean number of dissected mediastinal lymph nodes was 32. The length of hospitalization ranged from 5 to 17 days. Recovery was uneventful, and analgesics were not required by postoperative day 6. The two-windows method overcomes the three-dimentional inaccuracy due to the one-directional observation of the operative field employed during conventional thoracoscopy. In addition, since we developed this method for mediastinal lymph node dissection, the tracheal bifurcation can be confirmed under direct vision, increasing the accuracy of the procedure. The advantages of the two-window thoracoscopic method of pulmonary lobectomy are cosmesis, preservation of respiratory function, and reduced postoperative pain. In addition, there is reduced intraoperative bleeding and shortened operative time, while achieving mediastinal dissection similar to that of standard thoracotomy. The two-windows method of thoracoscopic pulmonary lobectomy is equal or superior to standard thoracotomy in every respect. This method should become the standard surgical technique for Stage I lung cancer.

Adenocarcinoma↗