Biomedical subjects

Tetsu Yamada

Publications and source records attributed to Tetsu Yamada.

6 recordsLinked to original sources

PubMed2006

Position of a chest tube at video-assisted thoracoscopic surgery for spontaneous pneumothorax.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is a good therapeutic option for young patients with primary spontaneous pneumothorax (PSP), but there sometimes exists unexpected prolonged hospital stay due to air leak after the operation. OBJECTIVES: The goal of this retrospective study was to clarify if the position of the chest tube placed at VATS for PSP affected the periods of postoperative hospital stay. METHODS: Seventy-one cases with PSP under age 40 who undertook VATS from January 1994 to February 2001 were examined for several factors. They were classified into two groups by the location of the tip of the chest tube placed at VATS as follows: upper medial pleural space (group I) and outside of there (group II). RESULTS: Fifty-three of the 71 cases (75%) were classified in group I and 18 (25%) were in group II. Between the two groups, there were no differences as to preoperative characteristics of the patients and intraoperative findings of blebs or bullae. On the other hand, postoperative air leak-related complications were more frequent in group II than in group I (p=0.004). Mean postoperative hospital stay was 5.1+/-1.9 days in group I and 8.4+/-4.3 days in group II (p<0.0001). CONCLUSIONS: Patients with the tip of the chest tube in the upper medial pleural space at VATS could be discharged earlier than the other patients. The chest tube placement is one of the important factors for the outcome of VATS for PSP.

Adult↗

PubMed2006

[Thymic basaloid carcinoma].

We report a case of thymic basaloid carcinoma combined with multilocular thymic cyst (MTC). A 72-year-old man was found to have an abnormal shadow on a chest X-ray without pny symptoms. Chest computed tomography (CT) showed a smooth edged anterior mediastinum tumor projecting to the left lung field. After preoperative chemotherapy by irinotecan hydrochloride (CPT-11) and radiotherapy of 40 Gy, chest CT showed a large part of the tumor projecting to the left lung field had changed to a cyst. After the pericardium and upper lobe of the left lung to which the MTC adhered was partially resected via left thoracotomy, the tumor was resected with innominate vein via median sternotomy. The operation was followed by CPT-11 chemotherapy and radiotherapy of 20 Gy. The tumor was thymic basaloid carcinoma 3 x 2.5 x 2 cm in size combined with MTC 8.2 cm maximum in diameter. As he died of another disease 6 months after excision, sufficient postoperative observation was not obtained. Thymic basaloid carcinoma is rare and only 14 cases including the present case have been reported.

Aged↗

PubMed2005

Surgical treatment of thoracic aortic aneurysm in patients with concomitant coronary artery disease.

OBJECTIVE: Surgical treatment of thoracic aortic surgery in patients with coronary artery disease was investigated. METHODS: Between 1990 and April 2003, 330 patients underwent elective thoracic aortic surgery. Fifty-six patients who underwent aortic root reconstruction were excluded and 274 patients were examined. Fifty-four (20%) patients showed concomitant coronary artery disease. Ten had undergone coronary revascularization previously; and 3 underwent coronary revascularization [2 coronary artery bypass grafting (CABG), 1 percutaneous transluminal coronary angioplasty (PTCA)] before aortic surgery. Twenty-three patients underwent elective CABG simultaneously and 2 patients had additional coronary artery bypass because of cardiac ischemia during operation. The number of patients who underwent thoracic aortic surgery including Asc Ao+AVR was 2, hemi arch 1, total arch 15, distal arch 5, distal arch+LV aneurysmectomy 1, and thoracoabdominal Ao 1. Two patients underwent coronary revascularization with arterial grafts and the others with SVG grafts. RESULTS: There was one hospital death (4%). In patients without coronary bypass, 2 patients suffered cardiac ischemic events. CONCLUSION: Our thoracic aortic operations with concomitant CABG using SVG were overall successful. Our current strategies for thoracic aortic surgery in patients with concomitant coronary artery disease include conducting a dipyridamole myocardial perfusion-imaging test first in patients not at risk of coronary artery disease, and if the test is positive, coronary angiography is performed and aggressive coronary revascularization is conducted where possible.

Aged↗

PubMed2005

[Successful treatment of bronchial mucoepidermoid carcinoma by bronchoplasty].

A 63-year-old man who was pointed out abnormal shadow on chest X-ray admitted to our hospital. Chest computed tomography (CT) showed a tumor originated from right upper bronchus and grew into right main bronchus. The tumor was diagnosed as mucoepidermoid carcinoma by bronchoscopic biopsy. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed abnormal uptake localized at the tumor. The standardized uptake values of the tumor 60 minutes after injection were 2.86, and 120 minutes after injection, it increased to 3.97. Right upper lobectomy with bronchoplasty by deep wedge resection of right main bronchus at the orifice of right upper bronchus and lymphadenectomy was performed. Pathological diagnosis was high-grade mucoepidermoid carcinoma without lymph nodes metastasis which was compatible with FDG-PET. Postoperative course was uneventful.

Bronchi↗

PubMed2004

A case of tuberculous granuloma at the supra-sternal notch that was difficult to differentiate from a thyroid tumor.

BACKGROUND: Despite a decline after World War II, the rate of tuberculosis remains higher in Japan than in other countries. We report a case of tuberculous granuloma at the supra-sternal notch that was difficult to differentiate from a thyroid tumor. CASE REPORT: The patient was a 75-year-old Japanese woman who was referred to our hospital for further investigations and treatment of an anterior neck tumor, that was diagnosed as a suspected of thyroid malignancy by another institute. The thyroid function and biological data were normal except for an elevated erythrocyte sedimentation rate. Imaging studies showed a mass at the supra-sternal notch, and the border between the tumor and the thyroid gland was indistinct. The tuberculosis bacillus group was identified by fine needle aspiration cytology. The patient was treated surgically for tuberculous granuloma, and histopathological findings revealed that the lymph node tuberuculosis had invaded the thyroid gland. We started anti-tuberculous therapy after the operation. The post-operative course was uneventful with good wound healing. CONCLUSIONS: When a markedly elevated erythrocyte sedimentation rate and c-reactive protein value are associated with an anterior neck mass, tuberculosis should be considered in the differential diagnosis of thyroid swelling. Fine needle aspiration cytology is a rapid, simple and effective diagnostic method for extra-pulmonary tuberculous lesions involving the neck. When there is abscess formation or features of compression, or if the mass cannot be differentiated from a thyroid tumor, combined therapy involving anti-tuberculous agents and surgery must be considered.

Aged↗

PubMed2004

Successful thoracoscopic debridement of descending necrotizing mediastinitis.

Descending necrotizing mediastinitis results from odontogenic, deep neck infection that spreads along fascial planes into the mediastinum. Although the optimal surgical approach remains controversial, nearly half of the cases require mediastinal debridement by thoracotomy. We report a case of successful thoracoscopic debridement for descending necrotizing mediastinitis due to odontogenic infection that failed to be drained by transcervical approach. Because of less invasiveness as compared with standard thoracotomy, the thoracoscopic approach should be used as early as possible in case of unsuccessful transcervical approach.

Abscess↗