Yasushi Hoshikawa

Thoracotomy for the management of intractable secondary pneumothorax is associated with a high perioperative risk related to the presence of underlying lung disease. This study was undertaken to determine factors associated with in-hospital morbidity among patients after general thoracic surgery for intractable secondary pneumothorax and to construct a risk model. PATIENTS AND METHODS: A total of 60 patients were included, of which 43 underwent elective surgery. Predicted morbidity rates were calculated using univariate analysis and multivariate logistic regression analysis. RESULTS: Of the 43 original patients, 10 (23%) developed postoperative complications. The following factors were found to be significantly associated with the occurrence of postoperative complications on univariate analysis: total protein, albumin, sodium ions, chorine esterase, O₂ inhalation, performance status, and the anesthesic score. On multivariate analysis, these factors were the performance status (95% confidence interval: 1.41-3850, odds ratio: 73.66, p=0.033). Conclusion: These results suggest that postoperative complications of secondary pneumothorax in elderly patients can be predicted by preoperative examinations. Poor performance status, nutrition, low sodium levels, and respiratory failure are dependent risk factors for postoperaive complications of secondary pneumothorax in elderly patients.

Thoracotomy for the management of intractable secondary pneumothorax is associated with a high perioperative risk related to the presence of underlying lung disease. This study was undertaken to determine factors associated with in-hospital morbidity among patients after general thoracic surgery for intractable secondary pneumothorax and to construct a risk model. PATIENTS AND METHODS: A total of 60 patients were included, of which 43 underwent elective surgery. Predicted morbidity rates were calculated using univariate analysis and multivariate logistic regression analysis. RESULTS: Of the 43 original patients, 10 (23%) developed postoperative complications. The following factors were found to be significantly associated with the occurrence of postoperative complications on univariate analysis: total protein, albumin, sodium ions, chorine esterase, O₂ inhalation, performance status, and the anesthesic score. On multivariate analysis, these factors were the performance status (95% confidence interval: 1.41-3850, odds ratio: 73.66, p=0.033). Conclusion: These results suggest that postoperative complications of secondary pneumothorax in elderly patients can be predicted by preoperative examinations. Poor performance status, nutrition, low sodium levels, and respiratory failure are dependent risk factors for postoperaive complications of secondary pneumothorax in elderly patients.

A 40-year-old man, diagnosed as acute myelogenic leukemia underwent a HLA-identical sibling peripheral blood stem cell transplant following an off treatment relapse. He subsequently developed chronic graft-versus-host disease (GVHD) and bronchiolitis obliterans caused recurrent pneumothorax. In order to control the recurrent medical-treatment-resistant pneumothorax, four surgeries (three left, one right) were necessary. It was thought important to reinforce the whole visceral pleura by covering it with an absorbable material sheet and fibrin glue in surgical treatment for recurrent pneumothorax.

The determination of plasma (1→3)-β-D-glucan is widely used for the diagnosis of deep mycosis, but it is often affected by various factors. We experienced a case with markedly increased plasma (1→3)-β-D-glucan after bilateral lung transplantation for pulmonary lymphangiomyomatosis. The patient's plasma (1→3)-β-D-glucan increased up to 2964 pg/ml the day after transplantation. We searched for the reason for this increase and it was suspected that blood from the surgical field, which contained gauze, returning to the circulation through a heart-lung machine might have caused the increase in plasma (1→3)-β-D-glucan. To examine this hypothesis, we experimentally measured the (1→3)-β-D-glucan level in saline in which gauze had been immersed. The result implies that (1→3)-β-D-glucan might have been eluted from the gauze. If large amounts of gauze are used in the surgical field and the blood aspirated is returned to the circulation, the postoperative plasma (1→3)-β-D-glucan level should be carefully interpreted.

A 40-year-old man, diagnosed as acute myelogenic leukemia underwent a HLA-identical sibling peripheral blood stem cell transplant following an off treatment relapse. He subsequently developed chronic graft-versus-host disease (GVHD) and bronchiolitis obliterans caused recurrent pneumothorax. In order to control the recurrent medical-treatment-resistant pneumothorax, four surgeries (three left, one right) were necessary. It was thought important to reinforce the whole visceral pleura by covering it with an absorbable material sheet and fibrin glue in surgical treatment for recurrent pneumothorax.

We report a case of tracheal bifurcation injury with destruction of carinal cartilage in association with blunt chest trauma. A 29-year-old male truck driver arrived at the emergency room of a local hospital with subcutaneous emphysema of the neck. His truck crashed into a larger truck from behind after he fell asleep at the wheel. He was unrestrained and hit his mid-chest hard on the wheel. He was diagnosed with a tracheal bifurcation injury and was brought to our university hospital. Chest roentogenogram and CT showed pneumomediastinum. Preoperative flexible bronchoscopy showed a laceration of ∅8 mm at the carinal cartilage of the tracheal bifurcation, through which air bubbles came in and out. This was repaired by complete carinal resection followed by montage-type carinoplasty, since we were afraid that simple repair of the laceration with debridement may have resulted in dehiscence of the suture line or airway stenosis by hypertrophic granulation. The patient was discharged on the 29th postoperative day without any anastomotic problems. There has been no report to our knowledge of carinal resection and reconstruction for a tracheal bifurcation injury. We propose that for a tracheal bifurcation trauma with a widespread destruction of carinal cartilage carinal resection and reconstruction should be selected over simple repair with debridement.