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1.
Ueshima Y Hamashima T Ikeda E Iwamoto N Shioaki Y Mutou F Kurioka H 《Kyobu geka. The Japanese journal of thoracic surgery》2004,57(10):984-986
A 53-year-old man presented with massive right hydrothorax just after introduction of continuous ambulatory peritoneal dialysis (CAPD). Because the glucose concentration of pleural fluid was markedly high compared with that of serum, we diagnosed pleuroperitoneal communication. Thoracoscopic surgery was performed and thinning of the diaphragm was found. We sutured the diaphragm to repair the thin portion and performed pleurodesis with 50% glucose solution. He restarted CAPD 1 month post-operatively and continued at home without pleural effusion. Eight months post-operatively, he experienced dyspnea again and chest X-ray showed right hydrothorax. Although the cause of recurrent hydrothorax is unknown, it may be that not only surgical repair but also more intense pleurodesis is needed. 相似文献
2.
Kazui T Nagumo T Izumoto H Komoda K Tanita T Kawazoe K 《Kyobu geka. The Japanese journal of thoracic surgery》2004,57(3):253-257
A 44-year-old male was admitted to our hospital owing to severe dyspnea of sudden onset. Chest X-ray disclosed bilateral giant bullae. His pulmonary function was severely depressed. VC (%) was 2.61 l (66.3%) and FEV1% (%) was 1.47 l (64.5%). Indication of surgical repair of giant bullae are; space occupying lesion more than 25-50% in 1 thorax, progressive dyspnea, enlargement over time irrespective of symptoms, and expectation that re-expand the normal lung. He was conducted two-staged bullectomy using video-assisted thoracoscopic surgery (VATS) with small incisions. First operation was performed to left lung. Pulmonary function improved. VC (%) increased 3.02 l (76.8%) and FEV1% (%) 2.36 l (76.6%). After second operation, which was performed to right lung, VC (%) was 2.40 l (60.5%) and FEV1% (%) was 2.21 l (92.1%). Hugh-Jones grade improved class IV to class I. Postoperative course was uneventful and he was discharged 15 days after second operation. Two-staged bullectomy was appropriate in this case, because he might have suffered from re-expansion pulmonary edema after first surgery. The extent of recovery of pulmonary function was unpredictable. And performing right lung bullectomy just after the left bullectomy may be dangerous, because the patient have to receive anesthesia with his resected left lung. There is some possibility that patient who has bilateral giant bullae shows severe dyspnea during the progress, care should be taken to conduct operation as soon as possible. 相似文献
3.
Szavay PO Drews K Fuchs J 《Surgical laparoscopy, endoscopy & percutaneous techniques》2005,15(5):305-307
The presentation of a congenital diaphragmatic hernia (CDH) beyond infancy is rare, as it is a common cause for severe respiratory distress in the newborn. In contrast to the newborn period, delayed diagnosis of right-sided congenital diaphragmatic hernia (RCDH) is known as it causes less severe symptoms than left-sided CDH. A case of an 8-month-old girl is reported. Chest x-ray and ultrasound examination of the diaphragm for symptoms of pneumonia revealed an RCDH. Thoracoscopic repair could be performed. The further course was uneventful. Thoracoscopic repair of a RCDH proved in this case to be feasible and safe beyond the newborn period. It avoided the morbidity of a major thoracotomy or laparotomy and provided an excellent cosmetic result. To our knowledge, this is the first report of thoracoscopic repair of RCDH. 相似文献
4.
Ishibashi H Akamatsu H Sunamori M Ishibashi T Iwata T 《Kyobu geka. The Japanese journal of thoracic surgery》2002,55(12):1069-1072
A 53-year-old male was admitted to the hospital because of progressive paralysis of inferior limb. Chest X-ray film and chest computed tomography (CT) on admission showed a small nodule with bullae in the right lower lung field. After CT-guided marking, partial lung resection including the nodule was performed. The cut surface of the resected specimen showed a tumor (10 mm in diameter) in a bullae measuring 14 mm in diameter. The tumor was diagnosed as amyloidosis. Fourty-six cases of primary localized pulmonary amyloidosis were reported in Japan. However, primary localized pulmonary amyloidosis with bullae is extremely rare, only 3 cases have been reported. 相似文献
5.
A 51-year-old man with a traumatic diaphragmatic rupture is presented. Preoperatively, diaphragmatic rupture and herniation of the stomach into the left thoracic cavity were suspected. Under thoracoscopic guidance, the stomach and omentum were repositioned in the abdominal cavity using Babcock forceps, and then the rupture site was closed using an endoscopic hernia stapler. The postoperative course was uneventful and the patient was discharged from our hospital with no symptoms. 相似文献
6.
Laparoscopic repair of congenital diaphragmatic hernia with prosthesis: a case report 总被引:4,自引:0,他引:4
We report here our experience in the treatment of a large congenital diaphragmatic hernia, an uncommon pathology, approachable
by laparoscopy. The patient was a 33-year-old woman with trisomy 21 syndrome, who only complained of colicky abdominal pain
and a cough for 7 months before the hospitalization. Thoracic and abdominal CT scans showed a large anteromedial diaphragmatic
hernia with slippage of the colon into the mediastinum and posterior displacement of the cardiovascular structures. The patient
underwent laparoscopic repair of the hernia. The colon was put back in the abdomen; the defect (8×4 cm) was repaired by a
Composix mesh (PTFE-polypropylene), fixed to the diaphragm by nonabsorbable stitches and staples. The patient was discharged
on the third postoperative day. The postoperative course was uneventful. Follow-up at 18 months didn't show any complications
or recurrence. We believe laparoscopic repair of diaphragmatic hernia to be the elective surgical choice, because of its technical
feasibility and certain intra- and postoperative advantages.
Electronic Publication 相似文献
7.
Cirrhosis is the most common indication for liver transplant. Literature addressing methotrexate (MTX)-induced liver cirrhosis in patients with psoriasis is sparse. We present a case of a nonalcoholic patient diagnosed with psoriasis that was treated with a weekly 5 mg dose of methotrexate, a chemotherapeutic and immunological modulator, for five years. The patient presented after five years with abdominal distension and lower limb edema along with ascites and esophageal varices and was diagnosed with liver cirrhosis. Upon the discontinuation of MTX, the patient showed clear regression of ascites and esophageal varices, and recovery of liver cirrhosis by de-escalating from Child-Pugh B to A. After five years of follow-up, Echography and Transient Elastography (Fibroscan) of the liver confirmed the full recovery of liver cirrhosis by the absence of steatosis and fibrosis. This study emphasizes the reversibility of MTX-induced liver cirrhosis: cirrhosis is not aggressive, can be reversible, and is dose- and duration-dependent. 相似文献
8.
Yatsuyanagi E Kusajima K Suzuki M Hirano T Sakurada T Kikuchi Y Takezawa C 《Kyobu geka. The Japanese journal of thoracic surgery》2003,56(12):1068-1071
A 71-year-old man was admitted to our hospital for treatment of an endobronchial tumor. Although he was asymptomatic and chest radiography showed no tumor shadow, bronchoscopic findings demonstrated an endobronchial tumor with a villous surface occluding the bronchus of the left upper division. Endobronchial resection was abandoned because we could not directly observe the cervix with a bronchoscope. In addition, because we could not diagnose the tumor histologically as benign by biopsy specimens, we elected to perform a segmentectomy of the left upper division. To reduce surgical stress, the operation was carried out using thoracoscopy. The tumor was finally diagnosed as endobronchial chondromatous hamartoma. The patient's postoperative course was uneventful. When endobronchial resection is not feasible, a less invasive surgical approach and method should be taken in patients with suspected endobronchial hamartoma. 相似文献
9.
Sohail R. Shah George K. Gittes Katherine A. Barsness Timothy D. Kane 《Surgical endoscopy》2009,23(1):215-215
Purpose Minimally invasive techniques continue to expand in pediatric surgery; however, there has been some debate over the appropriate
operative technique for the management of congenital diaphragmatic hernias in neonates [1–3]. We present a video of a thoracoscopic patch repair of a right-sided Bochdalek congenital diaphragmatic hernia (CDH) in
a 3-day-old male.
Methods Our patient was noted to have a right-sided CDH on chest X-ray following respiratory distress at the time of birth. The patient’s
remaining neonatal workup also confirmed hypoplastic transverse aortic arch with coarctation, ventricular septal defect (VSD),
and patent ductus arteriosus, which were initially diagnosed by prenatal ultrasound. After monitoring the patient for hemodynamic
stability and discussion with the family and involved pediatric cardiothoracic surgeons, the decision was made to proceed
with a thoracoscopic repair of the CDH.
Results The large right-sided CDH was noted to involve herniated small bowel, colon, and liver. The diaphragmatic defect was successfully
repaired thoracoscopically using a 5 × 5 cm polytetrafluoroethylene (PTFE) patch. The patient was extubated on the second
postoperative day and ultimately underwent aortic arch augmentation, VSD closure, and patent ductus arteriosus ligation and
division at 1 month of age. There has been no evidence of CDH recurrence in follow-up.
Conclusions As demonstrated by our video, large right-sided congenital diaphragmatic hernias requiring patch repair can be successfully
repaired thoracoscopically with appropriate surgeon comfort and experience. This minimally invasive approach may also be used
in neonates with associated cardiac defects with appropriate cardiothoracic surgical consultation and support. To our knowledge
this is the first reported case of a thoracoscopic repair of a Bochdalek (posterolateral) hernia with a prosthetic patch in
a neonate with significant congenital cardiac anomalies.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
10.
Kato T Sato Y Yamamoto S Takeishi T Hirano K Kobayashi T Hara Y Watanabe T Shirai Y Hatakeyama K 《Transplantation proceedings》2004,36(8):2321-2323
Type C liver cirrhosis is often associated with a nephrotic syndrome secondary to membranoproliferative glomerulonephritis. Liver transplantation in such patients may sometimes worsen viremia, causing renal dysfunction upon the introduction of immunosuppressive drugs. We present a case of a patient whose proteinuria decreased after liver transplantation. The patient was a 49-year-old male who had been followed due to chronic hepatitis type C from 1984. From 1999 he was diagnosed as having nephrotic syndrome. We performed a living related liver transplant on August 21, 2001. An intraoperative renal biopsy revealed the histology to show membranoproliferative glomerulonephritis. The volume of proteinuria was 2 to 11 g/day before surgery. After surgery it varied from 6 to 10 g/day, gradually decreasing to 1 to 2 g/day. One of the causes of reduced proteinuria may be alleviation of membranoproliferative glomerulonephritis by immunosuppression. But from the view that the recovery of the renal function followed the recovery of liver function, the major effect may have been alleviated hepatorenal syndrome. 相似文献
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患者男,30岁,因乏力、双下肢肌痛10d,于2012年2月17日就诊,5年前曾因纳差、腹胀人院。查体:面色晦暗,肝掌、蜘蛛痣(+),巩膜无黄染,肝脾肋缘下未及,腹部移动性浊音(++),双下肢轻度水肿。血液生化学检查:总胆红素(TBil)10.1μmol/L,AIJT63U/L,AST83U/L, 相似文献
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15.
Ronan A Cahill Suzanne Norris Richard B Stephens 《World journal of emergency surgery : WJES》2007,2(1):32-3
Although commonly detectable in patients with cirrhosis, rectal varices only infrequently cause significant hematochezia (0.5–3.6%).
While they may be expected to resolve with treatment of the concomitant portal hypertension, there is currently no standardized
approach to their management in isolation. Therefore many authorities recommend transjugular intrahepatic portosystemic shunting
(TIPS) as a means of alleviating otherwise recalcitrant bleeding. Conceptually, however, rectal varices should be as amenable
to local therapies as are their counterparts occurring at the esophagogastric junction. In this report, we describe the use
of endoscopic banding per ano to alleviate significant rectal bleeding in a patient with poorly controlled portal hypertension.
This allowed medical optimisation so that the underlying pathology could be controlled without recourse to TIPS or other means
of creating a formal portosystemic shunt. 相似文献
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Tsuboshima K Matoba Y Sato M Kobayashi I Kobayashi S Ohue H Watanabe Y Ohno T 《Kyobu geka. The Japanese journal of thoracic surgery》2012,65(7):599-601
A 59-year-old man treated with hemodialysis for liver cirhhosis and chronic kidney disease developed right pleural effusion and ascites. Ascites always decreased after thoracocentesis for pleural effusion. In spite of repeated treatment with chest tube drainage, massive pleural effusion reappeared. Under the diagnosis of pleuroperitoneal communication, surgical repair of the diaphragm by video assisted thoracoscopic surgery (VATS) were performed. Bulla and pin hole were found and they were resected and sutured. Surgery was safely and successfully accomplished though the patient had Child-Pugh B liver cirhhosis. Pleural effusion disappeared after surgery. 相似文献
18.
Allal H Montes-Tapia F Andina G Bigorre M Lopez M Galifer RB 《Journal of pediatric surgery》2004,39(10):1568-1570
H-type tracheoesophageal fistula (H-TEF) without esophageal atresia makes up 4% to 5% of esophageal congenital abnormalities. The authors present the thoracoscopic treatment of a 2.47-kg newborn boy with a fistula between the second and third thoracic vertebrae diagnosed by esophagography. Four trocars were used for fistula closure, and tracheal and esophageal suturing were accomplished without intraoperative incident. Five days after surgery, results of a barium swallow excluded anastomotic leaks. The chest tube was removed, and oral feeding was initiated. 相似文献
19.
Surgical removal of renal cell carcinoma after partial splenic embolization in a patient with liver cirrhosis: a case report 总被引:4,自引:0,他引:4
Makiyama K Senga Y Gotou A Sakuramoto T Hata Y 《Hinyokika kiyo. Acta urologica Japonica》2000,46(12):895-898
Partial splenic embolization is used to treat patients with liver cirrhosis accompanied by hypersplenism for improving thrombocytopenia and leukopenia. We report a case in which partial splenic embolization was used before nephrectomy because both renal cell carcinoma and liver cirrhosis were present. A 75-year-old woman visited our hospital complaining of abdominal distension. Computed tomography revealed a 5.5 cm left renal tumor. Liver cirrhosis, ascitis, splenomegaly was observed. Blood tests revealed pancytopenia; platelet count was 2.9 x 10(4)/mm3. The patient was treated by partial splenic embolization in an attempt to ensure a safe nephrectomy. After the embolization, her platelet count increased immediately to 19.2 x 10(4)/mm3, and left nephrectomy was performed successfully. 相似文献
20.
Becmeur F Talon I Schaarschmidt K Philippe P Moog R Kauffmann I Schultz A Grandadam S Toledano D 《Journal of pediatric surgery》2005,40(11):1712-1715