Auditory short, middle, and long latency responses in acutely comatose patients

For assessing comatose patients, the combination of auditory short, middle, and long latency evoked potentials (auditory brain stem response [ABR], middle latency component [MLC], and slow vertex response [SVR] ) is more comprehensive than auditory brain stem response (ABR) only or ABR with slow vertex response (SVR). Fifty-four acutely comatose patients were studied. Thirty-four of the patients had severe head injury and others had coma of varied etiology. Within two months after admission, 25 patients survived, while 29 patients died. Auditory evoked response measurements were conducted usually within 48 to 72 hours after admission. For patients with normal SVR, MLC, and ABR, there was 100% survival; with absent SVR but normal MLC and ABR, survival was 91%; with absent SVR and MLC and normal ABR, it was 60%; with abnormal ABR, it was 10%; no patient survived whose ABR was absent. It is emphasized that a normal MLC is clearly a predictor of survival of comatose patients, but a normal ABR is not always a reliable indicator of survival.     

An Experimental Study of Atrial Natriuretic Peptide Levels and the Effect of Inhaled Nitric Oxide After Pneumonectomy

(Received for publication on Feb. 24, 1999; accepted on Nov. 11, 1999)     

Hand-assisted laparoscopic adrenalectomy to a solitary adrenal metastasis from lung cancer

A 75-year-old man with right chest pain was diagnosed with primary lung cancer in the right apical portion, and was treated with chemoradiotherapy because of a synchronous left adrenal tumor of 1.6 cm. Since the adrenal tumor did not increase in size for three months and there were no other relapses, the right upper lobectomy of the lung with the excision of the chest wall was performed. Afterward, an enlargement of the left adrenal tumor was encountered; he was admitted to our hospital for an operation. For the metastatic adrenal tumor from lung cancer, we performed a hand-assisted laparoscopic adrenalectomy. He recovered rapidly and returned to the previous hospital in two weeks after the operation. After the first report in 1992, the laparoscopic adrenalectomy has been established as the curative operation to adrenal benign tumor. The indication is being expanded to the malignancy because of the improvement of operation techniques and advancement of the operation equipments. We conclude that the laparoscopic adrenalectomy for malignant tumor is a safe, curative, and clinically useful surgical technique.     

Advanced chemoresistant breast cancer responding to multidisciplinary treatment with hyperthermia, radiotherapy, and intraarterial infusion

We employed multidisciplinary therapy, consisting of hyperthermia, radiotherapy, and intraarterial infusion, for a patient with progressive advanced breast cancer that was resistant to epirubicin hydrochloride and cyclophosphamide (EC) therapy as well as being resistant to docetaxel hydrate, and obtained a good therapeutic response. Because estrogen and progesterone receptors were both negative and HER2 was 3(+), administration of trastuzumab was started, and this patient has shown no signs of recurrence at 33 months after our treatment. The results suggested that our multidisciplinary therapy can be an effective method for the treatment of progressive breast cancer showing resistance to major chemotherapy agents such as anthracyclines and taxanes.     

The effect and role of the intraaortic balloon pumping in off-pump coronary artery bypass

Eighty consecutive patients who underwent off-pump coronary artery bypass (OPCAB) were studied. They were divided into group I (n = 10) which received preoperative intraaortic balloon pumping (IABP), and group II (n = 70) which did not receive IABP. The indications for preoperative IABP were severe left main coronary artery disease in 7 patients, severe 3 vessel disease in 3 patients, unstable angina in 5 patients, acute myocardial infarction in 3 patients. There was no operative mortality in both groups. The average number of distal anastomosis 2.7/patients in group I and 3.3/patients in group II. There was no differences in ventilator support time, length of stay in the intensive care unit and morbidity between 2 groups. The average postoperative IABP support time was 5.4 hours. There was no IABP-related complication in group I. IABP was very effective to perform OPCAB surgery safety. Preoperative IABP may be effective modality to support OPCAB surgery not only in emergent case but also in elective case.     

Resection of synchronous lung and Vater's papilla cancer

We present a case of a 78-year-old man with a synchronous double cancer of the lung and Vater's papilla. A pancreaticoduodenectomy was performed for Vater's papilla cancer and a partial lung resection for lung cancer. The pathological diagnosis of the tumors was a well differentiated tubular adenocarcinoma and well differentiated bronchioloalveolar carcinoma, respectively. Although most cases of synchronous double cancers involve lung and gastric cancers, a combination of lung and Vater's papilla is extremely rare. This patient is still alive with no recurrence for 5 years after the last operation.