Use of the sandwich method with an ultra-high-molecular-weight polyethylene prosthesis and Marlex mesh in sternal reconstruction: Report of a case

A 52-year-old Japanese man with a slow-growing chondroma originating from the sternal bone was referred to our hospital. A subtotal resection of the sternum was performed, hereafter termed the sandwich method, and an originally designed prosthesis made from ultra-high-molecular-weight polyethylene and Marlex mesh was used for reconstruction. The postoperative course was uneventful without any symptoms due to paradoxical movement of the chest or regional abscess, and no disturbance in the movement of the upper limbs, such as a surgical sequelae, was observed.     

Involvement of the #12u lymph nodes around the upper lobe bronchi in patients with lung cancer of the right middle lobe, right lower lobe, or left lower lobe

Abtract In Japan, the lymph nodes around the upper lobe bronchi, known as the #12u nodes, are not included in the nodes recommended for dissection in patients with right middle lobe carcinoma, right lower lobe carcinoma, or left lower lobe carcinoma. However, histologic examination has revealed involvement of these nodes in pneumonectomy patients whose carcinoma originated in the right lower lobe. We histologically examined the lymph nodes from 152 patients with lung cancer to determine the incidence of involvement of the #12u lymph nodes. These nodes were found to be involved in 14 (9.2%) of the 152 patients. The rate of involvement was significantly higher in those with T2–T4 disease than in those with T1 disease, and was also significantly higher in patients with N2 disease than in those with N1 disease. There were two long-term survivors without recurrence, and one other patient who lived for more than 5 years before succumbing to the disease. In conclusion, to ensure removal of all the cancer tissue, it is recommended that the #12u lymph nodes be included in the nodes routinely dissected in patients with right lower lobe carcinoma, right middle lobe carcinoma, or left lower lobe carcinoma.     

Resolution of a leg ulcer after hysterectomy for huge uterine myoma

Venous ulcers are the most common type of leg ulcers, accounting for 80% to 90% of cases. We report a large, therapy-resistant ulcer present for three months on the right leg of a 44-year-old woman who also had a huge uterine myoma. Without any other treatment, the leg ulcer regressed spontaneously three months after a hysterectomy for the uterine myoma that had been demonstrated in a CT image to be compressing the right common iliac vein in the pelvis. Uterine myoma can become the cause of venous insufficiency of the leg, when it is big enough to disturb the blood circulation in the pelvis in individuals who have incompetent perforating veins.     

Surgically repaired bilateral giant bullae after long-time follow-up; report of a case

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.     

Multicenter Prospective Cohort Study of Renal Failure in Patients Treated with Colistin versus Polymyxin B

Nephrotoxicity is the main adverse effect of colistin and polymyxin B (PMB). It is not clear whether these two antibiotics are associated with different nephrotoxicity rates. We compared the incidences of renal failure (RF) in patients treated with colistimethate sodium (CMS) or PMB for ≥48 h. A multicenter prospective cohort study was performed that included patients aged ≥18 years. The primary outcome was renal failure (RF) according to Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE) criteria. Multivariate analysis with a Cox regression model was performed. A total of 491 patients were included: 81 in the CMS group and 410 in the PMB group. The mean daily doses in milligrams per kilogram of body weight were 4.2 ± 1.3 and 2.4 ± 0.73 of colistin base activity and PMB, respectively. The overall incidence of RF was 16.9% (83 patients): 38.3% and 12.7% in the CMS and PMB groups, respectively (P < 0.001). In multivariate analysis, CMS therapy was an independent risk factor for RF (hazard ratio, 3.35; 95% confidence interval, 2.05 to 5.48; P < 0.001) along with intensive care unit admission, higher weight, older age, and bloodstream and intraabdominal infections. CMS was also independently associated with a higher risk of RF in various subgroup analyses. The incidence of RF was higher in the CMS group regardless of the patient baseline creatinine clearance. The development of RF during therapy was not associated with 30-day mortality in multivariate analysis. CMS was associated with significantly higher rates of RF than those of PMB. Further studies are required to confirm our findings in other patient populations.     

A case of mediastinal vagal nerve neurinoma: a familial neurinomatosis]

We experienced an operation of a 16-year-old female of mediastinal vagal neurinoma. Abnormal shadow was pointed out on chest X-ray at physical examination of high school. Right thoracotomy was performed under the diagnosis of mediastinal tumor. There was a walnut sized mass on the right vagal nerve at just peripheral side of the recurrent nerve branch. The vagal nerve was cut at both sides of the mass not to injure the recurrent nerve. The tumor was removed en block. Two little finger sized masses were recognized in serratus anterior muscle and 5 th. intercostal nerve. These removed masses were diagnosed as neurinoma pathologically. While the mother of this case had been admitted on another hospital because of multiple neurinomatosis with bilateral acoustic neurinoma. Thus this case is of familial neurinomatosis, suggesting it's heredity like as neurofibromatosis (von Recklinghausen's disease).     

Effect of combined BCG and UFT therapy of human maxillary cancer transplanted into nude mice

Twenty male 5-6 week-old nude mice transplanted with human maxillary cancer (MC-Ya) were divided into 4 groups. Group I was treated with oral administration of 0.2 ml of 0.9% saline solution daily for 10-30 days, and served as control. Group II was treated with oral administration of 1 mg/mouse of BCG once a week for 10-30 days. Group III was treated with oral administration of 15 mg/kg of UFT daily for 10-30 days. Group IV was treated with the combination therapy of BCG and UFT. In comparison of the treatment effects in 4 groups, following results were obtained: 1) Mouse immunosuppressive acidic protein in the sera of nude mouse elevated in all groups, especially in group III. 2) The inhibitory effect on the growth of tumor was observed in group III and IV, especially in group IV, but not in group II. 3) The reason why the growth-inhibitory effect was observed more remarkably in group IV than in group III, would be explainable as the immunosuppression by UFT was restored by the immunostimulating effect of BCG.