Biomedical subjects

Yuji Shiraishi

Publications and source records attributed to Yuji Shiraishi.

8 recordsLinked to original sources

PubMed2005

Closure of a large bronchial fistula with a latissimus dorsi myocutaneous flap.

We describe a case of a large bronchial fistula and empyema after right upper lobectomy that was treated successfully with open window thoracostomy followed by a latissimus dorsi myocutaneous flap and limited thoracoplasty. A latissimus dorsi myocutaneous flap can provide immediate airtight closure of a large bronchial fistula, allowing lavage and curettage of the empyema cavity to reduce the chance of postoperative infection. An important aspect of this technique is that the deepithelialized skin side rather than muscle is sutured to an opening of the bronchus. As compared with other techniques, a latissimus dorsi myocutaneous flap is superior in that it requires a single incision and does not require an intraoperative change of position. In addition, the technique causes little dysfunction of the chest and shoulder and preserves the vascular supply to ensure the viability of the flap even if it was divided in a previous operation.

Adenocarcinoma↗

PubMed2005

[Pulmonary tuberculosis in elderly patients].

Since the introduction of rifampicin, it has been believed that pulmonary tuberculosis can be cured with medication alone. However, if tubercle bacilli are resistant to isoniazid and rifampicin, the success rate of medical treatment falls considerably. These bacilli are defined as multidrug-resistant tuberculosis (MDR-TB) and have been of great concern. To improve the outcome of chemotherapy in patients with MDR-TB, adjuvant resectional surgery has been advocated. Currently the most common indication for pulmonary resection in patients with tuberculosis is MDR-TB. Pulmonary resection for MDR-TB achieves a high cure rate with low morbidity and mortality. The majority of the MDR-TB patients in the previously reported surgical series were middle-aged, and pulmonary resection for MDR-TB has not been performed on the octogenarians. The oldest patient in our series was 65 years old. Nevertheless, pulmonary resection is worth considering for an octogenarian infected with MRD-TB because pulmonary resection achieves a high success rate with low morbidity and mortality.

Aged↗

PubMed2004

Transposition of modified latissimus dorsi musculocutaneous flap in the treatment of persistent bronchopleural fistula after posterolateral incision.

The condition of a 51-year-old man was complicated with empyema and bronchopleural fistula (BPF) after left upper lobectomy and thoracoplasty for pulmonary aspergillosis. On the postoperative day (POD) 12, the opened bronchial stump was directly closed and covered with a pedicled pectoralis major muscle flap. On POD 66, an open-window thoracostomy was done, because of empyema with Pseudomonas aeruginosa Two years later, we could fill the empyema cavity, and close the multiple BPFs with the transposition of a modified pedicled musculocutaneous (MC) flap and the additional thoracoplasty to gain good quality of life. Although the MC flap was a proximal part of the latissimus dorsi muscle, which was dissected along the posterolateral incision of the first operation, it could be successfully transplanted to cover the BPFs in the open-window. In some patients with a small open-window on the upper anterior chest wall, the pedicled proximal latissimus dorsi MC flap may be very useful for treating persistent BPFs even after a standard posterolateral incision.

Bronchial Fistula↗

PubMed2004

Pneumonectomy for nontuberculous mycobacterial infections.

BACKGROUND: Pneumonectomy is considered in the treatment of nontuberculous mycobacterial infections when an entire lung is affected. However, this procedure carries high morbidity. We report on our experience in using pneumonectomy for treating patients with nontuberculous mycobacterial infections. METHODS: Between 1983 and 2002, 53 patients infected with nontuberculous mycobacteria underwent 55 pulmonary resections. Of these patients, 11 (3 men, 8 women) underwent pneumonectomy (5 right, 6 left). Median age was 57 years (range, 43 to 69 years). Mycobacterium avium complex disease occurred in 10 patients and Mycobacterium abscessus disease in 1. Indications for pneumonectomy included multiple cavities in one lung and destruction of an entire lung. The bronchial stump was covered with a latissimus dorsi muscle flap in 7 patients and with an intercostal pedicle flap in 2. RESULTS: Operating time ranged from 142 to 477 minutes (median, 360 minutes). The median intraoperative blood loss was 555 mL (range, 130 to 1,245 mL). There was no operative mortality. Bronchopleural fistula occurred in 3 patients. All fistulas were observed after right pneumonectomy, and were treated by reclosure of the bronchus. Empyema occurred in 1 patient, who was treated with irrigation. All patients achieved sputum-negative status after surgery. Two late deaths occurred. One patient died of respiratory failure 11 months after surgery. A second patient, the only patient who had recurrent disease, died of respiratory failure 4 years postoperatively. CONCLUSIONS: Despite bronchial stump protection, right pneumonectomy carries a risk for bronchopleural fistula. Nonetheless, pneumonectomy can result in high cure rates in patients with nontuberculous mycobacterial infections.

Adult↗

PubMed2004

Resectional surgery combined with chemotherapy remains the treatment of choice for multidrug-resistant tuberculosis.

OBJECTIVE: Multidrug-resistant tuberculosis remains a significant health problem. The best available treatment for multidrug-resistant tuberculosis is the combination of pulmonary resection and antituberculous chemotherapy. We herein report the results of pulmonary resection combined with chemotherapy for multidrug-resistant tuberculosis at our institution during the years 2000 through 2002. METHODS: Between 1983 and 2002, 87 patients underwent 95 pulmonary resections for multidrug-resistant tuberculosis. Of these, the 30 (34%) patients operated on from January 1, 2000, to December 31, 2002, are reviewed in the present study. All patients were maintained on multidrug regimens preoperatively and postoperatively. Indications for surgical intervention included persistently positive sputum and a high risk of relapse. Thirty-three pulmonary resections were performed, consisting of pneumonectomy (n = 12), lobectomy (n = 17), and segmentectomy (n = 4). The bronchial stump was reinforced with a latissimus dorsi muscle flap in 29 resections. RESULTS: There was no operative mortality. Bronchopleural fistulas occurred in 2 patients. Five patients had a space problem. All patients attained sputum-negative status after the operation. Relapse occurred in 3 patients: 2 had a relapse at the bronchial stump, and the remaining patient had a relapse in the postlobectomy space. One late death occurred. Of the 29 survivors, 27 (93%) were free from disease, with a median follow-up of 24 months (range, 8-47 months). CONCLUSIONS: An increasing number of patients with multidrug-resistant tuberculosis are requiring resectional surgery in the 21st century. Pulmonary resection combined with chemotherapy achieves high cure rates with acceptable morbidity and remains the treatment of choice for multidrug-resistant tuberculosis.

Antitubercular Agents↗

PubMed2004

[Chylothorax].

Chylothorax is a rare complication after general thoracic surgery, but remains challenging for thoracic surgeons. Chylothorax can occur after any type of general thoracic procedures, including esophagectomy, pulmonary resection, and removal of mediastinal tumor. Unless being treated properly, chylothorax leads to high mortality. Therefore, prompt diagnosis and adequate therapy are crucial in the management of postoperative chylothorax. Chylothorax is usually discovered after a patient resumes taking fat-containing food. Milky fluid can be seen in the drainage system if a chest tube is still in place. When the diagnosis has been made, conservative treatment should be initiated at first, including cessation of oral intake and TPN. Evacuation of chylous fluid by closed chest tube drainage should also be done. A chest tube should be inserted in case the tube has already been taken out. If 10 to 14 days of conservative treatment fails, surgical treatment should be considered. Ligation or clipping of the thoracic duct itself or its tributaries is performed through open thoracotomy or video-assisted thoracoscopic (VATS) approach. The results of reoperation are usually satisfactory.

Chylothorax↗

PubMed2004

[Extrapleural completion pneumonectomy combined with chest wall resection for complex aspergilloma].

Completion pneumonectomy for complex aspergilloma remains challenging for thoracic surgeons. This pneumonectomy procedure often requires extrapleural dissection. Although extrapleural dissection is effective in preventing intraoperative contamination of the operative field, it is associated with massive bleeding. In addition, when the pleura has been severely thickened, it is difficult to conduct extrapleural dissection. We herein report 2 patients who underwent an extrapleural completion pneumonectomy combined with chest wall resection. In this technique, we avoided extrapleural dissection where dense pleural adhesions existed. Instead, we performed an en-bloc chest wall resection. This technique can decrease the amount of bleeding and prevent contamination of the operative field. It can also reduce the size of post-pneumonectomy space, and decrease the chance of post-pneumonectomy empyema and bronchial stump fistula. We advocate that extrapleural completion pneumonectomy combined with chest wall resection be considered in case that extrapleural dissection is extremely difficult.

Aged↗

PubMed2002

Surgery for Mycobacterium avium complex lung disease in the clarithromycin era.

OBJECTIVE: Since the introduction of clarithromycin, it has been assumed that pulmonary Mycobacterium avium complex (MAC) disease can be treated with medication alone. This study examines whether surgery can still play an important role in the management of MAC lung disease in the current era. METHODS: Between April 1993 and January 2001, 21 patients (11 men and 10 women) underwent a pulmonary resection for MAC infection. The median age of the patients was 56 years (range: 27-67 years). None of the patients were immunocompromised. Regimens employing clarithromycin were initiated preoperatively in all patients. The indications for surgery were failure of drug therapy in 19 patients and discontinuation of chemotherapy because of drug toxicity in two patients. The pulmonary resections (19 right lung, 2 left lung) performed included lobectomy in 16 patients, pneumonectomy in three, bilobectomy in one, and lobectomy plus segmentectomy in one. RESULTS: All of the patients survived the surgery. Six major postoperative complications occurred in six patients (28.6%) and these included two bronchopleural fistulas after right pneumonectomy, two space problems, one prolonged air leak, and one case of interstitial pneumonia. All postoperative complications were manageable, and four of these were treated surgically. All patients had sputum-negative status after their operation. Relapse occurred in two patients (9.5%) at six months and two years postoperative, respectively. The first patient, who originally had a right upper lobectomy, underwent a left upper lobectomy during the follow-up period, attaining sputum conversion. The second patient underwent a right pneumonectomy and then died of respiratory failure four years postoperatively. This one late death was the only fatality. CONCLUSIONS: Although it is associated with relatively high morbidity, surgery provides a high sputum conversion rate for patients whose MAC disease responds poorly to drug therapy. Even in the present clarithromycin era, pulmonary resection remains the treatment of choice when MAC lung disease has not been successfully eradicated by drug treatment alone.

Adult↗