Phrenic nerve injury can occur as a complication of lung transplantation. A 54-year-old man underwent single-lung transplantation due to interstitial pneumonia. The patient required circulatory support with venoarteri...Phrenic nerve injury can occur as a complication of lung transplantation. A 54-year-old man underwent single-lung transplantation due to interstitial pneumonia. The patient required circulatory support with venoarterial extracorporeal membrane oxygenation and was unable to be weaned from ventilatory support with nitric oxide. Although enhanced CT scanning showed stenotic anastomosis of the right pulmonary artery (PA), pulmonary angiograph findings revealed that PA flow was normal under sedation and considerably decreased with spontaneous breathing. Fluoroscopy showed that the right diaphragm moved inversely to the position of the left diaphragm, indicating that the right phrenic nerve was paralytic. We performed diaphragmatic plication 7 days after lung transplantation and weaning from ventilator support was accomplished soon thereafter. Phrenic nerve dysfunction is an important clinical problem following lung transplantation. In the present case, diaphragmatic plication was effective for treatment of circulatory failure due to phrenic nerve paralysis even in acute phase after lung transplantation.展开更多
Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the indications for lung transplantation. When patients with CTEPH undergo transplantation, massive bleeding can occur because of severe pleural adhesion...Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the indications for lung transplantation. When patients with CTEPH undergo transplantation, massive bleeding can occur because of severe pleural adhesions and collateral vessels that develop from the thoracic wall to the lungs. However, there has been no previous case report that has discussed the bleeding risk in detail. We report the case of a patient having CTEPH who underwent bilateral lung transplantation with massive blood loss (11,730 mL) in the first operation and required repeat operations for hemostasis. The patient underwent left upper lobectomy because compromised blood flew to the left upper lobe. He recovered from the operations by postoperative day 9;however, he died from pyothorax from an intractable air leak 56 days after transplantation.展开更多
Background: Orthotropic liver transplantation (OLTx) is recognized as a radical therapy for unresectable hepatocellular carcinoma (HCC) without distant metastasis. Although the outcome depends on distant recurrence of...Background: Orthotropic liver transplantation (OLTx) is recognized as a radical therapy for unresectable hepatocellular carcinoma (HCC) without distant metastasis. Although the outcome depends on distant recurrence of HCC, the predictors for recurrence after repeat resection are unknown. Case 1: A 52-year-old man, who had suffered from hepatitis B and underwent repeat local ablation therapies since 50 years old, underwent living-donor OLTx because of multiple HCC recurrence with tumor marker (TM) elevation but without distant metastasis. Histopathological diagnosis was moderately differentiated HCC. After the operation, he got TM normalization and was managed with cyclosporine A, without rejection. Although he underwent adjuvant chemotherapy, a pulmonary metastasis was found 1 year after the OLTx. He underwent wedge resection of the lung using video-assisted thoracoscopic surgery (VATS). Half a year after the operation, a recurrence was found in the transplanted liver with TM elevation. While a local ablation therapy was performed, TM was not normalized and new recurrence was found at the hilum of the right lung. Right upper sleeve lobectomy was performed, but he developed multiple recurrences, and died 4 months after the last operation. Case 2: A 32-year-old man, who has suffered from multiple HCC with hepatitis B and underwent hepatic resection and local ablation therapies since 28 years old, underwent living-donor OLTx because of multiple HCC recurrence without distant metastasis. Histopathological diagnosis was moderately differentiated HCC. He was managed using tacrolimus without rejection. Three years after the OLTx, a pulmonary recurrence was found without TM elevation. He underwent wedge resection using VATS. Four year after the last operation, a small recurrence was identified in the right lung without TM elevation, again. Wedge resection using VATS was performed. At the final follow-up visit, 3 years after the last operation, the patient was disease free with normal TM level. Comments: The long survivor without re-recurrence matched only few factors with negative predictors for recurrence after OLTx for HCC, while the other case had almost all factors present. The predictors may be useful also for the patients of the repeat pulmonary metastasectomy after OLTx for HCC.展开更多
文摘Phrenic nerve injury can occur as a complication of lung transplantation. A 54-year-old man underwent single-lung transplantation due to interstitial pneumonia. The patient required circulatory support with venoarterial extracorporeal membrane oxygenation and was unable to be weaned from ventilatory support with nitric oxide. Although enhanced CT scanning showed stenotic anastomosis of the right pulmonary artery (PA), pulmonary angiograph findings revealed that PA flow was normal under sedation and considerably decreased with spontaneous breathing. Fluoroscopy showed that the right diaphragm moved inversely to the position of the left diaphragm, indicating that the right phrenic nerve was paralytic. We performed diaphragmatic plication 7 days after lung transplantation and weaning from ventilator support was accomplished soon thereafter. Phrenic nerve dysfunction is an important clinical problem following lung transplantation. In the present case, diaphragmatic plication was effective for treatment of circulatory failure due to phrenic nerve paralysis even in acute phase after lung transplantation.
文摘Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the indications for lung transplantation. When patients with CTEPH undergo transplantation, massive bleeding can occur because of severe pleural adhesions and collateral vessels that develop from the thoracic wall to the lungs. However, there has been no previous case report that has discussed the bleeding risk in detail. We report the case of a patient having CTEPH who underwent bilateral lung transplantation with massive blood loss (11,730 mL) in the first operation and required repeat operations for hemostasis. The patient underwent left upper lobectomy because compromised blood flew to the left upper lobe. He recovered from the operations by postoperative day 9;however, he died from pyothorax from an intractable air leak 56 days after transplantation.
文摘Background: Orthotropic liver transplantation (OLTx) is recognized as a radical therapy for unresectable hepatocellular carcinoma (HCC) without distant metastasis. Although the outcome depends on distant recurrence of HCC, the predictors for recurrence after repeat resection are unknown. Case 1: A 52-year-old man, who had suffered from hepatitis B and underwent repeat local ablation therapies since 50 years old, underwent living-donor OLTx because of multiple HCC recurrence with tumor marker (TM) elevation but without distant metastasis. Histopathological diagnosis was moderately differentiated HCC. After the operation, he got TM normalization and was managed with cyclosporine A, without rejection. Although he underwent adjuvant chemotherapy, a pulmonary metastasis was found 1 year after the OLTx. He underwent wedge resection of the lung using video-assisted thoracoscopic surgery (VATS). Half a year after the operation, a recurrence was found in the transplanted liver with TM elevation. While a local ablation therapy was performed, TM was not normalized and new recurrence was found at the hilum of the right lung. Right upper sleeve lobectomy was performed, but he developed multiple recurrences, and died 4 months after the last operation. Case 2: A 32-year-old man, who has suffered from multiple HCC with hepatitis B and underwent hepatic resection and local ablation therapies since 28 years old, underwent living-donor OLTx because of multiple HCC recurrence without distant metastasis. Histopathological diagnosis was moderately differentiated HCC. He was managed using tacrolimus without rejection. Three years after the OLTx, a pulmonary recurrence was found without TM elevation. He underwent wedge resection using VATS. Four year after the last operation, a small recurrence was identified in the right lung without TM elevation, again. Wedge resection using VATS was performed. At the final follow-up visit, 3 years after the last operation, the patient was disease free with normal TM level. Comments: The long survivor without re-recurrence matched only few factors with negative predictors for recurrence after OLTx for HCC, while the other case had almost all factors present. The predictors may be useful also for the patients of the repeat pulmonary metastasectomy after OLTx for HCC.
