Mini-CPB provided a comfort and safety level similar to conventional control via satisfactory air handling, attenuated inflammatory response and hemodilution, with a better clinical outcome in patients undergoing high-risk CABG.

Minimized perfusion circuits (MPCs) have been criticized for insufficient air elimination. The deairing capabilities of a new MPC, including an ultrasound controlled deairing unit, were compared to a standard extracorporeal circuit (ECC) in a laboratory setup. During blood flow of 4.0l/min, we injected 30-cc air over a period of 30 s into the venous line of both systems (n = 10 measurements/15-min intervals). Air was detected during the first 2 min post injection using a dual-channel ultrasound bubble counter. Venous air bubble measurements were made after the MPC bubble trap and the ECC hard-shell reservoir, respectively. Arterial air bubble data were obtained after the arterial filters (40 microm). Venous bubble count was significantly (P < 0.01) reduced in the MPC group (5-250 microm, 681 +/- 177; >40 microm, 288 +/- 92) compared with the ECC group (5-250 microm, 19 272 +/- 682; >40 microm, 7642 +/- 520). After the arterial filter, minimal numbers of air bubbles (5-250 microm, 172 +/- 59; >40 microm, 0) could be detected in the MPC group, but large amounts of air (5-250 microm, 16 194 +/- 1072; >40 microm, 3732 +/- 997) were measured in the ECC group. The air elimination of the modern MPC is superior to conventional ECC, which may result in a reduction of neurological complications.

Objective: Early detection by CT screening and the minimally invasive thoracic surgery for lung cancer has been growing rapidly where total 5,410 cases of video-assisted thoracoscopic lobectomy (33.8%) were performed in the year 2003 in Japan. Today, technically, systematic node dissection can be done by VATS. We performed 202 VATS lobectomies including 20 segmentectomies with systematic node dissection or lymph node sampling for clinical stage 1 non-small cell lung cancer. The technical feasibility of video-assisted thoracoscopic lobectomy with systematic node dissection is demonstrated and long-term survivals is also recorded. Methods: A double-lumen endobronchial tube is inserted while the patient is placed in lateral decubitus position and single lung ventilation is instituted. Three skin incision of 1.5 cm for trocars is made, followed by a wedge biopsy of the tumor. Aditional 6 -7 cm utility thoracotomy and lobectomy is performed as in the standard procedures. Having done a lobectomy with hilar lymph node dissection using stapler or self-produced instruments, mediastinal node dissection is performed as in an open thoracotomy. Results: No mortality or major morbidity were recorded. The procedure was completed within an average of 249 minutes including wedge biopsy, frozen section diagnosis, sentinel node navigation study, etc. with an average 127g of hemorrhage. Median hospital stay was 10 days. Long-term outcomes were 88.1% of clinical stage 1a, 77.9% of clinical stage 1b, 91.4% of pathological stage 1a and 77.5% of pathological stage 1b. Conclusions: As the fundamental benefit behind this approach remains controversial, systematic node dissection can be done safely and sufficiently by VATS. In terms of long-term survival, video-assisted thoracoscopic surgery has a similar or better result compared to a standard thoracotomy.Objective: Videothoracoscopy is becoming the approach of choice for the removal of neurogenic mediastinal tumors. Tumors extending into the spinal canal (dumbbell-type) require a combined neurosurgical approach. The aim of the study was to evaluate the feasibility of videothoracoscopic resection of benign neurogenic tumors (BNT) of the posterior mediastinum including dumbbell-type tumors through a retrospective review of our experience. Methods: Between January 1993 and November 2005, 30 patients underwent resection of a BNT of the posterior mediastinum at our Institution. Twenty-five tumors developed in the costovertebral sulcus and five were dumbbell-type. Preoperative assessment included chest CT scan, nuclear magnetic resonance for dumbbell-type tumors and spinal angiography in case the tumor was located near the site of the Adamkiewicz artery. Results: Mean tumor size was 5.6Ϯ1.4 cm (range 4 -11). Videothoracoscopic resection was possible in 26 patients, of whom five were dumbbelltype tumors requiring a combined neurosurgical approach. Reasons for conversion to thoracotomy were pleural adhesions in one case and bleeding in three. Mean operative time was 215Ϯ42 minutes (range 180 -28...

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