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PVB may greatly contribute to enhanced recovery after thoracic surgery owing to effective analgesia and fewer side effects.

Tracheo-innominate artery fistula (TIF) is a surgical emergency with high mortality rates. Reported incidence is 0.1%-1.0% after tracheostomy with peak incidence 3 days to 6 weeks post procedure. TIF is usually fatal once it bleeds. For the successful management of TIF, treatment should be initiated immediately with the special considerations kept in mind. We describe two cases of TIF, and its clinical characteristics are reviewed in accordance with relevant literature.Keywords: tracheo-innominate artery fistula (TIF), tracheostomy, high-lying innominate artery source of bleeding, we performed flexible bronchoscopy that showed no active bleeding distal to the cannula tip. However, bleeding occurred again inside the tracheal tube. With the cuff of the tube maintained in the maximum hyperinflated state and the tracheostomy wound digitally compressed, the patient was immediately transferred to the operating room for surgical hemostasis. Unfortunately, we had no time to perform a computed tomography (CT) scan for this patient because this was an emergency case. A review of the CT scan, which had been taken about a year before, suggested that the TIF was probably above the sternal notch (Fig. 1). Therefore, unlike in the standard procedure, herein we made a suprasternal incision. After identifying the trachea and the overriding innominate artery, we successfully encircled the artery proximally and distally to the trachea and found the fistula posterior to the high-lying innominate artery. We debrided the fistulous segment of the innominate artery and reconstructed the artery in end-to-end fashion. Finally, the fistula of the trachea was repaired by suturing and the sternocleidomastoid flap was positioned between the trachea and artery to provide a mechanical barrier (Fig. 2). After controlling the blood flow of the fistulous segment of the artery, intra-tracheal bleeding was not observed. The amount of intra-operative bleeding was about 300 mL, and the operative time was 93 min. The post-operative course was uneventful with no sign of rebleeding. However, according to the findings of the CT

We present 3 cases of rapidly progressive interstitial pneumonia (RPIP) associated with clinically amyopathic dermatomyositis (C-ADM) that were treated with two courses of direct hemoperfusion with polymyxin B-immobilized fiber column (PMX-DHP). Despite initial treatment with high-dose corticosteroids, pulsed cyclophosphamide, and cyclosporine, the lung disease and hypoxemia deteriorated in all the patients. After PMX-DHP treatment, the PaO2/FiO2 ratio and serum LDH and KL-6 were improved, the abnormal shadows in chest high-resolution computed tomography (HRCT) scans gradually decreased, and, finally, all patients survived. These findings indicate that PMX-DHP treatment could be effective in the management of RPIP in patients with C-ADM in combination with conventional therapy.

Endoclips with RFID tags were located by our novel marking system in an experimental laparoscopic setting using canine stomachs with substantial accuracy comparable to conventional endoclips located by finger palpation through an open approach.

Patients with Sjögren's syndrome frequently have pulmonary involvement, but the involvement of nodular pulmonary lesions, including pulmonary amyloidosis, is rare. Most cases of pulmonary amyloidosis involve multiple nodules; solitary pulmonary nodular amyloidosis, as an associated condition of Sjögren's syndrome, is very rare. In our report, we present the case of an 80-year-old female with Sjögren's syndrome who was incidentally found to have a small solitary pulmonary nodule. The nodule showed high fluorodeoxyglucose uptake and contained areas of calcification. Because the probability that the nodular lesion was malignant could not be excluded, the tumor was excised using a thoracoscopic procedure; the final diagnosis was pulmonary nodular amyloidosis. Although most cases of pulmonary amyloidosis involve multiple nodules, amyloidosis should be considered in the differential diagnosis for a solitary pulmonary nodule in patients with Sjögren's syndrome.

Purpose: Analgesia following thoracotomy is routinely accomplished using epidural blockage performed by anesthesiologists. More effective pain control can be achieved with continuous paravertebral blockage performed by thoracic surgeons. We aimed to retrospectively analyze the effi cacy of paravertebral blockage for managing post-thoracotomy pain. Methods: The study included 125 patients who underwent continuous paravertebral blockage for the following types of thoracic surgery: video-assisted thoracoscopic surgery (n = 87), anterior axillary thoracotomy (n = 21), posterolateral thoracotomy (n = 16), and median sternotomy with additional left thoracotomy (n = 1). We retrospectively evaluated the analgesic effects of continuous paravertebral blockage by assessing whether a good cough effort could be performed and whether an additional painkiller was given as a rescue medication.

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