The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 20, Issue 6
Displaying 1-17 of 17 articles from this issue
  • Yoshiaki Nakashima, Takeshi Yamada, Masayuki Tanahashi, Yuu Hikosaka, ...
    2006 Volume 20 Issue 6 Pages 800-804
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    Two hundred and twenty three cases of resected peripheral small lesions of the lung less than 2cm in diameter were retrospectively reviewed to correlate the appearance of ground-glass opacity (GGO) on high-resolution CT (HRCT) and the pathological features. Three groups were designated according to the appearance of GGO; S lesion (solid nodule), S+G lesion (nodule with mixed solid and GGO components), and G lesion (pure GGO). Group S consisted of various lesions containing adenocarcinoma, other types of lung cancers, or benign lesions (e. g. mycobacteriosis, and non-specific inflammation). Those in group S+G mainly consisted of adenocarcinoma (90.7%; 69 of 75 cases). Those in group G (without scale-down between intervals) consisted entirely of adenocarcinoma (or atypical adenomatous hyperplasia) (15 cases). These results suggest that patients with small peripheral lung lesions containing GGO are good candidates for surgical resection.
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  • Noboru Nishiumi, Ryouta Masuda, Yoshimasa Inoue, Fumio Maitani, Masayu ...
    2006 Volume 20 Issue 6 Pages 805-810
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    Background: 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) plays an important role in determining disease stage and evaluating treatment response in cancer patients. However, there are few reports concerning the use of FDG PET for diagnosing postoperative recurrence of malignant tumors such as lung cancer. The present study was undertaken to evaluate the usefulness of FDG PET for early detection of the postoperative recurrence of lung cancer. Methods: Study subjects were 13 patients treated surgically for non-small cell lung carcinoma who had an elevated carcinoembryonic antigen level after surgery but showed no evidence of postoperative recurrence by chest computed tomography, head magnetic resonance imaging, or abdominal ultrasonography. FDG PET was performed in these patients. Results: FDG PET findings were positive in 10 of the 13 patients and negative in the remaining 3. Of the 10 PET-positive patients, 1 had local recurrence, 6 had metastasis to the mediastinal and/or hilar lymph nodes, and 3 had distant blood-borne metastasis. One patient underwent resection of a metastatic thoracic wall tumor, and the remaining 9 underwent chemoradiotherapy. Of the 3 patients who were PET-negative, 1 was false negative and eventually diagnosed with carcinomatous meningitis, and the other 2 showed no evidence of recurrence. Conclusions: FDG PET in combination with chest computed tomography may facilitate early detection of non-small cell lung carcinoma recurrence in patients showing an elevated tumor marker level after surgery.
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  • Yoshio Matsui, Yukitoshi Satoh, Tomoya Inagaki, Takuya Inagaki, Sakae ...
    2006 Volume 20 Issue 6 Pages 811-818
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    «Background»Although the main lymphatic drainage from the right middle lobe (RML) is usually by an inferior bronchial pathway passing via the subcarinal nodes, in some cases a route into the upper mediastinal nodes via the upper lobe node (#12u) has been reported. We have performed selective #12u dissection in addition to standard dissection (ND2a) in patients with non-small cell lung cancers (NSCLCs) in the RML. However, only limited information is available regarding the value of #12u dissection.«Patients and Methods»Between January 1980 and October 2004 complete resection was performed for 133 patients with NSCLCs of the RML. Among these, 86 patients with ND2a dissection were reviewed here. Patients with multiple lung cancers were excluded.«Result»Dissection of #12u nodes was performed for 47 out of 86 patients. The operative procedures were as follows: middle lobectomy for 26; upper and middle bilobectomy for 15; middle and lower bilobectomy for two; and pneumonectomy for four patients. The stage distribution according to #12u dissection was as follows: among patients with #12u dissection, 25 were stage I, five were II and 17 were III; among 39 without #12u dissection, 32 were stage I, two were II and five were III. The difference between the two approaches was statistically significant (P=0.018). Lymph node metastases included N1 disease in eight patients (9%) and N2 in 13 (15%). Among N1 cases, none were #12u-positive. Only two patients with N2 disease had #12u metastases. In these patients, multiple metastases were associated with a poor prognosis. The five-year survival rate for all 86 patients was 72%, and for these with and without #12u dissection, 68% and 78%, respectively (P=0. 320). Twenty five out of 86 patients (29%) suffered cancer recurrence, 21 patients out of 47 with (45%) and four out of 39 without #12u dissection (10%). As to the initial recurrence sites, 18 patients (67%) had distant relapse and the other nine (33%) local relapse. However, no patients demonstrated local recurrence at #12u lymph nodes.«Conclusions»Although the rate of metastasis to #12u nodes was low for cases of NSCLC in the RML, patients with such disease had a poor prognosis. No significant difference in survival was evident with reference to #12u dissection and there was no case with local recurrence at #12u nodes after ND2a resection. Therefore, dissection of #12u may not be indicated for NSCLCs in the RML.
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  • Mitsunori Higuchi, Hiroyuki Suzuki, Yutaka Shio, Fumihiko Yamada, Mika ...
    2006 Volume 20 Issue 6 Pages 819-823
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    A 77-year-old male was admitted because of the detection of an anterior mediastinal tumor. A CT guided needle biopsy was performed and he was diagnosed with thymic carcinoid. Preoperative FDG-PET showed abnormal accumulation in the tumor lesion. Tumor resection and thymectomy with mediastinal lymphnodes dissection was performed. Postoperative pathological diagnosis revealed atypical carcinoid and no metastases of mediastinal lymphnodes. He received radiation therapy after the operation. He has been well without recurrence. Thymic carcinoid is rare and classified as a neuroendcrine tumor which is different from thymoma. Although FDG-PET is reported to be useful in the diagnosis of lung cancer, Few thymic carcinoid cases detected by FDG-PET have been reported. It is expected that FDG-PET in the diagnosis of the thymic carcinoid tumor may be valuable.
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  • Ai Maeda, Makio Hayama, Masao Nakata, Kazuo Tanemoto
    2006 Volume 20 Issue 6 Pages 824-828
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    A 72-year-old female was admitted to our hospital for a further examination of hemoptysis. Chest computed tomography showed a dilated left B3 bronchus filled with low-density material and large calcifications. Bronchoscopic study revealed broncholithiasis obstructing the orifice of the left B3band a yellowish cluster of bronchomycosis. Via bacterial study, the cluster was identified to be Aspergillus fumigatus. Considering the difficulty in the bronchoscopic removal of the broncholithiasis and the possible risk of recurrent bronchomycosis, we performed left upper division segmentectomy. Stone analysis revealed that 98% of the components were calcium carbonate. These results suggested that the bronchomycosis was secondary to the broncholithiasis that was caused by mucus retention resulting from repeated chronic inflammations with the bronchiectasis. Surgical treatment should be considered for bronchomycosis with obstructive bronchial disorders.
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  • Takaaki arimura, Hirohiko sinohara, Masatomo yazawa
    2006 Volume 20 Issue 6 Pages 829-833
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    A 61-year-old male with a large lung cyst in the right middle lung field was being followed since the cyst was detected at group screening. In 2004, chest Xp revealed nodule in the right middle lung with disappearance of the cyst. The nodule was suspected to be lung cancer, and right upper lobectomy was performed. Microscopic findings showed necrotic tissue and epithelioid cell granulomas along the cyst wall. The nodule was diagnosed as mycobacterium infection. There are several reports of lung cysts, but it is difficult to diagnose lung cancer with lung cysts before an operation have been performed. Therefore, it is important that the lung cyst be followed carefully a long period of time.
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  • Satoshi Yodonawa, Isao Ogawa, Akira Fujiwara, Susumu Yoshida, Yukinobu ...
    2006 Volume 20 Issue 6 Pages 834-838
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    We report a case of completion pneumonectomy for obstructive pneumonia with deformation of the lower bronchus after left upper lobectomy. A 73-year-old man had undergone left upper lobectomy for squamous cell lung cancer arising from B1+2 and the bronchial stump was closed using the Sweet method by hand-suturing. One year after the operation, he suffered from pneumonia of the residual left lobe. Bronchoscopic examination revealed stenosis of the basal truncus forming a slit deformation of the lower bronchus. He was readmitted to the hospital for pneumonia despite improvement with conservative medical treatment. Balloon dilation was not effective, the residual lobe was severely fibrotic and infection control became difficult. Therefore, the patient underwent left completion pneumonectomy eight years after the initial operation. Macroscopic observation of the resected specimen revealed protrusions of the bronchial cartilage wall and severe stenosis of the basal truncus as deformation of the lower bronchus. It was considered that in this case, the shortness of the bronchial stump with the Sweet method was the cause of the bronchial stenosis.
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  • Hiroki Ootani, Humito Hara
    2006 Volume 20 Issue 6 Pages 839-842
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    A 59-year-old man was admitted to our hospital because of an abnormal shadow on a screening chest X-p. Chest CT showed a mass 1.0 cm in diameter in left lung S6, which had a cavity formation. We performed partial resection with video assisted thoracic surgey (VATS), because we could not distinguish the tumor from lung cancer. Intraoperativery, a frozen section of resection nodule was not recognized as containing malignant cells. We histologically diagnosed the tumor as pulmonary dirofilariasis with a finding of a body of Dirofilaria immitis after operation. Here we report a rare case of cavity formation in pulmonary dirofilariasis.
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  • Seiki Takashima, Hideharu Nakano, Takahiko Misao
    2006 Volume 20 Issue 6 Pages 843-846
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    A 66-year-old male, who had undergone internal fixation of a right clavicular fracture with two Kirschner wires three months previously, visited another physician, because of a right chest pain and dyspnea since he had carried an object weighing approximately 30kg 10 days before. The needle of a migrated Kirschner wire had penetrated the thoracic cavity at the dorsal aspect of the right chest wall, accompanied with a right pneumothorax. He was referred to our hospital for further treatment. An emergency operation was done by video-assisted thoracoscopic surgery. The Kirschner wire which had penetrated the right thoracic cavity was located and successfully removed. The recovery was uneventful.
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  • Hidehiro Konno, Junji Yoshida, Mitsuyo Nishimura, Takahiro Mochizuki, ...
    2006 Volume 20 Issue 6 Pages 847-850
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    A 65-year-old man underwent a right pneumonectomy with combined resection of the azygos vein for lung cancer (moderately differentiated squamous cell carcinoma, pT3N1M0, stage IIIA). Seventeen hours after surgery, he suddenly developed cardio-pulmonary insufficiency. Chest CT scan showed an enhancement defect in the superior vena cava (SVC) and left brachiocephalic vein. Under the diagnosis of SVC thrombosis, we surgically removed the thrombus and administered anticoagulants. The cardiopulmonary failure improved gradually, but he died of systemic cancer spread 63 days after pneumonectomy.
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  • Efficacy of PGA sheet + fibrin glue method
    Kotaro Mizuno, Ichiro Fukai
    2006 Volume 20 Issue 6 Pages 851-855
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    We report a case of intractable pneumothorax in a 78 year old man. Because of the presence of brittle pulmonary parenchyma, severe pleural adhesion, and his poor performance status, we hesitated to perform orthodox surgical fistula closure. We chose to perform the PGA sheet + fibrin glue method under key hole surgery instead. His intractable pneumothorax was cured successfully, and the ipsilateral lung has been re-expanded for 5 months. The PGA sheet + fibrin glue method may be a substitute technique to close a pleural fistula with minimum invasion.
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  • Fumiaki Kato, Akinori Iwasaki, Tatsu Miyoshi, Hiroyasu Nakajima, Takas ...
    2006 Volume 20 Issue 6 Pages 856-859
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    Ossification within primary lung cancer is extremery rare. Only 8 cases including our case have been reported. In this report, we present a 76-year-old man who was refered to our institution due to an abnormal shadow on chest roentogenogram. Chest Computed Tomography (CT) demonstrated an irregular mass with central calcification in the right lung (S2). Using Video-assisted thoracic surgery (VATS) a right upper lobectomy was performed. And this lesion was diagnosed as papillary adenocarcinoma with central ossification by histopathological examination. We discussed the literature concerning the mechanism of ossification in the carcinomatous lesion.
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  • Takahiko Misao, Hideharu Nakano, Seiki Takashima
    2006 Volume 20 Issue 6 Pages 860-863
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    A 74-year-old man with lung cancer was treated surgically by left lower lobectomy by video-assisted thoracoscopic surgery (VATS), and the early post-operative course was uneventful. After the threads of the thoracic drain site were removed on the 11th postoperative day, the wound opened and serous fluid discharged from the thoracic cavity, and the wound was re-sutured. A few days later, a spike fever with left pleural effusion appeared. Methicillin-Resistant Staphylococcus Aureus was positive in the culture of the pleural effusion. After chest tube drainage and antibiotics administrations failed to control the infection, re-operation by VATS was performed 25 days after the first surgery. All the fibrous thin septa in the multi-loculated cavities of empyema were debrided in order to form a single cavity for better drainage. Postoperative course after the second operation was uneventful, and the thoracic tube was removed 10 days later. VATS debridement is less invasive and very effective as a surgical approach for acute empyema after lobectomy.
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  • Masahiro Sakaguchi, Kenji Nakamura, Ken-ichi Omori, Yukiyasu Takeuchi
    2006 Volume 20 Issue 6 Pages 864-869
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    We present a rare case of so-called postpneumonectomy syndrome caused by displacement and rotation of the mediastinal structures into the dead space after bilobectomy of the right lung. A 73-year-old woman underwent right, middle and lower lobectomy because of pulmonary tuberculosis accompanied by aspergillosis in 1993 at 69 years old. Approximately four years later, she complained of exertional dyspnea and suffered near respiratory arrest. Chest X-ray, CT and bronchoscopic examination demonstrated marked narrowing of the left main bronchus. Pulmonary function studies evidenced upper airway obstruction. Corrective surgical repositioning was applied. After the thoracic space was reopened, lysis of adhesion, mobilization of the mediastial structures and anchoring pericardium to the anterior parasternal chest wall were performed. An expandable prosthesis was inserted into the space and filled with saline. The anteroposterior compression of the left main bronchus was relieved and the respiratory function was improved. Although the prosthesis was removed owing to infection, the improved status of respiration has been maintained for three years. Combination of mediastinal repositioning and plombage with an expandable prosthesis was useful in the management of postpneumonectomy syndrome.
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  • Akihiro Aoyama, Tatsuo Fukuse, Fengshi Chen, Hiroshi Hamakawa, Takuji ...
    2006 Volume 20 Issue 6 Pages 870-874
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication after lung transplantation. This report describes the first case of PTLD in Japanese lung transplant recipients, which was successfully treated with rituximab. A 38-year-old man with emphysema underwent double lung transplantation and developed polymorphic PTLD in the allografts 4 months later. Immunosuppression therapy was reduced and immunoglobulin and antiviral drugs were administered. This therapy was not effective and resulted in acute rejection managed with steroid pulse therapy. We subsequently treated the patient using rituximab, an anti-CD20 monoclonal antibody. Thereafter, the lesions in both lungs regressed slightly, but remained present. Positron emission tomography with fluoro-2-deoxy-D-glucose (FDG-PET) showed no uptake in the thoracic fields, so we did not give the patient further courses of rituximab. One year after the diagnosis of PTLD, the nodules had almost completely disappeared and the patient presented no evidence of recurrence now.
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  • Kentaroh Miyoshi, Norihito Okumura, Sung Soo Chang, Tomoaki Matsuoka, ...
    2006 Volume 20 Issue 6 Pages 875-880
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    We report two cases of resected pulmonary mucoepidermoid carcinoma in young adults. Case1: A 29-year-old female was admitted with the complaint of a cough. A computed tomography (CT) scan and bronchoscopy revealed an intrabronchial polypoid tumor at the orifice of the left lower bronchus obstructing the second carina. The patient underwent left sleeve lower lobectomy and mediastinal lymph node dissection. Case 2: A 27-year-old female was admitted with a fever and the complaint of a productive cough. A CT scan and bronchoscopy revealed an intrabronchial tumor in the right intermediate bronchus with atelectasis and pneumonia of the right middle and lower lobes. The patient underwent right middle and lower bilobectomy and mediastinal lymph node dissection. In both cases, histological diagnosis of a low grade mucoepidermoid carcinoma was made by intraoperative frozen-section examination, which contributed to the decision for the surgical strategy. Low grade mucoepidermoid carcinomas usually exhibit slow local growth without distant metastasis. The clinical outcome of the disease is generally good if the tumor can be completely resected. Conservative resection is achievable for many cases with this neoplasm. In Case1, we performed bronchoplasty and could avoid pneumonectomy. The two patients are doing well without recurrence 26 and 12 months after the surgeries, respectively.
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  • Masafumi Noda, Yasushi Hoshikawa, Itaru Ishida, Takeshi Oyaizu, Tetsu ...
    2006 Volume 20 Issue 6 Pages 881-885
    Published: September 15, 2006
    Released on J-STAGE: July 18, 2008
    JOURNAL FREE ACCESS
    A 40-year-old man, diagnosed as acute myelogenic leukemia underwent a HLA-identical sibling peripheral blood stem cell transplant following an off treatment relapse. He subsequently developed chronic graft-versus-host disease (GVHD) and bronchiolitis obliterans caused recurrent pneumothorax. In order to control the recurrent medical-treatment-resistant pneumothorax, four surgeries (three left, one right) were necessary. It was thought important to reinforce the whole visceral pleura by covering it with an absorbable material sheet and fibrin glue in surgical treatment for recurrent pneumothorax.
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