The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 11 , Issue 1
Showing 1-19 articles out of 19 articles from the selected issue
  • Ken-ichi Togashi, Katsuo Yoshiya
    1997 Volume 11 Issue 1 Pages 2-7
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Fifteen patients with bronchogenic cysts in the mediastinum were studied with respect to their surgical management, including indications for thoracotomy and thoracoscopic surgery. Seven patients (group A) undrerwent simple resection of the cyst alone, while eight patients (group B) required additional surgical procedures in the removal of the cyst. Clinical, surgical, and pathological findings were compared in the two groups. The preoperative diagnosis rate was 85.7% in group A and 25% in group B. The additional surgical procedures in group B included repairs of esophageal muscle defect in 3 cases, direct closure of tracheal defect in 1, patch closure of the defect of the right main bronchus in 1, thymectomy in 1, and resection of a sequestered lobe in 1. There was no malignant finding pathologically and no recurrence during the course. It may be thought that the patients in group A can undergo thoracoscopic surgery, but if asymptomatic, the indications for surgery requre careful consideration.
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  • Toshihiko Urakami, Kaoru Kondo, Toshio Kasugai, Tatuo Utchida
    1997 Volume 11 Issue 1 Pages 8-12
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    3 cm mini thoracotomy-combined thoracoscopic operation was performed on posterior mediastinal cystic tumors and good results were obtained by devising the development of its operative area. The subjects were a total of 5 cases comprising 3 cases of bronchogenic cyst, 1 case of pericardial cyst and 1 case of esophageal duplication, aged 1659 years with a sex ratio of 3 : 2 (M : F). Of these 5 cases, 1 of bronchogenic cyst had the mini thoracotomized area dilated because of difficult cystectomy due to ruptured cystic wall while the other 4 could be cystectomized. The point of this operation lies in the position of the mini-thoracotomy and the position of the thoracoport for developing the operative area. If the forceps can tract the lung from the thoracoport and well develop the operative area, the operative maneuver is practicable from the mini-thoracotomized area in practically the same time as ordinary thoracotomy with practically no postoperative wound pain and an excellent cosmetic result. The present operation is useful for posterior mediastinal cystic tumor, which is not associated with subjective symptoms and is frequently benign.
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  • Satoshi Hirano, Toshiji Motohara, Toshiya Nishibe, Yoshiaki Narita, Te ...
    1997 Volume 11 Issue 1 Pages 13-19
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    From 1962 to 1993 mediastinal tumor was diagnosed in 242 patients in our institute, we studied 83 of them (34.3%) with a histopathologic diagnosis of “cystic tumor”.
    The majority (about 80%) were cystic teratoma, congenital cyst or thymic cyst. Only 2 cases (2.4%) were diagnosed as malignant, both were cystoadenocarcinomas arising in the posterior mediastinum.
    Thirty percent of the patients had symptoms mainly chest pain, and the others were asymptomatic, but had abnormal routine chest Roentgenograms. The lager tumors such as teratoma and mesenchymal tumors tended to cause symptoms.
    For the diagnosis of cystic tumor, MRI was more accurate (90%) than CT scan (67.6%). Tumor markers in the cyst fluid were measured. Some selected tumors showed a non-specific high level of certain markers, such as CEA or CA19-9.
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  • Akihiro Nakamura, Yoshitaka Uchiyama, Norio Yamaoka, Masashi Muraoka, ...
    1997 Volume 11 Issue 1 Pages 20-24
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Thirty-one cases of resected large cell carcinoma of the lung were studied. The incidence of large cell carcinoma was 5.9 % of all resected lung cancers. Five of these cases (16.1%) were giant cell type. 41.9 % of the patients had symptoms, and leukocytosis (> 8, 000/mm3) was seen in 41.9 % of them. 48.4 % of these tumors were more than 5 cm in diameter, including 68% of those belonging to stage III or stage IV. DNA aneuploidy was seen in 86.4 % of the 22 evaluatd cases. Curative resection was performed in 54.8 % of the patients. The 5-year survival rate of resected large cell carcinoma was 33.2 %. Thus, prognosis of large cell carcinoma was significantly poorer than that of squamous cell carcinoma and adenocarcinoma. However, the 5-year survival rate of stage I cases was 80 %. In the early stage cases, surgical treatment may provide long-term suvival.
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  • Hideyuki Nishi
    1997 Volume 11 Issue 1 Pages 25-33
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    The present study attempted to extend the preservation time of a canine cadaver lung for transplantation with graft inflation and additives, urokinase and EPC (a phosphate diester linkage of Vit. E and Vit. C), to the flushing solution. Animals were sacrificed with potassium chloride and kept at room temperature for 2 hours until lung extraction. Heparin was not given. After cardiac arrest, the lungs were kept inflated (PEEP=15cmH2O) with continuous 100% O2 flow. At the extraction, the donor lungs were flushed with low potassium dextran glucose (LPDG) +EPC. At the end of flushing, Urokinse 120000U was administered into the pulmonary artery, the lungs were harvested and then preserved at 4t for 12 hours in Group 1 (n=6), for 18 hours in Group 2 (n=6), and for 24 hours in Group 3 (n=6). Then, bilateral single lung transplantaion (BSLT) was performed without using cardiopulmonary bypass. Following BSLT, dogs were maintained on a ventilator for 6 hours. Post-tansplant pulomnary function and hemodynamics were measured during this period. All animals of Group 1 and 2 showed good pulmonary function and stable hemodynamics during the 6-hour post-transplant assessment time in constract to only 2 cases of Group 3. By graft inflation with oxygen and addition of EPC and Urokinase to the flushing solution, the lungs of cadaver donor could be transplanted even after 2-hour warm ischemia and 18-hour cold preservation.
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  • Mitsunori Higuchi, Takashi Gunji, Hiroyuki Suzuki, Masao Kushida, Koic ...
    1997 Volume 11 Issue 1 Pages 34-39
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 48-year-old male with primary nodular pulmonary amyloidosis, which was detected in a group screening chest X-ray film is reported. His chest X-ray and CT scan showed multiple nodular shadows (220 mm) with calcification in bilateral lung fields. Before surgery we could not diagnose the tumor definitely despite full studies including bronchoscopic cytology, and therefore the largest tumor in left S9 (20 × 18 × 15 mm) was resected by thoracoscopic surgery. Microscopic examination confirmed the diagnosis of type AA amyloidosis. Postoperative examination revealed no amyloid deposit in other organs, so the diagnosis was primary nodular pulmonary amyloidosis. The patient has been well without any symptoms for 16 months after his discharge from hospital.
    Preoperative diagnosis of primary nodular pulmonary amyloidosis is difficult but thoracoscopic surgery is very useful for differential diagnosis from lung cancer and for definite diagnosis. Longer follow-up is needed because type AA amyloidosis is associated with complications such as connective tissue diseases, primary macroglobulinemia and malignant lymphoma.
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  • Masato Kanzaki, Takamasa Onuki, Masanobu Shioiri, Kazuhiro Sato, Masak ...
    1997 Volume 11 Issue 1 Pages 40-44
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 36-year-old male developed bloody sputum in August 1994. Three months later hemoptysis appeared. In January 1994, he presented to the outpatient clinic at our hospital with persistent hemoptysis. He had severe anemia. Chest X-ray film showed numerous bullae in the right upper lung field. A few bullae with clot were noted on chest CT. Bronchoscopic findings showed bleeding from B1, but cytology (sputum, brushing), BAL and TBLB were all negative. Because of severe anemia and dyspnea and frequent hemoptysis, his condition deteriorated and he underwent emergency right upper lobectomy on February 4, 1995. Histopathological finding showed that the tumor was a sarcomatoid carcinoma. He made favorable progress after the operation.
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  • Yoshitaka Masaki, Makoto Gomibuchi, Shuuji Haraguchi, Kouiti Hayashi, ...
    1997 Volume 11 Issue 1 Pages 45-48
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 27-year-old woman was admitted with dyspnea. Chest CT showed a large mediastinal tumor compressing the trachea. Chest MRI showed multiple lobules of the tumor. We diagnosed this tumor as a bronchogenic cyst. From a cosmetic point of view we could not choose posterolateral thoracotomy. Thoracoscopic surgery was impossible because of the tumor size and occupation. So we devised the ethanol injection therapy. Under a collar incision, we inserted a bronchofiberscope into the cyst from its upper part. At the same time, under guidance of transesophageal endoscopic ultrasonography, we certified immanent walls in the cyst and destroyed them by TBLB forceps to make a single lumen cyst. And we injected pure ethanol into it. Postoperatively the cyst became very small.
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  • Takumi Sasai, Yoshitaka Masaki, Yousuke Ishii
    1997 Volume 11 Issue 1 Pages 49-54
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 32-year-old woman was admitted to our hospital for blunt chest trauma due to a traffic accident. Bronchoscopy performed the next day revealed rupture of the trachea about 5 cm in length with airway stenosis. 6 days later, she began to complain of progressive dyspnea, and bronchoscopy showed severe stenosis of the ruptured trachea. EMS was inserted to manage the stenosis of the trachea. Dyspnea disappeared soon aftger this procedure with the tracheal lumen widely patent. 19 days after this treatment, she compained of dyspnea again and bronchoscopy showed re-stenosis of the trachea due to growth of granulation tissue within the EMS. Bronchoscopic resection of the granulation tissue was performed repeatedly but the stenosis could not be resolved by this procedure. Dumon stent was applied to control restenosis of the trachea on the 52nd day after insertion of the EMS. The clinical course has been satisfactory for one year after the use of Dumon stent and further follow up is needed to assess the long term result.
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  • Toshiharu Tabata, Tatsuo Tanita, Sadafumi Ono, Masafumi Noda, Yasushi ...
    1997 Volume 11 Issue 1 Pages 55-60
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We reported two cases of pulmonary hypertrophic osteoarthropathy (PHO) associated with bronchogenic carcinoma. Case 1 was poorly differentiated adenocarcinoma of the right upper lobe. Case 2 was large cell carcinoma of the left lower lobe. In both cases, bone and joint pain were present, and the abnormal accumulation of 99mTc-MDP in the bone scan films and the periosteal reaction in the bone X-ray fimis were shown before the operations. The bone and joint pain rapidly improved after resection of the primary lesions. The abnormal findings of bone scan and bone X-ray films subsequently improved. The bone scan examination was effective in following up postoperative bronchogenic carcinoma with PHO.
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  • Fujio Nagasaka, Masaaki Ohata, Mamoru Iida, Kazumitsu Omori, Yasushi N ...
    1997 Volume 11 Issue 1 Pages 61-65
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 63-year-old male who received right and left upper lobectomy for simultaneous bilateral primary lung cancer was reported.
    Chest X-ray film showed a coin lesion with pleural indentation of the right upper lobe, and fiberoptic bronchoscopy revealed an elevated lesion on the orfice of left upper lobe. Pathologically the right lesion was an adenocarcinoma and the left one a carcinoid tumor or small cell carcinoma. Clinical diagnosis was simultaneous bilateral lung cancer, and the stage was T1N0M0 (Stage I).
    One-stage bilateral upper lobectomy by median approach was carried out, and no complications developed after the operation.
    Postoperative pulmonary function was acceptable. The patient is alive 4 years after the operation despite recurrence of the left lung cancer, that was treated by irradiation.
    Median approach for one-stage bilateral upper lobectomy is useful procedure.
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  • Masaharu Nakade, Kazumi Iseki, Tetsuo Taniguti, Hiroaki Sakai, Hiroyos ...
    1997 Volume 11 Issue 1 Pages 66-73
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We report a patient with post-bronchial-tuberculosis bronchostenosis in whom bronchoscopic dilatation with a balloon catheter was successfully performed. The patient was an 18-year old female who had pulmonary tuberculosis at left S6 and bronchial tuberculosis of the left main bronchus. As a result of chemotherapy, the tuberculosis became inactive, but stenosis (needle eye size) of the left main bronchus (about 1.8 cm in length) immediately below the bifurcation of the trachea remained. We performed bronchoscopic dilation of the bronchus with a balloon catheter for vascular dilation. Observation of the patient's progress for more than 2 years revealed no restenosis with an internal diameter of 67 mm maintained. The results of objective examinations including blood gas analysis, respiratory function test, and lung perfusion scintigraphy were also no better than the result of the conventional surgical treatment. We feel that this technique can be indicated in the treatment of tuberculous bronchial stenosis if the focus is limited to the main bronchus and, that consideration be given to it before attempting surgical treatment.
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  • Satoshi Taga, Takashi Inoue, Akira Nagashima, Kosei Yasumoto
    1997 Volume 11 Issue 1 Pages 74-80
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 55-year-old woman was referred to our department complained of hemosputum, and abnormal shadow in the left lower lobe of the lung was noted by chest X-ray film and CT scan. Since no definite diagnosis could be made by the routine examinations, exploratory thoracotomy was performed. At thoracotomy an anomalous artery which originated from the descending aorta and supplied the left basal segment of the lung was detected. Based on the diagnosis as anomalous systemic arterial supply to the basal lung, left lower lobectomy was performed. Postoperative examinations of the resected specimen revealed that S8 and S9 were supplied by the anomalous artery, while, S6 and S10 were supplied by normal pulmonary artery without any sequestrated lung. Clinical features of this disease entity were discussed with a review of the literature.
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  • Tomohiko Ikeya, Shigeki Sugiyama, Eishin Hoshi, Yoshiyuki Anzai
    1997 Volume 11 Issue 1 Pages 81-84
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    An abnormal shadow was found on chest X-ray in a 27-year-old male. In X-ray and CT scan of chest, mass image was recognized in S2 area of the right lung. On pathologic examination with bronchoscopic biopsy, a leiomyosarcoma was suspected. We performed right upper lobectomy and lymph node dissection. The tumor measured 2.3 cm. Because spindle cell forming fasciculation and mitosis image were noted, and the specimen stained purple with azan stain, and yellow with van Gieson's stain, it was diagnosed as a pulmonary leiomyosarcoma. This case was only the fifth in which a pulmonary leimyosarcoma was reported to be dignosed by bronchoscopy before surgery.
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  • Tmonori Nakasone, Koji Kimino, Hideki Yamashita, Masao Kishikawa
    1997 Volume 11 Issue 1 Pages 85-89
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 51-year-old male was admitted to our hospital for further examination of a 2.5 cm round shadow in the right hilum on his chest X-ray film. Exploratory thoracotomy disclosed no malignacy, but postoperative histologic examination disclosed unknown origin metastatic carcinoma of the right pulmonary interlobar lymph node (#11i). A recurrent tumor appeared 1 year after operation and was reduced in size after chemotherapy. Additional right lower lobectomy (R2) was performed. Histologic examination disclosed no malignancy. Two recurrences with plasma CEA elevation appeared 7 months after reoperation. Transbronchial needle aspiration cytology (TBAC) disclosed poorly differentiated adenocarcinoma. The tumor was reduced in size and plasma CEA normalized after chemotherapy. Irradiation is seing continued.
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  • Hiroshige Nakamura, Kunio Araki, Yuji Taniguchi, Yoshimasa Suzuki, Mot ...
    1997 Volume 11 Issue 1 Pages 90-94
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We performed a thoracoscopic surgery for benign schwannoma originating from the left vagal nerve. The patient, a 76-year-old female, was admitted with an abnormal shadow on chest X-ray.
    Chest CT showed round tumor of 35 mm diameter which was enhanced by contrast between the descending aorta and pulmonary artery. Under thoracoscopy the tumor was located in mediastinum and connected with the intrathoracic vagal nerve. The tumor was resected by dissecting the capsule and conserving the vagal nerve. Pathological diagnosis was a benign shwannoma and the postoperative course was uneventful. Intrathoracic schwannoma arising from the vagal nerve was rare. Whether or not to resect the vagal nerve was most important issue and we concluded that thoracoscopically resection with conservation of the vagal nerve was a good operative selection if the age and the histology were considered.
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  • Shuji Haraguchi, Kiyoshi Koizumi, Hirohiko Akiyama, Iwao Mikami, Mituh ...
    1997 Volume 11 Issue 1 Pages 95-99
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 48-year-old woman complained of a cough, sputum, and fever which had persisted for a year and had not improved with conservative therapy. Her parents had died of pulmonary tuberculosis. She was also suspected of having old pulmonary tuberculosis. A chest X-ray showed atelectasis of the left lower lobe of the lung. A chest CT and a chest tomogram revealed the presence of some calcified masses, one of which was in the orifice of the left lower lobe bronchus of the lung. Bronchoscopic examination revealed a broncholith, but we failed to remove it.
    Therefore, a lobectomy, with removal of the broncholith, and calcified lymph node dissection were performed. Examination of the operative specimen showed atelectasis, fibrosis, and microabscesses containing branching filamentous structures positively stained with Gram's and silver methenamine stains. Culture studies were not helpful. These findings suggested that the lung was affected by nocardiosis. The broncholith consisted of calcium phosphate and calcium carbonate.
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  • Yutaka Iida, Hiroshi Tanabe, Satoshi Sakai, Hajime Hirose
    1997 Volume 11 Issue 1 Pages 100-103
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We reported a rare case of dilatation of the hemiazygos vein preoperatively diagnosed as posterior mediastinal tumor. A 76-year-old womam was admitted to our hospital because of a chest CT scan showing a mass shadow of the posterior mediastunum. We suspected a posterior mediastinal tumor like neurogenic one by chest MRI and so on. Therefore, we performed thoracotomy and Intraoperative findings revealed that the hemiazygos vein was dilated in about 50 × 30 × 25 mm beside the descending aorta and the thoracic vertebral body. The wall of the dilated hemiazygos vein was hard, there was no danger of rupture and no thrombus in the dilated hemiazygos vein, and so we did not resect it. Aneurysm of the azygos vein preoperatively diagnosed as posterior mediastinal tumor sometimes is reported, but we think that a case of dilatation of the hemiazygos vein regardless of the abscence of underlyng disease like cirrhosis of the liver, anomalies of the inferior vena cava and so on is very rare.
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  • Iwao Hioki, Yasumi Maze, Motoshi Takao, Makoto Kimura, Shoji Namikawa, ...
    1997 Volume 11 Issue 1 Pages 104-108
    Published: January 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Leiomyosarcoma as a mediastinal tumor is so rare that no more than 8 cases have been reported Japan, respectively. A 67-year-old male was admitted to another hospital with complaints of fever up and general fatigue. Chest X-ray revealed a mediastinal tumor, and he was admitted to our hospital. The density of the tumor was heterogeneous; that is, multiple high-density funiculi were seen in the fatty density. We therefore suspected that he had a thymoma, and performed an operation. Because the tumor was encapsulated and nearly non-invasive, extripation via a median skin incision and median sternotomy was performed successfully. Histologically, it was compatible with sarcoma and a definitive diagnosis of leiomyosarcoma was made based on immunology.
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