The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 11 , Issue 4
Showing 1-17 articles out of 17 articles from the selected issue
  • Hiroshi Date, Masayasu Yamanaka, Shingo Ichiba, Motoi Aoe, Motohiro Ya ...
    1997 Volume 11 Issue 4 Pages 495-499
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We present the results of volume reduction surgery (VRS) for diffuse emphysema in 14 patients. Bilateral VRS was performed through median sternotomy using a linear stapling device fitted with strips of bovine pericardium. Thirteen patients were male and one was female. The age ranged from 54 to 72 with an average of 65. Hugh-Jones classification was grade III in 7 cases and grade IV in 7 cases. Eight patients were dependent on oxygen therapy and 4 required steroid administration preoperatively. There has been no mortality. Of the 11 patients who completed one month follow-up assessment, 10 patients (91%) showed marked relief of dyspnea. Four of seven patients (57%) who was dependent on oxygen therapy preoperatively do not require oxygen any more. The mean forced expiratory volume in 1 second has improved by 48.4% from 742 ml to 1101ml (p<0.001). These changes have been associated with improvement in other parameters of pulmonary function, arterial blood gas analysis and exercise tolerance. We conclude that bilateral VRS is of significant value and safe for selected patients with diffuse emphysema.
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  • Takayuki Nakamura, Koji Chihara, Takashi Yoshimura, Shinichi Itoi, Tak ...
    1997 Volume 11 Issue 4 Pages 500-504
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    After lobectomy, cardiac arrhythmia occurred in 10 of 27 patients over 70 years of age whose preoperative electrocardiogram showed normal sinus rhythm. Atrial fiblillation in 10 patients including 2 cases with paroxysmal atrial tachycardia occurred on the first or the second postoperative day. Nine were treated with digitalis, and the remaining recovered sinus rhythm spontaneously. The preoperative %VC of the patients with arrhythmia (group A) was significantly lower than that of the patients without arrhythmia (group C) (p<0.05). Water balance on the first postoperative day was positive in group A but was negative in group C. The incidence of arrhythmia was significantly higher after right lobectomy than after left lobectomy (p<0.05). We suggest that preload and afterload to right heart were higher in group A than in group C, and resulted in cardiac arrhythmia in patients with unstability of right atrium especially after right lobectomy.
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  • Satoshi Hara, Nobuya Tanaka, Hiroshi Otsuka, Kosaku Nishi, Masayuki Ya ...
    1997 Volume 11 Issue 4 Pages 505-510
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Between 1983 and 1995, 31 patients underwent 33 thoracotomies for pulmonary metastases from colorectal cancer. Primary tumor was located in the rectum in 25 patients and in the colon in 6 patients. Five patients had prior hepatic metastases, four of those underwent curative hepatectomies and one received hepatic arterial injection of IL-2+5-FU followed by thoracotomy. There were solitary metastasis in 14 cases and multiple metastases in 19 cases including bilateral metastases in 11 cases. The overall median survival time and 5-year survival were 42.5 months and 29.5%. Patients with solitary metastasis showed prolonged survival compared to that of patients with multiple metastases, but there was no significant difference. There was no significant difference in survival between those with a disease-free interval of more than 2 years and those with less than two years disease-free interval. A slight survival advantage was noted for patients without hepatic metastasis, but the survival difference was not significant. Patients with normal perioperative CEA had a significantly prolonged survival compared with those whose CEA level was elevated (p<0.01). The 5-year survival of patients with mediastinal or hilar lymph node metastasis was significantly poorer (p<0.05).
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  • Sadafumi Ono, Tatsuo Tanita, Tsutomu Sakuma, Yugo Ashino, Satoshi Suzu ...
    1997 Volume 11 Issue 4 Pages 511-516
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    To clarify the effects of approach methods to thoracotory on lung function after lobectomy, the postoperative lung function of 3 groups receiving different approaches to thoracotomy were compared ; these were standard posterolateral (n=34), serratus anterior muscle-sparing (n=11), and muscle-sparing thoracotomy (n=10). The predicted postoperative values were calculated from preoperative lung function and pulmonary perfusion scan ratio, and compared them with the actual postoperative values. Good correlaions between the predicted values and the actual values in the 3 groups were noted. In the serratus anterior muscle-sparing and muscle-sparing thoracotomy groups, the ratios of actual values/predicted values of TLC, FRC and ERV were significantly higher than those of posterolateral thoracotomy group. The tendency for serratus anterior muscle-sparing or musce-sparing methods to preserve forced expiratory parameters (FVC, FEV1.0, and peak flow) compared to posterolateral incision was observed. We conclude that the muscle-sparing approach to thoracotomy is a useful method to preserve the lung function after lobectomy.
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  • Takamitsu Maehara, Yasufumi Hayashi, Takao Morohoshi, Kyota Iijima, Ka ...
    1997 Volume 11 Issue 4 Pages 517-522
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Immunohistochemical expression of sialyl-Lewis x carbohydrate antigen (sLex) was examined in relation to clinicopathological factors and prognosis in 66 patients with stage I non -small cell lung cancer, who underwent surgical resection. There were 36 adenocarcinoma, 24 squamous cell carcinoma, 3 large cell carcinoma and 3 adenosquamous cell carcinoma. A significant difference was detected in the expression of sLex between adenocarcinoma and squamous cell carcinoma.
    The incidence of sLex positive was not related to the histological differentiation or vascular invasion, but tumor with strong expression of sLex showed high frequency of recurrence of distant organs. Though vascular invasion and the expression of sLex were not significant prognostic factors by univariate analysis, those who was both positive for vascular invasion and high eypression of sLex had a worse prognosis. It is concluded that combined vascular invasion with expression of sLex may be a useful predictor of survival.
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  • Shinji Shimatani, Syuichi Sasamoto, Nobuhide Kato, Nobuo Okuyama, Shir ...
    1997 Volume 11 Issue 4 Pages 523-529
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 53-year-old man was admitted to our hospital with progressive dysphagia. His clinical diagnoses included primary esophageal cancer, primary lung cancer and metastatic brain tumor. Curative operation was not possible, but partial esophagectomy and lobectomy under left thoracotomy were performed at the same time to improve his dysphagia. Pathlolgical diagnoses were primary lung cancer and metastatic esophageal cancer. Only 2 cases of surgery for lung cancer and metastatic eshophageal cancer have been reported.
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  • Tohru Sato, Yoshiki Naruke
    1997 Volume 11 Issue 4 Pages 530-536
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Two cases with mediastinal or hilar lymph node metastasis of unknown origin are presented. The case 1 is a 65-year-old male patient in whom hilar lymph node metastasis was discovered after undergoing splenic tumor resection. The case 2 is a 74-year-old female patient in whom mediastinal lymph node metastasis was discovered during physical examination. Pathologically, the former case had adenocarcinoma and the latter one squamous cell carcinoma in metastatic lymph node. After surgery, both patients underwent systemic examinations to identify the primary lesion, but no primary lesion has been identified yet. In the near future, further examinations will be needed, taking metastasis from non-thoracic tumors into consideration.
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  • Hidefumi Sasaki, Yosuke Yamakawa, Hiroshi Niwa, Ichiro Fukai, Masanobu ...
    1997 Volume 11 Issue 4 Pages 537-541
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    An 80-year-old man admitted to our hospital because of lung cancer. He was treated by BAI chemotherapy with carboplatin. A chest X-ray film showed diffuse patchy shadows in both lung fields. The patient was treated with steroids, and his chest X-ray shadow showed improvement. But clinical condition became worse, and he died 20 days after chemotherapy. To our knowledge, this is the first reported case of pneumonitis caused by carboplatin.
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  • Nobuhiro Ono, Kiyoshi Satoh, Hiroyasu Yokomise, Koichi Tamura
    1997 Volume 11 Issue 4 Pages 542-545
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 74-year-old female was admitted to our hospital because of a chest abnormal shadow. Chest X ray films revealed a mass lesion in the right hilum. Chest magnetic resonance imaging demonstrated unhomogenous and slightly greater signal intensity than that of a muscle on Ti -weighted images, and lobulated and markedly increased signal intensity on T2-weighted images. She underwent tumor resection and the diagnosis of cavernous hemangioma was established by histopathological examination. Usually, it is difficult to diagnose mediastinal cavernous hemangioma pre-operatively. We reported some characteristic findings of the tumor on MRI and discussed about clinical features and treatment.
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  • Daisuke Kataoka, Masayuki Chida, Sumiko Maeda, Hiroshi Sasaki, Hideich ...
    1997 Volume 11 Issue 4 Pages 546-551
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 76-year-old woman visited our hospital because of dyspnea on effort. Chest X-rays showed abnormal shadow in the right lower lung field. CT scan and MRI revealed a Morgagni herniation.
    Herniation was repaired through a thoracic approach. Part of the large intestine and greater omentum had herniated into the thoracic cavity and caused atelectasis of the right middle lobe. Defect of diaphragm was 5 × 6 cm, and was closed with Marlex mesh.
    Even though thoracotomy has been reported to worsen post-operated lung function, we chose a thoracic approach to repair Morgagni herniation and obtained marked improvement of lung function.
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  • Toshihiko Iizasa, Yutaka Yamaguchi, Yasuhito Shimizu, Shigetoshi Yoshi ...
    1997 Volume 11 Issue 4 Pages 552-557
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We reported a 14-year-old female who was operated on a mediastinal bronchogenic cyst communicating with the right upper lobe and an abnormal bronchus. The patient had contracted pneumonia twice, and complained of a cold at this moment. Chest CT scan showed focal honeycomb part in S3 of the right upper lobe and a mediastinal cyst (3.0 × 3.0 cm) in the right side of the trachea. We diagnosed a mediastinal bronchogenic cyst communicating with focal heneycomb change in the right upper lobe under azygos arch through the abnormal bronchus. Combined resection of these leseions was performed. Histologically the cyst was diagnosed as bronchogenic and focal honeycomb lung of right S3 as severe inflammation of the lung, with no inflammatory change found in the cyst.
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  • Takeshi Mori, Hiroaki Hongo, Keiichiro Kondo, Norihisa Hanada, Yoichi ...
    1997 Volume 11 Issue 4 Pages 558-564
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 35-year-old man was hospitalized because of an anterior mediastinal mass invading the sternum and left brachiocephalic vein, and metastasizing to extrathoracic lymph nodes and the cervical and thoracic vertebrae. A diagnosis of thymic carcinoma, poorly differentiated squamous cell carcinoma, was made on percutaneous needle biopsy. We performed in vitro chemosensitivity test using an involved axillary lymph node. The tumor size was decreased dramatically by a combination of systemic and intra-arterial (via the bilateral internal mammary and thyrocervical arteries) administration using agents (CDDP, 5FU, MTX) selected on the basis of the chemosensitivity test. After chemotherapy, the primary tumor was resected together with the sternum, left brachiocephalic vein and mediastinal, neck and axillary lymph nodes. Histopathological examination of the resected specimen showed a few sporadic cancer nests in the fibrosis. Following surgery, postoperative chemotherapy and radiation (total 50.4 Gy) to the involved cervical and thoracic vertebrae were administered. Twelve months after surgery, the patient remains alive and has resumed his previous occupation.
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  • Nobuyuki Sato, Yuzo Sagara, Yuji Shiraishi, Kuniharu Miyajima, Akira H ...
    1997 Volume 11 Issue 4 Pages 565-569
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Pulmonary leiomyoma is a rare lung tumor and comrises 2% of benign lung tumors. We herein report two cases of parenchymal pulmonary leiomyoma that we encountered recently. In case 1, an asymptomatic 47-year-old male was found to have a pulmonary nodule in the right upper lung field on screening chest X-ray. He was hospitalized for thoracoscopic removal of the tumor. Microscopic findings revealed that the tumor was pulmonary leiomyoma. He has remained well since surgery and there is no evidence of tumor recurrence to date. In case 2, a 45-year-old female, who had undergone hysterectomy 17 years earlier for uterine leiomyoma, was found to have a pulmonary nodule in the left lower lung field on screening chest X-ray. She was hospitalized and chest computed tomography scan showed another small nodule in the right lower lobe. The left pulmonary nodule was resected by thoracoscopic surgery, and diagnosed as pulmonary leiomyoma pathologically, although the possibility that her tumor might be benign metastasizing leiomyoma from previous uterine leiomyoma could not be ruled out. Right lung nodule was so small that we decided not to remove that tumor at this time. Therefore, meticulous follow-up of this case is mandatory.
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  • Isao Kamiya
    1997 Volume 11 Issue 4 Pages 570-574
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 56-year-old male was hospitalized because of hemoptysis. Chest X-rays showed a cavity in the right upper lung field. Aspergillus fumigatus was found in all sputum specimens. Treatment with antifungul drug did not induce remission. The upper and middle lobes of the right lung were resected and partial resection of S6 were performed. Because of postoperative empyema with fistula formation, total extirpation of the remaining lung and omentopexy were performed. Further, because of the relapse of bronchial fistula, bronchial fistula closure via median sternotomy was performed. However, this did not induce complete cure. In our hospital, 7 patients with pulmonary aspergillosis were treated surgically during the past five years. 5 cases were cured completely without any complications. However, one case developed postoperative lung fistula and another developed empyema with fistula formation. Surgical treatment for pulmonary aspergillosis should obtain complete resection without any lesion remnant. In case of incomplete resection, procedures should be studied sufficiently considering the possibility of complication involving postoperative Aspergillus pyothorax.
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  • Yoshiki Naruke, Satoshi Shiono, Masami Abiko, Toshiaki Masaoka, Katumi ...
    1997 Volume 11 Issue 4 Pages 575-578
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 65-year-old male, complaining of anterior chest pain and fever, demonstrated an abnormal mass at the anterior mediastinum, which reduced from 60 to 15 mm in diameter after antibiotic treatment. Biopsy failed to clarify the diagnosis, and thymoma was strongly suspected due to radiological results. Extended thymectomy was performed. The completely encapsulated tumor was in the thymus, and included necrotic tissue. Microscopic examination with Grimelius staining showed dense-core neurosecretory granules in the cells, indicating carcinoid tumor of the thymus. Spontaneous regression of carcinoid tumor has seldom been reported. There have been no signs of recurrence for more than five years after surgery in this case.
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  • Fujio Nagasaka, Hisaki Umezawa, Kazumitsu Omori, Kazuo Kitamura, Yoshi ...
    1997 Volume 11 Issue 4 Pages 579-582
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 46-year-old woman with pulmonary arteriovenous fistula (PAVF) is presented. Plain chest X-ray film showed a homogeneous lung lesion and chest CT scan indicated a nodule with blood vessels. PAVF was suspected based on these findings, but pulmonary arteriography (PAG) could not be carried out because of iode hypersensitivity. 3D-CT was performed instead of PAG and was very useful for diagnosing this disease.
    The fistula existed at the periphery of right S8 and was about 15 mm in diameter. Therefore thoracoscopic resection was carried out. This technique for PAVF allowed preservation of pulmonary function with reduced surgical stress. Thoracoscopic resection should be the first choice of treatment for PAVF, especially for that in the periphery of the lung.
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  • Mitsuharu Sato, Katsuichi Kase
    1997 Volume 11 Issue 4 Pages 583-587
    Published: May 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 38-year-old woman had four episodes of recurrent right pneumothorax since August 1994 and was hospitalized on the fifth episode. Because each episode occurred within 3 days before or after the onset of menstruation, we suspected catamenial pneumothorax. To prevent recurrence, sugical treatment by thoracoscopy was selected. It revealed the presence of a tiny hole in the central tendon of diaphragm with several brown spots around it. We resected this focal lesion and closed the defect with an autosuture. Histological findings showed endometriosis of the diaphragm. The patient declined hormonal therapy, but recurrent pneumothorax occurred 2 months after thoracoscopic surgery. Thereafter, she was given Buzerelin (900 μg/day intranasally) and remained asymptomatic for 3 months. We discuss the mechanism of catamenial pneumothorax based on the histological findings and emphasized the necessity of hormonal treatment in addition to surgical treatment.
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