The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 11 , Issue 6
Showing 1-18 articles out of 18 articles from the selected issue
  • Akinori Iwasaki, Yasuteru Yoshinaga, Motohisa Kawahara, Kan Okabayasi, ...
    1997 Volume 11 Issue 6 Pages 692-698
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Carcinosarcoma are rare tumors that have both a malignant epithelial component and malignant storomal component. The histogenesis and biologic behavior are similar.
    We analyzed pulmonary carcinosarcoma including 5 of the so-called type and one pure type. One was intrabronchil and 5 peripheral. One case was located in a giant bullae. Our study examined p 53 immunostaining in these 6 cases, and found positivity in the so-called type and negativity in the pure type. There was no disparity in p 53 immunostaining between the epithelial and the stromal components. This concordance shows that the pulmonary carcinosarcoma are monoclonal, and suggests that so-called type and pure type develop by different mechanisms.
    Download PDF (2335K)
  • Kaoru Kondo, Toshihiko Urakami, Toshio Kasugai, Jouji Kato
    1997 Volume 11 Issue 6 Pages 699-703
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Between January 1990 and February 1997, 51 cases (26.3%) of bilateral spontaneous pneumothorax were treated among 194 patients who underwent 231 surgical treatments for spontaneous pneumothorax, including 191 thoracoscopic procedures and 40 standard thoracotomies. Five cases (2.6%) occurred simultaneously and 46 cases (23.7%) metachronously. Juvenile pneumothorax showed a tendency to develop bilateral pneumothorax more frequently. Bilateral pneumothorax occurred in 28 cases (45.9%) of spontaneous pneumothorax most frequently in teenaged patients. Bilateral one-stage procedure under thoracoscopy was performed for three cases (60.0%) of bilateral simultaneous pneumothorax. Bilateral onestage surgery under thoracoscopy is recommended for bilateral simultaneous pneumothorax. However, it had never been performed for cases of bilateral metachronous pneumothorax because contralateral pneumothorax after a unilateral procedure occurred in only 16.9% of all cases of unilateral pneumothorax, even 31.0% of teenaged patients. So bilateral one-stage surgery for contralateral preventive treatment is not recommended. It is suggested that the contralateral pneumothorax should be treated when and if it occurs.
    Recurrence of postoperative ipsilateral pneumothorax occurred in 10 sides (13.9%) treated by bilateral pneumothorax and in 9 sides (7.4%) treated by unilateral pneumothorax. Bilateral pneumothorax showed a tendency to recur more frequently. Moreover, 17 sides (11.4%) were treated by thoracoscopic surgery. So it is necessary that surgical pleurodesis is added for patients of bilateral pneumothorax and teenaged patients treated by thoracoscopic surgery.
    Download PDF (809K)
  • Masayoshi Inoue, Yoshitaka Fujii, Meinoshin Okumura, Yukiyasu Takeuchi ...
    1997 Volume 11 Issue 6 Pages 704-709
    Published: September 15, 1997
    Released: February 22, 2010
    JOURNALS FREE ACCESS
    Thymoma contains abundant immature T lymphocytes. Since thymic epithelial cells have an important key role in T cell development and selection, it may be possible that the immature T lymphocytes differentiate in thymoma. In this report, we analyzed the surface antigens on lymphocytes in a metastatic thymoma of lung to investigate the maturity. CD4-CD8- (DN) cells accounted for 3.6%, CD4+CD8+ (DP) cells for 75.2%, CD4+CD8+ (CD4SP) cells for 9.7 %, and CD4-CD8+ (CD8SP) cells for 11.5%. 85.9% of the lymphocytes expressed CD1. Although all CD8SP cells expressed CD3, TcRafl and CD69, a large proportion of CD4SP cells did not and were immature CD4SP cells which were differentiating to DP cells from DN cells. These results indicate that a metastatic thymoma contained abundant immature T cells, and also suggest that the tumor thymic epithelial cells may govern the developing T cells though incompletely.
    Download PDF (1094K)
  • Norio Yamaoka, Yoshitaka Uchiyama, Akihiro Nakamura, Masafumi Morinaga
    1997 Volume 11 Issue 6 Pages 710-716
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    41 patients with stage II non-small-cell lung cancer were treated by resection and complete mediastinal lymph node dissection. There were 16 patients with T1N1M0, 25 patients with T2N1M0. The overall 5-year and 10-year survival rates were 47.3% and 36.8% respectively. Survival of patients with squamous cell carcinoma tends to better than that with adenocarcinoma, and patients with lobar lymph nodes metastases tend to have better survival than thoses with hilar nodes metastases. No significant difference in survival was found accoding to other variables. Fourteen received postoperative chemotcerapy, 12 received irradiation and 14 had so further treatment. There was no improvement in survival with use of adjuvant therapy. In the patients with squamous cell carcinoma, the survival of stage II was no different than that of stage I, but was significantly better than that of stage III A. On the other hand, in the patients with adenocarcinoma, the survival of stage II was no different than of stage III A, but was significantly worse than that of stage I. These results indicate that patients with stage II squamous cell carcinoma may expect favorable prognosis, but patients with stage II adenocarcinoma poor prognosis.
    Download PDF (1037K)
  • Takahiro Mukaida, Shingo Ichiba, Motoi Aoe, Motohiro Yamashita, Kazuno ...
    1997 Volume 11 Issue 6 Pages 717-723
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We retrospectively studied 128 cases of thymoma (61 invaive thymomas and 67 encapsulated thymomas) treated at the Department of Surgry II, Okayama University Medical School between 1963 and 1995. Invasive thymoma cases showed the following characteristics compared to encapsulated cases; male dominant, greater frequency of epithelial predominant type. There was no significant defference between vascular resection cases and no vascular invasion cases in age, sex, and pathological type. In invasive thymoma, 20 cases needed vascular resection. Angioplasty alone was performed in 6 cases, reconstruction of LBCV (left brachiocephalic vein) with artifical graft in 7 cases, and reconstruction of LBCV and SVC with artificial graft in 7 cases. Two teflon grafts, six ePTFE (expanded polytetrafluoroethylene) grafts, and thirteen ePTFE grafts with ring were used for vascular reconstruction cases. Occulusion occured only in three grafts, and a good patency rate of grafts was achieved. In stage III invasive thymoma, the complete resection of tumor including vacular resection can improve the prognosis of vascular invasive cases which is the same as that of vascular noinvasive cases. To get better prognosis, however, more effective adjuvant therapy is thought to be needed preoperatively and/or postoperatively.
    Download PDF (1116K)
  • Akira Yamanaka, Toshio Fujimoto, Takashi Hirai, Shin Mutoh, Mitsuo Has ...
    1997 Volume 11 Issue 6 Pages 724-729
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    From 1984 to 1996, 35 patients with clinical stage III small cell lung cancer underwent treatmen in our hospital. Surgical resection was performed on eight patients (6 IIIA and 2 IIIB). Twenty-seven patients did not undergo surgical resection (11 IIIA and 16 IIIB). Pathological stages in the resected patients were stage I in one, IIIA in five, IIIB in one, and IV in one. Of the six patients who received preoperative chemotherapy, four obtained remission to clinical stage I, but only one to pathological stage I. Two patients died within two years postoperatively, and four patients obtained disease-free survival for three years postoperatively. Five-year-survival was 72.9% in the eight patients receiving surgical rsection, of whom the longet disease-free survival was 94 months. Systemic chemotherapy was administered to all 27 patients not receiving surgical resection. As a main agent of combination chemotherapy, cyclophosphamide was used in eight patients, and cisplatin or carboplatin in 23. Radiotherapy was also performed in 13. All patients died within 23 months, and the mean survival period and one-year survival were 9.9 months and 29.6% in the non-resected patients. As a result, some patients who obtained long survival were perfomed surgical resection even in stage III small cell lung cancer.
    Download PDF (983K)
  • Katsunari Matsuoka, Masatoshi Ito, Yoichiro Ueno, Jun Isobe, Takanobu ...
    1997 Volume 11 Issue 6 Pages 730-735
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Recently, video-assisted thoracoscopic surgery is performed widely not only for treatment of pneumothorax and resection of benign lung tumor but also for major pulmonary resection in lung cancer. However, it is difficult to complete the mediastinal lymph nodes dissection under thoracoscopic procedure. So we reviewed the lymph node involvement in resected peripheral, clinical stage I lung cancer. 107 tumors were resected in our hospital from 1984 to 1995, as peripheral, clinical stage I lung cancer amounting to 29% of all resected lung cancer during the same period. In the 85 cases with completely lymphadenectomy, 19 cases had lymph node involvement : 10 at Ni nodes, 8 at N2 nodes, and 1 at N3 node. Although no metastasis was found in squamous cell carcinoma which were less than 20 mm in diameter, 2 cases of mediastinal lymph node involvement were found in adenocarcinoma which were less than 20 mm in diameter. And there were no upper mediastinal lymph node involvement in carcinoma located in lower lobe. Then, squamous cell carcinoma less than 20 mm in diameter and carcinoma located in lower lobe may be candiates for video-assisted thoracoscopic surgery. And at the resection of peripheral, clinical stage I lung cancer under video assisted thoracoscopic surgery, it is necessary to evaluate the mediastinal lymph node involvement using mediastinoscopy and other methods.
    Download PDF (769K)
  • Masao Kushida, Akio Ohishi, Ryuzo Kanno, Koichi Yanai, Atushi Moriyama ...
    1997 Volume 11 Issue 6 Pages 736-744
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    After lung resection, it is recognized that reduction of the pulmonay vascular bed increases right ventricular afterload and influence right ventricular function. Therefore, we investigated how right ventricular function changes after lobectomy and pneumonectomy, measuring hemodynamics including right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume index (RVEDVI). 35 patients who had received lobectomy and 16 patients who had received pneumonectomy for lung cancer were examined.
    After lobectomy, right ventriclar afterload increased slightly, as stroke volume decreased but cardiac index increased. The decrease of RVEDVI might reduce stroke volume. However, the increase of heart rate increased the cardiac index as compared to the preoperative value. Right ventricular function was tolerant of the stress after lobectomy.
    After pneumonectomy, right ventriclar afterload increased significantly. Not only stroke volume decreased but cardiac index was also not stable. The decrease of RVEF might reduce stroke volume. Heart rate increased but cardiac index was not stable. This suggests that the increase of heart rate can not compensate for the decrease of stroke volume and the tendency of right ventricular failure after pneumonectomy.
    The change of RVEDVI was not correlated with that of mean right atrial pressure. Therefore, investigation of RVEDVI was useful for evaluating the right ventricular preload.
    Investigating hemodynamics including RVEF and RVEDVI is a reliable means to evaluate the right ventricular load and compensation influenced by the right ventricular afterload.
    Download PDF (1391K)
  • Shinji Kosaka, Nobuaki Miyamoto
    1997 Volume 11 Issue 6 Pages 745-748
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Mediastinal lymphangioma is a rare mediastinal tumor. Most of the cases were cystic lymphangioma, and mediastinal lymphangioma containing cavernous portion is very rare. Only eight cases were reported in Japan including our case.
    A 55-year-old man was admitted to Kochi Municipal Hospital with an abnormal density in the aortic-pulmonary window on chest roentogenogram. A chest CT scan revealed an hour-glass-shaped tumor in the left middle mediastinum, just above the left main pulmonary artery. Calcification was found in the anterior portion.
    The tumor was excised and found to consist of a spongelike portion and a cystic portion. Histopathological examination revealed that this tumor was lymphangioma, a spongelike portion was cavernous lymphangioma and a cystic one was cystic lymphangioma. Postoperative course was uneventful.
    Download PDF (1032K)
  • Yoshinori Hiramatsu, Masato Sasaki, Tetsuya Kimura, Yukio Chiba, Ryuus ...
    1997 Volume 11 Issue 6 Pages 749-754
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We have experienced two cases of tracheobronchial metatasis after lung cancer operation. One case involved a 68-year-old male who complained of bloody sputum at 6 months after pneumocectomy for stage III A adenocarcinoma. The second case involved a 47-year-old male with bloody sputum at 49 days after right upper lobectomy for stage III B adenocarcinoma. Both patients were diagnosed with several tracheobronchial metastases of adenocarcinoma due to lung cancer based on the bronchoscopic and pathological findings. Flexible fiberoptic bronchoscope guided KTP laser therapy was performed under local anaesthesia because of minimum invasion and rapid effects. Afeter the KTP laser therapy, the clinical courses were uneventful. These tracheobronchial metastases were well controled by the therapy. Further careful follow-up is neccessary to determine how long the effects would last.
    Download PDF (2904K)
  • Hiroshige Nakamura, Norimasa Ito, Yuji Taniguchi, Yoshiyuki Tanaka, Ki ...
    1997 Volume 11 Issue 6 Pages 755-759
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We performed a thoracoscopic surgery for pediatiric acute empyema. The patient, a 3-year-old girl, was admitted with parapneumonic empyema by γ-streptococcus infection. Because her empyema did not resolve with chest tube drainage and irrigation, thoracoscopic debridement in the fibrinopurulent loculated space was performed under general anesthesia. By instituting postoperative irrigation with two tubes, lung expansion was recovered and the empyema cavity disappeared. Then, the chest drains were removed.
    Instruments with 5 mm diameter, especially high-pressure suction cannulas to remove fibrin clots were very useful for this pediatric case. Thoracoscopic treatment for acute empyema has numerous advantages in the resolution of this disease.
    Download PDF (1966K)
  • Shigeo Matsui, Ken Kodama, Osamu Doi, Masahiko Higashiyama, Hideoki Yo ...
    1997 Volume 11 Issue 6 Pages 760-764
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A-67-year-old man was admitted to our hospital, because of finger clubbing and weight loss. Chest X ray film revealed a huge tumor in the right side of chest. Chest MRI (T2 weighted) suggested neither invasion to chest wall nor to abdominal cavity. Chest X-ray film, taken 4 years and 8 months before operation, was helpful for correct clinical diagnosis of localized malignant mesothelioma originating from interlobar pleura. At srugery the right lung was compressed to upper mediastinal side, but was not invaded by the tumor. After resection of the tumor, collapse of the right lung completely disappeared and no residual tumor was found macroscopically. The tumor was 18 cm in maximum diameter and 2000 g in weight, and histologically classified as locolized mesothelioma of pleura, fibrous type and low grade malignancy. Complete resection is necessary in the early stage, because the tumor tends to become huge and has a malignant potential.
    Download PDF (1904K)
  • Shun-ichi Watanabe, Hideo Sato
    1997 Volume 11 Issue 6 Pages 765-768
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A rare case of early pulmonary large cell carcinoma found in a giant bulla which contained coagulations and disseminated cancer is reported. A 57-year-old male was admitted because of hemosputum. He had been found to have a giant bulla on a routine chest X-ray film 7 years earlier. His chest X-ray film showed a giant bulla in the right lung and consolidation in the bulla. Bullectomy was performed, and histological examination incidentally revealed two early large cell carcinomas in the bulla. Histologically, one of them was thought to be the primary site with bleeding, and the other to be disseminated tumor on the opposite side of the cyst wall. Resection and pathological examination are necessary for patients with bullous disease.
    Download PDF (1831K)
  • Nanae Hangai, Toshio Kanai, Hiroki Ishikawa, Naoto Miyazawa
    1997 Volume 11 Issue 6 Pages 769-772
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Infected traumatic pulmonary pseudocyst is unusual. A 68-year-old male presented to our hospital with productive cough and general fatigue after suffering a minor chest contusion. Chest X-ray and CT scan showed a left-sided pneumothorax and a pulmonary cyst with an air fluid level in the left lower lobe. The patient was febrile with an elevated serum CRP and a diagnosis of an infected traumatic pulmonary pseudocyst was made. Despite antibiotic therapy, the patient's condition did not improve. CT guided thoracentesis performed under local anesthesia produced purulent drainage which grew pseudomonas. Following drainage the patient recovered promptly. The drainage tube was removed 37 days after drainage. CT scan performed 3 months after injury showed resolving cyst on his left lower lobe. We conclude that non-invasive CT guided drainage is an effective method to treat an infected traumatic pulmonary pseudocyst.
    Download PDF (1581K)
  • Toshio Noriyuki, Shinkichiro Yoshioka, Yoshihiro Miyata, Satoshi Shiba ...
    1997 Volume 11 Issue 6 Pages 773-776
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Thymic carcinoid is a rare, slow-growing malignant tumor that tends of recur long after its resection. Three cases of thymic carcinoid treated in our department were examined focusing on the initial operative method and recurrence. The tumor with adhesion to peripheral tissue was peeled off at the initial operation, with local recurrence developing. In the pathological findings, all tumors had a capsule, but many carcinoid cells invaded into the capsule. The metastasis of mediastinal lymphnodes was recognized in one of three cases at the initial operation, and in all of three at the reoperation. Accordingly, the surgical treatment of thymic carcinoid should follow the resection of peripheral tissue and dissection of the mediastinal lymphnodes. The recurrence of thymic carcinoid should be aggressively resected, because long survival case can be expected with reoperation.
    Download PDF (666K)
  • Hiroshi Izumi, Kouhei Mikami, Toshiro Futagawa, Akio Yamazaki, Yasuyuk ...
    1997 Volume 11 Issue 6 Pages 777-781
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Two cases of diffuse pulmonary hamartolymphangiomyomatosis (HAM) were reported. Case 1 was a 24-year-old woman whose chest CT scan revealed multiple bilateral cystic lesions suggesting HAM. Wedge resection and pleurodesis with partial pleurectomy were performed under thoracoscopy. Case 2 was a 25-year-old woman. Although bullae were not recognized on preoperative chest X-ray film or CT scan, thoracoscopic surgery was performed for treatment of spontaneous pneumothorax. However bulla was not found on thoracoscopy. Then thoracotomy was done, and the wedge resection of the suspected scar of bulla and pleurodesis with partial pleurectomy were performed. Histological examination of the resected specimen made a diagnosis of HAM. HAM is indeed a rare disease but is should be included in the differential diagnosis of pneumothorax in females. It goes without saying that histological examination of resected specimens is necessary even though in case of pneumothorax.
    Download PDF (1820K)
  • Michihiko Tajiri, Haruhiko Ishii, Tatsushi Yamagata, Makoto Ishibashi
    1997 Volume 11 Issue 6 Pages 782-787
    Published: September 15, 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We reported a case of bilateral lung metastases of rectal cancer simultaneously treated with open segmental resection on the right side and video-assisted lobectomy on the left side. In a 67-year-old male who had received low anterior resection of the rectum due to rectal cancer 6 years ago, chest X-ray and CT scan showed two lesions ; one in the right S2 and the other in the left S8. On pathological examination of the bronchoscopic biopsy specimen, adenocarcinoma was confirmed, but it was difficult to determine if they are metastases or primary cancers. Since both lesions were located in the center of the lobe, wedge resection was not indicated. Because we thought the usual bilobar resection would result in excessive loss of respiratory function, we chose an open segmental resection of the right S2 and video-assisted lobectomy of the left lower lobe. Post operative course was uneventful. In cases requiring bilobar resection this method may be a useful altenative that can conserve the patients' respiratory function.
    Download PDF (2228K)
  • 1997 Volume 11 Issue 6 Pages e1
    Published: 1997
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Download PDF (3064K)
feedback
Top