The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 12 , Issue 7
Showing 1-18 articles out of 18 articles from the selected issue
  • Taiji Okatani
    1998 Volume 12 Issue 7 Pages 738-745
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    The shortage of donor lungs limits the number of patients who can benefit from lung transplantation. We studied effects of flushing, warm ischemia after cessation of circulation, and cold preservation in rabbit lungs from cadaver donors (CDs) to investigate the clinical application of cadaver lung transplantation. We measured filtration coefficient (Kf) as micro-vascular permeability of the graft lungs as a sensitive indicator of lung injury in five study groups. Group A : no warm ischemia, no graft flushing, and no cold preservation (Kf=0.34±0.14), Group B : no warm ischemia, with graft flushing, and no cold preservation (Kf=0.42±0.06), Group C : no warm ischemia, with graft flushing, and cold preservation (Kf=0.60±0.13), Group D : warm ischemia for 60 minutes, with graft flushing, and cold preservation (Kf=0.92±0.21); Group E : warm ischemia for 90 minutes, with graft flushing, and cold preservation (Kf =1.25±0.09).
    Prolonged cold preservation significantly increased Kf of the graft, and aggravated the microvascular injury caused by warm ischemia after cessation of circulation.
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  • Akihiko Tanaka, Tei Sato, Hisayoshi Osawa, Akihiko Yamauchi, Tetsuya K ...
    1998 Volume 12 Issue 7 Pages 746-755
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    The reconstruction of the widely resected thoracic wall was successfully achieved with the use of long metal plates which had many perforations. Resection of multiple ribs, an average of 3.3 ribs were removed, was performed in 6 patients, including four with lung cancer, one with chondroma, and one with fibrous dysplasia.
    The method of the reconstruction was classified into three types according to the position of the fixed plates. (Method 1) The plates were fixed at right angle to the normal ribs. (Method 2) The two plates were crossed to form an X shape and were consequently fixed obliquely to the normal ribs. (Method 3) The plates were fixed in parallel to the normal ribs just like the resected ribs. These three methods were useful to make the hard bony thorax, because neither paradoxical movement of the chest wall nor fragmentation of the prosthesis occurred postoperatively in any of 6 patients. Moreover no one required removal of the prostheses due to wound infection or foreign body reaction.
    From a standpoint of creating a physiologically more natural bony thorax, the third method was recommended for reconstruction of the curved chest wall. And these long metal plates made it easy to reconstruct the curved chest wall, because they were long enough to cover the widely resected ribs and moderately soft enough to be appropriately bent or twisted by hand at the time of operation.
    Many materials and methods are available for the reconstruction of the thoracic wall, but most of them rebuilt only a plane chest wall, on the contrary we report the making of the curved chest wall.
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  • Kazuki Nakahara, Sadahiko Masuda, Yoshio Ohse, Minoru Tahara, Akio Yar ...
    1998 Volume 12 Issue 7 Pages 756-761
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We analyzed resected non-small cell lung cancer cases with intrapulmonary metastasis to the primary lobe (pml cases) in order to evaluate the feasibility of intentional limited surgery for small peripheral non-small cell lung cancer. Forty-six cases with pml were treated between 1975 to 1996. Thirty-two patients had adenocarcinoma, 10 squamous cell carcinoma, 2 adenosquamous cell carcinoma, and 2 large cell carcinoma. Tumor diameters of the primary lesions were as follows : only 1 case of squamous cell carcinoma had a diameter of less than 3.0 cm, compared with 7 cases of adenocarcinoma whose diameter was from a minimum 1.0 cm to 3.0 cm. Concerning the relation of pm with p and N factors, p0 was found in 47% of adenocarcinoma cases and 40% of squamous cell carcinoma, and N0 was seen in 38% of adenocarcinoma cases and 30% of squamous cell carcinoma cases. It was thus considered difficult to presume the presence of pm from p and N factors. Diagnosable rate of pm before and during surgery was low, and the presence of pm was diagnosed for the first time by postoperative pathological investigation in 66% of cases of adenocarcinoma and 40% of squamous cell carcinoma. In the pre-operative clinically morbid period, 5 cases of adenocarcinoma were diagnosed as c-T1N0M0, but there was no case of squamous cell carcinoma that was diagnosed as T1N0M0. As result of investigating 5 cases who were diagnosed as c-T1N0M0, all the cases were diagnosed as PM0 even during surgery. The tumor diameters in 4 of 5 cases were larger than 2.0 cm. The pms in these cases were present in the same segment as the primary lesion, but in the other 1 case, the tumor diameter was 1.5 cm, and pm was present in the segment different from the primary lesion. Furthermore, this case was NO and could have been defined as a case for whom limited surgery is applicable, and there was a strong possibility of letting pm subsist.
    From the above, we concluded that limited surgery on peripheral small early lung cancer can be established as the standard surgery for squamous cell carcinoma, but the application of limited surgery to adenocarcinoma must be carefully considered.
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  • Noriyoshi Sawabata, Keiji Iuchi, Akihide Matsumura, Hirofumi Sueki, Hi ...
    1998 Volume 12 Issue 7 Pages 762-765
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    The most reliable method for bullectomy is resection of the affected lung. In the case of multiple bullae, however, this method is time-consuming and costly. Besides, bullae with broad bases are hard to resect. In contrast, most bullae are rapidly and sufficiently ablated by heat. We assessed the contribution of a newly developed elector surgical unit tip for bulla ablation. From 1995 to 1997, 79 patients (69 males and 10 females, aged 17 to 82, 67 spontaneous pneumothorax, 17 giant bulla and 6 bullous emphysemas) underwent bullectomy combined with heat ablation using the tip among 133 patients received treatment for bullae related diseases. Indication criteria for surgical bullectomy were : ruptured bulla, solitary bulla on narrow bases or pedicles, conglomerate of small to medium bullae and giant bulla. For heat bulla ablation indications were : small to medium bullae commonly confine to edge of the lung, multiple superficial bullae, bullae with broad bases distended by air inflation and bullae with broad and flat surface slightly distended by air inflation.
    These bullae were shrunk with an electrocoagulator using a large ball tip 8 millimeters in diameter. Operation times averaged 106 +/-38 minutes, average chest tube duration was 4.8 + /-3.1 days, rate of complication (prolonged air leak) was 5.1% (4/79) and rate of postoperative pneumothorax was 6.3% (5/79).
    Heat bulla ablation is safe and effective in managing bullae.
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  • Hiroya Minami, Noriaki Tsubota, Masahiro Yoshimura, Yoshifumi Miyamoto ...
    1998 Volume 12 Issue 7 Pages 766-771
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We measured the preoperative and postoperative CEA levels in 402 consecutive patients who underwent resections of pulmonary adenocarcinoma from 1984 to 1995, and investigated the correlation between these levels and survival. The patients who were treated with induction chemo-radio therapy were excluded.
    The disease was more advanced (stage III, IV) in patients with initial CEA level above 5.0 ng/ml. CEA level had correlations with T and N factor, existence of dissemination and malignant effusion, but not with pulmonary metastasis.
    More patients (68.1%) with preoperative CEA level below 5.1 ng/ml had significantly complete resections than those (55.0%) with above 5.0 ng/ml.
    Regarding the 246 patients who had complete resections, the 5-year survival rate was 67.2 % in those with negative preoperative CEA (≤ 5.0 ng/ml, n=130), and this was significantly superior to the rate of 41.4% in those with positive preoperative CEA (≥_ 5.1 ng/ml, n=116). The survival rate in patients with positive preoperative and negative postoperative CEA (n= 82) was significantly superior to that in patients with positive preoperative and postoperative CEA (n=34). In each stage, there was no significant difference between the patients with positive preoperative and negative postoperative and those with negative preoperative and postoperative. This analysis shows that in pulmonary adenocarcinoma the postoperative change of CEA level is a very important factor reflecting the prognosis.
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  • Yoshinori Hiramatsu, Munehisa Imaizumi, Hideyo Watanabe, Hiromu Yoshio ...
    1998 Volume 12 Issue 7 Pages 772-777
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Surgical treatment for primary malignant mediastinal tumors was assessed based on our experience with 36 patients from January 1976 to December 1995.
    Preoperative needle biopsies and intraoperative biopsies were performed on 16 patients and 20 patients, respectively. The subtypes and cases : 11 invasive thymomas, 9 malignant germ cell tumors, 4 malignant lymphomas, 4 undifferentiated carcinomas and 8 others. Thirty-five patients underwent surgical resection, 13 of whom underwent complete resection. Nine combined resections were all complete resections. The overall 5 year and 10 year survival rates were 56.5% and 46.0% in all primary mediastinal malignant tumors (n=36), 100% and 70.0 % for complete resection which were significantly higher than 32.7% and 32.7% for incomplete resection. Radiotherapy, chemotherapy and preoperative therapy were performed on 20 patients, 14 patients and 2 patients, respectively.
    Complete resection was the superior treatment for primary malignant mediastinal tumors except malignant lymphoma. But currently the complete resection rate (36.1%) is low, especially for combined resection. To further improve the prognosis for patients with primary malignant mediastinal tumors, early detection and histological diagnosis are needed, and multiple therapeutic strategies considering histological subtypes are essential.
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  • Satoshi Hirata, Tadahiro Sasajima, Kazutomo Go, Susumu Koshiko, Eiji Y ...
    1998 Volume 12 Issue 7 Pages 778-782
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    The fact that lung surgery is not completely aseptic raises a controversy as to whether prosthetic vascular grafts should be used during lung surgery. We have developed a Rifampicin-bonded Gelatin-sealed Dacron Graft (RGS) to prevent such graft infection, and applied for combined resection of the aorta in T4 lung cancer.
    The patient was a 48-year-old man, who had a left axillary pain. Chest X-ray and CT scan showed a primary lung cancer (adenocarcinoma) in left S1+2. The tumor was diagnosed to invade the thoracic aorta by MRI at the level of Th5.
    Patch aortoplasty was performed using the graft under temporary bypass between left subclavian and left femoral artery, during left upper lobectomy for a patient with a lung cancer invading into the aortic wall. The favorable result of the present case suggests that RGS is a useful alternative for the treatment of lung cancer with aortic wall invasion.
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  • Hironori Kunisue, Hiroshi Date, Kazuhiko Shoga, Motoi Aoe, Motohiro Ya ...
    1998 Volume 12 Issue 7 Pages 783-786
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We report a case of successful thoracoscopic treatment for persistent air leakage after lung volume reduction surgery under local and epidural anesthesia. A 54-year-old man with a diagnosis of severe emphysema underwent lung volume reduction surgery via a median sternotomy. Postoperative course was complicated with massive persistent air leakage from the right lung. Due to the patient's poor condition, thoracoscopic surgery was performed under local and epidural anesthesia on the 43th postoperative day. Polyglycolic acid sheets and fibrin glue were used to control the air leakage. Pain and cough reflex were well controlled, and spontaneous breathing and hemodynamics were well maintained during the surgery.
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  • Mikihisa Fukuta, Kaoru Nakai, Takeshi Tokushima
    1998 Volume 12 Issue 7 Pages 787-791
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We report a 72-year-old female who was hospitalized due to a cough and hemoptysis. Chest CT scan on admission revealed a mass in the anterior mediastinum. CT guided percutaneous aspiration cytology demonstrated debritic fluid. Microscopically, degenerated substances and partially degenerated ciliated columnar epithelial cells were recognized. Therefore we suspected that this mass was a thymic cyst lined by ciliated columnar epithelium. A median sternotomy was performed. Macroscopic appearance of the resected specimen demonstrated a monolocular thymic cyst with thymus and fatty tissues. The content was debritic fluid. Microscopic appearance showed a monolocular thymic cyst of which the wall was surrounded by thymus and fatty tissues. The cystic wall was lined by ciliated columnar epithelium. Incidental thymoma was not recognized. From these findings, this case was diagnosed as a thymic cyst of which the wall was lined by ciliated columnar epithelium.
    Congenital thymic cysts are rare, and preoperative diagnosis is sometimes difficult. But in this case, as a result of percutaneous aspiration cytology, we were able to identify the epithelial cells, and diagnose this case as a congenital thymic cyst.
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  • Koichi Yoshikawa, Masato Morimoto
    1998 Volume 12 Issue 7 Pages 792-795
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 65-year-old woman was admitted to our department due to a pulmonary nodule and mediastinal mass on screening chest X-ray film. 28years previously a right nephrectomy had been performed with a diagnosis of renal cell carcinoma. A frozen section on diagnostic thoracotomy revealed pulmonary metastasis of renal cell carcinoma. Wedge pulmonary resection and mediastinal lymph node dissection were performed. Pathological diagnosis was pulmonary and mediastinal lymph node metastasis of renal cell carcinoma, clear cell type. The patient is doing well without recurrence for four years.
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  • Yuichi Akashi, Takashi Miura, Masao Chujo, Yozo Kawano, Mitsuyuki Arin ...
    1998 Volume 12 Issue 7 Pages 796-799
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We experienced 3 cases of spontaneous hemopneumothorax recently. One case was operated by standard thoracotomy. Because bleeding could not be controled by conservative treatment. In the other two cases, emergent operations with VATS were carried out immediately after being diagnosed. In all cases, we could find bleeding from the ruptured string between the parietal pleura and the apex of the upper lobe. Even in the latter two cases under VATS, we could remove the massive clots and stop the bleeding easily. So we suggest that VATS is a useful and more feasible approach for the initial treatment of hemopneumothorax to reduce total blood loss and avoid blood transfusion.
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  • Emi Machida, Hideki Nishimura, Keiichiro Takasuna, Masahisa Miyazawa, ...
    1998 Volume 12 Issue 7 Pages 800-804
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Tracheobronchial disruption due to chest trauma is relatively rare.
    Almost all patients with traumatic tracheobronchial disruption develop subcutaneous emphysema and severe dyspnea soon after injury. Usually, early diagnosis and adequate management are important to save these patients.
    We experienced a case of left main bronchial disruption diagnosed from left pulmonary atelectasis appearing 8 days after injury. A 26-year-old man who had suffered from blunt chest trauma was transferred to our hospital 6 days after the injury. Chest CT showed neither pneumothorax nor mediastinal emphysema. At 8 days after the injury, he developed left pulmonary atelectasis, and fiberoptic bronchoscopy revealed a complete obstruction of left main bronchus. He underwent a resection of the disrupted portion and an end to end anastomosis of left main bronchus. It should be emphasized that we should suspect tracheobronchial disruption whenever we evaluate patients with blunt chest trauma.
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  • Kenichiro Fukuhara, Kiyotoshi Inoue, Toshihiko Kato, Tatsuya Nishida, ...
    1998 Volume 12 Issue 7 Pages 805-809
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Cystic lymphangioma is a rare and benign congenital tumor. A case of mediastinal cystic lymphangioma is reported here. A 36-year-old male complained of cough and was admitted to Osaka City University Hospital because of a mass in the right mediastinum. We tried many examinations to achieve a diagnosis. Finally complete resection was performed. The resected mass contained brown serous liquid and was found to be a mono cystic space. The immunohistopathological examinations revealed a cystic lymphangioma. Now we can detect this disease by CT or MRI, but we cannot confirm that ; we can confirm that only by pathological examination. We are trying to discover other skills for diagnosis-intratracheal ultrasonography, cytology of the fluid contained in the cyst, immunohistopathological findings. Some cystic lymphangiomas are part of another syndrome and others redevelop after partial resection; therefore we think the best treatment is complete resection of the mass itself.
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  • Hiroshi Iwabuchi, Tetsuo Kamura
    1998 Volume 12 Issue 7 Pages 810-814
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We have experienced a case of bronchiectasis with recurrent respiratory tract infection. A 53-year-old female was admitted to our hospital suffering from frequent fevers and heavy pus sputum. According to her medical history, she had suffered from pneumonia when she was 7 years old and at 14 she had been diagnosed with bronchiectasis. Since that time, she had repeated bouts of pneumonia almost yearly, and the fever associated with these attacks was increasingly severe. Chest X-ray taken on admission showed severe bronchiectasis in left upper lobe and right middle S5 segment. Most notably the left upper lobe was completely destroyed and had become a hotbed for infection. We evaluated this case and found that it was a good indication for left lobectomy. Right lung was not operated on because bronchiectasis was limited only to one segment. Post-operatively, fever was reduced and sputum had decreased, improving the quality of life significantly.
    These findings suggest that it is very effective for the patients with bilateral bronchiectasis to resect the most damaged area of the lung.
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  • Masao Chujo, Takashi Miura, Youzo Kawano, Mitsuyuki Arinaga, Tsuyoshi ...
    1998 Volume 12 Issue 7 Pages 815-820
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A case of primary chest wall desmoid tumor was reported. A 27-year-old male complaining of back tumor was transferred to our hospital. He did not have a history of injury or surgery. CT and MRI showed that the tumor was located between the vertebra and the right scapula from 3rd to 5th thoracic vertebra level. A desmoid tumor was suspected from the specimen of a needle biopsy. Extirpation was performed in the prone position. The trapezius and major rhomboid muscles were intact. The tumor was located in the paravertebral muscles, and was growing cranially and caudally. The tumor was not invasive to the vertebra or the ribs. It was resected widely as far as possible, was 80×55×30 mm in size and 140 g in weight. Histopathological examination revealed a desmoid tumor. Adjuvant radiation therapy with a total dose of 44 Gy was administered to prevent local recurrence. No signs of recurrence have been found for 1 year and 6 months after the operation. Primary chest wall desmoid tumor is a rare entity and only 27 cases have been reported in Japan.
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  • Yasuhisa Okamoto, Toshinori Ohara
    1998 Volume 12 Issue 7 Pages 821-825
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 70-year-old man was admitted to our hospital for an abnormal shadow on chest X-ray film. Chest CT scan showed a mass shadow sized 1.5×1.2 cm at the periphery of the left S1+2. Bronchoscopic examination revealed a yellowish white pulpwood tumor which protruded from the orifice of the left upper segment bronchus. However, because no definitive histological diagnosis was obtained preoperatively, left upper lobectomy was performed. On histological examination, the tumor covered by normal bronchial epithelium was composed of adipose tissue, cartilage and fibrous tissue, which was considered endobronchial hamartoma. The peripheral lung tumor at S1+2 was diagnosed as moderately differentiated adenocarcinoma.
    This is the third reported case of endobronchial hamartoma associated with lung cancer.
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  • Shuhei Inoue, Shozo Fujino, Noriaki Tezuka, Keiichi Kontani, Takaaki K ...
    1998 Volume 12 Issue 7 Pages 826-831
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Seventeen cases of surgically excised pulmonary hamartomas during a 17-year period (1981-1997) were reviewed. Patient ages varied from thirty-eight to 69 years with an average of 52.8 years. Of seventeen cases, 12 patients were male and 5 patients were female. The size of the tumors varied in diameter between 0.7 cm and 15 cm (mean 2.49±3.31cm). Ten cases had a mass on right lung and 7 cases on the left lung, and all cases had a solitary mass. While fourteen cases were asymptomatic, one case had chest pain, and the other cases had a history of cough. Thoracotomy was carried out ; in all 7 enucleations, 7 wedge resections, and 3 lobectomies were performed. Histopathologically, fifteen cases were chondromatous hamartoma, and 2 cases were non-chondromatous hamartoma. Preoperative diagnosis was obtained by lung biopsy in only one case. Pulmonary hamartoma is a benign tumor, and the majority of cases are asymptomatic and slow growing. But the assessment of patients with hamartoma and carcinoma may be difficult, because the hamartoma can easily be mistaken for a metastasis and/or primary lung cancer. On cases with presumed pulmonary hamartoma, less invasive thoracoscopic surgery seemed valuable for both therapeutic and diagnostic purpose to avoid continuous non-rational treatment and mental stress of the patient due to the necessity for prolonged follow up with unconfirmed diagnosis since complete differentiation from malignant neoplasm was not satisfactory in many cases.
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  • Hisashi Ishikura, Kiyoshi Yoshizawa, Junji Morita, Kazumasa Miura, Yuu ...
    1998 Volume 12 Issue 7 Pages 832-836
    Published: November 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 35-year-old woman complained of left chest pain, and her chest X-ray and precontrast CT scan demonstrated a cystic and solid lesion of the left cost-phrenic angle. The lesion was removed under thoracoscopic assisted surgery. It was histologically diagnosed as a pulmonary fibro-leiomyomatous hamartoma (PFLH) because of increased number of leiomyomatous cells and bronchiolar structure. She did not have a uterine leiomyoma. PFLH cannot be histologically distinguished from metastasizing leiomyoma, so we suppose that it is essential to follow the clinical course and to search for other leiomyomas.
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