The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 13 , Issue 6
Showing 1-19 articles out of 19 articles from the selected issue
  • Toshiki Tanaka, Yoshikazu Kaneda, Masataro Hayashi, Takahisa Matsuoka, ...
    1999 Volume 13 Issue 6 Pages 713-717
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Between 1969 and 1997 we treated a total of 31 patients with myasthenia gravis employing radical surgery and were able to follow-up 27 patients. To define the clinical characteristics of patients in whom surgical treatment proved ineffective, we analyzed the factors that exerted a great influence on the surgical results. The incidence of patients whose disease remained unchanged or worsened during the follow-up period (ineffective group) was 25.9%, with a higher incidence in patients who had had the disease for a prolonged period (p = 0.022). However, there were no significant relationships between the surgical results and Osserman classification, sex, age at operation, associated thymoma, operative procedure and follow-up period. There results led us to conclude that surgical treatment should be performed as early as possible to achieve optimal results. Although surgical procedures such as simple or extended thymectomy were not considered to have influenced the follow-up results, long-term follow-up is necessary because thymectomy exhibits a tendency toward delayed remission.
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  • Takamitsu Maehara, Naoki Ishiwa, Makoto Ishibashi, Yasufumi Hayasi, Ta ...
    1999 Volume 13 Issue 6 Pages 718-724
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A retrospective analysis of the clinical features, operative procedures, postoperative complications and subsequent survival of 79 elderly patients (75 years old or over) undergoing surgery for lung cancer compared with 367 younger patients treated during the same period was performed.
    The elderly group were more likely to have male patients, squamous cell carcinoma, preexisting disease, and post operative complication.
    There was a statistically significant difference in the 5-year survival rate among the two groups (39.5% in the elderly group and 57.9% in the younger group), but no difference in the recurrence rate among two groups. We thought these results were influenced by some unrelated diseases. In the treatment of elderly lung cancer patients, we emphasize the importance of careful management in the perioperative period and thought that it was necessary to consider minimally invasive surgery or limited operation in selected cases.
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  • Maki Kubota, Noriaki Tsubota, Masahiro Yoshimura, Yoshifumi Miyamoto
    1999 Volume 13 Issue 6 Pages 725-729
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Fourteen patients treated with induction therapy consisting of CDDP (80 mg/m2) and VDS (3 mg/m2) or VP-16 (80 mg/m2) underwent pulmonary resection accompanied by bronchoplasty. One patient received 3 cycles, eight 2 cycles and five 1 cycle of the menu. Irradiation (average dose 43 Gy) was added in 11 of the 14 patients. Deep wedge resection of the bronchus was carried out in 8 and sleeve resection in 6 patients. Substernal fat pad was used for reinforcement at the site of the anastomosis in 8 patients. No significant complications concerning the bronchoplasty was observed. The menu we applied had no serious affect on the healing of the anastomosis. These result showed that bronchoplasty after chemo- or chemoradio therapy for advanced lung cancer remained an effective and safe lung saving surgery.
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  • Kazuhiro Sakamoto, Ken Ide
    1999 Volume 13 Issue 6 Pages 730-735
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We studied pulmonary tumors accompanied by spontaneous pneumothorax.
    From January 1995 to November 1998, we experienced 62 cases of spontaneous pneumothorax. There were 59 men and 3 women, aged 15 to 83 years old with an average age of 33.3 years. Twelve patients were 40 years old or more. Six pulmonary tumors were detected in 5 patients by preoperative chest CT scan. All of the 5 patients were male and their ages were 42, 53, 54, 58 and 70 years. Three of them had emphysema. The diameters of the tumors were 4 mm in two cases, 5 mm in two, 10 mm in one and 15 mm in one. No tumor could be detected by plain chest roentgenograms. We could not obtain the histological diagnosis of the tumors before the operations. The final diagnoses of the resected tumors were as follows : well differentiated squamous cell carcinoma in one case, bronchioloalveolar cell carcinoma in one, organizing pneumonia in one, intrapulmonary lymph node in one and a combined histology of intrapulmonary lymph node and focal fibrosis in the last case. Of the two cases of lung cancer, an additional lobectomy with lymph node dissection (R2a) was performed in one case. We performed only partial resection of the lung in the other case, because of severe emphysema. The pneumothorax in these cases was not related to the tumors, because all of the 6 tumors were located apart from the visceral pleura.
    In conclusion, we should keep in mind the possibility of associated lung diseases, especially malignant ones in elderly patients with pneumothorax.
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  • Asaoka Mineo
    1999 Volume 13 Issue 6 Pages 736-739
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    I retrospectively evaluated 82 patients with spontaneous pneumothorax detected between 1996 and 1998. The surgically and conservatively treated groups were compared with respect to hospital duration and costs. The overall recurrence rate was about 40%. Since about 60% of patients with a first episode of spontaneous pneumothorax do not require re-hospitalization, surgery without exception clearly represented excessive treatment. Unnecessary surgery causes physical and economic problems for both the patients and the national health care system.
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  • Takahiro Kinoshita, Yasuhiko Ohta, Yasumitsu Hirano, Syunichi Watanabe ...
    1999 Volume 13 Issue 6 Pages 740-743
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 56-year-woman was admitted to the hospital with an abnormal shadow in the left lower lung field on chest X-ray film. The findings on chest CT examination suggested a pulmonary arteriovenous fistula. Left pulmonary arteriogram showed a large fistula (60 mm) with feeding vessels of 8 mm in diameter in the left lower lobe. It seemed to be impossible to perform embolization because of the size of fistula and its feeding vessels. Right pulmonary arteriogram at the same time revealed a small fistula of 10 mm in diameter in the right lower lobe, which was treated by embolization. The fistula of the left lung was resected on thoracotomy.
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  • focusing on postoperative reccurrence
    Shinsuke Hisa, Mitsutoshi Shiba, Tomohisa Yasukawa, Naritoshi Yoshida, ...
    1999 Volume 13 Issue 6 Pages 744-748
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Although Video Assisted Thoracoscopic Surgery (VATS) has been the first choice surgical procedure for spontaneous pneumothorax, a relatively higher incidence of postoperative recurrence has been reported with it. The incidence of postoperative recurrence of spontaneous pneumothorax by VATS in our institute was 10 percent (3 cases in 30 cases), a higher recurrence rate as compared to previous open chest surgery.
    According to the operative finding of recurrent two cases after VATS, new small blebs could be observed along previous auto-sutured line, and these blebs were thought to be new ones after the first thoracoscopic surgery. It was suggested that newly formed blebs along previous auto-sutured line may be a major cause for 33 the high incidence of recurrence of pneumothorax after VATS.
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  • Katsutoshi Adachi, Motoshi Takao, Takuya Komada, Toshiya Tokui, Takats ...
    1999 Volume 13 Issue 6 Pages 749-753
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Here we report a case of extralobar pulmonary sequestration resected by video-assisted thoracic surgery.
    A 48-year-old woman was admitted to our hospital with an abnormal shadow in the right hilum on chest X-ray film. Chest CT and MRI demonstrated a mass lesion in the right posterior mediastinum. An operation by VATS was performed on January 24th, 1996. The mass existed between the right posterior mediastinum and right upper lobe with a tiny stalk connected closely to the hemi-azygos vein. The stalk did not contain major branches of the pulmonary artery, pulmonary vein, or bronchial artery. The resected mass was clinico-pathologically diagnosed as extralobar-pulmonary sequestration, which was consisted of the pseudoglandular period's tissue and normal mature pulmonary tissue.
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  • Masahiro Kase, Kazuhiro Sakamoto, Izumi Tomiyama
    1999 Volume 13 Issue 6 Pages 754-757
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We reported a case of right postoperative diaphragmatic hernia repaired under video-assisted thoracic surgery. The patient was a 50-year-old woman who was treated for catamenial pneumothorax two years earlier. At initial operation 2 small dark brown spots were found on the right diaphragm, which were coagulated by thoracoscopy. Although there has been no recurrence of pneumothorax, diaphragmatic hernia was found on her follow-up chest X-ray, At rethoracoscopic surgery, we confirmed that the herniated organ was a part of the liver, and repaired the defect of the diaphragm by a direct suture. The defect was about 30 mm in diameter. We suspected that the site of the hernia was a previously coagulated portion of the diaphragm.
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  • Hiroshi Yoshino, Susumu Amaya, Yasuhiro Matsunaga, Hiroshi Saito
    1999 Volume 13 Issue 6 Pages 758-761
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 55-year-old male who had been treated medically for right bronchiectasis since twenty years ago was admitted to our hospital. He complained of severe productive cough and dyspnea. Because the bronchiectatic lesion was extended through the right lung, we performed right pneumonectomy to remove the inflammatory lesion completely. After operation the complaints were significantly improved.
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  • Yoshihisa Kadota, Meinoshin Okumura, Hyung Eng Yoon, Masato Minami, Sh ...
    1999 Volume 13 Issue 6 Pages 762-766
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Osteosarcomas commonly originate in the extremities. We report a rare case of primary osteosarcoma of the rib. A 28-year-old male patient with a right anterior chest wall mass and pain was referred to our hospital. The tumor was hard, 7 × 8 cm in size and fixed on the 3rd to 5th rib. Radiological examination revealed the inhomogeneous tumor in the chest wall, which infiltrated the surrounding tissues and destroyed the ribs. The tumor was completely resected with a sufficient surgical margin. The tumor was histologically diagnosed as osteosarcoma. Adjuvant chemotherapy (CDDP + ADM, IFM, HD-MTX) was performed. The patient is alive without recurrence 3 years after the operation.
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  • Motoharu Tsuda, Shigeki Sugiyama, Hiroiku Hara, Yuuichi Hashimoto, Yos ...
    1999 Volume 13 Issue 6 Pages 767-769
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Case 1 was a 19-year-old man with steering wheel injury of the sternum complicated by pseudoarthrosis. After trimming of the pseudoarthrosis part, internal fixation with wire and plate and bone transplantation were done. Case 2 was a 67-year-old woman with spontaneous open fracture of the sternum with diabetes mellitus. Sternum was resected partially and reconstructed with Marlex-mesh and myocutaneous flap. Postoperative course was uneventful in both cases. Most of the sternal fracture is successfully treated by nonsurgical reduction and immobilization. In cases requiring surgery, the most suitable operative procedure should be applied.
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  • J. Koizumi, T. Koyanagi, T. Sakurada, Y. Kikuchi, K. Kusajima
    1999 Volume 13 Issue 6 Pages 770-773
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We report a rare case of primary mediastinal liposarcoma. A 77-year-old woman, who had undergone removal of a posterior mediastinal lipoma 6 years previously, was referred to our department for non-productive cough and abnormality in her chest roentgenogram.
    Computed tomography revealed bilateral posterior mediastinal tumors which were homogeneous and showed low attenuation.
    Two-stage tumor resection was carried out. Pathological study showed that the tumor was a primary mediastinal liposarcoma, Neither radiation therapy non chemotherapy was carried out. Surgical wide en bloc excision is the treatment of choice, and careful longterm follow up is needed.
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  • Satoshi Yodonawa, Makoto Tomoyasu, Tatsuo Yamamoto, Shigemi Ishikawa, ...
    1999 Volume 13 Issue 6 Pages 774-778
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 72-year-old woman was admitted to our hospital with an abnormal shadow on chest X-ray film. She sustained chest injury one year before. Chest CT revealed a tumor located at right lateral chest wall. Pathological diagnosis of needle biopsy was malignant fibrous histiocytoma (MFH), so we widely resected the whole chest wall with the tumor and four ribs (from 3rd to 6th). The defect of the chest wall was reconstructed with lattice threads. The tumor, 12 × 6 × 5 cm in size, was composed of atypical spindle and round cells, and the pathological diagnosis was storiform-pleomorphic type MFH. Postoperative chemotherapy (cisplatin and ifosphamide) was administered. MFH of the chest wall has been reported in only 21 cases in the Japanese literature.
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  • Masaharu Inagaki, Shingo Usui, Hiroo Okazaki, Naoya Funakoshi
    1999 Volume 13 Issue 6 Pages 779-783
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 28-year-old female who twice experienced operation for pelvic endometriosis was admitted to our hospital because of right pneumothorax. Thoracoscopy revealed multiple hollow abnormal regions in the central tendon of the diaphragm. Partial resection of the diaphragm was performed under VATS. Microscopic findings of the resected diaphragm showed small perforation, hemorrhage, and endometrial stroma. Pneumothorax recurred several times, because the patient refused hormone therapy. Second thoracoscopic operation confirmed the diagnosis of catamenial pneumothorax. The patient has been asymptomatic for 10 months after the second operation under hormone therapy.
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  • Kiyoshi Hiramatsu, Ken Nakagawa, Sakae Okumura, Sigehiro Tsuchiya, Kei ...
    1999 Volume 13 Issue 6 Pages 784-788
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Here we report a resectable case of lung metastasis from reconstructed gastric tube cancer after radical operation for esophageal cancer. A 63-year-old man underwent esophagectomy with reconstruction with a gastric tube through the antesternal route for a thoracic esophageal cancer in 1988. On follow up in our hospital serum CEA levels were as high as 18.4 ng/ml with no complaint in 1995. Endoscopic examination revealed Borrman type 1 cancer in the lower part of the gastric tube. Partial resection of the gastric tube and D2 lymph node dissection were performed. Serum CEA level decreased to within normal limits after the operation. In 1998 chest CT revealed a round mass shadow 5 × 5 mm in size in upper lobe S1a of the right lung with serum CEA level elevating again to as high as 16.6 ng/ml. Three months later chest CT was performed again and showed a mass shadow growing to 12 × 10 mm in size with parallel elevation of serum CEA level. We diagnosed lung metastasis of the reconstructed gastric tube cancer. Partial resection of the right lung was performed in 1998. Resected specimen was histologically diagnosed as well differentiated tubular adenocarcinoma compatible with a lung metastasis of the gastric tube cancer.
    In the Japanese and English literature this is the first case report of resection of lung metastasis from gastric tube cancer.
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  • Susumu Sasano, Hiroshi Yamamoto, Tokuro Otsuka, Yoshio Imura
    1999 Volume 13 Issue 6 Pages 789-794
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 23-year-old male who complained of hemosputum consulted another hospital five years ago. Chest X-ray revealed infiltration in the right lower lung field. He was diagnosed with bronchiectasis, with his past history of sinusitis also taken into account. He had a cough and sputum at rising during the past three years with a fever of 37 to 39t approximately once every two months. Recently, he underwent a medical check-up to get a job, and chest X-ray revealed an abnormal shadow in the right lower lung field. He was referred to our hospital for close examination. With chest X-ray and chest CT scan, intralobar pulmonary sequestration of the right lower lobe was suspected, so bronchoscopy and angiography were performed. The diagnosis was intralobar pulmonary sequestration with an aberrant artery from the celiac artery. We performed ligation of the aberrant artery and right lower lobectomy. Although intralobar pulmonary sequestration has increasingly been reported recently, there have been rare cases with aberrant artery from the celiac artery, as reported in this paper.
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  • Toshiya Bessho, Shoji Oura, Hirokazu Tanino, Tatsuya Yoshimasu, Junji ...
    1999 Volume 13 Issue 6 Pages 795-800
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Large cell neuroendocrine carcinoma (LCNEC) has a poor prognosis and the optimal therapy remains to be defined because of its rarity. We experienced a case of LCNEC with effective induction concurrent chemoradiotherapy (CCRT). A patient was a 49-year-old man who was admitted with cough. Chest X-ray and CT showed 11 × 6 cm mass in the lt-hilum. The serum levels of AFP (1, 314 ng/ml), CEA (35.7 ng/ml) and NSE (13.1 ng/ml) were high. LCNEC was diagnosed by open chest biopsy. Two cycles of chemotherapy (CDDP +Vp-16 : CVp) were not effective and the tumor rather enlarged. Sc CCRT (thoracic radiation of 40 Gy, 2 cycles of CVp) was performed. The tumor was decreased (clinical effect ; partial response) and the serum level of AFP was down to 148.4 ng/ml, Operation was done after CCRT. The tumor was located in the It-hilum and widely invaded to the pericardium. Left total pneumonectomy, resection of the invaded pericardium and dissection of mediastinal lymph nodes were performed (complete resection). Pathological stage was IIB (T3 (pericardium) N0M0). There are no findings of tumor recurrence 12 month after operation.
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  • Souu Ri, Takeshi Okayasu, Tomohiro Minagawa, Masako Kaneda, Tatuya Abe ...
    1999 Volume 13 Issue 6 Pages 801-806
    Published: September 15, 1999
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 62-year-old man on hemodialysis three times per week for chronic renal failure for one year was pointed out an abnormal shadow on the left upper lung field at routine chest X-ray examination. Bronchoscopic biopsy on admission revealed evidence of squamous cell carcinoma which arose from the orifice of the bronchus of the left upper lobe infiltrating into the lower bronchus. Since the patient's general condition had been well controlled on hemodialysis, left pneumonectomy and mediastinal lymphadenectomy were performed after pre-operative hemodialysis for three consecutive days. Post-operative hemodialysis was initiated on the first day after operation for two consecutive days and then maintained three times per week.
    Post-operative complications including hyperkalemia were successfully controlled by using glucose-insulin therapy. He was discharged 18 days after operation and has been observed on an outpatient basis.
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