The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 14 , Issue 5
Showing 1-16 articles out of 16 articles from the selected issue
  • lobulation occurs: an anatomical study
    Tohru Mawatari, Tokuo Koshino, Kiyofumi Morishita, Atsushi Watanabe, Y ...
    2000 Volume 14 Issue 5 Pages 591-601
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We dissected in detail the intrapulmonary bronchi and vessels of 62 human lung specimens with aberrant lobulation, especially those showing the right posterior pulmonary lobe (PPL, 25 specimens) or left upper anterior fissure (LUAF, 22 specimens).
    The LUAF-type aberrant fissure corresponded to the border between S3 and S4 in 59.1% of the entire 22 specimens. In other words, this aberrant lobe comprised either the entire lingual lobe or a smaller area. The upper division bronchus, B1+2+ B3, was longer than that in the control group, and A4 and A5 frequently formed a single trunk originating at the interlobar surface. Therefore, segmentectomy along this aberrant fissure, if conducted, would appear to be easier than usual. However, the aberrant lobe was not drained by a single vein, but often by two veins. Moreover, one of these drainage veins did not usually enter the superior pulmonary vein, but merged with the inferior vein. Thus, very careful treatment of veins might be necessary in spite of the favorable situation described above.
    The right PPL-type aberrant fissure corresponded to the border between S6 and other inferior segments in 92.0% of the entire 25 specimens. In the other cases, a fissure divided S8. Usually, B7 was not independent but formed a common trunk with B* or B8. V6 did not comprise a single vein but two veins, this situation being more frequent than in the control group.rNotably, in combination with the right PPL, abnormal communicating vessels (2-4mm in diameter), which have never been reported in normal specimens, were sometimes (36% of the right PPL specimens) observed running between A6 (or V6) and A2 (or V2), and A3, as well as between the former and other inferior segmental vessels. Accordingly, lobectomy or segmentectomy involving the PPL would seem to require thorough observation of the related vessels during surgery at both the interlobar and mediastinal surfaces. Thus, the aberrant pulmonary fissure, if evident, may be a good landmark for separation during surgery, although there is an associated pitfall.
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  • Yasushi Shintani, Katsuhiro Nakagawa, Kiyohiro Fujiwara, Masayoshi Ino ...
    2000 Volume 14 Issue 5 Pages 602-607
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    The efficacy of video thoracoscopic lung biopsy (VTLB) and open lung biopsy (OLB) were compared in patients with diffuse lung disease. The efficacy of surgical thoracoscopic lung biopsy and of transbronchial lung biopsy (TBLB) were compared too.
    17 patients undergoing VTLB were compared with 15 patients undergoing OLB . There were no significant differences in the number of biopsies, the size of tissue per biopsy, the sites of biopsy, or the diagnostic accuracy between the two methods . The patients undergoing VTLB had significantly shorter operative times and less blood loss. Complications occurred in 2/17 VTLB patients and 3/15 OLB patients.
    On the other hand, the rate of diagnosis of TBLB was low compared with VTLB or OLB .
    We conclude that VTLB should be considered as the final diagnostic step when the diagnosis is unclear despite through TBLB.
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  • Takumi Ichihashi, Shigeho Iida
    2000 Volume 14 Issue 5 Pages 608-611
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 59-year-old man was admitted with fractures of left 2nd through 12th ribs, clavicle, scapula and right 11th rib caused by blunt chest wall trauma. Concavity of left lateral chest wall without paradoxical movement was observed. His CT films revealed left mild hemopneumothorax and severe deformity of left-sided thorax. The distance between the interlobar pulmonary artery and one fractured rib was only about 1 cm. Tracheal intubation and positive pressure ventilation could not change the deformity of the chest. So we performed operation through a left posterolateral skin incision. Using the muscle-sparing technique the rib cage was exposed widely without division of the latissimus dorsi and serratus anterior muscles. Through minimum intercostal thoracotomy spaces an intestinal spatula was inserted into his thoracic space to protect the lung from damage by drilling of ribs. The fractured ribs (left 3 rd through 8th) were fixed with ten A-O plates and nails. After the treatment, his thoracic figure became nearly normal. Tracheotomy, controlled ventilation for about 2 weeks and intravenous hyperalimentation resulted in an uneventful postoperative course. He was discharged about 6 weeks after surgery. Now he has good pulmonary function without wound pain and displacement of the plates and the nails.
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  • Morio Ohta, Kiyoshi Ishikawa, Masayuki Kuniyoshi, Tsutomu Kawabata, Ke ...
    2000 Volume 14 Issue 5 Pages 612-617
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    An 18-year-old boy was admitted to our hospital with anterior chest pain. Chest X-ray and CT scan showed a huge mass on the anterior mediastinum. Laboratory examination revealed high levels of serum human chorionic gonadotropin (HCG). The diagnosis of primary anterior mediastinal germ cell tumor was made by preoperative percutaneous needle biopsy. Preoperative two courses of cisplatin-based combination chemotherapy were administered. The serum HCG level decreased rapidly to a normal level and tumor size was extremely reduced. Combined resection of the tumor and adjacent pulmonary and pericardial tissue was carried out through a median sternotomy. One course of the combination chemotherapy was added postoperatively. Seven years after the surgery, he has no signs of recurrence.
    In conclusion, preoperative cisplatin-based combination chemotherapy is effective, and aggressive surgical procedure is indicated for the treatment of mediastinal germ cell tumor.
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  • Kazutosi Kotani, Yoshiki Umemori, Shigeki Makihara
    2000 Volume 14 Issue 5 Pages 618-621
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Chondrosarcoma of rib origin is rare. A 71-year-old man came to our hospital with a mass in the right chest wall. We performed a wide resection of the chest wall. The defect of the chest wall was repaired with Prolene mesh. The histological examination revealed chondrosarcoma. The therapy to be selected first for chondrosarcoma is wide resection, because no efficacy can be expected of chemotherapy or radiation therapy for this tumor .
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  • Tatsuya Yoshimasu, Shoji Oura, Shinji Maebeya, Munehiro Nishida, Teruh ...
    2000 Volume 14 Issue 5 Pages 622-626
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Angiomyolipoma in the mediastinum is rare. A 74-year-old female was referred to our hospital because of an abnormal shadow in her right upper lung field on chest X-ray. Computed tomography and magnetic resonance imaging revealed a homogeneous mass beside the vertebral bone. The tumor was surgically extirpated. It was entirely encapsulated and measured 3.3×2.0×1.0cm. Microscopic examination revealed an angiomyolipoma without malignancy.
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  • Yasuyuki Shibata, Hiroshi Niwa, Takeshi Yamada, Hisanori Kani, Katsuto ...
    2000 Volume 14 Issue 5 Pages 627-630
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Granular cell tumor may be found in any organ such as the skin, esophagus and so on. We report a resected tumor originating in the chest wall . A 68-year-old woman consulted our center for abnormal shadow on chest X-ray. Tumor arising from the 3rd intercostal nerve was detected. Tumor was resected with a part of upper lobe of left lung and the 3rd and 4th rib . Pathologically, the tumor was diagnosed as granular cell tumor, that had not invaded the lung and rib.
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  • Hiroyuki Suzuki, Mika Hoshino, Seigo Kashimura, Takashi Kimura, Mitsun ...
    2000 Volume 14 Issue 5 Pages 631-636
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    An unusual case of pulmonary alveolar soft part sarcoma is reported . A 19-year-old woman was admitted because of an abnormality in the chest X-ray, with no respiratory symptoms. The chest X-ray showed a small mass lesion in the left middle lung field . The chest CT showed a circular nodular lesion of 1 cm in size in the left upper lobe . The nodule was resected under thoracoscopic surgery and was diagnosed as alveolar soft part sarcoma . Although the tumor seemed a metastatic lesion, any other primary site was detected . It is unknown whether the tumor was primary or metastatic.
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  • Masahiro Kase, Kazuhiro Sakamoto, Tatusi Yamagata, Eiji Kurata
    2000 Volume 14 Issue 5 Pages 637-644
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We reported two cases of racemose hemangioma of the bronchial artery. Case 1 was a 59-year-old man with liver cirrhosis, who was admitted with bloody sputum. The chest roentgenogramrevealed a tumor shadow about 40mm in diameter in the right lower lung field. Bronchoscopic examination showed an endobronchial polyp at the right B2. We suspected this polyp was a submucosal tumor, and then we performed transbronchial biopsy. Immediately after the biopsy, massive bleeding occurred with repeated massive bloody discharge in spite of bronchoscopic hemostasis. Then we performed right pneumonectomy including lung cancer of the lower lobe. The second case was a 41-year-old man, who was admitted with hemoptysis. He had expectorated bloody sputum from his childhood. Submucosal dilated vessels were found at the right upper bronchus on bronchoscopic examination. Bronchial arteriography revealed three convoluted bronchial arteries connected to the right pulmonary artery through the right upper bronchus. He underwent right upper lobe lobectomy. Pathological examinations of the two cases demonstrated dilated and convoluted vessels around the bronchus, suggesting racemose hemangioma of the bronchial artery.
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  • Motoki Sakuraba, Masahiro Mae, Tamami Yoshida, Kunihiro Oyama, Takamas ...
    2000 Volume 14 Issue 5 Pages 645-648
    Published: July 15, 2000
    Released: February 23, 2011
    JOURNALS FREE ACCESS
    We report a case was 24-year-old woman with a mediastinal mass shown on chest X-ray film. Chest CT revealed an anterior mediastinal tumor . A percutaneous biopsy was attempted, but no diagnosis was made. We suspected invasive thymoma, and an operation was performed. An extended thymothymectomy, partial resection of the pericardium and a left upper lobectomy were performed. Pathological findings were compatible to nodular sclerosing type Hodgkin's disease. Chemotherapy was performed after the operation and no recurrence appeared. This is a rare case of Hodgkin's disease in a mediastinal malignant lymphoma in Japan. It is important to differentiate of invasive thymomas from malignant lymphomas before operating. We reported a case of a difficult preoperative diagnosis .
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  • Hiroo Shikata, Junichi Matsubara, Shuji Tsuchishima, Masahiko Tsuka
    2000 Volume 14 Issue 5 Pages 649-654
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 12-year-old girl was admitted to our hospital with a huge abnormal shadow in her right chest. Her chief complaints were slight chest pain and a cough. A chest X-ray and Chest MRI showed a huge heterogenous mass that occupied almost all of her right chest cavity and measured 15×15×7.5cm in size, and was made up of soft tissue, fluid, fat, and calcium.
    Although we strongly suspected a mature teratoma, the origin was unknown. Because the serum CA19-9 level was extremely high at 3, 405 U/ml, normal: <37 U/ml, we could not completely reject the possibility of a malignant neoplasm in the mass. Therefore we decided to treat her surgically. The mass was too huge to be removed by a median sternotomy incision, so we added a submammary incision. The weight of the removed mass was 1700 g. Pathological findings revealed the mass to be as a mature teratoma without any malignant neoplasm. The extremely high serum CA19-9 level gradually decreased to almost normal levels after the operation. Her postoperative course passed without difficulty and she was able to leave our hospital one month after the operation.
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  • Osamu Kobayashi
    2000 Volume 14 Issue 5 Pages 655-659
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A rare case of intrapulmonary bronchogenic cyst is reported. A 47-year-old man was referred to our institution for an abnormal shadow on chest roentogenogram. It showed an elliptic mass in the right lower lung field. CT scan and MRI examination revealed a cystic tumor in the right lower lobe of lung. His serum CA19-9 level was 163.9 U/ml (normal≤37). The patient underwent surgical exploration. Operative findings showed a cystic mass lying in abnormal accessory fissures of the lower lobe. Partial resection of the lower lobe was performed. Histopathological examination showed a bronchogenic cyst. CA19-9 in the cyst fluid was elevated as 299, 300 U/ml. The serum CA19-9 level returned to normal after operation. Five cases, including this case, of bronchogenic cysts with high serum level of CA19-9 have been reported . The cause of its rise is not so clear.
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  • Takashi Muramatsu, Kazumitsu Ohmori, Kazuo Kitamura, Yoshio Namiki, Fu ...
    2000 Volume 14 Issue 5 Pages 660-665
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report on two cases of cardiogenic shock due to massive pulmonary thromboembolism after lung resection for bronchial carcinoma.
    In the first case, a left upper lobectomy was performed on a 55-year-old female for a primary lung adenocarcinoma. On the second postoperative day, she suddenly developed syncope followed by dyspnea and circulatory arrest. In the early period of this episode, the patient's chest X-ray, lab. findings, ECG, and clinical condition were not diagnostic of an acute pulmonary thromboembolism. However on the 5th postoperative day, acute pulmonary thromboem bolism was confirmed by pulmonary perfusion scintigraphy. Thrombolytic therapy was begun immediately. A 240, 000 IU bolus of urokinase was administered through a central line, followed by a further 480, 000 IU IV infusion over 5 hours. Rapid hemodynamic and clinical improvement followed the bolus dose and continued after treatment.
    In the 2nd case, a right peumonectomy was performed on a 57-year-old male for a primary squamous cell carcinoma. On the 3rd postoperative day, he suddenly developed syncope followed by dyspnea and circulatory arrest. In spite of one half hour of aggressive CPR and thrombolytic therapy, cardiac function did not recover. At autopsy massive pulmonary thromboembolism and pulmonary infarction were identified in the left main artery and the peripheral left lung area.
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  • Hirohiko Shinohara, Yasushi Yamato, Masanori Tsuchida, Takehiro Watana ...
    2000 Volume 14 Issue 5 Pages 666-671
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report a case of multiple tuberculous tracheal stenosis improved by step by step treatment.
    A 33-year-old female complaining of increasing dyspnea was admitted to our hospital. Multiple tracheal stenosis due to tuberculosis was observed. A veno-venous ECMO was first established under local anesthesia. A tracheostomy was then performed under the ECMO followed by a bougie with a intubation cannule. Laser ablation was performed to release the stenosis of oral side.
    After the operation, stenosis of the right main bronchus was dilated gradually using an angioplastic balloon under a broncho-scope. The patient has been doing well with a T-tube through the tracheostomy. Although it is difficult to treat long segment tracheo-bronchial stenosis, we believe that treatment can be performed safely under appropriate supporting methods, such as using ECMO and multi-staged management.
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  • Teruhisa Sakurai, Shoji Oura, Tatsuya Yoshimasu, Takako Nakamura, Kenj ...
    2000 Volume 14 Issue 5 Pages 672-675
    Published: July 15, 2000
    Released: February 23, 2011
    JOURNALS FREE ACCESS
    We describe a case of apical invading lung cancer responsive to concurrent chemoradiotherapy (CCRT). A 57-year-old man complained of right anterior chest pains due to invasive right apical lung cancer. He received preoperative CCRT (RT: 46 Gy, MVC: mitomycin, vindesine, carboplatin), resulting in a regression from the tumor. Therefore, we performed a right upper lobectomy and lymph node dissection (mediastinal and supraclavicular lesions) along with partial resections of the right brachiocephalic vein and the first rib, which had been invaded by the lung cancer, through standard median sternotomy and a collar incision with partial resection of the right clavicle. A pathological pathological examination revealed that the lesions had no malignant cells (Ef. 3). The patient was doing well without any tumor recurrence 3 months after the operation.
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  • Tohru Hasumi, Katsuhiko Isogami, Kazuhiro Ohkuda
    2000 Volume 14 Issue 5 Pages 676-680
    Published: July 15, 2000
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 27-year-old woman was admitted because of abnormal chest shadows. Chest CT, 3D-CT, and pulmonary angiography revealed mutiple pulmonary arteiovenous fistulas in the right S10, and left S8. Under thoracoscopic procedure, bilateral partial resection of the lung was performed in one session. This technique allows entire removal of the fistula with minimal surgical stress, to include preservation of lung function. Thoracoscopic surgery is an effective treatment for pulmonary arteiovenous fistula, especially when present at the periphery of the lung.
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