The outcome of surgery for lung cancer was assessed in 21 patients aged 80 years or more and compared with that in 807 patients aged under 79 years. No significant differences were observed in the histological types, disease stages, or postoperative survival rates between the two groups. Moreover, there were no significant differences in the survival rates of patients with stage I disease between the two groups, although 50% of the older patients underwent partial resection. Thus, we concluded that aged patients can undergo surgical treatment with a similar operative outcome to younger patients. Furthermore, partial resection with radicality is appropiate for elderly patients with stage I disease.

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Photopolymerized synthetic bioabsorbable hydrogel (Advaseal ^TM) was applied to 10 postoperative patients. Seven among the 10 showed an emphysematous change. We sealed the cut surfaces and stapled lines of the lung using Advaseal ^TM. Fourteen among 15 staple lines and six among 9 cut surfaces of the lung showed complete closure under the air-sealing test. One of 15 staple lines and three of 9 cut surfaces of the lung showed slight air leakage under the test. Five of 10 showed no air leakage from the drain immediately after the operation. The average postoperative duration of air leakage from the drain was 1.5 days. We have observed no biological toxicity during the trial. Advaseal ^TM is an effective sealant against pulmonary air leak in the cut surfaces and stapled lines of the lung.

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We report a case of thymolipoma. An asymptomatic 75-year-old woman was admitted toour hospital because of an abnormal shadow on chest X-ray. Chest CT scan demonstrated ananterior mediastinal mass, most of which was isodense with scattered areas of hypodensity. Ateratoma was suspected, and the right lobe of the thymus was performed. The tumor was 12.0×7.5×2.5cm in size. Histopathologically, it was diagnosed as thymolipoma. Thymolipomausually appears as a homogenous hypodensity mass on CT scan. In our case, the CT scan imagewas atypical, because the tumor contained much more thymic tissue than fat tissue.

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A case of extramedullary hematopoiesis in the bilateral posterior mediastinum is describedherein. The patient was a 58-year-old female diagnosed with jaundice in 1983. She wasadmitted to our department with abnormal shadows on a screening chest x-ray taken in 1998.CT and MRI scans of the chest revealed three well-demarcated solid paravertebral masses inthe bilateral posterior mediastinum. A preoperative blood examination suggested the existenceof hemolytic anemia. Extirpation of all mediastinal masses was performed after a diagnosisof multiple neurogenic tumors was made. The macroscopic appearance of the resectedspecimens was solid, soft and dark red. The histological diagnosis was extramedullaryhematopoiesis. A postoperative examination was performed, and she was diagnosed withhereditary sideroblastic anemia. It is emphasized that extramedullary hematopoiesis should beincluded in the differential diagnosis of posterior mediastinal masses, especially in patients withhemolytic anemia.

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In Japan, pulmonary infection due to Mycobacterium xenopi (M. xenopi) is a quite rarenontuberculous mycobacteriosis. We experienced a case of pulmonary infection due to M.xenopi, which required surgical intervention for diagnosis, because lung cancer could not beruled out on radiological studies.
A 51-year-old asymptomatic man with abnormal shadow on chest x-ray was admitted. Hehad a history of heavy smoking and pulmonary emphysema. Chest CT scan demonstrated amass with multiple small cavities at the apex of his right lung. Cytological and bacteriologicalsputum examination and bronchoscopic studies did not lead to diagnosis. Fluorodeoxyglucosepositron emission tomography (FDG-PET) scan showed marked FDG uptake at the apex of hisright lung, and lung cancer could not be ruled out. Partial resection of the lung including themass was done. Microscopic studies of the specimen revealed caseous granuloma, whichresembled tuberculoma. Postoperatively, the infectious agent was proved to be M. xenopi by DNA-DNA hybridization. He was treated with isoniazid, rifampicin, streptomycin, andethambutol for three months. Six months postoperatively, no recurrence has been demonstrated.

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The levels of CA19-9 and CA125 in blood were elevated in a 60-year-old woman withlumbago and compression fracture of a lumbar vertebra. Causative factor for these tumormarker abnormalities was investigated. Chest CT revealed a mass shadow in left lower lobe.A mass lesion resulting from intralobar sequestration in the left lower lobe was detected inchest CT examination. This lesion was resected with subsegmentectomy maneuver. Twoaberrant arteries branched form thoracic aorta into the sequestrated lung. In the lesion, abnormal bronchial trees run toward the origin of abnormal arteries, such as central toperipheral direction, and had no connection to normal bronchial trees. Immunohistochemically, epithelial cells in the lesion were stained with CA19-9 and CA125. After operation, the levelsof CA19-9 and CA125 in blood rapidly normalized. No malignant cells were detected from alumbar vertebra.

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A 78-year-old woman was referred to our hospital with a right anterior pericardiophrenicabnormal mass which was enlarging gradually. Chest CT, MRI and celiac angiography gavea diagnosis of Morgagni hernia whose content was probably omentum. Video-assisted thoracicsurgery was conducted, but narrow diaphragmatic defect made it difficult to replace theomentum, so that mini-thoracotomy was additionally performed. After replacement of thehernia content and resection of the hernia sac with an endocutter, the diaphragamatic defectwas closed and reinforced with several interrupted sutures. Since video-assisted thoracicsurgery is a less invasive technique, it is useful in the treatment of diaphragamatic hernia.However, as far as Morgagni hernia is concerned, mini-thoracotomy seems necessary becauseof the difficulties in replacing hernia content and repairing the diaphragamatic defect.

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The patient was a 76-year old woman who underwent an operation for gastric cancer 9 yearsago. When she was medically checked up for a polypoid lesion in the sigmoid colon, shecomplained of cough. A chest radiograph showed consolidation in the left lung field. She hadpneumonia, and treated with antibiotics. Because re-examinations after three months showedan enlarged shadow and high values of tumor markers, brushing cytology was performed underbronchoscopy and revealed adenocarcinoma cells. A left upper lobectomy was performed withmediastinal resections. Histological examinations showed a mucinous bronchioloalveolarcarcinoma (BAC) (goblet-cell type). In addition, as this specimen showed histologicalsimilarity with normal gastric pyloric mucosa, histochemical techniques for mucins were usedand revealed that the mucins in these BAC cells had the same quality as normal gastric mucins.These findings suggest that this BAC may functionally differentiate a gastric mucosa as gastricphenotypes.
This case may represent very interesting features in consideration of the oncogenesis and thetreatment strategy of mucus-producing BAC.

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A relatively rare case of cystic teratoma, which was pre-operatively diagnosed as perforating the bronchus by trichoptysis and aeration inside, is reported. A 36-year-old woman was admitted to our hospital with complaints of abnormal shadow on chest X-ray film. Chest CT scan showed an anterior mediastinal cystic mass with aeration inside, and she presentedtrichoptysis on admission. She could be diagnosed with cystic teratoma pre-operatively by these findings.
At surgery, an anterior mediastinal tumor perforating into the left B3 bronchus was revealed, and total resection of the tumor with adherent part of the left upper lobe was performed. The post-operative course was uneventful, and she has no symptoms at present.

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We experienced a case of non-Hodgkin's lymphoma (NHL) which developed from the rightsided chest wall without any history of pleural tuberculosis or chronic pyothorax. An 82-yearold woman was found to have a solitary right-sided chest wall tumor, and percutaneous needle biopsy led to the diagnosis of NHL. The response to chemotherapy was poor, and we performed right-sided chest wall resection and reconstruction to relieve the right chest pain. The tumor was diagnosed as B cell malignant lymphoma of diffuse large cell type. Local recurrence was revealed four months after operation and radiotherapy was performed. The patient is alive now without evidence of recurrence fifteen months after the first chemotherapy started. NHL developing from the chest wall has been reported as pyothorax-associated B cell lymphoma (PAL) and believed to be closely related to Epstein-Barr virus (EBV) infection. Our case is the 4th case in our country reported as a primary NHL developing from the chest wall without preceding pleural disease such as tubeculosis or pyothorax. In the tumor specimen of this case, furthermore, EBV-DNA was negative by PCR method, and EBV-encoded small RNAs (EBERs) was negative by in situ hybridization. These results indicate that EBV infection may not have been related to the tumor development in this case.

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This is a case report of congenital cystic adenomatoid malformation of the lung (CCAM) ininfant with respiratory infection. A female infant, 6 months old, was admitted to hospitalbecause of high fever. Chest X-ray showed infiltrative shadow in the right lower lung field.Chest CT and MRI were performed in our hospital, and showed a mass with multiple cysts inthe right lower lobe. Aberrant arteries were not confirmed by aortography. The patient wasdiagnosed with cystic disease of lung, and right lower lobectomy was performed at 1 year. Theresected lung had multiple small cysts. On histological examination, the cyst wall was lined byciliated columnar epithelium, and bronchial cartilage was absent through out the lesion. So thediagnosis of CCAM was confirmed. Because CCAM has a risk of recurrence, segmentectomyor lobectomy which includes the lesion is recommended in its management.

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A 9 week pulmonary rehabilitation program was successfully administered to a 38-year-old female who had had lymphangiomyomatosis with severe respiratory failure.
The program contained breathing techniques, training for activity of daily living (ADL), cycle ergometer and gait practice, and rehabilitation training of skeletal muscle . The trainingload was increased gradually beginning with low level techniques while monitoring the heartrate and pulse oxymeter. The criteria to terminate exercise were SpO₂ ‹85% and HR› (210-0.65×age×0.75).
At the beginning, she couldn't walk, but after 9 weeks of exercises, her training program reached 5 watts of cycle ergometer for 10 minutes, gait at the speed of 18 meters/minute for 10 to 15 minutes, and muscle training of her extremities.
With this efficient training program, improvement of her ADL and exercise endurance were obtained, and her 6 minute walking distance increased from 27 meters to 141 meters.
She is now waiting for a lung transplantation, but we have noticed that this program requires some re-evaluations and corrections according to the progress of her disease.

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A 70-year-old man was admitted to our hospital for further examination of a mass shadow in the left upper lung field noted on chest X-ray film. We diagnosed it as a primary squamous cell carcinoma of the lung by transbronchial lung biopsy, and then a surgical procedure was performed. At thoracotomy, the right ventricle, the left atrial appendage, and the root of the pulmonary artery and vein were recognized through a complete pericardial defect. The operation was finished without compensating for the defect because the residual lung did not adhere to the thoracic wall or was fully re-expanded enough to support the heart. Chest X-ray films after operation showed that the heart had shifted farther toward the left side compared with that before operation. Seven years after the operation, the patient is still alive without any sign of recurrence.

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A 59-year-old male with idiopathic thrombocytopenic purpura was hospitalized due to an abnormal chest X-ray film. Chest CT scan revealed a mass in the right upper lobe (S¹) and suggested lung cancer. Peri-operative high-dose intravenous gamma-globulin therapy (400mg/kg/day for five days) and platelet transfusion allowed the operation, resection of the upper lobe of the right lung and removal of regional lymphnodes, to be performed successfully. Peri-operative high-dose intravenous gamma-globulin therapy is thought to be a very useful method for preventing hemorrhagic tendency after the operation.

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In two cases with severe dyspnea, chest CT revealed emphysematous giant bulla occupying half or more of the hemithorax. We performed the intracavitary suction for the purpose of expansion of compressed normal lung and decompression for giant bulla. Intracavitary suction provided significant clinical improvement in each case. Bullectomy by VATS were performed safely under general anesthesia. There were no postoperative complications. Intracavitary suction of emphysematous giant bulla is a safe and effective modality before VATS bullectomy.

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A case of schwannoma originating in the left intrathoracic vagal nerve was reported. The patient presented to our hospital with hoarseness and an abnormal shadow on the chest roentgenogram. Under the diagnosis of benign mediastinal neurogenic tumor, an operation was carried out. The mass was 8×4×2.5 cm in size and originated from the left vagus nerve located proximal to the branch of the recurrence nerve. There was no evidence of invasion of the mass into the surrounding organs and tissues. The histological diagnosis was schwannoma. Subcapsular extirpation was done preserving the nerve fibers. However, postoperative horseness due to dysfunction of the recurrent laryngeal nerve occurred in this case. This is the 8th reported case of subscaplar extirpation for a mediastinal vagal schwannoma located proximal to the branch of the recurrence nerve in the Japanese literature. In 3 of these cases recurrence nerve function was reserved. We considered that subscapular extirpation is an effective procedure to preserve recurrence nerve function.

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We report a case of anterior mediastinal lipoma resected through a minimal thoracotomy under thoracoscopic assistance. A 53-year-old woman without symptoms was admitted for evaluation of an anterior mediastinal tumor on chest roentgenogram.
A routine chest roentgenogram demonstrated an abnormal mass shadow at the right cardiophrenic angle and the mass increased in size after 1 year observation from 4 cm to 5 cm in diameter. Computed tomogram showed a homogeneous mass of fat density on the right diaphragm and adjoining the heart and the right anterior chest wall. Magnetic resonance image revealed a well-demarcated mediastinal tumor with a fat signal intensity on both T1-weighted and T2-weighted images. The first trocar was placed at the eighth intercostal space along the midaxillary line. Thoracoscopic view showed a yellowish and round tumor bordering on pericardium, diaphragm, and anterior chest wall. Minimal thoracotomy was made through the fifth intercostal space with 5 cm skin incision along the lower mammary line. The tumor was soft and encapsulized without invasion to adjacent organs and was resected easily with assisted view of thoracoscope.
The tumor was histologically diagnosed as a mature lipoma. The diagnosis of mediasinal lipoma and its differentiation from malignant lesions is important for treatment and prognosis. Both computed tomogram and magnetic resonance image are useful in differentiating mediastinal lipoma, but they are not accurate in differentiating liposarcomas from benign lipomas. Thoracoscope assisted minimal thoracotomy procedure is less invasive than conventional procedure.

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We designed new clamps for the resection of lung metastases. The tumor grasping clamps have 3 to 4 arcuate claws to grasp metastatic lung tumors 5-15 mm in diameter. The partial resection clamps consist of two arcuate clamps that have a junction pin to connect the head of the clamps and the DeBakey Type edges to grasp the lungs tightly. There are 3 types of partial resection clamps which can hold from 1 cm to 4 cm of lung volume in diameter. We can resect various sizes and depths of lung metastases safely by selecting a suitable size and connecting the two clamps in a suitable angle. We can minimize the resection of normal lung tissue, avoid tumor residues and perioperative bleeding from pulmonary arteries in cases of deep metastases, and save surgical time by using these clamps.

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