The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 15 , Issue 2
Showing 1-16 articles out of 16 articles from the selected issue
  • Mitsuo Kawamura, Yasuhiro Takahashi, Kimito Orino, Yoshirou Sazawa
    2001 Volume 15 Issue 2 Pages 71-77
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    In the Department of Thoracic surgery at our hospital, over 13 year period from 1987 to 1999, 1, 005 patients underwent thoracic surgery for primary lung cancer (n=496) and other respiratory diseases (n=509). Of these, 106 patients (10.5%) received therapy for postoperative complications. The main complications were difficulty expectorating (33), prolonged airleakage (14), atrial fibrillation (13) and postoperative bleeding (11). Eight patients (0.8% of all patients and 1.6% of those with primary lung cancer) died of postoperative complications or lung cancer, five within 30 days and three after 30 days. The operative mortality, including all in-hospital deaths, was 0.8% for lobectomy (3/351) and 11.1% for pneumonectomy (4/36). The causes of deaths within 30 days were acute myocardial infarction, bronchopulmonary arterial fistula, ARDS, cerebral infarction, and suicide due to depression. The causes of hospital deaths after more than 30 days were empyema with bronchopleural fistula after pneumonectomy and disseminated intravascular coagulation due to lung cancer. In conclusion, greater care should be taken in selection of the pneumonectomy patients and in careful postoperative management.
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  • Kazumasa Miura, Junji Morita, Kiyoshi Yoshizawa, Taeko Nagao, Takahiro ...
    2001 Volume 15 Issue 2 Pages 78-81
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Records of eight patients under postpnuemonectomy space control with SF6 for over six years were available for review. We could not find any infectious problems of the control technique or SF6 toxicity. The control method with SF6 in the long term is safe. Its frequency per year decreased more than one year after pneumonectomy. It suggests that the absorption of SF6 has decreased because of thickened parietal pleura. Four of the eight patients underwent operation, chemothrapy, radiation and endoscopic resection. All of them did well. Postpneumonectomy space control with SF6 is effective for maintaining performance status for long periods.
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  • Kazuro Sugi, Hisashi Sakano, Yasushi Sato, Yoshikazu Kaneda, Kensuke E ...
    2001 Volume 15 Issue 2 Pages 82-86
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    The purpose of the study was to determine the accuracy and role of the sentinel node technique in patients with non-small cell lung cancer. This study was carried out on 25 patients with clinical T1N0M0 non-small cell lung cancer, undergoing lung resection. Peritumoral tissue was infiltrated with isosulfan blue dye and the first lymph node to stain was identified as a sentinel node. Eleven patients had sentinel lymph nodes. In 9 of these 11 cases neither the sentinel node nor any other lymph node contained metastatic carcinoma. In 2 cases unexpected N positive disease was documented in the sentinel node. In 14 patients no sentinel node was found. Final lymph node status was N0 in 13 patients, N1 in 1. The use of isosulfan blue dye for intraoperative lymphatic mapping is feasible. The specificity in our experience was good. The accumulation of further experience will determine the role of the sentinel node technique in patients with non-small cell lung cancer.
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  • Fengshi Chen, Akitoshi Tatsumi
    2001 Volume 15 Issue 2 Pages 87-91
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A series of 25 cases of thoracoscopic resection after CT-guided marking, using a hookwire with a string, for pulmonary peripheral tumorous lesions, were subjected to a study on the usefulness and safety of preoperative marking. Mean tumor size was 10.4±4.8mm in maximum diameter. Fourteen cases were smaller than 10 mm. Mean depth from visceral pleura was 5.5±6.7mm. Preoperative marking was useful for localization of lesions in 14 cases of lesions without pleural change. Placement of individual hookwires took 18.6±5.4minutes. Excisional biopsies required 27.8±17.6 minutes. Except for one case with intensive pleural adhesion, thoracoscopic resections were successfully performed. In all cases, definitive diagnosis was obtained intraoperatively by frozen section, which coincided with that provided by permanent pathology. We experienced complications in ten cases: pneumothorax in nine, and transient ischemic attack in one. The preoperative CT-guided marking using a hookwire with a string, which can be done conveniently and promptly, is useful in video-assisted thoracoscopic wedge resection of the lung. Complications such as pneumothorax should be kept in mind, and observations and biopsies under thoracoscopy after marking should be done as soon as possible.
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  • Ryota Tanaka, Ryuta Amemiya, Yuji Asato, Moriyuki Kiyoshima, Daiji Oka ...
    2001 Volume 15 Issue 2 Pages 92-98
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Between November 1991 and December 1999, 20 patients underwent surgical resection for pulmonary metastasis from colorectal cancer in our hospital. This study reviewed 10 of these patients who also underwent resection of hepatic metastases from colorectal cancer. There were 7 men and 3 women whose median age was 61 years. The primary site was the colon in 4 patients and the rectum in 6 patients. The stage of primary colorectal tumor was classified as II in 4 patients, III in 1 patient, IV in 5 patients. Three patients underwent hepatic resection metachronously with the primary colorectal tumor ; 2 patients underwent resection of both hepatic and pulmonary metastases metachronously with the primary lesion ; 4 patients underwent pulmonary resection after synchronous resection of hepatic metastasis and the primary lesion ; and 1 patient underwent hepatic and pulmonary resection for synchronous metastases with the primary lesion. No surgical mortality occurred in these patients. The 3-year and 5 -year survival rates were 66.7% and 22.2% respectively after primary resection. The survival rates were higher for metachronous metastases (n=5) than for synchronous metastases (n=5), although a significant difference was not demonstrated. Surgical resection for metachronous metastases was effective while for synchronous metastases, no evidence of an effect was displayed.
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  • Yukihito Saito, Hideyasu Omiya, Yuzo Shomura, Masahide Tokunou, Ken-ic ...
    2001 Volume 15 Issue 2 Pages 99-103
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Between January 1980 and March 1999, 229 patients were treated for chest trauma. Twenty -three failed to respond to traditional conservative measures and underwent emergency thoracotomy. The indications for thoracotomy were massive hemothorax/profuse air leak not responding to chest tube suction in 23 patients. In each, an extensive pulmonary laceration or injuries of major vessels were found. The pulmonary lacerations were treated by lobectomy/ pneumonectomy in four patients and by suture repair in eighteen. Extensive pulmonary laceration is a significant cause of morbidity and death among patients with blunt chest trauma. Twenty patients survived, while three patients died. Death was caused primarily by extrathoracic trauma in all of the three who died.
    Delayed diagnosis of tracheobronchial disruption resulting from blunt trauma continues to cause major morbidity and death. The initial clinical and rentogenographic findings are similar to those found in the larger group of patients with lesser trauma. However, continued and uncontrollable hemorrhage and massive air leakage characterized this entity. Tracheobronchial disruption should always be cosidered with massive blunt chest trauma. Bronchoscopy is indicated for unexplained pleural air leaks, lobar atelectasis, or persistent pneumothorax.
    Awareness of the condition, a high degree of suspicion in patients who do not respond to conservative measures, and prompt thoracotomy may be life-saving.
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  • Nobumasa Hamaguchi, Noriaki Fujishima, Masafumi Tamaki, Hiroaki Toba
    2001 Volume 15 Issue 2 Pages 104-108
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    The case of a 52-year-old man with multiple endobronchial granular cell tumors in the left main bronchus and trunchus intermedius is reported. The patient underwent chest CT examination because of a productive dry cough, and a mass in the left main bronchus was detected. Bronchoscopic examination revealed bilateral endobronchial tumors, and biopsy confirmed the diagnosis of granular cell tumor. The left main bronchus was almost occluded by a large yellowishwhite mass. The segmental resection of the left main bronchus was performed uneventfully. Histological findings of the resected specimen showed full-thickness wall inva-sion. We considered that surgical resection is recommended if the tumor is comparatively large. Another mass in the membranous portion of the trunchus intermedius was small and approximately 3 mm in diameter. The tumor was removed by punch forceps via fiberoptic bronchoscopy. At present, one year later, there has been no evidence of recurrence. This is the 3rd reported case of multiple granular cell tumors in the Japanese literature.
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  • Wataru Nishio, Takeshi Hatta
    2001 Volume 15 Issue 2 Pages 109-114
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 42-year-old man complained of general fatigue and 5 kg weight loss. A chest X-ray film showed a mass lesion (7 cm in diameter) in the right pulmonary apex, and a chest CT scan and a MRI film suggested chest wall invasion.
    Bronchofiberscopy proved no visible lesion, but brushing cytology from B1 a revealed large cell carcinoma. Radiation and chemotherapy were administered initially, and then an right upper lobectomy with partial resection of the parietal pleura and mediastinal lymphnode dissection was performed. Histological examination showed that almost all tumor cells were necrotic, and a few viable cells were characteristic of large cell carcinoma. Lymphnode involvement was not seen (p-T2N0M0). Six months later, the patient complained of appetite loss. An abdominal CT scan documented swollen left adrenal gland, but no other metastatic lesion was found. A left adrenalectomy was performed through an extra-peritoneal approach. Histologically adrenal tumor and lung carcinomas were resemble, and a definitive diagnosis of pulmonary large cell carcinoma metastasized to left adrenal gland was made. The post operative course was uneventful. More than 4 years after adrenalectomy, the patient is alive without recurrence.
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  • Kenji Hazama, Akinori Akashi, Yoshito Maehata, Kenji Nakamura
    2001 Volume 15 Issue 2 Pages 115-118
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 64-year-old woman was admitted to our hospital due to dyspnea on effort and wheezing. Bronchoscopy revealed an endobroncheal tumor arising from the membranous portion. Because the tumor was located near the vacal cords, laryngotracheal resection was considered to be necessary. Preoperative radiotherapy was performed in order to reduce the size of the tumor and to preserve her voice, but the tracheal stenosis was so severe that laser ablation and placement of Dumon stent were performed before radiotherapy. A percutaneous tracheostomy kit and percutaneous cardiopulmonary support device were prepared during stent placement due to concerns about the trachea becoming completely abstructed. The effect of the radiotherapy was evaluated as partial respone (PR). Tracheal resection and primary anastomosis were performed after the removal of the stent. The patient was discharged from hospital 6 weeks after the operation without major complications. She is alive without recurrence 16 months after the operation.
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  • Yoshitaka Ito, Makoto Oda, Yasuhiko Ota, Tetsuhiko Go, Yoshio Tsunezuk ...
    2001 Volume 15 Issue 2 Pages 119-121
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A case of bilateral recurrent pneumothrax in a patient with Marfan syndrome was reported. A 17-year-old male whose right pneumothorax had recurred twice during the past 3 years was admitted due to left pneumothorax complaining of chest pain and dyspnea. He was tall and thin with long tapered extremities, and echography revealed annulo-aortic ectasia. Air leakage continued inspite of left chest tube drainage followed by surgical treatment. Bullae were resected under VATS, and he was discharged 5 days later. Patients with Marfan syndrome should be observed carefully after operation because they frequently develop recurrent pneumothorax.
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  • Fumihiko Hirai, Nobuko Tsuruta, Masato Kato, Mitsuru Nakagaki
    2001 Volume 15 Issue 2 Pages 122-125
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report a case of paragonimiasis diagnosed and treated by video assisted thoracoscopic surgery (VATS). The patient was 41-year-old man in whom left pleural effusion was revealed by medical examination, without subjective symptoms. A computed tomographic scan of the chest did not reveal any lesion in the lung field. Although he had not eaten any uncooked fresh geothelphusa dehaani or wild boar meat, eosinophilia of the peripheral blood and the pleural effusion suggested paragonimiasis. We performed VATS to observe the pleural cavity and observed an elevated lesion at the posterior wall of the pleural cavity just above the diaphragm. Pathological examination of a resected specimen revealed granulation tissue with marked eosinophilic infiltration, although no organisms (paragonimus) were identified. Dot ELISA (enzyme linked immuno sorbent assay) tests yielded a conclusive diagnosis of paragonimus infection. After surgery, we administered 75 mg/m2 of praziquantel for three days. And in the period since surgery, three months, the patient has not shown any clinical symptoms, and his antibody titer of paragonimus has been decreasing. VATS is considered to be useful in the diagnosis and treatment of Paragonimiasis.
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  • Hisaichi Tanaka, Keiji Iuchi, Akihide Matsumura, Hirofumi Sueki, Hiros ...
    2001 Volume 15 Issue 2 Pages 126-130
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 48-year-old female contracted mycobacterium tuberculosis from 30 years of age and was treated by medication continuously. Her disease was resistant to medication and therefore, she had undergone three-times surgical resections, which were right upper-lobectomy at 32 years, right S6-segmentectomy at 35 years and right midle-lobectomy at 45 years. One year after the last operation, the tuberculosis recurred. Her sputum smear was Gaffky2. Her bacilli indicated multidrug-resistant tuberculosis, which was defined as resistant at least to refampin and isoniazid. She was referred to our hospital for second opinion of the surgical indication. The chest computed tomographic scan revealed two cavities in the residual right lower lobe. Her disease was isolated in the right lung. In 30th, November, 1999, she was subjected to the completion pneumonectomy. Post operative course was uneventful. Her sputum and pleural effusion were negative for tuberculosis. Oneb year after the operation, her disease has not recurred.
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  • Takayuki Tatebayashi, Megumu Kanno, Toshimitu Suzuki, Sumio Nitta
    2001 Volume 15 Issue 2 Pages 131-135
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A case of well differentiated fetal adenocarcinoma in a 27-year-old female is reported. An abnormal mass shadow was pointed out on chest roentgenogram. Six months later, due to an increase in the left upper lobe mass shadow, she was admitted to our hospital. She underwent left upper lobectomy with mediastinal lymph node dissection on December 11, 1999. The operative findings showed that an elastic hard tumor, 26×16mm in size, was localized in S3 and S4 of the left lung. Histopathologically, the case had complex glandular structures resembling fetal lung and morules, but there were no sarcomatous features. The stroma was scant and was composed of benign spindled cells.
    ChromograninA and neuron-specific enolase were present in a few glandular epithelial cells and in morules. Therefore, we diagnosed the tumor as well differentiated fetal adenocarcinoma. There are also some discrepancies in the clinical course and prognosis of the tumor. It is suggested that it is necessary to collect as many cases as possible, to make definite classifications and examine the clinical course and prognosis of pulmonary blastoma.
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  • Toshizumi Shirai, Makoto Yano, Satoru Kawaguchi
    2001 Volume 15 Issue 2 Pages 136-139
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report a surgical resection case of cavernous hemangioma in the thymus.
    A 71-year-old male was referred to our hospital because of abnormal shadow of the left lower lung field on chest X-ray film taken at a physical examination. Chest CT showed no abnormality in the referred lung field but a homogenous tumor in the anterior medistinum just in front of the main pulmonary artery. Plain chest X-ray and CT did not show any spot of calcification. Through a median sternotomy, the tumor was resected with the thymus on Dec. 16, 1998. The tumor was 3 cm in diameter, and histological examination revealed that it was a benign cavernous hemangioma. No capsule was found histologically, but the tumor was localized in the thymus. Therefore, we believe the tumor was resected completely. This case suggests that limited operation is possible if the pre-operative diagnosis is certain. We need more knowledge to make secure preoperative diagnosis of mediastinal hemangioma
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  • Takaaki Ishiyama, Yasushi Yamato, Masanori Tsuchida, Takehiro Watanabe ...
    2001 Volume 15 Issue 2 Pages 140-145
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Most cases of pulmonary aspergilloma are believed to arise from colonization and proliferation of Aspergillus in a preexisting pulmonary cavity (“secondary aspergilloma”). Tuberculosis is by far the most common condition associated with aspergilloma. The most common symptom is hemoptysis, with others including cough, dyspnea, and weight loss. In recent years, some cases of pulmonary aspergilloma are recognized to arise as a direct result of the intrabronchial proliferation of the fungus, with subsequent bronchial dilatation (“primary aspergilloma”). A 19-year-old man was referred to our hospital due to an abnormal shadow in the left lower lung on chest X-ray. Chest X-ray and chest CT scan showed a cavity with a fungus ball, but the patient complained of no symptoms. Surgical resection was performed, and the postoperative course was uneventful. The possibility of primary aspergilloma may be considered in this case.
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  • Shuichi Sasamoto, Shinji Shimatani, Satoshi Hamada, Nobuhide Kato, Kei ...
    2001 Volume 15 Issue 2 Pages 146-150
    Published: March 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A boy aged 2 years and 8 months was admitted to our hospital complaining of cough and severe dyspnea. Chest X-ray and CT scan revealed overinflation of the left upper lobe of the lung. Congenital lobar emphysema was confirmed after observation of left upper lobe bronchial stenosis during expiration by flexible bronchoscope. A left upper lobectomy was performed and the postoperative course was uneventful. Histological examination of the left upper lobe bronchus revealed normal bronchial wall structure. The patient's body weight at the time of surgery was just above the lower limit of the normal growth curve and caught up 16 months after surgery, suggesting that this disease suppressed the patient's normal growth.
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