The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 15 , Issue 4
Showing 1-15 articles out of 15 articles from the selected issue
  • Takuya Morita, Syuiti Tachibana, Manpei Kawakami, Tatsuhiko Orino, Kei ...
    2001 Volume 15 Issue 4 Pages 454-458
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Five on chronic hemodialysis with lung cancerpatients underwent pulmonary lobectomies in our institution. In order to perform lobectomy safely, we assessed the changes of serum potassium and CPK postoperatively. With judicious management, patients on chronichemodialysis undergoing elective lobectomy had a low operative mortality . However, the late results were extremely poor, especially in patients with congestive heart failure . Three of the 5 patients died of cardiac failure. These cases were complicated by pleural effusion pre-or postoperatively. We concluded that pleural effusion is a predictor of poor prognosis, and that close cooperation between surgeons and hemodialysis personnel over a long period is important.
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  • Ryoji Yamamoto, Hirohito Tada, Akihiro Kishi, Takashi Tojo, Hiroki Asa ...
    2001 Volume 15 Issue 4 Pages 459-464
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We investigated the effects of induction chemoradiotherapy on bronchial mucosal blood flow around the surgical site and the state of healing of the bronchial stump.r87 patients with primary lung cancer were divided into the following three groups: Group A, 75 patients who had no preoperative therapy ; Group B, 4 patients who had induction chemoradiotherapy (45Gy); and Group C, 8 patients who were operated from 2 months to 5 years after chemoradiotherapy (60Gy). Bronchial mucosal blood flow was measured pre-, intra-, and postoperatively (days 8-10) with a laser Doppler flowmeter. In Group C, bronchial mucosal blood flow was impaired around operation. Healing of the bronchial stump was poor and a bronchopleural fistula occurred in one patient. In Groups A and B, however, bronchial mucosal blood flow was preserved sufficiently and the healing of the bronchial stump was satisfactory. It is suggested that common induction chemoradiotherapy may have little effect on bronchial mucosal blood flow and healing of the bronchial stump, although preoperative chemoradiotherapy can adversely affect them in the chronic period.
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  • Hisashi Suzuki, Katsuyuki Endo
    2001 Volume 15 Issue 4 Pages 465-470
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 44-year old man with an abnormal shadow in the S10 of the right lung was suspected to have pulmonary adenocarcinoma by TBLB. In addition, the diagnosis of pulmonary sequestration was made by CT scanning that revealed an aberrant artery branching from the abdominal aorta. Under thoracotomy, a frozen section specimen obtained by needle biopsy showed adenocarcinoma, and right lower lobectomy (ND2) was performed. An aberrant artery was found feeding the mass lesion in the right lower lobe. Histological examination of the resected lung revealed no cancer tissue, but showed hyperplasia of atypical alveolar cells without mass formation, which was considered to be a reactive process of the chronic inflammation.
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  • Katsutoshi Adachi, Motoshi Takao, Naoki Hosaka, Toshiya Sasaki, Jin Ta ...
    2001 Volume 15 Issue 4 Pages 471-475
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Here we reported a rare case of lung cancer associated with a left ventricular myxoma. A 76-year-old man was admitted to our hospital because of an abnormal shadow on chest roentgenogram. Diagnostic imaging demonstrated a tumor, 20×20 mm in size, in the right lower lobe. Transbronchial lung biopsy was performed, and a diagnosis of squamous cell carcinoma of the lung was made. Transesophageal echocardiography performed because of his past history. There was revealed a mass in the left ventricle, suggestive of a cardiac myxoma. First, he underwent a posterolateral thoracotomy for resection of a lung cancer. Fifty days later resection of the left ventricular myxoma was performed on cardiopulmonary bypass. He was discharged from the hospital 32days after the second surgery. He has been followed as an outpatient for 12 months at our hospital without any signs of recurrence.
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  • Keisuke Ozawa, Kosuke Yamazaki, Hirokatsu Sugimoto, Yuka Kajiura, Kazu ...
    2001 Volume 15 Issue 4 Pages 476-479
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We have experienced three cases of a solitary sternal metastasis of breast carcinoma. In all three cases, full thickness chest wall resection and reconstruction were performed. Marlex mesh and titanium plate were used to stabilize the thorax, and a pedicled or free flap was used to close the myocutaneus defect. Chest wall reconstruction using a titanium plate combined with Marlex mesh achieved excellent stability of chest wall movement. Free myocutaneous flap of rectus abdominis muscle was more useful than pedicled flap to close the soft part defect.
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  • Koji Teramoto, Toshihiko Sato, Shotaro Iwakiri, Hisashi Sahara, Tsuyos ...
    2001 Volume 15 Issue 4 Pages 480-484
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    (ease1) A 17-year-old male was admitted to our hospital with dyspnea. His chest X-ray film showed pneumothorax. Chest CT scan on admission showed no cystic lesions; however at operation there were several blebs on the surface of the right lung. On microscopic examination of the surgical specimen there were fibrotic lesions without granuloma and infiltration of the eosinophils. But under electron microscopy several Langerhans' cells with Birbeck's granules in their cytoplasm were observed.
    (case2) A 24-year-old male presented with dyspnea and was admitted to our hospital. He wasdiagnosed with pneumothorax from chest X-ray films. Chest CT scan on admission showed no cystic lesions. However thoracotomy revealed multiple bullae on the surface of the left lung. Microscopic examination of the surgical specimens were not remarkable, but electron micros copy showed Langerhans' cells with Birbeck's granules in their cytoplasm. Chest X-ray films, chest CT scan and light microscopic examination were unremarkable for Langerhans' cell histiocytosis. But electron microscopic examination revealed that pneumothoraces of the two cases were caused by Langerhans' cell histiocytosis. From these results, it seemed that further examinations and follow-up in future would be needed.
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  • Hiroshi Suehisa, Kazuhiro Tsuji
    2001 Volume 15 Issue 4 Pages 485-489
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We experienced a case of candidiasis in a bleb detected during surgery for pneumothorax. The patient was an 18-year-old man. In October, 1999, he was diagnosed with left pneumothorax and improved with conservative therapy. In November, 1999, he presented cough and left anterior chest pain again, and was diagnosed with a recurrence of pneumothorax by chest Xray. The degree of collapse was 26%. A chest CT scan showed a cystic lesion in the left apex. We resected this cystic lesion and another in S6 segment with video assisted thoracic surgery (VATS). Histologically, the cystic lesion was a bleb, and granulation was found in the wall of the resected bleb. Furthermore, many multinucleated giant cells and hyphae of candida were found.
    Cadidiasis is an opportunistic infection developing in the immunocompromised host. This case had no underlying disease or findings suggesting systemic candida infection. So, it is considering that candida made on invasion via airway and increased in a bleb, but relation between pneumothorax and candida infection were unclear. Recently primary pulmonary mycotic infection is not rare, so it is necessary to diagnose and cure it keeping in mind the possibility of this entity.
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  • Kunio Narita, Hiroshi Iwanami, Haruhisa Hiyoshi, Eitaka Tsuboi
    2001 Volume 15 Issue 4 Pages 490-495
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 68-year-old female visited our hospital because of an abnormal shadow in her left lower lung field on chest X-ray. An isolated tumor of 10×7.5 cm in size was diagnosed as mesothelioma and was resected. The tumor was diagnosed as malignant mesothelioma by pathology. Six times operation in total (every 2-3 years) made possible her long survival for 12 years. To our regret, the patient died on the 31st postoperative day after the last operation because of complications. Malignant mesothelioma has the tendency to stay in the thoracic cavity with few distant metastasis. Extrapleural pneumonectomy is a surgical procedure facilitating complete resection and cure, in many cases, although tumor relapse is often seen and the burden on the patient is large. So partial resection of the pleura to maintain the quality of life of the patient may be the best option.
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  • Mikio Watanabe, Yoshihiko Osaka
    2001 Volume 15 Issue 4 Pages 496-499
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Two cases of empyema necessitatis complaining of left anterior chest wall mass were admitted to our hospital. One was a 74-year-old man who had undergone left pneumonectomy for pulmonary tuberculosis formerly, and the other a 60-year-old man with a past history of chest wall injury. Computed tomography of the chest revealed well-encapsulated contents with pleural calcification in the left hemithorax and a low density area suggesting abscess formation in the left chest wall. Open-window thoracostomy and resection of the abscess were performed for the former, and decortication and resection of the abscess were for the latter with a good outcome.
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  • rusult of surgical treatment
    Kenichiro Minami, Yukihito Saito, Hideyasu Omiya, Yuzo Shomura, Masahi ...
    2001 Volume 15 Issue 4 Pages 500-505
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We have experienced 8 cases of spontaneous hemopneumothorax during the last 10 years. All patients were male with a mean age of 34.8 years. As the initial subjective symptoms, all patients complained of chest pain and dyspnea. An emergency thoracotomy was required in 7 patients because of bleeding with or without cardiovascular collapse. Mean drainage volume of intrapleural hemorrhage was 3876 ml at the time of thoracotomy. Site of bleeding was from an interrupted end of funicular structure from the parietal pleura in 7 patients and from a ruptured bulla in 1 patient. We had 2 patients who experienced postoperative complications: prolonged air leakage and reexpansion pulmonary edema developing immediatery after surgery in one each.
    We conclude that early stage thoracotomy should be advocated to stop the bleeding and evacuate the coagulated blood from the pleural cavity to prevent the development of empyema or trapped lung due to fibrothorax.
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  • Yasunaru Sakuma, Shunsuke Endo, Tsuyoshi Hasegawa, Shinichi Yamamoto, ...
    2001 Volume 15 Issue 4 Pages 506-509
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 53-year-old man was admitted to our hospital with a chief complaint of hemoptysis. His chest computed tomography as well as bronchoscopic findings showed a tumor obstructing the right upper bronchus. Histological findings suggested a metastatic tumor of a left renal cell carcinoma which had been resected 8 years earlier. A right sleeve upper lobectomy was successful. Pathological findings demonstrated a unique expansion of endobronchial growth without any extension into lung parenchyma. He was alive with no signs of recurrence at 5years after the lung operation.
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  • Tohru Nakamura, Takeshi Okayasu, Souu Ri, Masanori Ohara, Masao Hosoka ...
    2001 Volume 15 Issue 4 Pages 510-514
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 60-year-old man was admitted to our hospital for dyspnea and disturbance of consciousness. His arterial blood gas analysis showed Po2 33 torr and Pco2 34.6 torr. At once endotracheal intubation and artificial respiration, were done. Chest CT showed a posterior mediastinal tumor compressing the left main bronchus. The next day Dumon stent was inserted to maintain the lumen of the left main bronchus and soon his consciousness became clear, and he was weaned from the artificial respiration. Then the microscopic findings of a metastatic neck lymphnode revealed spindle-shaped cells with a storiform pattern in bizarre mixoid cells, and a malignant fibrous histiocytoma (MFH) was diagnosed. We performed radiotherapy for the tumor (40Gy for the mediastinal, 25Gy for the neck). After the radiotherapy, the tumor was reduced to about 80% of its original size.
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  • Reiko Nakai, Masahiro Yoshimura, Yosifumi Miyamoto, Hidehito Matsuoka, ...
    2001 Volume 15 Issue 4 Pages 515-520
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 44-year-old woman, who had a history of chest pain, developed right pneumothorax at the time of menstruation. A right side thoracoscopy was performed. There was air leakage from the middle lobe, which was closed with stapling. Two months after the operation, she had a recurrent right pneumothorax related to menses. Repeated thoracoscopy revealed the presence of fenestrations on the diaphragm, which were resected by thoracoscopic procedure. Microscopic examination of lung and diaphragm specimens showed no evidence of endometriosis. Therapy with a gonadotropin-releasing hormone analogue was started in addition. Noepisodes of pneumothorax occurred in the ensuing one year. But after discontinuation of the drug, she had a recurrent right pneumothorax. This case is very interesting because pneumothorax was repeated even after the perforate pleura and diaphragmatic fenestrations were treated successfully. This suggests that several mechanisms play a role in catamenial pneumothorax.
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  • Makio Hayama, Itaru Nagahiro, Motoi Aoe, Hideki Itano, Yoshifumi Sano, ...
    2001 Volume 15 Issue 4 Pages 521-527
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 71-year-old man was referred to our hospital for further investigation and treatment of a tumor in the posterior mediastinum. The tumor was extirpated on August 22, 1988. The pathological diagnosis was well-differentiated liposarcoma and no additional therapy was performed. Eleven years later, recurrent liposarcoma was found by chest X-ray. The CT scan demonstrated two large tumors and two calcified small tumors in the posterior mediastinum. A re-operation was performed on December 15, 1999, and the pathological diagnoses of the tumors were dedifferentiated liposarcoma with rhabdomyosarcomatous element and chondrosarcomatous element. Well-differentiated liposarcoma of the mediastinum occasionally recurs as dedifferentiated type many years after the first operation. Therefore we have to follow up these patients for a long time even though the tumor seems to be resected completely.
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  • Shunsuke Fukino, Tamito Fukata, Kouichirou Okada, Hiroyuki Metsugi
    2001 Volume 15 Issue 4 Pages 528-534
    Published: May 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report a patient with tracheal obliteration due to post-intubation tracheal stenosis who recovered after circumferential resection and end-to-end anastomosis of the trachea. The patient was a 46-year-old woman who attempted suicide by swallowing poison. The patient was placed on artificial ventilation with tracheal intubation and the tube was retracted on the eighth day. Dyspnea occurred from the fifth day after tube retraction and the patient was tracheotomied and referred to our hospital. The cervical trachea was obliterated for 2.8 cm from 3 cm below the glottis. The tracheal incision made at the site 1.8 cm peripheral from the obliteration was used for anesthesia and a 3.2 cm circumferential resection of the trachea (6 cartilage rings) was performed followed by an end-to-end suture usingl6 stitches with 3-0 Maxon thread. The peripheral end of the anastomosis was in the region where inflammatory wall hypertrophy remained in the trachea. The resected trachea showed atrophic disappearance of tracheal cartilages and complete obliteration of 2.8 cm due to granular tissue and cicatricial fibers. Although mild stenosis of the anastomosis region was observed after the operation due to the tracheal wall hypertrophy mentioned above, stenosis was alleviated with the elimination of inflammation. To date there is no adverse effect on daily living activities.
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