The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 15 , Issue 5
Showing 1-17 articles out of 17 articles from the selected issue
  • Teruhisa Sakurai, Shoji Oura, Tatsuya Yoshimasu, Hirokazu Tanino, Kenj ...
    2001 Volume 15 Issue 5 Pages 538-543
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Sixteen patients with operable local advanced non-small cell lung cancer underwent concur rent induction chemoradiotherapy (CCRT) and surgical resection. The patients consisted of 15 males and one female (average age 56 years). Six had sqamous cell carcinomas, three adenocarcinomas, one adenosquamous carcinoma, one large cell carcinoma, one large cell neuroendocrine carcinoma and four were histologically undecided. Seven had apical invading lung cancer, four extensive chest wall invading, three mediastinal invading and two bulky N2. Major chemotherapy regimens included cisplatin 20 mg/m2 on days 1-5 and 29-33, and etoposide 32 mg/m2 on days 1-5 and 29-33. Radiotherapy (40 Gy in 20 fractions) began on day 1. The objective response rate was 69%, with 11 partial responses, without complete response. Operations were performed four weeks after CCRT. No treatment-related mortality was noted. Pathological examination of the surgical specimens showed Ef. 3 in 8 (50%), Ef. 2 in 6 (36%) and Ef. lb in 2 (12%). The overall survival rates by the Kaplan-Meier method were 57.1% and 28.6% at 3 and 4 years, with a median follow-up time of 24 months. These results suggest that CCRT for local advanced non-small-cell lung cancer is an effective induction therapy.
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  • Hidehito Matsuoka, Noriaki Tsubota, Wataru Nishio, Toshihiko Sakamoto, ...
    2001 Volume 15 Issue 5 Pages 544-548
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Eight cases of thymic cancer treated in our hospital (mean age 57.5 years, six males and two females) were reviewed clinically. Seven of the eight cases were poorly differentiated squamous cell carcinomas and the other was moderately differentiated squamous cell carcinoma. There were two stage I, three stage III and three stage IVb cases. Seven cases were macroscopically completely resected. The other stage IVb case with dissemination received only exploratory thoracotomy. Three stage III cases and two stage IVb cases were resected combined with lung, pericardium, diaphragma or innominate vein. Two stage III and two stage IVb cases were diagnosed as thymic cancer preoperatively with chest computed tomography and needle biopsy, and received induction chemoradiotherapy. These two stage III cases survived 32.5 and 47.0 month respectively after operation. But the other two stage IVb cases had metastasis in lung, liver and bone 19.8 and 11.3 month after operation respectively. One stage III case without induction therapy had metastasis in lung 12.3 month after operation. These three cases died 22.8 month after recurrence on average. The stage IVb case performed exploratory thoracotomy died at 16.5 month after operation in spite of postoperative chemoradiotherapy. Two stage I cases survived 121.4 and 74.0 month respectively after operation without adjuvant therapy. The 5-year survival rate of the resected cases was 47.6%. Complete resection produce good result single-handedly for stage I thymic cancer. Combined therapy including induction chemoradiotherapy and complete resection seems to be important to obtain better results for stage III case.
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  • Hisaichi Tanaka, Shinichiro Miyoshi, Mituaki Tatsumi, Mitsunori Ohta, ...
    2001 Volume 15 Issue 5 Pages 549-554
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    The purpose of this study was to clarify the validity of fluorodeoxyglucose-positron emission tomography (FDG-PET) in the evaluation of distant metastasis of non-small cell lung cancer (NSCLC). All metastatic lesions studied were confirmed clinically or histologically. FDG-PET detected 5 metastatic lesions in adrenal grand, 2 in liver, 1 in subcutaneous tissue, 1 in muscle. The size of the lesions ranged from 1 to 3 cm in diameter. Three of the 10 lesions were not diagnosed as metastatic with computed tomographic scan (CT). As to bone metastasis, true positive was 57% (4/7) in FDG-PET and 27% (4/15) in bone scintigraphy, respectively. We conclude that whole body FDG-PET is more useful than a combination of CT and bone scintigraphy to detect distant metastasis of lung cancer except for brain metastasis.
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  • When should a thoracoscopic approach be selected?
    Shinya Ito, Yoshimitsu Takashima, Jun Kobayashi, Reshad Khaled
    2001 Volume 15 Issue 5 Pages 555-560
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Thoracoscopic debridement was successfully performed in five patients with acute empyema. Postoperative course was good in all patients, and no recurrence of empyema was observed. VATS debridement was thought to be an effective means of providing complete drainage and breakdown of loculations, especially in the fibrinopurulent phase. By choosing appropriate timing of the operation, thoracoscopic debridement can be done safely even in those patients who have significant comorbid conditions. Early aggressive surgical approach using thoracoscopy may allow shortening of the hospital stay, and will prevent development as chronic empyema.
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  • Koji Ando
    2001 Volume 15 Issue 5 Pages 561-570
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Background: Mean pulmonary artery pressure (mPAP) is one of the important indicators for predicting the tolerance of a patient for a lung resection. Unilateral pulmonary artery occlusion test (UPAO) is widely used for the evaluation of mPAP and other indicators, but it is time consuming and expensive, and a more simple and reliable method is required.
    Patients studied: Fifty-seven consecutive patients regarded as candidates for a lobectomy or pneumonectomy on basis of spirometric tests and blood bas analysis were studied.
    Method: A Swan-Ganz-catheter (SGC) was inserted in the right pulmonary artery in each patient in OR shortly after the induction of anesthesia. Cardiac output and mPAP were measured perioperatively at the following points: post-intubation in the supine position, prethoracotomy in the lateral position, post-thoracotomy before lung resection, one lung ventila tion, pre-extubation, and postop.rday #1. Differences of mPAP were analyzed in relation to thoracotomy and/or the patient's position.
    Result: In the lateral position and during thoracotomy, mPAP increased by 2.2±4.7 mmHg in cases of right thoracotomy, and 3.4±4.0 mmHg in left thoracotomies. No patients were excluded as candidates for resection due to pulmonary hypertension. These findings were similar to our earlier findings, in which only two patients were excluded from 550 patients undergoing lobectomy or pneumonectomy.
    Discussion: The influence of thoracotomy on the mPAP was not as marked as expected. Using a SGC in the right pulmonary artery, mPAP measured following thoracotomy may be useful as the last minutes indicator for lung resection, using mPAP of 33 mmHg after occlusion of the main PA as the limit for right pneumonectomy, and 35 mmHg for left. These data could be applied to the lobectomies without PA occlusion.
    Conclusion: Perioperative monitoring of mPAP with SGC may be an alternative practical method of evaluating pulmonary circulation during lung resection.
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  • Hiroshi Hosoda, Hiroyuki Izumi, Makoto Sunamori
    2001 Volume 15 Issue 5 Pages 571-574
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Video assisted thoracic surgery (VATS) is widely used in the thoracic general surgery. Many devices for endosopic surgery have been developed and improved recently. However, almost all ready-made devices with the metal tip are unable to manipulate the organ, such as the lung, stomach or bowel, without tissue damage.
    To avoid the manipulation damage of the lung during VATS, we reformed a ready-made lung forceps. The tip of the forceps was ground with a file to adjust tip alignment. The rough textured latex rubber sheet which is used on table tennis racket was affixed to both sides of the tip with an adhesive which consisting a cyanoacrylate solution. Traction force was measured experimentally in porcine lung, and the tissue damage was examined histologically. Under identical conditions, the critical force of vertical traction was 286.7±23.1 (mean±SD) gram-force in our improved device and 146.7±5.8 gram-force in a ready-made one. Tissue damage from the pinching and traction was not caused in the porcine lung specimen by the improved forceps.
    Our improved device is superior to a ready made one in that the traction force is better and the tissue damage is less.
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  • Takaomi Hanaoka, Hideki Nishimura
    2001 Volume 15 Issue 5 Pages 575-578
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 67-year-old woman was seen at the hospital for follow-up after operation for uterine cancer at 60 years of age, right upper lobectomy for the first metastatic pulmonary tumor at 63 years, and wedge resection of the left upper lobe with video-assisted thoracic surgery (VATS) for the second one at 66 years. After the last operation, chest computed tomography (CT) scan showed an enlarged solitary peripheral nodular density in the lingular segment of the left lung. A wedge resection was performed with VATS to obtain the diagnosis. Histological examinations suggested that an intrapulmonary lymph node left alone with the former VATS adhered to the wound of port hole, led to organizing lesion, and thereby imaged as an enlarged tumorous shadow by CT.
    It is necessary to consider that CT scan may show pulmonary peripheral changes due to adhesions to the wound of port hole after VATS.
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  • Tetsuya Kondo, Mituharu Kokubo, Yukio Umeda, Tetu Sago, Hisasi Iwata, ...
    2001 Volume 15 Issue 5 Pages 579-583
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report an operative case of bilateral peripheral pulmonary arterial aneurysms. The patient was a 62-year-old woman complaining of fever. She was pointed out coin lesions at the left hilus region and the right lower lung field. Chest CT and pulmonary arteriography revealed saccular dilatation of the bilateral peripheral pulmonary artery. We diagnosed bilateral peripheral pulmonary arterial aneurysms. The lesions were located in the left upper lobe and the right lower lobe. As a literature review emphasized the necessity of resection whenever this diagnosis is made, so as to prevent a fatal outcome due to aneurysmal rapture, a left A 3 aneurysmectomy was successfully performed, and a right A8 aneurysmectomy was performed 2 months later. Histological examination of the resected specimen revealed that the pulmonary artery had marked aneurysmal dilatation of the lumen. There was no evidence of specific chronic inflammation or arteriosclerosis in the artery. Eleven such cases including this case were reported in Japan.
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  • Masaki Takashima, Yoshiaki Furuhata, Ryo Masuda, Isao Tanaka
    2001 Volume 15 Issue 5 Pages 584-589
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    This paper describes a resected case of CA19-9 producing lung cancer with acute inflammatory change.
    A 72-year-old man was admitted to our hospital because of general fatigue and fever. Chest X-ray and CT scan revealed a pneumonia-like shadow in the lower lobe of the right lung and laboratory findings showed an elevated serum CA19-9 level (1, 977 U/ml). Percutaneous needle aspiration cytology was done, and cytologic examination of a specimen of lung tissue revealed adenocarcinoma. There was no evidence of malignancy in the alimentary tract, and so we performed lower lobectomy of the right lung. Postoperative histological examination showed well-differentiated adenocarcinoma of the lung. The presence of CA19-9 was immunohistochemically demonstrated in almost all of the cancer cells. The serum CA19-9 levels were within the normal range 1 month after surgery. This demonstrated that this tumor was a CA19-9 producing lung cancer.
    The present case suggests that it is necessary to check CA19-9 in patients with lung cancer as well.
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  • Takuo Hara, Yasuhiko Ohta, Naohiro Ohta, Chikashi Hiranuma, Shun-ichi ...
    2001 Volume 15 Issue 5 Pages 590-594
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A rare case of giant pulmonary hamartoma with extra-visceral pleural growth is presented. A 45-year-old woman consulted us because of an abnormal shadow on chest roentgenogram. Chest CT and MRI showed a solid tumor (6 cm in diameter) with scattered calcifications between the anterior mediastinum and left lung, but it was quite difficult to confirm the tumor origin and to evaluate the relation with the left pulmonary artery. A thoracotomy revealed an extra-pulmonary mass rising out of left upper lobe, and it had to be excised and the surrounding tissue removed, with intraoperative histological diagnosis of cartilaginous hamartoma. It was concluded that, in such cases, intraoperative histological examination was essential to determine the optimum operative procedure.
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  • Tohru Sakuragi, Junji Yunoki, Yukinori Sakao, Masafumi Natsuaki, Tsuyo ...
    2001 Volume 15 Issue 5 Pages 595-599
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We devised a modified approach to extended thymectomy through full sternotomy with a lower limited median skin incision to achieve cosmetic advantages without sacrificing completeness of the resection. To ensure an excellent surgical view, a full sternotomy through a limited skin incision, 10 cm in length, was made and thoracoscopes were inserted through the 6th intercostal space bilaterally. In two patients with myasthenia gravis, we successfully performed extended thymectomy without any complications or scarring on the upper anterior chest wall using this approach. The patients were pleased with their postsurgical appearance. With a short follow-up of 3 to 5 months, no information about the long term relief of the myasthenic symptoms is available.
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  • Hisashi Iwata, Tsutomu Marui, Hideki Yamanaka, Hisato Takagi, Yoshio M ...
    2001 Volume 15 Issue 5 Pages 600-605
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 14-year-old female child presented with fever and an abnormal chest x-ray which showed complete collapse of the upper lobe of the left lung. CT showed complete atelectasis of the left upper lobe and 10 mm sized tumor including calcification. A polypoid, well circumscribed tumor protruded to the left main bronchus from the upper branch in bronchoscopic findings. Biopsy was not done because of hemophargic feature. Left sleeve upper lobectomy was performed. In the pathological findings, numerous anastomosing glands and irregular-shaped, mucin-filled cysts were seen. Clear and/or bubbly cytoplasm intermediate cells formed solid nests. Calcific concretions were also seen in the cystic lumen. In addition, they showed little mitotic activity, nuclear pleomorphism, or cellular necrosis. Therefore, low-grade epidermoid carcinoma was diagonised. Immunohistological findings showed CEA and CA125 positive. They showed significant reduction after operation.
    There were only 29 case reports of epidermoid carcinoma under 16 year old in Japan.
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  • Ryozo Hayashida, Toshihiro Matsuo, Shoji Ohtsuka, Yoshihisa Tanaka
    2001 Volume 15 Issue 5 Pages 606-612
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    The patient was a 69-year-old man who had undergone thoracoplasty with lucite sphere plombage for pulmonary tuberculosis at aged 25. In 1994, 44 years after the operation, he developed a mass in the right chest wall. This mass gradually protruded and in 1998, he was referred to us with a right chest wall giant mass. Computed tomography scanning and magnetic resonance imaging revealed a giant mass originating from the right throracic cavity and expanding into the extra thoracic space. Based on laboratory findings, CT imaging and needle biopsy specimen results together with his disease history a diagnosis of chronic expanding hematoma was made. Removal of the hematoma with the lucite sphere and thoracoplasty were performed.
    The hematoma weighed 6, 200g and was 31cm at the maximum diameter. The postoperative course was uneventful.
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  • Hiroo Shikata, Yoshimichi Ueda, Shuji Tsuchishima, Noriyuki Sasaki, Sh ...
    2001 Volume 15 Issue 5 Pages 613-618
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    The chest CT of a 59-year-old man revealed a tumor shadow in the left lower lobe. He underwent lobectomy. His pathological findings were poorly differentiated adenocarcinoma, and his clinical stage was estimated at stage IB (T2N0M0). His postoperative course seemed uneventful, but 10 days after surgery he suddenly complained of nausea and vomiting. Because he had undergone a laparotomy for the implantation of an artificial Y graft 13 years before, we estimated that his complaint was an adhesive obstruction. First, he was treated conservatively, but his condition showed little improvement. He required emergency surgery for an intussusception of the small intestine 50 days after the first lung operation. The cause of the intussusception was metastasis of primary lung cancer to the small intestine.
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  • Yukinobu Goto, Hiromichi Ito, Shinji Kikuchi, Fumito Imamura, Yukio Sa ...
    2001 Volume 15 Issue 5 Pages 619-624
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Malignant melanoma often presents multiple pulmonary metastases and results in a poor prognosis. The majority of recurrent malignant melanomas appear within 5 years after the initial treatment. We report a case of solitary pulmonary metastasis 12 years after the initial surgery. The patient was a 45-year-old woman who had received an operation and 5 courses of chemotherapy for malignant melanoma in the right thigh 12 years earlier. She consulted our department because of an abnormal shadow on chest X-ray film. Chest CT revealed a tumor with a diameter of 25 mm in right S4 lung invading into S3. The tumor was resected by partial resection of the right S3 and S4 lung and diagnosed as a pulmonary metastasis of malignant melanoma histologically. We have experienced 5 resected cases of pulmonary metastasis of malignant melanoma in our department. These cases show that pulmonary metastasis of malignant melanoma occur regardless of the long disease-free interval (DFI). When a chest abnormal shadow is found in a patient with a history of malignant melanoma even after a long DFI, pulmonary metastasis should be included in the differential diagnosis.
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  • Akio Yamazaki, Hideaki Miyamoto, Hiroshi Izumi, Tumin Ou, Toshiro Futa ...
    2001 Volume 15 Issue 5 Pages 625-629
    Published: July 15, 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 65-year-old man presented with the chief complaint of fever in July, 2000. Chest X-ray revealed an abnormal shadow extending from the right hilus to the mediastinum. Chest CT revealed a mass with multiple nodes spread over the anterior mediastinum. Thymoma was suspected based on the results of percutaneous needle biopsy, and the patient underwent extended thymectomy on September 22, 2000. Intraoperatively, multiple cysts associated with inflammatory findings, such as thickening of the mediastinal pleura, adhesions and swelling of mediastinal lymph nodes were noted throughout the entire thymus. Histopathological findings revealed lymphoid follicular hyperplasia of thymic tissues but no neoplastic lesions. Based on these findings, a diagnosis of multilocular thymic cyst associated with thymic hyperplasia was made. This is a rare case that preoperatively was difficult to diagnose.
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  • 2001 Volume 15 Issue 5 Pages e1
    Published: 2001
    Released: June 28, 2010
    JOURNALS FREE ACCESS
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