The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 16 , Issue 5
Showing 1-14 articles out of 14 articles from the selected issue
  • Kenjiro Fukuhara, Katsuhiro Nakagawa, Kiyohiro Fujiwara, Hiroyuki Shio ...
    2002 Volume 16 Issue 5 Pages 609-614
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A retrospective review was performed to evaluate the extent of mediastinal node metastasis and prognosis in resected non-small cell lung cancer patients showing metastasis only to ND2 region (n1 (-) n2 (+) patients) (n=80). Patients with single-station metastases had a significantly better survival rate than those with more than three station metastases. And there was no significant difference between cases with single-station metastases and n1 cases. This finding suggests that single mediastinal station metastases may be metastases to the sentinel lymph node. When we divided n1 (-) n2 (+) patients into two groups (group (1): cases whose primary tumor was located in the upper or middle lobe and LN metastases were seen at upper mediastinum only and cases whose primary tumor was located in the lower lobe and LN metastases were seen at lower mediastinum only; group (2): cases whose primary tumor was located in the upper or middle lobe and LN metastases were seen at lower mediastinum only and cases whose primary tumor was located in the lower lobe and LN metastases were seen at upper mediastinum only.), group (2) had a significantly worse survival rate. Group (2) cases are a high risk group for limited mediastinal lymphadenectomy.
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  • Wataru Nishio, Noriaki Tsubota, Hidehito Matsuoka, Toshihiko Sakamoto, ...
    2002 Volume 16 Issue 5 Pages 615-620
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We reviewed our surgical results for 64 patients with diffuse pleural mesothelioma (DPM) from 1986 to December 2000.
    Nineteen patients underwent extra pleural pneumonectomy (EPP). Among them median survival time (MST) and 2 year survival rate for the patients with stage III disease (n=17) were 9 months and 25% respectively. Morbidity included pulmonary embolism (n=2), broncho-pleural fistula (n=1), and diaphragmatic hernia (n=1). There was one surgery related death.
    Since 1994 we preferred pleurectomy as a radical operation for totally resectable cases to EPP, because microscopic examination revealed visceral pleurectomy enabled complete resection for mesothelioma cells from lung parenchyma. Then 32 patients underwent pleurectomy. In this group MST and 2 year survival rate for the patients with stage I disease (n=7) were 33 months and 57%, those for the patients with stage II (n=8) 15 months and 47%, and those for the patients with stage III (n=15) 8 months and 29% respectively. One patient experienced operative morbidity (pneumonia), but there was no mortality.
    Thirteen patients underwent only pleural biopsy or probe thoracotomy mainly due to locally progressive disease (stage IV, n=8).
    Non-epithelial histology and stage III, IV disease were associated with decreased survival (p<0.05). Operative method (EPP vs. pleurectomy) did not significantly affect survival.
    Both EPP and pleurectomy had equivalent high recurrence rates for completely resected cases (16 of 18 {89%} and 19 of 20 {95%}, respectively), so combined adjuvant therapy seems to be indispensable for the treatment of DPM.
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  • Kazuhiro Ueda, Nobuhiro Fujita, Hisashi Sakano, Kouichi Saeki, Toshiki ...
    2002 Volume 16 Issue 5 Pages 621-625
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Thoracoscopic partial resection of the lung (TPR) has been developed to be a safe procedure . This technique will be applicable to day surgery (DS) in the near future. The aim of this retrospective study was to clarify indication criteria for DS in TPR. Forty-seven patients representing performance status 0-1 and undergoing TPR between January1994 and August 2001 were enrolled in this study. Those who had started oral intake and were free from chest drainage tube, urinary catheter and oxygenation, and finally able to walk alone at 24 hours after operation were retrospectively considered to be eligible for day surgery (DS group; 21 patients). Twenty-six patients were considered to be non-DS group.rUnivariate analysis indicated that abnormal respiratory function, diffuse respiratory disease, and body mass index>27 or<17 were significant risk factors for DS (all p<0.05). In summary, 45% of patients were assessed to be able to be discharged from hospital within 24 hours after operation. Indication criteria for day surgery were, first, absence of diffuse pulmonary disease, second, normal pulmonary function, and third, body mass index between 17 and 27.
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  • Yoshitaka Nagatsuka, Hiroshi Iwabuchi, Harubumi Kato
    2002 Volume 16 Issue 5 Pages 626-629
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We reported a case of blunt complete transection of the cervical trachea. The patient was a 38-year-old man, who was injured on the neck by an iron-board weighting 1.5 tons. He developed hemoptysis, subcutaneous emphysema and dyspnea. He was transferred to our hospital by helicopter. Chest X-ray and chest CT showed subcutaneous emphysema and mediastinal emphysema, and bronchoscopy found complete transection of the cervical trachea at 3 cm below the vocal cord. We immediately performed tracheoplasty. The postoperative course was satisfactory, and he has returned to work in good health now.
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  • Hiroshi Okitsu, Hiromiti Yamai, Hirokazu Taketi, Shouji Sakiyama, Kazu ...
    2002 Volume 16 Issue 5 Pages 630-634
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We reported a very rare case of tiny carcinoid arising in an epidermoid cyst of the thymus. The patient was a 50-year-old female who had anterior chest compression. Chest X-ray showed a tumor shadow in the right upper mediastinum. Chest CT and MRI revealed a substantial tumor 2.0×2.0cm in size located in the thymus, and so we suspected thymoma and performed thymectomy. Macroscopic findings of the resected specimen showed a tumor 25×24×20 mm in size in the right upper portion of the thymus. Cut surface of the resected specimen showed a simple cyst filled with keratin. Microscopic findings showed a tiny typical carcinoid arising in an epidermoid cyst of the thymus. Immunohistochemical studies showed positive staining of carcinoid tumor cells with chromogranin and neuron-specific enolase. The postoperative course was uneventful and there are no findings of tumor reccurence 16 months after operation.
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  • Tadahiko Shien, Hiroya Maeda, Tomoya Takao, Hiromasa Yamamoto, Tetsuno ...
    2002 Volume 16 Issue 5 Pages 635-639
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Malignant melanoma often presents skin, lymph node, lung, liver metastases and results in a poor prognosis. Some reports of later ecurrence of chroidal malignant melanoma (beyond 10 years) now exist in the literature. We report a case of metastatic melanoma of the lung 24 years after initial treatment. A 65-year-old man was admitted because of an abnormal shadow on the chest X-ray. He had a past history of left eye extraction for choroidal malignant melanoma 24 years earlier. Chest CT revealed a solitary tumor (20mm in diameter) in left 55 lung. Percutaneous needle aspirationcytology was done, and cytologic examination of a specimen of lung tissue revealed metastatic malignant melanoma. Left upper lobectomy was perfomed. Pathological examination revealed metastases in interlobar lymph nodes. He was alive with no signs of recurrence at 8 months after the lung operation. Patients with a history of malignant melanoma have a risk of recurrence even 10 years after initial treatment. Therefore, they have to be followed up for a long time, and resection of a solitary metastatic tumor can obtain long-term survival.
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  • Tatsuya Yoshimasu, Shoji Oura, Hirokazu Tanino, Yozo Kokawa, Teruhisa ...
    2002 Volume 16 Issue 5 Pages 640-644
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 33-year-old male with invasive thymoma underwent surgery on October 11, 1994. Multiple pleural dissemination of thymoma was detected by chest computed tomogram in December 1999 . The patient also suffered from myasthenia gravis at the same time. After steroid therapy for myasthenia gravis, he received arterial infusion chemotherapy for multiple pleural dissemination as induction therapy . A total of 40mg/m2 CDDP and 16mg/m2 ADM was administered through the 1st-9th intercostal arteries . Chest computed tomogram 3 weeks after chemotherapy could not detect any residual tumors. We decided that there was no need to perform surgical resection. The patient is still alive and disease-free at 21 months after chemotherapy . Arterial infusion chemotherapy through intercostal artery may be a useful treatment for the pleural dissemination of thymoma.
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  • Hiromichi Itoh, Katsuyuki Endo
    2002 Volume 16 Issue 5 Pages 645-649
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 65-year-old man was admitted complaining of a painful swelling on the left side of the chest wall, fever and cough. Chest CT scan demonstrated a tumor, 30×40mm in size, adjacent to the calcified parietal pleura of long-standing pyothorax. Examination of a specimen obtained by percutaneus needle biopsy resulted in a diagnosis of malignant lymphoma, diffuse large B cell type. Tumor resection and removal of the entire pyothorax was performed on March 22, 2001 under the diagnosis of pyothorax-associated lymphoma (PAL). The lung was preserved. A resected specimen histologically confirmed the above diagnosis . EBV genomes in Southern blot of the tumor demonstrated oligoclonal proliferation. EBV-encoded small RNAs (EBERs) was positive in EBV- in situ hibridization. EBV-LMP1 (Epstein-Barr virus latent membrane protein 1) and EBNA2 (Epstein-Barr virus nuclear antigen 2) were negative.After CHOP therapy, he has been well for 10 months without any signs of recurrence.
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  • Hiromichi Yamai, Hiroshi Okitsu, Hirokazu Takechi, Masako Okada, Nobuo ...
    2002 Volume 16 Issue 5 Pages 650-654
    Published: July 15, 2002
    Released: February 23, 2011
    JOURNALS FREE ACCESS
    We reported a rare case of cervical thymic cyst including normal parathyroid tissue in its wall. The patient was a 43-year-old female who was admitted to our department for further evaluation of gradually increasing precordial compression since two years. Clinical examination showed an elastic and soft tumor (measuring 2.8×1.5cm) in the left neck. Cervical MRI films showed a cystic lesion in the anterior mediastinum extending to the left neck, which was revealed as a low intensity area on T1 and high intensity area on T2. Cervical ultrasonography also showed a cystic lesion with hypoechoic pattern. There were many ciliated columnar epithelia in the aspiration biopsy specimen. Based on these findings, we suspected cystic disease and operated to obtain a final diagnosis. Operative findings showed the cyst continuing to the left lobe of thymus, and we resected both the cyst and the left lobe of thymus. Pathological findings demonstrated that the cyst was covered with thymic tissue including Hassall's bodies, and the cystic lumen was composed of a layer of ciliated columnar epithelium. In addition, normal parathyroid tissue was observed in the cystic wall. We considered that the parathyroid tissue lost its way into the cystic wall during the prototype removing phase.
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  • Tatsuo Nakagawa, Noritaka Isowa, Minoru Aoki, Kenji Inui, Masanori Kit ...
    2002 Volume 16 Issue 5 Pages 655-660
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We presented a case of cervicomediastinal lipoma with a review of Japanese cases. This case was the oldest case of cervicomediastinal lipoma among 17 such cases. The patient was a 74-year-old man, who was treated as having bronchial asthma and pulmonary emphysema. He was admitted to our hospital because of increasing dyspnea, a palpable cervical mass and a left-sided thoracic mass shadow on chest X-ray films. Chest CT and MRI revealed a mass lesion extending from the antero-superior mediastinum to left side of the neck. The mass lesion was completely resected. The tumor was encapsulated, yellow and soft measuring 10x 9x 6cm. Pathologic diagnosis was lipoma composed of mature adipose cells. The patient was free from recurrence during a 40-month follow-up until he died of pneumonia.
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  • Susumu Kawano, Tadashi Akiba, Shuji Sato, Makoto Yamashita, Makio Kawa ...
    2002 Volume 16 Issue 5 Pages 661-665
    Published: July 15, 2002
    Released: February 23, 2011
    JOURNALS FREE ACCESS
    A 51-year-old woman consulted our hospital with complaints of cough, dyspnea, and edema of the left arm. Chest CT, MRI and angiogram demonstrated a tumor of the anterior mediastinum. Needle biopsy specimen of the tumor obtained under CT guidance was diagnosed as sarcoma pathologically. Extended tumorthymectomy was performed and the pathological diagnosis of the tumor was synovial sarcoma. To our knowledge, only one synovial sarcoma of the mediastinum has been reported previously, and our case is the second report in Japan.
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  • Kunio Araki, Hiroshige Nakamura, Hajime Fukui
    2002 Volume 16 Issue 5 Pages 666-669
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 60-year-old-man was admitted to our hospital because of hemoptysis and wheeze. Chest X-ray and CT showed an old tuberculous shadow with thickness of pleura, calcification and cavity formation in the right upper lobe. Bronchial arteriography before operation revealed a fistula from the right bronchial artery to right upper pulmonary artery. Therefore right bronchial arterial embolization (BAE) was performed. On the next day right upper lobectomy and resecsion of the right upper bronchial artery were performed through a thoracotomy. Although it was difficult to dissect a pleural adhesion, the total blood loss was controlled within 630ml. The operation could be performed without any trouble. BAE was useful method for bronchial artery-pulmonary artery fistula to control bleeding during operation.
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  • Masato Tochii, Takashi Suda, Yoshinobu Hattori, Koji Negi, Hiroshi Sug ...
    2002 Volume 16 Issue 5 Pages 670-674
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We experienced a case of lung abscess misdiagnosed as adenocarcinoma based on cytologic findings of the sample obtained from transbronchial brushing. In May 2001, a 46-year-old man who complained of right anterior chest pain was referred for further examination regarding an abnormal shadow detected in the middle lobe of the right lung on chest CT. Pathologic findings by transbronchial direct biopsy showed only inflammatory granulomas, whereas a brushed sample revealed atypical cells. A diagnosis of adenocarcinoma was made. A right upper and middle lobectomy accompanied with partial resection of the right lower lobe was performed. Pathological findings of the resected specimen showed a lung abscess with organizing pneumonia, but no evidence of malignant neoplasm. Atypical cells were seen among the inflammatory cells, but only as part of the inflammatory focus.
    Diagnosis should not be made on cytologic findings alone, because of the possibility of false-positive results. In that case, further examination should be made pre or intraoperatively.
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  • Toshimichi Asano, Toshifumi Kaneko, Toshifumi Shimada, Satoshi Yano, H ...
    2002 Volume 16 Issue 5 Pages 675-679
    Published: July 15, 2002
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We reported a rare case of mucoepidermoid carcinoma of the thymus, together with some bibliographical comments.
    Ten years before, a 51-year-old female was pointed out an abnormal shadow on chest roentgenogram, and chest CT scan revealed an anterior mediastinal cystic tumor. But she did not receive further therapy.
    Ten years before, a 51-year-old female was pointed out an abnormal shadow on chest roentgenogram, and chest CT scan revealed an anterior mediastinal cystic tumor. But she did not receive further therapy.
    The patient underwent an operation via a median sternotomy. The tumor had invaded the left mediastinal pleura. It was removed in total with partial resection of the left mediastinal pleura. The cut surface was cystic, partially with a solid focus. From the pathological findings, the tumor was diagnosed as mucoepidermoid carcinoma of the thymus, low-grade. CA19-9 levels in the cyst fluid were 260×105 IU/ml. The postoperative course was entirely uneventful. The patient was discharged from the hospital on 22nd postoperative day. The elevated serum CA19-9 level normalized 2 months after the operation.
    Mucoepidermoid carcinoma of the thymus is so rare that only 10 cases of the disease including this case have been reported in the Japanese literature.
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