Embolization of the bronchial artery is commonly performed in patients with repeated episodes of hemoptysis. Thirty-eight patients underwent arterial embolization at our hospital between November 1997 and November 2001. This paper discusses the application of this method, the timing for performing embolization, the selection of embolization material, and treatment outcomes.
The 38 subjects in the present study included 13 patients with bronchiectasis, 6 patients with pulmonary tuberculosis (1 active, 5 inactive), 6 patients with lung cancer, 6 patients with idiopathic bleeding in the airways, 2 patients with aspergillosis, and 1 patient each with metastatic lung tumor (renal cell carcinoma), pneumoconiosis, emphysema, pneumonia, and lung abscess.
Hemorrhage was successfully arrested by embolization in 37 of the 38 patients, and lung resection was required in only 1 patient. Embolization with metal coils provided acceptable hemostasis. However, in patients with hemoptysis in whom it is difficult to control infectious processes, collateral vessels may subsequently develop.rTherefore, when shunt blood flow is not observed in the bronchial artery, it is considered advisable to perform embolization using only Spongel (gelatin) to control infectious processes.

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We investigated whether intraoperative palmar skin temperature and palmar skin blood flow could be useful for an assessment of compensatory sweating. Subjects were twenty patients receiving Endoscopic thoracic sympathectomy (ETS) for primary palmar hyperhidrosis. All patients were placed in a semi-sitting position under double-lumen intubated anesthesia. We interrupted the bilateral nerve conduction to the palms from the T2, T3 and T4 ganglia, through two 0.8-cm subaxillary incisions.
A pair of laser-doppler skin blood flowmetry probes and skin temperature meters were placed on the palmar side of the second and third fingers. Palmar hyperhidrosis disappeared after ETS in all cases, but compensatory sweating developed in all cases, especially in the thigh and back. After completion of ETS, the average skin blood flow and temperature increased by 24.8ml/min/100g and 2.19°C respectively. A significant correlation was found between compensatory sweating and the increase of palmar skin temperature and palmar skin blood flow. We conclude that an increase in palmar skin temperature and palmar skin blood flow may be useful in predicting the range of compensatory sweating following ETS.

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A 55-year-old female was admitted to our hospital with left pulmonary atelectasis shown on a chest X-ray and a middle mediastinal cyst revealed by computed tomography. After admission, air fluid level appeared for a short period on radiographs. The preoperative diagnosis was mediastinal bronchogenic cyst, and tumor resection was performed. Microscopic examination revealed that the tumor was a bronchogenic cyst. It was thought that infection of the cyst and communication with the airway had caused the air fluid level.

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A 66-year-old man was admitted due to a slightly high temperature as high as 37°C and dull pain in the right chest. Diminished breath sounds were audible over the right lung. A chest CT scan showed an 30×20 cm sized tumor in the right lung. As laboratory examination data showed a WBC of 38, 900/μl with eosinophilia and high serum levels of CRP, he was suspected to suffer from pyothorax. Based on percutaneous needle biopsy of the tumor and the high value of serum granulocyte colony-stimulating factor (G-CSF), G-CSF producing large cell carcinoma of the lung was suspected. Right lower lobectomy, partial resection of the right upper and middle lobes, and resection of the chest wall and diaphragm invaded by the tumor were performed.
The tumor including resected lung, resected intercostal muscles, and resected ribs weighed in total about 1600 grams. Histopathological examination demonstrated lung large cell carcinoma. Immunohistochemical staining with anti-G-CSF monoclonal antibody showed positive results in the tumor. White blood cells and serum G-CSF decreased postoperatively.
Despite postoperative adjuvant chemotherapy with paclitaxel+carboplatin, the patient died due to aggravation of his general conditions associated with local recurrence in the chest wall 8 months after surgery. Including our case, there have been fifteen cases of resected G-CSF producing lung large cell carcinomas reported in the Japanese literature. Almost all patients died due to recurrence within several months post operatively. As our patient had leucocytosis with eosinophilia and slightly high serum levels of IL 6, there might have some influence of cytokines besides G-CSF.

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A 69-year-old male who presented with fever and cough had been treated for chronic lymphocytic leukemia at another hospital. As a chest x-ray film showed pneumonia of the upper field of the left lung, the patient was referred and admitted to our hospital. A chest CT scan showed pneumonia in the left upper lobe and possible stenosis of the left upper bronchus. A polypoid tumor was seen at the upper division of the left upper bronchus by bronchoscopy .Diagnosis was a squamous cell carcinoma. Clinical stage was 1A (T1N0M0). Surgical treatment was done because chronic lymphocytic leukemia is associated with a long survival . Although left upper lobectomy was planned, left pneumonectomy was performed because the bronchus of the surgical margin was not enough with upper lobectomy . Mucoepidermoid carcinoma was diagnosed with pathological findings of the resected specimen . Pathological stage was 2A (T1N1M0), because lymph node of #13 was metastatic . The post-operative course was almost uneventful .More than two years and 5 months after left pneumonectomy, the patient is alive without recurrence of mucoepidermoid carcinoma but is still being treated with chemotherapy and radiation therapy for CLL at another hospital.

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A 59-year-old female was admitted to our hospital because of an enlarged abnormal shadow on chest roentgenogram. Chest roentgenogram revealed a wedge-shaped abnormal shadow in the left middle field. The mass slightly changed in position with the change in patient's position. A pedunculated tumor arose from the visceral pleura of left upper lobe. The tumor was completely resected through thoracotomy. Histologically, spindle and polymorphic tumor cells were scattered in the collagen fibers. Only a few atypical cells were recognized. An immunohistochemical study was positive for CD34, vimentin and negative for cytokeratin, calretinin and EMA. From these immunohistochemical staining findings and microscopic findings, the tumor was diagnosed as a solitary fibrous tumor. SFT should be kept in mind when preoperative images show a mobile tumor, even when it is a large tumor. Thoracic surgery is well indicated for this type of tumor.

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A 19-year-old female had suffered from right chest pain for 5 years. The chest pain was lancinate and gradually increasing. MRI showed a mass in the right third intercostal space. A chest X-ray also showed bent ribs (the third and fourth). The tumor was enhanced with contrast medium on chest CT.
The tumor was resected including periostea of the ribs. The patient's chest pain was relieved after removal of the tumor. The tumor was 2cm in size and rich in blood vessels. It was histopathologically diagnosed as glomus tumor . Microscopic findings showed enlarged blood vessels and growth of uniform glomus cells around the vessels . These cells were immunohistochemically positive for anti α-SMA antibody. The tumor was also diagnosed as malignant glomus tumor, due to its large size (≥2cm) and deep location. Since glomus tumor of the chest wall is very rare, we presented the case together with a literature review.

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A 59-year-old woman showed multiple bilateral pulmonary nodules on chest X-ray . Two tumors excised videothoracoscopically were diagnosed as adenoid cystic carcinoma, and the primary lesion was identified in the sublingual gland. After the resection of the sublingual tumor she underwent bilateral lung metastasectomy . Six lesions in the left and nine lesions in the right were removed. Since the first metastasectomy she showed recurrence of the tumor limited to the lungs and has undergone metastasectomies of the lungs three times: two bilateral procedures and once left side alone. She is currently alive 4 years after the first excision. Adenoid cystic carcinoma of salivary gland is a slow-growing, invasive tumo, and effective chemotherapy for the disease has not been established. In the case of multiple lung metastasis of a tumor which is resistant to chemotherapy, multiple metastasectomy following primary resection might be a therapeutic option .

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We encountered two cases of TO lung adenocarcinoma affecting the hilar and mediastinal lymph nodes. Patient 1 was a 73-year-old man and patient 2 was 53-year-old man. Enlarged lymph nodes were revealed in both patients in the right hilar and mediastinal regions using chest X-ray and CT. A CT guided mediastinal biopsy in patient 1 and a thoracoscopic mediastinal biopsy in patient 2 were performed, and led to the diagnosis of adenocarcinoma of the lymph nodes. However, no primary focus in the lung or other organs was found in these patients. We performed systematic bilateral mediastinal lymph node dissection including the tumor and right upper lobectomy because of the possibility of origin in the upper lobe of the lungs in the two patients. Tumor cells showed immunoreactivity for antisurfactant apoprotein antibody. Therefore, we diagnosed TO lung cancer with right hilar and mediastinal lymph node metastasis. After these operations, patient 1 and 2 have survived 64 and 36 months, respectively, without primary tumor presence, recurrence or distant metastasis. Consequently, the immunohistochemical method using antisurfactant apoprotein antibody showed the usefulness for the diagnosis of TO lung adenocarcinoma.

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A 43-year-old woman was admitted to our hospital with hemoptysis in February 2002. She had a past medical history of hemoptysis 5 years previously. Chest CT, chest MRA, and angiography showed that the right subdiaphragmatic artery passed through the right pulmonary ligament and perfused the right lower lobe. In addition, in the venous phase, the right lower pulmonary vein was seen to drain into the left atrium. A diagnosis of pulmonary sequestration (Pryce type I) was established in this case. At surgery, two aberrant arteries were observed in the pulmonary ligament and partial resection of the basal segment with ligation of these aberrant arteries was performed. No postoperative complications were encountered. We were able to minimize loss of pulmonary function by performing partial resection in this case.

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A 19-year-old male was admitted to our hospital because of sudden loss of consciousness and respiratory arrest. He was diagnosed as having synchronous bilateral tension pneumothorax with giant bullae, and recovered following pleural drainage. Bilateral thoracoscopic bullectomy was performed, but his chest X-ray studies confirmed the presence of free air space in the bilateral pleural cavities for a few months . After discharge, chest X-ray examination demonstrated many neogenetic pulmonary bullae that were became progressively increasing in size . From this case, we recognized that patients with synchronous bilateral tension pneumothorax needed immediate diagnosis, pleural drainage, and careful follow up .

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Case: A 35-year-old man was admitted for treatment of right pneumothorax. He had been treated for myasthenia gravis associated with hyperthyroidism. We found his postoperative respiratory care was rarticularly difficult. Under epidural and intravenous anesthesia, he was performed lung plication, extended thymectomy and subtotal thyroidectomy. We think this an effective method to provide optimal operating condition and without postoperative respiratory disorder.

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A 37-year-old man complained of left chest pain, and consulted a general physician. A mass shadow was pointed out in the left lower lung field on a chest radiograph, but he did not receive further examination. Several months later, because of left chest wall swelling, increasing pain and hemosputum, he was referred to our hospital. Chest CT showed a large chest wall tumor, more than 10 cm in diameter, invading the left lower lung fields (S^9-10). No definitive diagnosis could be made after examinations including sputum culture, cytology, and transbronchial lung biopsy (TBLB). Finally, a sarcoma of chest wall was suspected by CT guided percutaneous fine needle aspiration cytology. The tumor was extirpated. Histopathological specimen of the tumor showed sulfur granules, which indicated pulmonary actinomycosis, and ABPC was administered after surgery. To our knowledge, pulmonary actinomycosis with chest wall abscess has been rarely reported recently in Japan. Pulmonary actinomycosis should be considered in the differential diagnosis of chest wall mass lesions, invading lung fields.

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Chondrosarcoma of the rib is rare. We followed up a case of chondrosarcoma of the 9th rib for a year preoperatively. A 34-year-old woman came to our hospital because of chest X-ray abnormal shadow. We recommended her to be operated because we suspected the tumor was chondrosarcoma on the findings of chest CT, chest MRI and bone scintigraphy. But she rejected the operation. She came to our hospital again after a year to be operated. Chest CT showed that the calcified lesion in the tumor was enlarged. We strongly suspected the tumor to be a chondrosarcoma and performed a wide resection of the chest wall. Histological examination revealed grade 1 chondrosarcoma originating in the 9th rib. There has been no sign of recurrence to date, about one year and five months postoperatively.

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A case of very long term retention of bronchial foreign body with bronchial inflammatory granuloma is presented. A 25-year-old male was hospitalized after detection of atelectasis of the left lower lobe during a medical check up.rBronchofiberscopy revealed a tumor obstructing rt B⁹⁺¹⁰, and the periphery could not be observed. By histological examination of the biopsy specimen, it was diagnosed as granuloma. But as there was a possibility of malignant tracheobronchial tumor, thoracotomy was performed to resect the tumor. The tumor was like a pedunculated polyp, and pathological findings revealed no malignancy. The chest X ray film on postoperative day 8 showed atelectasis like the preoperative chest X ray film. Bronchofiberscopy was performed again, revealing a tumor obstructing rt B⁹⁺¹⁰ like the preoperative bronchofiberscopy finding. When the tumor was resected by forceps under bronchofiberscopy, there was a foreign body (polypropylene splinter) and it was removed. Detailed history taking revealed an episode of foreign body aspiration; a severe chest pain and cough after a bread eating competition at an athletic meeting at age seven. This granuloma was considered a reactive granuloma caused by the foreign body aspirated at age seven.

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