The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 17 , Issue 7
Showing 1-18 articles out of 18 articles from the selected issue
  • One family case report
    Nobuhiro Tanimura, Hirofumi Kanda, Toshihiro Kawahira, Sachiyo Kamitan ...
    2003 Volume 17 Issue 7 Pages 710-714
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We encountered one family with 5 cases of Rendu-Osler-Weber syndrome associated with pulmonary arteriovenous fistulas (PAVFs). Epistaxis tendency was noted in all cases. Multiple PAVFs were seen in cases 1, 3, 5, but solitary PAVF presented in cases 2 and 4. In cases 1 and 4, coil embolization and combined surgical therapy were performed. In case 3, coil embolization was performed three times, and right S6 segmentectomy was performed in case 5. PAVF may cause critical complications, such as brain abscess and sepsis. Therefore even if the PAW is small, medical treatment should be positively considered. PAVF is a benign disease and can recur, so transcatheter embolization should be considered as the first choice of treatment. When surgery is required, minimally invasive surgery that preserves lung functions, such as fistulectomy, should be performed.
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  • Yukinori Sakao, Toru Sakuragi, Yuji Takeda, Shinji Tomimitsu, Masafumi ...
    2003 Volume 17 Issue 7 Pages 715-720
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    One hundred twenty-eight patients with lung cancers who underwent lobectomy and hilar and mediastinal lymph node dissection in our department from December 1995 to December 2001, were classified into two groups according to with or without predeposit of autoblood. Autologous blood donation was performed 5-7 days before surgery with a volume of 400 ml. Group A included 77 patients with pre-deposit of autoblood and group B included 51 without predeposit of autoblood. The rate of allogeneic transfusion was significantly lower in Group A than in group B (6.5%, 19.6% respectively, p=0.03). There was no significant difference in mortality and morbidity between the two groups. Furthermore, there was no significant difference in 5-year survival rate after surgery between the two groups.
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  • Yukiyasu Takeuchi, Akinori Akashi, Tomofumi Oda
    2003 Volume 17 Issue 7 Pages 721-724
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 38-year-old man was referred to our hospital because of recurrent hemoptysis. Chest CT showed lack of left basal pulmonary artery, high concentration of the lower lung field, and the existence of an aberrant artery arising from the descending thoracic aorta. These findings indicated an anomalous systemic arterial supply from the descending thoracic aorta to the normal basilar segment of the left lower lobe. Division of the aberrant artery and left lower lobectomy was successfully performed entirely under video-assisted thoracoscopic surgery (VATS). The patient was discharged after an uneventful recovery on postoperative day 10. The VATS procedure is a useful and low-invasive approach for anomalous systemic arterial supply from the descending thoracic aorta to the normal basilar segment of the left lower lobe.
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  • Osamu Takahashi, Kenji Nakamura
    2003 Volume 17 Issue 7 Pages 725-728
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report the case of a 29-year-old female with bronchogenic cyst with tracheal fistula in the neck. She consulted a hospital for coughing and high fever where a diagnosis of abscess caused by tracheal fistula was made. A drainage tube was placed for this abscess from the skin and we injected contrast medium through this tube leading to a diagnosis of cystic disease with tracheal fistula. We operated to remove the cyst and close the fistula and no recurrence of bronchogenic cyst or tracheal fistula has been detected since the operation. Bronchogenic cyst with tracheal fistula is rarely diagnosed preoperatively.
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  • Kunio Narita, Munehisa Imaizumi, Yuuichi Ueda, Hiroshi Iwanami
    2003 Volume 17 Issue 7 Pages 729-734
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 58-year-old man was admitted to our hospital because of right anterior chest pain and hemoptysis. Chest X-ray and CT showed an infiltrative shadow in the right upper lung field, and bronchofiberscopy revealed active bleeding from the right B1. After transcatheter embolization of the bronchial artery, right upper lobectomy was performed because of continued hemoptysis. On the 2nd POD, a bronchoscopy confirmed the disruption of the right upper lobe bronchial stump.rSurgical correction was impossible due to deterioration in clinical condition with bilateral diffuse pneumonia and liver dysfunction. After selective bronchial intubation to the left main bronchus, he was at first ventilated with IPPV, but progressive impairment was observed in PaO2 values, so dual-mode independent lung ventilation with unilateral high-frequency jet ventilation was started, ventilating the healthy lung with CPPV and the controlateral with HFJV. Immediately after initiation of jet ventilation, right middle and lower lobe reexpanded and PaO2 was improved. Jet ventilation was continued for 3 days. An attempt was made to disconnect the patient from the jet ventilator, allowing him to breathe spontaneously.
    In conclusion, dual-mode independent lung ventilation with HFJV is an effective ventilatory support for the treatment of the patient with bronchopleural fistula refractory to conventional therapy.
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  • Hiroo Shikata, Yoshimichi Ueda, Yasuhisa Noguchi, Junichi Matsubara
    2003 Volume 17 Issue 7 Pages 735-739
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    In a follow-up examination on a 64-year-old male one and a half years after aortic valve replacement, a chest X ray revealed an large upper mediastinal abnormal shadow. The patient had no clinical symptoms. Computed tomography demonstrated a medial mediastinal mass 7cm in size. All laboratory data including tumor markers were within normal limits. 67Ga citrate scintigraphy revealed high biological activity. Before surgical management, anticoagulant therapy was changed to heparin infusion by Warfarin potassium. Video-assisted thoracic surgery was performed to obtain a definitive diagnosis. Pathological findings of the resected part of the specimen revealed suspicion of a malignant tumor. VATS was changed to median sternotomy for the radical surgical treatment. The tumor was completely resected without any invasive or metastatic lesions. During the tumor resection, the left innominate vein was divided temporarily to allow surgical procedure and anastomosed again without any prosthetic graft. Pathological examination of the resected specimen showed primary and not metastatic features. Final histopatholocical fingings revealed that the tumor was anaplastic seminoma. After the operation, the clinical course was uneventful.
    The patient received one course of combination chemotherapy (Cisplatinum, Etoposide and Bleomycin: BEP), one month after the operation. Neutrophilic white cells decreased to 20% of the total white blood cell count (400/μl) as a result of severe bone marrow suppression by chemotherapy. Bone marrow suppression improved by injection of GCFS for several days. The patient left our hospital after his white blood cell counts recovered to a normal range. He is currently being followed as an outpatient without any evidence of recurrence.
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  • Kanetaka Maeshiro, Shinzo Takamori, Yasuhiro Terazaki, Keisuke Miwa, M ...
    2003 Volume 17 Issue 7 Pages 740-746
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Cases of diaphragm rupture have been reported involving the left chest, but few cases of the right side rupture have been noted. Recent reports of right side diaphragmatic rupture have been increasing, however.
    We treated 4 patients with traumatic rupture of the right diaphragmatic, from September 2000 to November 2001. All injuries were incurred in traffic accidents, and included impaction of the liver to the thoracic cavity. Thoracotomy was performed in 2 cases, laparotomy in 1case, and thoracotomy with laparotomy in the other 1. In the early stage, laparotomy was employed to examine for abdominal organ damage. In elective operation cases, thoracotomy was advocated two patients supposing adhesion to the lung.
    Underwent operation in the early stage, and 2 were elective after circulation had become stable. All 4 patients survived. The possibility of infection due to the diaphragmatic rupture itself is low. However it is important to search for and treat any additional injures. Elective operation can be performed safely after the respiratory status and circulation status have become stable.
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  • Ryo Maeda, Seiki Hasegawa, Takashi Yoshimura, Masatsugu Nakagawa, Hiro ...
    2003 Volume 17 Issue 7 Pages 747-750
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    An abnormal mass shadow, which had been gradually growing for three years, was found on the chest X-ray of a 21-year-old Japanese male. CT scan of his chest showed the mass to be located in the right S9 segment. After right lower lobectomy and lymph node dissection, the resected tumor was found to measure 4cm and was pseudocapsuled. It was diagnosed as a pulmonary leiomyosarcoma because imagings showed a combination of spindle cell forming fasciculation and mitosis. The patient is alive and well with no evidence of recurrence 150days after surgery.
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  • Akira Nagashima, Yuko Tashima, Takashi Yoshimatsu, Toshihiro Osaki
    2003 Volume 17 Issue 7 Pages 751-755
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Pleomorphic adenoma is the most common form of major salivary gland tumor, but it is extremely rare in the trachea. We present a case of pleomorphic adenoma of the trachea in a 45-year-old female. She was admitted to our hospital because of severe dyspnea. The day before, she had undergone bronchoscopy and biopsy of a tracheal tumor at another hospital. Emergency bronchoscopy and Nd-YAG laser ablation of tracheal tumor was done under local anesthesia. A tracheal tube was then inserted beyond the tumor, and tracheal sleeve resection was done under general anesthesia. The pathological examination revealed a pleomorphic adenoma with focal atypical areas. The postoperative course was uneventful, and the patient is alive without recurrence 6 years after resection.
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  • Masashi Muraoka, Shinji Akamine, Takao Takahashi, Tsutomu Tagawa, Yasu ...
    2003 Volume 17 Issue 7 Pages 756-761
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 69-year-old woman suffering from chronic pulmonary emphysema developed hypoxia and was treated with HOT (home oxygen therapy). Her chest X-ray revealed a 12 mm diameter nodular shadow in the left lower lobe, which suggested lung cancer. Pulmonary function test showed 410 ml of Forced Expiratory Volume in 1.0 second (FEV1.0) and 26.6% of FEV1.0% due to severe chronic obstructive pulmonary disease (COPD). She was a likely candidate for pulmonary resection, however, we also considered lung volume reduction surgery (LVRS) for severe emphysema, as the tumor was located in the target area for LVRS. Almost 30% of the left lung was resected under Video-assisted Thoracic Surgery (VATS). The tumor was histologically diagnosed as stage I adenocarcinoma and the surgical margin was free. Her post-operative pulmonary function was maintained as the same degree as the preoperative function and her quality of life has improved by discontinuing HOT in daily life. This case report suggests that lung cancer patients with severe pulmonary emphysema have a range of options for pulmonary resection, including LVRS.
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  • Manpei Kawakami, Kousuke Tokitsu, Takuya Morita, Takahiko Hashimoto, T ...
    2003 Volume 17 Issue 7 Pages 762-765
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report two cases of invasive thymoma with cardiac tamponade as initial manifestation. Case 1 was a 63-year-old man complaining of palpitation and case 2 was a 59-year-old woman who consulted our hospital with shortness of breath and palpitation. In both cases, chest X-ray on admission showed enlargement of CTR and Chest CT revealed massive pericardial effusion and mediastinal mass.
    In case 1, pericardial drainage and excision of the mediastinal tumor were performed. The pathological diagnosis of the surgical specimen was thymoma with direct invasion to the pericardium. In case 2, needle biopsy of the mediastinal tumor was performed to yield the pathological diagnosis of epithelial dominant thymoma. Both patients were treated with chemoradiotherapy. We herein report two uncommon cases of invasive thymoma presenting with symptoms of cardiac tamponade as the initial manifestation.
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  • Takeshi Mori, Masakazu Yoshioka, Hironori Kobayashi, Kenji Watanabe, K ...
    2003 Volume 17 Issue 7 Pages 766-770
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 14-year-old boy was admitted due to recanalization of the pulmonary arteriovenous fistula (AVF). He had received coil embolization therapy for AVF located in the superior segment of the left lower lobe (S6) when he was 8 years old. Computed tomography (CT) on admission showed an AVF 4cm in diameter in S6 and 5mm in the posterior segment of the right upper lobe. Digital subtraction angiogram (DSA) showed 2 drainage veins: the superior segmental tributary of the left inferior pulmonary vein and the left basal pulmonary vein. There were no pathological findings on brain magnetic resonance imaging. We selected surgery instead of embolization, because surgery was judged to be a more effective and more successful treatment than embolization for this recanalized AVF case, on the basis of preoperative examination. Partial resection of the right lung (S2) was initially done under thoracoscopy. Afterwards, he underwent left lower lobectomy because of these findings of the lung: dilatation of the left basal pulmonary vein and widespread dilated vessels on the pleura. Selection of the therapeutic method was very important for successful treatment of a recurrent case after embolization of the AVF.
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  • Seiji Mega, Kazumi Itoi
    2003 Volume 17 Issue 7 Pages 771-776
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Three cases of diffuse malignant pleural mesothelioma underwent extrapleuralpneumonectomy from 1997 to 1999. The three patients all had epithelial type (Stage Ib-III). One month and six months after the operation, all patients had fibrinoid tissues removed under video assisted thoracoscopic surgery and underwent chemothermotherapy (hypotonic cisplatin treatment). After discharge, all patients have received UFT, and pleuroclysis with adriamycin, cisplatin once a month. The three patients are all alive without recurrence 55, 50, 30 months after the operation. Diffuse malignant pleural mesothelioma is an aggressive malignant tumor currently incurable by any form of therapy. Removing fibrinoid tissues and chemothermotherapy combined with pleuropneumonectomy may be effective for diffuse malignant pleural mesothelioma.
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  • Takuya Morita, Syuichi Tachibana, Manpei Kawakami, Kousuke Tokitsu, Ta ...
    2003 Volume 17 Issue 7 Pages 777-781
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 54-year-old-man was admitted to our hospital with obstruction of truncus intermedius due to squamous cell carcinoma of the lung. Chest CT showed lymphadenopathy (N2) and pleural effusion. Bone scintigram revealed a single band-form accumulation of radioisotopes in the right fourth rib, and MRI suggested a metastatic lesion in the rib. The patient successfully underwent rib resection combined with middle and lower lobectomy. Pathological findings of the resected rib showed only the healing process of fracture but not metastasis. Since some patients with clinical bone metastasis can be false-positive, an operation for lung cancer should be indicated more agressively in this situation.
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  • Isao Matsumoto, Makoto Oda, Masayuki Yoshida, Shigeharu Sawa, Susumu F ...
    2003 Volume 17 Issue 7 Pages 782-786
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report a case of primary lung cancer in which almost all of the tumor contained glycogen-rich clear cytoplasm. The patient, a 73-year-old male, suffered from von Recklinghausen disease. A chest X-ray taken in lung cancer mass screening detected an abnormal shadow in the right lower lung field. The results of analysis of tumor markers were normal, but chest CT examination showed an irregularly shaped tumor with a diameter of about 5 cm at S6 to S9 of the right lung. The tumor was adjacent to the thoracic wall without infiltration. A pulmonary needle-biopsy taken under ultrasonic guidance yielded tumor cells with clear cytoplasm. Pulmonary metastasis of renal cancer was suspected, so a detailed examination was conducted, but no abnormalities were found in areas other than the lung. Therefore, the right lower lobectomy and ND2a lymph node dissection were performed.
    Resection yielded a grayish fragile tumor measuring 50×45×45 mm at the periphery of right lower pulmonary lobe S9. Microscopic examination revealed proliferation of large filled tumor cells. Their nuclei were large and some cells were polynucleated, and the cytoplasm was eosinophilic in some areas and contained clear cytoplasm in others, with the latter being dominant. The clear cytoplasm was PAS-positive and digested by diastase, suggesting that the contents were rich in glycogen. The tumor was devoid of elements specific to an adenocarcinoma or squamous cell carcinoma, therefore, the diagnosis was large cell carcinoma originating in the lung and presenting feature of clear cell carcinoma.
    There is still a controversy about whether or not a clear cell cancer is an independent histological entity. It was difficult to decide if our case represented a subtype of large cell carcinoma or clear cell carcinoma. In either instance, it seems that there are several histological types among those containing glycogen rich cells, and further analysis of additional cases is awaited.
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  • followed by radical operation: a case report
    Tatsu Miyoshi, Sakae Okumura, Yukitoshi Satoh, Ken Nakagawa
    2003 Volume 17 Issue 7 Pages 787-793
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We present here a case of primary adenoid cystic carcinoma of the trachea, treated by electrosurgical snaring followed by radical operation. We could confirm the heat effects of electrosurgical snaring on the peritracheal soft tissue at the site where tumor resection was performed. The patient was a 62-year-old female with a compliant of dyspnea on effort. Bronchofiberscopy revealed a 10mm smooth surfaced, intraluminal, polyp-like tumor located in the tracheal wall 5.5cm distal from the vocal cords. For airway management and pathological diagnosis, electrosurgical snaring was performed. Histologically, the tumor was diagnosed as an adenoid cystic carcinoma of the trachea. Since the margin of the specimen was positive for cancer cells, radical surgical resection was performed. The effects of heat on her tracheal wall due to endoscopic snaring were confirmed during the operation as degeneration of tracheal cartilage and fibrosis of peritracheal connective tissue, involving the right recurrent nerve. The fibrosis made surgical approach more difficult to preserve the right recurrent nerve.
    Electrosurgical snaring requires further study into output power for snaring, output time and snaring position, to minimize the heat effect on peritracheal soft tissue.
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  • Hisaichi Tanaka, Keiji Iuchi, Akihide Matsumura, Meinoshin Okumura, Mi ...
    2003 Volume 17 Issue 7 Pages 794-797
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 50-year-old female had undergone left upper segmentectomy for stage1A bronchogenic adenocarcinoma in July 1996. In August 2001, a routine chest CT scan detected a mass adjacent to the previous segmentectomy, and local ecurrence of bronchogenic carcinoma was suspected A bronchoscopic examination detected no recurrence, and sputum cytology revealed no malignant cells. Bacteriological examination of her sputum detected no specific findings. She underwent left thoracotmy in October 2001. Needle aspiration cytology revealed pus with tubercle bacilli, and partial resection of the residual left lung was performed.She received anti-tubercle therapy in the postoperative course. The previous CT scan and the operative specimens for bronchogenic carcinoma revealed no finding of pulmonary tuberculosis retrospectively. Small primary-infected lesion reactivated endogenously triggered with the foreign body reaction of staples, leading to disturbance of healing.
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  • Shinji Kikuchi, Hiroo Okazaki
    2003 Volume 17 Issue 7 Pages 798-802
    Published: November 25, 2003
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 27-year-old woman was admitted to our hospital because of bilateral pneumothorax. She had been diagnosed with tuberous sclerosis at 5 years old. Chest CT showed diffusely-scattered tiny nodules and thin-walled cysts present throughout both lung fields. Pulmonary lymphangioleiomyomatosis and multifocal micronodular pneumocyte hyperplasia were diagnosed histopathologically by video-assisted thoracoscopic surgery. After operation, she developed recurrent pneumothorax bilaterally seven times, despite anti-hormone therapy. Reoperation by thoracoscopy using fibrin glue and absorbable mesh for newly-formed cyst was performed, and no signs of recurrence have been found.
    This case of LAM and MMPH occurring in a patient with TS was extremely rare. It may be effective for this type of pneumothorax to apply an absorbable mesh with fibrin glue to decrease the postoperative recurrence rate.
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