The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 18 , Issue 2
Showing 1-18 articles out of 18 articles from the selected issue
  • Kenjiro Fukuhara, Katsuhiro Nakagawa, Hiroyuki Shiono, Yoshihisa Kadot ...
    2004 Volume 18 Issue 2 Pages 88-92
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A retrospective study was performed to evaluate patterns of recurrence and prognosis in resected non-small cell lung cancer cases with ipsilateral intrapulmonary metastasis (pm (+) lung cancer (n=89; pml (metastasized in the same lobe with primary); 65, pm2 (metastasized in the different lobe from primary); 24)). The 3-year and 5-year survival rates of patients with pml and pm2 were 28.9%, 14.2% and 26.6%, 21.3%, respectively (N. S.).
    When we divide pm (+) lung cancer patients into two groups group (1); patients who survived more than 3 years (n=22); group (2); patients who survived less than 3 years (n=67), significant differences were recognized between the groups in CEA value (p=0.002) and p-n factor (p=0.007). Multivariate analyses also showed that both factors were significant prognostic factors. The 5-year survival rate of pm (+) lung cancer patients with normal CEA level and p-n0 disease was 50.7%, which was nearly equal to stage I B (53.3%) and II A (47.1%) patients and significantly higher than III B (9.4%) patients.
    No significant difference in survival rates according to operative method was observed in pm (+) lung cancer patients. Postoperative distant metastases were detected in 53 of 89 (59.6%) pm (+) lung cancer patients, and 56.6% of these were intrapulmonary metastases (only 13.3% of which were ipsilateral).
    These results suggest that pneumonectomy is not useful to prevent recurrence in pm (+) lung cancer patients and the staging system should be revised to consider CEA level and p-n factor because of good prognosis in pm (+) lung cancer patients with normal CEA level and p-n0 disease.
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  • Yasuhiro Kitamura, Nobuyoshi Shimizu, Motoi Aoe, Hiroshi Date, Itaru N ...
    2004 Volume 18 Issue 2 Pages 93-97
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Allotransplantation of cryopreserved trachea was performed with tracheal grafts from cadaveric canine donors to examine grafts which had been cryopreserved for one year or more could be survived. Immediately after the circulation stopped, 7th tracheal cartilage ring was removed from adult mongrels and was cryopreserved in a storage solution at -80°C.The grafts (n=22) were divided into 3 groups for which the cryopreservation periods were 2 to 6 months, 6 months to 1 year, and 1 year or longer. After thawing, each graft was transplanted back to the same site and the rate of engraftment was compared at 2 months after transplantation. Engraftment occurred with 12 of the 13 grafts cryopreserved for 2 to 6 months, all 4 of the grafts cryopreserved for 6 months to 1 year, and 4 of the 5 grafts cryopreserved for 1 year or longer. These results indicate that canine tracheal grafts cryopreserved for 1 year or longer remain viable after allotransplantation, suggesting that such grafts could be cryopreserved for a long period in the Trachea Bank.
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  • Kenjiro Fukuhara, Katsuhiro Nakagawa, Masahiro Sakaguchi, Teruo Iwasak ...
    2004 Volume 18 Issue 2 Pages 98-102
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A retrospective review was performed to evaluate the prognostic value of cigarette smoking index for pathological stage I lung cancer patients (n=579). The following variables were included: age, gender, TNM stage, preoperative respiratory and circulatory complications, postoperative respiratory and circulatory complications, Brinkman Index, and histological type. Cox's univariate and multivariate analyses were applied to quantify the associations with overall and cancer-related survival. Age, TNM stage, preoperative respiratory and circulatory complications and Brinkman Index had prognostic significance for overall survival. Brinkman Index was the second strongest factor predicting prognosis next to age. However, only age and TNM stage had prognostic significance for disease-specific survival. Causes of cancer-unrelated death were pulmonary disease (n=44), second primary cancers (n=33), cardiac and cerebrovascular disease (n=24), and others (n=21). Cigarette smoking index is an important prognostic factor in evaluating overall survival in pathological stage I lung cancer patients, but there were several cancer-unrelated deaths among the studied patients.
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  • Shinsuke Saisho, Masao Nakata, Shigeki Sawada, Hideyuki Saeki, Akira K ...
    2004 Volume 18 Issue 2 Pages 103-108
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    The purpose of this study was to evaluate the efficacy and safety of pulmonary resection for lung cancer in the octogenarian. From January 1996 to December 2002, 26 patients over 80 years old with lung cancer (10 female and 16 male, mean age; 82.3 years old, range 80 to 88) underwent pulmonary resection in our institution. Of those, 24 patients had preoperative morbidity and 13 had insufficient pulmonary function. Standard operation (lobectomy) was performed in 17 patients and limited resection was performed in 9 parients (5 were segmentectomies and 4 were wedge resections). All patients who underwent limited resection were clinical stage IA. Although the rate of postoperative morbidity was as high as 42.3% (11/26), the operative mortality rate was 3.8% (1/26). There was a significant difference in the incidence of postoperative morbidity between the two groups (58.8% in standard operation group versus 11.1% in limited operation group; p=0.036). The overall survival rate at 3 years was 74.0%, and there was no difference between the two groups.
    We concluded that, with an appropriate selection of patients and procedures, lobectomy can be performed safely for octogenarians, resulting in good prognosis. Also, it was suggested that limited resection may be preferable for clinical stage IA patients with poor pulmonary reserve.
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  • Shingo Takano, Takeshi Kawamura, Hiroyuki Kaneko, Tomoo Okushiba, Kazu ...
    2004 Volume 18 Issue 2 Pages 109-113
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 46-year-old man consulted a doctor for chest pain. From the findings of a chest roentgenography, it was diagnosed as right hemopneumothorax. At insertion of a chest drain, bloody pleural effusion, in a volume of 1200 ml, flowed out. Chest roentgenography and computed tomography showed a nodule in the right upper lobe . For the hemopneumothorax, video-assisted thoracic surgery (VATS) was performed . An old bleeding spot was identified in the parietal pleura. Immediately below the bulla at the apex of the lung, a nodal tumor, 1.5cm in diameter, was found. Partial resection of the apex of the right lung, inclusive of the tumor, was carried out. During postoperative pathological examination, it was diagnosed as large cell carcinoma, and a right upper lobectomy was performed by thoracotomy two weeks after the first operation. Postoperatively, two sessions of chemotherapy with Vindesine and Cisplatin were administerd. Presently, one year and 10 months after the second surgery, no sign of recurrence has been found and the patient is doing well. It's rare that primary lung cancer is found incidentally to hemopneumothorax. We report this case and refer to previous cases of pneumothorax complicated with lung cancer.
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  • Hiroki Asada, Shin-ichi Takeda, Noriyosi Sawabata, Masayosi Inoue, Yos ...
    2004 Volume 18 Issue 2 Pages 114-119
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We herein present 2 cases of mediastinal teratoma with intrapulmonary perforation, and its diagnostic pitfall in its variable manifestation.
    Case 1: A 35-year-old female presented with a complaint of fever and a solid anterior mediastinal tumor was detected on chest computed tomogram (CT). Definitive diagnosis was not obtained, despite several biopsies to rule out malignancy, until surgical extirpation was achieved . The resected specimen finally disclosed a mature teratoma with intrapulmonary perforation.
    Case 2: A 49-year-old female who received medication for chronic hemoptysis was found to have an abnormal shadow on chest X-ray. A chest CT showed a cystic mass with a thick wall in the anterior mediastinum, suggestive of mature teratoma. A needle biopsy did not reach a histological diagnosis, but the mass was confirmed to be mature teratoma with intrapulmonary perforation following surgical resection . In some mediastinal teratoma, there are cases that shows very slight symptoms, although they are actually perforated into the lung. So, as a diagnosis of teratoma, we should know its variable manifestation.
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  • Tomoe Katoh, Kazuaki Kawano, Takayuki Kuga, Ken Hirata, Masataro Hayas ...
    2004 Volume 18 Issue 2 Pages 120-123
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 52-year-old male was admitted because of an hourglass transmural lipoma penetrating his left first intercostal muscle, and growing to intra-and extra-thorax areas. Only three hourglass transmural lipomas in adults have been reported in Japan. Combined left collar incision with partial upper median sternotomy provided a good surgical view, and the lipoma was completely resected from intra-and extra-thorax areas. Pathology revealed infiltrating type intramuscular lipoma, which has a tendency for recurrence. Combined left collar incision with partial upper median sternotomy was found to be useful for complete resection of the tumor existing intra-and extra-thoracically in the antero-superior thorax.
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  • Masatoshi Gika, Yoshimasa Inoue, Iwao Takanami
    2004 Volume 18 Issue 2 Pages 124-127
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Left pneumonectomy with partial resection of the pericardium had been performed on a 58-year-old male with lung cancer after radiation and esophagotomy for pharyngeal and esophageal cancer. Though bronchopleural fistula occurred three months after the surgery, it recovered under conservative treatment. Six months after the surgery, he was admitted to our hospital for recurrent pharyngeal cancer and metastasis of a cervical lymph node. After the first course of chemotherapy, bronchopleural fistula recurrence was detected. The fistula was covered completely with fibrin glue-coated collagen fleece via bronchoscope, allowing irrigatation of the intra-thoracic space. While bronchopleural fistula following pneumonectomy is a very troublesome and often life-threatening complication, endoscopic management using fibrin glue-coated collagen fleece was effective for this patient.
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  • Hirochika Matsubara, Wataru Takahashi, Eiki Mizutani, Satoshi Nagasaka ...
    2004 Volume 18 Issue 2 Pages 128-131
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Metastases of the liver and both lungs were found in a 73-year-old male after surgical treatment for colon cancer and Alpha-fetoprotein producing gastric cancer. After resection of the hepatic metastasis, as his general condition permitted, the metastases of the lungs were removed in two stages. Immunohistochemically, the metastatic lung tumors were found to be positive for AFP which revealed the tumors to be metastasis from gastric cancer. The serum levels of CEA and AFP were reduced after resection of the metastatic lung tumors. Patterns of metastases from gastric cancer to the lungs are usually carcinomatous lymphangiosis, and coin lesions are rare. It has also been very difficult to prove such metastases. In this case, we could prove metastasis because the gastric cancer was positive for AFP production.
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  • Masashi Gotoh, Taku Okamoto, Jun Nakano, Takashi Nakashima, Daiki Masu ...
    2004 Volume 18 Issue 2 Pages 132-135
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 66-year-old woman was hospitalized with a nodular shadow on chest CT . She had undergone mastectomyat the age of 64 for breast cancer, and chemotherapy (DMpC therapy) had been under way.
    Chest CT on admission demonstrated a small nodular shadow (12mm in size) with spicula and notch in S8 of the left lung. The F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) showed high accumul ation in the nodule. It was diagnosed as pulmonary cryptococcosis by video-assisted thoracoscopic lung biopsy.
    It is difficult to differentiate lung cancer and pulmonary cryptococcosis, because pulmonary cryptococcosis often shows CT findings similar to lung cancer and often demonstrates false positive on FDG-PET.
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  • Hisashi Iwata, Tsutomu Marui, Koyo Shirahashi, Yukiomi Fukumoto, Yukio ...
    2004 Volume 18 Issue 2 Pages 136-140
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 59-year-old male was admitted for a left hilar mass observed on a chest x-ray. He denied a history of fever, weight loss or bone pain. Chest CT showed a solid, clear-surfaced tumor near the left main bronchus. Chest MM showed a mass that was high intensity on T1 and low intensity on T2. Bronchoscopy did not diagnosis. In addtion, there were no abnormal findings on brain and abdominal CT, or on a radiographic survey of his skeleton. The patient underwent left upper lobectomy. Histological finding showed a tumor comprised sheets of moderately large and small oval cells, eccentric nuclei and few mitoses. The tumor was positive for IgG and kappa chain but negative for IgA, IgM, and lambda chain immunohistochemicaly. Therefore, extramedullary plasmacytoma was diagonised. The patient is doing well with no evidence of disease in 4 year of follow up.
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  • Yuichi Shibuya, Takahiro Okabayashi
    2004 Volume 18 Issue 2 Pages 141-144
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    A 65-year-old female complained of chest discomfort and a mediastinal mass was found on chest roentogenography. Chest CT showed an anterior mediastinal mass and a small nodule with spiculae in S10 of the right lung. She had swelling of the left supraclavicular lymph nodes and a pathological study revealed metastases of poorly differentiated carcinoma. Extended thymec tomy with partial resection of the right upper lobe and lymph nodes dissection of cervical, mediastinal, and hilar lymph nodes and S10 segmentectomy of right lung were performed by median stenotomy and thoracoscopic approach. A pathological examination revealed the coexistence of large cell neuroendocrine carcinoma of the thymus and bronchiolo-alveolar cell type adenocarcinoma of the lung.
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  • Takatoyo Kambayashi, Nobuhiro Ono, Yasuji Terada
    2004 Volume 18 Issue 2 Pages 145-148
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Background. Parathyroid cysts are usually located in the anterior neck. Mediastinal parathyroid cysts are rare. Case report. A 44-year-old man was referred to our department because of an abnormal mass in the mediastinum. A chest X-ray showed the shift of the trachea to the left. Chest CT and MRI revealed a mediastinal cystic mass measuring 60×25×20mm attached to the right side of the trachea extending into the right lower pole of the thyroid gland. The cystic mass was removed by cervical incision and mediastinoscopy. Parathyroid hormone content in the serous fluid within the cyst was 2930pg/ml and histopathologic examination revealed a parathyroid cyst. Summary. We removed a mediastinal parathyroid cyst located in the right side of the trachea using cervical incision and mediastinoscopy without using thoracotomy or median sternotomy.
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  • Masayoshi Inoue, Noriyoshi Sawabata, Shin-ichi Takeda, Masaru Koma, To ...
    2004 Volume 18 Issue 2 Pages 149-153
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    The surgical outcome of patients with persistent multiple N2 following preoperative induction therapy (IT) have been reported to be extremely poor. We adopted combined video-assisted mediastinoscopy and exploratory videoassisted thoracoscopy (MS+VATS) for restaging following IT in order to select good candidates for pulmonary resection, and report here on 4 pilot cases. Patient age ranged 56-70 years. Three males and 1 female were enrolled and histological diagnosis was adenocarcinoma in all patients. c-N2 was diagnosed by exploratory thoracoscopy in 1 patient, transbronchial needle aspiration cytology in 1, and conventional computed tomography in 2. As preoperative induction therapy, 3 patients received concurrent chemoradiation and 1 was treated with chemotherapy alone. MS+VATS showed neither mediastinal node involvement nor pleural dissemination in 3 patients who underwent curative pulmonary resection. However, MS+VATS detected persistent multiple N2 in 1 patient, whose cancer was regarded as unresectable. We propose that MS+VATS could be a useful strategy for restaging following IT in non-small cell lung cancer patients.
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  • Masaki Kajimoto, Hironori Tenpaku, Yasumi Maze, Tomoaki Sato
    2004 Volume 18 Issue 2 Pages 154-158
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report a case of empyema successfully treated by two-procedure operation. An 80-year-old male with a complaint of continuous fever was suspected of pyelonephritis and admitted to another hospital. However, fever continued after antibiotics therapy. Chest CT showed a low density area (10×6cm) in the left posterior intrathoracic space, and the patient was referred to our hospital for treatment of empyema in September 2002. Chest tube drainage was immediately performed, and discharge culture showed Escherichia coli. Openwindow thoracotomy was performed because pleural effusion did not change to clear in spite of washing through the drainage tube. Chest wall reconstruction was performed with an omental flap and myocutaneous flap of the latissimus dorsi on the 36th postoperative day. The patient's postoperative course was good. Two-procedure operation was an effective technique, for empyema with refractory pleural effusion.
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  • Naohiro Nose, Mantaro Kodate
    2004 Volume 18 Issue 2 Pages 159-162
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We describe a case of CA 19-9 producing thymoma. A 60-year-old man was admitted to our hospital because of an anterior mediastinal mass on computerized tomography (CT). Laboratory data showed an elevated serum CA 19-9 level of 116.7 U/ml. We suspected thymoma and thymo-thymectomy was performed. The pathological diagnosis of the tumor was Type B2 thymoma in the WHO classification and also non-invasive thymoma with Masaoka stage I. Immunohistochemical study demonstrated that some tumor cells stained positively for CA 19-9. No significant lesions were detected in the liver, gall-bladder, pancreas or gastrointestinal tract. The CA 19-9 level was normalized on the 15th postoperative day. Serum CA 19-9 may be a useful diagnostic parameter and follow-up marker in some patients with thymoma.
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  • Jun Satoh, Ryuzo Kanno, Koichi Fujiu, Hiroyuki Suzuki, Yutaka Shio, Mi ...
    2004 Volume 18 Issue 2 Pages 163-166
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    We report a rare case of acute manifestation of chronic tuberculous pyothorax which seemed to be prevalent through the diaphragm and to bring about liver abscess. A 76 year-old man who had undergone artificial pneumothorax for right lung tuberculosis at the age of 30 years old developed high fever. A chest roentgenogram showed opacity of the right hemithorax and chest computed tomography revealed a collapsed right lung and a low density area encapsulated by thick pleura with calcification. After 19 days, abdominal computed tomography disclosed a lower density area in the right subphrenic space and in the adjacent right lobe of the liver. A diagnosis of acute manifestation of chronic tuberculous pyothorax associated with liver abscess was made. Percutaneous drainage of the liver abscess was performed, but the high fever continued. After the drainage of the pyothorax, fever was reduced, but air leakage from the right lung persisted. No pathogens were found from the purulent matter. Thoracoplasty, plombage of the omentum and the latissimus dorsi muscle were performed. Four years after the surgery, he is well without relapse of pyothorax or liver abscess.
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  • Takayuki Shiina, Hideki Nishimura, Kazutoshi Hamanaka
    2004 Volume 18 Issue 2 Pages 167-170
    Published: March 15, 2004
    Released: June 28, 2010
    JOURNALS FREE ACCESS
    Congenital cystic adenomatoid malformation of the lung (CCAM) has been reported in stillborn babies or neonates, but it is rarely seen in youths or adults.
    We report a case of CCAM in a 16-year-old female. She was admitted to our hospital for left chest pain, and chest X-ray showed a cystic lesion in the left lower lung field, 11.5×10cm in diameter, and mediastinal shift to the right side. Chest computerized tomography showed a cystic lesion in the left lower lobe. She underwent segmentectomy of the basal section of the left lung under videoasisted thoracic surgery. The resected surgical specimen was a large cyst, 8×8cm in diameter, with a thick wall of multiple small cysts with thin walls. The proximal bronchus was obstructed, and the distal segment was branched. Macroscopic findings showed that the cyst wall was lined by stratified ciliated columnar epithelium, and this wall was composed of elastic tissue without cartilage plates. We have to think primarily of CCAM is a kind of cystic disease of the lung over puberty.
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