The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 22 , Issue 7
Showing 1-24 articles out of 24 articles from the selected issue
  • Hiroiku Hara, Mitsutaka Suzuki
    2008 Volume 22 Issue 7 Pages 976-980
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    Background: Descending necrotizing mediastinitis (DNM) is a very rare and fatal disease, with a high mortality rate. If it occurs, the clinical course is rapid and grave. In this study, we investigated previous cases and consider how the treatment strategy, especially surgical approach, can be improved. Patients and Methods: Between 1998 and 2007, 10 DNM patients were managed. Eight males and 2 females were included. The mean age was 62. 6 (range, 41-75) years old. Results: Initial triggers were deep neck infection in 8 patients, and dental infection in 2. They were classified into 4 type I, 2 type IIA, and 4 type IIB by Endo classifications. Cervical drainage and tracheotomy were performed in all patients. Further, mediastinal drainage was added in patients classified into types IIA and IIB. Mediastinal drainage was performed via the neck in 3 patients, VATS in 1 patient, and neck and VATS in 2 patients. Postoperative, artificial respiration was temporarily performed in all patients. At initial operations, some anaerobes were identified in 7 patients. MRSA was later noted in 3 patients. All patients are currently alive. However, complications of peptic ulcer occurred in 2 patients. Conclusion: The surgical approach for DNM is controversial. However, it is certain that tracheotomy and cervical drainage are necessary. Such a procedure is useful to create an airway and half the expansion of DNM. It is thought that cervical drainage is inadequate for types IIA and IIB, and so mediastinal drainage via VATS or thoracotomy is strongly recommended. However, our experience spanning 10 years revealed that open drainage and curettage of the mediastinum via VATS or thoracotomy are not essential. They have to be performed when mediastinal drainage via the neck is inadequate. The accuracy of timing is crucial.
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  • Masayuki Tanahashi, Satoru Moriyama, Eriko Suzuki, Hiroshi Haneda, Nao ...
    2008 Volume 22 Issue 7 Pages 981-986
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    In this study we analyzed the usefulness of adjuvant chemotherapy for non-small-cell lung cancer (NSCLC) based on the histoculture drug response assay (HDRA). From 2001 to 2006, we administered HDRA-based adjuvant chemotherapy to 39 patients with p-Stage III NSCLC after surgery. We examined the chemosensitivity to CDDP, CBDCA, paclitaxel, docetaxel, gemcitabine, and irinotecan. The patients comprised 28 men and 11 women, and their mean age was 64.8 years old. Histological analyses identified 27 adenocarcinomas, 8 sqamous cell carcinomas, and 4 others. The 3- and 5-year survival rates of 14 patients treated with 2 HDRA-positive drugs were both 85.1%. On the other hand, the 3- and 5-year survival rates of 25 patients treated with 1 HDRA-positive drug or 2 HDRA-negative drugs were 46.9 and 0%, respectively. Therefore, the prognosis of patients treated with 2 HDRA-positive drugs was significantly better than that of those treated with 1 HDRA-positive or 2 HDRA-negative drugs (p=0.01). This suggests that HDRA may be useful to improve the survival of patients with p-Stage III NSCLC.
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  • —six resected cases—
    Masaya Okuda, Sung-soo Chang, Jun Nakano, Noriyuki Misaki, Shinya Ishi ...
    2008 Volume 22 Issue 7 Pages 987-991
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    Introduction: Pulmonary arteriovenous fistula (PAVF) is known as an abnormal connection of congenital or acquired origin between an artery and a vein. PAVFs require surgical or interventional treatments to reduce left-to-right shunts and avoid cardiocerebral symptoms or life-threatening situations. We retrospectively investigated the surgical treatment of solitary PAVF. Materials and Methods: A total of 6 cases were diagnosed with solitary PAVF and underwent surgical resection between April 1999 and December 2007 in Kagawa University Hospital. They consisted of one male and five females with a mean age of 52.3 (range, 38 to 63). Four of the six cases were asymptomatic, and the remaining two showed symptoms (syncope, brain abscess, and stroke). In four of the six cases, thoracotomy approach was performed, whereas in two other cases, thoracoscopic approach was selected. One of the six cases received a segmentectomy, while the others received partial resection using simultaneous stapler/cutter. Results: All cases were successfully resected without complications. There were no relapsed cases. The feeding arteries showed a mean diameter of 6.5 mm, and the mean fistula diameter was 16.5 mm. The aberrant vessels were located at the surface of the pleura in five of the six cases, and were detected easily. The remaining one case underwent detection by ultrasonography. Conclusion: Although interventional treatment for PAVF has recently become the first choice, various complications and failure cases have been reported. When interventional treatment cannot be performed or more definitive treatment is required, a surgical resection should be selected for the treatment of solitary PAVF.
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  • —The influence of CT screening on clinical diagnosis—
    Shigeki Sawada, Eisaku Komori, Hiroshi Suehisa, Ryoichi Toyosaki, Taka ...
    2008 Volume 22 Issue 7 Pages 992-996
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    Objective. In some cases of lung cancer, it is difficult to obtain a histological diagnosis with bronchoscopy or computed tomography (CT)-guided needle biopsy. In 1999, CT screening was started in our area, and the rate of detection of indeterminate lung nodules has increased. In practice, when CT findings are highly suggestive of lung cancer, resection is often performed without a histological diagnosis. In this study, indeterminate rates for total lung cancer related to resection were evaluated. Rates of benign disease for indeterminate cases were also evaluated. Methods. A retrospective study. A total of 1039 patients diagnosed with lung cancer or suspected lung cancer underwent resection between 1997 and 2005. In 516 patients, a histological diagnosis was not obtained preoperatively. CT screening was initiated in 1999 in our area. Indeterminate rates and reasons for the lack of a preoperative histological diagnosis were compared before and after the initiation of CT screening. The postoperative histology was reviewed, and the accuracy of the preoperative diagnosis was evaluated. Results. Before the initiation of CT screening, the indeterminate rate was approximately 28 %. After the initiation of CT screening, the indeterminate rate has increased to approximately 55 %, and the major reason for indeterminacy was that the tumor was too small for bronchoscopy or CT-guided needle biopsy. Of the 516 patients, postoperative histological examination demonstrated benign disease in 69 (13.4 %). The rate of benignity showed a decreasing tendency during the study period. Conclusion. The initiation of CT screening has increased the preoperative indeterminate rate. Some unnecessary resections for benign diseases were performed. However, the accuracy of diagnosis has improved due to change of our strategy for small nodules.
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  • Shigeo Toda, Tadasu Kohno, Mingyon Mun, Tomoaki Yoshiya
    2008 Volume 22 Issue 7 Pages 997-1000
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    Although chest tube drainage is performed after every thoracic surgery in most institutions, we don't perform chest tube placement after VATS (video-assisted thoracic surgery) for mediastinal tumor without lung resection. From November 1999 to October 2005, 111 patients underwent VATS for mediastinal tumor in our hospital. Indications for chest tube placement are simultaneous lung resection, risk of postoperative bleeding, and pleural effusion requiring drainage. We didn't leave the chest tube in 100 out of 111 patients. One patient required chest tube drainage after surgery because of lung collapse. No complications were observed in the other patients. In conclusion, chest tube placement after VATS for mediastinal tumor is not necessary in selected patients.
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  • Eiji Okura, Hyun-Eun Yoon
    2008 Volume 22 Issue 7 Pages 1001-1006
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is used to differentiate malignancy from benignity, determine the disease stage, and evaluate the response to treatment in cancer patients. Recently, the number of reports concerning the use of FDG-PET for diagnosing the postoperative recurrence of malignant tumors is increasing. We found FDG-PET to be useful for detecting the postoperative recurrence of lung adenocarcinoma in the thoracic wall. The patient was a 67-year-old man who underwent right upper lobectomy with ND2 dissection to treat adenocarcinoma (p-T1N0M0) in 2004. Twenty-three months after surgery, the carcinoembryonic antigen level rose to 14.6 ng/ml. Systemic examinations revealed neither recurrent tumor nor double cancer. However, FDG-PET revealed the accumulation of radioactivity in the Th2 right paravertebra. Chest computed tomography was performed, and a thoracic wall tumor was detected in the same place. Thirty-three months after the first surgery, a second surgery to resect the tumor of the chest wall was performed, in 2006. We diagnosed this tumor as a local recurrence. FDG-PET appears to be useful for detecting the postoperative recurrence or metastasis of non-small cell lung carcinoma.
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  • Tsuneo Hirayasu, Tomonori Furugen, Tadahiro Uehara, Tomofumi Yohena, T ...
    2008 Volume 22 Issue 7 Pages 1007-1011
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    A 47-year-old woman was admitted on feeling a swelling on her left precordium. Chest CT revealed a 3×6 cm mass on the posterior surface of the pectoralis major muscle. Because perioperative frozen-section diagnosis revealed a desmoid tumor, we resected the tumor including the pectoralis major muscle, pectoralis minor muscle, and the periosteum of the clavicle where the tumor was in contact. Two years later, computed tomography (CT) revealed a mass with a growth tendency in the vicinity of the previously resected site, and the patient underwent reoperation with a diagnosis of recurrent desmoid tumor. The tumor showed invasive growth extending close to the axillary region and brachial plexus. To prevent nerve injury, we resected the tumor as much as possible and additionally performed radiation therapy after surgery. There was no evidence of recurrence 3 years and 8 months after reoperation. Although complete resection is important for the surgical management of desmoid tumors, it seems necessary to select the treatment option of resecting the tumor as much as possible in combination with other therapeutic modalities in cases where complete resection may lead to a significant deterioration of the postoperative quality of life, as in the present case.
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  • Masahiko Takata, Yoshihumi Miyamoto
    2008 Volume 22 Issue 7 Pages 1012-1016
    Published: November 15, 2008
    Released: June 04, 2009
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    Traumatic fracture of the sternum is rare among traumatic bone fractures. Most sternum fractures are managed nonoperatively. Surgical treatment is indicated for chest pain associated with dislocation. In the course of conservative management of sternal fractures, we have rarely experienced nonunion. Sternal nonunion is usually reported after sternotomy for cardiac surgery, but rarely after blunt chest trauma. Symptomatic sternal nonunion requires surgical treatment. We report the case of a 16-year-old male with traumatic sternal nonunion who was treated using a plate and autogenous bone graft. We select the “Locking Plate” (COMPACT 2.4 Plus, SYNTHESIS) to fix the sternum. The “Locking Plate” involves a type of mono-cortical fixation, so it is not necessary to protect the retrosternal tissue. Plating of the sternum, accompanied by autogenous bone graft, is an effective method of treating sternal nonunion.
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  • Takatoyo Kambayashi, Tomoko Irie, Hironobu Nakatsukasa, Yukio Takaki
    2008 Volume 22 Issue 7 Pages 1017-1021
    Published: November 15, 2008
    Released: June 04, 2009
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    A 60-year-old man was admitted to a local hospital because of fever and cough that had persisted for a month. He was diagnosed with pneumonia in the right lower lobe and underwent antibiotic administration. Despite treatment with antibiotics for about 3 weeks, the clinical symptoms and inflammatory reactions did not improve. Chest CT imaging and bronchofiberscopy was performed, yielding a pathologic diagnosis of adenocarcinoma of the lung, about 9 cm in diameter, in the right lower lobe. He was admitted to our hospital for the medical treatment of lung cancer and pneumonia. Five days after hospitalization, he experienced a sudden onset of right-sided chest pain, and chest CT imaging revealed a remarkable, thin-walled mass with marked central necrosis and a large increase in right pleural effusion. Perforation of the tumor and thoracic empyema were suspected. An operation (right middle and lower lobectomy) was performed the next day, because it was considered difficult to improve the condition without surgical excision. The inside and visceral pleura of the tumor lapsed broadly into necrosis, and perforation was noted at two sites in the visceral pleura.
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  • Toru Kawaoka, Gaku Fukamitsu, Katsuhiko Morita
    2008 Volume 22 Issue 7 Pages 1022-1026
    Published: November 15, 2008
    Released: June 04, 2009
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    A 75-year-old woman was admitted to our hospital for evaluation of an abnormal shadow found incidentally in the right upper lobe on chest CT. 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) revealed accumulation in the mass, and the standardized uptake value was 5.2, increasing on delayed scan. Right upper lobectomy was performed for the diagnosis and treatment, and the pathologic sample revealed pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. About 29 cases of pulmonary MALT lymphoma including our case have been reported with FDG-PET, and 25 of them showed accumulation. FDG-PET is sometimes useful for imaging pulmonary MALT lymphoma before and after treatment.
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  • Takehiro Sakai, Yuta Ogura, Daisuke Kimura, Takao Tsushima, Ikuo Fukud ...
    2008 Volume 22 Issue 7 Pages 1027-1032
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    A 68-year-old man receiving medication for hypertension was pointed out as showing an abnormal chest shadow. Cytological and histopathological examinations revealed adenocarcinoma of the left upper lobe. The stage of the lung cancer was evaluated as cT1N0M0, stage IA by preoperative radiological examinations. Chest radiography identified cardiomegaly, and the cardiothoracic ratio was 55 percent. An electrocardiogram showed incomplete right bundle branch block with a sinus rhythm. The patient underwent surgery by left thoracotomy under general anesthesia. When we started the operation at the hilum, bradycardia and ventricular extrasystole suddenly developed and led to cardiac arrest. Open chest massage and catecholamine injection led to the resumption of beating. The surgery had to be abandoned. Cardiac evaluation by echocardiography showed asymmetrical hypertrophy of the interventricular septum without disturbed cardiac function. The patient was diagnosed with hypertrophic non-obstructive cardiomyopathy. On the 44th postoperative day, left upper lobectomy with node dissection was successfully performed under general anesthesia by left thoracotomy after the introduction of a temporary pacemaker. The blood pressure and heart rate remained stable during surgery. Microscopic examination revealed an adenocarcinoma, and the final diagnosis of lung cancer was T1N2M0, stage IIIA. The postoperative course was uneventful, and the patient was discharged on the 21st postoperative day following the second surgery. Although 6 years have passed since surgery, the patient has remained free from cardiac events and the recurrence of lung cancer.
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  • Hironobu Wada, Chikabumi Kadoyama, Yuuichi Sakairi
    2008 Volume 22 Issue 7 Pages 1033-1037
    Published: November 15, 2008
    Released: June 04, 2009
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    A man in his thirties, who received medical treatment for schizophrenia in a mental hospital, was emergently brought to our hospital by ambulance because he ingested about 100 ml of kerosene in a suicide attempt at his home during temporary discharge. Although physical findings and an X-ray were normal at the first medical examination, chemical pneumonia due to kerosene aspiration was diagnosed 6 hours after admission because of the appearance of tachypnea, stridor, hypoxia, and infiltration of the right lower field. He received emergency treatment with a respirator and antibiotics. Infiltration of the right lung was reduced, but a 6 cm in diameter, tumorous shadow was left in the right middle lobe, so a right middle lobectomy was performed. He subsequently maintained a good condition and was transferred to the mental hospital 30 days after surgery. Surgical resection for lung abscess is seldom needed because of the success of medical therapy, but it can be an effective modality in selected cases.
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  • Yoshihiko Osaka, Mikio Watanabe, Takeshi Kikuchi
    2008 Volume 22 Issue 7 Pages 1038-1041
    Published: November 15, 2008
    Released: June 04, 2009
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    A 41-year-old male who was suffering from pulmonary disease caused by Mycobacterium abscessus (M. abscessus) is herein described. His chest radiographic findings showed a cavity lesion with a granular shadow in the right upper lung field. Acid-fast bacilli were noted in sputum specimens, and a M. abscessus was identified in a culture analysis. He was treated with IPM/CS, AMK, and CAM, and thereafter a right upper lobectomy was also performed. At twenty-four months postoperatively, no recurrence has been demonstrated. M. abscessus is a rare pathogen in Japan. We recommend that the M. abscessus should be treated as early as possible in order to avoid the occurrence of extensive lung damage.
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  • Hitoshi Igai, Tatsuo Nakagawa, Keiji Ohata, Tomoaki Matsuoka, Kotaro K ...
    2008 Volume 22 Issue 7 Pages 1042-1045
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    The patient was a 56-year-old woman. Seven years ago, partial resection of the liver was performed for hepatic MALToma. In 2007, chest computed tomography (CT) revealed that multiple nodular shadows in the left upper lobe had grown compared with 2 years previously. Additionally, F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) showed accumulation in the nodule, neck lymph node, and pharynx. Therefore, we suspected the relapse of MALToma. Because biopsy of the pharynx or neck lymph node was technically difficult, left S1+2, S3 segmentectomy under video-assisted thoracic surgery (VATS) was performed to confirm the diagnosis and plan treatment. The immunohistologic sample revealed pulmonary MALToma. MALToma is a rare disease. Although MALToma shows a comparatively good prognosis, we must follow-up patients closely to check for relapse or metastasis, in spite there being an interval of several years.
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  • Tomomi Murata, Isao Matsumoto, Tsuyoshi Yachi, Syuhei Yoshida, Makoto ...
    2008 Volume 22 Issue 7 Pages 1046-1049
    Published: November 15, 2008
    Released: June 04, 2009
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    An eighty-year-old female underwent hysterectomy and bilateral ovariectomy for uterine endometrial stromal sarcoma and ovarian cysts at another hospital ten years previously. Chest X-ray showed a nodule of 2.5 cm in diameter in the right upper lung field. Chest CT scan revealed a nodule of 2.5 cm in diameter in the right S3 of the lung. PET identified an abnormal accumulation of FDG at the nodule site, so a malignant tumor was suspected. The patient underwent right upper lobectomy of the lung, and the nodule was diagnosed as metastasis of the endometrial stromal sarcoma. We report a rare case of lung metastasis presenting 10 years after uterine endometrial stromal sarcoma.
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  • Yoshitaka Kasai, Daiki Masuya, Naoki Magono, Harukazu Yoshimatsu, Yuji ...
    2008 Volume 22 Issue 7 Pages 1050-1054
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    A 22-year-old man was admitted to our hospital with an abnormal shadow on a chest X-ray. Computed tomography scan revealed a mass shadow with a clear margin, approximately 4 cm in diameter, in the right lower lobe. Bronchoscopy revealed an endobronchial tumor almost completely occluding the orifice of the right B10a. A biopsied specimen of the tumor led to a diagnosis of adenocarcinoma. A right lower lobectomy and LN dissection was performed. The solid tumor was 40×30×30 mm in size and obstructed the right B10a, with mucoid impaction. Histologically, the tumor was a low-grade malignant mucoepidermoid carcinoma. This case is of interest because it originated in the peripheral bronchus, and massive mucoid impaction was seen. We also reviewed the clinical features of 39 cases under the age of 30 years reported in Japan.
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  • Naoki Watanabe, Toshiyuki Waku
    2008 Volume 22 Issue 7 Pages 1055-1060
    Published: November 15, 2008
    Released: June 04, 2009
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    A 44-year-old woman was referred to our institution with superior vena cava (SVC) syndrome and a huge mass in the left breast. US-guided CNB from the breast was consistent with invasive ductal carcinoma. Firstly, we diagnosed the mediastinal mass as lymph node metastasis of the breast cancer. Primary systemic chemotherapy (q1w paclitaxel followed by q3w cyclophosphamide, 5- fluorouracil, and epirubicin) was performed, and radiation therapy applied to the mediastinum was started concurrently. After chemotherapy, the breast cancer showed a complete clinical response, and the opacity of the mediastinum remained unchanged. The breast cancer and mediastinal mass showed marked differences in drug sensitivity, and so we doubted the synchronous existence of double malignancies. We performed radical resection of the mediastinal tumor, and the mass was diagnosed pathologically as Type B3 thymoma.
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  • Ryoji Onari, Tatsuya Okimoto, Atsuo Kimura, Tsuneo Okumichi
    2008 Volume 22 Issue 7 Pages 1061-1066
    Published: November 15, 2008
    Released: June 04, 2009
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    The coexistence of pulmonary tuberculosis and lung cancer occurs at a high rate on reviewing epidemiological studies, but their differential diagnosis is difficult in radiology. A 56-year-old man with active pulmonary tuberculosis was treated by antituberculous chemotherapy with INH, RF, and EB. After the initial chemotherapy for nine months, abnormal, streaky shadows over the bilateral lungs on chest X-ray were decreased or disappeared. However, a nodular shadow with a cavitation on segment 5 in the left upper lobe of the lung was enlarged. For a definitive diagnosis, exploratory thoracotomy was performed. By lung biopsy, pulmonary squamous cell carcinoma was diagnosed, and we subsequently performed upper lobectomy (ND2a). In the management of active pulmonary tuberculosis, physicians should perform frequent chest imaging follow-up and assessment considering lung cancer. For a definitive diagnosis, exploratory thoracotomy should be carried out promptly.
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  • Hisao Mizutani, Kouichi Kayano
    2008 Volume 22 Issue 7 Pages 1067-1071
    Published: November 15, 2008
    Released: June 04, 2009
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    We report a patient showing an initial episode of primary spontaneous pneumothorax occurring bilaterally and simultaneously, which is rare in young females, treated with an immediate VATS bullectomy. The patient was a premenarcheal 14-year-old girl. Human growth hormones had been prescribed by another physician to improve her short stature. One month before admission, she experienced chest pain, which improved without any medication. She presented to her physician with a 4-day history of coughing, was diagnosed with bilateral pneumothorax, and was referred to our hospital. A chest radiograph obtained on admission showed collapsed lungs of Kircher class III on the right and class II on the left. On the same day, we performed bilateral chest tube drainage. One day later, chest CT-scan was conducted after a chest radiograph confirmed that both lungs had re-expanded. It revealed bilateral lung bullae which were limited to the apex, but no evidence of diffuse lung disorders. She was diagnosed with primary spontaneous pneumothorax, and, on the third hospital day, bilateral VATS was performed with the patient in the lateral position. Pathological examination of the resected lung specimens revealed subpleural bullae and emphysematous changes in adjacent lung parenchyma. The chest tubes were removed one day after the operation, and she was discharged on the fourth postoperative day.
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  • Hideki Ichinari, Kazuhiko Mine, Yuji Taneda, Fumiaki Kawano, Koichiro ...
    2008 Volume 22 Issue 7 Pages 1072-1076
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    A 63-year-old male was admitted to our hospital because of an abnormal finding on chest radiography. Chest X-ray films and a chest CT scan showed a tumorous lesion of 6.6 cm in diameter in the right upper lobe. Right upper lobectomy was performed with video-assisted thoracoscopic surgery. It was a grossly gelatin-like tumor and histologically mucinous cystadenocarcinoma. Because mucinous cystadenocarcinoma of the lung is of low-grade malignancy and difficult to diagnose as malignant preoperatively, it is recommended to perform lung resection with VATS. We report this unusual case, with a review of the Japanese literature.
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  • Yasunori Shikada, Satoshi Kaneko
    2008 Volume 22 Issue 7 Pages 1077-1079
    Published: November 15, 2008
    Released: June 04, 2009
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    A 77-year-old man was diagnosed with prostatic carcinoma. Chest CT examination revealed a 10 mm nodular shadow in S10 of the left lung, suggestive of a metastatic lung tumor. Because the staging of prostatic carcinoma was necessary, partial resection of left lung was performed under thoracoscopic surgery. The tumor was a well-demarcated granuloma with coagulation necrosis. Worm of Dirofilaria immitis was identified in the pulmonary artery. Finally pulmonary dirofilariasis was diagnosed. Because the final diagnosis was only possible based on histological evidence from a resected specimen, thoracoscopic surgery is a very useful method.
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  • Akihiro Ohsumi, Yuki Teranishi, Syoji Kitamura, Miyuki Nagasawa, Toru ...
    2008 Volume 22 Issue 7 Pages 1080-1083
    Published: November 15, 2008
    Released: June 04, 2009
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    We report the rare case of a clear cell tumor of the lung. A 60-year-old woman with a round and well-marginated nodule in the S3 of the right lung underwent thoracoscopic, partial resection. Histopathological specimens of the resected tumor revealed cells with an abundant, clear cytoplasm containing glycogen, and were supported by sinusoid-type vessels. Immunohistochemically, the tumor was positive for PAS, Melan A, and negative for HMB-45, being diagnosed as a clear cell tumor of the lung.
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  • Toshihiko Waku, Naoki Watanabe
    2008 Volume 22 Issue 7 Pages 1084-1087
    Published: November 15, 2008
    Released: June 04, 2009
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    A 71-year-old man with a previously identified azygos lobe was admitted to another hospital due to right spontaneous pneumothorax. Because the lung had still not expanded after a period of six days of medical management, the patient, showing a progressively worsening pneumomediastinum which might cause tachycardia, low blood pressure, and severe dyspnea due to the compression of blood vessels and the trachea was referred to our hospital. Emergency video-assisted thoracoscopic surgery (VATS) was attempted. VATS showed severe pleural adhesions between the azygos lobe and mediastinal pleura, and pneumothorax and pneumomediastinum due to an air leak from a bulla in the azygos lobe. VATS led to technical difficulties, and so it was necessary to convert to thoracotomy. After dissection of the adhesions, bullectomies were performed. Preoperative awareness of the exact course of the azygos vein and the azygos lobe facilitated by chest computed tomography (CT) was useful for the safe VATS procedure and insertion of a chest drain. With pleural adhesion in an azygos lobe, the VATS procedure might involve surgical risks as well as technical difficulties, and it may be necessary to convert to thoracotomy.
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  • Shigeru Nakane, Akinori Akashi, Kenjiro Fukuhara, Emiko Tomita
    2008 Volume 22 Issue 7 Pages 1088-1093
    Published: November 15, 2008
    Released: June 04, 2009
    JOURNALS FREE ACCESS
    We report a granular cell tumor (GCT) that arose from the trachea extending to the left main bronchus. A 40-year-old male presented with pneumonia. Chest CT scan findings revealed an intratracheal polypoid tumor invading the posterior mediastinal tissue. Fiberoptic bronchoscopy showed a tumor extruding from the trachea into the left main bronchus, which was shown to be a GCT from biopsy findings. After evaluating the extension of the tumor using preoperative chest CT 3-D reconstructive images, the mass was completely resected by a tracheo-bronchial wedge resection. The tumor, which measured 30×23×17 mm, had extended in an extraluminal direction from the muscular posterior wall of the trachea and bronchus, though no adjacent tissue was invaded. GCTs, regarded as benign tumors originating from Schwann cells, rarely arise in the area of the trachea and main bronchus. Since occurrences at multiple sites and relapses have been reported, patients require long-term follow-up.
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