The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 23 , Issue 6
Showing 1-24 articles out of 24 articles from the selected issue
  • Masafumi Noda, Hisashi Oishi, Sumiko Maeda, Takeshi Oyaizu, Tetsu Sado ...
    2009 Volume 23 Issue 6 Pages 788-791
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    The subjects of this study were 10 cases with chondrosarcoma of the chest wall surgically treated by resection in our hospital between 2000 and 2008. The primary site was the rib in 8 and sternum in 2 cases. In cases of rib origin, while 3 were confined to the primary site, invasions to the vertebral body or diaphragma were encountered in 4 and 1, respectively. Chest wall reconstruction was carried out in 9 cases. The surgical margins were wide in 7 and marginal in 3 cases. Fatal postoperative complication was experienced in one case. Three of 10 patients experienced recurrence within 3 years, of these, one showed local recurrence, and two showed multiple lung metastases. All these were cases receiving marginal resection. The three year disease-free survival rate was 66.7% for all patients. Early detection and early surgical treatment to ensure a sufficient margin on surgery are essential for complete resection. In addition, not only wide resection but also postoperative adjuvant chemo (+radio) therapy is likely to be important to improve survival in cases showing a high-grade malignant pathology.
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  • Shigeharu Moriyama, Hiromasa Yamamoto, Kentaroh Miyoshi
    2009 Volume 23 Issue 6 Pages 792-797
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    We analyzed patient profiles and therapeutic outcomes in 9 cases of postoperative bronchopleural fistula encountered in our hospital between January 1995 and December 2007. The mean patient age was 67.4 years (range, 58-73 years). All patients were male. Primary diseases on initial operations were pulmonary cicatrization in 1 patient and primary lung cancer in 8. The incidence of postoperative bronchopleural fistula among primary lung cancer patients was 1.3% for all anatomical pulmonary resections, 7.7% for left pneumonectomy, and 6.1% for right lower lobectomy. Right lower lobectomy showed a significantly higher risk compared with other lobectomies (p<0.001). Especially in right lower lobectomy, cutting of the right bronchial artery was suggested to be one of the causes of bronchopleural fistula. Postoperative bronchopleural fistulas occurred after 2-3 weeks in 7 of the 9 patients, and after one month in the other 2. The fistula was successfully treated by bronchofiberscopic occlusion in 1 patient. While the first re-operation combined with pedicled omentopexy was successful in 4 patients, the remaining 4 patients unsuccessfully underwent only primary closure of the bronchofistula or additional lobectomy. Three of these 4 patients finally achieved successful closure on the second re-operation with pedicled omentopexy. One patient finally showed failed closure of the fistula. Four patients developed postoperative MRSA pneumonia, with 3 of these patients dying of subsequent ARDS. One patient recovered from MRSA pneumonia and was discharged. The mortality rate was 33.3% for all cases and 37.5% for the 8 re-operated cases. Re-operation should be performed in the early stage of postoperative bronchopleural fistula, before pyothorax becomes advanced. Pedicled omentopexy is a useful procedure and should be applied in the first re-operation, if available. Postoperative pneumonia is a fatal complication of this condition and must be managed as a priority.
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  • Kenji Misawa, Osamu Mishima, Morihisa Kitano
    2009 Volume 23 Issue 6 Pages 798-801
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    We studied 43 cases of primary spontaneous pneumothorax managed using a portable thoracic drainage kit (Thoracic Egg®, Sumitomo Bakelite Company Limited, Tokyo, Japan) at our institution between March 2007 and September 2008. Ages were between 13-69 years (mean: 33), with 32 males, 11 females, 18 right-sided, 25 left-sided, 27 with no prior history, and 16 recurrences. Seventeen cases were treated by outpatient visits only. Eighteen cases required surgical intervention for persistent air leaks or recurrences. No cases required the use of continuous suction drainage or replacement with a larger bore trocar catheter, but one case required replacement due to obstruction of the catheter by kinking. Two accidental decannulations did not result in lung collapse and were not replaced. We believe Thoracic Egg® is useful for outpatient drainage and the management of primary spontaneous pneumothorax. We found that inserting a three-way stopcock between the catheter (9Fr) and drainage bottle facilitated the straightforward confirmation of pulmonary fistulae, and allowed for the drainage of large volumes without concern over catheter obstruction.
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  • Hideyuki Nishi, Kazuhiro Washio, Masayuki Mano, Nobuyoshi Shimizu
    2009 Volume 23 Issue 6 Pages 802-806
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    Methods: Between 1993 and 2008 in our institution, 24 patients with malignant pleural mesothelioma underwent extrapleural pneumonectomy. We evaluated 10 patients with recurrence. Results: There were 9 males and 1 female. The median age was 62.3 years (range, 54 to 75 years). The histology was epithelioid in 7, sarcomatoid in 2, and biphasic in 1. There were 8 patients with clinical stage II and 2 patients with stage III. There were 2 patients with pathological stage II and 8 patients with stage III. Two patients received adjuvant chemotherapy and one patient radiation therapy after extrapleural pneumonectomy. The median time to first failure was 8.5 months (range, 1 to 17 months). The sites of initial recurrence were local in 8 patients and distant in 2. All patients received chemotherapy after the diagnosis of recurrence (regimens consisted of pemetrexed in 3 patients and gemcitabine in 7). The median disease-free survival period of 24 patients was 13.2 months, and that of 10 patients with recurrence was 7.0 months. The median survival from recurrence was 9 months. Conclusion: The most common site of recurrence was the ipsilateral hemithorax. Future strategies should investigate methods of enhancing local tumor control.
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  • Kohei Ando, Tekkan U, Takahiro Omori, Michihiko Tajiri, Takashi Ogura
    2009 Volume 23 Issue 6 Pages 807-811
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    A 58-year-old woman, incidentally shown to have a right-sided spontaneous pneumothorax on chest radiograph at a medical check-up, visited our hospital. She had a previous history of surgery for left-sided spontaneous pneumothorax, and her sister and two brothers had experienced spontaneous pneumothorax. Chest CT scan showed multiple cystic changes of the bilateral lungs. She had some acrochordons and some suspected lesions of fibrofolliculomas on the face. We associated the above findings with Birt-Hogg-Dube (BHD) syndrome. We performed an operation to treat her pneumothorax, detected a 2-cm bulla on the bottom of the lung which was suspected to be the cause of this pneumothorax, and resected the bulla employing video-assisted thoracic surgery. After the operation, we finally diagnosed her illness as BHD syndrome with DNA sequence analysis of her BHD gene. BHD syndrome is an autosomal dominant dermatosis, and it sometimes accompanies multiple lung cysts, spontaneous pneumothorax, and renal tumors. When a patient shows multiple lung cysts and has a family history of pneumothorax, BHD syndrome should be borne in mind.
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  • Akihiko Kitami, Yoshito Kamio, Ryozo Gen, Shugo Uematsu, Hiroaki Nakaj ...
    2009 Volume 23 Issue 6 Pages 812-815
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    A 37-year-old woman was admitted to our hospital to investigate the cause of recurrent respiratory infection. Chest CT revealed the presence of an anterior mediastinal tumor and disseminated lesion in the left pleural space. Biopsy of the mediastinal tumor disclosed type B2 thymoma. Blood examination demonstrated hypogammaglobulinemia. The patient was diagnosed with immunodeficiency associated with stage IV A thymoma (Good's syndrome). Two courses of modified ADOC chemotherapy (nedaplatin, doxorubicin, vincristine, and cyclophosphamide) was administered. Although chest CT revealed regression of the mediastinal tumor and intrapleural disseminated lesions, a bilateral interstitial infiltrative shadow caused by pneumocystis pneumonia developed after chemotherapy. The patient received radiotherapy twice for the recurring lesion of the mediastinum and left pleura at the outpatient clinic. Although pneumocystis pneumonia was a complication after the second round of radiotherapy was administered to the patient, her condition improved after the administration of sulfamethoxazole/trimethoprim and prednizolone.
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  • Hiroyuki Tao, Junichi Komoto, Takahiro Oto, Masaomi Yamane, Shinichi T ...
    2009 Volume 23 Issue 6 Pages 816-820
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    We report the case of a solitary bronchial papilloma with middle lobe syndrome that was speculated to be a hilar malignant tumor on 18F-deoxyglucose positron emission tomography (FDG-PET). A 66-year-old woman was referred to our hospital complaining of a continuous productive cough. Computed-tomography of the chest showed a right hilar mass and consecutive bronchial tumor with heterogeneous enhancement. The bronchial tumor and hilar mass were FDG-PET-positive, with a maximum standard uptake value of 10.6, suggesting a malignant neoplasm. Bronchofiberscopic tumor biopsy was repeated twice, but only suggested atypical squamous epithelium. An open biopsy of the bronchial tumor through a right thoracotomy was conducted, and intra-operative frozen sectioning of the bronchial tumor led to a diagnosis of papilloma. Then, a right middle sleeve-lobectomy was performed. The right hilar mass turned out to be mucopurulent secretions filling, obstructing, and dilating the right middle bronchus. The pathological diagnosis was mixed squamous cell and glandular papilloma. The patient is doing well without any signs of recurrence one year after the operation. It is important to note that bronchial tumors with obstructive pneumonia can present hilar cancer-like findings on FDG-PET.
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  • Isao Sano, Hiroyuki Minami, Keitarou Matumoto, Sigeyuki Morino, Gou Ha ...
    2009 Volume 23 Issue 6 Pages 821-825
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    The case was a 32-year-old female. A chest CT, obtained while the patient visited our hospital for the treatment of urolithiasis, revealed an opacity in the right lung. Thoracoscopic partial resection of the lung was performed, and the postoperative examination of permanent sections revealed an atypical carcinoid. After about 2 weeks, right middle lobectomy, ND2a, was performed. The pathological staging was pT1N2M0 stage IIIA. The postoperative course was uneventful. However, hypercalcemia, an elevated level of intact PTH, and swelling of three parathyroid glands were noted, suggestive of primary hyperparathyroidism, and surgery was performed. The pathological diagnosis was parathyroid hyperplasia. Multiple endocrine neoplasia type 1 was suspected, and gene screening was carried out. As a result, a mutation in exon 4 of the MEN1 gene was identified, allowing a definitive diagnosis. It is relatively rare for multiple endocrine neoplasia type 1 to be associated with pulmonary carcinoid, and so this case is reported with a review of the literature.
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  • Aki Kuroda, Setsuyuki Ootake
    2009 Volume 23 Issue 6 Pages 826-832
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    A 67-year-old male who had received extraperiosteal paraffin plombage 34 years previously showed a low-level fever and expectoration of paraffin. He was diagnosed with left pneumonia due to perforation of the plombage cavity based on examinations and imaging findings, and underwent an operation. We found it difficult to separate the plombage cavity, ribs, and left upper lobe due to strong adhesion, and so resected the plombage space with the left upper lobe. Pathological findings showed the absence of perforation. His symptoms resolved, and he was discharged from the hospital on postoperative day 21. It remains a possibility that such patients developing late complications of extraperiosteal paraffin plombage will seek medical treatment in the future.
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  • Hiroyuki Adachi, Takamitsu Maehara, Akiko Shotsu, Kouhei Ando, Kazuhir ...
    2009 Volume 23 Issue 6 Pages 833-837
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    A 27-year-old pregnant woman at the 19th gestational week developed spontaneous pneumothorax. Chest tube drainage was performed, but her course was unfavorable. At the 21st gestational week, thoracoscopic surgery was performed. The postoperative course was uneventful, and she was discharged on the 3rd postoperative day. Thereafter, she experienced no recurrence of the pneumothorax, and delivered a healthy baby. Some reports state that pneumothorax occurring during pregnancy should always be treated conservatively. However, we think we should perform thoracoscopic surgery in the case of recurrence or prolonged air leakage, because there is a risk of recurrence on delivery and prolonged drainage-related infection.
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  • Motoki Matsuura, Toshiya Fujiwara, Kazuhiko Kataoka, Noritomo Seno
    2009 Volume 23 Issue 6 Pages 838-842
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    We experienced and report 2 cases of bronchopleural fistula after right pneumonectomy closed with an omental pedicled flap, because bronchopleural fistula after pneumonectomy is a serious postoperative complication, being necessary to perform appropriate and immediate treatment. Case 1, a 78-year-old man with diabetes mellitus, underwent right sleeve pneumonectomy, as pleomorphic carcinoma and metastatic lymph nodes invaded widely from the right main bronchus through to the middle trunk. On the 16th postoperative day, we treated dehiscence of the bronchial anastomosis using an omental pedicled flap to close the fistula following thoracotomy and laparotomy. Case 2, a 59-year-old man, underwent right pneumonectomy with excision of the left atrium simultaneously under extracorporeal circulation. This tumor was squamous cell carcinoma. A similar surgery was performed eight months after the operation because pyothorax and bronchopleural fistula developed as complications while undergoing outpatient chemotherapy. Bronchial fistula relapses easily following one-step suture and closure because the surroundings of the bronchial edge and fistula have already fallen into the blood flow obstruction. As the omentum has an anti-inflammatory action and improves the local blood flow of the bronchial wall, this procedure to use the omental pedicled flap directly was straightforward and very useful for the closure of the bronchial fistula.
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  • Akihiro Ohsumi, Toru Tanaka, Masatsugu Hamaji, Yuki Ohsumi
    2009 Volume 23 Issue 6 Pages 843-848
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    Carinal reconstruction necessitates significant care in cases with chronic lung infection. Herein, we present a patient who underwent wedged carinal pneumonectomy for a left main bronchus carcinoid tumor with a chronically infected, destroyed lung. A 63-year-old female had a history of bronchiectasis for over 30 years. Her left lung showed signs of repeated pneumonia. Videobronchoscopy revealed total obstruction of the orifice of the left main bronchus by a carcinoid tumor. After withdrawing massive sputum by suction through a fiberoptic bronchoscope, extrapleural wedged carinal pneumonectomy and carinal reconstruction were performed. There was no postoperative complication. The sufficient control of overflowing sputum and careful extrapleural dissection were effective procedures for avoiding complications in carinal reconstruction of a chronically infected lung.
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  • Yasuko Hosaka, Yasushi Yamato, Katsuo Yoshiya, Teruaki Koike
    2009 Volume 23 Issue 6 Pages 849-853
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    A 52-year-old woman was admitted to our hospital with the diagnosis of an unenhanced middle mediastinal tumor on the right side of the heart and enlargement of the superior vena cava (SVC) as an incidental finding on a chest and abdominal CT during an examination for abdominal pain. We performed a thoracoscopic biopsy of the tumor, which was hemorrhagic and was present from the lower part of the SVC to the top of the diaphragma. The tumor was diagnosed as cavernous hemangioma according to the pathological examination. The incidence of mediastinal hemangioma is less than 0.5% of all mediastinal tumors, and middle mediastinal hemangioma is very rare. Therefore, we herein report this rare case of middle mediastinal hemangioma with enlargement of the SVC.
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  • Keiji Ohata, Norihito Okumura, Mamoru Takahashi, Akihiko Yamashina, To ...
    2009 Volume 23 Issue 6 Pages 854-860
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    We experienced 2 cases of segmentectomy for anomalous systemic arterial supply to normal basal segments of the lung by video-assisted thoracoscopic surgery (VATS). Segmentectomy conserving the normal lung area enabled preservation of the respiratory function with radical cure. The VATS procedure with minithoracotomy was minimally invasive and appropriate for safety. Case 1: A 29-year-old female was diagnosed with an anomalous systemic arterial supply to normal basal segments of the lung, and the aberrant artery distributed to the basal segments of the left lower lobe. Left basal segmentectomy was performed by VATS. Case 2: A 36-year-old female was diagnosed with an anomalous systemic arterial supply to normal basal segments of the lung, and the aberrant artery was supplying the right S9 and S10. Right S9+S10 segmentectomy was performed by VATS.
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  • Tatsuhiko Ikeda, Hirohisa Horinouchi, Hideo Morioka, Hiroo Yabe, Yuich ...
    2009 Volume 23 Issue 6 Pages 861-865
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    Case 1: A 79-year-old woman complained of chest pain of her anterior chest wall. Chest CT showed a tumor surrounding the sternum. Tumor biopsy revealed metastasis of ovarian cancer. Anterior chest wall resection including the mid-part of the sternal body and anterior parts of the bilateral second and third ribs was performed as well as partial resection of the right upper lobe, followed by chest wall reconstruction. Case 2: A 58-year-old man was referred to our hospital for the treatment of thoracic vertebral, sternal, and pelvic metastases of thyroid cancer. Surgical resection was chosen for the metastatic sternal tumor. Full thickness chest wall resection including resection of the manubrium of the sternum and partial resection of the bilateral clavicle and anterior part of the first and second ribs were performed, followed by chest wall reconstruction. In both cases, we used a titanium reconstruction plate and polypropylene mesh. Postoperative courses were uneventful, and flail chest was not observed. Reconstruction of the bony part of the anterior chest wall with the titanium reconstruction plate and polypropylene mesh was straightforward and effective for the resection area through selecting an adequately sized plate. This method provided sufficient rigidity as well as protection of the thoracic organs.
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  • Norihisa Ohata, Noriyasu Usami, Tetsuo Taniguchi, Takahiro Souma, Kohe ...
    2009 Volume 23 Issue 6 Pages 866-870
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    A 77-year-old man underwent a right upper sleeve lobectomy for lung cancer. He had a fever with dyspnea and hemoptysis on the sixth postoperative day. A chest radiograph showed an infiltrative shadow in the middle lobe, and fiberoptic bronchoscopic findings disclosed a stenosis of the middle lobe bronchus. Computed tomography with contrast medium demonstrated an absence of blood flow in pulmonary arteries and veins in the affected lobe, leading to a diagnosis of pulmonary lobar torsion. We emergently performed a right middle lobectomy on the seventh postoperative day. The middle lobe of the lung was twisted 45-degrees counterclockwise, with the appearance of a rotten, dark red mass. The pathologic diagnosis of the resected specimen was gangrene of the lung. For the early detection of pulmonary torsion, not only careful clinical observation and bronchoscopic examination but also enhanced CT with contrast material was useful. Although CT findings of the torsive lung include a consolidated lobe, bronchial obstruction or distortion, and an abnormal pulmonary vascular relationship, we emphasize the importance of the evaluation of pulmonary blood flow when pulmonary torsion is suspected.
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  • Yoshitaka Kasai, Daiki Masuya, Hirofumi Matsuoka, Harukazu Yoshimatsu, ...
    2009 Volume 23 Issue 6 Pages 871-874
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    A 53-year-old female who had undergone a total abdominal hysterectomy for uterine leiomyoma was admitted to our hospital with multiple nodules identified on a chest radiograph. A computed tomography scan revealed a nodule with a clear margin, approximately 15 mm in diameter, in the right S6, and multiple small bilateral nodules. FDG-PET revealed no accumulation in any nodule. Thoracoscopic biopsy was performed to facilitate a diagnosis. Histologically, the tumor was diagnosed as a benign metastasizing leiomyoma. We report a rare case of benign metastasizing leiomyoma successfully diagnosed by FDG-PET.
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  • Shoko Tanaka, Yuichi Ozeki, Hiroshi Hashimoto, Takefumi Nakayama, Tada ...
    2009 Volume 23 Issue 6 Pages 875-880
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    We report a case of multiple nodular pulmonary amyloidosis diagnosed by video-assisted thoracoscopic lung biopsy. A 64-year-old woman was admitted to our hospital because of an abnormal chest shadow. Chest radiograph and chest computed tomography (CT) on admission showed multiple nodules in the bilateral lung fields. 18F-FDG PET/CT demonstrated lesions with intense FDG activity, with a standardized uptake value (SUV) of 3.46. She underwent partial lung resection including the nodule with video-assisted thoracoscopic surgery. The pathological diagnosis was amyloidosis (type AL ramda), and we diagnosed her illness as multiple nodular pulmonary amyloidosis. She was subsequently diagnosed as having primary Sjögren's syndrome. Nodular pulmonary amyloidosis with Sjögren's syndrome is a very rare condition, and lung biopsy employing video-assisted thoracoscopic surgery is a useful and safe way to establish the diagnosis.
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  • Masanori Okada, Hiroyuki Tao, Masaomi Yamane, Takahiro Oto, Yoshifumi ...
    2009 Volume 23 Issue 6 Pages 881-885
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    A 74-year-old woman with chronic hiatus hernia of the mixed type was diagnosed with lung cancer and referred for surgery. After a lobectomy with lymphadenectomy, she presented tachycardia and medication-resistant, asthma-like dyspnea. Computed tomography of the chest revealed that the hiatus hernia had become aggravated and the protruding stomach was compressing the heart and left lung. Hernia repair was performed as an emergency surgery. Her cardio-pulmonary dysfunction recovered immediately after the operation. It is important to note that patients with hiatus hernia may possibly develop life-threatening cardio-pulmonary dysfunction after thoracic surgery. In such cases, hernia repair should be considered.
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  • Toshihiko Waku, Naoki Watanabe
    2009 Volume 23 Issue 6 Pages 886-890
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    A 59-year-old man was referred to our hospital for further examination regarding probable interstitial pneumonia detected in a company medical examination. Chest CT revealed interstitial pneumonia, and multiple angular pulmonary nodules in the subpleural region of the bilateral lung field. It was not possible to distinguish benign from malignant lesions based on chest CT findings preoperatively. Therefore, we performed thoracoscopic partial resection of the right lower lobe. The lung specimens showed pulmonary emphysema and fibrosis with interstitial pneumonia, and reactive intrapulmonary lymph nodes with anthracotic changes. Reactive intrapulmonary lymph nodes less than 1 cm in diameter result from exposure to inflammatory changes due to pneumonia after chemotherapy, bronchial asthma, and interstitial pneumonia, on condition that small intraparenchymal pulmonary lymph nodes naturally exist in peripheral regions distal from the fourth bronchial bifurcated level. Multiple angular pulmonary nodules resulting from exposure to inflammatory changes can not be distinguished from metastatic nodules based on chest CT findings preoperatively. Therefore, a pathological study with thoracoscopic partial resection is necessary and sure procedures to exclude malignant disease under the present conditions.
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  • Junji Ichinose, Tadasu Kohno, Sakashi Fujimori, Tomoharu Yoshiya
    2009 Volume 23 Issue 6 Pages 891-895
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    We report two cases of bilateral metastatic lung tumors of uterine leiomyosarcoma. (Case 1) In 1987, a 59-year-old woman underwent hysterectomy and was given a diagnosis of uterine leiomyosarcoma. In 1991, nodules in her right lung were pointed out. In 2002, following her consent, we performed VATS involving a right lower lobectomy and wedge resection of the right S2 and S3, and left S3 and S6. The seven tumors excised were verified to be lung metastases of uterine leiomyosarcoma. No evidence of recurrence was found during the 6-year postoperative follow-up period. (Case 2) A 47-year-old woman underwent hysterectomy with left oophorectomy. The lesion was diagnosed as leiomyosarcoma of the uterus. A chest CT taken 6 months after resection revealed multiple pulmonary nodules. She underwent VATS involving wedge resection of the right middle and lower lobes, and left upper and lower lobes. Two nodules were diagnosed as lung metastases of uterine leiomyosarcoma. There has been no sign of recurrence for 1 year since the operation. Simultaneous bilateral VATS for pulmonary metastases of uterine leiomyosarcoma is one of the effective treatment options.
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  • Hisashi Oishi, Tohru Hasumi, Yasuki Saito, Jiro Abe
    2009 Volume 23 Issue 6 Pages 896-900
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    The usefulness of video-assisted thoracoscopic surgery (VATS) for acute empyema has already been reported. Herein we report a case of successful VATS for acute empyema which extended into the retroperitoneal space. A 41-year-old homeless man was admitted to our institution with a complaint of back pain, lumbago, and dyspnea. Chest computed tomography (CT) demonstrated pleural effusion, with gas bubbles, in the right pleural cavity. Acute empyema was suspected. CT also showed an abscess of empyema extending into the retroperitoneal space. A chest tube was inserted and continuous suction drainage was started. However, CT revealed that the abscess remained in the right pleural cavity and retroperitoneal space. Curettage, drainage, and irrigation were performed by VATS. A fistula to the retroperitoneal space was identified in the back lower part of the pleural cavity, and copious purulent exudates were discharged from this fistula into the pleural cavity. The chest tube was removed on postoperative day 13, and the patient was discharged from the hospital on postoperative day 25. The patient achieved rehabilitation back into society and had experienced no recurrence of empyema at the 1-year follow-up. An appropriate procedure by VATS achieves satisfactory results in spite of severe cases of acute empyema.
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  • Koei Ikeda, Ichiro Kubota, Yasuhiro Hirotsu
    2009 Volume 23 Issue 6 Pages 901-904
    Published: September 15, 2009
    Released: December 14, 2009
    JOURNALS FREE ACCESS
    We report a case of diaphragmatic hernia seen as a late complication of video-assisted lung lobectomy. An 81-year-old woman underwent video-assisted lower lobectomy of the left lung for adenocarcinoma, which was 2.5 cm in diameter. Eleven months after surgery, she experienced nausea and vomiting, and chest radiograph and chest computed tomography revealed that the stomach had herniated into the left thoracic cavity. Surgery was performed 7 days after the symptoms first occurred. Posterolateral thoracotomy revealed 1,000 ml of bloody pleural effusion and adhesion of the stomach to the chest wall. We resolved the adhesion and reduced the stomach and greater omentum into the abdominal cavity. The hiatus in the central tendon of the diaphragm was sutured. The post-operative course was uneventful, and the patient maintains a favorable course without recurrence of either the lung cancer or diaphragmatic hernia.
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