The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 25 , Issue 6
Showing 1-22 articles out of 22 articles from the selected issue
  • Kenji Misawa, Yasunori Nishida, Satoshi Nishi, Osamu Mishima, Morihisa ...
    2011 Volume 25 Issue 6 Pages 586-588
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    Preoperative evaluation of lobulation between the upper and middle lobes of the lung is difficult on conventional CT scanning.
    We evaluated the degree of lobulation through our designed peripheral vessel depiction method on the basis of preoperative CT angiography in 15 patients who underwent right upper lobectomy from January to December 2010. The degree of lobulation between the upper and middle lobes was classified into 3: good, fair, and poor.
    In 3 of the 5 cases classified as good regarding lobulation, division of the minor fissures was unnecessary on surgery, while all of the 9 fair cases and 1 poor case required division of the fissures with Endo GIATM; the poorly lobulated case required a thicker staple.
    The results suggest that the preoperative evaluation of lobulation by employing the peripheral vessel depiction method is useful for lung surgery.
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  • Tohru Hasumi, Fumihiko Hoshi, Masaki Kawamura, Yasuki Saito
    2011 Volume 25 Issue 6 Pages 589-594
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    We performed an L- or reversed L-shaped mini-sternotomy combined with a supraclavicular approach for cervico-mediastinal tumor resection in three patients. In case 1, the tumor was a ganglioneuroma that originated from the left sympathetic trunk of the Th1, measuring 80×40×43 mm and located at the C7 to Th4 vertebral level. In case 2, the tumor was a neurofibroma that originated from the left sympathetic nerve, measuring 65×40×30 mm and located at the C7 to Th4 vertebral level. In case 3, the tumor was an intrathoracic goiter on the right side, measuring 75×40×40 mm and extending into the retrotracheal region at the level of the azygos arch. In all cases, an L-shaped mini-sternotomy was made at the tumor-side second intercostal space, without ligation of the internal thoracic vessels and opening the thoracic cavity. This combined approach, providing excellent exposure of the anterosuperior compartment of the mediastinum, was considered a safer and less invasive procedure for the resection of cervico-mediastinal tumors.
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  • Takayuki Imakiire, Toshiro Obuchi, Wakako Hamanaka, Yasuhiro Yoshida, ...
    2011 Volume 25 Issue 6 Pages 595-599
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    We reviewed 15 patients with pulmonary sequestration. Between 1994 and 2010, 15 patients (five males and 10 females, mean age of 27. 2 years old) with pulmonary sequestration were surgically treated at either of two hospitals. Clinical symptoms such as cough, fever, and hemoptysis led to a diagnosis in 13 patients, and the remaining two were incidentally diagnosed on radiograph as part of a health check. Preoperatively, aberrant arteries were identified by contrast-enhanced computed tomography (CT) in 11 cases, but not in 4 cases. Lung lobectomy was performed in 12 patients, segmentectomy in two, and resection of an extrapleural lesion in one; in 11 patients through open thoracotomy and in four using video-assisted thoracic surgery (VATS). In two of the four patients undergoing VATS, the surgical approach was converted from VATS to open thoracotomy because of thick adhesions or a large aberrant artery. Aberrant arteries were successfully occluded with a stapling device in eight patients, ligation-and-resection in six, and suturing in one case of a large aberrant artery. There was no morbidity and no mortality. In conclusion, three-dimensional CT is useful for detecting an aberrant artery in pulmonary sequestration cases, and a stapling device can be used for dividing the aberrant artery.
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  • Kotaro Mizuno, Osamu Kawano, Ichiro Fukai
    2011 Volume 25 Issue 6 Pages 600-603
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    (Objective) Postoperative aspiration pneumonia caused by miss-swallowing is a life-threating complication, especially in patients who undergo general thoracic surgery. In order to prevent postoperative aspiration pneumonia, the role of the swallowing support team (SST) has been examined for patients who underwent thoracic surgery. (Methods) We selected 39 cases out of 380 patients who underwent general thoracic surgery from April 2008 to August 2010. Thirty-nine cases fulfilled the following criteria, i) over 75 years old, ii) experiencing episodes of miss-swallowing in daily life, and iii) having an episode of cerebral infarction. (Results) Five patients were finally selected, who were treated with SST postoperatively. Two of the 5 cases improved on SST intervention, while the remaining 3 cases were not allowed oral intake. These 3 cases required enteral nutrition treatment. No postoperative pneumonia was present. (Conclusion) It is likely that SST intervention for groups at high-risk of miss-swallowing likely prevents life-threating postoperative aspiration pneumonia.
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  • Daisuke Masuda, Tatsuya Nishida, Katsuhiko Akiduki, Yoshimitsu Tei, Yo ...
    2011 Volume 25 Issue 6 Pages 604-610
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    Because of the difficulty in diagnosing small-sized peripheral lung lesions, pre-operative computed tomography (CT)-guided lung needle marking is performed before video-assisted thoracic surgery (VATS). However, percutaneous CT-guided marking is associated with several complications caused by thoracocentesis. The complications associated with thoracocentesis have already been reported, such as pneumothorax, intrapulmonary hematoma, and hemothorax. Air embolism following CT-guided marking is a rare complication, but efforts must be taken to avoid this complication because it is associated with serious sequelae and mortality. Therefore, we developed a new CT-guided marking method that did not involve thoracocentesis, and found that this method can be performed accurately and safely. After performing chest CT with a patient in the lateral position, we inserted an 18-gauge indwelling needle into the skin up to the parietal pleura above the pulmonary lesions, without causing centesis of the visceral pleura. Next, the external tube of the indwelling needle was placed in the chest wall. Subsequently, VATS was performed. Under one-lung anesthesia, a central vein catheter with guidewire was inserted into the thoracic cavity through the external tube using a double lumen tube with 3 thoracoports. The top of the catheter was equipped with a small staining stype (round-cotton), and the central venous catheter was pulled toward the chest wall. After conventional ventilation, the visceral pleura above the pulmonary lesions was found to be pigmented, and partial resection of the lung was performed. We confirmed the staining of the visceral pleura above small peripheral pulmonary lesions in a specimen. This method was useful for supplementary diagnosis because there were no complications associated with centesis of the visceral pleura.
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  • Yuichiro Ozawa, Shinji Kikuchi, Hideo Ichimura
    2011 Volume 25 Issue 6 Pages 611-614
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A 67-year-old woman presented to our hospital complaining of a feeling of food being stuck in her chest. A chest radiograph showed an elevation of the left diaphragm. Chest CT revealed the diaphragm eventration and incidentally detected a ground-glass opacity (GGO) with partial consolidation, 25 mm in diameter, in the left lower lobe. We planned a simultaneous surgical diagnosis of the GGO lesion and diaphragm plication. After the diagnosis of the GGO lesion as invasive lung adenocarcinoma by frozen sectioning, we performed a left lower lobectomy and mediastinal dissection. When we observed the abdominal lumen through an incision made in the diaphragm, we identified greater omentum adhesion of the diaphragm. Inspection of the abdominal cavity may prevent accidental injury of the abdominal organs attributable to diaphragm plication.
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  • Toshiya Fujiwara, Toshio Nishikawa, Kazuhiko Kataoka, Motoki Matsuura
    2011 Volume 25 Issue 6 Pages 615-620
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A 61-year-old woman was referred to our hospital with an abnormal chest shadow on a medical checkup. At the first medical examination, a tumor was noted in her bilateral conjunctiva. Chest CT showed an ill-defined multiple tumor shadow in the right lung. On positron emission tomography, the accumulation of fluorodeoxyglucose was observed in the pulmonary tumors and right parotid gland. Bronchoscopy revealed a normal bronchial surface. Brushing cytology examination suggested a malignant lymphoma. We performed video-assisted right upper lobectomy and partial resection of the right lower lobe for a definitive diagnosis. The pathologic diagnosis was MALT lymphoma in all specimens. The parotid gland tumor was resected and diagnosed as a MALT lymphoma. The patient was doing well 2 years after the operation without recurrence. Conclusion. We report herein a rare case of multiple MALT lymphoma of the lung, conjunctiva, and parotid gland, and provide a review of the literature.
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  • Tomohiro Nakajima, Atsushi Watanabe, Takuro Obama, Masahiro Miyajima, ...
    2011 Volume 25 Issue 6 Pages 621-625
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    We report a case of metastatic rib tumor of hepatocellular carcinoma. The patient presented with pain in the right thoracic area. Chest radiograph demonstrated a rib tumor. Chest CT showed a rib tumor protruding from the posterior portion of the right fourth rib. Abdominal CT revealed a hypervascular mass, which measured 40×32 mm, in the S6 of the liver in the arterial phase. The mass was washed-out in the delayed phase. The rib tumor was suspected to be metastasis from hepatocellular carcinoma. Partial extirpation of the fourth rib, fifth rib, and rib tumor was performed using VATS with a minithoracotomy and two ports. Histopathological study confirmed metastatic hepatocellular carcinoma. This study presents the usefulness of video-assisted thoracoscopic surgery (VATS) for posterior rib tumors.
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  • Kota Imashimizu, Toshiro Futagawa, Hironori Matsuzawa, Kenji Suzuki
    2011 Volume 25 Issue 6 Pages 626-629
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A 37-year-old woman developed spontaneous pneumothorax of the right lung in the 25th gestational week. We employed conservative techniques rather than surgery. The chest tube was replaced repeatedly to prevent infection. She delivered a healthy normal female infant on labor induction using an epidural anesthetic under chest drainage in the 37th gestational week. Video-assisted thoracoscopic bullectomy was performed 4 days after delivery. The postoperative course was uneventful, and she was discharged on the 7th post-operative day. We managed conservative techniques over 12 weeks without causing wound infection or empyema.
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  • Teppei Wakahara, Kazuya Uchino, Kenta Tane, Yugo Tanaka, Syunsuke Tauc ...
    2011 Volume 25 Issue 6 Pages 630-634
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A 63-year-old male was pointed out as showing an abnormal shadow on a chest radiograph. Chest CT showed a well-circumscribed mass in the anterior mediastinum. The tumor was suspected of being a solitary fibrous tumor on CT-guided needle biopsy. We performed resection of the tumor and pericardium, suspected of being invaded, by median sternotomy. The postoperative pathological diagnosis was dedifferentiated liposarcoma, and we performed postoperative chemotherapy. Dedifferentiated mediastinal liposarcoma is very rare. We report this case with a review of the relevant literature.
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  • Tatsuhiko Nishii, Takashi Muramatsu, Motohiko Furuichi, Hiroaki Morook ...
    2011 Volume 25 Issue 6 Pages 635-638
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A 31-year-old woman underwent a left lower lobectomy under a diagnosis of intralobar pulmonary sequestration. On the second postoperative day, the drainage fluid turned cloudy white, and a diagnosis of chylothorax was made by pleural effusions. As conservative treatment, oral intake cessation and peripheral parenteral nutrition were implemented for 10 days; however, chyle in pleural effusions was demonstrated on the 12th postoperative day. As conservative therapy was considered ineffective, she was started on a continuous subcutaneous infusion of octreotide on the 14th postoperative day. After starting the continuous infusion of octreotide, drain discharge was reduced. On day 6 of this treatment, removal of the drain was possible.
    The patient was discharged from the hospital on the 23th postoperative day. No recurrence was observed over the 6-month observation period.
    Recently, the usefulness of octreotide for refractory chylothorax has been reported. In cases of ineffective conservative therapy for chylothorax, octreotide is relatively safe compared to other therapies, and could be considered as one of the treatment options.
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  • Shinji Takeshita, Takashi Muramatsu, Mie Shimamura, Motohiko Furuichi, ...
    2011 Volume 25 Issue 6 Pages 639-642
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    We present a case of well-differentiated fetal adenocarcinoma. The patient was a 32-year-old female, experiencing cough symptoms from around November 2006. Chest radiography taken in January 2007 at a nearby clinic revealed a 20×25-mm tumor in the left middle lung field.
    She underwent bronchoscopic examination. However, a definitive diagnosis was not established, and she was referred to our hospital. With the preoperative diagnosis of a lung tumor, left lower lobectomy with ND2a was performed. The tumor was finally confirmed as a well-differentiated fetal adenocarcinoma (pT1N0M0, stage I a), which is rarely observed in Japan or internationally. Well-differentiated fetal adenocarcinoma is generally of low-grade malignancy, and patients have a favorable prognosis.
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  • Tomoharu Yoshiya, Tadasu Kohno, Sakashi Fujimori, Mingyon Mun, Junji I ...
    2011 Volume 25 Issue 6 Pages 643-648
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    Henoch-Schönlein purpura (HSP) is a systemic vasculitis, which occurs mostly in children. It also occasionally affects adults.
    A fifty-year-old man with advanced lung cancer (pathological findings showed adenocarcinoma, pT3N1M0: IIIA) had undergone resection of the entire left lower lobe and lingular segment with regional lymph nodes. He had been treated with antibiotics for postoperative pneumonia caused by a stricture of the left upper division bronchus. He was readmitted to our hospital complaining of palpitation, dyspnea, and left anterolateral chest pain. He was given a diagnosis of flaired postoperative pneumonia with intercostal neuralgia. His signs improved with antibiotics and nerve block. Several days after discharge, however, he was admitted again with a high fever, which resulted from the empyema associated with the postoperative pneumonia. In the course of the treatment, he suddenly developed severe abdominal pain and frequent diarrhea, with slight hemorrhage. Abdomino-pelvic computed tomography and abdominal ultrasonography ruled out bowel obstruction, and revealed thickened hemorrhagic infiltration in the small intestinal wall. A stool culture and toxin A test eliminated possible MRSA enteritis and pseudomembranous enterocolits. A few days later, the bilateral lower extremities swelled with purpura and arthralgia. Lower extremity Doppler showed no thrombus. Skin biopsy revealed leukocytoclastic vasculitis. We diagnosed the patient with HSP. His clinical symptoms improved with an oral corticosteroid after the fenestration of empyema. However, the patient developed 2+ hematuria and albuminuria with 6.17 g/day. His serum alubmin level was 2.1 g/dl. Based on renal biopsy, he was diagnosed with purpura nephritis, and steroid pulse therapy was initiated (methylprednisolone at 500 mg, intravenously, daily, for 3 days). His urinalysis improved, and he was discharged with an oral corticosteroid.
    The etiology of HSP is unknown. It is hypothesized that various triggers including bacteria, viruses, drugs, and malignancy stimulate the formation of IgA immune complexes. They may deposit in small blood vessels in several organs. In our case it was difficult to determine what may have triggered HSP. Primary lung cancer, antibiotics for preceding postoperative pneumonia, or empyema may contribute to cause HSP.
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  • Yoshitaka Ito, Yosuke Shimizu, Yasuharu Kaizaki
    2011 Volume 25 Issue 6 Pages 649-652
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A 24-year-old female consulted our hospital because of an abnormal shadow pointed out on a chest radiograph film during a medical check-up. CT showed two nodules located in the mediastinum in contact with the pericardium. MRI showed nodules consisting of cystic components exhibiting a low signal intensity on T1-weighted imaging and high signal intensity on T2- weighted imaging. Under the diagnosis of a benign mediastinal cyst, video-assisted thoracic surgery was performed. A fistula to the pericardium was observed inside a cyst, and another cyst was easily deflated on applying manual pressure. We diagnosed multiple pericardial diverticula using the two methods.
    Thoracoscopic surgery was useful for the diagnosis of pericardial diverticulum.
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  • Naoko Imamura, Hajime Watanabe, Takahisa Koizumi, Tomoki Nakagawa, Ryo ...
    2011 Volume 25 Issue 6 Pages 653-656
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A double aortic arch is a rare congenital malformation, with an incidence of less than 0. 2%. We report one surgical case of a double aortic arch with right lung cancer. A 74-year-old female with a history of lung tuberculosis about 50 years ago was pointed out to have an abnormal shadow on a chest radiograph for follow-up of diabetes mellitus. CT scan showed a double aortic arch and a tumor with an irregular margin measuring about 23 mm in the middle lobe (S5). Bronchoscopy showed no abnormal branching of the bronchi. Adenocarcinoma was diagnosed by TBLB. The clinical stage was T1bN0M0, stage I A. We initially attempted thoracoscopic surgery, but we converted to standard thoracotomy because adhesion of the right upper lobe was severe. A right upper and middle lobectomy with ND1b was performed. The pathological stage was t2an0m0 (adenocarcinoma, mixed subtype). Some reports on lung cancer involving the right aortic arch noted that there were no abnormalities in the branching of the pulmonary artery or vein or the bronchi. However, in this case, the branching of the right pulmonary artery was similar to the left, which could have occurred due to incomplete interlobar fissures. Thus, we should pay close attention to multiple variations of the arteries, veins, bronchi, and nerves when treating lung cancer involving a double aortic arch during surgery.
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  • Haruaki Hino, Shingo Ikeda, Ryoji Kawano, Tatsuhiro Hoshino, Toshiya Y ...
    2011 Volume 25 Issue 6 Pages 657-661
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    Paraganglioma of the posterior mediastinum is relatively rare. We report a 50-year-old male patient, who was shown to have an abnormal shadow on a chest radiograph in a health examination. He was admitted for the gradually growing right posterior mediastinal tumor. The tumor was 30×15 mm and slightly homogenously contrasted by computed tomography, facing the right side of the 8-9th thoracic vertebrae. Magnetic resonance imaging showed almost the same image in T1 and T2 phases, with no invasion to the vertebrae. The tumor was resected with thoracoscopic surgery. Although, during the operation, a sudden elevation of the blood pressure up to 180 mmHg was observed on tumor manipulation, the postoperative course was uneventfull, and the diagnosis was paraganglioma of the posterior mediastinum immunohistochemically. We report the clinical features and biological characteristics of paraganglioma of the mediastinum compared with other case reports.
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  • Gaku Saito, Masayuki Toishi, Takayuki Shiina, Ryoichi Kondo, Keiichiro ...
    2011 Volume 25 Issue 6 Pages 662-666
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A 74-year-old woman underwent right middle and lower lobectomy for lung cancer in 1997. Four years and seven months later, she was referred to our hospital for hemoptysis due to pulmonary aspergillosis. We performed right completion pneumonectomy; however, a bronchopleural fistula occurred. Fenestration was additionally performed to sterilize the thoracic cavity. Ten months after the fenestration treatment, pedicled omentopexy was performed, but thoracic empyema caused by MRSA infection developed. Therefore, re-fenestration was performed for the empyema. After the operation, we began to sterilize the thoracic cavity with a methylrosaniline chloride solution for MRSA. Due to repeated sterilization of the thoracic cavity and improvement of her nutritional status, the infection could be controlled. Then, the empyema cavity gradually decreased in size. Finally, the bronchopleural fistula and skin defect were closed. There has been no sign of recurrence of the bronchopleural fistula up to the present.
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  • Kenji Minami, Takuya Iwasaki, Tomoki Takemoto, Takesi Hirohata
    2011 Volume 25 Issue 6 Pages 667-671
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    We encountered a case of pulmonary mucormycosis in an immunocompetent patient with spontaneous pneumothorax. A 19-year-old man had chest pain, and was examined a few days later. He was diagnosed with a left spontaneous pneumothorax, and a chest tube was inserted into the pleural cavity. He was admitted to our hospital because of air leakage, and remained for a week. Chest CT revealed several bullae and a surgical scar in the left apex of the lung. Drainage from the chest tube became turbid on the day of his surgery, and empyema occurred. We performed partial resection of the lung employing VATS. He followed a favorable course and left the hospital six days after surgery. The pathological findings revealed Mucor in the thickened pleura. Culture examination of the pleural effusion revealed Mucor. He was followed up with no medication, and has remained free of symptoms of Mucor.
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  • Tohru Hasumi, Yasuki Saito, Jiro Abe, Fumihiko Hoshi, Masaki Kawamura, ...
    2011 Volume 25 Issue 6 Pages 672-677
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A 33-year-old woman was referred to our hospital because of pain in her left shoulder. Radiological examinations revealed a well-circumscribed 45×25-mm mass in the left thoracic inlet, suggesting a benign tumor. The tumor was resected using a thoracoscopic procedure assisted by mini-thoracotomy, and diagnosed as a desmoid tumor, showing a positive surgical margin on histological examination. Seventeen months later, she underwent radiotherapy of 60 Gy for a local recurrent tumor involving pain in the left arm. After radiotherapy, the tumor slightly regressed and the arm pain disappeared. She has remained progression-free for 40 months since radiotherapy. Desmoid tumors are histologically benign tumors without any metastatic potential, but they are very locally aggressive and tend to recur even after complete resection. Radiotherapy is an effective alternative if treatment is required for an unresectable lesion or if surgery may result in major functional defects, and it achieves a high local control rate even in a post-recurrent setting.
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  • Haruhisa Kitano, Shoji Asakura, Masutaro Ichinose
    2011 Volume 25 Issue 6 Pages 678-682
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A 52-year-old man underwent omentoplasty and thoracoplasty for the treatment of tuberculous empyema in 1995. In 1999, he developed hemoptysis caused by Aspergillus empyema, whereby antifungal therapy was implemented, and hemorrhaging subsided. Two years later, hospitalization was required due to recurrence of the hemoptysis, and, although bronchial arterial embolization and bronchial occlusion with a silicone filler (Endobronchial Watanabe Spigot) were performed, hemoptysis could not be fully prevented. Arteriography revealed that the gastroepiploic artery communicated with the periphery of the left pulmonary artery and was embolized with coils, and no hemoptysis was detected. In 2003, another reappearance of hemoptysis led to embolization of the residual gastroepiploic artery. Subsequently, only a minor recurrence of hemoptysis was reported. Hemoptysis caused by gastroepiploic artery post-omentoplasty for empyema is reportedly a rare occurrence, and embolization was a successful and effective follow-up procedure. We report this case with a review of the relevant literature.
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  • Koichi Fukumoto, Koji Kawaguchi, Takehiko Okagawa, Toshiki Okasaka, No ...
    2011 Volume 25 Issue 6 Pages 683-686
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    A 72-year-old male underwent a right upper lobectomy with mediastinal lymph node dissection for primary lung adenocarcinoma in March 2010. The pathologic stage was pT2aN1M0, stage IIA. Re-thoracotomies were required twice for intrathoracic hemorrhage on the 3rd and 13th postoperative days. Further examinations revealed a very low serum level of factor VIII, and a high serum level of factor VIII inhibitor. The disease condition was diagnosed as acquired hemophilia A. Although thoracic empyema and sepsis developed afterward, the patient was treated with an open-window thoracotomy and hemostatic therapy for 3 months, and discharged 243 days after the first operation. When unusual bleeding occurs after surgery for patients with malignant tumors, acquired hemophilia should be listed in the differential diagnoses because it is a rare but fatal disease.
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  • Noriaki Tsubota
    2011 Volume 25 Issue 6 Pages 687-694
    Published: September 15, 2011
    Released: October 26, 2011
    JOURNALS FREE ACCESS
    In Japan, discussion on surgical treatment for malignant pleural mesothelioma (MPM) has been focused mainly on how to safely perform extrapleural pneumonectomy (EPP) from a technical standpoint. While registration for the first prospective trimodality study of MPM in Japan has just finished as scheduled, a coming study will include pleurectomy/decortication (P/D) as one of the possible surgical arms. In this article, the following subjects are discussed:
    I . The history of EPP and P/D results and their limitations. At present, the mortality rate is about 4% at best, and the recurrence rate is very high.
    II . The sudden onset of acute lung injury on the 3rd POD in an EPP patient. There seemed to be three possible causes: (1) a very small hole developed at the stapled bronchial stump, subsequently leading to aspiration of the remaining lung, (2) perioperative over-hydration, or (3) ARDS in the remaining lung, brought on by an unknown cause.
    III . Confusion about the endothoracic fascia (EF). It is unclear whether EF remains on the chest wall after EPP or is removed with the resected EPP specimen. According to textbooks, it is reasonable to suppose that the EF consists of variable amounts of areolar connective tissue, affording a natural cleavage plane for separation of the subjacent pleura from the thoracic wall.
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