The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 26 , Issue 6
Showing 1-22 articles out of 22 articles from the selected issue
  • Jun Suzuki, Hiroyuki Oizumi, Hirohisa Kato, Ken Fukaya, Hikaru Watarai ...
    2012 Volume 26 Issue 6 Pages 586-590
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    For safe and accurate segmentectomy, it is important to understand the anatomic features of the pulmonary vascular branch before performing the operation.
    We report the usefulness of three-dimensional computed tomography (3DCT) simulation for segmentectomy.
    It is necessary to obtain contrast between the pulmonary artery and vein in single-time imaging. In this study, we investigated 2 imaging procedures.
    A is the normal procedure for 3DCT, and B is a new procedure that involves injecting normal saline after injecting the contrast agent.
    We investigated 22 people who had undergone segmentectomy from January 2008 to November 2009. Ten people underwent procedure A and 12 underwent procedure B.
    The ratio of good contrast images to poor contrast images for 3DCT was 1: 9 for procedure A and 9: 3 for procedure B. We set the region of interest (ROI) in the pulmonary artery and left atria in the CT image and estimated the CT number.
    We calculated the difference in the mean average CT number for the pulmonary artery and left atria for both procedures. The difference was 22.1 for procedure A and 106.6 for procedure B.
    Procedure B provided a considerably better contrast image than that provided by procedure A and was useful in obtaining a contrast image between the pulmonary artery and pulmonary vein in single-time imaging.
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  • Hiroyuki Adachi, Taketsugu Yamamoto, Shizu Saito, Hiroko Nemoto, Yasus ...
    2012 Volume 26 Issue 6 Pages 591-596
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    To evaluate the results of resection of pulmonary metastases from oral, head, and neck cancers (OHNC), we retrospectively reviewed 13 cases that received metastasectomy in our hospital from January 2000 to March 2011. Twelve were male and 1 was female. The median disease-free interval (DFI) from the time of treatment of OHNC was 12 months (range, 1-73). Eleven cases received partial resection, 1 received segmentectomy, and 1 received lobectomy.
    The overall 5-year survival rate after pulmonary metastasectomy was 45.7%, and the median survival time was 23 months. Poor prognostic factors were DFI of less than 12 months and primary OHNC stage IV on univariate analysis, but multivariate analysis revealed no significant prognostic factor. Like metastasectomy from colorectal cancers, pulmonary metastasectomy for OHNC also provides a chance for long-time survival.
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  • Yasushi Ikuta, Kazuki Tamura, Yoshiaki Kinoshita, Kouko Hidaka, Takaom ...
    2012 Volume 26 Issue 6 Pages 597-601
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    A 48-year-old woman was referred to our hospital for additional examination concerning pleural effusion and intraperitoneal masses after complaining initially of abdominal pain and shivering. CT scan showed diffuse multiple cystic lesions in the lung parenchyma, left pleural effusion, and retroperitoneal lymphadenopathy. Chylous effusion was obtained via thoracocentesis, and examination revealed lymphangioleiomyomatosis (LAM) giving rise to chylothorax. Because the chylothorax resisted conservative therapy, surgery was scheduled. A preparation containing milk and olive oil was administered, and direct thoracoscopic suturing of the chylous flow point was performed along with lung biopsy and pleurodesis with talc poudrage. The chylous flow disappeared immediately following surgery, and the clinical diagnosis based on the histological examination of biopsy specimens was LAM. In the event that surgery is indicated for chylothorax caused by LAM, we suggest attempting the procedure through an approach from the chylous effusion side rather than heedlessly ligating the thoracic duct directly above the diaphragm through the right thoracic cavity.
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  • Yumi Hino, Masahiro Kaji, Naofumi Miyahara, Rei Kobayashi, Keiichi Sue ...
    2012 Volume 26 Issue 6 Pages 602-608
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    A 38-year-old woman complaining of left chest and back pain was admitted to our hospital. Chest CT showed a giant anterior mediastinal tumor with left pleural effusion due to perforation of the tumor. Laboratory data showed a high serum level of CA19-9. The mediastinal tumor was resected and diagnosed pathologically as an immature teratoma. It has been reported that perforated mediastinal teratomas often show elevating serum tumor marker levels. The serum tumor marker may be useful in the diagnosis of a perforating mediastinal teratoma.
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  • Naoya Ishibashi, Nobuyuki Sato, Yoshinori Okada, Takashi Kondo
    2012 Volume 26 Issue 6 Pages 609-614
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    We report two cases of sclerosing mediastinitis. A 52-year-old man complaining of hoarseness showed a mediastinal mass on chest computed tomography (CT). Pathologically, surgical biopsy specimens demonstrated non-specific fibrous tissue and lymphocyte infiltration. A diagnosis of sclerosing mediastinitis was established, and corticosteroid hormone therapy was started. As a result, the mediastinal mass lesion shrank. The other patient was a 72-year-old woman who presented with dyspnea and hematuria. CT showed masses spreading from the posterior mediastinum to retroperitoneal space. As in the 1st case, surgical biopsy specimens showed non-specific fibrous tissue and lymphocyte infiltration histopathologically. This patient also received steroid hormone therapy. CT findings revealed size reduction of both the mediastinal and retroperitoneal mass lesions within two months, and the symptoms disappeared. We concluded that corticosteroid hormone therapy may be an option for the treatment of sclerosing mediastinitis.
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  • Yasushi Ikuta, Koichiro Shimoyama, Kazuki Tamura, Shinji Akamine, Yosh ...
    2012 Volume 26 Issue 6 Pages 615-619
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    A 39-year-old man was admitted to our hospital because of an abnormal shadow in the left pulmonary hilum on a chest radiograph during a medical check-up. The chest CT showed a 5-cm, well-defined, solitary tumor with enhancement and calcification in the left pulmonary hilum. Left upper lobectomy was performed due to suspicion of malignant lymphoma, mesenchymal tumor, lung cancer, or hamartoma, for diagnosis and treatment, because the left upper lobe contained the mass. The histopathological diagnosis was the hyaline vascular type of Castleman' s disease. Castleman' s disease is an uncommon lymphoproliferative disorder that can occur wherever lymph nodes are present. Castleman' s disease most commonly occurs in the chest, along the tracheobronchial tree in the mediastinum or lung hilus. We report a case of solitary Castleman' s disease in the pulmonary hilum.
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  • Toshiteru Tokunaga, Masahiko Higashiyama, Ayako Fujiwara, Takashi Kano ...
    2012 Volume 26 Issue 6 Pages 620-624
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    A 71-year-old man was referred to our hospital for suspected local recurrence of stage I lung cancer following carbon beam radiation therapy performed 2 years prior because of refusal of surgery. The primary lesion had been gradually increasing in size during the follow-up period, and was diagnosed as local recurrence based on transbronchial biopsy findings. In addition, multiple infiltrative shadows were found around the tumor by chest computed tomography, which were clinically diagnosed as intrapulmonary metastasis. Salvage surgery was performed, and the postoperative course was uneventful. Histological findings revealed local recurrence of lung adenocarcinoma. The lesions around the primary site resulted in a final diagnosis of intrapulmonary metastasis.
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  • Haruka Takeichi, Shunsuke Yamada, Atsushi Suga, Tomoki Nakagawa, Ryota ...
    2012 Volume 26 Issue 6 Pages 625-628
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    A 32-year-old man was admitted to our hospital because of an abnormal shadow in the left lower lobe. Chest computed tomography showed a smooth nodule shadow in the left S6, approximately 3.7 cm in diameter. The tumor was not diagnosed by transbronchial biopsy. However, it showed FDG accumulation on PET examination. We suspected that this tumor was malignant, so a left lower lobectomy by video-assisted thoracoscopic surgery (VATS) was performed for complete resection. Pathological examination confirmed a diagnosis of fibrosarcoma. The patient showed no evidence of recurrence after 15 months of follow-up.
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  • Chihiro Takasaki, Hironori Ishibashi, Naoyuki Fujiwara, Takumi Akashi, ...
    2012 Volume 26 Issue 6 Pages 629-632
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    A 46-year-old male presented with a mediastinal tumor on routine chest radiography. Chest computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated an 82×35×80-mm right anterior mediastinal tumor. One and half months later, he consulted again with chest pain and shortness of breath. CT showed left pleural effusion and the growing size of the tumor. As the intraoperative diagnosis by video-assisted thoracoscopic biopsy revealed type B2 thymoma, thymo-thymectomy with partial resection of the pericardium was performed. As thymoma with chest pain and pleural effusion is very rare, we presented this case with a review of the literature.
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  • Hitoshi Suzuki, Ryou Maeshiro, Kentaro Inoue, Chiaki Kondo, Motoshi Ta ...
    2012 Volume 26 Issue 6 Pages 633-637
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    A 54-year-old male was admitted to our hospital for further evaluation of a mediastinal mass detected during a routine screening chest radiograph. On chest computed tomography scan, a soft tissue density, heterogeneous, 30-mm, spherical mass was seen in the superior mediastinum invading the right brachiocephalic vein. We performed an operation via a transmanubrial approach. The right brachiocephalic vein and phrenic nerve showed strong adhesion to the tumor, and were excised in order to resect the tumor. Histological examination revealed that the tumor was composed of clusters of well formed capillary vessels with focal areas consisting of sheets of epithelioid cells with poorly formed vascular channels. The tumor cells stained positive for CD34 and vWF and negative for TTF-1, αSMA, desmin, and cytokeratin, leading to our diagnosis of mediastinal epithelioid hemangioendothelioma (EHE). Mediastinal EHE has been reported in only 39 cases in the literature, including our case.
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  • Kenji Misawa, Osamu Mishima, Yusuke Takahashi, Satoshi Nishi, Morihisa ...
    2012 Volume 26 Issue 6 Pages 638-641
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    Anatomical S10 segmentectomy is difficult because arteries and bronchi are located in the deep parenchyma. We report a case of thoracoscopic S10 segmentectomy that was safely performed. A 48-year-old man was referred to our hospital because of a pulmonary nodule detected on CT examination. Chest CT revealed a small nodule with ground-glass opacity in the S10. The nodule did not shrink or disappear on CT during the 10-month follow-up. So, the nodule was suspected to be lung cancer. Right S10 segmentectomy was performed by employing a thoracoscopic surgical procedure. Preoperatively, 3-D images were obtained by CT angiography (CTA), CT bronchography (CTB), and lung field condition CT (LCT). The intraoperative anatomical findings accurately reflected the preoperative 3-D image. In this case, this 3-D image was useful for a safe and smooth thoracoscopic operation.
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  • Toshio Nishikawa, Yasunori Ishii, Yukio Kimura, Masanobu Mori, Yasuaki ...
    2012 Volume 26 Issue 6 Pages 642-646
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    A 36-year-old woman consulted for a tumor shadow in the lung field in January 2009. Chest CT showed a mass in the right-middle lobe, and FDG-PET showed abnormal accumulation in the mass. Bronchoscopic examination showed a mass in the right B5 bronchus. Although a diagnosis could not be made based on a pathological study, we strongly suspected a malignant tumor, and performed an operation. The operative procedure was a right-middle and lower lobectomy and lymph node dissection. The specimen showed a mass with a polypoid lesion in the bronchus. The post-operative diagnosis was pulmonary pleomorphic adenoma by pathological study. She has experienced no recurrence up to the present.
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  • Satoshi Nagasaka, Hideyuki Ito, Ayako Seike, Naoko Kimura, Satsuki Kin ...
    2012 Volume 26 Issue 6 Pages 647-653
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    We performed salvage resection involving 3 lobectomies and 1 wedge resection for cases where stereotactic body radiation therapy (SBRT) failed (3 primary lung cancers and 1 metastatic colon cancer). Wedge resection was performed following upper lobectomy on the same side. No firm adhesion was detected, suggesting that SBRT influenced the adhesion between the parietal and visceral pleura, and that of the hilum. The surgeries were performed as usual, and excellent postoperative courses were observed. The number of patients undergoing stereotactic body radiation therapy is expected to increase in the future. However, in cases of recurrence, salvage surgery can be considered as a positive approach, if the condition is operable.
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  • Shizu Saito, Kohei Ando, Takamitsu Maehara, Munetaka Masuda
    2012 Volume 26 Issue 6 Pages 654-657
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    Massive extrapleural hematoma secondary to blunt chest trauma is rare, especially in non-anticoagulated patients. We report a case of huge extrapleural hematoma in a non-anticoagulated 28-year-old patient secondary to blunt chest trauma after rugby training. In this case, we performed video-assisted thoracic surgery to control the bleeding and remove the huge hematoma. He remained in hospital for only 4 days after the operation.
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  • Koichiro Kajiura, Shoji Sakiyama, Hiroaki Toba, Yukikiyo Kawakami, Koi ...
    2012 Volume 26 Issue 6 Pages 658-662
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    Giant mediastinal tumor sometimes causes fatal respiratory and circulating failure on general anesthesia. We encountered a surgical case of giant mediastinal mature teratoma involving percutaneous cardiopulmonary support (PCPS). A 20-year-old woman was referred to our hospital for a giant mediastinal tumor discovered on a checkup. CT showed a 10×9-cm anterior mediastinal tumor including a cystic lesion, carcifications, and fat elements. The most stenotic part of the trachea was 5 mm around the bifurcation pressed by tumor. There was a giant abdominal cystic lesion pressing on the bilateral femoral vein. We expected a risk of respiratory failure due to airway obstruction on general anesthesia. It was deemed difficult to employ PCPS urgently because of the bilateral femoral vein stenosis. We employed PCPS before the induction of general anesthesia. The operative procedure was aspiration of the cystic part of the tumor at first, and it was extirpated by median sternotomy. Pathological findings were of a mature teratoma.
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  • Toshinari Ema, Ryoji Kawano
    2012 Volume 26 Issue 6 Pages 663-667
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    A 65-year-old female was referred to the outpatient critical care unit of our hospital after she had stabbed herself on the right side of the chest with a kitchen knife. Her consciousness was clear, and vital signs were stable. We diagnosed her with hemopneumothorax caused by right lung damage. She was a Jehovah's Witness, and refused transfusion.
    We decided to perform an emergency operation without blood transfusion. She underwent right lower lobectomy without blood transplantation, and total blood loss was 700 ml. No blood transfusion was required after the operation. The patient's postoperative course was uneventful.
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  • Yasushi Ikuta, Kazuki Tamura, Keiko Hashimoto, Kumiko Shohno, Yukie Ya ...
    2012 Volume 26 Issue 6 Pages 668-672
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    The current report represents a surgical case of infant intralobar pulmonary sequestration (ILS). A 4-month-old girl was referred to our hospital for further examination concerning cough and fever. Because a chest radiograph showed an infiltration shadow in the left lower lung field, pneumonia was diagnosed. However, the pneumonia resisted treatment, and contrast chest CT (3D-CT angiography) showed an aberrant artery arising from the descending thoracic aorta, running towards the left lower lobe, and ultimately connecting to two anomalous veins which drained into the inferior pulmonary vein. Evaluation by CT revealed ILS in the left lower lobe, and the patient underwent left lower lobectomy at the age of seven months. The diagnosis was verified histologically. We suggest that cases of neonatal or infant ILS accompanied by respiratory distress undergo immediate surgery, while those without respiratory distress are treated with surgery during the infant stage after the careful consideration of postoperative complications, infection risk, and prospects of subsequent healthy lung development. It is our opinion that lobectomy involving the affected area can be considered an appropriate surgical method for the treatment of neonatal or infant patients with ILS.
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  • Yoshin Adachi, Kunio Araki, Hiroyuki Metsugi, Takeshi Tokushima
    2012 Volume 26 Issue 6 Pages 673-676
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    We report a case of rapid enlargement of a pulmonary hamartoma with interstitial pneumonitis. A 78-year-old man was admitted to our hospital after a tumor in the right lung was found on routine chest computed tomography (CT). Plain chest CT revealed a round nodule, which was 10×6 mm, in S7 of the right lung. This nodule was growing in size. We suspected that it was lung cancer, and the patient underwent wedge resection of the right lung via video-assisted thoracic surgery. The pathological finding was pulmonary hamartoma. In general, pulmonary hamartomas are slow-growing; however, in this case, the pulmonary hamartoma showed rapid growth. This was a rare case of pulmonary hamartoma.
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  • Shinichirou Ishimoto, Takashi Muramatsu, Mie Shimamura, Motohiko Furui ...
    2012 Volume 26 Issue 6 Pages 677-682
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    A 41-year-old-female was admitted to our hospital because of a complaint of chest pain. She had undergone surgical resection of a tumor in the right chest wall 15 years previously, and metastatic lung tumor in both lungs and recurrent tumor of the right chest wall 13 years previously. The pathological findings were all mesothelioma. This time, chest computed tomography revealed a large tumor in the right chest cavity. She then underwent surgical resection. The final diagnosis was confirmed by immunohistologic findings and genetic analysis for the detection of SYT gene rearrangement using RT-PCR. SYT-SSX1 fusion gene transcripts were demonstrated. A diagnosis of synovial sarcoma of the chest wall was made. Because the pathological findings were similar to those of previous samples, we conducted genetic analysis of them. SYT-SSX1 fusion gene transcripts were demonstrated. A diagnosis of synovial sarcoma of the chest wall and lungs was made. Most synovial sarcomas affect deep soft tissues of the extremities. Primary chest synovial sarcoma is extremely rare. A careful observation may be required.
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  • Yoshitaka Ito, Hiroaki Kobayashi, Masaya Takizawa, Mitsuru Takahashi, ...
    2012 Volume 26 Issue 6 Pages 683-687
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    The locking plate is a new device that is fixed with not only bone but the screw itself. A 37-year-old female consulted our hospital because of sustaining an injury in a traffic accident. On arrival, paradoxical respiration was observed in the right anterior chest wall, and mechanical ventilation was started for acute respiratory failure. CT showed a high-grade dislocation of the fractured sternum and multiple rib fractures on both sides. Under the diagnosis of severe flail chest due to sternal fracture and multiple rib fractures, repair surgery of the chest wall was performed. The sternum with a high-grade dislocation was reduced with double wires and fixed with a locking plate. The right rib fracture and left costal cartilage fracture were sutured. After internal fixation by mechanical ventilation was performed, external fixation with bust bands was carried out. Fixation with the locking plate was effective for sternal fracture with flail chest and high-grade dislocation.
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  • Noboru Nishiumi, Haruhiko Kondo, Akinori Iwasaki, Tomoyuki Goya
    2012 Volume 26 Issue 6 Pages 688-696
    Published: September 15, 2012
    Released: October 16, 2012
    JOURNALS FREE ACCESS
    Background: To prepare for the publication of its Proposals For Surgery, 8th Edition, Gaihoren requested members to review medical costs associated with various surgeries. Methods: In October 2010, the Japanese Association for Chest Surgery distributed a questionnaire to 29 facilities. Medical materials were classified as non-reimbursable or reimbursable, and each facility was asked to report their costs. Twenty-seven of the 29 facilities responded. Median costs were calculated for 25 surgical procedures/498 cases. Results: Non-reimbursable and reimbursable costs for lung cancer surgery (pulmonary lobectomy) were 123,288 and 284,373 yen, respectively. Respective costs for pulmonary segmentectomy were 100,624 and 269,273 yen and those for pulmonary wedge resection were 105,814 and 251,209 yen. Respective costs of video-assisted thoracoscopic surgery (VATS) for lung cancer surgery (pulmonary lobectomy) were 163,026 and 301,209 yen. Respective costs of VATS for pulmonary segmentectomy were 194,786 and 301,209 yen and those for pulmonary wedge resection were 131,086 and 219,273 yen. Respective costs of VATS for bullous lung disease were 125,360 and 189,273 yen and those for malignant mediastinal tumor were 181,648 and 184,889 yen. The Japanese Association for Chest Surgery recommend setting medical fee points for lung cancer surgery by classifying open thoracotomy and VATS separately and considering the high cost of treating malignant mediastinal tumors.
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