The Thopaz chest drain system is a portable suction unit which allows mobilization of the patient, with digital flow recordings. The aim of this study was to evaluate the safety and efficacy of the Thopaz chest drain system in thoracic surgery. First, thirty patients were evaluated over 6 months. Air-leaks within a range of 10-620 ml/min were found. There was no adverse effect due to the device in this clinical trial. The staff were trained in the use and care of the device, and they could improve their level of understanding of it. Second, Thopaz was compared with the current analogue drainage system in 60 patients that underwent pulmonary resection. Patients' background and types of pulmonary resection were not different between the groups. The Thopaz system has been shown to make it easier to walk after surgery and reduce the duration of chest drainage. Thus, the Thopaz system was found to be generally well tolerated after lung surgery.

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Objective: It is generally assumed that pneumothorax occurs on a day with 'bad weather'. We prospectively examined whether pneumothorax onset relates to the weather, especially hours of sunshine.Methods: From 1 April, 2011 to 31 May, 2012, for 427 days, all new patients with spontaneous pneumothorax referred to our hospital were interviewed about the exact dates of symptom onset. In 37 patients (34 males and 3 females, 34.5 years old on average), pneumothorax occurred on 36 of the 427 days. Meteorological parameters such as hours of sunshine, and the mean, maximum, and minimum temperatures were statistically analyzed between the days with pneumothorax onset and the other days.Results: Hours of sunshine were significantly shorter on days with pneumothorax onset than the other days (3.68±3.29 vs. 5.29±4.21 hr; p=0.0090, respectively). The mean and minimum outdoor temperatures significantly increased on days with pneumothorax onset, compared to those of two days before (0.84±2.04 vs.-0.015±2.76, 1.20±3.42 vs.-0.03±3.25°C;p=0.025, 0.038, respectively).Conclusion: Decreasing hours of sunshine simply represents weather with thick clouds or rain, namely ' bad weather'. Our results demonstrate that pneumothorax onset was significantly correlated with a change in the weather, although it is unclear what kinds of meteorological factor affect our health.

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We retrospectively studied 56 patients who underwent thoracoscopy under local anesthesia at our institution from 2006 to 2011, in order to evaluate the preoperative performance status and peri- and postoperative complications. Thirty-four patients underwent examination including biopsy, 20 patients underwent curettage for empyema, and 2 patients underwent lung fistula treatment. Regarding the preoperative performance status, 24 patients (43%) had scores from 2 to 4. Acute empyema was the most common cause of a poor performance status (10 cases, 42%), while empyema was seen in about 70%of patients. A definitive diagnosis was obtained in 90%. Postoperative complications involved only one patient (1.7%) who suffered from pneumothorax. Our review indicated that thoracoscopy under local anesthesia is a safe procedure for the examination of or therapy for high-risk patients with empyema or pneumothorax.

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Food is the most common airway foreign body, showing several unique characteristics compared with other foreign materials. For example, radiographic examination is not helpful as a diagnostic tool due to the high radiolucency of food materials, and their fragility sometimes results in extreme difficulties in removal with endoscopic techniques. From January 2000 to October 2011, 9 patients with airway foreign bodies were treated at Fukuoka University Hospital, who included 6 cases of food foreign body aspiration. There were 4 infants and 2 adults, and the aspirated food foreign bodies included beans (n=5) and a piece of meat (n=1). All patients underwent foreign body removal safely and successfully with endoscopic techniques under general anesthesia. Removal procedures involved either a flexible fiber-optic (n=3) or rigid bronchoscopic technique (n=3). There were no serious complications caused by airway interventional procedures. Endoscopic airway foreign body removal is a complicated and high-risk procedure. Collaboration with well-trained anesthesiologists or other medical staff is extremely important for its safe performance.

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A 51-year-old man presented with fever, cough, and hemosputum. He was diagnosed with pneumonia and abscess of the right lung. The patient's symptoms continued to worsen despite the administration of antibiotics. Right empyema and a strongly enhanced 1.8-cm-diameter nodule inside the lower lobe were observed on contrast-enhanced CT scan 26 days after admission. Chest drainage was performed, but the patient went into shock due to hemorrhage 3 days later.Emergency surgery was performed, and hemorrhage of a pulmonary artery pseudoaneurysm was identified.

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Juvenile BAC is extremely rare. A 16-year-old female, who had been previously healthy, visited this hospital after an abnormal chest shadow was pointed out in a school medical check-up in May 2009. A chest scan found no anomaly in the area that the check-up had pointed out, but a 7-mm GGO was pointed out in the right upper lobe of her lung. Since then, follow-up observation was carried out, with no reduction in the shadow. In August 2010, partial lung resection was performed under thoracoscopy. With the intraoperative examination revealing no malignancy, the surgery was finished. However, when this hospital consulted the Japanese Society of Pathology on the case, it was eventually diagnosed as non-mucinous BAC. Juvenile GGOs are often difficult to deal with, but, considering the radiation dose in CT examinations during follow-up, early surgery might have been one of the important options.

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An asymptomatic 41-year-old woman, who had a history of right thyroidectomy, was pointed out to have an abnormal opacity in a chest radiograph. Chest computed tomography (CT) scan showed two masses in the superior mediastinum. The caudal mass, which measured 64 mm in diameter, was lobulated with a well-defined border, including some calcification. The cranial one, which measured 16 mm in diameter, was globular and located adjacent to the left lobe of the thyroid gland. Heterogenous contrast enhancement was observed in the masses. Chest magnetic resonance imaging (MRI) demonstrated two mediastinal masses with iso intensity on T1-weighted imaging and heterogenous intensity on T2-weighted imaging. FDG uptake was slightly increased in the masses. They were resected through a median sternotomy. They were not connected to the left lobe of the thyroid gland. Pathologically, they were diagnosed as adenomatous goiter. According to Rives' classification, they were aberrant mediastinal goiter. Aberrant mediastinal goiter is rare. It is assumed to originate from intrathoracic ectopic thyroid tissue. Aberrant mediastinal goiter should be considered in the differential diagnosis of a mediastinal tumor, especially in cases with a history of adenomatous goiter.

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Aberrant mediastinal goiters are very rarely seen. They originate from the ectopic thyroid tissue located in the mediastinum, without any connection with the cervical thyroid gland. Aberrant mediastinal tumors usually have their vascular supply from local mediastinal vessels. We report a case of aberrant mediastinal goiter resected by VATS. A 70-year-old female was admitted for the treatment of a mediastinal tumor. Computed tomography revealed a middle mediastinal tumor that measured 30×25×70 mm. MRI revealed neither communication between the mass and thyroid gland, nor major feeding vessels. The tumor was resected with VATS and cervical incision, and diagnosed as adenoma isolated from the thyroid gland. The surgical approach should be determined carefully by the location of the tumor.

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We report 3 different cases of chronic expanding hematoma (CEH) of the thorax. Case 1: A 70-year-old man with a history of thoracoabdominal aortic replacement became aware of a painful left chest wall mass. The patient underwent the extirpation of a hematoma. Case 2: A 74-year-old woman with a history of lobectomy for tuberculosis became aware of hemoptysis. The patient underwent a left pneumonectomy. Case 3: An asymptomatic 74-year-old man with a history of tuberculous pleuritis was admitted with an increasing mass in the right thorax. The patient underwent a right lower lobectomy. In the treatment of CEH, a surgical strategy corresponding to each patient's general state is required.

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A 66-year-old woman, who had undergone computed-tomography as a follow-up for laryngeal cancer, had been pointed out as showing double tumor shadows in the right upper lobe and thickening of the pulmonary interstices. With a diagnosis of primary lung cancer complicated by interstitial pneumonia (IP), we performed a right upper lobectomy. The diagnoses were squamous cell carcinoma and adenocarcinoma, double primary cancer. After the first lung surgery, she received partial lung resection two times; the diagnoses were large cell neuroendocrine carcinoma and squamous cell carcinoma.IP is well-known as a risk factor for lung cancer, but it is very rare that someone has metachronous multiple occurrences of three pathological types of lung cancer. Because IP patients have the potential for multiple occurrences of lung cancer, they should undergo close follow-up to identify new lesion in an early stage.

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The patient was a 78-year-old man who underwent colon cancer surgery in July 2009. He was thought to have a 32-mm nodule in the left lower lobe of the lung based on computed tomography (CT) in the first year after surgery. It was thought to be a metastatic tumor of colon cancer or primary lung cancer. He underwent thoracoscopic examination,which showed a small amount of pleural effusion, and numerous nodules in the pericardial and visceral pleura. His pathological exam showed a malignant lymphoma. He received chemotherapy after the operation, and the tumor showed shrinkage. Now, at 18 months after surgery, he is doing well.

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A 53-year-old female was admitted to our hospital with an anterior mediastinal mass shadow, measuring 12×8.5 cm in size on chest computed tomography (CT). The tumor was separated from the thyroid gland and suspected to compress the brachiocephalic vein. FDG-PET showed heterogenous accumulation of FDG (SUVmax 3.79) in the tumor. In the blood test, the serum thyroglobulin level was 481 ng/ml. A thymoma or aberrant goiter was suspected, and tumor extirpation (a median sternotomy+left neck collar-like incision) was performed. The tumor had a thin capsule around it, and no invasion to the surrounding structure was found. Pathological examination revealed that the tumor was composed of thyroid tissue with no malignant cells. Therefore, it was considered to be an aberrant goiter originating from the thymus.

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A 69-year-old man underwent right lower lobectomy for primary lung adenocarcinoma (pT3N2M0: Stage IIIA), but superficial incisional surgical site infection (SSI) occurred after surgery. Two months after the surgery, re-suture was performed. Chest computed tomography and brain magnetic resonance imaging (MRI) performed 5 months after the surgery led to the suspicion of recurrence of adenocarcinoma on the right chest wall with spinal invasion and brain metastasis, respectively, and the patient was admitted to our hospital for internal treatment. Three days after admission, the patient experienced high-grade fever of 38.3 degrees, and the results of blood tests revealed an elevated white blood cell count and C-reactive protein level. In addition, the patient complained of back pain. Both blood culture and pus culture obtained from the re-suture site were positive for methicillin-sensitive Staphylococcus aureus (MSSA). T2- weighted spinal MRI showed a high signal intensity, spreading to the adjacent vertebral bodies, at the Th6/7 disc space. By antibiotic therapy alone, subsequent blood culture yielded negative results for MSSA, the blood inflammatory response decreased, and back pain improved. Follow-up spinal and brain MRI revealed fibrotic scar formation in the Th6/7 disc space and shrinkage of the brain nodule, respectively. On the basis of these findings, the patient was diagnosed with pyogenic spondylodiscitis and brain abscess due to the systemic spread of SSI along hematogenous routes via the chest wall and thoracic cavity.

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Although the uniportal VATS technique has recently been performed for spontaneous pneumothorax, it usually requires an extended incision, because of difficulties in performing the normal procedure through one port. In this report, we present an improved 1 port ＆ 1 puncture method without extending the skin incision for bullectomy, covering the stump with a poly-glycolic acid (PGA) sheet and applying fibrin glue in the same way as the typical three-port method. The 1 port ＆ 1 puncture method is promising in the treatment of spontaneous pneumothorax.

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An 85-year-old woman, who visited a local hospital complaining of bloody sputum, was referred to our hospital for further examination of a mass shadow detected on a chest radiograph. Bronchoscopic examination revealed a dark-red polypoid lesion occluding the orifice of the middle bronchus, which was pathologically diagnosed as malignant melanoma. The lung was considered the primary site because there was no history of malignant melanoma and screening revealed no suspected primary lesion at other sites. Although there were abnormal shadows suspected of being metastases to the upper and lower lobes, complete resection was possible, and thoracoscopic right middle and lower lobectomy, plus partial resection of the upper lobe with systematic lymph node dissection, were performed. Pathological examination revealed that the stage was T4N0M0 stage 3A and multiple nodules were focal organizing pneumonia with a few metastatic lesions in the lower lobe suspicious of bronchial spread. The postoperative course was favorable, and the patient is being followed without adjuvant therapy. Careful observation is necessary because of the poor prognosis of malignant melanoma.

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Cases of Wegener granulomatosis with pneumothorax have been reported; however, reports of giant pulmonary cysts are very rare. A 54-year-old woman with dry cough presented to our clinic with infiltrative shadows in the right apex and left upper lung field on a chest radiograph in Dec. 2009. Bronchoscopy was performed, and many small white nodules on the bronchial wall were observed. Pathology documented granulation tissue with vasculitis, and c-ANCA was positive. The patient was diagnosed with Wegener granulomatosis. Treatment was initiated, and the patient improved clinically. Repeat chest radiographs showed no shadow, except for a cavitary lesion. Eight months later, the patient presented with dyspnea on exertion, and a chest radiograph showed a huge pulmonary cyst occupying about half of the left lung field and pneumothorax. The patient was admitted and thoracotomy was performed. The cyst had a see-through wall, a 5-mm hole was in the wall, and the cyst was connected to a thick-walled cavitary lesion. Lobectomy was performed. She had no complications, and was discharged.

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Background: Mediastinal nonseminomatous germ cell tumor with somatic-type malignancy (GCT-STM) is rare and associated with a poor prognosis. We report a clinical case of nonseminomatous germ cell tumor with malignant transformation of the somatic component with brain metastases.Case: An 18-year-old male presented with chest pain, and an anterior mediastinal mass was seen on the image exams. Chest CT and MRI revealed a large heterogeneous lesion measuring 14×11 cm. Histological findings of needle-biopsied specimens suggested teratoma. Although the immature component was not defined, tumor markers (AFP) elevated. Four courses of BEP therapy (bleomycin, etoposide, cisplatin) led to a tumor marker decrease, but the tumor showed further growth. Brain MRI revealed several metastatic lesions within 5 mm in diameter. Because the huge tumor markedly compressed mediastinal structures, en bloc resection of the primary tumor was performed after gamma knife surgery for multiple brain metastases. The tumor, measuring 21×14.5×8.5 cm, was completely resected with partial resection of the pericardium and a part of the right upper lobe of the lung. Microscopic examination revealed that most of the tumor was a mature teratoma which consisted of skin, gastrointestinal glands, bone, cartilage, neural tissues, pancreatic tissues, and necrotic tissues. Partially atypical cells were detected in some areas, but there were no viable tumor cells. Pathological and immunohistological studies showed a germ cell tumor with somatic-type malignancy. The concentrations of serum AFP and HCG-β decreased to within normal limits after surgery. Stereotactic radiosurgery was performed for second brain metastases three months after surgery. There has been no sign of recurrence for 32 months.Conclusion: Primary mediastinal nonseminomatous GCT-STM is recognized as difficult to treat. In this case, good control of the disease was achieved by multimodality treatment.

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Benign metastasizing leiomyoma (BML) is a rare condition that occurs predominantly in women during the reproductive years. We encountered two cases of BML.Case 1, a 34-year-old woman, with multiple nodules throughout both lungs, complained of general fatigue. Five bronchoscopic biopsies failed to be diagnostic. A lung biopsy at surgery revealed BML. Her medical history included hysterectomy for uterine leiomyoma. After follow-up for over 25 years, her general condition has not worsened.Case 2, a 44-year-old woman, with 3 nodules in the right upper lobe, and 2 in the left upper lobe, was admitted to our hospital. A thoracoscopic lung biopsy revealed BML. After follow-up for over 5 years, the lesions have shown no marked change without hormone therapy.

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A 66-year-old female was referred to our hospital with a tumor in the right posterior mediastinum, which was detected by chest CT. CT showed a tumor, located on the right side of the third and fourth thoracic vertebrae, measuring 30×20 mm in diameter. The tumor also revealed peripheral punctate enhancements in the early phase, but no enhancement was observed in the delayed phase. Magnetic resonance imaging (MRI) revealed iso-intensity on T1-weighted images (T1WI) and heterogeneous intensity on T2WI. Until surgery, a neurogenic tumor was considered. Because it showed signs of rapid growth, we performed surgery. Intraoperatively, the lesion bled easily, and the final volume of bleeding was 500 g. Pathological diagnosis confirmed the diagnosis of hemangioma. Few case studies reporting the preoperative diagnosis of mediastinal hemangioma have been published, because the lesion presents various patterns on CT and MRI. Thus, this study suggests that a differential diagnosis of hemangioma should be considered, even in the case of mediastinal tumors with minimal enhancement on CT and MRI.

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A 32-year-old man consulted his family doctor with a complaint of right chest pain which had started 2 months previously. There were no remarkable findings on chest radiograph imaging at the first examination, but 1 month thereafter, an abnormal shadow was seen on chest radiograph imaging during a routine health check-up, and the patient was referred to our department. Chest computed tomography revealed a mass of 75 mm in diameter on the right side of the anterior mediastinum, and surgery was undertaken. Perioperative findings revealed a cystic lesion accompanied with a dark-brown liquid effusion. The cyst adhered to the diaphragm and pericardial fat pad. We considered the origin of the cyst to be the visceral pleura of the right middle lobe of the lung. We performed a cystectomy and wedge resection of the right middle lobe under video-assisted thoracoscopic surgery. The pathologic diagnosis was a mesothelial cyst. We believe that the mesothelial cyst had rapidly enlarged in a short period due to the rapid accumulation of liquid, probably due to inflammation.

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A 77-year-old man presented to our hospital with a chief complaint of an abnormal shadow, 7 mm in size, in the left upper lobe of the lung, pointed out by chest low-dose CT screening during a medical health check-up in March 2012. It was not detected by the previous check-up 2 years ago. Thin-slice CT images showed that there was a pure ground-glass nodule (GGN), ovoid in shape, and 9 mm in the maximum diameter. The lung cancer lesion underwent wedge resection with video-assisted thoracic surgery in May 2012. The pathologic diagnosis was p-stage 0-adenocarcinoma in situ (AIS), according to the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma, 2011. Although AIS shows non-invasive slow-growing type early lung cancer with only a lepidic growth pattern, there was fear of the underestimation of malignancy based on the findings of routine TSCT images and pathologic Hematoxylin-Eosin staining in this case, because of the tumor volume doubling time, 151 days, on CT images, and immunohistochemical analysis.

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