The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 29 , Issue 2
Showing 1-25 articles out of 25 articles from the selected issue
  • Fumihiro Ishibashi, Hajime Tamura, Yukiko Matsui, Yasumitsu Moriya, To ...
    2015 Volume 29 Issue 2 Pages 122-128
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    Completion pneumonectomy (CP) for non-small cell lung cancer may be required for local recurrence or second primary lung cancer. We evaluated the CP indications, postoperative complications, and prognosis by retrospectively reviewing 7 men and 2 women, with a mean age of 66.1 (52-77) years, who underwent CP (Jan. 1994 to Dec. 2013). The first primary lung cancer histology included adenocarcinoma (5), squamous cell carcinoma (3), and basaloid carcinoma (1); p-stage IA for 2, p-stage IB for 2, p-stage IIA for 2, and p-stage IIB for 3. Initial surgeries were lobectomy with mediastinal lymph node dissection. CP was performed for second primary lung cancer in 3, and local recurrence in 6. Post-CP complications were cerebral infarction, wound dehiscence, and wound infection (1 patient each). After CP, survival ranged from 2 to 90 months; the actuarial 5-year survival rate was 14.8%. Three of 9 patients survived for>3 years. Generally, CP is difficult, with high postoperative morbidity and mortality rates; however, prolonged survival can result if complications are successfully managed perioperatively. CP is an effective therapeutic method for recurrent or second primary lung cancer.
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  • Takuji Fujinaga, Masaki Ikeda, Koji Takahashi
    2015 Volume 29 Issue 2 Pages 129-134
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    Brambilla and colleagues first described the clinicopathological features of basaloid carcinoma of the lung in 1992, which is now classified as a variant of squamous cell carcinoma or large cell carcinoma in the World Health Organization classification. Basaloid squamous cell carcinoma (BSC) is rare and its associated prognosis is reportedly poor. Between January 2006 and December 2013, 9 out of 553 cases of lung cancer surgically resected in our hospital were pathologically diagnosed as BSC. They comprised 6.4% squamous cell carcinomas and 1.6% whole lung cancers during the period. In this article, the authors analyzed the clinicopathological features and prognosis of 9 BSC patients. Two with a pure basaloid pattern showed a relatively early recurrence. No significant difference in 5-year survival was seen between BSC and non-BSC.
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  • Hidenori Kouso, Genkichi Saito, Yasuji Yoshikawa
    2015 Volume 29 Issue 2 Pages 135-140
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    A 58-year-old woman with chronic kidney disease was referred to our hospital for a lung mass detected by chest radiograph and chest computed tomography (CT). Chest CT showed a smooth and well-defined nodule of 14 mm in the right upper lobe. The serum ProGRP level was very high, at 602 pg/mL. A preoperative pathological diagnosis was not obtained. The patient underwent a right upper lobectomy for the lung mass, and it revealed a typical pulmonary carcinoid tumor pathologically. Although the serum ProGRP level immediately decreased after surgery, it remained at 162 pg/mL. Serum ProGRP is a useful marker of small cell lung cancer, and is also known to show a high level in patients with renal dysfunction. This report describes an extremely rare case of a typical pulmonary carcinoid tumor with chronic kidney disease showing a markedly high level of serum ProGRP.
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  • Naohisa Chiba, Sung Soo Chang, Masao Saito, Yuichiro Ueda, Shinya Ishi ...
    2015 Volume 29 Issue 2 Pages 141-145
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    Primary lung leiomyoma is a rare disease which accounts for about 0.04% of all lung tumors. It is classified into endobronchial and lung parenchymal types according to the location of the tumor. We report a surgically treated case of endobronchial leiomyoma radiographically suspected of being a malignant tumor. A 50-year-old man was taken to a clinic with a complaint of a cough persisting for two months. An abnormal shadow was pointed out in the left upper lung field on a chest radiograph. He underwent fiberoptic bronchoscopy and biopsy was performed of the tumor in the orifice of the left upper bronchus, leading to a diagnosis of leiomyoma. He was admitted to our hospital for surgical treatment. Although pathologically malignant findings were not detected in the biopsy specimen, the tumor was suspected of being malignant because [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) revealed significant uptakes in the tumor and swelling lymph nodes in the hilum and mediastinum. A left upper lobectomy was performed with a complete thoracoscopic view. The histopathological diagnosis after surgery was benign leiomyoma. The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. We should take into account that endobronchial leiomyoma may reveal radiographic findings of positive FDG uptake or local lymph node swelling, probably due to obstructive bronchial inflammation mimicking a malignant tumor.
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  • Kazuya Fujinaga, Hisato Ito, Yasuhiro Sawada, Yu Shomura, Toru Mizumot ...
    2015 Volume 29 Issue 2 Pages 146-149
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    The patient was a 43 -year-old man who presented with a typical Cushingoid appearance and elevated serum adrenocorticotropic hormone (ACTH) and cortisol levels, indicating ACTH-related Cushing's syndrome. Chest computed tomography revealed a 1.6×1.3-cm nodule in the inferior lobe of the right lung. The patient received surgery for a suspected ACTH-releasing lung tumor. Right lower lobectomy with lymph node dissection was performed on the basis of the pathological diagnosis during surgery of a pulmonary carcinoid tumor. The postoperative histological diagnosis indicated a typical carcinoid tumor. Immunohistochemical analysis with anti-ACTH antibody yielded positive results. The serum ACTH level decreased after resection.The patient showed favorable recovery after treatment, without any recurrence.
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  • Takeshi Kawaguchi, Takashi Watanabe, Norikazu Kawai, Takashi Tojo
    2015 Volume 29 Issue 2 Pages 150-154
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    We discuss minimally invasive techniques using LigaSureTM in chest wall resection. A patient with a metastatic chest wall tumor from a renal cell carcinoma underwent 8th-10th rib chest wall resection. A primary incision of 10 cm was made posteriorly over the ninth rib, followed by posterior chest wall dissection through this incision. The intercostal muscles and vessels were divided using LigaSureTM, and the dissection continued anteriorly using LigaSureTM with visual monitoring using a thoracoscope. Dissection of the anterior edge of the chest wall was difficult through the main incision, and a utility port was added anteriorly to divide the anterior edge of the ribs under direct vision. LigaSureTM was effectively and easily used to divide the intercostal muscles and vessels. Chest wall resection using LigaSureTM via video-assisted thoracoscopic surgery was suggested to be an effective, minimally invasive approach for chest wall tumor resection.
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  • Harushi Ueno, Kiyoshi Nakashima, Yuka Kadomatsu, Toshiki Okasaka, Shoi ...
    2015 Volume 29 Issue 2 Pages 155-159
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    A 45-year-old man was referred to our hospital because of left pleural effusion noted on chest radiograph. Further examination led to a diagnosis of idiopathic chylothorax. Conservative treatment failed to control the chylothorax, and we performed closure of the leakage point in the left diaphragm and ligation of the right thoracic duct using video-assisted thoracoscopic surgery. Pleurodesis on the left side was performed on postoperative day 1 because of incomplete healing. However, right chylothorax appeared on postoperative day 18; therefore, we performed pleurodesis on the right side. Idiopathic chylothorax is rare and difficult to treat conservatively. Even with surgical treatment, some cases are recurrent. We report a case of refractory idiopathic chylothorax treated with bilateral pleurodesis following surgery.
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  • Mariko Aoyama, Takanori Miyoshi, Seiya Inoue, Naoki Hino, Masaru Tsuyu ...
    2015 Volume 29 Issue 2 Pages 160-165
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    We report a case of intralobar pulmonary sequestration treated by thoracoscopic lobectomy. The patient was a 30-year-old man. He consulted the hospital for fever, arthralgia, and general fatigue. He was diagnosed with intralobar pulmonary sequestration and empyema based on CT, and consulted us for treatment. He received MEPM therapy. After chemotherapy, the symptoms disappeared, but chest CT showed persistent inflammation with a cavity. We perfomed thoracoscopic left lower lobectomy. He was discharged after 10 days. An early operation after the first infectious disease for intralobar pulmonary sequestration is safe and useful.
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  • Takanobu Sasaki, Tomonori Furugen, Takao Teruya, Yukio Kuniyoshi
    2015 Volume 29 Issue 2 Pages 166-170
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    A 61-year-old female patient was found to have a tumor during follow-up investigations for ANCA (anti-neutrophil cytoplasmic antibody) -associated vasculitis. The tumor had a diameter of about 4 cm, with an increasing size, and was located in the right lower lobe (S10). Therefore, she was referred to our institution. The tumor size gradually increased and serum CA19-9 was abnormally high (max: 1,480 U/mL). We considered lung malignancy and performed surgery, which served for both diagnosis and treatment. The tumor had an increased amount of blood vessels on its surface and was soft-elastic. As the tumor was close to the right inferior pulmonary vein, partial resection was difficult, and so we performed a right lower lobe lobectomy. The tumor mass was filled with a pus-like liquid component showing a high viscosity. Bacterial and acid fast bacterial cultures of the contents were negative. Based on the clinical course and postoperative pathological findings, we diagnosed her with a bronchogenic cyst. After surgery, we confirmed a rapid decrease in CA19-9 levels (20 U/mL).
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  • Makoto Motoishi, Keigo Okamoto, Ryosuke Kaku, Satoru Sawai
    2015 Volume 29 Issue 2 Pages 171-175
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    A 70-year-old man with a history of COPD received chest CT. A small nodule of 7 mm in diameter was detected in segment 1 of the right lung. Retrospectively, the lesion was detectable about one year ago, and had slightly enlarged. Chest and abdominal CT did not show other obvious tumor lesions. PET-CT revealed no abnormal accumulation, including in the right lung nodule. Thoracoscopic partial resection, including the lesion, was performed for diagnosis and treatment. Microscopic examination showed the diffuse proliferation of large atypical lymphoid cells with rough chromatin and prominent nucleoli, and small lymphocytic cells. Immunohistochemically, the tumor cells stained positive for CD20 and CD79a, and high-level Ki67 expression was observed. The lesion was diagnosed as diffuse large B-cell lymphoma (DLBCL). PET-CT taken 5 months after the operation revealed no abnormal findings. The final diagnosis was pulmonary DLBCL presenting as a small solitary nodule.
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  • Yoshitake Murata, Takahisa Matsuoka, Shinjiro Nagai, Katsunari Matsuok ...
    2015 Volume 29 Issue 2 Pages 176-180
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    A 65-year-old woman was referred to our hospital for pulmonary nontuberculous mycobacterial infection. Chest CT showed cavities in both upper lobes. Even though she underwent antimycobacterial chemotherapy for a year, the cavities enlarged. We performed a right upper lobectomy under video-assisted thoracoscopic surgery, because a large cavity in the right upper lobe was the main source of bacterial discharge. A year after the operation, a small cavity in the left lung showed improvement on chest CT.
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  • Takuya Matsui, Kotaro Mizuno, Risa Oda, Takeshi Yamada
    2015 Volume 29 Issue 2 Pages 181-186
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    Mucosa-associated lymphoid tissue (MALT) lymphoma in the thymus is relatively rare. We present two cases of MALT lymphoma of the thymus with a review of the literature. The first patient was a 67-year-old woman. She visited a local physician with a cough. Chest computed tomography showed a well-circumscribed and lobulated mass in the anterior mediastinum. She was referred to our hospital and recommended to undergo surgery because the mass was suspected of being a cystic thymoma or a thymic cyst. Tumor resection was performed under video-assisted thoracoscopic surgery using carbon dioxide insufflation. The second patient was a 43-year-old woman. She was referred to our hospital because of a sore throat. Chest computed tomography showed a well-circumscribed and smooth mass in the anterior mediastinum. Because the mass was suspected of being a thymoma, we performed tumor resection through a sternotomy approach. She was diagnosed with Sjogren' s syndrome after surgery. In both cases, the resected specimens led to a diagnosis of MALT lymphoma of the thymus.
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  • Mika Hoshino, Takumi Yamaura, Satoshi Muto, Jun Ohsugi, Mitsunori Higu ...
    2015 Volume 29 Issue 2 Pages 187-192
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    A 50-year-old female with diabetes mellitus was admitted to our hospital because of recurrent hemoptysis. Chest computed tomography revealed a mass with air cavities and wall thickness. A blood test showed a systemic inflammatory reaction and the level of plasma aspergillus antigen was high. Initially, she was diagnosed with chronic necrotic pulmonary aspergillosis and administered an anti-fungal agent. Because the hemoptysis did not improve, she underwent right upper lobectomy as a curative surgery. Post-operative pathological findings showed fine hyphae in the removed materials but did not show the fungal body of Aspergillus. She was diagnosed with pulmonary actinomycosis. She has been well without any recurrent lesions for four years since surgery followed by one-year penicillin treatment. Pulmonary actinomycosis is often too difficult to definitively diagnose, because it is often necessary to distinguish it from lung cancer, pulmonary tuberculosis, and fungal infection. Cases of pulmonary actinomycosis with massive hemoptysis and pulmonary nodules may require early diagnosis and treatment.
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  • Ryota Sumitomo, Jun Kobayashi, Masato Okuda
    2015 Volume 29 Issue 2 Pages 193-197
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    Unilateral pulmonary artery hypoplasia is a rare anomaly. Chest radiograph shows diminished hilar vessels and hyperlucency of a uniIateral lung. We present a 78-year-old man with dyspnea on effort, who was followed as a patient with left pulmonary artery hypoplasia and pulmonary hypertension. Follow-up chest radiograph and CT incidentally showed a nodule in the left upper lobe, which was diagnosed as adenocarcinoma through transbronchial biopsy. Although the partial pressure of oxygen in arterial blood was 56.5 Torr, he was considered appropriate for surgery because a lung perfusion scintigram showed extremely poor perfusion in the affected lung. Video-assisted thoracic surgery (VATS) lobectomy was safely performed. After the operation, both his symptom and the partial pressure of oxygen in arterial blood were markedly improved, with the latter increasing to 71.9 Torr.
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  • Hidenao Kayawake, Norihito Okumura, Akihiko Yamashina, Takashi Nakashi ...
    2015 Volume 29 Issue 2 Pages 198-203
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    We report three cases of pulmonary resection for new lesions in the contralateral lung following pneumonectomy. Case 1: A new lung lesion was suspected in the right lower lobe in a 72-year-old man with a three-year history of left pneumonectomy for squamous cell carcinoma, and wedge resection of the right lower lobe was performed. The postoperative diagnosis was metastatic lung cancer from the contralateral lung. The postoperative course was favorable, but he died of lung cancer after 14 months. Case 2: New lung lesions in the right upper and middle lobe were suspected in a 66-year-old man with a three-year history of left pneumonectomy for adenocarcinoma, and wedge resection of the right upper and middle lobes was performed. The postoperative diagnosis was metastatic lung cancer from the contralateral lung. The postoperative course was favorable, but he died of pneumonia after 43 months. Case 3: A new lung lesion in the right upper lobe was suspected in a 71-year-old man with a 20-year history of left pneumonectomy for MALT lymphoma. S1 segmentectomy was performed, and the postoperative diagnosis was adenocarcinoma. The postoperative course was favorable, but he died of fulminant hepatitis after 39 months. The postoperative courses of all three patients were uneventful. By selecting appropriate operative cases and appropriate operative methods on the basis of preoperative assessment of the cardio-pulmonary function, size and location of the tumor, and time-course after pneumonectomy, pulmonary resection for new lesions in the contralateral lung following pneumonectomy may be a treatment option.
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  • Hideki Ichinari, Eiichi Chosa, Akihiro Yonei, Kazuhiko Mine, Atsushi K ...
    2015 Volume 29 Issue 2 Pages 204-209
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    Gastric metastasis from primary lung cancers is quite rare. In such a case, resection of the affected tissue is rarely performed. We herein describe a case of resection of the abovementioned case. A 60-year-old man was found to have right massive pleural effusion. He was diagnosed with c-TxN2M1a and c-stage IV lung cancer on the basis of detailed examination combined with the presence of adenocarcinoma cells in the pleural effusion. Chemotherapy with carboplatin+paclitaxel was initiated. After three cycles of chemotherapy, the patient developed herpes zoster infection. Following this, we decided to stop chemotherapy. Two years later, he underwent a follow-up examination, and CT revealed the disappearance of the thoracic diseases and a newly developed gastric submucosal lesion, and positron emission tomography-computed tomography indicated no other lesion. Noninvolvement of surrounding structures suggested that we could perform total gastrectomy, D2 lymph node dissection, pancreatic tail resection, and splenectomy. The adenocarcinomatous nature of the gastric and lymph node metastases from lung cancer was later demonstrated pathologically. We report a rare case of resection of gastric metastasis from lung cancer. These cases are recommended for multimodality therapy, including surgical operations.
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  • Keiji Yamanashi, Yuichiro Ueda, Junko Tokuno, Ryota Sumitomo, Tsuyoshi ...
    2015 Volume 29 Issue 2 Pages 210-214
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    A 78-year-old man exhibiting a slowly-expanding middle mediastinal mass was admitted to our hospital. He underwent aortic valve replacement 31 years ago. Enhanced chest computed tomography showed a 75-mm heterogeneous mass with rim enhancement in the middle mediastinum. Mixed signal intensity in a mosaic pattern was seen on T2-weighted magnetic resonance imaging. Based on his clinical course, a chronic expanding hematoma of the thorax was diagnosed preoperatively. Because the tumor was growing and we could not rule out the possibility of a malignant tumor, surgery was performed. The tumor was removed with remnants of the capsule on the mediastinal side due to marked adhesion. Histopathological examination confirmed the diagnosis of chronic expanding hematoma. The postoperative course was uneventful. He remains well after 9 months, with no sign of recurrence of chronic expanding hematoma.
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  • Naohiro Nose, Tetsuya So, Takeaki Miyata, Takashi Yoshimatsu, Atushi S ...
    2015 Volume 29 Issue 2 Pages 215-219
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    An 82-year-old male was admitted to the Department of Orthopedic Surgery at our hospital for right distal tibioperoneal fractures. He had been followed-up by his primary doctor for depression. On chest radiograph performed on admission, a right lung tumor suspected to be lung cancer was detected. After surgery for the fracture, a right middle lobectomy+ND2a-1 via video-assisted thoracic surgery was performed. On the third night after surgery, the patient' s roommate discovered the patient sitting on the floor hanging himself with towels hooked over the rail of the window. The strangulation was interrupted immediately, and spontaneous breathing without impaired consciousness was identified. The patient was subsequently moved to a high care unit on suicide watch. On the next morning, he was discharged for referral to a psychiatrist. Not only depression, but also lung cancer, are risk factors for committing suicide. Physicians should therefore pay increased attention to the possibility of suicide in patients with both diseases.
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  • Takao Higuchi, Asahi Nagata, Toshinori Hamada, Takaomi Koga, Katsuo Su ...
    2015 Volume 29 Issue 2 Pages 220-225
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    The patient was a 63-year-old male who had high levels of CEA in 1997. In 2002, CT revealed a swelling of the right upper mediastinal lymph node. Although metastatic carcinoma was diagnosed by biopsy, the primary lesion remained unknown. We performed a dissection of the mediastinal lymph node by VATS. The CEA levels normalized for 9 years. However, in 2011, the levels increased, and CT revealed bronchial wall thickening at the right superior bronchus. Class V diagnosis was achieved by cytology; therefore, right upper lobectomy was performed. Large cell carcinoma was diagnosed resembling that of the mediastinal lymph node. The CEA levels normalized, and he has remained recurrence-free for 3 years.
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  • Yoshihiko Kimura, Hiroshi Toda
    2015 Volume 29 Issue 2 Pages 226-230
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    We report a case of thymic cancer successfully treated with S-1. A 50-year-old man underwent squamous cell thymic cancer resection with concomitant resection of the left brachiocephalic vein, left lung, and pericardium. Multiple left pleural disseminations were revealed during the operation. Postoperative radiotherapy of the mediastinum and left pleural cavity and combination chemotherapy of cisplatin and etoposide were performed. At approximately three years after surgery, the progression of the disseminated tumors occurred. Carboplatin/paclitaxel chemotherapy reduced the tumors, but the response duration was brief. Subsequent administration of S-1 markedly shrank the tumors, and the effectiveness has continued for three and a half years. This case suggests that S-1 may be effective for squamous cell thymic cancer.
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  • Toshinari Ema, Ryoji Kawano
    2015 Volume 29 Issue 2 Pages 231-235
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    A female patient in her 40s was referred to our hospital for an operation without blood transfusion involving a right lung lower lobectomy for metastasis from rectal cancer. At her previous hospital, she had received radical surgery for rectal cancer in 2008. At two years after the operation, she was diagnosed with multiple lung inoperable, and the lung tumor was inoperable. Although she had once started to receive chemotherapy. She chose to discontinue it because of the severe side effects. After that, she received radiation therapy (total of 50 Gy) to the tumor in the right lower lobe, she which had enlarged and existed on the proximale side. It led to disease, increased and was then followed up. However, the tumor of the right lower lobe slowly increased. The tumor surrounded the right right inferior pulmonary vain, so a curative operation was considered very difficult. Furthermor, due to the fact she was a Jehovah's Witness, she wanted to receive an operation without blood transfision. She thus visited our hospital. We considered such an operation to be very risky but not impossible. After six course of FOLFOX therapy at our hospital, although the effect was Stable disease, we succeeded in perfouming a right lung lower lobectomy without blood transfusion.
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  • Kiyomichi Mizuno, Kouzou Matsushita, Yasushi Ito, Satoshi Ohi, Kazuya ...
    2015 Volume 29 Issue 2 Pages 236-240
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    A 67-year-old woman, who received postoperative chemotherapy, was admitted to the hospital for granulocytopenia and severe pneumonia, sepsis, and DIC. After intensive care, she developed a lung abscess in the right upper lobe. Antibiotics and transbronchial drainage were unsuccessful, she underwent fenestration and cavernostomy open drainage of the right anterior chest. The general status improved, and infection in the cavity was under control, so we performed omental pack through a retrosternal route with sternal elevation bar and closure of fenestration. The patient was discharged with a favorable clinical condition on the 18th postoperative day. We suggest that a retrosternal route through sternal elevation leads to smooth surgery for similar cases.
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  • Hitoshi Suzuki, Shin Shomura, Kentaro Inoue, Masaki Yada, Hironori Ten ...
    2015 Volume 29 Issue 2 Pages 241-245
    Published: March 15, 2015
    Released: March 26, 2015
    JOURNALS FREE ACCESS
    Prostate cancer is rarely diagnosed by the detection of lung metastases. We report a case of prostate cancer in a 59-year-old man detected based on abnormalities on chest radiograph and the serum prostate-specific antigen (PSA) level (6.76 ng/mL) on follow-up for prostatic hypertrophy. Chest computed tomography (CT) revealed multiple abnormal nodules in both lung fields. On the first prostate biopsy and transbronchial lung biopsy, neither lung nor prostate cancer was detected, and he was followed. One year after the first biopsy, chest CT revealed more nodules in both lung fields and the PSA level showed further elevation. A second prostate biopsy and transbronchial lung biopsy were performed, but no cancer was detected. He was diagnosed with moderately differentiated prostate adenocarcinoma with multiple lung metastases without any other metastatic lesion after VATS lung biopsy. Maximum androgen blockade (MAB) therapy was performed after the operation. Three months after the start of MAB therapy, his PSA level had normalized and the multiple pulmonary metastases had completely disappeared. There has been no evidence of recurrence or PSA relapse over a follow-up period of 25 months. Isolated pulmonary metastases from prostate cancer are rare, with only 46 previously described cases in the literature.
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