The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 29 , Issue 5
Showing 1-24 articles out of 24 articles from the selected issue
  • Yuki Owada, Yuki Nakajima, Takuya Inoue, Hiroyasu Kinoshita, Kenichi I ...
    2015 Volume 29 Issue 5 Pages 546-551
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    Between 1978 and 2013, 63 patients with lung metastasis of breast cancer were surgically treated at our institution, and we investigated these patients to identify potential prognostic factors. The median OS after pulmonary resection was 43.1 months. A size≥3 cm, an estrogen receptor (ER)-negative status, a disease-free interval (DFI) <24 months, and metastasis to the mediastinal and/or hilar lymph nodes were factors indicating a poor prognosis, as shown by univariate analysis. Multivariate analysis revealed that a size≥3.0 cm was an independent factor indicating a poor prognosis. We could not show a significant difference between patients based on whether the tumors were completely resected or not, so surgical treatment alone had less therapeutic importance. However, surgery for the purpose of obtaining a sufficient amount of metastatic tissue for a definitive diagnosis of the hormone receptor status may be necessary. The only prognostic factor identified in the multivariate analysis was a tumor diameter larger than 3 cm. It is necessary to further consider not only the tumor diameter but also some prognostic factors that affect the possibility of recurrence after complete resection of lung metastasis of breast cancer.
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  • Masahiro Mitsuoka, Yasuhiro Terazaki, Yusuke Okamoto, Takashi Teishika ...
    2015 Volume 29 Issue 5 Pages 552-558
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    The chance of detecting a small peripheral pulmonary nodule has recently increased due to the marked progress in the capability of computer tomography (CT). Although preoperative CT-guided marking has been developed to identify the site of a nodule, there are some problems such as air embolism. We have performed intraoperative marking of a small pulmonary nodule using CT-like images, also called cone-beam CT (CBCT) images, produced using the Hybrid OR System. This system consists of Allura Xper FD20 (Phillips Co., Ltd., Netherlands) and Magnus Table (Maquet Co., Ltd., Germany). Nineteen small nodules in 17 patients were resected using this procedure. None of them were diagnosed preoperatively. There were eight primary lung cancers, nine pulmonary metastases from other malignancies, and two benign regions. All regions could be clearly detected by CBCT. There was no complication related to this procedure. This method can be a very useful technique of intraoperative pulmonary marking which can avoid serious complications such as air embolisms for the patient.
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  • Naoya Kawakita, Toshiyuki Hirose, Atsushi Morishita, Masayuki Sumitomo
    2015 Volume 29 Issue 5 Pages 559-565
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    Video-assisted thoracoscopic surgery for acute empyema is less-invasive, and its safety has been emphasized in many reports. With the expansion of indications, however, it has been suggested that the incidences of complications and death are high in patients with a poor general condition. During the three years from January 2011, we performed thoracoscopic surgery for acute empyema after pneumonia in 35 patients. Among them, 10 patients (29%) experienced postoperative complications, and there were 3 cases (8.6%) of in-hospital mortality. The results of our examination of the preoperative factors affecting postoperative complications showed that the minimum preoperative serum albumin value in the group with complications, 2.4±0.4 g/dL, was significantly lower than that in the group without complications, 2.9±0.6 g/dL (p=0.012), and that patients with a performance status (PS) of 3-4 experienced complications more frequently than those with a PS of 0-2 (p=0.002). In a receiver operating characteristic (ROC) curve analysis, a cutoff value for albumin of 2.5 g/dL or less demonstrated a sensitivity of 84% and specificity of 80% for predicting the development of complications. It was considered that we should judge the risk groups for complications before surgery and consider appropriate therapeutic strategies in the future.
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  • Nobuo Tsunooka, Kyo Hirayama, Fumio Matsuda, Keitaro Inazawa
    2015 Volume 29 Issue 5 Pages 566-571
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    A retrospective review was performed of the clinicopathological features of 20 patients with adenosquamous cell carcinoma (ASC) of the lungs who were treated surgically between 2005 and 2013. They were compared with those of 710 patients with adenocarcinoma (AC) and 174 patients with squamous cell carcinoma (SC) who were treated during the same period. The ASC group had a higher Brinkman index, a higher median maximum standardized uptake value on fluorodeoxyglucose positron emission tomography, and higher concentrations of carcinoembryonic antigen and cytokeratin 19 fragments compared with the AC group. In addition, pathological stage IA ASC was less common than pathological stage IA AC, and stage IIB ASC was more common than stage IIB AC and stage IIB SC. The recurrence rate of ASC was higher than that of AC and SC. This could be because the ASC group had higher rates of vascular invasion and lymph node metastasis than the other groups based on logistic regression multivariate analysis of the risk factors. Distant metastases or local recurrences developed in 10 patients in the ASC group. Such metastases were more frequent in patients who were heavy smokers, had higher carcinoembryonic antigen concentrations, and had higher vascular invasion scores.
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  • Takahisa Matsuoka, Naoko Imanishi, Shinjiro Nagai, Katsunari Matsuoka, ...
    2015 Volume 29 Issue 5 Pages 572-575
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    We retrospectively reviewed one-hundred cases of acute empyema treated by video-assisted thoracic surgery (VATS) in our institute from April 1998 to April 2013. We divided these cases into two groups: first half group (n=44; April 1998-September 2008) and latter half group (n=56; October 2008-April 2013), and we examined the patients' profiles and clinical course. The durations of preoperative symptoms and preoperative pleural effusion before surgery were 2.2 weeks and 6.2 days in the latter half group, but 4.7 weeks and 14.1 days in the first half group, respectively (p<0.0001). The number of postoperative complications was significantly higher in the cases with a duration of preoperative symptoms of more than 2 weeks (p=0.0244). The postoperative drainage periods were 3.5 days in the latter half group and 4 days in the first half group (p=0.0293). Only one case of recurrence of empyema was observed, but that patient was treated successfully with antibiotics. There have been no hospital deaths. VATS is a safe and effective method for the management of acute empyema. Although early diagnosis and treatment is indispensable, it is important to raise the awareness of all doctors encountering acute empyema.
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  • Hiromitsu Takizawa, Mitsuhiro Tsuboi, Koichiro Kajiura, Hiroaki Toba, ...
    2015 Volume 29 Issue 5 Pages 576-581
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    Since lung cancer patients with visceral pleural invasion show a poorer prognosis even with a tumor size of 2 cm or smaller, these patients are not suitable candidates for sublobar resection. Therefore, we evaluated the accuracy of the intraoperative diagnosis of visceral pleural invasion. Twelve doctors who belong to the Department of Thoracic Surgery answered clinical questions and the data were collected. Of the 30 eligible patients who showed pleural changes, 14 were male and 16 were female, and the mean age was 66.8 years (range, 41-81 years). The mean tumor size was 22.7 mm (range, 16-57 mm). The histologic type was adenocarcinoma in 22 patients, squamous cell carcinoma in 7 patients, and another cell type in 1 patient. There were 22 patients with (pl 1≤) and 8 patients without (pl 0) visceral pleural invasion. The doctors were given the following information: 1. Preoperative CT, 2. Histologic type, and 3. Thoracoscopic movies showing pleural changes, and they answered whether or not there was visceral pleural invasion (PL≤1 or PL 0). Sensitivity, specificity, and accuracy were calculated from the data. The overall average sensitivity, specificity, and accuracy were 66.7% (range, 37.5-87.5%), 61.4% (range, 45.5-86.4%), and 62.8% (range, 53.3-80.0%), respectively. The accuracy of intraoperative diagnosis for visceral pleural invasion is not high; therefore, novel diagnostic procedures are expected in the future.
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  • Shuichi Shinohara, Hidehiko Shimokawa, Tomoko So, Hidetaka Uramoto, Fu ...
    2015 Volume 29 Issue 5 Pages 582-586
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    A 21-year-old man with a yolk sac tumor of the mediastinum presented to out hospital after chemotherapy with multiple cisplatin-based regimens. Despite persistent elevated serum AFP after 3rd-line chemotherapy, surgery was preferred because further chemotherapy was suggested to be no longer effective. Complete resection was achieved, and he was alive without tumor recurrence as of 17 months after surgery.
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  • Hiroya Yamagishi, Shin-ichi Sumitomo, Masashi Ishikawa, Tetsuya Fukui, ...
    2015 Volume 29 Issue 5 Pages 587-592
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    Liposarcoma in the mediastinum or chest wall is rare. We report a case of liposarcomas in both regions with different histologies. A 67-year-old man was referred to our hospital because of an abnormal shadow on a chest radiograph. CT showed a 55-mm mass in the mediastinum, and a 47-mm mass in the right anterior chest wall. We suspected myxoid liposarcoma and lipoma, respectively. Thoracotomy was performed for the mediastinal mass. It was diagnosed as myxoid liposarcoma histologically, and the surgical margin was microscopically positive. He received adjuvant radiotherapy to the mediastinum with a total dose of 60 Gy in order to prevent tumor recurrence. During the follow-up after radiotherapy, the mass in the chest wall had been growing slowly. Sixteen months after the thoracotomy, the chest wall tumor was marginally resected, and diagnosed as well-differentiated liposarcoma. Since myxoid and well-differentiated types have different genetic alterations, we concluded that these tumors had developed independently. He was alive without any evidence of recurrence as of 19 months after the chest wall operation.
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  • Kumi Mesaki, Toshihito Hanaoka, Tetsuji Fukuhara, Kazuhiko Nakagawa, K ...
    2015 Volume 29 Issue 5 Pages 593-599
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    An 84-year-old man was monitored for an expanding mass shadow in the right thorax. His medical history included lung cancer, which had been treated by right upper lobectomy. Computed tomography (CT) revealed expansion of the mass shadow into the retroperitoneum. On the basis of findings of aspirates, we diagnosed the mass as a hematoma. Although the patient's symptoms resolved with conservative treatments transiently, symptoms and expansion of hematoma repeated. We removed the hematoma with the capsule, performed thoracoplasty, and filled the vacant thoracic space with the omentum and an intercostal muscle flap. The postoperative course was mostly favorable. Approximately 9 months later, a subcutaneous hematoma appeared near the surgical scar on the patient's back. We applied drainage and several OK-432 injections. After that, there was no recurrence of the hematoma. There are a few case reports describing chronic expanding hematoma (CEH) in the thorax progressing into extrapleural spaces. Especially, cases of CEH in the thorax progressing into the retroperitoneum are rare. In our case, the hematoma expanded into the retroperitoneum perforating the diaphragm and formed new lesions. A similar case has not been reported. In addition, the recurrence of hematoma was observed in spite of a small amount of capsule remnant, and was treated conservatively. In conclusion, we encountered a rare and interesting case of CEH in the thorax. This case will help to understand the mechanism of progression and recurrence of CEH, and decide on treatments.
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  • Kazuki Hayashi, Jun Hanaoka, Masayuki Hashimoto, Yasuhiko Ohshio, Tomo ...
    2015 Volume 29 Issue 5 Pages 600-604
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    A 52-year-old man was admitted because of poly-lymphadenopathy from the left superior mediastinum to the neck, which was not diagnosed by needle biopsy. We suspected malignant lymphoma and performed partial biopsy under local anesthesia and video-assisted thoracic surgery (VATS) biopsy under general anesthesia, but we were unable to establish a diagnosis. Finally, we resected the largest swollen lymph node by L-shaped mini-sternotomy with a supraclavicular approach, and the hyaline vascular-type of Castleman's disease was diagnosed. When it is difficult to make a definite diagnosis of Castleman's disease by partial biopsy, en bloc resection of a swollen lymph node should be performed. Because Castleman's disease usually involves the mediastinum, which contains many important blood vessels and nerves, it is important to select the surgical approach depending on the location of swollen lymph nodes.
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  • Toshiya Fujiwara, Kouta Araki, Hitoshi Nishikawa, Kazutoshi Kotani, Mo ...
    2015 Volume 29 Issue 5 Pages 605-609
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    We herein report a case of spontaneous regression of thymic cancer diagnosed after thoracic injury. Case: A 54-year-old male, who had sustained multiple fractures and pneumohemothorax, was referred to our hospital for follow-up after thoracic injury. Chest computed tomography revealed a nodular tumor, 29 mm in diameter, in the left anterior mediastinum at the time of injury. Three months later, the nodule had regressed to a size of 18 mm in diameter. The accumulation of fluorodeoxyglucose was observed in the nodule by positron emission tomography. We diagnosed the patient with a thymic epithelial tumor and performed thymectomy. On intraoperative examination of the frozen section, the nodule was diagnosed as a thymoma. Histopathological examination of the resected specimen revealed a thymic carcinoma. The patient received four cycles of combined platinum chemotherapy as adjuvant therapy and is currently disease-free at 12 months postoperatively. Even if a tumor regresses in size during follow-up, careful observation is required.
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  • Ryo Okabe, Noritaka Isowa
    2015 Volume 29 Issue 5 Pages 610-614
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    A 58-year-old man with traumatic hemopneumothorax was discharged from our hospital after treatment with chest drainage. Three days later, he was readmitted complaining of right chest and back pain, and empyema was diagnosed. Eight days later, purpura appeared on the lower extremities and he was diagnosed with Henoch-Schönlein purpura by a dermatologist, suggesting that the purpura was due to empyema. We therefore performed thoracoscopic surgery for the empyema. Acute renal failure developed postoperatively and hemodialysis and intravenous pulse steroid therapy were initiated. The renal function gradually improved, and he was discharged 66 days postoperatively.
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  • Tetsuya Fukui, Shinnichi Sumitomo, Masashi Ishikawa, Tomoki Nishida, H ...
    2015 Volume 29 Issue 5 Pages 615-621
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    A 30-year-old man presented with an anterior chest wall swelling and fever of 39°C. He had a history of pneumonia of the right middle lobe 1 year before being referred to our hospital. Computed tomography (CT) revealed an abscess in the anterior mediastinum extending to the subcutaneous tissue. Subcutaneous incisional drainage and intravenous antibiotic treatment were performed. Chest CT after the drainage demonstrated the disappearance of the mediastinal abscess. Ten months after the first drainage, the mediastinal abscess relapsed, and we performed right thoracotomy for the purpose of mediastinal drainage. However, the mediastinal abscess relapsed again 3 months later. We chose a median sternotomy approach for radical treatment of the abscess. In this immunocompetent young male case, the mediastinal abscess is assumed to have arisen from the former pneumonia. As for the surgical treatment of mediastinitis, a median sternotomy approach seems to be used less and less today. The risk of postoperative osteomyelitis of the sternum is a major concern and less-invasive approaches such as video-assisted thoracic surgery (VATS) drainage are preferred recently. Our experience indicates that median sternotomy can be a satisfactory approach for the treatment of recurrent anterior mediastinal abscess.
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  • Takuya Watanabe, Katsumi Nakamae, Osamu Kawano, Ichiro Fukai, Motoki Y ...
    2015 Volume 29 Issue 5 Pages 622-626
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    A 69-year-old male with diabetes mellitus developed a bronchial fistula after right pneumonectomy. Direct stump closure by wrapping with an intercostal muscle flap failed, resulting in fenestration. The fistula deteriorated with a maximal diameter of 3 cm over a one-year period. Direct suturing was not possible as the fistula was large, and we used a free costal cartilage as a tight seal for it. The free costal cartilage, harvested from the sixth rib, was adjusted to the size of the fistula and fixed to be airtight by interrupted suturing. An omentum flap, prepared in advance, was attached to the cartilage, and the whole procedure was completed by thoracoplasty. His postoperative course was uneventful, resulting in complete closure, which was ascertained by bronchoscopy eight months after the operation. This case shows that it is possible to use a free costal cartilage flap for successful closure of a large bronchial fistula.
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  • Yoko Kataoka, Keigo Okamoto, Mayumi Oshio, Makoto Motoishi, Jun Hanaok ...
    2015 Volume 29 Issue 5 Pages 627-631
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    A 52-year-old woman presented with anterior chest pain and fever. Chest computed tomography revealed a 50-mm, left anterior mediastinal cystic tumor with a thickened wall, and left pleural effusion. A few days after admission, the chest pain, fever, and pleural effusion disappeared. Thymothymectomy was performed to confirm the diagnosis. Histopathologically, the tumor was composed of an extended necrotic area, and some viable tumor cells were observed in the subcapsular region. Therefore, the diagnosis was a stage I (Masaoka staging) type B1 thymoma. No recurrence has been observed for approximately 2 years since the surgery. Thymomas have a variety of pathological features such as cystic and hemorrhagic changes and necrosis. However, thymomas with extended necrosis are very rare. Therefore, we report this case with a review of the literature.
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  • Ayaka Asakawa, Masashi Kobayashi, Akiko Ui, Hironori Ishibashi, Kenich ...
    2015 Volume 29 Issue 5 Pages 632-636
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    We report a case of neck and mediastinal neurofibroma in a 23-year-old woman, who had been diagnosed with neurofibromatosis type 1 (NF1) in childhood. The patient presented with swelling of the parotid gland and neck and a mediastinal tumor. A physical examination identified café-au-lait spots and Lisch nodules. Preoperative computed tomography revealed a 70×53-mm tumor ranging from the neck to the tracheal bifurcation. Fluoro-2-deoxyglucose positron emission tomography revealed partial uptake in the parotid gland, superior sulcus tumor, and neck to the mediastinal tumor, indicating malignancy. The superior sulcus tumor was successfully excised without damage from the subclavian vessels and brachial plexus via a transmanubrial approach, and the neck to the mediastinal tumor was excised via this and a videothoracoscopic approach. The pathological findings indicated non-malignant neurofibromas. Our experience revealed that the transmanubrial approach was valuable as an operative procedure for excising a superior sulcus tumor.
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  • Tadashi Sakane, Kotaro Mizuno, Risa Oda, Takuya Matsui, Masaaki Sano, ...
    2015 Volume 29 Issue 5 Pages 637-642
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    Developing pleuroperitoneal communication as a complication of continuous ambulatory peritoneal dialysis (CAPD) is rare; however, approximately 50% of patients who do require a conversion to hemodialysis. We report three cases of video-assisted thoracoscopic surgery (VATS) for pleuroperitoneal communication in patients undergoing CAPD, showing successful results. In case 1, the patient was a 47-year-old female. In case 2, the patient was a 73-year-old female. Both developed right hydrothorax on postoperative day (POD) 4 after the commencement of CAPD. In case 3, the patient was a 57-year-old male who developed right hydrothorax on POD 43 after the commencement of CAPD. We suspected that all three patients had pleuroperitoneal communication, and performed VATS in all of them. In case 1, we repaired the diaphragmatic defect with direct suture closure. In cases 2 and 3, we covered the diaphragm with a polyglycolic acid sheet and fibrin glue, because the diaphragmatic defects could not be detected. CAPD could be continued in cases 1 and 2. In case 3, the hydrothorax relapsed 10 months after the operation, and we therefore covered the diaphragm with a polyglycolic acid sheet and fibrin glue again. No recurrence has been detected since then, and CAPD has been continued. VATS is a minimally invasive surgery that contributes to the continuation of CAPD treatment, and, as a result, it is considered an effective surgical procedure for pleuroperitoneal communication.
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  • Toshihiro Ojima, Saya Miyahara, Shigeki Sugiyama, Hiroshi Kajiwara, Yo ...
    2015 Volume 29 Issue 5 Pages 643-649
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    We report the case of a primary pulmonary mucosa-associated lymphoid tissue (MALT) tumor with trisomy 18. An 80-year-old man was referred to our hospital for an abnormal chest shadow detected during a routine health check-up in 2012. Chest computed tomography revealed a 4.0×2.8×2.5-cm tumor shadow in the right lower lobe (S7+8). Transbronchial biopsy performed for the tumor did not show any malignancy. However, as the tumor grew slowly, partial resection was performed via video-assisted thoracic surgery. Based on the results of immunohistochemical staining and gene analysis, the tumor was diagnosed as a primary pulmonary MALT tumor with trisomy 18.
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  • Takuya Onuki, Masami Kuramochi, Masaharu Inagaki
    2015 Volume 29 Issue 5 Pages 650-656
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    The patient was a 54-year-old man with a history of myocardial infarction, emphysema, and hepatic dysfunction. He was diagnosed with a left lung abscess by his previous physician, and, as a result, had taken various antibiotics over a period of one month. At the time of transfer to our hospital, his left upper lobe had collapsed. Chronic pulmonary aspergillosis was suspected; however, a definite diagnosis had not been made. Prior to surgery, embolization was performed in the bronchial and abnormal arteries flowing from the thoracic wall, and the left upper lobe was resected through a postero-lateral thoracotomy at the 5th intercostal space. Although marked adhesion was present between the left upper lobe and thoracic wall, there was only a small amount of blood loss during dissection of the adhesion. The final diagnosis was chronic aspergillosis. Approximately 2 weeks after surgery, infectious pneumonia developed. Broad spectrum antibiotics and itraconazole were administered, and the symptoms improved within 2 weeks. Preoperative arterial embolization for chronic pulmonary infection can reduce the amount of intraoperative blood loss. Following the long-term administration of antibiotics, it can be difficult to identify pathogens causing postoperative pneumonia in patients with pulmonary infection who are eligible for surgery. These pathogens may become resistant to many antibiotics, and caution should be exercised when choosing antibiotics and antifungal agents.
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  • Yoshihiro Miyauchi, Tamo Kunimitsu, Hiroyasu Matsuoka, Yuichiro Onuki, ...
    2015 Volume 29 Issue 5 Pages 657-661
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    We report a patient with peripheral lung cancer in the left lower lobe who underwent sleeve lobectomy and double barreled reconstruction of the bronchi, but subsequently interlobar lymph node metastasis invading the bronchus was discovered. The tumor and metastasized lymph node were extirpated en bloc with division of the main bronchus and upper division bronchus. The superior division bronchus and lingular bronchus were anastomosed side by side, and those bronchi were anastomosed to the left main bronchi. The patient has been doing well without recurrence. Sleeve lobectomy and double barreled-reconstruction with segmental bronchi may be applicable for patients with peripheral lung cancer and interlobar lymph node metastasis invading the bronchus but not invading the pulmonary artery to avoid pneumonectomy.
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  • Hirotaka Kumeda, Takashi Eguchi, Takayuki Agatsuma, Masayuki Toishi, T ...
    2015 Volume 29 Issue 5 Pages 662-666
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    A 74-year-old male underwent chest CT during the investigation of a gallstone, which incidentally revealed a right apical 5-cm mass. Bronchoscopy was performed, revealing no malignancy. Two months later, FDG-PET examination was performed, showing abnormal FDG accumulation in the right apical mass and multiple liver nodules. Because fever-up and liver function abnormality occurred shortly after the FDG-PET examination, the patient was treated with antibiotic therapy, and the liver nodules subsequently disappeared. At this time point, the size of the right apical mass decreased from 5 to 3 cm in the maximum diameter. The lesion was followed by CT 4 months later, revealing re-enlargement of the mass to 4 cm in maximum diameter. Bronchoscopy was performed again, and the cytology revealed malignancy. We performed a right upper lobe lobectomy. The tumor was adhered to the apical parietal pleura, and it was excised together with the tumor. The pathological diagnosis was a poorly differentiated squamous cell carcinoma, pT3N0M0 stage IIB. The postoperative course has remained uneventful, and he has been followed-up for 13 months with no evidence of recurrence. Spontaneous regression of a non-small cell lung cancer is rare, and the mechanism remains unclear. It may be one possibility that immune system activation due to the liver abscesses induced the spontaneous regression of the lung tumor in this case.
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  • Hiroaki Oiwa, Katsuyuki Asai, Takahiro Mochizuki, Shigeru Momiki
    2015 Volume 29 Issue 5 Pages 667-672
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    Thrombus formation in the pulmonary vein stump is a potentially lethal complication after anatomic lung resection, especially after resection of the left upper lobe of the lung. A long left superior pulmonary vein (LSPV) stump is one of the causes of thrombosis in the pulmonary vein stump. A 69-year-old man was admitted to our hospital with an abnormal shadow on a screening chest radiograph. Bronchial biopsy and brushing confirmed squamous cell carcinoma. The patient underwent left upper lobectomy with systematic lymph node dissection, with a final diagnosis of pT3N0M0-IIB, pm1. To prevent thrombus formation in the pulmonary vein stump, we divided the LSPV to be as short as possible in the pleural space. The patient was prescribed adjuvant chemotherapy consisting of 3 cycles of CDDP+GEM. Enhanced computed tomography (CT) revealed a thrombus in the stump of the LSPV 7 months after surgery. Anticoagulant therapy was immediately initiated. Enhanced CT performed 3 months later revealed that the thrombus in the stump of the LSPV had disappeared. We suggest that creating an LSPV stump that is as short as possible is insufficient to prevent thrombus formation in the stump.
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  • Takanobu Sasaki, Tomonori Furugen, Takao Teruya, Yukio Kuniyoshi
    2015 Volume 29 Issue 5 Pages 673-676
    Published: July 15, 2015
    Released: July 29, 2015
    JOURNALS FREE ACCESS
    We describe congenital esophagobronchial fistula in a 50-year-old female who initially presented elsewhere with a chief complaint of hemoptysis. Chest CT revealed signs of inflammatory change and bronchial dilation mainly in the superior segment of the right lower lobe of the lung (S6). She was diagnosed with esophagobronchial fistula and referred to our institution for surgery. Marked adhesions were located around the pulmonary artery due to inflammation, and the fistula was surrounded by a small number of adhesions. The fistula and diverticulum were excised using a linear stapler, a right lower lobectomy was performed, and the bronchus and fistula stump were covered with an intercostal muscle flap. The pathological findings showed stratified squamous epithelium and muscularis mucosa in the fistula, with a transition to columnar epithelium.
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