The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
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Showing 1-17 articles out of 17 articles from the selected issue
  • Ryota Sumitomo, Hiroaki Murakami, Yosuke Otake, Cheng-long Huang
    2019 Volume 33 Issue 6 Pages 588-593
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    Although it was previously reported that interrupting the pulmonary vein first may be associated with an improved prognosis in patients undergoing lobectomy for non-small cell lung cancer, performing vein interruption first may lead to lung congestion, which can increase the operative duration and intraoperative bleeding. However, the effect of the vessel interruption sequence during lobectomy on pulmonary congestion is not clear. Therefore, we conducted an observational study on the relationship between pulmonary congestion and the vessel interruption sequence during lobectomy. Patients who underwent lobectomy for a pulmonary tumor at our hospital between January 2017 and December 2018 were included. Patients in whom the effluent pulmonary vein was interrupted after interruption of all pulmonary arteries were classified into the A-first group, while patients who underwent interruption of the effluent pulmonary vein before interruption of any pulmonary artery were classified into the V-first group. The value of the amount of blood removal divided by the resected lobe volume was defined as an index of lung congestion. Then, 27 patients were classified into the A-first group and 21 patients into the V-first group. The index of lung congestion was significantly higher in the V-first group than in the A-first group (35.2±15.7 and 25.3±12.9, respectively, p = 0.02). On the other hand, no significant difference was noted between the two groups in the operative duration, intraoperative bleeding, or blood removal. Although interrupting the pulmonary vein first may be associated with pulmonary congestion during lobectomy, no effect on the operative duration or intraoperative bleeding was identified.

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  • Makoto Yoden, Keigo Okamoto, Kazuki Hayashi, Ryosuke Kaku, Yasuhiko Os ...
    2019 Volume 33 Issue 6 Pages 594-598
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    We report a 70-year-old man who was referred to our hospital for stage IIIA (cT4N1M0) non-small cell lung cancer of the right lower lobe. The tumor was considered unresectable because of the patient's poor respiratory function, and so chemotherapy was initiated. The chemotherapy was effective (ycT1aN0M0), and the residual disease was resected completely via segmentectomy. Convalescence was uneventful, and the patient did not require home oxygen therapy. He remains under observation (performance status: 0) with no sign of recurrence for 12 months.

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  • Ryota Kiriyama, Takehiko Okagawa, Hironori Oyamatsu, Seijiro Niimi
    2019 Volume 33 Issue 6 Pages 599-603
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    Pulmonary actinomycosis involving multiple nodules is relatively uncommon. We report a case of pulmonary actinomycosis involving multiple nodules requiring surgical resection of the remaining nodules after antibiotic therapy. A 71-year-old man admitted to our hospital for pyothorax was found to have multiple nodules in the right lung on chest computed tomography. Although most nodules disappeared after 2 weeks of antibiotic therapy, a nodule in the right S8 remained and gradually enlarged. We performed partial resection based on a suspected diagnosis of malignancy. As a result of pathological findings, the patient was subsequently diagnosed with pulmonary actinomycosis. It is important to reconsider if the period of antibiotic therapy is adequate when a nodule remains after the others have disappeared and include pulmonary actinomycosis as a differential diagnosis. Moreover, a linear shadow from the nodule to pleura may represent pleural inflammation or the initial image of pleural thickening, leading to suspected pulmonary actinomycosis. Therefore, it should be noted that knowledge of the clinical course and image findings could be helpful for differentiating pulmonary actinomycosis from others.

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  • Shogo Yobita, Masayuki Tanahashi, Haruhiro Yukiue, Eriko Suzuki, Naoko ...
    2019 Volume 33 Issue 6 Pages 604-607
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    A 49-year-old woman had suffered 8 repeated episodes of right pneumothorax. When thoracoscopic surgery was performed for the purpose of making a diagnosis and administering treatment, multiple holes were found in the right diaphragm, so partial resection of the diaphragm was performed. A pathological examination revealed ectopic endometrial tissue around the abdominal side of the diaphragm, so we diagnosed the patient with catamenial pneumothorax. It is important to consider catamenial pneumothorax in women showing repeated pneumothorax, even if the frequency does not correspond to the menstrual cycle. In addition, surgery may help clarify the cause and mechanism.

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  • Yoshinori Shitara, Masatoshi Ishizaki, Ryoichi Onozato, Kohei Tajima, ...
    2019 Volume 33 Issue 6 Pages 608-612
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    A man in his 60s was admitted to our hospital for further examination of an abnormal shadow that was observed on a screening chest radiograph. Chest computed tomography showed an anterior mediastinal tumor of 6.5 cm with deviation of the trachea to the left side. The tumor showed a heterogeneous density with calcification and a clear margin. Video-assisted thoracoscopic surgery (VATS) with right cervical collar incision was performed to remove the tumor. The tumor was separated from the thyroid gland and completely extirpated. The pathologic diagnosis was adenomatous goiter. Aberrant mediastinal goiter is a rare disease. The surgical approach should be carefully determined according to the location and size of the tumor. VATS is a useful approach for aberrant mediastinal goiter.

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  • Masaki Shimoji, Kenichi Suda, Kenji Tomizawa, Toshiki Takemoto, Yasush ...
    2019 Volume 33 Issue 6 Pages 613-618
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    The solitary fibrous tumor (SFT) is a rare mesenchymal tumor that arises most commonly from the pleura. The NAB2-STAT6 fusion gene has been reported as a driver mutation of SFT. Here, we encountered a rare case of SFT that arose in lung parenchyma, and we identified the NAB2-STAT6 fusion gene in that tumor. The patient was a 73-year-old man who was noted to heve a growing mass on a chest radiograph. CT showed a circumscribed mass in the right lower lobe (S8). FDG-PET showed slight uptake of FDG in the tumor and the maximal standardized uptake value (SUVmax) was 2.59. Transbronchial lung biopsy failed to obtain an adequate amount of tissue. Because the possibility of lung cancer was suspected, a right lower lobectomy and mediastinal lymph node dissection were performed. Histopathological examination showed the dense growth of tumor cells with oval nuclei. Immunohistochemical examination showed diffuse staining for CD34, CD99, bcl-2, and strong positivity for STAT6, indicating a diagnosis of intrapulmonary SFT. We extracted RNA from the tumor and identified the NAB2 (exon 4) - STAT6 (exon 2) fusion gene using RT-PCR (reverse-transcriptase polymerase chain reaction) and direct sequencing.

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  • Koki Maeda, Koichi Sakasegawa, Hiroo Nishijima, Nobuhiro Imamura, Shoi ...
    2019 Volume 33 Issue 6 Pages 619-623
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    Background. Torsion of the remaining lobe after a lobectomy is a rare complication which requires prompt surgical intervention. The twisted lobe is repositioned or resected on a case-by-case basis. Case. A 63-year-old man with COPD underwent right upper lobectomy and lymph node dissection for T2aN0M0 lung cancer. The patient had a compromised pulmonary function with a forced expiratory volume in 1 second of 1.32 L and a diffusion capacity of 30.9%. Emergency rethoracotomy was performed due to incomplete middle lobe torsion that was suggested by computed tomography. The middle lobe was repositioned to preserve the lung function. The middle lobe recovered successfully and the subsequent clinical course was uneventful. Conclusion. Repositioning of a twisted lobe can be performed in selected patients after careful assessment.

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  • Shunsaku Miyauchi, Kazuhiko Shien, Junichi Soh, Hiromasa Yamamoto, Mas ...
    2019 Volume 33 Issue 6 Pages 624-628
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    Teratomas are usually slow-growing and asymptomatic tumors; however, they may occasionally grow rapidly. We describe a surgical case of a mature mediastinal teratoma showing rapid growth during pregnancy. A 27-year-old primigravida was admitted with an abnormal shadow identified on a chest radiograph. The chest radiograph revealed an anterior mediastinal mass. Magnetic resonance imaging confirmed a multilocular cystic lesion measuring 10 cm in diameter, extending to the right hemithorax. She reported chest pain, and examination revealed right jugular vein distention; thus, we clinically suspected a rapidly growing tumor. We performed a median sternotomy and tumor resection with partial resection of the upper lobe of the right lung and pericardium. Histopathological examination confirmed the diagnosis of a mature teratoma without any immature or malignant component. The patient's postoperative course was unremarkable, and she delivered a full-term neonate 25 weeks postoperatively. We report a rare case of a mature mediastinal teratoma showing rapid growth during pregnancy. Careful preoperative examination and a meticulously performed surgical procedure can ensure a safe operation even for pregnant women presenting with such conditions.

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  • Yusuke Shinchi, Koji Hayashi
    2019 Volume 33 Issue 6 Pages 629-633
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    We encountered a patient with pulmonary mucormycosis involving both lungs during treatment for acute lymphoblastic leukemia (ALL) who responded well to surgical treatment. The patient was a 63-year-old female. She developed a fever and had difficulty breathing on day 22 after commencement of treatment for ALL, and chest CT revealed left upper lobe consolidation. Suspecting a fungal infection based on CT findings, micafungin (MCFG) therapy was started. Chest CT on day 49 showed a cavity and fungus ball in the left upper lobe. On day 69, CT-guided biopsy of the left lung was performed and a definitive diagnosis of pulmonary mucormycosis was made. CT revealed the appearance of faint ground-glass opacities in the right lung after the biopsy, although the lesions improved by changing MCFG to Liposomal amphotericin B therapy. However, since the left lung lesion persisted, we performed left pneumonectomy. Her postoperative course was extremely good with no further symptoms of mucormycosis. Regardless of the extent of lung resection required, early surgical treatment is useful for patients with pulmonary mucormycosis showing resistance to antifungal therapy, especially those that occur during ALL treatment.

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  • Go Kamimura, Kazuhiro Ueda, Takuya Tokunaga, Aya Takeda, Masaya Aoki, ...
    2019 Volume 33 Issue 6 Pages 634-640
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    Background. Reduction of lung cancer lesions mainly based on ground-glass shadows makes it difficult to evaluate the resection margin if it is difficult to touch during surgery. Therefore, the resected specimen was inflated outside the body, and CT was performed to assess whether it was possible to confirm the presence of the tumor and measure the resection margin.

    Case. 1) A 82-year-old female underwent partial resection of the right lung for suspected lung cancer in the lower right lobe S10. 2) A 70-year-old female underwent partial resection of the right lung for suspected lung cancer in the lower right lobe S9.

    Method. Each excisional specimen after partial excision was punctured as thinly as possible with a thin needle as far as possible from the pleura distant from the tumor, and a syringe was used to inject air slowly and sufficiently. Then, a well-expanded resected specimen was placed in a closed container and taken into the CT room.

    Results. By inflation of the resected specimen similar to that inside the body and performing CT, it was possible to confirm the resection of the unpalpable lesion and measure the excision margin by CT.

    Conclusion. It was convenient and useful to confirm the existence of the tumor and evaluate the surgical margin without damaging the specimen by inflating the resected lung during the operation and performing CT evaluation for a palpable lesion.

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  • Tetsuki Sakamoto, Teiko Sakurai, Kensuke Kojima, Tomoki Utsumi, Hyunge ...
    2019 Volume 33 Issue 6 Pages 641-646
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    "Pulmonary aspergillosis" is a collective term used to refer to conditions caused by infection with a fungus of Aspergillus species. Individuals with pulmonary aspergillosis undergo antifungal therapy. Surgical treatment (e.g., bronchial artery embolization (BAE) ) can be considered in patients suffering from pulmonary aspergillosis if control of hemoptysis is very poor. The indication (s) for surgical treatment must be considered very carefully, but emergency surgery is indicated in the event of sudden, massive hemoptysis. We describe four patients who underwent emergency surgery due to massive hemoptysis. Two of the four were complicated by allergic bronchopulmonary aspergillosis (ABPA) and one with nontuberculous mycobacteriosis (NTM). BAE was carried out for hemoptysis, but control of the latter was not possible in any of the four patients. A left upper lobectomy was performed for one patient with pulmonary aspergilloma alone, a left residual pneumonectomy and left lower lobectomy in each of the patients with ABPA, and a left pneumonectomy in the patient with NTM. Hemoptysis was controlled in all patients. However, the patient with NTM died due to complications, and the other three patients survived. These data suggest that surgical therapy can be a rescue procedure for patients with massive hemoptysis that cannot be controlled by BAE.

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  • Hayato Nanami, Naohisa Chiba, Jun Kobayashi, Masato Okuda
    2019 Volume 33 Issue 6 Pages 647-651
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    We encountered a case of pneumothorax in a patient with amyotrophic lateral sclerosis (ALS). He had begun using noninvasive positive pressure ventilation (NPPV) at night. He had been diagnosed with ALS one year previously, with finger contracture as a symptom. He presented with left tension pneumothorax and was treated with chest drainage. However, there was persistent air leakage. We decided to perform pneumothorax surgery on consultation with a neurologist, an anesthesiologist, the patient, and his family. We treated the pneumothorax by thoracic surgery under general anesthesia without muscle relaxants. Postoperatively, there were many wrinkles, and CO2 narcosis occurred on postoperative day 2, resulting in reintubation. Tracheostomy was performed because we predicted that long-term ventilation control would be required on postoperative day 4. After regular airway clearance and respiratory rehabilitation, the patient was discharged on postoperative day 97 with TPPV throughout the day. There are few reports of surgery under general anesthesia for patients with ALS. In this case, although the patient could be treated safely by thoracic surgery, post-operative treatment was difficult.

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  • Hisatoshi Asano, Satoshi Arakawa, Daiki Kato, Shohei Mori, Takeo Nakad ...
    2019 Volume 33 Issue 6 Pages 652-655
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    Lung metastasis from prostate cancer often shows systemic relapse and recurrence, with multiple lung nodules and elevated serum prostate-specific antigen (PSA) levels. We report a rare case of a patient with single lung metastasis and a normal serum PSA level after prostate cancer surgery. An 80-year-old man underwent radical prostatectomy, radiation, and hormonal therapy for prostate cancer. A nodule was detected on plain chest CT. The nodule showed an increasing size. Tumor markers, including serum PSA levels, were within the normal range.

    Suspecting metastatic lung tumor, we performed thoracoscopic partial resection of the right lower lobe. Histologically, the cytoplasm of the tumor cells was clear and proliferated to form a cribriform structure. Immunohistochemical staining revealed positive staining for PSA, and negative staining for TTF-1 and NapsinA. The lung nodule was diagnosed as lung metastasis from prostate cancer.

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  • Itsuki Yuasa, Hiroaki Sakai, Yasumiko Hirayama, Takehisa Fukata, Hirok ...
    2019 Volume 33 Issue 6 Pages 656-660
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    We report the efficacy of conservative treatment using an endotracheal spiral tube with a mobile wing for postintubation tracheal rupture. An 85-year-old man was admitted to our hospital with cardiopulmonary arrest due to anaphylactic shock caused by antibiotics. After intubation, subcutaneous emphysema showed progression. Chest CT and bronchoscopy confirmed a 4-cm laceration of the membranous trachea extending 1 cm cranial to the carina. Surgical repair was abandoned because of intrathoracic adhesions, and conservative treatment was performed. Tracheostomy was done on hospital day 14, and left lung ventilation was changed to bilateral ventilation. At this time, the cuff was placed between the laceration and carina using a spiral endotracheal tube with a movable wing. On hospital day 28, we confirmed that the laceration was covered with normal epithelium, and the tracheostomy was closed. Our experience suggests that a spiral endotracheal tube with a mobile wing is useful for patients who have tracheal rupture with a laceration located near the carina.

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  • Shinichi Sakamoto, Koichiro Kenzaki, Takako Kubo, Shoko Norimura, Kazu ...
    2019 Volume 33 Issue 6 Pages 661-666
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    Objective: Pleuroperitoneal communication is a complication that can occur in patients during continuous ambulatory peritoneal dialysis (CAPD). The present study aimed to evaluate the efficacy of video-assisted thoracic surgery (VATS) for pleuroperitoneal communication.

    Method: From 2010 to 2018, 7 patients with CAPD underwent VATS to repair their diaphragm. We retrospectively analyzed the clinical features, intraoperative findings, and outcome of each patient.

    Results: Three of the patients were male and four were female. The mean age was 56.3 years. To detect diaphragm lesions, we injected a dialysis solution containing indigo carmine into the intraperitoneal cavity. Leakage points were detected in four patients, inflated blebs with blue staining were detected in two patients, and no change in the diaphragm was detected in one patient. There were no complications. However, the patient for whom we could not detect any change in the diaphragm during surgery had recurrence. The mean duration to restarting CAPD was 5.7±2.2 days and the mean postoperative stay was 15.8±8.0 days. Two patients were converted to hemodialysis due to heart failure and peritonitis within the observation period, whereas the other patients continued CAPD.

    Conclusion: Surgical treatment by VATS is safe for patients with renal failure and is especially effective for patients with diaphragm lesions detected during surgery.

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  • Mitsunori Higuchi, Kenichi Utano, Ikuro Oshibe, Nobutoshi Soeta, Takur ...
    2019 Volume 33 Issue 6 Pages 667-671
    Published: September 15, 2019
    Released: September 15, 2019
    JOURNALS FREE ACCESS

    We report the case of a 69-year-old male suffering from back discomfort. He was referred to our department from orthopedic surgery. Preoperative CT revealed a left posterior mediastinal tumor of 25 mm in diameter at the Th8 level, and 3D-CT showed the artery of Adamkiewicz (AKA) with a hair-pin turn from the 8th intercostal artery as well as 9th intercostal artery. He underwent complete tumor resection under VATS without any injuries of AKA. During surgery, we could detect the 8th intercostal artery adjacent to the mediastinal tumor, which had already been detected before surgery. The postoperative pathological diagnosis was neurinoma. He has been well for 7 months since surgery without paraplegia or back discomfort. Preoperative detection of AKA before surgery in the case of a posterior mediastinal tumor close to the descending aorta is important to prevent postoperative paraplegia after surgery.

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