The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 7 , Issue 4
Showing 1-15 articles out of 15 articles from the selected issue
  • Masahiko Higashiyama, Osamu Doi, Ken Kodama, Hideoki Yokouchi
    1993 Volume 7 Issue 4 Pages 416-422
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Thoracoscopic surgery was performed in four patients with benign tumors in the thoracic region : a Schwannoma, a lipoma of the chest wall spreading into the thoracic cavity, a localized mesothelioma of the pulmonary pleura, and a posterior mediastinal tumor (Dumbbell type) of Schwannoma. Thoracoscopy was performed under general anesthesia with a double lumen endotracheal tube. The thoracoscope was introduced into the pleural cavity, and one or two additional microthoracotomies were made as needed for the introduction of endoscopic instruments. The tumor was resected under thoracoscopic visualization and removed through a microthoracotomy incision. The Dumbbell type tumor, after being separated from the spinal root by laminectomy, was resected thoracoscopically. Since thoracoscopic surgery causes little “surgical trauma”, the patients recover much faster with less pain. There are also cosmetic advantages. Therefore, thoracoscopic surgery is a useful technique for certain benign tumors in the thoracic region.
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  • Hajime Maeda, Noboru Nakano
    1993 Volume 7 Issue 4 Pages 423-428
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We examined the function of the upper extremity after thoracotomy in 39 patients. Group I included 25 lung cancer patients, Group II included 10 empyema patients, and Group III included 4 miscellaneous patients. Standard posterolateral thoracotomy was performed in Groups I and II, and axillary vertical thoracotmy (the latissimus dorsi muscle was preserved) in Group III. The mean ages of groups I, II and III were 65.7, 64.1, and 52.8 years respective-ly. Among 10 items of upper extremity motion in daily life, 3 items (combing the hair, reaching an overhead shelf, putting on and taking off an undershirt) were significantly restricted on the operated side. There was no significant difference between Group I and Group II and no restriction in Group III. On the 6 measurements of the range of shoulder motion, extension, abduction, and external rotation were significantly decreased. Abduction in Group II was especially decreased (115.2 ± 28.5° : 154.5 ± 21.1°, p <0.01). Both the operative procedure and patient's individual features were considered to be factors in upper extremity dysfunction after posterolateral thoracotomy.
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  • Kazuhito Dobashi, Wataru Nakahashi, Takashi Yoshimatu, Yoshio Horiuti, ...
    1993 Volume 7 Issue 4 Pages 429-435
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    During a 9-year period (1981 to 1989), 18 patients with emphysematous bullae occupying more than 15% of a hemithorax were surgically treated. Their ages ranged from 31 to 61 years with a mean of 46 years. All were males. Twelve had giant bullae. Four patients complained of dyspnea, three had infection and one had contralateral spontaneous pneumothorax. Eight patients had no symptoms. Bullectomy and pneumorrhaphy were performed in 17 patients, and lobectomy in one. There were no significant postoperative complaints. Two of the four with dyspnea patients were improved and two were unchanged. In eight patients with no dyspnea, there was no significant difference between the pre and post operative % VC and % FEV 1.0. We conclude that emphysematous bullae should be resected not only in patients with dyspnea or complications such as infection or spontaneous pneumothorax but also in asymptomatic patients with progressing bullae occupying more than one segment of the lung.
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  • Hideki Miyazawa, Takashi Arai, Keizo Inagaki, Takatomo Morita, Makoto ...
    1993 Volume 7 Issue 4 Pages 436-441
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    From 1982 through 1991, 23 patients with pulmonary atypical mycobacteriosis underwent pulmonary resections. The patients ranged is age from 19 to 65 years (average 43 years), and 57% were males. Mycobacterium avium-intracellulare complex, which was resistant to multiple drugs, was the most frequent causative organism in 22 patients, and one patient was infected with Mycobacterium kansasii. Localized atypical mycobacterial infection unrespon-sive to chemotherapy was the operative indication for 20 of the 23 patients. The other 3 patients, who had negative preoperative sputum smears, underwent pulmonary resection for diagnosis. Sensitivity studies in 23 patients showed a very low response to many drugs, except cycloserine. In 20 patients the mean length of preoperative drug treatment was 29 months (median, 16 months). In those treated with simple lobectomy or wedge resection (n=14) the mean length of preoperative chemotherapy was 17 months (median, 9 months); it was 21 months (median, 20 months) in the group treated with lobectomy plus segmentectomy or bilobectomy (n=4), and 47 months (median, 40 months) in those treated with pneumonectomy (n=4). Complications occurred in four patients, one of whom died of respiratory failure. These patients were treated medically for a long time (mean, 59 months). Complete follow-up in 22 patients (mean, 60 months) revealed only three reactivations at 1, 15 and 21 months postoperatively. They had no symptoms but sometimes had positive sputum cultures.
    Earlier resection in patients with indolent pulmonary atypical mycobacteriosis is advocated before wide spread infiltration and lung destruction.
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  • Hidemichi Yaita, Teruyoshi Ishida, Keizo Sugimachi
    1993 Volume 7 Issue 4 Pages 442-447
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We have treated thoracoscopically 7 patients with spontaneous pneumothorax using a multifire ENDO GIA 30 stapler device. The resected blebs ranged from 5 to 50 mm in diameter. There were 5 men and 2 women aged 17 to 44 years. Since the postoperative pain was minimal, analgesics were not used. The chest drain was removed within 24 hr after operation, and there were no postoperative complications related to thoracoscopic surgery. There was very little blood loss. The postoperative hospital stay was about 4 days. As a safe and cosmetic procedure, thoracoscopic surgery with the endoscopic GIA stapler should be considered the treatment of choice for spontaneous pneumothorax.
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  • Tadashi Uyama, Shoji Sakiyama, Nobuyuki Tanida, Masayuki Sumitomo, Shu ...
    1993 Volume 7 Issue 4 Pages 448-455
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Pleural thickening has been reported to be one of late complications after lung transplantation. Although it might be a sequela of operative maneuvers or of the rejection process, the etiology of the pleural changes in lung allografts is still uncertain. To ascertain the cause, pleural changes of lung allografts were investigated histologically and immunohistologically, in a rat lung transplantation model.
    The pleura of lung isografts showed no pathological changes except for mild edema on the first day after transplantation. Recipient cells started to migrate into the subpeural tissue of lung allografts early after transplantation (latent phase). In the vascular phase, recipient lymphocytes in the subpleural tissue increased in number. Subsets of the lymphocytes were CD4-positive and CD8-positive cells in almost equal numbers. Macrophages also infiltrated in the area. These infiltrating cells were similar to those in perivascular and peribronchial areas. In the late vascular or alveolar phase, fibroblasts were observed among the infiltrating cells and fibrotic changes started. In the destructive phase, collagen formation with marked pleural thickening was dominant.
    In this rat lung transplantation model, the pleura of lung allografts was involved in the rejection process soon after transplantation. Inadequate immunosuppression or repeated rejection could cause pleural changes and lead to functional deterioration of lung allografts because of decreased compliance.
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  • Izumi Torniyama
    1993 Volume 7 Issue 4 Pages 456-463
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    The efficacy of high-porosity tracheal prostheses made of ordinary (12 μm in diameter) and ultrafine (3.7 μm) polyester fibers (SS-grafts) was investigated in rabbits.
    SS-grafts, 7 or 7.5 mm in inner diameter, previously reinforced with polypropylene fibers were implanted into the subcutis of rabbits, together with support tubing inserted into their lumina. The grafts were removed 3 weeks (group A) or 6 to 9 weeks (group B) after implantation. Histological examination showed that granulation tissue in the grafts in group B was more evenly distributed throughout the entire graft and had a more well developed vascular metwork than did that in group A.
    One-to 1.5-cm-long vascularized grafts in both groups were then transplanted from the subcutis into the cervical trachea of the same hosts. All 3 rabbits in group A were sacrificed 3 to 4 weeks after the operation because of evident stridor and labored breathing. The grafts showed marked destruction and stenosis due to abscess formation. In group B, 4 of 8 rabbits survived more than 4 weeks without respiratory symptoms, one was sacrificed because of moderate stridor at 3 weeks and the other 3 died of severe diarrhea or perforation of gastric ulcer. The grafts 4 weeks after replacement had columnar mucociliary epithelium throughout the grafts without stenotic changes in the lumina. These results indicate that SS-grafts that have been previously well vascularized readily undergo epithelialization and are infectionresistant. These prostheses seem to be useful for circumferential replacement of defects in rabbit tracheas.
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  • Cheng-long Huang, Morihisa Kitano, Toru Shindou, Miyuki Nagasawa
    1993 Volume 7 Issue 4 Pages 464-471
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Complications after pneumonectomy include continuous intrathoracic bleeding and mediastinal shift. The thoracic balloon was used in 11 postpneumonectomy patients (8 with lung cancer and 3 with empyema) in an attempt to prevent such complications. Pneumonectomy was performed in 9 patients, pleuropneumonectomy in 1, and omental plombage in 1.
    During surgery, 450 to 600 ml of air was injected into the thoracic balloon through an air filter. Type 1 thoracic balloon were used in 9 patients, and Type 2 (combination of balloon and drainage tube) in 2. Infusion of sulfur hexafluoride, SF6, into thoracic cavity was performed in 8 patients after removal of the thoracic balloon.
    The respiratory and circulatory systems were stable in patients with thoracic balloons on the second postoperative day, and no significant complications were observed in any of the patients with thoracic balloons. In summary, it is believed that the placement of thoracic balloons in the pleural space after pneumonectomy is a simple, safe and useful method of preventing both intrathoracic bleeding and mediastinal shift.
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  • Toshihiko Urakami, Tohru Kobayashi, Hiroshi Matsui
    1993 Volume 7 Issue 4 Pages 472-476
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    To assess the effect of thoracoscopic operation for spontaneous pneumothorax, we treated 29 patients with spontaneous pneumothorax by clipping, looping or bullectomy via thoracoscopy. We performed clipping with endo-clips in 6 patients, looping with endo-loops in 1 patient and bullectomy or partial lobectomy with endo-GIA in 16 patients. In 6 patients whose bulla or region of air leak could not be detected along with thoracoscopic operation, we added 3 cm mini-thoracotomy.
    Clipping with endo-clips was effective for bullae with narrow necks. Bullectomy or partial lobectomy with endo-GIA was most effective and reliable for bullae with broad necks.
    One advantage of this operation is the reduction of post thoracotomy pain. When performed along with mini-thoracotomy, thoracoscopic operation is useful in treating patients with any type of bullae.
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  • Tsutomu Saito, Hiroshi Okitsu
    1993 Volume 7 Issue 4 Pages 477-482
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    The authors treated a 54-year-old male patient who had a long-term survival for 86 months. He had 6 cervical lymphadenectomy procedures and bilateral axillary dissection after left pneumonectomy for lung cancer. The first lymphadenectomy was performed because lymph node metastasis was recognized in the left supraclavicular fossa 14 months after the initial operation. Subsequently, 4 lymphadenectomies were carried out because of recurrence of cervical lymph node metastasis. Although radiation therapy was performed in the left cervical region because of the possibility of remaining tumor at the time of recurrence 42 months after the initial operation, recurrence was found in the cervical region. Lymph node metastases in the right cervical region and both axillae were resected as much as possible. It was considered that aggressive surgical treatment is effective for cervical lymph node metastasis because no other distant metastases were observed for 77 months following the initial operation, and the performance status of this patient was good, even though tumor remained in the left cervical region.
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  • Mitsutaka Kadokura, Makoto Nonaka, Shigeru Yamamoto, Takashi Narisawa, ...
    1993 Volume 7 Issue 4 Pages 483-488
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 57-year-old male was admitted for evaluation of an abnormal shadow in the right upper mediasinum of his chest X-ray. His chief complaints was nocturnal dyspnea. Chest CT and MRI showed tracheal compression due to a cystic mass in the right paratrachea, which compressed the brachiocephalic trunk and the right common carotid artery. Bronchofiberscopy showed marked stenosis of the trachea. He underwent a median sternotomy with a right half collar incision, and the cystic tumor was removed. The cyst had no communication with the pericardial cavity. The size of the resected specimen, filled with serum, was 7 × 6 × 5 cm. Histopathological examination of the specimen showed a mesothelial-lined structure overlying a thin layer of fibrous tissue. After the course of surgical treatment, lung function improved remarkably compared to the preoperative state.
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  • Ryohei Yamashita, Katsuya Morita, Mitsuyo Kosugi, Chyo Kobayashi, Yuse ...
    1993 Volume 7 Issue 4 Pages 489-495
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 6-year-old boy was admitted to our hospital with fever and cough. Chest X-ray films on admission showed multiple cystic lesions with air-fluid levels in the left upper lobe. CT scan of the chest revealed multilobulated cystic lesions containing air-fluid levels in the left apicodorsal segment. Since a chest X-ray film taken at the age of 8 months showed a large cystic space occupying the left upper lung field, the present multicystic lesion was thought to be congenital. The patient underwent a left apicodorsal segmentectomy. The postoperative course was uneventful, and the patient was discharged on the ninth day. Microscopic examination of the resected specimen showed many cysts of various sizes lined by ciliated columnar epithelium. The histological diagnosis was congenital cystic adenomatoid malformation (CCAM) of the lung.
    CCAM of the lung in older children has rarely been reported. When cystic pulmonary lesions of uncertain origin are seen in older children and such patients have histories of recurrent airway infection, CCAM of the lung should be considered in the differential diagnosis.
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  • Futoru Toyoda, Shinichirou Ohta, Hirohisa Inaba, Yoshihiko Kageyama, Y ...
    1993 Volume 7 Issue 4 Pages 496-500
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 62-year-old-man was admitted to our hospital for evaluation of an abnormal shadow in the left upper lung field on his chest X-ray film. We diagnosed lung cancer originating from left B1+2 (cT3N1M0, stage IIIA). The pulmonary angiogram showed no filling of the left superior pulmonary vein. Left pneumonectomy was performed. The left superior pulmonary vein was ligated within the pericardium. Two hours after surgery, the patient's left lower extremity became cold and pulses were not palpable below the femoral artery. A Diagnosis of acute left femoral embolism was established and embolectomy was performed through the left femoral artery. A tumor embolism was found.
    Tumor embolism is a rare, but severe complication of primary lung cancer. So, to prevent this complicaton, it is very important to recognize how the tumor invades the pulmonary venous lumen. But it may be very difficult to do this preoperatively, and even during the operation. Based on our experience and data from 27 cases reported in the literature, we think that large and poorly differentiatd tumors that spread to the hilum may invade the pulmonary venous lumen. In such cases, the possibility of pulmonary venous invasion should be considered.
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  • Noboru Wakita, Tsutomu Shida
    1993 Volume 7 Issue 4 Pages 501-507
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 49-year-old man was admitted to our hospital because of suspicious lung shadows detected during a regular check-up. He had no respiratory symptoms and considered himself well. The roentgenogram and computed tomograph of the chest showed multiple tumor shadows in both lung fields. Physical findings were within the normal range. Laboratory data revealed elevations of WBC count, CRP and CEA.
    Metastatic lung tumor was considered as a possibility, but definitive diagnosis could not be confirmed preoperatively. Resection of the tumors in the left lung field was performed.
    Microscopic findings of the resected tumors showed proliferation of fibrous tissue with infiltration by inflammatory cells (lymphocytes, plasma cells and hemosiderin-laden macrophages) and abscess formation. Thus, the final diagnosis was inflammatory pseudotumor of the lung.
    Three months after surgery, chest roentgenogram disclosed no tumor shadows in the right lung field.
    We believe that this disease may be caused by infection of the respiratry tract and that its natural course may be brief.
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  • Tetsuyuki Okubo, Takeshi Okayasu, Naoto Hasegawa, Tatsuzo Tanabe, Taka ...
    1993 Volume 7 Issue 4 Pages 508-516
    Published: May 15, 1993
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Ewing's sarcoma is a very rare malignant bone tumor. A 23-year-old female was admitted because of an abnormal shadow on chest X-ray. Computed tomography showed a mass growing into the thoracic cavity from right chest wall. It was diagnosed Ewing's sarcoma by needle biopsy. She was treated with Rosen's combination chemotherapy followed by surgery. The tumor was resected completely along with the adjacent ribs, lung tissue and diaphragm. Histological examination of the resected specimens showed extensive necrosis in most of the tumor. She was treated with radiation therapy and chemotherapy. She is alive and working with no distant metastasis or local recurrence one year after surgery.
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