The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 8 , Issue 2
Showing 1-17 articles out of 17 articles from the selected issue
  • Shoji Sakiyama, Tadashi Uyama, Taizo Fukumoto, Masafumi Tamaki, Tanida ...
    1994 Volume 8 Issue 2 Pages 110-116
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We examined histologically the bronchial changes in rat lung allografts during the process of acute rejection. The lungs of BN donor rats were orthotopically transplanted to the left hemithoraxes of LEW recipient rats (n=15). LEW to LEW isografts were used as controls (n=12). Recipient rats were sacrificed daily from 1 to 6 days after transplantation. Left lungs were fixed with 2.5% phosphate-buffered glutarlaldehyde, embedded in paraffin and stained with hematoxylin-eosin, methylgreen-pyronin and PAS. In the bronchial epithelium of allografted lungs, an increased percentage of goblet cells, sawtooth-like changes and mitosis were observed. Disturbed basal cell alignment and vacuole degeneration of epithelial cells appeared in the alveolar phase. The ratio of goblet cells to epithelial cells was significantly increased in middle sized bronchi with a diameter of 500 to 999 μm on day 3 (mainly during the vascular phase). As a result of progressive bronchial damage, the ratio decreased rapidly from day 5 on. In conclusion, the bronchial epithelium of allografted lungs changes through the following three steps in the process of acute rejection. In the first step, the bronchial epithelium reacts with hyperplasia against submucosal inflammation. In the second step, the epithelium shows atypism and pleomorphism. In the final step, the epithelium goes on to cell death and necrosis.
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  • Hiroshige Nakamura, Yoshiyuki Tanaka, Hirotoshi Horio, Mikihisa Fukuda ...
    1994 Volume 8 Issue 2 Pages 117-123
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Six cases of thymic cyst in our hospital were studied, clinicopathologically. The 6 cases of thymic cyst consisted of9.7% of all mediastinal tumors, 14.3 % of thymus related tumors and 60.0% of congenital cysts.
    CT and MRI were most useful for diagnosis of thymic cyst. The internal density of the tumor showed from -10 to 20 Hounsfield unit in CT and dark signal intensities inT1 and bright signal intensities in T2 weighted image of MRI. But, definitive diagnosis was oftendifficult. The preoperative diagnosis of six were thymic cyst in one case, thymus related with MG in 2 cases, thymoma in one case and pericardial cyst in 2 cases.
    Pathological examination showed the epithelial cells and thymic tissues with Hassal's body in the cyst wall, but in one case incidental thymoma was recognized beside the cyst wall.
    All cases of thymic cyst were resected and they were well and alive with no evidence of recurrence. It was concluded that thymic cyst should be carefully managed because of the difficulty of diagnosis, complications of incidental thymoma, malignant transformation and rupture of the cyst with intracystic bleeding.
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  • Hiroharu Tsuji, Shinsuke Hara, Shinji Akamine, Akihiro Nakamura, Takao ...
    1994 Volume 8 Issue 2 Pages 124-128
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Carcinoid tumors arising in the thymus are rare. In a 23-year review (1970 to 1992) of surgically treated thymic tumors in the first department of surgery, Nagasaki University School of Medicine, only five cases of thymic carcinoid were identified : three men and two women aged 41 to 57 years (mean 48.2 years) at the time of operation. Follow-up information was available in all patients, the longest being six years and five months and the shortest one year and eight months after surgery. Recurrence and/or metastasis developed in three of the four patients who had undergone total excision of the tumor. An aggressive surgical approach with complete initial excision of the tumor and of the subsequent recurrence along with radiation is the best available treatment.
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  • Tsuyoshi Yoshitake, Isamu Sugawara, Junn Nakajima, Motohiro Kawauchi, ...
    1994 Volume 8 Issue 2 Pages 129-134
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    In this study we investigated rejection signs using HE and immunohistochemical staining of the transplanted lung and the recipient's spleen during the subchronic phase after homologous single lung transplantation in three Japanese monkeys.
    The immunosuppressant FK605 was given after surgery, but no steroid.
    Immunohistochemical staining (ABC-GO method) was performed using human antilym-phocyte monoclonal antibodies CD8, CD4 (T cell) and CD20 (B cell).
    Rejection signs were observed in the transplanted lung of all three monkeys. HE staining revealed scattered infiltration of mononuclear cells in the perivascular region of the transplant-ed lung, whereas normal and recipient's lungs had no such perivascular cell infiltration.
    Immunohistochemical staining confirmed the cross-reaction of human antibodies CD8 and CD20 with Japanese monkey cells, but not antibody CD4.
    CD8- and CD20-positive cells infiltrated the perivascular tissue of the transplanted lung.
    In the spleen of the recipient, CD8-positive cells formed an irregular population surrounding the follicles in the white pulp of the spleen and CD20-positive cells accumulated in clusters in the follicles. These T and B cell populations in the recipient's spleen were less distinct than those in the spleen of a normal monkey.
    From these results, we concluded that the allo-transplanted lungs were still attacked with rejection in the subchronic phase even if an immunosuppressant was administered after transplantation. At this time the morphological features of stimulated immune response were almost absent in the recipient's spleen.
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  • Eiichi Hayashi, Masazumi Maeda, Kohtarou Kameyama, Ayanori Shugita, Hi ...
    1994 Volume 8 Issue 2 Pages 135-147
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    The allogenic reaction of thymus was studied in a model of skin transplantation in mice. The animals were divided into three groups : control (group C); autotransplantation (group aUG); and allogenic transplantation (group aLG). The reaction to allogenic antigen was observed mainly with respect to the change of T cell subsets. After day 7, following transplantation, the skin grafts showed rejection histologically, and the percentage of CD8 lymphocytes in the grafts clearly increased in comparison with that of group C and aUG (p <0.01), and the relative thymus weight and the percentage of Double Positive (DP) lymphocytes in group aLG incresed in comparison with those of group C and aUG (p <0.01). After day 7, a direct correlation between CD8 lymphocytes in the graft and DP lymphocytes in the thymus was found (r = 0.41, p <0.05), and the following formula was obtained. The percentage of DP lymphocytes in thymus= 0.08 × the percentage of CD8 lymphocytes in graft + 82.14 These results indicate that the immunological responses of thymus to the allogenic antigen occur according to the intensity of rejection.
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  • Kiyoshi Yoshizawa, Junji Morita, Kazumasa Miura, Masafumi Tamaki, Eita ...
    1994 Volume 8 Issue 2 Pages 148-153
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    This new technique of mediastinoscopy using instruments of video-assisted thoracic surgery (VATS) is carried out under general anesthesia. The mediastinoscope is introduced as usual. Through the channel of the mediastinoscope, a rigid 5mm diameter, 0 degree thoracoscope is inserted with a video camera attached. An assistant watching the video monitor holds the thoracoscope. Lymph nodes are dissected bluntly from the surrounding connective tissue and removed with forceps and scissors designed for VATS. If needed, an electrocautery probe can be used with ease. We have performed five medeiastinoscopic node biopsy using this method and noted the following advantages. The operator and assistants can observe the field at the same time. A wider view makes the procedure safer, and larger specimens can be biopsied than with the usual method.
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  • Tetsuhiro Shiota, Taeko Sugiyama, Toru Enokibori, Hirofumi Kato
    1994 Volume 8 Issue 2 Pages 154-159
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 65-year-old man. A giant bulla was discovered on a chest X-ray film at another hospital in 1987, but there were no clinical symptoms. The patient caught a cold, and his breathing became progressively more labored. He was brought to our hospital by ambulance on February 28, 1992. On admission, chest X-rays showed a giant bulla in the left lung with a remarkable shift of the mediastinum to the right side. The giant bulla was excised surgically. Emphysematous changes in the residual lung were mild, and its re-expansion was good. The post -operative levels of FVC, %FVC, FEV1.0 and FEV1.0% were significantly improved and there was no dyspnea.
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  • Noboru Fujino, Teiso Kiyama, Shin-ichi Hayasaka, Takesi Yosinaga, Etuo ...
    1994 Volume 8 Issue 2 Pages 160-163
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 42-year-old man with a mesenchymal chondrosarcoma of the chest wall was treated with a combination of surgery, chemotherapy and radiotherapy. The resected tumor was composed of small round to spindle cells and islands of chondroid tissue.
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  • Hirofumi Sueki, Kazuya Nakahara, Yoshitaka Fujii, Akihide Matsumura, M ...
    1994 Volume 8 Issue 2 Pages 164-168
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We report a rare case of a foreign body granuloma in the cervical region. A 60-year-old male was admitted with the complaint of a cervical tumor which had gradually increased in size. He had had right upper lobectomy and thoracoplasty for pulmonary tuberculosis 26 years earlier. The tumor was incised, and a substance which looked like gauze was found. Bacteriological cultures were sterile. Computed tomographic scan demonstrated an in-homogeneous mass from the neck to the site of the thoracoplasty. A diagnosis of gauze-related foreign body granuloma was made, and surgical removal of the tumor was successfully performed.
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  • Haruhisa Hiyoshi, Hiroshi Iwanami, Kunio Narita, Masanori Tachibana, M ...
    1994 Volume 8 Issue 2 Pages 169-173
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Mediastinal leiomyosarcoma are rare tumors ; only six cases have been reported in Japan. A 72-year-old male was found to have an abnormal shadow in the right upper lung field on a chest roentgenogram. Chest CT showed an ill-defined nodule of the right S1 area and low density area in the right mediastinum. The diagnosis was lung cancer with mediastinal lymph node metastasis, and thoracotomy was performed. On histological examination the lung tumor was diagnosed as primary lung cancer, and the medistinal tumor was suspected to be leiomyosarcoma. Immunohistochemical staining of the mediastinal tumor was positive for smooth muscle actin, so we concluded that the diagnosis was mediastinal leiomyosarcoma associated with primary lung cancer.
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  • Kazumasa Miura, Junji Morita, Kiyoshi Yoshizawa, Masafumi Tamaki, Hisa ...
    1994 Volume 8 Issue 2 Pages 174-178
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 15-year-old man was found to have an anterior mediastinal mass on a chest roentgenogram. Preoparatively, serum levels of lymphocytes and anti-Ach R antibody were elevated. Pathological examination of the resected lesion showed idiopathic thymic hyperplasia.
    Idiopathic thymic hyperplasia is a rare condition of the mediastinum. Only 34 patients well -documented cases have been reported in the literature. It has been postulated that it does not occur in autoimmune diseases, but our patient had elevated serum levels of anti-Ach R antibody without MG. The levels returned to normal postoperatively, indicating that true thymic hyperplasia can produce anti-AchR antibody.
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  • Naoki Kanemitsu, Hiroyasu Yokomise, Hiromichi Katakura, Toru Bandou, K ...
    1994 Volume 8 Issue 2 Pages 179-184
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 34-year-old man admitted with dyspnea on effort as his chief complaint. A chest X-ray film showed bilateral giant bullae. A pulmonary angiogram showed adequate patency of the peripheral pulmonary vessels, so significant improvement of respiratory function was expected. He underwent two-stage bullectomy and plication successfully. Preoperative respiratory function test results were : VC 3.91l, %VC 93.8%, FEV1.0 1.43l, FEV1.0% 47.2%, PaO2 64. 7torr, PaCO2 40.6torr, pH 7.427. Four months after surgery the results were : VC 5.01l % VC 120.1%, FEV1.0 3.70l, FEV 1.0% 72.8%, PaO2 81.7 torr, PaCO2 43.0 torr, pH 7.403. Another remarkable finding was that his preoperative Holter ECG showed sick sinus syndrome, but immediately after the two stage operation it had disappeared.
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  • Shigeki Sugiyama, Keiichi Yamamoto, Tomohiko Ikeya, Naoki Miyamoto, Ka ...
    1994 Volume 8 Issue 2 Pages 185-189
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We have tried a new technique to cover the bronchoplastic anastomotic site by the latissimus dorsi muscle at the same thoracotomy site.
    In thoracotomy, cutting of the latissimus dorsi muscle should be avoided because this muscle is very long and is useful to cover the bronchopleural fistula or defect of the chest wall. Recently we have performed this muscle sparing thoracotomy and inserted the spared latis-simus dorsi muscle by way of the third intercostal space to the anastomotic site of wedge bronchoplasty.
    At first, we perform sleeve or wegde resection of a right or left upper lobe from the main bronchus. After anastomosing the bronchus, a few sutures should be placed at the anastomotic site fixing the latissimus dorsi muscle. A part of the latissimus dorsi muscle (about 5cm) should be taken from the distal site without injuring the thoracodornal artery, which is very important for the blood supply of this muscle. This latissimus dorsi muscle should be fixed to the bronchoplastic anastomotic site with the previously placed sutures.
    We applied this method in 3 lung cancer patients. All patients had been shown to have tumors in the right upper orifice by preoperative bronchoscopy. One case was stage I (T2N0M0), while the other cases were stage III (T3N1M0 and T2N2M0). The postoperative courses were uneventful and one case received radiotherapy four weeks after operation.
    In conclusion, this technique to cover the anastomotic site of the bronchoplasty is very simple and easy for patients receiving adjuvant therapy, and is not accompanied by the complication of postoperative bronchopleural fistula.
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  • Mitsuo Kawamura, Yasuhiro Takahashi, Youji Sakata
    1994 Volume 8 Issue 2 Pages 190-195
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 28-year-old female was admitted with abnormal chest shadows. The series of her chest X-rays showed slow-growing multiple calcified tumors in the right upper lobe. Right upper lobectomy was performed. Pathologically, all the lesions were plumonary hamartomas. Her medical history showed a total gastrectomy for multiple gastric leiomyosarcoma at the age of 13 years with no reccurrence. Although no evidence of an extra-adrenal paraganglioma could be identified, two criteria of Carney's triad were satisfied.
    In patients who have one or two of the three rare neoplasms that constitute this syndrome, careful follow-up should be continued to search for the other neoplasms.
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  • Hisaichi Tanaka, Yasushi Tanaka, Takashi Tojo, Akihiko Ichimiya, Masah ...
    1994 Volume 8 Issue 2 Pages 196-201
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 71-year-old woman who had worked packing carpets for 20 years, was admitted with left pleural effusion, Microscopic examination of the thoracoscopic biopsy specimen revealed biphasic malignant pleural mesothelioma.
    On October 15, 1992, the parietal pleura with tumors was totally resected. The pathological findings were biphasic malignant pleural mesothelioma with much osseous and cartilaginous formation. This is a rare case and only the third reperted in the Japanese literature.
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  • Hiromichi Katakura, Hiroyasu Yokomise, Naoki Kanemitsu, Toru Bando, Si ...
    1994 Volume 8 Issue 2 Pages 202-207
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 63-year-old male was admitted because of an abnormal shadow on his chest x-ray. A transbronchial lung biopsy revealed squamous cell carcinoma and idiopathic pulmonary fibrosis. Mediastinoscopy, left upper lobectomy, partial resection of the left lower lobe and dissection of mediastinal lymph nodes were performed. On the 4th day after operation, PaO2 was low and reticular shadows on chest x-ray were increased. Antibiotics and methylprednisolone (6g/day) were administered, but his condition did not improve, and he died on the 29th day after operation. Our experience indicates that when surgery is necessary for a patient with idiopathic pulmonary fibrosis, we must be very careful that the duration of the operation is short and the oxygen concentration must be less than 50% during the operation to prevent lung damage.
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  • Hiroshi Saito, Yoshio Tsunezuka
    1994 Volume 8 Issue 2 Pages 208-212
    Published: March 15, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Two patients with of postpneumonectomy chylothorax were successfully treated with intrathoracic injection of OK-432, autologous blood and thrombin in the lateral decubitus position. It was considered that OK-432 induced fibrin in the early phase and fibrous changes in the late phase after rapid blood coagulation. This new intrathoracic injection therapy should be tried first for postpneumonectomy chylothorax because it is easy, effective and repeatable.
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