The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 8 , Issue 4
Showing 1-17 articles out of 17 articles from the selected issue
  • Kimihiro Nakajima, Kenji Okayasu, Etsuro Hiraguchi, Yoshiaki Narita, H ...
    1994 Volume 8 Issue 4 Pages 441-446
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Bronchopleural fistulas were found in 15 males (3.1 %) of 480 patients. They were 4976 years of age (mean 63.6 yr) with lung cancer resected in one hospital between 1973 and 1992. A control group of 465 patients without bronchopleural fistulas was also studied. The 2 groups did not differ significantly with respect to age, maximum size of tumor, or lymph node status (i. e., presence or absence or degree of invasion). In 7 of the 15 patients (46.5 %), bronchoplueral fisula had developed after total pneumonectomy. The incidence of bronchopleural fistula before and after the use of surgical autosutures was also studied. Eight bronchopleural fistulas occurred in 8 of 231 lung cancer patients (2.8 %) after autosuture had been instituted. The incidence during the 2 periods was almost the same. The authors emphasize the role of preoperative chemotherapy and total pneumonectomy in the development of bronchial fistulas.
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  • Shinnichi Sumitomo, Takeshi Funatsu, Rikuro Hatakenaka, Yoshito Matsub ...
    1994 Volume 8 Issue 4 Pages 447-454
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Computed tomography (CT) and mediastinoscopy were compared prospectively as staging modalities to assess mediastinal node status in 147 patients with presumed operable lung cancer. Computed tomography was associated with a sensitivity of 54.5%, specificity of 86%, positive predictive index (PPI) of 32.3%, negative predictive index (NPI) of 93.9%, and over all accuracy of 82.6%. The sentitivity (70.5%), specificity (100%), PPI (100%), NPI (96.3%), and accuracy (96.6%) of mediastinoscopy exceeded those observed with CT. The sensitivity and PPI of CT in adenocarcinoma and PPI of CT and the sensitivity of mediastinoscopy in squamous cell carcinoma were low in the assessment of cell type of the tumor.
    Mediastinoscopy is the most accurate method of investigation in the staging of mediastinal nodes in cases of lung cancer, and its routine use seems to be justified.
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  • Hiroyoshi Ayabe, Hiroharu Tsuji, Yutaka Tagawa, Katsunobu Kawahara, Sa ...
    1994 Volume 8 Issue 4 Pages 455-459
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We review 7 patients treated with bronchoplastic lobectomy for small-cell lung cancer. There were 5 males and 2 females with an average age of 59.7 years. All 7 had intermediate cell type small-cell cancer which was stage I in one patient and stage IIIA in 6 according to postoperative pathological findings. The operative procedures performed were right upper sleeve lobectomy in 4 patients, right upper wedge lobectomy in one, left lower sleeve lobectomy in one, and left lower lobectomy and lingular segmentectomy with sleeve bronchoplasty in one. Postoperative complications occurred in 2 patients, who died 37 days and 3 months after surgery, respectively. Three patients died of recurrent metastatic lung cancer, 7, 8 and 17 months after lung resection. Only 2 patients are alive now 3 months and 8 years after bronchoplasty. There was no local recurrence of small cell cancer at the bronchial anastomosis.
    Because no local recurrence was noted at the site of anastomosis and there was one longterm survivor, bronchoplasty for small-cell lung cancer is recommended.
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  • Masatoshi Kurihara, Yoshihito Takeno
    1994 Volume 8 Issue 4 Pages 460-464
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Conventional thoracoscopic ablation of blebs required three or five stab wounds. Forty patients with spontaneous pneumothorax were treated with a new procedure, called “two puncture technique”, using a PDS II-endoloop. An incision was made in the mid-axillary line in the 5th intercostal space. A trocar was inserted, and a semiflexible thoracoscope was passed through it. The other trocar was placed in the mid-axillary line in the 3rd intercostal space. The identified bleb was grasped with an atraumatic grasper through this trocar. A PDS II-endoloop was placed around the grasper and guided to the bleb through the same trocar, and finally placed around the bleb and secured. This procedure was repeated for double ligature of the bleb.
    Thoracography (TG), chest CT and thoracoscopy (TS) must be performed before operation in our center. To study the indications for this technique, we recorded the size and number of blebs. To study the extent of surgical damage and the recurrence rate after this approach, we measured eight variables : operation time, duration of fever (more than 37°C), highest postoperative temperature, volume of blood loss at operation, total volume of drainage for two days after operation, white blood cell counts on the 1st postoperative day, CRP on the 3rd POD and rate of postoperative recurrence. It was possible to use the technique for blebs up to 5 cm in diameter and in segments 1, 2, 3, 6, and 8. The average time of operation was 59.6 (SD ± 33. 7) minutes. The average period of postoperative fever was 3.8 (SD ± 1.3) days. The avarage value of the highest temperature was 38.0 (SD ± 0.4). The bleeding during operation was slight. The average volume of drainage after operation was 57 (SD 70) ml. The average WBC count was 9870 (SD ± 1550) /mm2. The average value of CRP was 11.5 (SD ± 7.1) mg/ dl. There has been no recurrence of blebs in any of 40 patients.
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  • Tsuyoshi Imaizumi
    1994 Volume 8 Issue 4 Pages 465-472
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We examined the preventive effect of monocronal antibodies against neutrophil and endthelial adhesion molecules on reperfusion injury after unilateral pulmonary ischemia.
    Warm ischemic lung models were prepared in rats. Warm ischema was maintained for 45 minutes, and the reperfusion time was 8 hours. The rats were divided into three experimental groups. In group I (control group), the rats were treated with 1 mg/kg mouse IgG antibody before ischemia. In group II (WT. 1 group), the rats were treated with 1 mg/kg anti-LFA-1 anti-body (WT. 1) before ischemia. In group III (WT. 1/1A29 group), the rats were treated with 1 mg/kg anti-LFA-1 antibody and 1 mg/kg anti-ICAM-1 antibydy (1A29) before ischemia. In all 3 groups, the lung tissue wet/dry weight ratio (W/D ratio), lung tissue myeloperoxidase activity (MPO activity) and respiratory index (RI) were measured.
    In group I, the W/D ratio, MPO activity and RI were significantly increased after 2 hours and 8 hours of reperfusion. In groups II and III, these parameters were increased after 8 hours of reperfusion, but the increase was significantly less than in group I. In group III, the increase of W/D ratio and RI was significantly less than in group II after 8 hours of reperfusion.
    These results suggest that antibodies against neutrophil and endthelial adhesion molecules effectively reduced reperfusion injury.
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  • Kazuyuki Yagi, Toshiki Hirata, Kenji Inui, Masahiro Kawashima, Yoshimi ...
    1994 Volume 8 Issue 4 Pages 473-479
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Between September 1980 and December 1991, 64 patients with empyema were operated on in the respiratory division of Shimada Municipal Hospital. Open thoracostomy was performed in 13 patients (20%). The mean age was 66 years. The diagnoses were : chronic empyema 7/47 (15%), postoperative empyema 5/9 (56%) and acute empyema 1/8 (13%). All the patients who were treated with open thoracostomy for chronic empyema had tuberculosis with fistula, and acid fast bacilli were found in 5 of them (71%). Except in the one patient with liver cirrhosis, who was in a pre-DIC state, closure of the thoracostoma was possible in 6 patients (86%), and open thoracostomy was effective. Postoperative empyema developed after pneumonectomy in 2 patients, after lobectomy in 2, and after giant bullectomy in one. Open thoracostomy was eventually carried out in 4 patients after pneumonectomy and in one after lobectomy. Bacterial examinations showed Pseudomonas aeruginosa in 2 patients and gram (+) and gram (-) bacteria in one. All 5 patients with postoperative empyema died without closure of the thoracostoma. In some patients open thoracostomy was delayed, or it should have been performed before any radical intervention. One patient with lung cancer recurrence could be discharged and followed as an outpatient as a result of the open thoracostomy. For patients in whom drainage and irrigation are ineffective, open thoracostomy is recommended.
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  • Kunimoto Nezu, Sogo Iioka, Keiji Kushibe, Noriyoshi Sawabata, Takashi ...
    1994 Volume 8 Issue 4 Pages 480-486
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Thoracoscopic resection of a bleb or a bulla was performed under local anesthesia in 14 patients with spontaneous pneumothorax. Indications were the absence of parietal pleural adhesion and the precise identification of the location of the bleb prior to the procedure. Before the operation, 0.5 % lidocaine was administered intrathoracically and butorphanoltartrate plus diazepam intravenously to reduce pain and anxiety during the procedure. The method utilized was the 3-puncture technique. The resection was performed with an Endo-GIA, Endo-CLIP and Endo-GIA plus Endo-CLIP in 8, 2 and 2 patients, respectively. The thoracoscopic surgery under local anesthesia was quite successful in all but 2 patients (success rate 86 %). The 2 unsuccessful cases were an elderly patient with empyema who developed dyspnea during the procedure and a patient with acute empyema resulting in adhesion of the parietal pleura. There were no particular problems encountered during the procedure in terms of stability of hemodynamics or arterial blood gas abnormalities. Postoperative complications were seen in 2 patients (pulmorary fistula and transient atelectasis). The average duration of hospitalization after the procedure was 5.5 days. Thoracoscopic surgery under local anesthesia can be performed safely is patients with spontaneous pneumothorax when pleural adhesion is absent and the location of blebs is known. We believe that this technique can further simplify thoracoscopic surgery for pneumothorax.
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  • Akinori Iwasaki, Takuo Kusano, Koei Ando, Satoshi Yoneda, Takayuki Shi ...
    1994 Volume 8 Issue 4 Pages 487-490
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    Flow cytometry was used to examine 4 malignant teratomas and 7 benign teratomas of the mediastinum. The benign teratomas revealed no DNA aneuploidy, while the malignant teratomas revealed high aneuploidy. The prognosis for patients with high DNA aneuploidy in malignant teratoma is worse than that for those with low aneupoidy. Therefore, the information provided by flowcytometric analysis in useful in the choice of adjuvant therapy. In addition, it may contribute to a more accurate prediction of the prognosis for patiants with malignant teratoma.
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  • Hideo Tachibana, Yasuomi Mukaeyama, Hiroyuki Yamagishi, Satoshi Tobe, ...
    1994 Volume 8 Issue 4 Pages 491-496
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 15-year-old male with chest pain and dry cough was referred to our hospital with a suspected mediastinal tumor. Chest X-rays and a CT scan showed a huge tumor mass in the anterior mediastinum, with invasion to the upper lobe of the left lung and pericardium. Serumα-Fetoprotein (AFP) was21, 800ng/ml, and the nonbinding capacity of AFP to Concanavalin-A was 38 %. The serum lactate dehydrogenase (LDH) isozyme pattern showed a marked increase in LDH-1. The serum levels of CEA and HCG were normal. Percutaneous needle biopsy of the tumor suggested a yolk sac tumor. After two courses of combination chemotherapy consisting of carboplatin, etoposide, cyclophosphamide and pirarubicin, there was a rapid decrease in the serum AFP level and a gradual decrease in the tumor's size. The tumor was completely removed together with the invaded structures, and a third course of chemotherapy was admnistered. The patient is alive without any signs of reccurence, two years post-surgery. Mediastinal yolk sac tumors shovld be treated by complete surgical resection after combination chemotherapy.
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  • Shigeki Hatakeyama, Kazushi Oshimo, Junji Morita, Kiyoshi Yoshizawa
    1994 Volume 8 Issue 4 Pages 497-502
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 25-year-old man was admitted to our hospital because of an abnormal shadow on a routine chest roentgenogram. A CT scan of the chest showed a mass in the anterior mediastinum. Laboratory examination revealed elevated levels of AFP (971.6 ng/ml) and HCG (16.3 mIU/ ml), which were highly indicative of malignant germ cell tumor. Imaging examination indicat-ed that the mass was resectable, so surgery was performed prior to chemotherapy. On the 16th day after the first chest X-ray, the patient underwent median sternotomy. A mass infiltrated the pericardium and left lung. Therefore, the mass was extirpated along with the thymus and part of the pericardium and left lung. The tumor was 6 × 4.5 × 2.5 cm in size and weighted 110 g. Histological examination revealed an admixture of mature teratoma, seminoma, yolk sac tumor and embryonal carcinoma. Starting on the 7th postoperative day, the patient received three courses of PVB therapy. Both AFP and HCG became negative in the 1st postoperative month. The patient is alive with no sign of recurrence more than two years after the operation.
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  • Kazuhiro Yasufuku, Toshihiko Iizasa, Takahisa Tamiya, Hiroto Suzuki, M ...
    1994 Volume 8 Issue 4 Pages 503-507
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    We report a case in which the laryngeal mask airway (LMA) was useful for the removal of a foreign body in a child. A 23-month-old boy was admitted to our hospital with a complaint of stridor. Although chest roentgenogram showed no abnormal findings, a bronchial foreign body was suspected because of his condition and history. The foreign body, a chestnut, in the left upper lobe bronchus, was removed safely with a fiberoptic bronchoscope. In this case fiberoptic bronchoscopy was peformed without intubation, using an LMA. The LMA was found to provide a better and more secure airway than the face mask. Furthermore, the insertion of wider diameter bronchoscopes with adequate O2 saturation during the examination was possible. The insertion of the same bronchoscopes through pediatric intubation tubes would have created many complications.
    This case suggested that the use of the LMA is useful in maintaining a secure airway during the removal of bronchial foreign bodies in children.
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  • Yuzo Sagara, Yusuke Mitoma, Yuji Shiraishi, Kanae Fukushima, Hikotaro ...
    1994 Volume 8 Issue 4 Pages 508-513
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 48-year old woman was admitted to our hospital with the complaint of bloody sputum. Her chest X-ray taken two months befor admission showed only a faint small shadow in the right upper lung field, but two months after admission, her chest X-ray film showed a large dense shadow, approximately 3 × 4 cm in diameter. Right upper lobectomy was performed. Histological examination revealed so-called sclerosing hemangioma with bronchial and vascular invasion. We concluded that sclerosing hemangioma can become malignant.
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  • Izumi Tomiyama, Masamichi Hara, Toshio Imada, Haruhiko Nakayama, Haruh ...
    1994 Volume 8 Issue 4 Pages 514-518
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 21-year-old healthy male who had traveled to Phoenix, Arizona, several times was admitted to our university hospital for evaluation of a coin lesion in his chest X-ray. A well-demarcated tumor 1.5 cm in diameter was seen in S3. Pulmonary tuberculosis was highly suspected by chest tomography and CT scan. Intracutaneous tuberculin skin reaction was negative. A specimen obtained by trans-bronchial lung biopsy was not large enough for diagnosis. Open lung biopsy was performed. Histological examination revealed granulomatous lesions with caseous necrosis, epithelioid cells, lymphoid cells, and foreign body giant cells. Close examination disclosed PAS reaction and Grocott's stain positive endosporulating spherules of Coccidioides immitis within the giant cells. Pulmonary coccidioidomycosis, which is a rare fungal disease found in certain endemic areas in America, was diagnosed.
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  • Tsugio Furukawa, Kotaro Koyanagi, Koji Irie, Takero Yoshida
    1994 Volume 8 Issue 4 Pages 519-523
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 60-year-old female was admitted because of an abnormal shadow on chest X-ray. Computed tomography and bone scintigraphy showed a tumor of the right 8th rib. The serum gammaglobulin level was slightly high and serum M-protein was demonstrated by electrophoresis. Bone marrow biopsy of the iliac bone revealed no malignant cells. We suspected a solitary plasmacytoma of the rib and performed rib resection. The presence of monoclonality of the IgG k chain in the tumor was demonstrated by a immunohistochemical study of the operative specimen. Serum M-protein disappeared after rib resection. Solitary plasmacytoma of the rib associated with production of an M-protein at the time of diagnosis in rare. Since it is reported that about one-third of patients with solitary plasmacytoma will develop multiple myeloma, we are going to follow this patient carefully for many years, and if necessary we will add adjuvant radiotherapy.
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  • Yoshio Tsunezuka, Hiroshi Saito
    1994 Volume 8 Issue 4 Pages 524-528
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    The patient was a 56-year-ole woman who had a history of right pneumothorax, which had been treated with continuous intrathoracic drainage 9 months earlier. She was admitted to our hospital because of dyspnea. The chest roentgenogram revealed right pneumothorax and a mass shadow in the right pleural cavity. The operative and macroscopic findings revealed that the tumor arose from the visceral pleura of the right upper lobe. Air had leaked from the base of the tumor.
    The pathological diagnosis was fibrous type of localized pleural mesothelioma. It was considered that the tumor caused the pneumothorax. Localized pleural resothelioma presenting as pneumothorax is rare and the clinical course is of interest.
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  • Tatsuo Yamamoto, Akira Fujiwara, Osamu Ishibashi, Yoshihisa Inage, Eii ...
    1994 Volume 8 Issue 4 Pages 529-533
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 65-year-old woman had a left supraclavicular tumor and left Horner's sign. An excisional biopsy failed to provide enough tissue because of bleeding. Preoperative angiography revealed abundant blood-supply from feeding arteries. Therefore, embolization was carried out. The tumor was resected without massive intraoperative bleeding. The histological diagnosis was malignant paraganglioma. Angiography and embolization are thought to be useful in the preoperative management of malignant paraganglioma.
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  • Shuhei Inoue, Yuji Suzumura, Kentaro Takahashi
    1994 Volume 8 Issue 4 Pages 534-540
    Published: May 20, 1994
    Released: November 10, 2009
    JOURNALS FREE ACCESS
    A 62-year-old male was admitted to our hospital on July 30, 1990, with cough, sputum, fever, backache and an extrathoracic tumor. He had had a right lower lobectomy and partial resection of the diaphragm in 1988 for chronic expanding hematoma caused by fracture of the right 7th and 8th ribs in 1963. The diagnosis of extrathoracic hematoma was based on chest X-rays, chest CT scan, intercostal arteriography and thoracentesis. A metal wire for rib fixation protruded into the hematoma. The hematoma was resected and three wires removed on Aug. 13, but the extrathoracic hematoma recurred suddenly on Sep. 29. Intercostal arteriography was repeated on Oct. 5, and embolization of the intercostal artery was performed to prevent extravasation into the hematoma. After this procedure, the extrathoracic hematoma was absorbed gradually. He is doing well 3 years after the intercostal embolization.
    The transcatherter bronchial artery occlusion technique is now well accepted in the management of massive and repeated hemoptysis. However, intercostal artery embolization has not been reported. We think that intercostal artery embolization is a very promising therapeutic approach for extrathoracic hematoma.
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