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 1-18 articles out of 18 articles from the selected issue
  • Shinji Fujioka, Yasuki Hachisuka, Yosuke Kiriyama, Yasutaka Hagimori, ...
    2020 Volume 34 Issue 2 Pages 98-106
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    We retrospectively reviewed 110 patients with acute empyema treated by video-assisted thoracoscopic surgery (VATS) in our institute from April 2006 to August 2018. The study population consisted of 93 males and 17 females, with a mean age of 69.8 (years), performance status 1 of 47 (case), and BMI of 21.4. The operation was performed by VATS under general anesthesia (GV) in 84 patients and VATS under local anesthesia (LV) in 26 patients. According to the American Thoracic Society classification, 84 patients had fibrinopurulent phase empyema. 79 patients had multiple empyema cavities. The mean operative time, postoperative chest tube duration, postoperative stay, and postoperative follow-up period were 108.5 (min), 20.0 (days), 28.1 (days), and 97.7 (days), respectively. Postoperative complications were observed in 31 patients. Outcomes were favorable in 104 patients, hospital death in 6 patients, and postoperative 30-day death in 3 patients due to other diseases. Compared with the GV group, the LV group had a longer period of antibiotic administration before and after surgery, more patients with a single empyema cavity, and shorter operative time. Postoperative complications and prognoses were not significantly different between the GV and LV groups. Our review indicated that VATS in patients with acute empyema was a safe and effective procedure.

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  • Yuuki Kou, Hirokazu Tanaka, Nobuhisa Yamazaki, Hiroyoshi Watanabe, Mak ...
    2020 Volume 34 Issue 2 Pages 107-110
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    A 38-year-old man was pointed out as showing irregularities on a chest radiograph during a medical checkup at his company. He was referred to our hospital for further examinations. Chest computed tomography (CT) showed a large 12-cm-diameter tumor in the anterior mediastinum. CT-guided biopsy was performed and he was diagnosed with thymic adenocarcinoma. He underwent extended thymectomy. The tumor was diagnosed as primary thymic adenocarcinoma with enteric differentiation. Primary thymic adenocarcinoma of the enteric type is extremely rare. Thymic cancer is an unfavorable disease and there is no established standard treatment for advanced-stage cases. However, as for the enteric type, possibilities of an improved prognosis have been suggested, and so it is hoped that more cases will be collected to illustrate the characteristics of the enteric type.

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  • Naoto Kitahara, Takashi Doi, Hideki Nagata, Eiji Okura, Yoshihisa Kado ...
    2020 Volume 34 Issue 2 Pages 111-115
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    A 63-year-old woman with ovarian cancer underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by chemotherapy. One year after the operation, a pleural nodule behind the right fifth costal cartilage was detected on computed tomography (CT). Three years after the operation, CT showed the growth of the tumor that involved the adjacent fifth intercostal muscle and diaphragm without destructive change of the ribs or costal cartilage. We performed resection of the chest wall tumor including diaphragm and wedge resection of the right middle lobe.

    Histologically, it was confirmed as metastasis from ovarian cancer. Six years after the chest wall resection followed by chemotherapy, she is alive without recurrence. We encountered a rare case of surgical treatment for solitary chest wall metastasis of ovarian cancer that resulted in long-term survival.

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  • Aya Takeda, Kazuhiro Ueda, Toshiyuki Nagata, Koki Maeda, Satomi Imamur ...
    2020 Volume 34 Issue 2 Pages 116-120
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    A 65-year-old man underwent right upper and middle lobectomy with upper mediastinal and subcarinal lymph node dissection for synchronous right upper and middle lobe cancer. We applied fibrin glue to the upper mediastinum and subcarina to prevent postoperative bleeding and chylorrhea. Two days after surgery, we identified chylous pleural effusion. In spite of fasting, the amount of discharge persisted at over 1.5 L per day. Therefore, we performed reoperation three days after the initial operation.

    After the induction of general anesthesia, indocyanine green (ICG) was injected into the inguinal lymph node under echography-guidance. After rethoracotomy, we could identify the responsible site in the paratracheal region, in which the pooling of infrared ICG was recognized using a near-infrared thoracoscope. We repaired the responsible site by Z suture. In addition, the sutured site was reinforced with fibrin glue followed by covering with a free fat pad.

    The diet was started on the fourth day after reoperation, which did not lead to recurrence of chylothorax. The patient was discharged from the hospital on the twelfth day after reoperation.

    Near-infrared fluorescence imaging of ICG was straightforward and useful to identify the leakage point of chyle.

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  • Masataka Matsumoto, Tomoki Takemoto, Shuta Ohara, Kenichi Suda, Tetsuy ...
    2020 Volume 34 Issue 2 Pages 121-125
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    We report the case of a 33-year-old man with thymus carcinoid. The 4.6-cm solid tumor was found in the anterior mediastinum by computed tomography. A concentration of FDG was observed in the anterior mediastinal tumor consistent with computed tomography (SUV max = 7.04). A concentration of FDG was also observed in the pancreas.

    Blood collection results indicated the presence of hypercalcemia, and parathyroid adenoma was suspected by computed tomography. Also, his father was MEN type 1. We diagnosed him with thymic carcinoid complicated with MEN type 1. We performed a total thymectomy. Polygonal cells with coarse circular nuclei of chromatin proliferated densely, and rosette structures were scattered as HE staining findings. The fission figure was 8/10 HPF. CD56, chromogranin, and synaptophysin were positive. Ki67 was 24.6% based on immunopathological findings. The pathological diagnosis was atypical carcinoid. MEN type 1 is considered to be associated with 25% of thymic carcinoids, and particular atypical carcinoids are considered to be associated with a poor prognosis.

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  • Yoshifumi Makimoto, Toshiro Obuchi, Akinori Iwasaki
    2020 Volume 34 Issue 2 Pages 126-129
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    A woman in her 40s had been suffering from intractable hiccups for two years after trying countless medicines, including tranquilizers, without success. She developed depression and suffered from seizure-like convulsions due to panic. When her family contacted me for help, I instructed her to breathe in a unique combination of gases I had recently developed to cure the intractable hiccups. Approximately five minutes into the procedure, her hiccups were completely resolved. This further strengthens my theory that abolishing the venous-arterial CO2 gradient is a definitive treatment for hiccups.

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  • Masanori Okada, Kazuhiro Okada, Yujiro Kubo, Ryuji Nakamura, Toshiya F ...
    2020 Volume 34 Issue 2 Pages 130-136
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    A 52-year-old man who had undergone a living renal transplantation had been receiving immunosuppressive therapy with methylprednisolone, tacrolimus, and mycophenolate mofetil for 6 years and had remained free from rejection. A pulmonary nodule with a diameter of 12 mm was detected in the right middle lobe of the lung. Because of the risk of malignancy, the patient underwent surgery for the diagnosis and treatment of the nodule. The nodule was resected under video-assisted thoracoscopic surgery and an intraoperative rapid diagnosis confirmed an inflammatory nodule. A subsequent pathological examination revealed a round, yeast-like fungus detected using periodic acid-Schiff staining and Grocott staining, supporting a diagnosis of pulmonary cryptococcosis. A blood sample tested negative for cryptococcal antigen, so additional treatment was not prescribed. While transplant recipients require immunosuppressive therapy after transplantation, such treatment increases the incidence of infection and malignant disease. A pathological examination after an excisional biopsy should be used to diagnose pulmonary nodules developing in patients receiving immunosuppressive therapy.

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  • Yoshiyuki Susaki, Noriyoshi Sawabata
    2020 Volume 34 Issue 2 Pages 137-142
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    A 44-year-old woman presented to our hospital with persistent sputum. Chest computed tomography showed a posterior mediastinal nodule of 2.0 cm in maximum diameter on her right Th4-5 spine. The patient had a history of uterine myoma and Caesarean sections. She underwent thoracoscopic resection with a preoperative diagnosis of a neurogenic tumor. Macroscopically, the nodule was a thin-walled cyst, and had no direct communication with the sympathetic trunk, tracheobronchial tree, or esophagus. Histologically, the cyst wall was lined with low columnar cells, partially with cilia, and positive for ER and PgR. Therefore, it was diagnosed as a Mullerian cyst. The postoperative course was uneventful. A posterior mediastinal cyst in perimenopausal women should lead to the consideration of a Mullerian cyst.

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  • Ryuichi Yoshimura, Hirozo Sakaguchi, Tetsuya Umesaki, Akitoshi Yanagih ...
    2020 Volume 34 Issue 2 Pages 143-148
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    An 81-year-old man was referred to our hospital for further examination of a right pleural tumor that had been found with computed tomography. We performed partial pleural resection and intrapleural perfusion with hyperthermic-chemotherapy. The tumor was pathologically diagnosed as a localized biphasic malignant mesothelioma. Twenty-four months following the initial operation, a mass was observed in the right 6th intercostal space using computed tomography. This was considered to be a local recurrence. Partial pleural resection was successfully performed. The tumor was pathologically diagnosed as a transitional malignant mesothelioma. This was thought to be a recurrence of the initial pleural tumor. This is a rare and important report of a patient with transitional malignant mesothelioma.

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  • Mao Yoshikawa, Yuji Hirami, Kentaroh Miyoshi, Akio Ando
    2020 Volume 34 Issue 2 Pages 149-153
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    A 79-year-old man with a medical history of bladder and prostate cancer was referred to our respiratory department because of an enlarged pedunculated nodule in a bulla of the right lung, S9 peripheral, detected on chest computed tomography (CT). Bronchoscopy did not yield a definitive diagnosis of the nodule. A metastatic lung tumor or primary lung cancer was suspected because the nodule showed a high uptake of 18F-fluorodeoxy glucose on positron emission tomography. Therefore, we performed right lung S8-9 segmentectomy by video-assisted thoracic surgery. The pathological diagnosis was solitary squamous cell papilloma, which showed papillary growth with fibrovascular interstitial and stratified squamous epithelia with mild atypia. Part of the bronchus could be observed on the surface of the bulla. We considered that the bulla had been formed by air trapping due to endobronchiolar obstruction caused by the papilloma. Typical CT findings are rarely reported. Squamous cell papilloma should be included in the differential diagnosis of a solitary pulmonary nodule in a bulla.

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  • Hirotoshi Suzuki, Jotaro Shibuya, Masashi Handa, Teruhisa Udagawa, Kat ...
    2020 Volume 34 Issue 2 Pages 154-160
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    A 56-year-old male with traumatic cervical spinal cord injury at the C4 level visited a clinic due to dysphagia and difficulty of sputum expectoration. A giant anterior mediastinal tumor was detected, and he was introduced to our hospital. The result of ultrasound-guided biopsy was thymoma, and he was diagnosed with myasthenia gravis. CT showed that the giant tumor was 105×95×74 mm. Complete resection of the tumor and extended thymothymectomy via clamshell incision was performed. The tracheal intubation tube was extubated on postoperative day (POD) 9, and left and right thoracic drains were removed on POD 33 and POD 50, respectively. His dysphagia gradually improved without postoperative pain or MG crisis, although orthostatic hypotension and a high fever caused by disorder of heat release were present. He was discharged on POD 70. No recurrence has been noted for 6 months post-operatively.

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  • Emiko Tomita, Kenjiro Fukuhara, Akinori Akashi
    2020 Volume 34 Issue 2 Pages 161-165
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    Congenital bronchial atresia (CBA) is a rare congenital abnormality resulting from focal interruption of a lobar, segmental, or subsegmental bronchus with associated peripheral mucus impaction and associated hyperinflation of the obstructed lung segment. We describe a case of CBA with tension pneumothorax that occurred due to rupture of the apical bulla and induced hemorrhage and partial destruction of the obstructed lung segment. A 17-year-old male was diagnosed with CBA at age 15. He had been asymptomatic and followed without therapy. He was admitted to the previous hospital for left tension pneumothorax. We performed segmentectomy of the left S1+2. CBA associated with tension pneumothorax should be treated surgically.

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  • Yusuke Kita, Yoshimasa Tokunaga, Taku Okamoto
    2020 Volume 34 Issue 2 Pages 166-170
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    Case 1. The patient was a 59-year-old male with an anterior mediastinal tumor detected on CT. CT showed a 15-mm nodule that was non-uniformly contrasted, and MRI showed a shadow with a low signal. We performed thoracoscopic resection for diagnosis and treatment of a suspected high-density protein cyst or thymoma. The resected specimen was histologically diagnosed as a micronodular thymoma with lymphoid stroma (MNT). Case 2. The patient was a 63-year-old man with an anterior mediastinal tumor and solitary pulmonary nodule detected on CT during follow-up for rectal cancer. CT showed a 13-mm nodule with homogeneous enhancement that tended to increase in the mediastinum, and an 8-mm nodule in the lower right lobe. MRI showed a well-marginated 19-mm nodule with a low signal. We performed thoracoscopic resection for diagnosis and treatment of a suspected thymoma and metastatic lung tumor. The resected specimen was diagnosed as MNT and a metastatic lung tumor of rectal cancer histologically. Recurrence of neither has been observed.

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  • Ryoji Kawano, Yasuhiro Takahashi, Rei Kobayashi, Kana Nagayama, Kana K ...
    2020 Volume 34 Issue 2 Pages 171-177
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    We herein report three patients who underwent lobectomy (two left upper lobectomies and one left lower lobectomy) for lung cancer, and developed embolic cerebral infarction in the early postoperative period. Two of these patients were treated with endovascular thrombectomy, which markedly improved their general condition; however, the remaining patient did not receive aggressive endovascular treatment because cerebral infarction occurred in an extended area of the cerebral hemisphere. Recent reports suggested that embolic cerebral infarction after pulmonary resection may cause thrombosis in the stump of the pulmonary vein in patients who undergo lobectomy. Such a complication is particularly frequent in patients who undergo left upper lobectomy compared with other lobectomies. These three patients with brain infarction had undergone a lobectomy of the left lung and there were no other risk factors causing cerebral infarction. Therefore, we considered it highly likely that the thrombus generated on the stump of the pulmonary vein caused the brain infarction. Endovascular thrombectomy is extremely useful for treating acute embolic cerebral infarction. However, realistically, it is difficult to prevent thrombus formation at the stump of the pulmonary vein through surgical techniques. It is thus necessary to consider anticoagulant therapy in patients after undergoing left-sided lobectomy.

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  • Ryuji Nakamura, Toshiya Fujiwara, Kazuhiro Okada, Yujiro Kubo, Masanor ...
    2020 Volume 34 Issue 2 Pages 178-181
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    We herein present the case of a 68-year-old man. He underwent left lower lobectomy for lung cancer. In the following year, he experienced right tension pneumothorax twice, and underwent thoracic drainage as conservative treatment. Three days after discharge, he experienced tension pneumothorax and was re-admitted to our hospital. On admission, his consciousness level was E2-V3-M5, according to the Glasgow Coma Scale, and he showed low oxygen saturation levels. Considering the severity and short interval of recurrence, we decided to perform surgery. However, his pulmonary function was inadequate because of combined pulmonary fibrosis and emphysema and post-pulmonary resection status associated with lung cancer.

    Therefore, we decided to perform video-assisted thoracoscopic bullectomy with extracorporeal membrane oxygenation (ECMO) to maintain the oxygen levels during the operation in cooperation with the cardiovascular surgery department as well as other departments. The operation was successfully performed, and the postoperative course was uneventful. Furthermore, he was discharged on postoperative day 10. He remained stable without the recurrence of pneumothorax or exacerbation of interstitial pneumonia.

    We consider that ECMO is an effective approach to provide respiratory support for patients with a poor pulmonary function undergoing thoracic surgery.

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  • Aya Yamamoto, Takashi Iwata
    2020 Volume 34 Issue 2 Pages 182-186
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    Case. A 75-year-old male presenting with hemoptysis was referred to our department for the treatment of a metastatic pulmonary tumor from prostate cancer. Chest computed tomography demonstrated 3 nodules in the periphery of the bilateral lungs and elevation of the left diaphragm. He also complained of abdominal symptoms such as distension. A pulmonary function test showed restrictive disorder. Simultaneous surgery of bilateral wedge resection of the metastatic tumor and left diaphragmatic plication was carried out. First, left wedge resection of S1+2 was performed under lateral mini-thoracotomy. The thin and slackened diaphragm was incised, the omentum was dissected, and then diaphragmorrhaphy was performed by continuous suture. Finally, multiple right wedge resection was performed via thoracoscopy. Intraoperative separated lung ventilation proceeded without problem. The abdominal symptoms disappeared immediately. The pathological diagnosis of the resected lung tumor confirmed metastasis from prostate cancer. His general status was markedly improved by an increase in his dietary intake, facilitating chemotherapy for metastatic prostate cancer that was contraindicated preoperatively. Conclusion. He was complicated by a low pulmonary function. However, by preceding diaphragmorrhaphy, contralateral lung resection could be safely performed.

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  • Yoshifumi Shimada, Yoshinori Doki, Masataka Segawa, Takahiro Homma, Na ...
    2020 Volume 34 Issue 2 Pages 187-194
    Published: March 15, 2020
    Released: March 15, 2020
    JOURNALS FREE ACCESS

    In right S1 segmentectomy, an approach from the ventral side toward the dorsal side of the pulmonary hilum is commonly used; however, intersegmental veins branching from the central vein can be identified more easily on the interlobar or dorsal side of the pulmonary hilum in some cases. Additional benefits of confirming the running direction of intersegmental veins based on multidirectional views include detection of variant or aberrant vessels, as the pulmonary vein includes several anatomical variations and branching patterns. When we have difficulty in dissecting intersegmental lung parenchyma in thoracoscopic right S1 segmentectomy, intersegmental demarcation lines can be more reliably identified through the combined use of multidirectional approaches involving the pulmonary hilum rather than the use of a unidirectional approach.

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