[Show abstract][Hide abstract]ABSTRACT: The purpose of performing pleural cauterization is developing heat denaturation, and we can induce pleural thickening and also reduce the bullae by shrinking the pleura It originates in a method of the cauterization whether there will be tissue damage. So a safe and reliable method of cauterization is required. Here, we investigated the indications for and effectiveness of cauterization techniques performed at our facility. We perform cauterization while dropping saline solution, so when using a Salient Monopolar Sealer, we can avoid excessive thermo-coagulation and more easily control cauterization. Furthermore, on the basis that only emphysematous pleura will turn white on cauterization, bullae can be distinguished, which is particularly effective in the case of lesions with unclear borders. In the case of a large emphysematous bulla, shrinkage of the bulla by cauterization can provide a sufficient surgical field, and a smaller lesion can then be stapled.
Article · Apr 2011 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract]ABSTRACT: A 54-year-old man felt a mass on the left axilla three years previously. Because some malignant melanomas metastasized to the left axillary lymph node, we thoroughly examined him from head to foot to identify the primary tumor. We found the primary tumor in the left flank and performed resection and cancer chemotherapy. We found a 10mm tumor in the middle lobe of the right lung, one year and six months after the surgery of the primary tumor. It was suspected that the tumor was a metastasis of the malignant melanoma to the lung, and that surgery was necessary, but he refused it. However, because of tumor enlargement, he accepted right middle lobectomy. It was 11 months after his abnormal chest shadow was pointed out. The tumor was an oncogenic lesion of 33mm including the border; the sectioned surface was white. For tissue pathologic findings, we diagnosed the metastases to the lung of the amelanotic melanoma. The postoperative course is good and he has been followed up in the outpatient department for 18 months postoperatively. It is thought that there are few cases with surgical indication for this disorder, however if surgical complete resection is possible, then prognosis improvement is expected, and therefore it is important to examine the presence of positive surgical indication.
[Show abstract][Hide abstract]ABSTRACT: We examined the efficacy and toxicity of a divided schedule of cisplatin and vinorelbine with concurrent radiotherapy followed by surgery in patients with locally advanced non-small cell lung cancer (NSCLC). Patients with clinical stage IIIA or IIIB NSCLC were eligible if they had a performance status of 0 or 1, were 75 years or younger, and had adequate organ function. Patients were treated with cisplatin (40 mg/m2) and vinorelbine (20 mg/m2) on days 1 and 8 every 3 weeks. Thoracic radiotherapy (2 Gy per fraction; total dose, 40 Gy) was given concurrently. Surgical resection was performed after induction therapy had been completed. If disease was considered clinically inoperable after induction therapy, patients received 2 additional cycles of the chemotherapy and 20 Gy of additional radiotherapy. Twenty-three patients (20 men and 3 women; median age, 63 years; age range, 45-72 years) were enrolled. The overall response rate was 78.3%. Although grade 3-4 toxicities included neutropenia in 95.7% of patients and anemia in 39.1%, no grade 3-4 radiation pneumonitis or esophagitis occurred. Thirteen patients (56.5%) underwent thoracotomy and complete resection. There were no treatment-related deaths. The median survival time was 36 months (range, 4-78 months), the 2-year survival rate was 74%, and the median time to disease progression was 15 months (range, 2-59 months). This trimodality therapy is effective and well tolerated and is an acceptable therapeutic option for patients with locally advanced NSCLC.
[Show abstract][Hide abstract]ABSTRACT: Relapsing polychondritis (RPC) is a rare disease affecting not only cartilage but also other tissues with a high glycosaminoglucan content, specifically, sclera, cornea, aorta, and non-cartilaginous ear parts. A review of 23 cases managed by the authors along with a literature review of 136 other cases was published by McAdam et al., and many of the following comments are based on that review. In this article, a case of subglottic tracheal stenosis that occurred in a patient with RPC is presented. On April 2006, a 77-year-old female was admitted to our hospital with severe dyspnea associated with a 15-year history of RPC. Dyspnea increased progressively during the few months prior to admission. In this case, the trachea softened by dissolution of cartilage due to RPC ; therefore, the tracheal diameter shrank, and the subglottic trachea collapsed with resulting disappearance of the tracheal air shadow on radiographs. As a semiemergency, the patient underwent intubation with an endotracheal tube. After tracheotomy, insertion of a silicone tracheal T-tube was performed through tracheotomy fenestration. The patient developed pneumonia thereafter and died of respiratory failure on January 2007.