[Show abstract][Hide abstract] ABSTRACT: Spraying with Sodium Thiosulphate Solution (STSS, Detoxol®) is reported to be useful in reducing the side effects of Iodine dyeing on the esophagus. In order to determine the optimal concentration of STSS and its efficacy, STSS was administered in the following concentrations. Group A: 10% (Original Solution), Group: B 5%. Group C, 2.5%. Group D: 1.7% and Group E: saline with no STSS, and a questionnaire was conducted to assess the side effects. The results showed that the higher the concentration, the less frequent and short lasting the side effects were. The effects of STSS on diagnostic efficacy was also evaluated. After spraying with STSS, the 2.5% solution removed iodine gradually but there were differences in discoloration among the various degrees of inflammation. When iodine dyeing was repeated, clear images with a good contrast were obtained. Excess iodine was neutralized and details of the surface and vascular pattern were more readily observed. Spraying with STSS seemed to increase the diagnostic ability of the procedure.
No preview · Article · Aug 2007 · Digestive Endoscopy
[Show abstract][Hide abstract] ABSTRACT: A 56-year-old woman was pointed out an abnormal shadow on chest roentgenogram. Chest CT and MRI showed a solid mass with a cyst at right anterior mediastinum. Clinical diagnosis was thymoma with cyst, and surgical excision was performed. The histopathological examination of the resected specimen demonstrated that the epithelia of the cyst wall was single cuboidal or squamous cells and contained some foci of thymic tissue. The solid mass was capsulated and predominantly composed of lymphocytes. The pathological diagnosis was a thymoma (predominantly lymphocytic type) with thymic cyst. She is doing well for 10 years postoperatively.
No preview · Article · Sep 2001 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: A 44-year-old female was admitted to our hospital because of the left cervical tumor. Radiologic examination showed that the tumor was 5 cm in diameter and was inhomogeneous. The tumor was spread to the upper mediastinum. Esophagoscopy showed that the tumor was covered by the normal mucosa. Percutaneous fine needle biopsy did not appear the histopathological diagnosis. The patient underwent surgical resection through the cervical approach and the tumor was located between the mucosal and muscular layers of the esophagus. The tumor was enucleated without any complication. Histopathological diagnosis was leiomyoma. Postoperative course was uneventful. Expecting diagnosis and positive complete resection is recommended for leiomyoma of the esophagus.
No preview · Article · Mar 2001 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: A 32-year-old man who underwent evaluation for dyspnea and left chest pain proved to have a left pneumothorax and a right giant bulla. After surgery for the left pneumothorax, drug induced liver injury was observed. Seventeen days after surgery, left giant bulla was infected and niveau formation was seen with high fever. After administration of antibiotics, the niveau was disappeared and the body temperature was down, however, drug induced liver injury was caused. After that, again, the niveau formation was noticed in the right bulla. We speculated that adequate drug therapy could not used because of liver injury if the right bulla would be infected one more time. Bullectomy of the right lung was performed. One year after surgery, there were no signs of infection. We usually administer the adequate antibiotics against the infectious giant bulla without surgical therapy because the bulla will be reduced with the infection. However, there is a situation like this case that surgical treatment is required because of the drug induced liver injury.
No preview · Article · Oct 2000 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Localized solitary plasmacytoma of the bone (SPB) is a rare disease and is characterized by only one or two isolated bone lesions with no evidence of disease dissemination. A previously healthy 44-year-old male was admitted for evaluation of an abnormal radiographic shadow in the left middle lung field with symptoms of left back pain. Radiological evaluation revealed a peripheral opacity in the left chest wall, which was highly suspected to be a chest wall tumor. CT-guided transcutaneous needle biopsy of the tumor was performed and the specimens showed a monomorphous population of mature plasma cells. The bone marrow biopsy findings revealed no evidence of myeloma and bone scanning revealed only abnormal accumulation in the left seventh rib. He had mild M-proteins in a urine sample and Bence-Jones protein was detected. Immunoelectrophoresis revealed mild biclonal gammopathy of Bence-Jones protein of both the kappa and lambda light-chain types. Under a diagnosis of solitary bone plasmacytoma, preoperative radiation therapy with doses of 40 Gy for the tumor was performed. He underwent complete en bloc resection of the chest wall, including one-third of the left sixth and seventh ribs, the intercostal muscle and the parietal pleura. The protein abnormalities in the urine sample disappeared following surgical resection. Adjuvant chemotherapy using melphalan and prednisolone was performed. He is doing well without evidence of tumor recurrence 2 years following his initial diagnosis.
No preview · Article · May 2000 · Japanese Journal of Clinical Oncology
[Show abstract][Hide abstract] ABSTRACT: After lung lobectomy or pneumonectomy, the mediastinal shift and diaphragmatic elevation are occurred. Because this phenomenon may affect the heart positional change, we studied the electrocardiographic QRS axis in the frontal plane (from leads I and III) and the postoperative arrhythmia. Seventy three patients who had no heart disease including arrhythmia before the surgery were recorded their electrocardiogram (ECG) before their surgery and after their discharge. When the postoperative ECG was recorded, they had no respiratory failure nor cancer recurrence, and their lungs were fully expanded in their thoracic cages. After right upper lobectomy (19 cases), the axis was twisted rightward slightly (2.1 degrees). Right middle lobectomy (2 cases, 9.5 degrees) and right upper and middle lobectomies (3 cases, 7.3 degrees) twisted the heart axes more rightwards. Right lower lobectomy (12 cases, -1.0 degree) and right middle and lower lobectomies (3 cases, -17.7 degrees) contorted their axes leftwards and right pneumonectomy (5 cases, 31.4 degrees) rightwards. The axes were turned rightwards after the left upper lobectomy (18 cases, 2.8 degrees) and the left lower lobectomy (7 cases, 3.9 degrees). Left pneumonectomy (4 cases, -4.0 degrees) twisted the axis leftwards. After the surgery, arrhythmias were recorded in 14 cases and, among these patients, 5 cases were required the oral anti-arrhythmic medication. Most of these cases changed their heart axes after the surgery and it is suggested that the axial deviation may contribute to their postoperative arrhythmia.
No preview · Article · Sep 1999 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Gingival metastasis from lung cancer is very uncommon. We report a case of distant metastasis of pulmonary adenocarcinoma
in the mandibular gingiva. A 54-year-old man was admitted to our hospital on September 1, 1997 with hemoptysis. Right upper
lobectomy with mediastinal lymph node dissection was performed on September 16. On the 14th postoperative day, the patient
complained of a gingival swelling. In the lower right premolar area, a wide pedunculated mass was seen on the mandibular gingiva.
Excisional biopsy of the tumor was performed, and histopathological examination revealed that the tumor was a metastatic lesion
from the pulmonary adenocarcinoma. The patient received 46.8 Gy of linac irradiation to the tumor area and the entire oral
condition improved markedly. However, bilateral adrenal gland metastases were recognized, and left inguinal lymph node metastasis
was detected 2 months after lung resection. He developed tumor metastases to multiple organs and died of respiratory failure
on December 12, 1997.
No preview · Article · Jul 1999 · International Journal of Clinical Oncology
[Show abstract][Hide abstract] ABSTRACT: Asymptomatic spontaneous pneumothorax (ASPT) is an uncommon condition. Between January 1, 1989 and December 31, 1997, 269 patients were admitted to our department with spontaneous pneumothorax. Of the 269 patients, 5 had no symptoms at the time of discovery. Their ages ranged from 15 to 61 years (mean, 37.8 years), and all of them were male. Of the 5 patients with no complaints, 2 had bilateral metachronous pneumothoraces and 3 had hemilateral pneumothorax. All of these ASPTs were revealed by chest roentgenographs taken during medical examinations or follow-up studies relating to other diseases. The mean value of body mass index (BMI) was 19.96 +/- 1.4 (range 18.7 - 22.1). Two of the 5 patients underwent bilateral partial lung resection. Histopathological examination of the resected specimens showed elastofibrosis, scar formation, and an interruption of the elastic fiber of the pleura. In these 5 cases, clinical courses were uneventful, and relapse of the pneumothorax did not occur. Clinical physicians should be aware of the possibility of asymptomatic pneumothorax, as well as the optimal radiographic techniques for revealing small pneumothoraces.
No preview · Article · Jul 1999 · Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
[Show abstract][Hide abstract] ABSTRACT: It is well known that xenotransplantation leads to immediate graft dysfunction. This study was designed to specifically examine the role of platelets in mediating lung hyperacute xenorejection (HXR) in a guinea pig-to-rat model. A total of 18 lungs were perfused with blood using an ex vivo apparatus. The animals were divided into the following four groups: a CE group comprising circuit only with rat blood; a SYN group comprising rat lungs and blood; a XE group comprising guinea pig lungs and rat blood; and an SH group comprising guinea pig lungs and rat blood with sarpogrelate hydrochloride, a suppressor of platelet aggregation. The platelet and serotonin in the blood were lower and the wet/dry weight ratio of the lung (W/D) in the XE group were higher than those in the SYN group after perfusion. The platelet count was higher, but the serotonin and W/D were lower in the SH group than in the XE group. These results suggest that platelets strongly affect HXR. Thus, the administration of drugs to suppress platelet aggregation would reduce xenotransplanted lung edema.
[Show abstract][Hide abstract] ABSTRACT: To explore the anatomical repositioning of the middle lobe following right upper (RU) lobectomy, we measured the lobar volumes of the lung and the branching angles of the airway, and defined their changes after RU lobectomy in a rabbit model. Groups A1 (n = 10) and A2 (n = 10) were control groups and groups B1 (n = 10) and B2 (n = 10) underwent RU lobectomy. Casting material was introduced into the airway and a heart-lung bloc was removed form the thoracic cavity in all groups. In groups A1 and B1, the volume of each lobe of the bilateral lungs was measured, while in groups A2 and B2, bronchial casts were made and the branching angles of the airway were measured. The volume ratio of the right upper lobe (RUL) to the total lung was 12.0 +/- 0.4% in group A1; however, after RU lobectomy, the volume ratio of the right middle lobe (RML) to the total lung increased from 8.7 +/- 0.6% in group A1 to 13.5 +/- 0.8% in group B1. The volume of the left lung also increased from 43.0 +/- 0.5% in group A1 to 48.8 +/- 1.1% in group B1. The angle between the truncus intermedius and the RML bronchus was significantly smaller in group B2, at 109.0 +/- 3.5 degrees, than in group A2, in which it was 138.5 +/- 1.7 degrees. The angle between the RML bronchus and the coronal plane was 57.5 +/- 2.5 degrees in group A2 and 33.5 +/- 3.3 degrees in group B2. Our method of measuring the bronchial branching angle subsequent to RU lobectomy proved useful to illustrate postoperative positional changes and expansion of the remaining lobes.
[Show abstract][Hide abstract] ABSTRACT: A 62-year-old man who underwent right upper lobectomy for lung cancer developed an obstruction of the right middle lobe (RML) bronchus in the 5 months postoperatively. Chest X-rays showed obstructive pneumonia in the remnant RML, and bronchoscopy revealed complete obstruction due to bending of the RML bronchus. Re-thoracotomy and resection of the RML was performed 7 months after the first surgery. The patient's postoperative course was uneventful. Obstruction of RML may occur more easily in patients with a huge upper lobe and a narrow and flat RML bronchus.
No preview · Article · Oct 1997 · Journal of Bronchology
[Show abstract][Hide abstract] ABSTRACT: Nine hundred and seventy-three consecutive patients were referred to our hospital for thoracotomy to treat chest diseases between January 1, 1981, and December 31, 1995. Of these patients, 20 males were readmitted within a mean of 20 months with a diagnosis of contralateral pneumothorax. Sixteen of the patients with a mean age of 28.5 years (range 16-76 years of age) had been operated on for bullous lung disease. The remaining four, with a mean age of 60.8 years (range 54-71), had been operated on for lung cancer. All of the 20 patients had received unilateral thoracotomy for lung resection. One patient had undergone pneumonectomy for lung cancer; three had undergone lobectomy; and 16 had been treated by partial lung resection. The patient who had undergone pneumonectomy was found to have contralateral pulmonary metastasis of lung cancer. In the other 19 patients, emphysematous bulla was the origin of the contralateral pneumothorax. The mean value of body mass index (BMI) of the group was 18.4 as compared to 21.7 in the patients who did not go on to develop contralateral pneumothorax, a significant difference (p < 0.05). In conclusion, postoperative contralateral pneumothorax was correlated to the existence of emphysematous changes of the lung and a significantly lower BMI. We conclude that patients with BMIs less than 20 may be at increased risk of developing postoperative contralateral pneumothorax.
[Show abstract][Hide abstract] ABSTRACT: A 21-year-old male with an enlarged tumor mass shadow in the anterior mediastinum extending to the right lung field with malignant pleural effusion was admitted on September, 1994, because of complaints of right anterior chest pain, pyrexia and general fatigue. On admission, the serum alpha fetoprotein (AFP) level was elevated to 1030 ng/ ml. Histopathological findings of the specimens obtained by CT-guided percutaneous needle biopsy revealed a non-seminomatous germ cell tumor of the mediastinum. Two courses of preoperative chemotherapy with CDDP, VDS, PEP and VP-16 were administered. Serum AFP level decreased rapidly to 6 ng/ml after the chemotherapy. The patient underwent the right total pleuro-pneumonectomy combined with partial resections of the superior vena cava, the pericardium and the diaphragm. The patient has been well for 28 months postoperatively.
[Show abstract][Hide abstract] ABSTRACT: After the cessation of circulation, organ function deteriorates. In cadaveric lung transplantation, protecting the endothelium of the pulmonary artery (PA) from warm ischemic injury is important. We studied the effects of flush height, reperfusion flow rate, and magnesium on the PA in an isolated, non-blood-reperfused lung model (rabbits, n=6 in each group) . A lowpotassium dextran solution was infused into the PA from a height of 60 cm (groups 1 and 2) or 30 cm (groups 3 through 5), immediately (group 1) or 2 hours (groups 2 through 5) after death. The heart-lung bloc was excised, ventilated, and reperfused at a flow rate of 100 ml/minute (groups 1 through 3) or 50 ml/minute (groups 4 and 5) for 30 minutes. MgCl2 was added to the flush solution (10 mmol/1) in group 5. The pulmonary arterial pressure (PAP) during the flush period (PAPFP) and the flush flow rate (FFR) were recorded. Airway pressure (AWP) and PAP were monitored during the 30-minute reperfusion. After reperfusion, the wet/dry weight ratio (W/D) of the left lung was calculated as an estimate of the extent of lung edema. In group 2, lung failure, indicated by a frothy bronchial exudate, appeared in all animals during the flush period. In group 3, PAPFP was higher and FFR was lower than in group 1, and all lungs failed during the reperfusion period. In group 4, although all lungs were reperfused for 30 minutes, AWP and W/D were higher than in group 1. In group 5, W/D was lower than in group 4. To avoid PA damage caused by overperfusion of the graft, flush height and reperfusion flow rate should be lowered in cadaveric lungs. Magnesium in the flush solution was an effective means of preventing pulmonary edema.
[Show abstract][Hide abstract] ABSTRACT: During a 15-year period between January 1, 1980 and December 31, 1994, 38 patients were admitted to the department for treatment of giant bulla. Of these 38 patients, 19 (50%) had spontaneous pneumothorax; and 14 had the lesion on the site of giant bulla and 5 on the contralateral site. The incidence of pneumothorax on the site of giant bulla tended to occur in the aged patients. There was no significant difference in the incidence of pneumothorax between existence of smoking habit and non-smoker. However, there were significant differences in the incidence of pneumothorax between upper lobe and another lobes which were the primary site of giant bulla. Of the five patients with contralateral pneumothorax, four were treated with axillary incision for the contralateral pneumothorax prior to operation for the giant bulla, and the remaining one case with conservative drainage because of chronic emphysema. Histopathological examination for the resected specimens showed an increase or interruption of the elastic fiber of the pleura. It is etiologically thought that pneumothorax in these cases might be caused not only by the structure of the pulmonary alveoli but also by weakened pleura.
[Show abstract][Hide abstract] ABSTRACT: A 2-year-old boy was admitted for elevation of infiltrative shadow in the left middle lung field on a chest X-ray. The clinical diagnosis was emphysematous bullae with inflammation of left upper lobe. He received chemotherapy with antibiotics prior to the operation. Left inferior lingual segmentectomy was performed on April 18, 1989. The histopathological examination of specimen revealed congenital cystic adenomatoid malformation (Stocker type II) of the lung. However, relapse of the CCAM was observed 3 years later. Left completion upper lobectomy was performed on December 8, 1992. The patient has been well for 30 months postoperatively.
No preview · Article · Nov 1996 · [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
[Show abstract][Hide abstract] ABSTRACT: Tracheobronchial stenosis can arise as a congenital disorder with other associated abnormalities in infants, but it may also occur as an acquired lesion secondary to prolonged intubation and other factors. We report the preoperative radiologic and bronchofiberscopic findings of bronchial narrowing associated with cardiovascular disease in adults. In the past 2-years, 22 patients with thoracic aortic aneurysm (TAA) and one adult with patent ductus arteriosus (PDA) were admitted to our department. These 23 patients were examined preoperatively by computed tomography (CT) and magnetic resonance imaging (MRI) for evaluation of the hemodynamic condition. Of these patients, seven were found to have bronchial narrowing associated with TAA or pulmonary artery dilation caused by PDA and were examined by broncho-fiberscopy (BFS) preoperatively. In another 16 of these 23 patients, mild bronchial compression was detected retrospectively. Bronchial narrowing was evident with BFS in the left main bronchus in three of the seven patients, in the orifice of the left lower lobe bronchus in two, and in the orifice of the left superior segment bronchus (B6) in two. Preoperative CT or MRI indicated bronchial narrowing, which was clear in two of the seven cases and probable in five cases. Of these seven cases, four patients had postoperative respiratory complications (atelectasis and/ or pneumonia). We conclude that clinicians must be aware, preoperatively, of the possibility of existence of bronchial narrowing due to compression by a dilated large blood vessel.
(C) Williams & Wilkins 1996. All Rights Reserved.
No preview · Article · Sep 1996 · Journal of Bronchology and Interventional Pulmonology