ABSTRACT
The patient was an 83-year-old man who had undergone thoracoscopic subtotal esophagectomy 1 year and 6 months earlier with no evidence of recurrence. He was hospitalized for heart failure. On day 6 of hospitalization, a plain chest X-ray revealed bilateral pneumothorax and bilateral subdiaphragmatic free air, and CT showed a large amount of free air in the abdominal cavity. Gastrointestinal perforation was ruled out because of the absence of both abdominal findings and an elevated inflammatory response. Because the patient had a history of surgery for esophageal cancer, we assumed that air from the right spontaneous pneumothorax had disseminated into the contralateral thoracic and abdominal cavities. Therefore, a right chest drain was inserted. Air leakage persisted despite improvements in both collapsed lungs and the disappearance of intraperitoneal free air. No improvement was observed even after performing pleurodesis with autologous blood and glucose solution. Surgery was deemed challenging due to the patient’s low heart function; thus, pleurodesis was performed again using OK-432, which ameliorated the pneumothorax. To our knowledge, there have been no Japanese reports of pleurodesis using OK-432 for pneumothorax after esophagectomy.
ABSTRACT
We report the first case in the Japanese literature of toxic shock syndrome following incisional hernia repair. We performed incisional hernia repair in a 54-year-old man with a BMI of 32.6 kg/m2 who underwent sigmoidectomy for cancer of the sigmoid colon one and half years earlier. Postoperative course was complicated by subcutaneous hemorrhage, which resolved with conservative management, and he was discharged on the 9th postoperative day. However, 3 days after discharge, he was readmitted with shock, high fever, diarrhea, vomiting, somnolence, and acute renal failure. He was diagnosed with toxic shock syndrome (TSS) due to TSS toxin-1 produced by MRSA infection of the subcutaneous hematoma. Drainage was performed and vancomycin, clindamycin, and gamma-globulin therapy were administered, with intensive supportive care. Treatment was successful and he was discharged 24 days after admission.
ABSTRACT
We report a case of accessory breast cancer in the right axillary region. A 67-year-old woman visited our department complaining of a lump in the right underarm. We suspected cancer of an accessory breast from the findings of mammography and ultrasonography; a histological diagnosis of breast cancer was obtained by needle biopsy. With a preoperative diagnosis of accessorybreast cancer accompanied by ipsilateral axillary nodal involvement, the patient underwent wide local resection of the right axillary region with lymph-node dissection (level II). Histopathological findings of the resected specimen revealed that the tumor was composed of solid tubular carcinoma with intraductal component, with normal breast tissue in the region adjacent to the tumor. A diagnosis of right axillary accessory breast cancer (pT2, N1, pStage IIb) was confirmed. Postoperative chemotherapy and radiotherapy were administered. At present, 18 months after surgery, no sign of recurrence has been observed.