[Pulmonary Amyloidosis Observed by Thoracoscopy:Report of a Case].

The case is an 80-year-old woman with Sjögren's syndrome. During the follow-up of multiple pulmonary nodules, an enlarged nodule was observed in the peripheral of the right S3 interlobar region. Fluorodeoxyglucose- positron emission tomography (FDG-PET) showed FDG accumulation only in the S3 nodule, which led to suspicion of primary lung cancer. Because of its difficult location to reach by bronchoscopy, a right lung S3 segmentectomy was performed. Intraoperative findings revealed a hard yellowish- white nodule just below the pleura. Pathological examination showed that the nodule consisted of an acidophilic structureless material, which was positive for Congo red staining and disappeared after permanganate treatment. Based on the above findings, we diagnosed amyloid A( AA)-type amyloidosis. In this case, the nodule was located just below the pleura and we could observe it by thoracoscopy. There have been few reports of thoracoscopic observation of pulmonary amyloidosis, and we report with intraoperative findings.

Combined resection of lung cancer and thoracic aortic wall with simultaneous thoracic aortic endografting: a case report.

BACKGROUND: Combined resection of lung cancer and the thoracic aortic wall with thoracic aortic endografting has been reported. However, whether the resection and endografting should be performed simultaneously or in two steps remains controversial. CASE PRESENTATION: A 68-year-old man was referred to our hospital because of left chest pain. Chest contrast-enhanced computed tomography revealed a huge tumor of the left lower lung lobe, and invasion to the aortic wall was suspected. Bronchoscopic examination was performed, revealing squamous cell carcinoma with a programmed death ligand 1 expression level of 90%. The clinical stage was T4N0M0 stage 3A. After neoadjuvant chemotherapy and radiotherapy, we performed one-stage surgery with the patient in the right lateral decubitus position and the left inguinal region exposed for femoral vessel isolation. Posterolateral thoracotomy was performed with making a latissimus dorsi muscle flap. The pulmonary artery, vein, and left lower bronchus were cut with a stapler. After hilar isolation, we evaluated the involvement of the descending aorta and marked the area of the involved aortic wall by a surgical clip. Using the left femoral artery approach, a GORE TAG conformable thoracic stent graft was delivered to the descending aorta. After thoracic aortic endografting, the involved aortic wall was resected and the left lower lobe of the lung and resected aortic wall were resected en bloc. The adventitial defect was covered by the latissimus dorsi muscle flap. The operating time was 474 min, and the blood loss volume was 330 mL. The postoperative pathological diagnosis was adenocarcinoma with an epidermal growth factor receptor mutation of exon 19 deletion. The residual viable tumor was 7 mm in diameter and close to the resected aortic wall. The patient's postoperative course was uneventful. Five days after surgery, chest contrast-enhanced computed tomography revealed no endoleak or stent migration. Three months after surgery, he was alive with neither recurrence nor stent graft-related complications. CONCLUSIONS: One-stage surgery involving combined resection of lung cancer and the thoracic aortic wall with simultaneous thoracic aortic endografting in the right lateral decubitus position with the left inguinal region exposed is safe and acceptable.

Microscopic thymoma with a thymic cyst that enlarged over a 2-year period.

An 81-year-old woman was referred to our hospital because of right lung cancer. She underwent right upper lobectomy. Pathological examination revealed stage 1A adenocarcinoma. Four months postoperatively, chest computed tomography showed a small nodule with a diameter of 6 mm at the anterior mediastinum. After 2 years, the nodule had increased to 13 mm. To confirm the diagnosis and treat the mediastinal tumor, we resected the tumor and surrounding thymic tissue by a left robotic thoracic approach, considering the adhesion in the right thoracic cavity after right pulmonary resection. The operating time was 43 min. The patient had a favorable postoperative course and was discharged 3 days after surgery. Pathological examination revealed microscopic thymoma with a diameter of 400 µm very close to a thymic cyst. Microscopic thymoma can occur around a thymic cyst without myasthenia gravis, and the thymic tissue around the anterior mediastinal cyst should be resected.

Double polytetrafluoroethylene patch repair for diaphragmatic defect caused by diaphragmatic rupture following diaphragmatic resection with endostapler.

A 41-year-old man developed phrenic nerve palsy after the resection of anterior mediastinal tumor, who underwent diaphragmatic resection with an endostapler. After the surgery, the surgical stump ruptured, resulting in a large diaphragmatic defect with the liver prolapsing into the thoracic cavity. Then, the diaphragmatic defect was closed with a polytetrafluoroethylene (PTFE) patch. The diaphragm was reconstructed using a second PTFE patch overlaying the diaphragmatic defect that had been closed by the first PTFE patch, because solely patching the diaphragmatic defect had a risk of recurrence of diaphragmatic elevation due to remaining original diaphragm and the presence of phrenic nerve palsy. The second PTFE patch was fixed to the lower ribs by non-absorbable suture. The postoperative course was favorable. After 3 months, his symptoms and pulmonary function improved. We underwent double PTFE patch repair in a patient with both huge diaphragmatic defect and phrenic nerve palsy.

Successful use of left ventricular support device (Impella 5.0) and extracorporeal membrane oxygenation (ECMO) for postoperative cardiac arrest after lung cancer surgery: a case report.

Postoperative hemodynamic support with an Impella 5.0 was effective in a man who underwent lung lobectomy for lung cancer and cardiogenic shock. A 75-year-old man presented to hospital with an abnormal chest shadow on radiography. After thorough examination, the patient was diagnosed with lung cancer, and left lower lobectomy was performed. On the 2nd postoperative day, the patient experienced cardiac arrest because of a sudden drop in saturation of percutaneous oxygen. After a third defibrillation, his heartbeat resumed, and he was intubated and placed on a ventilator. Coronary angiography revealed acute coronary syndrome and the patient fell into a state of shock, which required venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. Nevertheless, the circulatory dynamics are unstable, and Impella 5.0 was introduced. VA-ECMO and the Impella 5.0 were discontinued on the 6th and 8th postoperative days, respectively. The patient was eventually transferred to a nearby facility for further rehabilitation 109 days later.

Right upper lobectomy for lung cancer with a displaced right bronchus: Two case reports.

Case 1 describe a 73-year-old man with an abnormal opacity in the upper lobe of the right lung on chest computed tomography (CT), which was done during the postoperative follow-up for bile duct cancer. The chest CT scan showed a ground glass nodule (GGN) measuring 1.0 cm and another one measuring 0.6 cm of the right lung. Case 2 involved a 79-year-old woman with an abnormal opacity in the upper lobe of the right lung on a chest CT that was obtained after she fell down the stairs. The CT scan showed a solid mass measuring 3.0 cm in the right upper lung. Both the patients underwent bronchoscopy before surgery and showed bronchial branching abnormalities. The surgical procedures could be performed accurately since sufficient information had been acquired pre-operatively and they diagnosed lung cancer. Both the patients were able to undergo radical surgery for lung cancer and are currently doing well with no postoperative complications or recurrence of lung cancer.

Extracutaneous neutrophilic infiltration of the spleen and lung associated with pyoderma gangrenosum of the skin.

We describe a patient with extracutaneous pyoderma gangrenosum (PG), who presented with chest pain. Histological examination showed extracutaneous neutrophilic infiltration of the spleen and lung, with later findings of PG.

Metachronous multiple pulmonary nodules 9 years after esophagectomy: a case report.

A 79-year-old man was referred to our hospital for further examination. He had undergone radical esophagectomy with right thoracotomy 9 years ago. Four cycles of chemotherapy (CDDP +5-FU) were also performed for him. Eight years after esophagectomy, two nodules were identified in the upper lobe of the right lung on chest computed tomography (CT). Owing to the possibility of new primary lung cancer, partial resection was performed. Histopathological examination revealed squamous cell carcinoma. One year and two months later, follow-up chest CT scan revealed a nodule shadow of 1.5 cm in the left apex and a nodule shadow of 0.9 cm below the S9 pleura. Hence, partial left lung resection was performed. Five months after left lung resection, a metastatic liver tumor was found on abdominal CT and left lobectomy of the liver was performed. One year after hepatectomy, the patient died due to peritoneal dissemination.

Preliminary exploration for evaluating acuity of oral texture perception.

Despite the important role of oral texture perception in feeding and nutritional homeostasis, its impairment has not been of particular clinical interest, and no clinical protocol is available to evaluate its acuity. This preliminary study aimed to establish a method to evaluate the acuity of oral texture perception. Because texture perception is regarded as reflecting integrity of the sensorimotor system of the jaw and mouth, we hypothesized that the ability to perceive various aspects of food texture would correlate with each other, and tested our hypothesis in 11 healthy adults. First, we prepared three types of test foods with different dominant textures, each of which comprised a series of stimuli with different ingredient concentrations; we used these test foods in discrimination tests involving pairwise comparison. Tests performed using the up-down staircase method revealed significant correlation among the discrimination thresholds for three test foods, suggesting that acuities of texture perception correlated with each other across different textural attributes. Second, we examined the associations between the acuity of texture perception and some aspects of mechanical sensation of the tongue: tactile and two-point discrimination thresholds, as well as the graininess recognition threshold. The acuity of texture perception of the subjects whose sensitivity was low for at least one of these aspects of mechanical sensation (n = 5) was significantly lower than that exhibited by the other subjects (Wilcoxon rank-sum test, p = 0.0417). We concluded that oral texture perception ability can be evaluated by discrimination tests for specific aspects of texture, using appropriate test foods.