[A case of bloody sputum due to the migration of a temporary cardiac pacing lead into the bronchus].

A 60-year-old man with bloody sputum was admitted to our institute. Prior to the present admission, he had undergone coronary artery bypass graft surgery (GABG) at our institute 20 month earlier. The fiber optic bronchoscopy findings showed the cause of bleeding to be due to the migration of a post surgical temporary myocardial pacing lead which had been cut off at skin level after a CABG. Under general anesthesia we thus removed this migrated lead using both a fiber optic bronchoscope and forceps. The wire lead was easily removed and the patient has since suffered no more instances of bloody sputum.

[A case of old pulmonary tuberculosis with repeated hemoptysis which presented therapeutic difficulties].

A 74-year-old male who had been infected with pulmonary tuberculosis since 1938 underwent thoracoplasty in 1955. After the operation, no symptoms manifested until 1988 when he developed hemosputum and hemoptysis in association with a cold with fever. Although he was admitted to a hospital, the symptoms could not be controlled, so he was referred to our department. The lesion causing the hemorrhage was considered to be in the upper lobe of the left lung. However, it would have been difficult to preserve respiratory function in the case of left upper lobectomy, because he had already undergone thoracoplasty on the right side. Therefore, bronchial artery embolization (BAE) using Spongel was performed. Second embolization was performed because hemoptysis referred after one month. However, the hemoptysis recurred again, so that two branches of the left subclavian artery and the left internal thoracic artery were ligated. No hemoptysis and hemosputum occurred for a while, but 2 years and 9 months after the operation, the patient was admitted due to hemoptysis with fever and coughing. Since the bronchial artery was embolized twice with spongel and twice with platinum coil, the patient's course has been good for 5 months.

[Right ventricular myxoma with near obstruction of the pulmonary artery].

Right ventricular myxoma is very rare. To our knowledge, only 23 cases in Japan have been reported in the literature. A 76-year-old male was admitted with complaints of cough and dyspnea. We found an abnormal floating mass in the right ventricular outflow tract by echocardiography and cineangiocardiography. The digital subtraction angiography showed that the following mass continuously lodged in the pulmonary artery with total occlusion of the left main pulmonary artery and near obstruction of the right pulmonary artery. Furthermore he had the constitutional signs of myxoma and the serum IL-6 level reached 41.7 pg/ml. Under extra-corporeal circulation, we salvaged the right ventricular outflow tract to the right lung, resecting the tumor, originated from the right ventricular septum and extended to bilateral main pulmonary arteries.

[A case of pulmonary solitary metastasis of renal cell carcinoma nine years after radical nephrectomy].

A 65-year-old woman was admitted to our department when a routine screening chest X-ray film demonstrated pulmonary solitary nodule. Nine years before, left nephrectomy had been performed with a diagnosis of renal cell carcinoma, and postoperative course was uneventful. Chest X-ray and CT confirmed the presence of well-circumscribed mass in the right lower lobe of lung. With a presumptive diagnosis of pulmonary metastasis of renal cell carcinoma, right lower lobectomy and resection of mediastinal lymph nodes was performed. The pathological diagnosis was metastasis of renal cell carcinoma, granular cell subtype. Pulmonary solitary metastasis of renal cell carcinoma, especially nine years after radical nephrectomy is rare case.

[A case of bilateral coronary artery fistulae into main pulmonary artery].

A case of coronary-pulmonary artery fistulae was presented with the review of the literature. A 46-year-old man was admitted to our department with an ischemic change in leads III, a VF on ECG. Although he had no complaint, the exercise ECG showed significant depression of ST segment in leads II, III, V4, V5. Coronary angiography revealed fistulae from left anterior descending branch to main pulmonary artery, and also from right coronary artery to main pulmonary artery. No coronary organic narrowing were found. Ligation of the fistulae was performed and postoperative course was uneventful.

[Peri- and postoperative management in one staged operation of cardiac disease combined with pectus excavatum].

Patients with pectus excavatum occasionally have coexisting surgical heart disease. During a 10-year period up to the end of 1988, we surgically treated a total of 2015 cases of pectus excavatum, including 12 cases with one staged operation for pectus excavatum and heart disease. Proving the advantage of our one staged operation for the coexisting diseases we studied data resulting from the perioperative management in the group of one staged operations (n = 5), and in the other group of single valve replacement (n = 10). Operative time, amount of operative blood loss and total amount of transfused blood, were 433 +/- 66 min. (mean +/- SD), 3180 +/- 1867 ml and 4836 +/- 2247 ml, in the former group (n = 5), respectively. These data were almost similar to those in the latter group (n = 10). Postoperative ventilatory support time and ICU stay time also showed little difference between two groups. We conclude these data supports our previous report that one staged operation has no perioperative disadvantage in the surgical treatment of patients with both cardiac disease and pectus excavatum.

Degree of severity of pectus excavatum and pulmonary function in preoperative and postoperative periods.

Pulmonary function was evaluated in 138 patients with pectus excavatum, paying particular attention to the degree of severity of chest deformity. We defined the severity of deformity quantitatively based upon a computed tomographic index obtained from a computed tomogram. We recognized a positive relationship between computed tomographic index (x) and percent vital capacity (y), as follows: y = 137x + 58 (n = 138, r = 0.61, p < 0.05). Pulmonary function tests were performed from 2 to 42 months postoperatively. Vital capacity decreased about 10% from the baseline value during the initial 2 months after surgical treatment and recovered to the preoperative level by 1 year after surgery. At 42 months after surgical correction, the pulmonary function was maintained at the baseline level and the severity of deformity was significantly improved. Surgical procedures for the treatment of pectus excavatum--sternocostal elevation and sternal turnover--resulted in an excellent cosmetic result but did not importantly affect respiratory function.

[A case of aortitis syndrome with anastomoses from left coronary artery to bronchial artery].

We reported a case of aortitis syndrome with about 10-year course from onset. The patient was a 44-year old female suffering from a cardiac failure. The angiogram revealed presence of aortic regurgitation, The angiogram revealed presence of aortic regurgitation, pulmonary vascular lesions, anastomosis from left coronary artery to bronchial artery and hypervascularity of bronchial artery. We considered the anastomosis from left coronary artery to bronchial artery as a collateral blood flow for the ischemic lesions of the lung. We abandoned aortic valve replacement because of the severe pulmonary vascular lesions and of the pulmonary dysfunction.

[Two cases of thymic carcinoid].

Two cases of thymic carcinoid tumor were reported. Case 1 was 64-year-old male who was admitted to our hospital with a complaint of dyspnea. He was proved to have a huge anterior mediastinal tumor by chest X-ray and chest CT. After radiation therapy, the tumor was resected on February 5, 1981. Pericardium was partially resected and showed tumor invasion. Sixty-four days after operation, he died due to respiratory insufficiency. Case 2 was 71-year-old male who was pointed out to have an abnormal shadow by X-ray mass screening and was admitted to our hospital. Chest X-ray and chest CT revealed the presence of an anterior mediastinal tumor. Resection of the tumor was done on February 13, 1986. Although the tumor showed mediastinal lymph node metastasis and invaded to the pericardium and the right lung, it was resected completely. Cytological examination of pericardial effusion showed tumor cells at the time of resection. He is now quite well and without any evidence of recurrence 3 year and 1 months after operation. Histopathologically, the tumors of two cases consisted of relatively uniform cells with abundant clear or slightly eosinophilic cytoplasm and regularly and centrally located nuclei. Mitotic figures were occasionally seen in both cases. Many tumor cells were positively to Grimelius stain. On the other hand, Fontana-masson stain was negative. Immunohistochemically, the tumor cells were positively stained with anti-NSE and anti-GRP antibodies in Case 1 and with anti-NSE antibody in Case 2.(ABSTRACT TRUNCATED AT 250 WORDS)

[Multiple primary cancers in surgically resected lung cancer patients].

Among 337 cases of surgically resected lung cancer from April 1977 to March 1984, there were 24 cases (7.12%) of multiple primary cancers including 22 cases of double cancer and one case each of triple and quadruple cancer. They consisted of 17 males and 7 females and the patient age at the time of the lung resection ranged from 32 to 81 years old (average: 67.4). In double cancer cases, the most common site of the other primary cancer was the lung (9 cases), followed by the stomach (5 cases), the colon (4 cases), the pancreas (2 cases), and there was one case each of the salivary gland and the skin. The cases of triple and quadruple cancer involved multiple primary lung cancer associated with mammary and esophageal cancer, respectively. There were 14 synchronous and 8 metachronous cases. The histology of lung cancer in 13 cases of double cancer was adenocarcinoma in 6, squamous cell carcinoma in 2, large cell carcinoma in 3, small cell carcinoma in 1, and adenosquamous cell carcinoma in 1. The histology of 11 cases of double or triple primary lung cancers was squamous cell carcinoma in 17, adenocarcinoma in 5, and large cell carcinoma in 1. In 24 cases 19 lobectomies, 4 pneumonectomies and one partial resection of the lung was performed for the first primary lung cancer. All cancer lesions of other organs apart from the lung were also surgically resected.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of serum carbohydrate antigen 19-9 in carcinoma of the lung--a comparison with carcinoembryonic antigen].

Serum levels of carbohydrate antigen 19-9 (CA 19-9) were measured in 235 untreated patients with lung cancer, 20 patients with benign pulmonary disease and 39 healthy controls. In almost all these patients, carcinoembryonic antigen (CEA) was determined at the same time. The positivity of CA 19-9 in lung cancer patients was significantly higher than in those with benign pulmonary disease (30.2% vs. 5%: P less than 0.05). With regard to histological types of lung cancer cases, the positivity of CA 19-9 in adenocarcinoma cases was higher than that in cases of squamous cell carcinoma (39.6% vs. 16.4% : P less than 0.01). With regard to clinical stages of lung cancer positivity of CA 19-9 in stage IV (37.9% vs. 10.3% : P less than 0.01) or stage III (30.3% vs. 10.3% : P less than 0.05) was significantly higher than in stage I. Sensitivity, specificity and accuracy in the detection of lung cancer were 31%, 95%, and 36% for CA 19-9, and 46%, 80% and 49% for CEA, respectively. Combined evaluation with CA 19-9 and CEA gave the highest specificity (98%) when both were measured, and the highest sensitivity (55%) when at least one was measured. Combined assessment of CA 19-9 and CEA improved the measurement of each one in the detection of lung cancer.