Lung lobe torsion following lobectomy.

Three cases of postoperative pulmonary lobe torsion were reported. Two of three showed hemorrhagic infarctions, and as a result underwent rethoracotomies and removal of the affected lobes. From these experiences, we consider that computed tomography (CT) and bronchofiberscopic examinations are useful for the diagnosis of advanced torsion.

[Surgical treatment of mycotic lung diseases].

Eighteen cases of mycotic lung disease, which included 17 pulmonary aspergillosis and one cryptococcosis, were treated surgically. Lobectomy was performed in 4, segmentectomy in 1, partial resection of lung in 4, cavernostomy in 2, open window thoracotomy in 4 and exploratory thoracotomy in 1. The authors would like to emphasize following points; 1) Of eighteen, cases, there were five patients over 70 years old and results of surgery in those were uneventful. 2) Two cases developed the postoperative empyema which was caused by the remnant lesion invaded with aspergillus fumigotus. From this experience it was considered that in the invasive aspergillosis the limited resection of the lesion was not recommended because of its local recurrence. 3) Omentopexy was effective for the treatment of mycotic empyema.

[Analysis of postoperative thoracic empyema].

We experienced 15 cases of pyothorax after thoracotomy. Six were pyothorax without bronchial fistula and 9 were with fistula. All of former were cured by the closed drainage and/or open window thoracostomy. Two of pyothorax with fistula, who were treated with the tube drainage, died of respiratory insufficiency. Five cases who underwent the open window thoracostomy survived well. Omentopexy was performed in 2 of pyothorax with fistula and results were excellent.

Lung allografts with and without omentopexy in canines--bronchofiberscopic and histologic observation of bronchial anastomosis healing.

An endoscopic evaluation of the effects of omental wrapping around the bronchial anastomosis of lung allografts in an early post-transplant phase, was performed in 13 mongrel dogs. Disruption or marked stenosis of the anastomotic portion was bronchofiberscopically observed more frequently in dogs without omental wrapping than in dogs with omental wrapping and the above findings were later confirmed histologically by light microscopic observation.

Malignant lymphoma of the posterior mediastinum with transverse myelopathy.

A case of malignant lymphoma in the thoracic paravertebral region with a severe spinal cord compression syndrome is presented. The patient was a 59-year-old female who had had right hypochondralgia as initial symptoms for more than one year. Chest radiograph and computed tomographic (CT) scanning on admission to another hospital had demonstrated a mass lesion in the thoracic paravertebral area. Due to the subsequent occurrence of progressive cord compression syndrome, she was transferred to our institution for the purpose of surgical treatment. Myelography demonstrated an obstruction of the spinal canal at the level of the 8th thoracic vertebra. CT-myelography showed a paravertebral tumour which extended through the intervertebral foramen into the epidural space and also spread to the posterior thoracic wall in succession. Tumour extirpation and decompressive laminectomy by single stage operation were performed. The pathological diagnosis was extranodal malignant lymphoma, diffuse, medium-sized cell type, with immunohistological demonstration of B-cell markers. Postoperatively, she was given a combination chemotherapy with VEPA (vincristine, cyclophosphamide, prednisone and doxorubisin), and the functional disorder has improved to some extent. To our knowledge, this is the first case of soft tissue malignant lymphoma in the posterior mediastinum.

Anterior rib strut grafting for the treatment of malignant lesions in the thoracic spine.

Anterior stabilization during thoracotomy, using the patient's own ribs, was carried out seven times in six subjects with malignant lesions of the thoracic vertebrae. The primary malignancy was lung carcinoma in four cases, thyroid carcinoma in one case, and alveolar soft tissue sarcoma in one. Resection of the lung tumor and spinal surgery were carried out simultaneously. Four of the six patients had complete paraplegia and two had partial paraplegia prior to the operation. After the decompression and anterior stabilization, three subjects responded well and three responded poorly because of respiratory insufficiency.

Resection of metastatic lung tumor: the evaluation of histologic appearance in the lung.

The analysis of the data resulting from 58 operations for metastatic lung tumors is presented. The surgical procedures performed were unilateral lung tumor resection in 27 cases and bilateral lung tumor resection in 13 cases. The total cumulative five year survival rate was 41 per cent. The resected tumors were divided into two types according to the histologic appearance of the tumor margin: infiltrative and non-infiltrative (pseudo-capsulated). The cumulative five year survival rates were 14.7 per cent and 53.2 per cent, respectively. Lymph node metastasis was found in four patients with the infiltrative type of metastatic tumor.

Traumatic lung pseudocyst.

Traumatic lung pseudocyst is an uncommon lung injury due to closed chest trauma. Four cases are reported; all were male and one was a child. Three cases showed spontaneous resolution of the pseudocyst and in one case, where resolution was slow, lobectomy was carried out at the patient's insistence. Diagnosis poses no serious problems as there is inevitably a history of substantial chest trauma. The chest radiograph shows a characteristic cavitatory lesion. The pseudocysts may be multiple. Tomography may be helpful in diagnosis and computed tomography can be particularly useful in the demonstration of paramediastinal traumatic pseudocysts.

Plasma cell granuloma of the lung--resection and steroid therapy.

We report on three resected cases of intrapulmonary plasma cell granuloma. All of them were asymptomatic. One of them showed bilateral multiple lesions and in this case bilateral partial resections of lung in one stage were performed. Under light and electron microscopy the lesions were composed of plasma cells and other kinds of inflammatory cell. The plasma cells were mature and had rich endoplasmic reticulum but no kind of intracytoplasmic inclusion. Steroid therapy was effective for the recurrent lesion after the operation.

[Malignant fibrous histiocytoma of the thoracic region].

A clinicopathological investigation of five malignant fibrous histiocytoma (MFH) in the thoracic region was performed. They were two cases of metastasis to the lung and 1 each of the primary lesion in the lung, chest wall and sternal region. This tumor usually occurs on the extremities, in the abdominal cavity or the retroperitoneal areas, so instances of its arising in the thoracic region, except for metastatic episodes, are considered to be rare. Tumors in 4 cases were excised surgically, while one was inoperable. On light microscopy, the lesions were found to be composed of two types of neoplastic cells, fibroblast-like cells and histiocyte-like cells, showing the characteristic histologic pattern of storiform and pleomorphic. Electron-microscopically, these two types of cells were discriminated according to the quantitative and quantitative differences of the various intracytoplasmic organelles. The histogenesis of malignant fibrous histiocytoma has been commonly considered to be the histiocytic cell derived from the bone marrow. However, more detailed pathological investigations are necessary.