[Surgical Treatment for Congenital Bronchial Atresia and Intralobar Sequestration in the Same Lobe].

A 21-year-old man who had a history of pneumonia twice presented with chest discomfort. Computed tomography( CT) revealed dilatation of the atretic bronchus that was not continuous with the proximal one, and surrounding hyper-lucent lung fields in the outer and mediastinal sides of the right basal segment, and the absence of B10b+c. CT also demonstrated the presence of A10b+c in the former field and the aberrant artery from the inferior phrenic artery in the latter. Right basal segmentectomy was performed under the diagnosis of congenital bronchial atresia and intralobar sequestration. Pathological diagnosis accorded with preoperative one.

Role of alternative donor allogeneic hematopoietic stem cell transplantation in patients with intermediate- or poor-risk acute myeloid leukemia in first complete remission.

Allogeneic hematopoietic stem cell transplantation (HCT) offers the most effective prevention of relapse and has significant overall survival (OS) benefits for patients with acute myeloid leukemia (AML) in first complete remission (CR1). We conducted a retrospective analysis of a cohort of patients with intermediate- or poor-risk AML. The purpose of the present study was to investigate the role of alternative donors for AML in CR1. We analyzed 1561 patients who underwent HCT from an HLA-matched related donor (MRD), HLA 8/8-matched unrelated donor (MUD), or umbilical cord blood (UCB). The results of a multivariate analysis showed that HCT from UCB (HR = 1.28, 95% CI: 1.07-1.52), age ≥50 years (HR = 1.36, 95% CI: 1.14-1.62), male (HR = 1.42, 95% CI: 1.21-1.66), PS > 1 (HR = 1.68, 95% CI: 1.17-2.42), and poor-risk cytogenetics (HR = 1.53, 95% CI: 1.29-1.81) had an inferior prognostic impact on OS. We conclude that an MUD is the best alternative to an HLA identical MRD for patients with AML in CR1. UCB is an alternative option if neither MRD nor MUD are available, or when patients need to receive urgent HCT for poor-risk AML in CR1.

Endostapling the aberrant artery filled with embolized coils for intralobar pulmonary sequestration: a report of two cases.

Intrapulmonary sequestration is a rare congenital bronchopulmonary malformation. Surgery is generally standard treatment, and thoracoscopic resection has been accepted recently. Some patients have inflammatory change of the sequestrated lung and adhesion to the adjacent organs. In those cases, it is difficult to identify the aberrant artery. In thoracoscopic surgery cases, fatal intraoperative hemorrhage from the aberrant artery has been reported. We describe two patients with infected intralobar pulmonary sequestration who were treated by endostapling the aberrant artery filled with embolized coils. A 28-year-old man who had complained of right back pain and high fever was admitted to our hospital. The chest computed tomography (CT) scan showed infected intralobar pulmonary sequestration with consolidation and fluid collection in the right lower lobe. An aberrant artery entered the consolidation from the celiac trunk. After coil embolization, thoracoscopic right lower lobectomy was performed with endostapling of the aberrant artery, which had a diameter of 10 mm and was filled with metallic coils. A 51-year-old woman who had complained of repeated pneumonia was admitted to our hospital. The chest CT scan showed infected intralobar pulmonary sequestration with consolidation and fluid collection in the basal segment of the right lower lobe. After coil embolization, thoracoscopic right lower lobectomy was performed with endostapling of the aberrant artery arising from the right inferior phrenic artery, which had a diameter of 5 mm and was filled with coils. Both patients' clinical courses were uneventful postoperatively. Pathological examinations confirmed intralobar pulmonary sequestration with pneumonia. Endostapling with coils for treating the aberrant artery in pulmonary sequestration is a simple and safe technique of thoracoscopic resection. A coil-embolized artery can be identified easily in the inflamed, scarred pulmonary ligament, and intraoperative bleeding from the aberrant artery can be prevented.

Covering the staple line with polyglycolic acid sheet versus oxidized regenerated cellulose mesh after thoracoscopic bullectomy for primary spontaneous pneumothorax.

OBJECTIVE: The aim of this study was to compare coverage with oxidized regenerated cellulose mesh and that with polyglycolic acid sheet to decrease the incidence of postoperative recurrent pneumothorax. METHODS: From August 2010 to August 2014, a total of 112 patients with primary spontaneous pneumothorax undergoing thoracoscopic bullectomy were enrolled. We compared the clinicopathological characteristics between recurrent and non-recurrent cases and examined their association with the material used for visceral pleural coverage: polyglycolic acid sheet versus oxidized regenerated cellulose mesh. RESULTS: 57 patients underwent thoracoscopic bullectomy plus coverage using oxidized regenerated cellulose mesh and 55 underwent thoracoscopic bullectomy plus coverage using polyglycolic acid sheet. The recurrence rate among all patients was 13.3%. No severe postoperative complications were observed in either group. There were no significant differences in the perioperative outcomes. However, the postoperative recurrence rate was significantly higher in the oxidized regenerated cellulose mesh group than in the polyglycolic acid sheet group (22.8 vs 3.6%). CONCLUSIONS: Our results suggest that coverage with oxidized regerated cellulose mesh was not superior to coverage with polyglycolic acid sheet for postoperative recurrent pneumothorax.

Enlarged mediastinal air cyst in a patient with bronchial diverticula localized in the left main bronchus: a case report with surgical and bronchoscopic findings.

BACKGROUND: A mediastinal air cyst is a rare computed tomography (CT) finding. Once the lesion is identified, it is difficult to diagnose and treat. Meanwhile, bronchial diverticula have been reported as a CT finding observed in certain pulmonary pathologic conditions. We encountered the case of an enlarged mediastinal air cyst accompanied with bronchial diverticula and upper lobe-dominant fibrous changes of the lung. CASE PRESENTATION: A 69-year-old man with a chronic cough who had regularly visited a chest physician for upper lobe-dominant pulmonary fibrosis was referred to our hospital for the examination of an enlarged mediastinal air cyst. Chest CT exhibited an air cyst (size, 30 mm) connected to the lumen of the left main bronchus (LMB) and multiple tiny outpouches only on the LMB. Flexible bronchoscopy showed bubbling from slits or indentations of the bronchial mucosa only in the LMB but not in the right main bronchus or lobar bronchus. For therapeutic diagnosis, we removed the air cyst. Based on clinical, surgical, and pathological findings, we diagnosed the air cyst as an enlarged bronchial diverticulum. CONCLUSIONS: This is the first case wherein bronchoscopic and surgical findings of bronchial diverticula and an enlarged bronchial diverticulum are reported. There are possible pathogenic mechanisms in cases of pulmonary disease that are attributable to enlargement of the bronchial diverticula.

Endobronchial dental prosthesis retrieval by a snare technique using a flexible bronchoscope and fluoroscopy: Two case reports and technical tips.

We describe two cases in each of which a dental prosthesis, presenting as an endobronchial foreign body (FB), was successfully retrieved using a snare technique employing a flexible bronchoscope and fluoroscopy that enabled us to avoid the need for rigid bronchoscope and thoracotomy. In one case, the FB was peripherally lodged and bronchoscopically invisible. In the other case, the FB was observed in the right intermediate bronchus, but the grasping basket and forceps were unable to retrieve it. The combination of a flexible bronchoscope and fluoroscopy extended the application of the snare technique to bronchoscopically invisible FBs and facilitated placement of an encircling loop around the FB. Since dental prostheses are rigid and irregular in shape, the snare loop technique can be used. For patients in a stable condition with a dental prosthesis FB, using the snare technique with a flexible bronchoscope and fluoroscopy is a good option. We provide technical tips based on our experiences.

Thick lung wedge resection for acute life-threatening massive hemoptysis due to aortobronchial fistula.

Massive hemoptysis from an aortobronchial fistula due to thoracic aortic dissection is an extremely rare symptom, but is a potentially life-threatening condition. We report a case of acute massive hemoptysis due to aortobronchial fistula that was successfully controlled by a simple and rapid thick wedge resection of the lung with hematoma by using the black cartilage stapler. A 65-year-old man was admitted to our hospital with acute massive hemoptysis. After tracheal intubation, chest computed tomography revealed hematoma in the left lung and ruptured aortic dissection from the distal arch to the descending aorta. He was diagnosed with aortobronchial fistula and underwent an emergency surgery on the same day. We performed posterolateral thoracotomy. A dissecting aortic aneurysm (diameter, ~80 mm) with adhesion of the left upper lobe and the superior segment of the lower lobe was found. The lung parenchyma expanded with the hematoma. We stapled the upper and lower lobes by using the black cartridge stapler along the aortopulmonary window. Massive hemoptysis disappeared, and the complete aortic dissection appeared. Aortic dissection with adherent lung was excised, and graft replacement of the distal arch and descending thoracic aorta was performed. Proximal lung wedge resection using black cartridge stapler is a simple and quick method to control massive hemoptysis from aortic dissection; hence, this procedure is an effective option to control massive hemoptysis due to aortobronchial fistula. This technique could rapidly stop massive hemoptysis and prevent dissection of the adherent lung tissue and intra-thoracic bleeding.

Reexpansion pulmonary edema after surgery for spontaneous pneumothorax in a patient with anorexia nervosa.

INTRODUCTION: Several adverse effects on the pulmonary system in patients with anorexia nervosa (AN) have been reported. We present a case of AN who presented with a complicated reexpansion pulmonary edema (RPE) after video-assisted thoracic surgery (VATS) for spontaneous pneumothorax. PRESENTATION OF CASE: A 23-year-old woman with severe anorexia nervosa (weight: 25 kg, body mass index: 8.96 kg/m(2)) underwent VATS for spontaneous pneumothorax. Five hours after the surgery, she immediately presented acute cardiorespiratory insufficiency. Chest radiography showed an infiltrating shadow in the entire right lung. She was diagnosed with reexpansion pulmonary edema that was treated with methylprednisolone pulse therapy and mechanical ventilation. She recovered and was extubated on postoperative day 4. The chest drain tube was removed on postoperative day 5. DISCUSSION: Bullectomy or ligation of bullae for spontaneous pneumothorax in a patient with AN has never been reported. In our case, bullae were identified in preoperative CT and we chose ligation of the bullae instead of the bullectomy using automatic suture device because of poor wound healing concerned. CONCLUSION: We present a case of RPE after VATS for spontaneous pneumothorax in a patient with AN. Malnutrition owing to AN results in critical complications such as RPE.

Thrombus formation in the pulmonary vein stump after left upper lobectomy: a report of four cases.

Left upper lobectomy may be followed by complications such as thrombus formation in a stump of the left superior pulmonary vein (LSPV), which may cause systemic embolization. We have encountered four such cases, which account for 3.4% of all left upper lobectomies performed at our institution. Right renal infarction was observed in one of these four cases; the remaining cases were asymptomatic, with the thrombus incidentally detected by enhanced computed tomography (CT). The postoperative duration for the detection of the thrombus varied from 4 days to 24 months. Even in a case in which the superior pulmonary vein (PV) was divided by posterolateral thoracotomy, CT showed that the stump was long enough intrapericardially for thrombus formation. Anticoagulant therapy was administered in all the cases, resulting in dissipation of the thrombus. Therefore, when a thrombus is detected in a pulmonary stump, an anticoagulant should be administered.

[Spontaneous tension hemothorax due to rupture of a solitary fibrous tumor of the posterior mediastinum].

A 37-year-old man was transported by ambulance to our hospital due to abrupt chest pain. The pain began when he was practicing a combative-type sport. He denied any impact or blunt trauma. A chest radiograph revealed massive left pleural effusion with a mediastinal shift. Thoracentesis revealed a hemothorax;therefore, we performed an emergency thoracotomy. The intraoperative findings revealed a rupture of a posterior mediastinal tumor itself located between the descending aorta and the thoracic vertebra. After we identified the artery of Adamkiewicz that originates away from the tumor and evaluated the degree of tumor extension into the inter-vertebral foramen, we safely performed an elective tumor resection 1 month after the initial emergency operation. In patients with a hemothorax caused by rupture of the tumor itself, an elective tumor resection after detailed investigation should be considered if hemostasis can be achieved in the emergency thoracotomy.

Cardiac tamponade due to coronary artery rupture after pulmonary resection.

We present a case of cardiac tamponade after lung resection. A 68-year-old man underwent single-staged bilateral lung resection (right wedge resection and left S8 segmentectomy) for metastatic lung tumors from rectal cancer and lost consciousness on postoperative day 4. Because an enhanced whole-body computed tomography scan showed pericardial effusion as the only abnormal finding, we performed rethoracotomy, which revealed that the cardiac tamponade was due to coronary artery rupture. We suggest that it would be more reasonable to approach the pericardial space by rethoracotomy rather than median sternotomy because exploration of the surgical site is the first essential step.

Primary synovial sarcoma of the lung successfully resected under temporary bypass.

A 48-year old man presented with chest pain and haemoptysis. Chest computed tomography showed a 60-mm mass in the left upper lobe of the lung, adjacent to the distal aortic arch. Bronchoscopic cytology revealed the presence of malignant cells and, in the absence of evidence of distant metastasis, a thoracotomy was performed. Although the tumour was firmly adherent to the distal aortic arch, under temporary bypass from the left subclavian artery to the descending aorta, it was successfully resected en bloc with the section of the aorta attached to it. The tumour was diagnosed as a primary synovial sarcoma of the lung on the basis of histopathological findings and fluorescent chromogenic in situ hybridization, showing SS18 gene rearrangement.

Sternal Osteomyelitis and Abscess Caused by Elbowing during a Basketball Game.

A 15-year-old boy was referred to our hospital for further investigation and treatment of sternal osteomyelitis due to blunt chest trauma, more specifically elbowing during a basketball game 19 days earlier. On an initial presentation, his chest was markedly swollen and chest computed tomography demonstrated a sternal fracture and massive fluid collection in the chest wall. Since his general condition remained fairly good, we initially selected minimal drainage concomitant with antibiotics; if it was unsuccessful, we planned to switch to a more radical debridement procedure. The patient recovered without further invasive intervention and was discharged on postoperative day 26. There is no sign of recurrence six months after operation. This case report indicates that minimal drainage would be a good option for treatment in a phased strategy.

Carcinomatous meningitis from non-small-cell lung cancer responding to gefitinib.

The prognosis for carcinomatous meningitis remains poor, and focal neurological dysfunctions usually do not improve despite the available treatment options. We report a case of carcinomatous meningitis from non-small-cell lung cancer treated with gefitinib, which brought about a sustained clinical response. A 40-year-old Japanese man was diagnosed with adenocarcinoma in the right lower lobe of the lung, and with multiple pulmonary and brain metastases. Six courses of carboplatin and paclitaxel chemotherapy and gamma-knife radiosurgery induced a near complete response in all lesions. However, 2 months later, cauda equina syndrome and left oculomotor paralysis from carcinomatous meningitis developed rapidly. Magnetic resonance imaging of the brain and spinal cord revealed the enhancement of leptomeningeal disseminations. The patient was treated with 250 mg/day gefitinib. All his neurological symptomatology disappeared within 2 weeks. The shrinkage of the leptomeningeal disseminations was confirmed by follow-up magnetic resonance imaging. The patient is currently doing well and is able to work. Cancer relapse was not observed at 4 months after the initiation of gefitinib. Although the survival benefit is controversial, gefitinib may have a role in the treatment of carcinomatous meningitis from non-small-cell lung cancer to improve neurological dysfunctions.