RESUMO
Empyema caused by methicillin-resistant Staphylococcus aureus (MRSA) remains an intractable infection producing high mortality. The authers report a case of MRSA empyema following video-assisted thoracic surgery (VATS) for lung cancer. The case was 73-year-old male with some risks such as pulmonary emphysema, decreased renal function, and previous history of brain infarction. He received wedge resection and the staple lines were wrapped with polyglycolic acid (PGA) felt. Ten days after the operation, he was complicated MRSA pyothorax. By thoracoscopic procedures under local anesthesia, fibrinopurulent tissues were cleaned and 3 of chest tubes were replaced. Intrathoracic infected space was cleaned with physiological saline solution. The patient made favorable progress and recovered. Further empyema has not been developed for 24 months. VATS under local anesthesia and irrigation technique was safe and so useful. Nowadays, PGA felt is often used to reinforce the staple lines of lung. PGA felt is an absorbable but artificial material. We have to care about infectious problems. However, we could control the MRSA pyothrax without removing the PGA felt.
Assuntos
Empiema Pleural/cirurgia , Neoplasias Pulmonares/cirurgia , Complicações Pós-Operatórias/cirurgia , Cirurgia Torácica Vídeoassistida , Idoso , Anestesia Local , Empiema Pleural/microbiologia , Humanos , Masculino , Resistência a Meticilina , Assistência Perioperatória , Pneumonectomia/métodos , Ácido Poliglicólico , Complicações Pós-Operatórias/microbiologia , Infecções Estafilocócicas , Técnicas de Sutura , Suturas , Irrigação Terapêutica , Resultado do TratamentoRESUMO
The case was 54-year-old male with some risks such as chronic heart failure, atrial fibrillation, and liver chirrhosis. He was admitted because of severe back pain and diagnosed as empyema by preoperative thoracentesis. By thoracoscopic procedures under local anesthesia, fibrinopurulent tissues were cleaned as much as possible and 3 of chest tubes were replaced. The final diagnosis was Bacillus cereus pyothorax by bacterial cultures of pleural effusion. Intrathoracic cavity was cleaned with physiological saline solution. The patient made favorable progress and recovered. Thoracoscopic surgery under local anesthesia with thoracic irrigation was so effective and safe methods to control the infection.
Assuntos
Anestesia Local , Bacillus cereus , Empiema Pleural/cirurgia , Infecções por Bactérias Gram-Positivas , Toracoscopia , Antibacterianos/uso terapêutico , Cardiomiopatia Dilatada/complicações , Claritromicina/uso terapêutico , Empiema Pleural/microbiologia , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Irrigação Terapêutica , Cavidade TorácicaRESUMO
We report a case of a previously healthy 76-year-old male with cavitating pleomorphic carcinoma of the lung. He was admitted because of an abnormal lung shadow on chest X-ray. Computed tomography (CT) showed a well-demarcated nodular shadow within thin-walled cavity in the right upper lobe. Because the lesion was revealed as adenocarcinoma by transbronchial lung biopsy, right upper lobectomy was performed. By histopathologic examination of the resected specimen, the nodule contained a component of spindle cell features and the cavity wall was composed of adenocarcinoma. The final diagnosis was pleomorphic carcinoma. Postoperative course has been uneventful for 12 months after surgery.
Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Adenocarcinoma/diagnóstico , Idoso , Carcinoma/patologia , Carcinoma/cirurgia , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pneumonectomia , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
A 61-year-old female was admitted because of an abnormal lung shadow on chest X-ray. She had suffered from idiopathic thrombocytopenic purpura (ITP) for more than 7 years. Computed tomography (CT) revealed that an irregular shadow, about 2 cm in diameter, was located in the upper lobe of the right lung. After intravenous immunogrobulin injections for 5 days, a hematology test indicated increased platelet counts and we performed thoracoscopic surgery successfully without blood transfusions. However, 4 months after surgery, a hematology test indicated decreased platelet counts again. Thirteen months after the operation, gastrointestinal fiberscopic examination showed Helicobacter pylori infection. After the urea breath test, eradication therapy let to a recovery in platelet counts.
Assuntos
Adenocarcinoma/complicações , Infecções por Helicobacter/complicações , Helicobacter pylori , Neoplasias Pulmonares/complicações , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Púrpura Trombocitopênica Idiopática/etiologia , Feminino , Infecções por Helicobacter/tratamento farmacológico , Humanos , Pessoa de Meia-IdadeRESUMO
An asymptomatic 67-year-old female was admitted because of an abnormal shadow on chest X-ray. Computed tomography (CT) revealed that a well-marginated round mass with low density, about 4 cm in diameter, was located in the right hilum. The border was enhanced at contrast material-enhanced CT. Magnetic resonance imaging (MRI) [T2-weighted] showed the lesion as a high intensity tumor. Because of the extra-pleural sign on CT and normal results of broncho-fiberscopic (BFS) examination, mediastinal tumor was suspected. We performed thoracoscopic surgery and revealed that the tumor was in lung, not in mediastinum. Biopsy of the easy-bleeding tumor was performed. The histopathological diagnosis was hemangiopericytoma. There was no remarkable change for 1 years. Hemangiopericytomas should be considered in the differential diagnosis of well-marginated masses. Thoracoscopic surgery is the useful methods to diagnose the hemangiopericytoma.
Assuntos
Hemangiopericitoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Idoso , Erros de Diagnóstico , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico , ToracoscopiaRESUMO
INTRODUCTION: In vivo gene transfection using a recombinant adenoviral vector leads to diminished gene expression in a time-dependent manner that disappears within 4 weeks. CTLA4Ig blocks CD28-mediated costimulatory signal, and inhibits immune responses. We investigated the duration of transgene expression after administration of adenoviral vector containing CTLA4Ig gene (AdCTLA4Ig). METHODS: We injected 1 x 10(9) plaque forming units (pfu) of AdCTLA4Ig into rats (n = 7) via the tail vein. Thereafter, the blood samples were collected for assay of serum CTLA4Ig levels using enzyme-linked immunosorbent assay. RESULTS: The CTLA4Ig level reached the maximum (range, 65-86 microg/mL; average, 75 microg/mL) on days 3 to 5 after injection. Detectable levels of CTLA4Ig were observed up to 49 days. When we injected AdCTLA4Ig in combination with FTY720 administration, the maximum levels were higher and the detectable levels persisted longer. CONCLUSIONS: Because directly injected adenoviral transgene expression had been reported to disappear between 21 to 30 days, we conclude that AdCTLA4Ig inhibits the immune response and prolongs the transgene (CTLA4Ig gene) expression. Some additional immunosuppressants, like FTY720, may be useful to enhance AdCTLA4Ig effects.
Assuntos
Regulação da Expressão Gênica , Imunoconjugados/genética , Abatacepte , Adenoviridae , Animais , Ensaio de Imunoadsorção Enzimática , Vetores Genéticos , Imunoconjugados/sangue , Cinética , Masculino , Ratos , Ratos Endogâmicos Lew , Proteínas Recombinantes de Fusão/biossíntese , TransfecçãoRESUMO
A 57-year-old female was admitted because of chest and back pain. Computed tomography (CT) revealed that many well-marginated lymph nodes were located in mediastinum and abdominal para-aortic area, especially in the right lower mediastinum. These lymph nodes were enhanced at contrast material-enhanced CT. We performed thoracoscopic surgery. The histopathologic diagnosis was multicentric Castleman disease (MCD). MCD should be considered in the differential diagnosis of multiple lymph nodes swelling with hyper globulinemia. Thoracoscopic surgery is the useful method to resect the lymph nodes and diagnose MCD.
Assuntos
Hiperplasia do Linfonodo Gigante/diagnóstico , Hiperplasia do Linfonodo Gigante/cirurgia , Toracoscopia , Adulto , Hiperplasia do Linfonodo Gigante/patologia , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/patologia , MediastinoRESUMO
An asymptomatic 66-year-old female was admitted because of an abnormal shadow on chest X-ray. Computed tomography (CT) revealed that a well-marginated round mass with low density, about 3 cm in diameter, was located in the right anterior superior mediastinum. The border was partially enhanced at contrast material-enhanced CT. Magnetic resonance imaging (MRI) [T 2-weighted] showed the lesion as a high intensity tumor. We performed thoracoscopic surgery and resected the easy-bleeding tumor completely. The tumor was dark red in color and contained old blood. The histopathological diagnosis was hemangioma. There was no recurrence for 3 years. Hemangiomas should be considered in the differential diagnosis of well-marginated masses. Thoracoscopic surgery is the very useful methods to resect the mediastinal hemangioma.
Assuntos
Hemangioma/diagnóstico , Cisto Mediastínico/diagnóstico , Neoplasias do Mediastino/diagnóstico , Toracoscopia , Idoso , Diagnóstico Diferencial , Feminino , Hemangioma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Cisto Mediastínico/cirurgia , Neoplasias do Mediastino/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We reported a case of thymic carcinoma. A 61-year-old man was admitted to evaluate an abnormal shadow of lung field by chest X-ray. Routine chest computed tomography (CT) showed no abnormal findings on the lung field, but thymic tumor was incidentally detected. We suspected thymoma, performed a mediansternotomy and thymectomy with partial resection of pericardium. Pathological findings diagnosed undifferentiated carcinoma (large cell type) of thymus, the patient underwent radiation therapy of the mediastinum at a total dosage of 50 Gy and chemotherapy [cisplatin (CDDP) + vinorelbine ditartrate + mitomycin C (MMC)]. He has been doing well without recurrence for 2 years after the operation.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Grandes/cirurgia , Radiografia Torácica , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X , Vimblastina/análogos & derivados , Carcinoma de Células Grandes/tratamento farmacológico , Carcinoma de Células Grandes/radioterapia , Cisplatino/administração & dosagem , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Dosagem Radioterapêutica , Timectomia , Neoplasias do Timo/tratamento farmacológico , Neoplasias do Timo/radioterapia , Vimblastina/administração & dosagem , VinorelbinaRESUMO
A case of a patient with a intrathoracic chronic expanding hematoma presenting as a neoplasm is reported. A chronic encapsulated intrathoracic hematoma is rare condition and is clinically included in a category of chronic hemorrhagic empyemas as a type of chronic empyemas in Japan. The clinical picture of our case suggested a slowly growing tumor. Though needle biopsy was performed, only blood was aspirated. Intraoperative findings revealed a intrathoracic hematoma with a tough capsule. It adhered to the chest wall hardly. Histopathological investigations revealed that the capsule consisted of a collagenous outer layer and a newly vascularized inner layer with fibrosis. Hemosiderin deposits suggested recurrent bleeding from fragile vessels. The mechanisms of hematoma formation and its expanding nature are discussed. The hematoma appeared to have been enlarged by repeated exudation or bleeding from capillaries inside the capsule.
Assuntos
Hematoma/cirurgia , Doenças Torácicas/cirurgia , Doença Crônica , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Sobrevivência de Enxerto/fisiologia , Imunoconjugados/genética , Transplante de Pulmão/fisiologia , Abatacepte , Animais , Sobrevivência de Enxerto/genética , Imunoconjugados/uso terapêutico , Masculino , Modelos Animais , Ratos , Ratos Endogâmicos Lew , Ratos Endogâmicos , Proteínas Recombinantes/uso terapêutico , Transfecção , Transplante HomólogoAssuntos
Imunoconjugados/genética , Propilenoglicóis/uso terapêutico , Traqueia/transplante , Transfecção/métodos , Transplante Homólogo/imunologia , Abatacepte , Animais , Terapia Combinada , Cloridrato de Fingolimode , Imunoconjugados/uso terapêutico , Imunossupressores/uso terapêutico , Masculino , Modelos Animais , Período Pós-Operatório , Ratos , Ratos Endogâmicos Lew , Ratos Endogâmicos , Proteínas Recombinantes/uso terapêutico , Esfingosina/análogos & derivados , Fatores de Tempo , Traqueia/patologia , Transplante Heterotópico , Transplante Homólogo/métodos , Transplante Homólogo/patologiaAssuntos
Terapia de Imunossupressão/métodos , Transplante de Pulmão/imunologia , Adenoviridae/genética , Animais , Antígenos de Diferenciação/análise , Antígenos de Diferenciação/imunologia , Vetores Genéticos , Humanos , Imunossupressores , Ratos , Ratos Endogâmicos Lew , Ratos Endogâmicos , Transplante Heterotópico , Transplante Homólogo/imunologiaAssuntos
Sobrevivência de Enxerto/imunologia , Terapia de Imunossupressão/métodos , Imunossupressores/uso terapêutico , Transplante de Pulmão/imunologia , Propilenoglicóis/uso terapêutico , Adenoviridae/genética , Animais , Cloridrato de Fingolimode , Vetores Genéticos , Sobrevivência de Enxerto/efeitos dos fármacos , Masculino , Ratos , Ratos Endogâmicos Lew , Esfingosina/análogos & derivados , Transfecção/métodos , Transplante HomólogoRESUMO
The question whether the tumor is primary or metastatic sometimes arises in patients with intrathoracic tumor. Especially, adenocarcinoma presents more difficulties in distinguishing primary tumors from secondary or deciding its origin. We reported a case of mediastinal signet-ring cell carcinoma. A 51-year-old female was admitted because of an abnormal shadow during mass screening. Chest X-ray showed a semicircular, well-demarcated shadow on right cardiophrenic angle. Chest computed tomography (CT) revealed a homogeneous mass, approximately 4 cm in diameter. The investigations of whole body failed to reveal any other tumor. At operation, the tumor was adherent to the esophagus but easily resected. Histologically, the tumor was mainly composed of signet-ring cells. Immunohistochemically, surfactant apoprotein (SPA) was strongly demonstrated in tumor cells. SPA is specific to the lung and the tumor was diagnosed as the metastasis in mediastinal lymph nodes. The primary site was considered to exist in lung. But the primary site was not found over 46 months in spite of repeated further examinations.
Assuntos
Carcinoma de Células em Anel de Sinete/cirurgia , Neoplasias do Mediastino/cirurgia , Neoplasias Primárias Desconhecidas , Carcinoma de Células em Anel de Sinete/patologia , Feminino , Humanos , Neoplasias do Mediastino/patologia , Pessoa de Meia-IdadeAssuntos
Antígenos de Diferenciação/genética , Rejeição de Enxerto/prevenção & controle , Imunoconjugados , Imunossupressores , Traqueia/transplante , Transplante Homólogo/imunologia , Abatacepte , Adenoviridae , Animais , Antígenos CD , Antígenos de Diferenciação/uso terapêutico , Antígeno CTLA-4 , Doença Crônica , Terapia Genética/métodos , Vetores Genéticos , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto/imunologia , Terapia de Imunossupressão/métodos , Masculino , Ratos , Ratos Endogâmicos Lew , Ratos Endogâmicos , Fatores de Tempo , Traqueia/patologia , Transplante Heterotópico , Transplante Homólogo/patologiaRESUMO
Pulmonary amyloidosis is a rare pulmonary lesion. We report a 42-year-old male admitted for further evaluation of abnormal chest shadow. A chest CT demonstrated a nodular shadow in right S3. We tried transbronchial and percutaneous lung biopsy, but could not diagnose. We performed partial lung resection by video-assisted thoracoscopic surgery. Pathological diagnosis of the lesion was pulmonary amyloidosis. Immunohistochemical examination revealed this amyloid composed of AL kappa protein. No clinical evidence of amyloid deposits were found in other organs. We finally diagnosed this case as a localized nodular pulmonary amyloidosis.
Assuntos
Amiloidose/cirurgia , Pneumopatias/cirurgia , Cirurgia Torácica Vídeoassistida , Adulto , Amiloidose/diagnóstico , Humanos , Pneumopatias/diagnóstico , Masculino , Nódulo Pulmonar Solitário/diagnóstico , Nódulo Pulmonar Solitário/cirurgiaRESUMO
Pulmonary aspergillosis and lung cancer rarely occur simultaneously. We report a 66-year-old man with a round shadow in the thin-wall cavity of the right upper lobe. Radiological findings and transbronchial biopsy revealed squamous cell carcinoma complicated by aspergilloma at the site. Right upper lobectomy suggested that early lung cancer arose from preexisting lung scars containing an aspergilloma.
Assuntos
Aspergilose/complicações , Carcinoma de Células Escamosas/complicações , Pneumopatias Fúngicas/complicações , Neoplasias Pulmonares/complicações , Idoso , Carcinoma de Células Escamosas/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , MasculinoRESUMO
In patients undergoing pneumonectomy with concomitant pericardiectomy, patch closure of the defect in the pericardium is required to prevent postoperative cardiac herniation. We used harvested autologous fascia lata as a pericardial patch in such operations on 6 patients with progressive lung cancer after induction chemoradiotherapy.
Assuntos
Fascia Lata/transplante , Pericardiectomia , Pericárdio/cirurgia , Pneumonectomia , Humanos , Neoplasias Pulmonares/cirurgia , Métodos , Transplante AutólogoRESUMO
A 71-year-old male, diagnosed as lung cancer, underwent unilateral pulmonary occulusion test. Through the guidewire, 7.5 Fr thermodilution catheter with occlusion balloon was introduced to the left pulmonary artery from the right internal jugular vein. Heparinized physiological saline solution was injected into the distal site of the occulusion. The occulusion time was 15 minutes. Pulmonary artery pressure and wedge pressure were within normal range. Soon after the examination, the pulmonary arteriogram (PAG) showed the defect of the branch to the lingular segment and the lower lobe. We made a diagnosis of pulmonary thrombosis. Three days after the administration of urokinase and heparin, both pulmonary perfusion scintigram and PAG exhibited the reperfusion to these areas. After the thrombolytic therapy was accomplished, antithrombin III and protein C in the serum showed within normal range. It was possible that the damage on the intima due to the thermodilution catheter or the guidewire and the following blood congestion by the pulmonary artery occulusion caused the thrombosis.