[Descending Necrotizing Mediastinitis with Empyema Necessitated Two Performances of Surgical Drainage for Successful Treatment:Report of a Case].

The case was a 57-year-old woman. She visited a local doctor with a chief complaint of sore throat. A retropharyngeal abscess was suspected, and she was referred to our otolaryngology. Contrast-enhanced computed tomography(CT) scan revealed continuous fluid retention from the retropharyngeal space to the neck and the superior and posterior mediastinum with bilateral pleural effusion. The patient was diagnosed with descending necrotizing mediastinitis with empyema, and on the same day cervical drainage, thoracoscopic bilateral mediastinal drainage, empyema curettage and tracheostomy was performed. Postoperative contrast-enhanced CT scan revealed a widespread residual mediastinal abscess and thoracoscopic bilateral mediastinal drainage was performed again on the 11th postoperative day. After reoperation, the inflammation gradually subsided and she was discharged 47 days after reoperation.

[The Postoperative Recurrence of Adenosquamous Cell Carcinoma of the Lung as a Polypoid Mass in the Tracheal Lumen;Report of a Case].

The case is 77 years old, female. She was referred to a local doctor with a chief complaint of cough and wheezing and was treated as asthma. However, symptoms did not improve and she was referred to our hospital. She had a history of right upper lobectomy for lung cancer about 2 years before, with the pathological diagnosis of adenosquamous cell carcinoma, pT1aN0M0, stage I A. Chest computed tomography (CT) scan showed a pedunculated polypoid mass almost occupying the lumen in the trachea immediately above the tracheal bifurcation, and the emergency bronchoscopic resection using a high-frequency snare under general anesthesia was performed. Postoperatively, 50 Gray of radiotherapy was added.

[Endobronchial Hamartoma of the Subsegmental Bronchus;Report of a Case].

The case was 56 years old male. An abnormal shadow was pointed out by chest computed tomography (CT) at a medical examination. The CT scan revealed a 13 mm mass shadow that contacts with the B5a of the right middle lobe. Bronchoscopy revealed a yellow colored lesion that occluded B5ai. A non-cartilage type endobronchial hamartoma was suspected and the biopsy was performed, but a definitive diagnosis was not achieved. The lesion was surgically resected by the right middle lobectomy, and the histopathological diagnosis was an endobronchial hamartoma consisting mainly of mature adipose tissue.

[Synchronous Thymic Carcinoma and Primary Lung Cancer].

A 79-year-old woman visited a local doctor with a chief complaint of cough. A computed tomography (CT) scan revealed an anterior mediastinal tumor and 20 mm sized ground-glass nodule (GGN) in the right upper lobe. Bronchoscopy was performed, but no definitive diagnosis was made for GGN and follow-up observation was made with an image. The anterior mediastinal tumor was a solid tumor of 50 mm in size, and invasive thymoma was suspected. A total thymectomy with pericardial partial resection was performed through a median sternotomy. Histopathological diagnosis was squamous cell carcinoma, and no pericardial infiltration was observed. On the other hand, GGN of the right upper lobe during follow-up increased in size and thoracoscopic surgery was performed 3 months after surgery for thymic carcinoma. Adenocarcinoma was diagnosed by rapid diagnosis and the upper lobectomy with lymph node dissection were conducted. No signs of recurrence have been observed for 5 years after operation.

[Lung Cancer Complicated with Empyema Due to Intratumoral Abscess;Report of a Case].

A 73-year-old man was admitted to our hospital because of fever. A chest computed tomography (CT) scan revealed a 10-cm-sized irregular mass with air-fluid level in the left lower lobe, and sputum cytology revealed squamous cell carcinoma, which was diagnosed as a giant squamous cell carcinoma with intratumoral abscess. Later, the empyema developed and drainage was performed for empyema and intratumoral abscess. Two weeks later, left lower lobectomy and lymph node dissection were performed by posterolateral thoracotomy. After surgery, there were no serious complications or relapse of empyema.

[Bronchogenic Cyst in the Anterior Mediastinum;Report of a Case].

The case is 61 years old, female. The mediastinal mass was pointed out at a medical examination, and she visited our hospital. A plain computed tomography (CT) scan showed a 12×35 mm mass in the anterior mediastinum, and a thymoma was suspected. Magnetic resonance imaging( MRI) showed low signal at T1-weighted image and high signal at T2-weighted image. A benign cystic mass such as a thymic cyst and a pericardial cyst was suspected, and thoracoscopic resection was performed. Pathologically, a bronchogenic cyst was diagnosed.

[Primary Pleomorphic Rhabdomyosarcoma of the Chest Wall;Report of a Case].

The case was 70 years old, female. She visited a nearby hospital complaining of a mass in the right breast which was diagnosed as a chest wall tumor and referred to our department. A computed tomography (CT) scan revealed a 10 cm-sized contrast enhanced mass with bone destruction of the 3rd and 4th ribs. Invasion to the mammary gland tissue was not observed. A malignant tumor was suspected by percutaneous needle biopsy and the tumor was excised with the chest wall including the 3rd, 4th and 5th ribs. Histopathological diagnosis was a pleomorphic rhabdomyosarcoma. No signs of recurrence have been observed for 5 years after the operation.

Candidate biomarkers predictive of anthracycline and taxane efficacy against breast cancer.

BACKGROUND: Since breast cancer shows diversity in clinical behaviors, a standard therapy does not always lead to favorable outcomes. MATERIALS AND METHODS: The expression statuses of candidate markers, including topoisomerase-II alpha (TOP2A), beta-tubulin (B-tub), and tissue inhibitor of metalloprotease-1 (TIMP-1), were immunohistochemically evaluated in 70 breast cancer tissues from 68 patients with advanced breast cancers receiving chemotherapy. RESULTS: The response rates to anthracycline and taxane were 70.5% and 67.2%, respectively. Overall, 25.1% ± 29.7%, 8.32% ± 10.1%, and 16.37% ±17.5% of cancer cells in the tumors studied were positive for B-tub, TOP2A, and TIMP-1 expressions, respectively. However, positive molecule expression did not differ between patients who did and did not exhibit clinical responses to treatment. The proportion of TOP2A-positive cancer cells was significantly higher among anthracycline responders than among nonresponders in HR-negative cancer (15.4% ±17.5% vs. 2.0% ± 2.4%, respectively, P = 0.048), whereas TOP2A and TIMP-1 expression statuses did not differ in HR-positive cancer. When patients were stratified according to B-tub, TOP2A, or TIMP-1 expression statuses (B-tub ≥10% vs. <10%, TOP2A ≥5% vs. <5%, TIMP-1 ≤20% vs. >20%, respectively), the proportion of patients with ≥10% B-tub-positive cancer cells was significantly higher in taxane responders than in nonresponders (72.4% vs. 37.5%, respectively, P = 0.016). Anthracycline responders showed a trend to have a higher proportion of patients with either ≥5% TOP2A-positive cancer cells or ≤20% TIMP-1-positive cancer cells compared to nonresponders (86.7% vs. 61.5%, respectively, P = 0.066). CONCLUSION: Immunohistochemical TOP2A, TIMP-1, and B-tub expression analyses are expected to be useful for predicting tumor responses to chemotherapy.

[Extralobar pulmonary sequestration mimicking posterior mediastinal tumor].

The case was 13-year-old man. He visited local hospital due to high fever and back pain. He was diagnosed as acute pleuritis based on a chest computed tomography( CT) scan and referred to our hospital for treatment. Chest CT scan revealed a round shaped mass with clear margin at the left vertebrophrenic angle. A neurogenic posterior mediastinal tumor was suspected. Thoracoscopic surgery revealed that the mass had 2 thin string-like structures connecting to the descending aorta, and was suspected to be a pulmonary sequestration. The resected tumor was pathologically confirmed to be an extralobar pulmonary sequestration most of which was hemorrhagic necrosis caused by arterial infarction.

[Acute empyema with fistula successfully treated by curettage and endobronchial Watanabe spigot (EWS)].

A 49-year-old woman was referred to our hospital because of empyema. A chest drainage tube inserted and lavage performed. Her general condition improved but the infection and a major air leakage remained. On the 10th day after chest drainage, we performed thoracoscopic debridement and occlusion of bronchopleural fistulas using cellulose oxidized( Surgicel) and fibrin glue. Expansion of the lung and the improvement of inflammation were observed. but a major air leakage remained. On 29th postoperative day, we performed bronchial embolization using endobronchial Watanabe spigot (EWS). The leakage stopped the 7 days after bronchial embolization, we removed chest tube and 10 days after bronchial embolization she was discharged.

[Renal infarction and acute arterial obstruction of the lower extremity encountered after surgery for primary lung cancer].

The patient was 68-year-old who underwent left upper lobectomy and lymph node dissection. On the 4th postoperative day, he developed vomiting and lumbar pain. On 5th postoperative day, he complained of pain, sensory paralysis and cold sensation of the right lower extremity. Computed tomography(CT)examination revealed left renal infarction and acute arterial obstruction of the right common iliac artery. Emergency thrombectomy of the right lower extremity was performed. Postoperatively, he received anticoagulant therapy and was able to leave the hospital on the 20th postoperative day. Attention should be paid to the infarction of abdominal organs when developing abdominal symptoms after lung cancer surgery in elderly patients.

[Pleuroperitoneal communication detected at the beginning of continuous ambulatory peritoneal dialysis; report of a case].

A 61-year-old female was diagnosed as having end-stage renal failure developed dyspnea soon after introduction of continuous ambulatory peritoneal dialysis (CAPD). Chest X-ray showed a right-side massive pleural effusion. Pleuro peritoneal communication was suspicious, because the hydrothorax significantly improved by the stop of CAPD. We performed video-assisted thoracic surgery. Using indigo carmine containing peritoneal dialysis fluid through a CAPD catheter, we found a fistula on the diaphragm from which blue dialysis solution flowed out like a fountain. The fistula of the diaphragm was directly closed with a surgical stapler and covered using cellulose oxidized (Surgicel) and fibrin glue. She could restart CAPD on postoperative days 7, and no recurrence of hydrothorax has been detected for 10 months after surgical treatment.

[Recurrence after bullectomy by video-assisted thoracic surgery for spontaneous pneumothorax in younger ages].

We reported 2 cases of recurrent pneumothorax after thoracoscopic bullectomy. The patients are 19-year-old and 21-year-old men. The distensible bullae without macroscopic emphysematous change were found at initial surgery in both patients. They experienced the recurrence at 21 months and 25 months respectively. Interestingly, small bullae along the overall length of the previous stapled line were found in both cases. Histological examination of the resected lungs at the 1st and 2nd operation disclosed microscopic emphysema in the macroscopically normal lung tissue. Pathologic findings suggest that new bullous lesions developed from the microscopic emphysematous lesion around the stapled line. Distortion of lung tissue by stapling is likely to be the cause of new bullous formation. Reinforcement around stapled line covered with absorbable material might be necessary at the initial surgery to prevent recurrence in younger patients.

Novel bronchofiberscopic catheter spray device allows effective anesthetic spray and sputum suctioning.

STUDY OBJECTIVES: To evaluate how serum lidocaine concentrations (SLC) rise when lidocaine is administered by a Bronchofiberscopic Catheter Spray Device (BCSD), and to demonstrate the effect on the aspiration speed of a substitute for sputum when a catheter spray remains in the channel of the bronchofiberscope (BF). METHODS: This is a prospective randomized clinical study. After lidocaine ultrasonic nebulizer, the BF was inserted orally. During the procedure patients received 4% lidocaine by two methods. In Group 1, 11 patients received lidocaine by bronchofiberscopic (BF) injection. In Group 2, 15 patients received lidocaine by spraying from the diameter 1.06 mm catheter through the BF channel. SLC were measured at 40 min from onset of nebulization. Separately, we examined how effectively sputum was aspirated through the BF channel with a catheter. RESULTS: Total lidocaine dose (TLD) is the total dose used for nebulization and for the BF injection or spray. The TLD for Groups 1 and 2 were 698.2+/-162.1 mg (mean+/-SD) and 498.7+/-103.8 mg, respectively (P = 0.03). The SLC for Groups 1 and 2 were 1.28+/-0.72 and 1.48+/-0.70 mg/l, respectively (P = 0.49). CONCLUSIONS: Using BCSD allows easier in administration of lidocaine and is not associated with a significant increase in SLC in comparison with BF injection. Although sputum aspiration using the BF inserted with our catheter was somewhat slow, we did not feel inconvenient so much. Compared to the conventional method, using BCSD may be preferable for patients and bronchoscopists.

Progressive increase of CD4(+)/CD45RC(-) lymphocytes after allograft rat lung transplantation: a marker of acute rejection.

BACKGROUND: Acute rejection remains one the most serious problems in lung transplantation. Although biopsy has been used for assessing the dysfunction of grafts, it is difficult to determine rejection at an early stage. Lymphocyte infiltration and activation play an important role in acute rejection of transplanted organs, and the dynamic change of lymphocyte subpopulations might be a marker to determine graft rejection after lung transplantation. METHODS: A rat lung transplant model was used. Graft-infiltrating lymphocytes in lung tissues were examined by means of histology, and isolated cells were analyzed by means of flow cytometry. Phenotypes of lymphocytes in the regional and remote lymph nodes, spleen, peripheral blood, and bronchoalveolar lavage fluid were also measured by means of flow cytometry. RESULTS: After allograft transplantation, increased lymphocytes were seen in allografts but not in isografts. In allografts the percentage of T cells increased from day 1 to day 5, whereas that of B cells was decreased. The CD4(+)/CD8(+) ratio decreased in allografts. The proportion of CD4(+)/CD45RC(-) cells increased in the allografts, which was mainly due to the increase of CD45RC(-) cells in the total CD4(+) cells. Similar changes were found in regional mediastinal lymph nodes but not in the mesenteric lymph nodes, spleen, or peripheral blood. Thus this is a specific response to lung allografts. Importantly, CD45RC(-) cells were significantly increased in the bronchoalveolar lavage fluid. CONCLUSION: Significant change of lymphocyte subpopulations is a sign of lymphocyte activation. Increased CD4(+)/CD45RC(-) cells in lung allografts could be an early marker of acute rejection, which can be examined by means of lung lavage and flow cytometry.