Kyobu geka. The Japanese journal of thoracic surgery最新文献

Dopamine-secreting paragangliomas is known to be rare. The average annual incidence rate was reported 0.8 per 100,000 person-years. Approximately 1 to 2% of paragangliomas occur in the chest. We describe a patient with a large dopamine-secreting cardiac paraganglioma, right adrenal tumor and carotid body tumor. A 26-year-old man with progressive exertional dyspnea was referred to our hospital for further management of multiple paragangliomas. Positron emission tomography (PET) and PET-computed tomography (CT) detected those three legions. The diameter of cardiac paraganglioma was over 45 mm and was biggest among three tumors. Firstly, therefore, we planned cardiac paraganglioma resection. Through left lateral thoracotomy in the 4th intercostal space via, cardiac paraganglioma was resected under cardiopulmonary bypass and beating heart. Postoperative course was uneventful. Tumor cells were positive for synaptophysin and chromogranin A. Free metanephrines in the serum and urinary fractionated metanephrines normalized after cardiac surgery while the other two tumors remained untreated.

We report a case of postoperative perforation in the bronchus intermedius membrane after pulmonary resection for lung cancer. An 83-year-old man with lung cancer underwent thoracoscopic right lower lobectomy+ND2a-1 dissection. On postoperative day 11, subcutaneous emphysema appeared to him, and chest radiograph showed niveau formation and pleural effusion on the operative side. Chest computed tomography( CT) suggested a bronchial membrane defect of the bronchus intermedius. We confirmed a bronchial perforation in the bronchus intermedius membrane by bronchoscopy and performed urgent operation. The defect of the perforated membrane was too large to be sutured directly, so a middle lobectomy was performed. After this operation, the patient had a small bronchial stump fistula which was successfully treated with endoscopic bronchial occlusion. Although the patient required treatment for heart failure, he recovered and was discharged 44 days after the reoperation. This perforation could be caused not only by bronchial ischemia due to subcarinal lymph node dissection, but also by injury to the adventitia of the bronchus intermedius membrane due to rough handling and unrecognized burning of the injured area with an electric scalpel. Thermal damage caused by energy devices needs to be noted.

We report a case of coronary artery bypass grafting using thromboelastography in a 42-year-old male patient with hemophilia A. He was diagnosed with hemophilia A at the age of three years old, and was also infected with hepatitis C and human immunodeficiency virus (HIV). He complained of chest pain at home and was brought to our institute and diagnosed with acute myocardial infarction. Concerned about the risk of bleeding, coronary artery bypass grafting was selected to avoid permanent administration of antiplatelet agents. Although there were concerns about bleeding caused by various coagulation factor abnormalities due to the use of cardiopulmonary bypass, we could accurately assess the coagulation factors by using thromboelastography and replenishing them in appropriate amounts. The operation was performed safely as usual and successfully finished.

Objective: Combined small cell lung cancer is the only subtype of small cell lung cancer and is a relatively rare histology. However, its histopathological and molecular biological characteristics are not well understood to date.

Methods: There were 512 surgical resections for lung cancer performed in our department from June 1, 2019 to June 1, 2023. Among them, 5 cases( 1.0%) were diagnosed postoperatively as combined small cell lung cancer.

Results: The median age was 75 years. Tumor markers showed elevated newron specific enolage (NSE) in all cases measured. Imagingly, all patients had irregular, solid mass shadows on chest computed tomography( CT) scan. Abnormal fluorodeoxyglucose-positron emission tomography( FDG-PET) accumulation was also observed. Postoperative histopathological examination revealed that one patient was staged upstaging from the preoperative stage, and four patients were treated with carboplatin and etoposide as adjuvant therapy.

Conclusions: Preoperative diagnosis of combined small cell lung cancer is difficult, but it is important to keep this disease in mind in terms of preoperative lymph node evaluation. Postoperative adjuvant therapy should be administered as in small cell carcinoma. However, further case series are needed, as gene mutations and treatment with immune checkpoint inhibitors are also attracting attention.

A 73-year-old man was referred to our hospital with a right pleural effusion. Chest computed tomography( CT) showed multifocal pleural effusion, and chest drainage was performed. Actinomyces meyeri was detected in the pleural fluid culture. Despite antibiotic treatment, the patient's condition did not improve, and a curettage was performed for empyema. The chest tube was removed on postoperative day 7 and the patient was discharged home uneventfully on day 21. Intravenous antibiotics were given for 16 days, followed by oral antibiotics for 6 months. Actinomycosis empyema is a rare disease with no established duration of treatment, but a total of 6 to 12 months of treatment is generally recommended.

Case 1 was a 59-year-old man who underwent aortic valve replacement (AVR) at the age of 38, for aortic regurgitation. Case 2 was a 51-year-old man who underwent AVR at the age of 34, for aortic regurgitation. Both cases required surgery for ascending aortic aneurysms. These patients showed aneurysm at the site of the prior aortotomy. In both of the patients used felt-strip was used for closing aortotomy. Intraoperative findings showed enlargement of the aorta around the felt-strip, which was a finding of true aneurysm. Both cases underwent ascending aortic replacement. The mechanism of aortic aneurysm development was thought to include persistent mechanical stimulation by the felt-strip and ischemia of the vasa-vasorum due to compression of the felt-strip. The use of felt-strips for the aortotomy suture should be avoided, especially in young patients.

An 80-year-old male underwent chest computed tomography (CT) due to complaints of right-sided chest pain. A chest wall tumor was identified in the right eighth intercostal space, corresponding to the location of his pain. The patient was subsequently referred to our department for further evaluation and treatment. Utilizing single-port thoracoscopic surgery, the tumor was successfully excised. Intraoperatively, the tumor was found beneath the parietal pleura, was contiguous with to the intercostal nerve. Histopathological analysis confirmed the diagnosis of schwannoma originating from the intercostal nerve. The right-sided chest pain was reduced after operation significantly. No recurrence or relapse of symptoms was observed during follow-up. Although schwannoma of the chest wall in asymptomatic in many cases, in this case, localized pain corresponding to the tumor site was evident. This emphasizes the importance of considering schwannoma in the differential diagnosis of chest pain.

Persistent sciatic artery( PSA) is a rare congenital anomaly and often results in aneurismal or occlusive changes. A 82-year-old woman was reffered with diagnosis of Stanford type A acute aortic dissection complicated cardiac tamponade. Emergent aortic arch replacement was performed. Cardiopulmonary bypass was established by central cannulation into true lumen of aortic arch because of asceding aortic rupture during the operation, axillary arteries dissection and hypoplastic femoral arteries. Post-operative course was uneventful. She was transferred to the local hospital 32 days after the operation for the purpose of rehabilitation.

Multiple myeloma (MM) is a disease with a poor prognosis, and there are few reports of cardiac surgery complicated by this disease, which can lead to various perioperative complications such as bleeding tendency due to coagulation defects, changes in blood viscosity, immunocompromise, and bone marrow insufficiency when undergoing cardiac surgery. In recent years, with the spread of minimally invasive cardiac surgery (MICS), avoidance of sternotomy has become an option. We present a case of a 70-year-old man who underwent aortic valve replacement using MICS procedure for aortic regurgitation complicated with MM.

We encountered a case in which emergency surgery was performed for a penetrating lung injury complicated by a hemodynamic cerebral infarction. A 45-year-old man sustained a chest injury due to a scattered piece of metal and was admitted to a nearby hospital. He was confirmed to have hemorrhagic shock due to a right hemopneumothorax, and a chest tube was inserted he was transferred to our hospital. Chest radiography and computed tomography (CT) revealed a metal fragment in the right lung and confirmed the diagnosis of a penetrating lung injury due to a foreign body. The patient also presented with total blindness of an unknown etiology. Emergency surgery was performed to treat the injury and remove the foreign body. A large amount of blood and hematoma were removed from the right thoracic cavity, and a metal fragment was found in the lower lobe of the right lung. After removing the foreign body, pulmonary suturing was performed. On the following day, head magnetic resonance imaging revealed multiple cerebral infarctions in the bilateral occipital lobes, left frontal lobe, and left cerebellar hemisphere. However, no vascular occlusion or thrombus was found, and the patient was diagnosed with hemodynamic cerebral infarction due to hemorrhagic shock.