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A 61-year-old woman was found to have multiple ground-glass nodules( GGNs) in both lungs by chest computed tomography (CT) scan. The lesion of the right S2 contained a partial solid component and was suspected to be minimally invasive adenocarcinoma. Three-dimensional CT showed two anomalous V2s descending dorsally to the intermediate bronchus and draining into the inferior pulmonary vein. Thoracoscopic segmentectomy of the right S2 was performed safely. The pathological diagnosis was adenocarcinoma in situ. Since aberrant pulmonary vessels increases the surgical risk during video-assisted thoracoscopic anatomical lung resection, preoperative three-dimensional CT is useful in performing safe surgical procedure.

A 33-year-old man underwent radical surgery for urachal cancer. Histology of the cancer revealed an adenocarcinoma of the urachus, Sheldon stage ⅢA. He developed a right lung nodule 23 months after the surgery. Partial lobectomy was performed;it revealed an adenocarcinoma compatible with urachal carcinoma. Additionally, 2 right lung metastases measuring 0.5 cm and 1.6 cm in diameter were found 12 months after partial lobectomy. The patient was treated with 4 different chemotherapy regimens including TS-1 and cisplatin, paclitaxel, folinic acid・fluorouracil・oxaliplatin(FOLFOX), and folinic acid・fluorouracil・irinotecan (FOLFIRI). Computed tomography reports showed progression of the pulmonary nodules, now measuring 1.4 cm and 10 cm in diameter. There was no evidence of distant metastasis except for in the lung and local recurrence. Right pneumonectomy was performed;the histology of the specimen confirmed urachal adenocarcinoma. Three months later, he developed cerebellar metastasis. The tumor was removed by neurosurgeons. The patient died of widespread metastases 6 months after the pneumonectomy.

A 77-year-old man was referred to our hospital because of massive opacification of the right hemithorax on chest radiography. Chest computed tomography (CT) revealed a 25×18-cm heterogeneous tumor in the right hemi-thorax. Chest CT scan obtained 6 years before the referral showed an 8×2-cm homogeneous lipomatous mass in the anterior mediastinum suggesting a well-differentiated liposarcoma. The follow-up chest CT scan obtained 12 months before the referral showed a 4×2-cm heterogeneous solid component within the lipomatous mass of the mediastinum suggesting the development of a dedifferentiated liposarcoma. The tumor was completely resected through a median sternotomy and anterior right thoracotomy. The pathological diagnosis was dedifferentiated liposarcoma originating from a well-differentiated liposarcoma of the anterior mediastinum.

A 74-year-old man was brought to our hospital for an acute exacerbation of respiratory failure. He had severe progressive dyspnea for a few days and had received home oxygen therapy for 4 years. Chest radiography revealed a giant bulla occupying the entire right hemithorax with a remarkable shift of the mediastinum to the left. Chest radiographies of previous 4 years had shown the bulla occupying half of the right hemithorax. It had expanded to its present size over the past month. Treatment consisted of immediate puncturing of the bulla followed by elective intracavity drainage. An urinary catheter was inserted into the bulla under local anesthesia. There was persistent aid leakage from the bulla. A histoacryl-lipiodol mixture was used for bronchial occlusion, and intracavity instillation of minocycline was performed to collapse the bulla. Air leakage from the bulla had ceased on the next day, and the bulla was completely eliminated.

A 78-year-old woman with a history of mitral valve stenosis underwent open mitral commissurotomy in 1976. In 1990, she underwent mitral valve replacement (Medtronic-Hall 29 mm), tricuspid annuloplasty(DeVega method), and pacemaker implantation for bradycardiac atrial fibrillation. However, in June 2012, she developed anemia of unknown cause. Prosthetic valve dysfunction was suspected, because intermittent changes in the left ventricular inflow was detected by echocardiography. Fluoroscopy actually confirmed the presence of prosthetic valve dysfunction. Therefore mitral valve re-replacement(ATS Medical, Inc. 29 mm) and tricuspid annuloplasty (Cosgrove ring 30 mm) were performed. Monitoring the changes in the left ventricular inflow is recommended when prosthetic valve dysfunction in a single leaflet is suspected.

Simultaneous bilateral spontaneous pneumothorax (SBSP) occurred in a 16-year-old male. He presented with severe dyspnea. Chest X-ray showed bilateral pneumothorax. Computed tomography revealed bilateral apical bullas. Chest tubes were promptly inserted bilaterally. The patient underwent single-stage bilateral video-assisted thoracoscopic surgery( VATS). Bilateral bullectomy was performed sequentially. Saline poured in to test for air leakage did not escape to the opposite pleural cavity, suggesting no pleuro-pleural communication. Post-operative course was uneventful. A bilateral single-stage VATS by a conventional lateral approach with intra-operative patient repositioning is a safe, feasible and familiar technique for treatment of SBSP.

Aortic valve replacement using CEP Magna 21 mm bioprosthetic valve was performed because of aortic valve stenosis in a 75-year-old man with maintenance dialysis. In the 39th postoperative month, the bioprosthetic valve malfunction due to calcification was noted, and it was replaced. Judging from the previously reported cases, malfunction of an artificial valve in the 39th month is thought to be relatively early. Early-stage calcification of a bioprosthetic valve is considered to be caused by secondary hyperparathyroidism due to artificial dialysis. Therefore, careful consideration is necessary in selecting an artificial valve in a dialysis patient. To prevent early-stage calcification of a bioprosthetic valve in a dialysis patient, strict control of parathyroid hormones, blood phosphorus and calcium levels is necessary. In addition, due to the attendant risk of calcification of bioprosthetic valves, mechanical valves are recommended to dialysis patients, who are expected to survive for more than 3 years and who are not expected to develop hemorrhagic complications.

A 80-year-old female with an eventration of the left diaphragm, which had been noticed with routine chest roentgenogram in 2006, presented with severe dyspnea and shock vital in 2012. The chest X-ray on admission disclosed elevation of the left hemidiaphragm, dislocation of the heart to the right. The diagnosis of eventration of the diaphragm was confirmed with a computed tomographic scan. She underwent diaphragmatic plication with endostaplers by thoracoscopic surgery. The postoperative course was uneventful except for transient reexpansion pulmonary edema. The patient was extubated on the 5th postoperative day. Dyspnea has disappeared after the operation. She was in a good condition without requiring any additional oxygen.

A 44-year-old female was presented to our department with a 4-day history of shortness of breath and chest pain. The chest X-ray showed pneumothorax with completely collapsed left lung. Thoracentesis was performed. She complained of dyspnea and the oxygen saturation decreased to 74% after thoracentesis. The 2nd chest X-ray and computed tomography demonstrated a left-sided pulmonary edema. A 67-year-old man came to our department complaining of persistent cough. The chest X-ray showed pneumothorax with collapsed right middle and lower lobes. Thoracentesis was performed. He complained of dyspnea and the oxygen saturation decreased to 87% after thoracentesis. The 2nd chest X-ray and computed tomography demonstrated an expanded right upper lobe, but also pulmonary edema in the right middle and lower lobes. Those patients were treated with supplemental oxygen without endotracheal intubation. Their oxygen saturation stabilized within 12 hours. They were successfully treated with the sole administration of oxygen.

A 65-year-old male was referred to our department because of an abnormal shadow on chest X-ray. He had been suffering from rheumatoid arthritis for 10 years. He had been treated with tumor necrosis factor antagonist(etanercept)for the past 3 years and 6 months. Computed tomography of the chest revealed an irregular shaped pulmonary nodule with the longest diameter of 4.3 cm in the left upper lobe. The diagnosis of lung carcinoma was made. He underwent video-assisted left upper lobectomy with lymph node dissection. Histological examination revealed poorly differentiated squamous cell carcinoma. The tumor was classified as stage ⅢA with T4(pm2)N1M0. No adjuvant chemotherapy was performed because he had recurrent arthralgia after operation and new anti-rheumatic-drug was required. He is free from disease with a follow-up period of 11 months.

A 58-year-old female was admitted to our hospital for investigation of serum elevation of carbohydrate antigen (CA 19-9). Computed tomography of the chest revealed a spiculated pulmonary nodule with the longest diameter of 3.7 cm in the right lower lobe. The diagnosis of lung adenocarcinoma was made. The patient underwent right lower lobectomy with lymphnode dissection. Histological examination revealed acinar type adenocarcinoma. The tumor was classified as stage IB with T2aN0M0. Immunohistochemically, the tumor cells stained positively for CA19-9. The serum CA19-9 level returned to a normal level after operation, but increased again with mediastinal lymphnode metastasis and brain metastasis. She died after an operation in 16 months.

A 63-year-old female was admitted to our hospital for investigation of serum elevation of carcinoembryonic antigen (CEA). She underwent high anterior resection for a rectal cancer 5-years ago. Chest computed tomography (CT) obtained 5-years ago showed a nodule in the right S10, measuring 1.3 x 0.8 cm in size. The nodule was assessed as benign. Chest CT on admission showed the enlarged nodule with a pleural indentation, measuring 2.2 x 1.6 cm in size. Definitive diagnosis could not be established. Since it was difficult to exclude the possibility of malignancy, video-assisted partial resection was performed. Histological examination of the nodule revealed primary adenocarcinoma in frozen sections. Lobectomy with lymph node dissection was performed. The ultimate diagnosis was adenocarcinoma with mixed subtypes. The tumor was classified as stage IA with T1bN0M0. We reported this case because it was a rare slow-growing adenocarcinoma that had a 5-years clinical history before operation.

A 83-year-old female was referred to our hospital for investigation of a persistent cough. A chest X-ray showed enlargement of the mediastinum. Computed tomography of the chest showed an anterior mediastinal mass with a maximal diameter of 6.5 cm, which had invasion to the lung. The patient underwent thymothymectomy combined resections of the lung, pericardium, and left innominate vein through a median sternotomy. Histological examination of the resected tumor revealed a World Health Organization (WHO) classification type B3 thymoma with infiltration into the lung. There were no infiltrations of the tumor into the pericardium and the innominate vein. A persistent cough disappeared after surgery. No adjuvant chemotherapy was performed. She is still free from disease with a follow-up period of 4 months. We report a rare case of thymoma detected with a persistent cough derived from pulmonary invasion.

Recently pericardial drainage after cardiac surgery has been done using silicon tubes of small diameter. For more effective drainage, we set one of the drainage tubes circularly, coursing behind the left ventricle, through the transverse sinus, and ending at the right side of the atrium (circular pericardial drainage). As compared to conventional drainage using 28 Fr chloroethilene tubes, drainage time was shorter and no late tamponade had occurred. Circular pericardial drainage may be useful.

A 53-year-old male was admitted to our hospital because of dyspnea. Chest radiograph showed a massive right-sided hydrothorax. He was suffering from chronic renal failure and had undergone continuous ambulatory peritoneal dialysis (CAPD) for 8 months. The diagnosis of pleuroperitoneal communication (PPC) was made using injection of indigocarmine into the peritoneal cavity with subsequent pleural detection by thoracocentesis. Injection of contrast media into the peritoneal cavity showed a dome shaped radio-opaque shadow which is located on the diaphragmatic dome followed by the movement of contrast media into the thoracic cavity. Video-assisted thoracic surgery (VATS) was performed under general anesthesia. To identify the point of communication, the method of detecting air leakage was employed. A bleb like lesion on which the hole existed was observed at the center of the diaphragm, and air leakage was identified by filling the thoracic cavity with saline. The pressure in the peritoneal cavity was maintained at 10 mmHg by continuous CO2 inflation. Direct closure was performed to repair the PPC, which succesfully stopped the air leakage. CAPD could be restarted immediately after surgery. No recurrence of hydrothorax has been detected for more than 14 months after surgery.

A 69-year-old female visited our hospital because of dyspnea. Chest X-ray showed an abnormal shadow in the right lower lung field. Chest computed tomography (CT) showed a round, well-circumscribed, homogenous subpleural nodle of 8 mm in diameter in the right lower lobe, which had no calcification and no pleural indentation. Bronchofiber scope, abdominal CT, brain magnetic resonance imaging (MRI), bone scintigraphy could not establish definitive diagnosis. Scince the possibility of malignancy could not be excluded throughout, video-assisted thoracoscopic surgery was performed to obtain confirmed diagnosis. Pathological examination revealed non-chondromatous hamartoma of the lung. Non-chondromatous hamartoma should be considered in the differential diagnosis of pulmonary nodles. We report a rare case of non-chondromatous hamartoma.

Primary malignant fibrous histiocytoma located in the right side of the heart is extremely rare. We reported a case with literal reviews. A 71-year-old woman was admitted of faintness due to hypotension and marked edema of her lower extremity. With no time she was deteriorated into cardiogenic shock. Echocardiography demonstrated a tumor like mass which occupied her whole right ventricular cavity. Emergency tumor resection was carried out because of her status. Histological and immunohistochemical studies revealed the tumor was malignant fibrous histiocytoma. She died of pulmonary failure on nineteenth day after surgery.

Metastatic lung tumor from renal cell carcinoma were studied in 29 cases. Eighteen patients were treated surgically, 11 were treated non-surgically. The overall 5-year survival rate with the patients of pulmonary resection was 53.5%, and that with those of conservative therapy was 0%, and this difference is statistically significant (p < 0.05). There was no significant difference in any characteristics such as sex, age, stage, grade, disease free interval, metastatic pattern and combination with or without interferon therapy. There was no significant difference in surgically treated patients with pulmonary metastasis in terms of any factors such as age, sex, stage, grade, disease free interval, pulmonary metastasis pattern, metastatic number, surgical procedure, combination with or without interferon therapy statistically. Analysis for the surgically treated patients with pulmonary metastasis from renal cell carcinoma shows no significant difference in prognosis with any characteristics. This result shows efficacy of surgery even if for the patients with synchronous bilateral multiple pulmonary metastasis from renal cell carcinoma.

A 42-years-old female was referred to the university hospital because of cystic lesions of the right superior mediastinum. Drainage tube was found at right supraclavicular fossa with prolonged lymphatic discharge. We diagnosed this case as a benign cystic lymphangiomas with CT scan and CT scan with cystography and chemical analysis of the contents of the cyst. Intralesional OK-432 therapy for cystic mediastinal lymphangioma was performed. OK-432 was administered through intralesionally placed drainage tube. Excellent result was obtained. A few weeks later, residual lymphatic discharge through drainage tube became stopped. No expansion of the mediastinal cyst was found after drainage tube removal. Intralesional OK-432 therapy for cystic mediastinal lymphangioma was very effective and useful, it should be recommended for the management of the first choice of therapeutic method for cystic mediastinal lymphangioma because of no neurological deficit after this treatment.

A 75-year-old man of chylothorax after anterior spinal fusion successfully underwent thoracoabdominal operation in order to ligate chyloleakage. Not only preoperative milk intake but also intraoperative administration of milk through nasogastric tube was useful for identification of the site of leakage. OK-432 was administered through locally placed and chest tube after operation, after which residual chyloleakage was stopped. lntraoperative administration of milk through nasogastric tube was useful and OK-432 injection through topical and chest tube may be effective, these should be recommended for management of chylothorax.

Sixteen cases of primary lung cancer in patients younger than 40 years old had been operated on at the department. There were 8 males and 8 females and the male-to-female ratio was 1:1 that was closer than the ratio in elder patients over 40 years. Histologic types were adenocarcinoma in 7 cases, squamous carcinoma in 5 cases, carcinoid in 2 cases, and small cell carcinoma in 2 cases. In younger patients, adenocarcinomas, small cell carcinomas, and carcinoids were more commonly found than squamous cell carcinomas. Patients in stage I, II, and IIIA and those undergoing a curative resection were predominant in cases without any symptoms preoperatively. The 5-year survival rate of the 16 patients younger than 40 years was 42.9%, that was not significantly different from that of elder patients over 40 years old. This relatively better prognosis might be owing to a fact that operated patients were dominantly composed of asymptomatic patients. In younger patients who have good physical status and respiratory function compared with elder patients, aggressive surgical diagnosis followed by resection, if the definitive diagnosis of malignancy is established may contribute to the improvement of prognosis for patients who was suspected of having malignancy.

Three cases of adult intrapulmonary sequestration were presented. They were all females ranging from 22 to 49-year-old (mean age 35 yrs.). Chest X-rays showed abnormal shadows in the right or left lower lobe. Aortograms showed aberrant arteries in each cases, and the diagnosis of pulmonaly sequestration was made preoperatively. Lobectomies were performed in all cases because of recurrent bronchopulmonary infections. We could not classify our cases based on Pryce's classification by unclear margins between sequestrated lungs and normal pulmonary tissues. All cases had no histories of infantile bronchopulmonary infections which supported the theory of acquired origin.

Ninety seven patients with metastatic lung tumors were treated surgically in our department. Second pulmonary resections were performed in 13 patients. They consists of 9 males and 4 females, their age ranged from 12 to 75 years old (average 54.4 years old). Tumors originate from sarcoma in 5 cases, laryngeal cancer, colorectal cancer, renal cell cancer in 2 cases respectively, oral cavity cancer and transitional cell cancer in 1 case respectively. No second pulmonary resection was performed in patients with metastatic lung tumors originating from lung cancer or breast cancer, because they metastatize not only lung but also general organs. No second pulmonary resection was required in patients with testicular tumor and choriocarcinoma, because chemotherapy take good effect on them.

In this study, we evaluated 15 surgically treated cases of lung cancer with scalene node metastasis. Eleven males and 4 females with ages ranging from 41 years to 78 years (average 59.1 years) were examined. Seven cases was in the right upper lobe, 3 in the left upper lobe, 2 in the right lower lobe, 2 in the left lower lobe, 1 in the middle lobe. Adenocarcinomas were found in 9 cases squamous cell carcinomas were in 4 cases and large cell carcinomas were in 2 cases. Two cases was in T 1, 7 in T 2, 2 in T 3, 4 in T 4. In all cases, lobectomy was performed. Five year survival rate was 14.3% as determined by the Kaplan-Meier method. Average survival period was 26.6 months. Three cases survived over 3 years including one case survived over 10 years.

We reported a case of a fatal graft-versus-host disease (GVHD) which developed in a 65-year-old, male patient which was considered to have been induced by irradiated fresh blood donated by his son after a coronary bypass surgery. Fresh blood was obtained from his relatives, and a 15 Gy irradiation was performed before transfusion. The diagnosis of acute GVHD was made by clinical symptoms and histological examinations of the skin and the bone marrow. He died of sepsis on the 19th post-operative day. The HLA typing of the lymphocytes, revealed that the patient had A 2, A 24, Bw 52, Bw 62, Cw 4, DR 2, and his son had A 24, Bw 52, DR 2. A 24 and Bw 52 were homogeneous making his son histocompatible with one of the patient's haplotype. This might well be attributable to the occurrence of GVHD in this case, meaning that 15 Gy irradiation was not sufficient for the prevention of this disease.

A case is reported in which simultaneous surgical correction of coronary atherosclerosis and cholelithiasis was performed. A 71-year-old man was admitted with severe stable angina and right hypochondrial dull pain. Coronary angiograms disclosed severe triple vessel disease, and abdominal echography demonstrated gallstone. He underwent bypass of left anterior descending, diagonal, obtuse marginal, and right coronary arteries with autogenous saphenous vein on cardiopulmonary bypass. The procedure was followed immediately by cholecystectomy. His postoperative course was uneventful.