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患児は9歳，男児．上気道炎で近医経過観察中，39度台の発熱が遷延し，左側胸水貯留を認めるようになり紹介された．多房性の膿胸を呈しており胸腔ドレーンを留置したが症状の改善は得られず，小開胸を用いた胸腔鏡補助下胸腔内掻爬ドレナージ術を施行した．胸腔内は胸膜の癒着が著しく，癒着の間に多房性の胸水が少量づつ貯留していた．肺は胼胝で覆われ拡張できなくなっていた．鈍的に癒着を剥離したのち，可及的に胼胝を切除した．胸腔内を充分洗浄しドレーンを留置した．小児においては，膿胸の進行が急速であること，体格上，充分な太さの胸腔ドレーンを留置できないことから，早期にドレナージ不良となることが予想され，ドレナージが効かなくなった段階ですみやかに手術療法を考慮すべきである．手術においては，小開胸を用いた，胸腔鏡補助下胸腔内掻爬ドレナージ術が有用であった．

A 62-year-old man was admitted to the hospital because of a lump in the neck. After admission, cervical CT, ultrasonography, scintiscan and blood examination revealed an adenoma of the right lobe of the thyroid with slight hyperthyroidism. At operation, we found two tumors and no connection was found between the tumors and the thyroid gland. Only tumor extirpation was performed. The gross pathological specimens were 50×40 mm and 25×27 mm in size. Histological findings revealed the adenomatous goiters of the two accessory thyroid glands. After the operation thyiroid function tests were within normal limits. So-called ectopic thyroid glands are classified into two groups whether the thyroid gland is in the right place or not. This case is very rare and is worth for reporting. We think that ectopic thyroid gland with normal thyroid gland should be called accessory thyroid gland.

The colon is the very rare site of metastasis of breast cancer. We emphasize that the intestine should be considered as a possible metastatic lesion of the advanced breast cancer from our experience. A 56-year-old women underwent a standard radical mastectomy for a right breast tumor on July 1990. Pathological diagnosis was infiltrating ductal breast cancer: T1n1 b m0-stage II. The patient was treated with 51 Gy local radiotherapy and chemoendocrinotherapy after surgery as an outpatient. Around February 1991, a tumor marker started to increase. Careful examination could not detect any evidence of recurrence of the breast cancer. However, multiple enlargment of para-aortic lymphnodes was found by CT, and a colon cancer was suspected by barium enema in January 1992. Right hemicolectomy was performed. Histologically, it was found that the breast cancer metastasized to the ascending colon.