Search

While transbronchoscopic air insufflation has been described in refractory atelectasis as a therapy without any serious complications, 3 cases of gastric rupture during the same procedure have been reported when it was used to support tracheal intubation by employing the jet of oxygen from the wall pipeline. Here, we report a 66-year-old woman who underwent transbronchoscopic oxygen insufflation using a flexible fiberscope to clear away secretions during an endobronchial silicon spigot removal procedure. She suffered a sudden drop of blood pressure with pneumomediastinum, subpleural and subcutaneous emphysema, and bilateral pneumothorax. Blood pressure recovered rapidly when we stopped the insufflation. Tube thoracostomy was initiated, and she recovered well without systemic air embolism. We conclude that transbronchoscopic oxygen insufflation using the wall pipeline does carry a potential risk of serious barotrauma, and is not to be recommended except with the use of a pressure monitor or pop-off valve.

Mediastinal cystic seminoma is uncommon; only 17 cases have been reported, most diagnosed postoperatively, without recurrence on follow-up, even without radiotherapy. Here, we report a mediastinal seminoma showing a unilocular cyst with enhancing thickened wall in computed tomography (CT) and septal structures in magnetic resonance imaging (MRI) in a 24-year-old man. Fluorodeoxyglucose (FDG) uptake was not significant. Histopathologically, seminoma cells were found scattered in the cyst wall. Twenty months after resection, the patient's quality of life is good, without chemotherapy or radiation. Cystic seminoma has a good prognosis and complete resection without adjuvant therapy might be sufficient for young patients of reproductive age.

主気管支腔内を中枢側進展し，一側無気肺による急性呼吸不全を来たした右上葉肺癌に対し，全身麻酔硬性気管支鏡下腫瘍debulkingを施行し，その後待機的根治切除を行った2例を経験した．いずれも低分化型腺癌で，右主気管支の腫瘍を硬性外筒でcore outし，無気肺を改善させてから，待機的に右上葉管状切除術を施行した．症例1は46歳，男性，病理病期III b期（p-T4N2M0）で，現在術後39ヵ月で無再発生存中であり，症例2は79歳男性，病理病期II b期（p-T3N0M0）で，術後日常生活に復したが術後5ヵ月で腫瘍死となった．硬性気管支鏡下腫瘍debulkingは，QOLの一時的な改善のみならず，肺癌に対するその後の集学的治療をすすめる上で有用であった．

Background. Lung cancer rarely shows a lymph node metastasis to pulmonary hilar and/or mediastinal regions without the primary site of the lung being unable to be detected. Case. A 68-year-old man demonstrated a right abnormal hilar shadow on a chest X-ray film. A computed tomography (CT) revealed an enlarged mass at the right pulmonary hilar node, and this mass was diagnosed to be poorly differentiated carcinoma by transbronchial aspiration cytology. However, no primary lesion in the lung was apparent, and the extrathoracic findings showed no abnormalities despite a thorough examination. We thus performed a tumorectomy with right upper lobectomy and mediastinal nodal dissection because of the possibility of a lung origin based on the lymphatic routes to the tumor. The microscopical and immunohistochemical findings were consistent with small cell carcinoma in the pulmonary hilar node. Although no primary lesion of the resected lobe and also other lobes of the lung was found despite detailed examinations, positive immunoreactivity against anti-thyroid transcription factor-1 (TTF-1) antibody revealed this tumor to have originated in the lung. Therefore, we consider that this patient is a rare case of primary unknown T0 lung cancer with metastasis in the pulmonary hilar lymph node. Conclusions. In case of T0 lung cancer, since the primary lesion may later be identified, a strict follow-up study after the operation is necessary.

The indications and suitable approaches for treating upper airway obstruction secondary to thyroid cancer are controversial. Patients with thyroid cancer generally have a good prognosis, but airway stenosis and vocal cord paralysis are not uncommon. Subglottic airway stenting may be challenging, due to stent migration, granulation tissue formation and supraglottic stenosis. In this study, we evaluated the application of covered self-expandable metallic stents to relieve upper airway obstruction. This was a retrospective study of 5 patients with airway stenosis due to thyroid cancer treated in 2009 and 2010. Immediate airway enlargement was achieved in 3 patients with stenosis at the middle mediastinum. Gradual enlargement over 2 months was observed in the remaining 2 patients with stenosis at the cervical level. The performance status was improved in all 5 patients, including a case with anaplastic carcinoma. The follow-up averaged 13 months (range, 8–27 months). Granulation tissue developed at both ends of the stent in 3 patients, sputum was retained in 2 cases and bacterial colonization was detected in all 5 cases. No stent migration was reported. Additional tracheostomy was required in 2 patients, due to proximal tumor growth or progressive bilateral vocal cord paralysis after 10 and 6 months, respectively. In conclusion, stenting for central airway stenosis secondary to thyroid cancer may be beneficial, even in patients with anaplastic carcinoma. Long-term regular bronchoscopic follow-up is required to monitor complications, as patients with thyroid cancer are at high risk of granulation tissue formation, sputum retention and bacterial colonization.

Parenchyma-sparing main bronchial sleeve resection is a safe and effective procedure to restore impaired lung function. We present a case illustrating recovery of lung perfusion in a 24-year-old woman with dyspnea on exertion because of bronchial tuberculosis. Bronchoscopic examination revealed pin-hole stenosis of the left main bronchial orifice. 99mTc-macroaggregated albumin perfusion scanning revealed essentially absent left lung perfusion. Because of bronchomalacia in the distal portion, six rings of the left main bronchus were resected by carinoplasty. Symptoms abated and perfusion recovered to a large extent 2 months later. She became pregnant and delivered successfully 12 months postoperatively.

A 71-year-old man with a right hilar mass shadow was referred to our department. Chest computed tomography showed a small fatty area inside. Convex probe endobronchial ultrasound (CP-EBUS) images revealed a heterogeneous low-echoic mass, resembling a stone wall and showing a smooth sliding movement along the tracheal wall during respiration. Transbronchial needle aspiration (EBUS-TBNA) was performed and cartilage cells were identified, compatible with the presence of a hamartoma. The patient requested follow-up without surgical intervention. CP-EBUS images are easier to interpret than other methods for monitoring respiratory dynamics. We conclude that CP-EBUS is a useful addition to techniques both for non-invasive imaging as well as guiding pathological examination.

The purpose of this study is to retrospectively examine the postoperative pulmonary fistula as a complication after the use of either electrocautery or a harmonic scalpel without stapling devices.The subjects of this study consisted of 28 patients who received a segmentectomy for a pulmonary malignant tumor, 25 cases of lung cancer and 3 of metastatic lung tumor. The electrocautery was used in 17 patients (EC group) and the harmonic scalpel in 11 (HS group). The levels of postoperative air leakage and postoperative complications were examined among the two groups retrospectively. The histological findings of the cut surface of the segmentectomy by electrocautery and harmonic scalpel were also examined.Hemostasis and air leakage both were well controlled during the operation, and the postoperative drainage period was short. No major postoperative complications occurred, and all patients began walking in the early postoperative days. However, 1 to 3 postoperative months after discharge, 8 patients showed late onset of a pulmonary fistula, 3 of the 17 (18%) in the EC group and 5 of the 11 (45%) in the HS group. The histological findings of the cut surface of the segmentectomy showed that most of the layer of coagulation necrosis by the harmonic scalpel measured 2 mm thick, and it was denser than that cut from electrocautery. The lumen of the bronchus markedly decreased in size, but it remained, as it also did under the effects of electrocautery.In the months following the operation, the incidence of the late onset of a pulmonary fistula was higher when the harmonic scalpel was used. It was believed that the small bronchial stump could not tolerate the airway pressure because the thick coagulation necrosis delayed healing of the postoperative wound. It was necessary to ligate the stump of a small bronchus, even though the stump had been temporally closed by coagulation necrosis with the electrocautery or harmonic scalpel during the operation.

Toyota succeeded in the fall of 1984 in manufacturing a complex engine and transmission control system using a newly developed single-chip microcomputer. This microcomputer, equipped with an 8K-byte ROM (Read Only Memory) and a 256-byte RAM (Random Access Memory), a powerful real time processing function, and a high-speed optimum instruction set, is better suited for automobiles. Application of the latest CMOS technology has enabled lower power consumption and improved noise immunity. The new system, which includes a new function, the electronic spark advance with knock control in addition to the conventional sophisticated system, has greatly improved the performance and driveability of vehicles. The newly designed electronic control unit (ECU) has been greatly improved in reliability and has not changed in its size with the adoption of the highly integrated new microcomputer, which is due to the fact that it uses fewer LSIs (Large Scale Integrated circuits) than the conventional ECU, although it includes the great additional function.