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Background Although an airway stent is used for malignant central airway stenosis or obstruction, long-term outcomes are unknown. In this study, we retrospectively analyzed the clinical features of patients who required stenting for malignant central airway stenosis or obstruction. Patients and methods We retrospectively analyzed clinical data from 116 patients with stenting for central airway stenosis or obstruction who underwent treatment at Toho University Hospital from 1998 to 2018. We evaluated the clinical features, prognoses, and complications for stenting in these patients. Results The distribution of the 116 patients was as follows: lung cancer, 53; esophageal cancer, 40; thyroid cancer, 8; and others, 15. Patients with thyroid cancer had a significantly higher rate of complications after stenting than patients with lung cancer (P=0.0062), esophageal cancer (P=0.0029), and others (P=0.0062). Patients with esophageal cancer had a significantly worse prognosis than patients with lung and thyroid cancer. In patients with lung cancer the prognosis was significantly different between patients who underwent additional treatment for lung cancer after stenting and patients with no treatment (P=0.0398), and patients who received chemoradiotherapy for lung cancer after stenting had a significantly better prognosis than patients with no treatment (P=0.0306). Conclusion Stenting for airway stenosis/obstruction may improve prognosis in patients with lung or thyroid cancer, especially if patients with lung cancer undergo additional treatments after stenting, although airway stenting for patients with esophageal cancer was palliative. New treatment strategies may be necessary for patients with esophageal cancer after stenting to improve prognosis.

Silicone airway stents are used to manage central airway stenosis or obstruction, although their impact on long-term survival remains unknown in patients with central airway stenosis or obstruction due to thoracic malignancy. In this study, we retrospectively analyzed the impact of silicone stents on survival. We retrospectively analyzed clinical data of 106 patients with central airway stenosis or obstruction due to thoracic malignancy treated by stenting at Toho University Omori Medical Center between 1998 and 2018. Patients treated with silicone stents had significantly higher survival rates than patients treated with metallic stents (p = 0.0173). Silicone stents patients also had significantly more additional treatments for thoracic malignancy after stenting than metallic stents patients (p = 0.0007). Notably, significantly more silicone stents patients underwent chemoradiotherapy or radiotherapy (p = 0.0268, p = 0.0300). During multivariate analyses, the additional treatment, including chemoradiotherapy or radiotherapy, was an independent optimal prognostic factor. Silicone stents patients had significantly higher survival rates than metallic stents patients. Although stenting for airway stenosis or obstruction due to thoracic malignancy may be mainly palliative, additional treatments after stenting should be considered to improve the prognoses of patients with airway stenosis or obstruction due to thoracic malignancy.

Background We conducted a multicenter randomized study of adjuvant S-1 administration schedules for surgically treated pathological stage IB-IIIA non-small cell lung cancer patients. Methods Patients receiving curative surgical resection were centrally randomized to arm A (4 weeks of oral S-1 and a 2-week rest over 12 months) or arm B (2 weeks of S-1 and a 1-week rest over 12 months). The primary endpoints were completion of the scheduled adjuvant chemotherapy over 12 months, and the secondary endpoints were relative total administration dose, toxicity, and 3-year disease-free survival. Results From April 2005 to January 2012, 80 patients were enrolled, of whom 78 patients were eligible and assessable. The planned S-1 administration over 12 months was accomplished to 28 patients in 38 arm A patients (73.7%) and to 18 patients in 40 arm B patients (45.0%, p = 0.01). The average relative dose intensity was 77.2% for arm A and 58.4% for arm B (p = 0.01). Drug-related grade 3 adverse events were recorded for 11% of arm A and 5% of arm B (p = 0.43). Grade 1–3 elevation of bilirubin, alkaline phosphatase, aspartate aminotransferase, and alanine transaminase were more frequently recorded in arm A than in arm B. The 3-year disease-free survival rate was 79.0% for arm A and 79.3% for arm B (p = 0.94). Conclusions The superiority of feasibility of the shorter schedule was not recognized in the present study. The conventional schedule showed higher completion rates over 12 months (p = 0.01) and relative dose intensity of S-1 (p = 0.01). Toxicity showed no significant difference among the shorter schedule and the conventional schedule, except for grade 1–3 elevation of bilirubin. Trial registration This randomized multicenter study was retrospectively registered with the UMIN-CTR (UMIN000016086, registration date December 30, 2014).

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.

Aim: The aim of this study was to clarify the relationship between pathological effects and the prognosis of patients with stage III non-small cell lung cancer (NSCLC) treated with induction chemoradiation. Methods: Patients who were untreated and potentially resectable with stage III NSCLC were enrolled. They received carboplatin and docetaxel with concurrent radiotherapy (5 × 2 Gy/week with a total dose of 40 Gy) followed by surgery. We assessed the relationship between the pathological effect (Ef) (Ef 1: slight pathological response, Ef 2: moderate pathological response, Ef 3: complete pathological response) and prognosis. Results: In all, 30 patients with stage III NSCLC (24 men and 6 women, mean age 60.7 years, 17 with adenocarcinomas and 13 with squamous cell carcinomas, 21 with clinical stage IIIA and nine with stage IIIB) participated in the trial and underwent induction chemoradiation. A total of 27 patients (90%) with complete response, partial response and stable disease had surgical resection. The pathological effect was Ef 1 and Ef 2 in 10 patients each, and Ef 3 in seven patients. Median survival was 10.9 months in patients with Ef 1 and 49.6 months in patients with Ef 2. Six out of seven Ef 3 patients are alive at the time of writing with a mean survival of 77.1 months (14–104 months). There was a significant difference in overall survival based on pathological effect rating (P = 0.0036). Conclusion: The Ef rating was well correlated with prognosis after induction chemoradiation.

70歳男性．Chronic obstructive pulmonary disease（以下COPD）を合併した低肺機能の肺癌に対し肺葉切除術を施行した．Hugh-Jones分類 II 度で1秒量0.77 Lの重症COPDに合併した肺腺癌（C-T2N0M0）に対して，まず術前呼吸リハビリテーションおよびTiotropiumbromideの吸入を行い，3週間後に1秒量が0.81 Lに改善した．術後予測1秒量は予測値の33％であったが，無効肺容量の減少効果を期待して，左上葉切除術を施行した．術後3ヵ月の1秒量は0.77 Lであり極端な低下を認めず，術後3年10ヵ月の現在，呼吸機能は安定している．一般には肺葉切除の非適応と判断された重症COPD合併肺癌に対して，呼吸リハビリの併用と手術によって無効肺容量を減少させることによって肺機能を維持することができた1例を経験した．

Background: The purpose of this study was to clarify the clinical characteristics of lung cancer patients with abnormal accumulation of fluoro-2-deoxyglucose (FDG) in the gastrointestinal tract imaged by positron emission tomography (PET). Methods: Of 1071 consecutive patients with primary lung cancer who underwent PET from October 2005 through to March 2010, 25 patients (2.3%) showed localized abnormal FDG accumulation in the gastrointestinal tract. We retrospectively compared the location of abnormal accumulation in the gastrointestinal tract, the maximum standardized uptake value in 1 hour, and final clinical diagnosis. Results: Of the 25 cases, 12 (48%) were true PET-positive cases (esophageal cancer in one case, gastric cancer in one, colorectal cancer in seven, gastrointestinal stromal tumor in one, and lung cancer metastasis to the stomach and small intestine in one patient each). The 13 cases with false PET-positives were gastric polyp in one, gastritis in four, colon polyp in two, diverticulitis in one, and normal physiological accumulation in five. There was also a significant difference between malignancy and benign intestinal accumulation excluding the stomach (P = 0.002). Conclusion: PET was useful for screening the gastrointestinal tract (except the stomach) for malignancy in lung cancer patients.

肺肉腫では時に中枢側気道内進展による呼吸不全症状を呈することがある．今回我々は急速に増大した肺肉腫に対し，硬性鏡下腫瘍削除術による術前気道確保と，気管吻合部狭窄に対する術中Dumonステント留置が有用であった一例を報告する．症例は21歳男性，主訴は窒息症状．右主気管支から下部気管をほぼ閉塞する腫瘤を認め，緊急硬性鏡下腫瘍削除術により，中枢気道の確保と右無気肺の改善を得た．切除標本で紡錘形細胞肺肉腫が疑われ，二期的にスリーブ右肺全摘術を施行した．右肺門部から右上葉および気管右壁に腫瘤を形成しており，分岐部を含め気管5軟骨輪と左2軟骨輪を切除し端々吻合した．術中に吻合部過緊張による吻合部狭窄を生じたため，Dumonステントを挿入して再吻合した．術後4ヵ月で局所再発を認め，doxorubicin/ifosfamideによる化学療法で一時PRを得たが，次第に化学療法無効となり術後26ヵ月で腫瘍死した．

症例は26歳男性，右季肋部鈍痛を主訴に近医を受診し，右下肺野に腫瘤影を指摘され当院紹介となった．1年前の胸部X線写真では同腫瘤影は明らかではなく，心横隔膜角の直下に淡い斑状影が疑われたのみであった．胸部CTでは右横隔膜上に嚢胞状腫瘤を認め，腫瘤の栄養血管が腹腔動脈から分岐していた．大動脈造影では腹腔動脈から分枝し腫瘤に流入する異常動脈を認め，静脈相では下肺静脈に流入していた．肺分画症と診断し，右肺下葉切除を施行した．異常動脈は肺靱帯に含まれておりstaplerで切離した．嚢胞部分は一層の気管支上皮に裏打ちされ，内部に多量の凝血塊を含んでおり，出血により著明に拡張した分画肺の気管支腔と考えられた．肺葉内肺分画症では，感染症状を伴わず，出血による急速な増大や，さらには破綻による血胸や出血性ショックを呈することがあるため，診断に留意する必要がある．

We report a case of pulmonary Mycobacterium abscessus (M. abscessus) infection with destructive growth in the entire right lung. The patient was 56-year-old woman who had had pulmonary tuberculosis at the age of 40 and had been diagnosed as having pulmonary Mycobacterium abscessus infection 4 years prior to admission at our hospital. Although various antibiotics were administered, persistent fever, hemoptysis and weight loss developed. After undergoing a right pneumonectomy, her clinical symptoms improved dramatically and sputum excretions of M. abscessus ceased. No relapse of the disease has been observed in the 2 years since surgery. Pneumonectomy was very effective for refractory M. abscessus infection that destroyed the right lung.

症例は66歳男性，右上肺野腫瘤影を指摘され精査したところ，右S2末梢の35mm大の扁平上皮癌と右B7入口部の結節型内視鏡的早期扁平上皮癌を認めた．同時性多発肺癌と判断し，右S2扁平上皮癌に対して，右上葉切除および縦隔リンパ郭清を行い病理病期II B（pT3N0M0）であった．術後3ヵ月目に右B7入口部扁平上皮癌に対して61.2GyEの炭素イオン線照射を行い，CRとなった．術後5年3ヵ月，無再発生存中である．多発肺癌に対し，重粒子線治療は局所制御能に優れ，第二癌の根治的治療法のひとつとして有効と思われた．

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．

A 55-year-old man was hospitalized for treatment of a giant, fluid-filled bulla in the upper lobe of the right lung. The infection was resistant to antibiotics, and the resulting drug-induced liver dysfunction prohibited us from performing emergency lobectomy. Percutaneous drainage of the bulla was done initially, using a 28-Fr chest tube, after which the symptoms of infection improved rapidly. Despite a small air leakage, which became evident on day 4 of drainage, shrinkage of the bulla was achieved, and elective bullectomy was performed after continuous drainage for 21 days. Thus, percutaneous drainage was effective in controlling the infection and minimizing the invasiveness of surgery.

78歳非喫煙男性．発熱・喀痰のため近医受診し，胸部X線写真で右下肺野に10cm大の空洞を有する15cm大の腫瘤影を指摘された．肺化膿症として2ヵ月間の抗生剤投与を受けたが軽快せず，喀痰細胞診で腺癌を認め，当院紹介となった．壊死・感染を伴った肺癌の診断で右下葉切除術を施行したところ，空洞内容は白色粘液で充満しており，粘液産生性の細気管支肺胞上皮癌であった（pt2n0m0）．術後経過は良好であったが，術後3ヵ月で両肺に多発する小空洞陰影として再発し，術後11ヵ月で多発転移巣の薄壁嚢胞化を認めた．気管支肺胞上皮癌としては大空洞を伴い特異な経過を呈したため考察を加え報告する．

肺の高悪性度神経内分泌腫瘍には大細胞神経内分泌癌と小細胞癌とが含まれるが，両者は組織学的に鑑別困難な場合がある．これらを一括して術後経過を検討したところ，病期I期であった17例のうち，7例は術後15ヵ月までに死亡し，10例は25～145ヵ月間再発なく生存していた．そこで，早期死亡例と長期生存例との間における高悪性度神経内分泌腫瘍の病理学的差異について検討した．その結果，組織学的に特定の構造を示すことなく充実性に増殖する腫瘍は早期死亡例に多く，神経内分泌への分化を示す腫瘍や他の癌腫成分が混在する腫瘍は長期生存例に多く存在した．また，早期死亡例では長期生存例に比しMIB-1標識率が有意に高かった．病期I期の高悪性度肺神経内分泌腫瘍では，形態学的な癌の分化傾向の程度やMIB-1標識率から予後を推測しうると考えられた．

Objective. To demonstrate the characteristic clinical features of acute exacerbation of interstitial pneumonia(IP)associated with lung cancer after anti‑cancer treatment. Methods. Consecutive 776 cases with lung cancer between June 1999 and April 2007 were retrospectively evaluated to clarify the clinicopathological characteris‑ tics of acute exacerbation of IP associated with lung cancer after anti‑cancer treatment. Results. Among 776 cases of lung cancer 39 cases(5%)had concomitant IP. Acute exacerbation of IP after treatment was found in 6 of the 39 cases(15%) and 4 cases(10%)died of respiratory failure. There were no significant differences in LDH KL‑6 SP‑D PaO2 %VC or %DLco between the acute exacerbation group and the non‑acute exacerbation group before anti‑ cancer treatment. Of the 6 cases with acute exacerbation of IP after treatment exacerbation occurred after chemo‑ therapy in 5 out of 24 cases(21%) and after surgical resection of the lung cancer in 1 out of 6 cases(17%) .A mong the 6 cases with acute exacerbation of IP the subclassification of IP was IPF in 4 and collagen vascular disease‑IP(CVD‑ IP)in 2. Among the 4 cases who died of respiratory failure after acute exacerbation of IP the underlying systemic dis‑ ease was IPF in 2 and CVD‑IP in 2. Conclusion. Both IIPs and CVD‑IP should go through the anti‑cancer treatment

全世界で禁煙運動が繰り広げられている中, ニコチンパッチ置換療法が効果をあげてきている。禁煙外来における本療法の成績と問題点につき検討した。2001年9月～2004年7月までに禁煙外来に受診した93名を対象とした。このうち約2週間の節煙期間を置いた上で, 約2カ月間のニコチンパッチ置換療法を施行したのは59名 (63%) で, 禁煙開始後1カ月目, 3カ月目, 6カ月目, 12カ月目の4点で呼気COガス濃度測定を行い, 禁煙達成率を調べてみた。置換療法施行群の禁煙後1カ月, 3カ月, 6カ月, 12カ月の禁煙達成率は, それぞれ65%, 50%, 42%, 37%と徐々に低下し, 禁煙12カ月後の禁煙達成者は, 本療法実施者の約1/3と少なかった。一方, 2週間の節煙後にニコチンパッチ置換療法を施行しなかった34名は結局禁煙できなかったが, 初診時呼気CO濃度20～29 ppm : 9名, 30 ppm以上 : 14名と, 初診時CO濃度がニコチンパッチ施行群に比べて高い例が多かった。ニコチンパッチ置換療法による禁煙達成率は, 短期観察では良好であったのに, 長期観察では低率となった。医師による厳重な初期観察をはずれると, 再喫煙する者が多いことは, 喫煙の健康被害についての啓蒙教育がいまだ不十分であることや, 非喫煙家族あるいは友人からの精神的サポート, 医療者側のサポートが欠かせないことが示唆された。

〈目的〉各種気管病変による気管壁の異常所見は，通常のCT検査および内視鏡検査で確認するのにとどまってきた。通常のCT検査に呼吸運動を加えたdynamic CT検査が，気管病変の診断に新たな情報をもたらすか否かを検討した。〈対象および方法〉dynamic CT検査は，通常の胸部CT画像から壁運動が最も異常を示すと思われる部位で深呼吸時に，1秒スキャン1秒インターバルでデータ収集を行った。連続的に作成した画像をシネモードにして気管壁の動きを観察した。対象は2000年8月～2002年4月の間に検査された気管病変9例で，その内訳は，年齢28～86歳，男女比5：4で，A群：気管壁伸展例2例（気管憩室1例，皮膚弁による気管壁欠損部補填1例），B群：腫瘍あるいは損傷による気管狭窄例7例（悪性腫瘍による気管狭窄4例，気管損傷3例）の2群に分類して検討した。〈結果〉dynamic CT検査は気管壁を動的にとらえることができた。気管壁が軟弱となっている気管憩室と皮膚弁による気管形成術後の2例では，吸気終末あるいは呼気終末時に続く最後の怒責によって気道内圧が上昇したときに，軟弱部が外側に膨隆することにより著明な気道腔開大が認められた。一方，腫瘍性狭窄例では全例で呼気時の狭窄が著明となり，腫瘍浸潤のために気管壁の動きが不良となった範囲とその程度を明示することができた。〈結論〉気管におけるdynamic CT検査は，病変の範囲および進行状況を把握するのに有用であり，さらに治療法を検討する上での一助になると思われた。

A ciliated muconodular papillary tumor has been reported to be a peripheral low-grade malignant tumor, consisting of ciliated columnar cells and goblet cells with basaloid cell proliferation. Although ciliated muconodular papillary tumors have not yet been classified according to the World Health Organization classification, they can pose diagnostic and therapeutic problems. Here we report a resected case of ciliated muconodular papillary tumor with computed tomography findings reminiscent of adenocarcinoma, showing a small irregular nodule adjacent to the intersegment pulmonary vein. There was no uptake of F-18 fluorodeoxyglucose positron emission tomography. The patient underwent surgical resection, and a lobectomy was performed because intraoperative needle biopsy suggested neoplastic proliferation. No EGFR mutations were detected. No recurrence was noted during 24-month follow-up after lobectomy.

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.

症例は2歳8ヵ月の男児で, 咳嗽, 呼吸困難のために当院に入院.胸部X線, CTで左上葉の過膨脹を認めた・全身麻酔下の気管支鏡検査で左上葉支のチェックバルブ状の狭窄を認め先天性肺葉性肺気腫と診断した.治療は左上葉切除を行い, 術後経過は順調であった.病理検査では左上葉気管支壁に異常は認めず, 原因不明であった.手術時の体重は正常下限であったが, 術後1年4ヵ月には体重は平均値にまで増加し, 先天性肺葉性肺気腫が患児の正常な成長に障害となっていた可能性が示唆された.

薄壁空洞を形成した原発性肺腺癌を経験した.症例は59歳, 男性.咳嗽, 血痰, 発熱を主訴に近医受診, 胸部X線写真およびCT写真上, 右上葉に直径約6.5cm大の薄壁空洞を伴う陰影を認め当院紹介となった.精査にて原発性肺腺癌と診断, 右上葉切除術を施行した.病理診断で低分化型腺癌と診断 (P-T3NOMO), また空洞壁内には壊死組織凝血壊死像やfibrinの析出を認めた.空洞形成の原因は腫瘍内部の壊死によると考えられた.術後5カ月目に左肺野に同様の薄壁空洞が多数出現し転移と診断, その後も空洞は急速に発育し, 10カ月目に癌死した.肺癌における薄壁空洞形成は比較的稀である.自験例における空洞形成の成因は病理所見, 臨床経過などから癌細胞自体から分泌される蛋白分解酵素によるCell Autophagism説が疑われた.文献的考察を加え報告する.

Controversy exists regarding the relationship of the degree of c-erbB-2 amplification to other prognostic factors in breast cancer. To determine the degree of amplification of c-erbB-2 exactly, a sensitive and quantitative method is required. We have developed a competitive PCR method to quantitatively determine the amplification of the c-erbB-2 oncogene. Using this method, we evaluated DNA from 27 breast cancer tissue specimens and DNA from peripheral blood leukocytes from a normal individual. Regarding the relationship between the degree of c-erbB-2 amplification and clinicopathological factors, we found a greater degree of amplification of the c-erbB-2 oncogene in estrogen receptor- negative or progesterone receptor-negative specimens than in positive ones and in lymph node metastasis-positive specimens than in negative specimens, in stages II, III, and IV of disease compared with stage I disease, and in samples with positive lymphatic vessel invasion than with no lymphatic vessel invasion. Generally, these factors were seen in the group of patients who had a bad prognosis. By univariate analysis and multivariate analysis, reverse correlation was observed between amplification of c-erbB-2 and overall survival. Regarding disease-free survival, these relationships were observed only with univariate analysis in our group of patients.

An 86-year-old woman with a 30-year history of goiter was hospitalized with severe stridor and progressive dyspnea on exertion that had worsened over the past year. The trachea was severely compressed by a huge mass, measuring 15 cm in diameter, on the left side of her neck. For the prevention of postoperative instability, a Dumon stent was placed in the trachea for 3 days. The postoperative course was uneventful and she was discharged on day 32. With the temporal placement of the Dumon stent, the airway became secured and early ambulation was possible. We prefer temporal Dumon stent placement for patients at risk for tracheomalacia who have marked tracheal stenosis, especially in the elderly, instead of either prolonged intubation or performing a tracheostomy.

The various methods of treating the numerous types of anterior mediastinal neoplasms are undergoing refinements; however, prior to the commencement of any treatment, an accurate histologic diagnosis must be established. We conducted a retrospective analysis of biopsies performed through a parasternal anterior mediastinotomy (PAM) on 21 patients with an anterior mediastial mass suspected of being malignant by computed tomography (CT) and other clinical information. Patients with possible localized thymomas were excluded. Mediastinotomy, which enables relatively large tissue samples to be taken, was performed through the bed of the second or third costal cartilage under local anesthesia. In 19 of the 21 patients (90%), the histologic diagnosis made from the mediastinotomy biopsy was identical to the final diagnosis. Conversely, although the tissue obtained from needle biopsy was sufficient for a histologic diagnosis in 11 of 12 patients, the histologic diagnosis made from the needle biopsy was the same as the final diagnosis in only 5 of 10 patients (50%). Thus, diagnostic accuracy was significantly higher in the mediastinotomy biopsies than in the needle biopsies (P = 0.0318). Moreover, the mediastinotomy biopsy specimens revealed subtypes of lymphomas and germ cell tumors. All of the patients from whom a mediastinotomy biopsy had been taken began appropriate therapy without delay according to the histologic diagnosis. These results suggest that the PAM approach should be chosen as the preferred method of biopsy for suspected malignant anterior mediastinal tumors.

肺転移を切除した稀な胃癌5例について, 原発巣と転移巣を臨床病理学的に比較するとともに免疫組織化学的に糖鎖抗原 (SLX, CA19-9) の発現を検討した.再発転移形式で分類すると, 肺の転移巣再切除が可能と思われたのは3例であった.これらは肺を主たる標的臓器として転移巣を形成する傾向があったと考えられ, 共通点は転移巣の病理組織が分化型 (腸型) であり, CA19-9が陽性を示したことであった.このうち1例に5年生存が得られた.この1例は原発巣よりも転移巣でSLXの減弱がみられた.胃癌の結節状肺転移の形成や予後に糖鎖抗原が関与している可能性が示唆された.

一時的バイパス設置下に切除し得た大動脈漫潤肺癌2例を経験した.症例1は64歳男性, 左上葉大細胞癌。腫瘍は下行大動脈に浸潤しており, 左鎖骨下動脈一下行大動脈間にバイパスを設置し大動脈の外膜のみを剥離して, 左上葉切除によって摘出した.症例2は48歳男性, 左下葉腺癌.腫瘍は下行大動脈に浸潤しており, 腫瘍を挟み下行一下行大動脈間にバイパスを設置して大動脈環状切除を行い, 左下葉切除によって摘出した.肺癌の大動脈浸潤例に対する一時的バイパスの設置は補助循環を使用する事なく簡便でかつ安全な方法であると考えられた.

This paper descibes a case of recurrent pneumothorax two months after a thoracoscopic bullectomy for spontaneous pneumothorax which needed another bullectomy. A 25-year-old man was seen at the male visited our hospital because of right chest pain and was admitted with a diagnosis of right spontaneous pneumothorax. We successfully performed a thoracoscopic bullectomy and the patient was discharged from the hospital. However, on the 67th postoperative day, the patient was re-admitted because of recurrent pneumothorax, and on the 77nd postoperative day, we performed another bullectomy via axillary thoracotomy. At the re-operation, one bulla measuring about 1.5 cm which was located from near the staples of th first operation was found to be ruptured. It is thought that a major cause of such a recurrent case is oversight of bullae and neoplasms or their enlargement. Mechanisms and causes of recurrent pneumothorax should be further investigated.

大腸癌肺転移を切除した20例の原発巣と転移巣について, 糖鎖抗原 (SLX, CA19-9) の発現を免疫組織化学的に調べ, 予後や転移との関連について検討した.原発巣と肺転移巣の糖鎖抗原の発現はほぼ同等であった.SLXを発現している群では原発巣切除後の生存率が発現していない群より不良であった.CA19-9と肺転移個数とに関連がみられ, 転移個数では4個までと5個以上で生存率に差を認めた.原発部位別では, 結腸癌は全例が糖鎖抗原陽性であり, 直腸癌は60%が陽性-であった.大腸癌の好肺転移性や予後と糖鎖抗原発現との関連が示唆された.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is becoming more common for diagnosing intrathoracic lymphadenopathy, including tuberculous lymphadenopathy. We herein report two cases of complications possibly related to EBUS-TBNA for tuberculous lymphadenopathy. The first patient was a 26-year-old woman who developed intrabronchial polypoid granulomas exclusively at puncture sites two months after undergoing EBUS-TBNA. Although endobronchial extension may occur, the risk of aggravation caused by puncture should be considered. The second patient was a 39-year-old woman with transient smear-positive bloody sputum that developed immediately after EBUS-TBNA and persisted for three days. Temporary isolation following EBUS-TBNA should be considered for possible tuberculous lymphadenopathy.

Malignant central airway obstruction is a life-threatening presentation requiring emergency palliative procedure. In selected patients, bronchoscopic intervention could be used as a bridge to curative resection. Here we report a 54-year-old male with pulmonary sarcoma of the right upper lobe, presenting with acute respiratory failure because of endobronchial extension. Emergency coring with the rigid bronchoscope and Dumon stent insertion stabilized the patient, and subsequent lobectomy resulted in occurrence-free survival over a 71-month follow-up.

Here, we present a 54-year old man 9 years after induction chemoradiotherapy and subsequent lower bilobectomy for Stage IIIA lung cancer suffering late complications of pyothorax and bronchopleural fistula in a severely damaged lung. Open-window thoracostomy and subsequent completion pneumonectomy via median sternotomy and anterior thoracotomy were performed. Although sternal wound infection required steel wire removal and debridement, with wound dressing at home, the patient could return to work. Late complications from infected treatment-damaged lungs need to be taken into consideration after induction chemoradiotherapy and subsequent surgery.

A 22-year old man presented with a massive haemothorax 25 days after bullectomy for a spontaneous pneumothorax. Thoracoscopic surgery revealed ongoing bleeding from the chest wall caused by a sharp edge of the Endoloop Ligature (Ethicon Endo-Surgery) used to resect the remaining small part of the lung at the earlier staple bullectomy. The point where bleeding was occurring was clipped and covered using a collagen patch coated with human fibrinogen and thrombin. The protruding sharp edge of the Endoloop was excised together with the surrounding lung tissue, using a stapler. Although prevention of this type of complication is difficult, awareness of the potential problem may help in managing such extremely rare events.

A 45-year-old man with bronchial carcinoid arising from the subsegmental middle-lobe bronchus was treated by video-assisted thoracic surgery. Lobectomy with mediastinal and hilar lymph node sampling was successfully performed in this patient. To obtain a tumor-free surgical margin on the middle-lobe bronchus, the interlobar pulmonary artery was retracted posteriorly, the middle-lobe bronchus anteriorly. The bronchus was then stapled and transected.

A method of endoscopic treatment via rigid bronchoscopy for treatment of tracheobronchial obstruction due to malignant tumor was discussed.Five cases involving the trachea, one case involving the tracheobronchus and 5 cases involving the main stem bronchi were treated with a Dumon bronchoscope (EFER, France) under general anesthesia from 1992 to 1995.Three cases of Nd : YAG laser irradiation to the endoluminal mass and 6 cases of Dumon stent to the extrinsic compression were performed successfully, and each airway obstruction was rapidly relieved. The quality of life was improved in these cases, however 2 other cases had a difficulty in stent fixation.Endoscopic treatment with a rigid scope is a safe and successful procedure because it maintains a good airway with a large open tube and is more comfortable for the patients, especially for those with a significant or life-threatening obstruction of a major airway.Bronchoscopists should use rigid bronchoscopes as well as flexible bronchoscopes in treating airway obstructions.

We report a case of metachronous quadruple cancer with all lesions resected duaring a 6-year period. A 63-year-old man was operated on for a middle pharynx tumor at the age of 57 and for a cancer in the oral cavity at the age of 61. Subsequently, an abnormal shadow was seen on a chest X-ray film and the patient underwent a left upper lobectomy. The lung tumor was pathologically diagnosed as “primary lung cancer”. Duaring this admission, a minute esophageal tumor was also detected duraing esophageal endoscopy and the lesion was excised by endoscopic mucosal resection. These has been no sign of recurrence as of 10 months after the 4th operation. Some notes on 33 cases of quadruple cancer seen in the Japanese literatiure are also presented here.

悪性腫瘍の胸椎転移例に対して人工椎体を用い切除再建を行い, 良好な結果を得た.症例は64歳男性で, 右第2-3肋骨から第2-3胸椎にわたった腫瘍を認め, 組織学的には未分化癌であった.術前に40 Gyの放射線照射を行ったところ, 腫瘍は著明に縮小した.手術は胸壁側は腫瘍より約5cm離して肋骨, 横突起まで合併切除し第2-3胸椎及び上下の椎間格を切除.チタン性の人工胸椎を挿入固定した腫瘍はすべて線維化巣におき変わっており, 術前放射線治療が著効を示したものと考えられた.人工椎体は変位等もなく固定は良好で日常生活に支障はなく, また術後15ヵ月を経過し, 原発巣と考えられる腫瘍は認めない.