Combined thoracoscopic lung resection and laser ablation for lung cancer with pulmonary emphysema: report of a case

The incidence of clinically detectable parenchymal liver metastases in patients with recurrent ovarian carcinoma has been infrequently reported, but autopsy findings indicate that they are the second most common site of distant metastases in patients with epithelial ovarian carcinoma. The case of a 58-year-old patient who developed parenchymal liver metastases as the first site of recurrent ovarian carcinoma is presented. The different spreading routes of this malignancy, as well as a review of the incidence of liver metastases are discussed.     

Left partial anomalous pulmonary venous connection found during a lobectomy for lung cancer: report of a case

We report herein the case of a 68-year-old man in whom a partial anomalous pulmonary venous connection (PAPVC) was found during an operation for primary lung cancer. The preoperative clinical findings did not suggest a vascular shunt, and intraoperatively the anomalous vein was seen to drain only from the left upper lobe into the left innominate vein. The lower pulmonary vein connected normally, and there was no atrial septal defect nor any other anomalous condition. A left upper lobectomy with ligation of the anomalous connected vein was performed uneventfully. This type of PAPVC is extremely rare, and is especially noteworthy because there were no clinical signs.     

Technical feasibility of video-assisted lobectomy with radical lymphadenectomy for primary lung cancer

The morbidity and mortality for video-assisted curative resection of lung cancer was evaluated retrospectively. Forty-one consecutive patients with stage I and II lung cancer underwent video-assisted curative lobectomy with complete hilar and mediastinal lymphadenectomy. Conversion to an open procedure was necessary in two patients. The operating times for the second half of the series were shorter than for the first half. Compared with patients receiving a standard open procedure, the video-assisted patients experienced satisfactory results. We conclude that video-assisted curative lobectomy with complete lymphadenectomy for stage I and II lung cancer is technically feasible in the majority of patients, although follow-up is required to determine the long-term prognosis. Comparative series between video-assisted and open procedures should not be conducted until the surgeon has acquired the necessary video-assisted skills. A prospective randomized trial will determine the actual value of video-assisted procedure for lung cancer treatment.     

A voice-controlled robot assisted thoracoscopic surgery for pulmonary tumor

We herein report a case of voice-controlled robot assisted thoracoscopic surgery for a right apical tumor in a 55-year-old male. The patient was referred to our hospital for further examination of an abnormal shadow on chest X-ray. A chest computed tomographic scan indicated a suspicion of malignancy. Thoracoscopic surgery using a voice-controlled robot was conducted. The thoracoscope connected with the robotic arm was inserted through the trocar. In all maneuvers (forward and backward, right and left, up and down, insertion and extraction), the robotic arm moved appropriately immediately after the voice commands were issued, and favorable operative fields were obtained. Thoracoscopic partial resection of the involved lung was successfully performed with no complications. The operative time was 140 min. The postoperative course was uneventful. Voice-controlled robotic technology innovations may become the operating surgeon's third arm in the future. They will be further used not only in laparoscopic but also in thoracoscopic surgical procedures. Regular use will lead to greater skill in thoracoscopic application with the advent of new robotically assisted endoscopic surgery.     

Is video-assisted thoracoscopic lobectomy a unified approach?

BACKGROUND: Few surgeons worldwide currently perform video-assisted thoracoscopic (VAT) lobectomy. We conducted a questionnaire survey of this selected group of surgeons to gain insight into their current practice. METHODS: A survey with 25 questions on VAT lobectomy including operative approaches, techniques, its role in their practice, and limitations were mailed to 45 thoracic surgeons worldwide who are believed to perform this operation. RESULTS: Thirty-three completed questionnaires were analyzed. Among those surgeons practicing VAT lobectomy, the vast majority work in an academic or government institution and have at least 5 years of practice experience. Two thirds reported that at least 40% of all their thoracic procedures are currently performed using VAT techniques. However, considerable variations exist regarding preference for VAT lobectomy (one third uses VAT techniques in less than 10% of all lobectomies performed, whereas another third uses it in more than 40% of lobectomies), their approaches to mediastinal and hilar lymph nodes, and their operative techniques. The latter range from a purely endoscopic technique to one that is more appropriately termed minithoracotomy with video-assistance when the surgeons operate primarily by looking through the utility thoracotomy. There were no significant differences in the practices of surgeons working in different continents, except that Asian surgeons were more likely to use suture ligation as opposed to a staple-cutter on pulmonary vessels. CONCLUSIONS: Video-assisted thoracoscopic lobectomy is not a unified approach. Considerable variations exist among the small group of surgeons performing this procedure, in their approach to surgical oncology as well as the operative technique. Distinctions in these different operative approaches must be made before one can make a meaningful comparison of results. Different terms should probably be introduced to further clarify the exact techniques used.     

A case of ectopic amylase-producing lung cancer

A case of amylase-producing lung cancer is reported. A 58-year-old man was admitted to our hospital because of abnormal shadow on chest X-rays. Transbronchial lung biopsy showed adenocarcinoma at the right upper lobe. Amylase levels were elevated to 915 IU/l in the serum and 960 IU/l in urine. Amylase isozyme pattern identified "salivary-type" amylase. Right upper lobectomy was performed. Both serum and urine, amylase levels were decreased within normal limits after operation. Enzyme labeled immunoperoxidase method on this specimen proved that tumor cells were producing amylase ectopically.     

Analysis of small peripheral lung cancer diagnosed by open lung or thoracoscopic biopsy

Interferons are cytokines produced by cells in response to stimulation by certain antigens and infectious agents. In recent years, recombinant interferons have been developed, which have antiviral, antiproliferative, and immunomodulatory functions. Several cutaneous reactions have been reported, including cutaneous ulceration at injection sites. We now report three cases of cutaneous ulceration caused by interferon beta-1b injections. In addition, we review all of the previously reported cases of cutaneous ulceration caused by recombinant interferons and discuss the different mechanisms by which these substances may produce this effect.     

Prediction of postoperative pulmonary hemodynamics for the second lobectomy after the contralateral lobectomy

We presented 7 cases who were performed the second lobectomy for the second lung cancer after the first successful lobectomy on the contralateral lung (3 cases for right upper lobectomy + left lower lobectomy and 4 cases for right upper lobectomy + left lower lobectomy). In 6 patients, the predicted postoperative FEV1 estimated by multiplying the preoperative FEV1 by the fraction of perfusion to the contralateral lung was less than 800 ml/m2BSA, which is our first cut-off for identifying lung resection candidates. Unilateral pulmonary arterial occlusion test (UPAO) revealed that total pulmonary vascular resistance (TPVRI) in 3 of those 6 patients was lower than 700 dyne.sec.cm-5/m2BSA, our second cut-off for lung resection. More precise postlobectomy pulmonary hemodynamics in another 3 of those 6 patients were then estimated by adapting selective pulmonary occlusion test (SPAO). Since TPVRI during SPAO was lower than the cut-off value, it was suggested that second lobectomy would be feasible with low incidence of post operative cardiopulmonary complication. There was no serious complications in all 7 cases during their postoperative course. We believe that more precise prediction of postoperative pulmonary hemodynamics by adapting UPAO and SPAO could be one of the tools to minimumize postoperative cardiopulmonary complications in those patients needed second lobectomy for the second lung cancer after the first successful lobectomy on the contralateral lung even though their impaired lung fung function.     

Longitudinal follow-up of pulmonary function after lobectomy in childhood - factors affecting lung growth

We examined the changes in pulmonary function values in 27 patients who underwent a lobectomy due to cystic lung disease and compared the results regarding such factors as disease type, age at operation, and preoperative infections. Percent vital capacity (%VC) decreased immediately after lobectomy, but recovered to normal values within 2 postoperative years and remained within or above the normal range. The ratio of residual volume to total lung capacity (RV/TLC) rose temporally with the increase in %VC, but then remained normal after 2 postoperative years. There was no difference in %VC and RV/TLC between diseases, while bronchial atresia showed a significantly lower correlation with percent of forced expiratory volume at 1 s. The older group operated upon at over 4 years of age and the group that had infections before operation showed relatively low %VC and high RV/TLC. Some patients demonstrated extremely low %VC along with funnel chest deformities. Our study suggests that overinflation of the remaining lung compensates VC in the early period after lobectomy while subsequently alveolar multiplication occurs. Factors affecting compensatory lung growth were considered to be operation later than 4 years of age, preoperative infection, and a thoracic deformity.     

Thoracoscopic-assisted pulmonary resection in lung cancer

BACKGROUND: Thoracoscopic-assisted pulmonary resection for lung cancer is controversial. The appropriateness of this approach has to be compared with the golden standard of an open resection. METHODS: This study consists of 66 patients with a clinical stage 1 disease. A thoracoscopic exploration was executed in 41 patients. Only in 16 cases was a thoracoscopic resection finally possible. The clinical and pathological TNM classification, the histological types and the surgical procedure are reported. The reasons for conversion are documented. RESULTS: To investigate the appropriateness of the thoracoscopic approach we evaluated only the pathologically proven stage 1 disease in both groups. Postoperative complications, hospital stay and survival are compared. CONCLUSION: Until now we can conclude that there is no adverse effect on survival because of the thoracoscopic approach.     

A case of pneumoconiosis (welder''s lung) suspected to be lung cancer

PURPOSE: Seizures provoked by television viewing may be triggered by patterns in the television image or by flicker from the display itself. We examined the incidence of EEG abnormalities elicited by patterns displayed on television sets with two different frame rates to evaluate the likely contribution of photosensitive and pattern-sensitive mechanisms to television- and video-game epilepsy. METHODS: Televisions with frame rates of 50 and 100 Hz were used to present 35 patients who were photosensitive or pattern-sensitive with grating patterns. These patterns comprised vertical square-wave and sine-wave gratings of 90% contrast, and the spatial frequency was varied between 0.25-7 cycles/degree. EEGs were analysed for laboratory sensitivity to patterned and unpatterned intermittent photic stimulation (IPS). RESULTS: Significantly fewer EEG abnormalities were elicited by patterns displayed on the 100 Hz frame-rate television than on the 50-Hz frame-rate television. No abnormalities were observed in response to the blank screens of either television. Thirty-three patients showed abnormalities in response to patterned IPS but only 15 in response to diffuse flash. Two patients showed no laboratory evidence of photosensitivity. Patients who were sensitive to patterned IPS at 50 Hz were significantly more likely to demonstrate abnormalities to patterns displayed on the 100-Hz frame-rate television than were patients who were not sensitive to 50-Hz patterned IPS. CONCLUSIONS: We suggest that for many patients, the combination of high-contrast patterns and screen flicker may elicit the observed EEG abnormalities. For patients with sensitivity to screen flicker, the use of a high frame-rate television may be beneficial in reducing the risk of seizures.     

A case of binocular blindness in small cell lung cancer

A monoclonal antibody (mAb) binding to protein C (PC) heavy chain but not to activated PC was found to inhibit PC activation by free thrombin, suggesting that epitope involved the activation site. Using a set of overlapping synthetic peptides, we confirmed that this mAb recognizes the sequence encompassing the thrombin cleavage site (165QVDPRLI(171)). Surprisingly, epitope was only accessible in the absence of calcium, half-maximal inhibition of mAb binding occurring at 100 microM Ca2+. Thus, our antibody provides direct evidence that conformation and/or accessibility of the activation site differ between the apo and Ca2+-stabilized conformers of PC.     

A case of esophageal cyst resected by thoracoscopic surgery

A 59-year-old woman was admitted with back pain and an abnormal chest shadow in the left hilar region. Her chest CT scan showed a posterior mediastinal mass surrounding the descending aorta. By transesophageal ultrasonography, a diagnosis of mediastinal cyst was made. She underwent thoracoscopic resection under general anesthesia with new endoscopic devices including endo-scissors, endoscopic hemoclips and electrocautery. Pathologically, the tumor was an esophageal cyst lined by ciliated columnar and squamous epithelium overlying smooth muscle layers. She made an uneventful recovery. Her back pain subsided following the operation. Thoracoscopic resection is a useful technique for patients with mediastinal cystic tumor.     

A case of pulmonary arteriovenous fistula beneath the surface of the lung]

Mediastinal Hodgkin's disease has rarely been reported in the literature in Japan; however, it is not uncommon in Europe and North America. A 32-year-old woman with isolated mediastinal Hodgkin's disease mimicking thymoma is herein described. A preoperative diagnosis of thymoma led to a combined resection of the mediastinal tumor together with the entire thymus, left innominate vein, and left phrenic nerve. The resected tumor was histologically diagnosed to be Hodgkin's disease of the nodular sclerosis type. Adjuvant 40 Gy irradiation of the mediastinum and neck was added postoperatively. The patient is doing well at present with no signs of recurrence 8 months after the operation.     

The coexistence of pulmonary tuberculosis and lung cancer

For appropriate approach to diagnosis of pulmonary tuberculosis, it is necessary to understand the pathological processes from primary infection and acquisition of cellular immunity to reactivation, progression and cure of the tuberculous lesions. The outlines for roentgenological diagnosis are reviewed, which are the process of primary infection and cure after acquisition of cellular immunity, the process of reactivation and progress of postprimary pulmonary tuberculosis, and roentgenological characteristics of primary and postprimary pulmonary tuberculosis. The outlines of roentgenological aspects of pulmonary mycobacteriosis due to M. avium complex and M. kansasii are reviewed, which are increasing in Japan.     

Needle localization of peripheral lung nodules for video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery provides an alternative to conventional thoracotomy for resection of peripheral lung nodules. To localize small peripheral lung nodules that may not be visible or palpable by the surgeon, we have placed a Kopans hook wire percutaneously into the lung as a guide. The indications for localization included previous nondiagnostic percutaneous needle aspiration biopsy (PNAB) (n = 4), nodules too small for PNAB (n = 2), nodules inaccessible to PNAB (n = 3), and planned resection of a known peripheral tumor less than 1 cm (n = 1). The localization procedure was performed with computed tomographic guidance in all patients. The nodules ranged in size from 2 to 15 mm and were located immediately subpleural to 2-cm deep the pleura. A 20-gauge Greene biopsy needle was used as an introducer for a 35-cm-long Kopans hook wire. Patients were sent directly to the operating room in a dependent position. All ten nodules were successfully resected, including hamartoma (n = 1), carcinoid tumors (n = 2), granulomas (n = 3), adenocarcinoma (n = 1), fibrosis (n = 1), benign metastasizing leiomyoma (n = 1), and lymphoma (n = 1). In two patients, the wire slipped out of the lung. Small focal pneumothoraces developed in five patients. There were no major complications. This procedure can safely and effectively localize nonvisible or nonpalpable pulmonary nodules for thoracoscopic surgery for diagnostic purposes or for resection of small peripheral tumors in patients who cannot tolerate a lobectomy or pneumonectomy.     

Video thoracoscopic lung biopsy in diffuse interstitial lung diseases

The present study examined the use of video thoracoscopic lung biopsy (VTLB) in diffuse interstitial lung disease, in comparison with open lung biopsy (OLB). Twenty and fifteen patients underwent VTLB and OLB, respectively, from 1987 to 1997 at the Central Chest Hospital, Thailand. Data in mean (SD). The mean age was 39 years in both groups. VTLB yielded equivalent size of lung tissues, 4.7 (2.32) cm3, and was as diagnostically useful as OLB. Estimated blood loss, 60 (37) mls, and length of pleural drainage, 2.8 (0.5) days, were comparable in either technique. As OLB had been in practice for decades, it took shorter operative time, 64 (11) mins, than VTLB, 105 (30) mins, (p = 0.005). Both VTLB and OLB approaches were safe and not associated with major postoperative complications.     

No-cut thoracoscopic lung plication: a new technique for lung volume reduction surgery

Three-dimensional (3-D) intravascular ultrasound (IVUS) allows for the visualization of entire coronary segments, provides more detailed insights into the geometry of atherosclerotic plaques and facilitates serial studies. Automated quantitative 3-D IVUS methods reduce the analysis time and the subjectivity of boundary tracing, and permit complex IVUS studies. The 3-D IVUS approach is not restricted to research applications, but may be used as a valuable clinical tool. Evaluation of the coronary segment of interest before catheter-based coronary interventions provides information which may facilitate the selection of interventional devices. Moreover, 3-D IVUS allows for a careful assessment of the procedural results and potential post-procedural complications. ECG-gated image acquisition, automated contour detection, and approaches using data of both 3-D IVUS and biplane angiography represent the recent progress in this field. Three-dimensional IVUS will surely gain further importance and become a routine technique, if the interest and research effort is sustained.     

Relapse of pulmonary Mycobacterium kansasii disease associated with large-cell cancer of the lung: a case report

A 43-year-old caucasian male diabetic presented with purulent cough and a history of weight-loss, elevated temperature, night-sweat and dyspnea. Four years previously, the patient had undergone a 12-month antimycobacterial regimen because of pulmonary mycobacterium kansasii (MK) disease of the left upper lobe (LUL). Treatment had led to complete recovery with the exception of minor fibrous residuals in the involved pulmonary segments. Chest radiograph and computed tomography (CT), performed on recent admission, revealed a dense infiltration of these residual-containing segments. Microbiological evaluation of bronchial brushings, aspirates and histology of the transbronchial biopsies indicated a relapse of pulmonary MK disease. Although antimycobacterial treatment was started immediately, therapeutic effects were only minimal and remained to be limited to the initial phase of the treatment. After four weeks of treatment, the patient's general condition worsened again. Follow-up CT of the lung showed a marked increase of the infiltration in the left apicoposterior lobe and re-bronchoscopy showed a tumorous protrusion of the bronchial wall involving the apicoposterior segment ostium, a finding which was not seen in the previous bronchoscopy. Histology of the transbronchial biopsies revealed a carcinoma mainly from large-cell type.