Kyobu geka. The Japanese journal of thoracic surgery
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Comparative Study
[Is video-assisted thoracic surgery lobectomy better than minimally invasive open thoracotomy?].
This article reviews our experiences of the current video-assisted thoracic surgery (VATS) lobectomy and minimally invasive open thoracotomy for resection of lung cancer. Between August 1999 and April 2007 at Saiseikai Central Hospital, Tokyo, Japan, we performed VATS lobectomy in 243 patients with clinical stage I lung cancer. It is certain that VATS lobectomy is acceptable in view of its low invasiveness, mortality, morbidity. ⋯ Therefore, we consider VATS lobectomy to be one of the therapeutic options in patients with clinical stage I lung cancer. However, what is most important is to achieve an anatomic lobectomy and complete mediastinal lymph node dissection. It may be that it is not important for differences of approach methods.
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Case Reports
[Bilateral pneumothorax of an amyotrophic lateral sclerosis patient under mechanical ventilation].
Amyotrophic lateral sclerosis (ALS) is a progressive and fatal disease. To support breathing of some patients with ALS in its severe condition, mechanical ventilation is indispensable. However, mechanical ventilation has been known to induce pneumothorax by the damage of lung cells in response to mechanical stretch. ⋯ On 42nd POD, a drainage pressure was increased up to -15 cm H2O. Then an air leak disappeared, and the lung expansion was obtained. The adjustment of a chest tube drainage pressure seems to be important, especially when a pneumothorax patient on mechanical ventilation is treated.
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Video-assisted thoracic surgery (VATS) is increasingly being used for congenital cystic lung diseases but there are very few reports of VATS lobectomy because of its technical difficulties. Congenital pulmonary airway malformations (CPAM) is a rare congenital developmental abnormality; an immediate and proper surgical resection must be performed for prevention of malignant transformation and recurrent pulmonary infection. Here, we report a case of a 1-year-old girl with type II-CPAM who was successfully treated with VATS lobectomy. ⋯ An ultrasonic cutting and coagulating surgical device was used to incise the incomplete fissure. Histological examination showed type II-CPAM of the right lower lobe accompanied with lung abscess and S10 hypoplasia. For a certain category of patients, surgical lobectomy using the thoracoscopic approach can be a safe and effective treatment for infants with CPAM.
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Case Reports
[Surgical treatment for the second double lung cancers following chemotherapy for small cell lung cancer].
We report a case with surgery for the 2nd primary double lung cancers-adenocarcinoma and squamous cell carcinoma which developed in the right upper lobe after 5 years successful control by chemotherapy for small cell lung cancer in the left upper lobe. Long term survivors with small cell lung cancer have recently increased as a result of progress of chemotherapy. ⋯ Although several causes have been proposed on the development of 2nd primary lung cancer after small cell lung cancer treatment, smoking history was strongly suggested as a cause in this case. Careful follow-up especially focusing on 2nd primary lung cancer development is necessary for patients after successful treatment for small cell lung cancer.
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We report 3 cases of endovascular stent-grafting (ESG) for mycotic thoracic aortic aneurysm. The case 1 was a rupture of pseudoaneurysm of the descending aorta caused by mediastinitis due to perforation of esophageal ulcer. The patient underwent emergent ESG for temporary control of the rupture. ⋯ His blood culture demonstrated methillin-resistant Staphylococcus aureus (MRSA). He died of rupture to bronchus and esophagus at 18th day after ESG. We believe that ESG is useful in high risk patients for temporary management of the rupture.