[Hemothorax Due to Rupture of an Aneurysm of a Branch of the Right Subclavian Artery with von Recklinghausen's Disease].

A 52-year-old man with a history of von Recklinghausen's disease presented to our hospital with abrupt onset of right chest and back pain. A contrast-enhanced chest computed tomography (CT) revealed massive right hemothorax, extravasation of the contrast medium at a branch of the right subclavian artery, and a tumor surrounding the second right dorsal rib. Based on findings from emergent angiography, hemothorax secondary to the rupture of an aneurysm of a branch of the right subclavian artery was diagnosed, and transcatheter arterial embolization(TAE) was performed. After hemostasis, intrathoracic hematoma was removed by surgery, and a recurrence of hemothorax did not occur until at least 8 months after the initial TAE procedure.

[Congenital Defect of the Left Pericardium with Spontaneous Pneumothorax;Report of a Case].

Congenital cardiac membrane deficiency is a relatively rare condition. Here, we report a case of congenital cardiac membrane deficiency that manifested as left spontaneous pneumothorax. A 72-year-old man was hospitalized for recurrence of the spontaneous pneumothorax. Computed tomography findings led us to suspect pericardial deficits, and the perioperative findings during thoracoscopic surgery for the pneumothorax confirmed complete absence of the left pericardium. We resected a lung cyst but did not treat the pericardial deficit. The patient's postoperative course was uneventful.

[Emergency Surgery for a Lung Hernia after Resection of a Metastatic Rib Tumor;Report of a Case].

The patient was a 60-year-old woman who underwent chest wall resection for a metastatic tumor in the anterior portion of the right 3rd rib, from thyroid cancer. The anterior portion of the right 3rd rib and the 2nd and 3rd intercostal muscles were resected, and chest wall reconstruction was not performed. On the 5th postoperative day, the patient developed a pulmonary hernia. Radiologically, more than half of the right upper lobe and middle lobe were prolapsed from the resected chest wall. The patient complained of cough and dyspnea, and an emergency surgery was performed. Elevated intrathoracic pressure due to obesity was considered to be a serious risk factor of the lung hernia after chest wall resection without reconstruction.

[Postoperatively Diagnosed Pulmonary Actinomycosis;Report of Three Cases].

Three cases of pulmonary actinomycosis have been postoperatively diagnosed in our hospital in the past 3 years. All the cases were preoperatively difficult to differentiate from lung cancer, and all were diagnosed in men. One of the patients was diagnosed on the basis of clinical symptoms, while the other 2 patients were diagnosed during the treatment and follow-up of other diseases. On radiological examination, 2 patients showed mass-like shadows, and the 3rd showed a cavitary lesion; fluorodeoxyglucose (FDG) -positron emission tomography showed high FDG accumulation in all the patients. One of the patients was pathologically suspected with lung cancer on transbronchial lung biopsy. Right upper lobectomy was performed in 2 patients, and right lower lobectomy in 1. One of the patients who underwent right upper lobectomy, also received chest wall resection because of the perioperative finding of chest wall invasion of lung cancer. Clinically, all the cases were preoperatively diagnosed as lung cancer.

Synovial sarcoma of the mediastinum: report of a case.

We report a case of synovial sarcoma of the mediastinum, a very rare tumor, in a 50-year-old man hospitalized with anterior chest pain. Chest X-ray and computed tomography (CT) on admission showed a 10 x 8-cm mass in the right anterior mediastinal space, compressing the superior vena cava. A diagnosis of sarcoma was established by a CT-guided percutaneous needle biopsy. Systemic examination revealed no metastasis to the contralateral pleural cavity or other distant organs, and we resected the mediastinal sarcoma. Pathological and immunohistochemical analyses confirmed a diagnosis of monophasic synovial sarcoma. The patient is alive with recurrence 9 months after his operation, and is receiving chemotherapy with ifosfamide.

Operation for lung cancer in patients with idiopathic pulmonary fibrosis: surgical contraindication?

BACKGROUND: Patients with idiopathic pulmonary fibrosis have an increased incidence of lung cancer. The purpose of this study was to determine the outcome of surgical treatment of lung cancer with idiopathic pulmonary fibrosis. METHODS: From January 1992 through December 2001, 64 patients who had simultaneous lung cancer and idiopathic pulmonary fibrosis were treated. Twenty-one (33%) of them underwent surgical resection of lung cancer, and their data were reviewed. RESULTS: There were 56 men and 8 women with an average age of 69 years (range, 43 to 85 years). In the surgical group, there were no early postoperative deaths, and nonfatal complications occurred in 2 patients (10%). Among the 14 patients with stage I cancer, a second primary lung cancer developed in 5 (36%). The causes of death in the surgical group were cancer related in 7 patients, exacerbation of idiopathic pulmonary fibrosis in 7, and other in 2. Five of the 7 patients who died of a cancer-related cause had development of a second primary lung cancer. The actuarial 2-year survival rate of the surgical group was 52% overall, 58% for patients with N0 or N1 disease and 25% for those with N2 disease (p = 0.05). CONCLUSIONS: The long-term results in one surgical group were poor partly because of the high incidence of a second primary lung cancer and partly because of the poor natural history of idiopathic pulmonary fibrosis. These patients require intensive surveillance even after curative resection of lung cancer.

Respiratory failure due to vocal cord paresis in myasthenia gravis.

This report describes a female patient with myasthenia gravis who developed respiratory failure due to vocal cord paresis. The diagnosis was delayed due to the absence of other myasthenic symptoms (e.g. ptosis, muscle weakness and dysphagia). On direct laryngoscopy, her vocal cords were seen to be in the paramedian position and to move apart after the intravenous injection of edrophonium. The patient initially presented with ocular myasthenia and later returned with isolated respiratory failure. A review of the pertinent literature revealed few reports on myasthenia gravis presenting in this manner.