[Synchronous Multicentric Thymoma].

A 76-year-old man was referred to our hospital because of an abnormal shadow on chest X-ray. His physical exams and laboratory data were not notable. Chest computed tomography (CT) showed 2 nodular lesions with clear margin in anterior mediastinum. The nodule at the left inferior pole of the thymus was 9 cm in diameter, and another one at the right inferior pole was 3.5 cm in diameter. We performed thymo-thymectomy by median sternotomy. Histological study revealed that the left tumor was type B2 thymoma and the other one was type A thymoma. Both were completely encapsulated without invasion, which means stage Ⅰ by Masaoka's classification. The patient has showed no evidence of recurrence for 11 years following the surgery. This is the 1st case in Japan that reported synchronous multicentric thymoma with apparently different histology of type A and B2.

Video-assisted thoracoscopic surgery for lung cancer in patients on hemodialysis.

PURPOSE: Surgical treatment of lung cancer in patients receiving hemodialysis carries a high risk because of poor cardiac function and a fragile electrolyte balance. Because the number of patients receiving hemodialysis has increased, the proportion of such patients with lung cancer is expected to rise. However, few studies have examined the results of surgery for lung cancer in hemodialysis patients, especially by video-assisted thoracoscopic surgery (VATS). METHODS: We conducted a retrospective analysis of 5 hemodialysis patients who underwent VATS for lung cancer. RESULTS: All patients were men, and the mean age was 70.4 years. The operative procedure was lobectomy in 4 patients and segmentectomy in 1. During the perioperative period, none required urgent hemodialysis. There were no critical complications and in-hospital deaths. Three of the 5 patients are currently alive and recurrence-free. One patient died of recurrence at 4 month after surgery, and the other patient died at 17 months after surgery without cancer recurrence. CONCLUSIONS: VATS appears to be a safe procedure for hemodialysis patients with lung cancer, and the long-term outcome is satisfactory.

Surgical results of video-assisted thoracic surgery and risk factors for prolonged hospitalization for secondary pneumothorax in elderly patients.

BACKGROUND: The treatment of secondary pneumothorax in elderly patients is difficult because of underlying diffuse lung injury and complex medical comorbidities. Such patients still have high morbidity rates, resulting in longer periods of hospitalization. METHODS: To examine the results of video-assisted thoracic surgery for elderly patients (aged 70 years or over) with secondary pneumothorax and investigate the risk factors for hospital stay longer than 7 days, we retrospectively analyzed the results obtained in such patients at our institution. RESULTS: From among 73 patients who entered this study, 7 patients (9.6%) had postoperative complications. Video-assisted thoracic surgery could treat pneumothorax in 71 patients, except for the 2 who died in hospital. The median postoperative drainage and hospital stay periods were 2 days (1-40 days) and 5 days (2-51 days). Patients with interstitial pneumonitis, pulmonary infection and low total protein or sodium levels were the risk factors for hospital stay longer than 7 days. CONCLUSIONS: VATS is a safe and effective procedure for secondary pneumothorax in elderly patients. Patients with interstitial pneumonitis, pulmonary infection, and hyponutrition state were the risk factors for postoperative hospital stay prolongation.

Tracheal stenosis after metal stent insertion treated successfully with a T-tube.

Tracheal stenosis after intubation is a fairly common complication, and treatment of such cases can be difficult. A 52-year-old woman was admitted to our hospital because of severe dyspnea. Seven years previously, she had suffered tracheal stenosis after tracheal intubation and had undergone tracheal resection and placement of a self-expandable metal stent. In this case, tracheal restenosis had occurred and we successfully treated the patient by insertion of a silicone T-tube after tracheotomy. Use of a T-tube is safe and effective for relief of tracheal restenosis after self-expandable metal stent placement.