[Pulmonary Epithelial Hemangioendothelioma Needed to Differentiate from Metastatic Lung Tumor;Report of a Case].

Pulmonary epithelioid hemangioendthelioma(PEH) is rare malignant disease known to originate from hemangioendthelial cells. We report a case of PEH that is difficult to differential diagnosis on image. A 55-year-old woman was diagnosed with malignant lymphoma 15 years ago and had been followed-up. She referred to our hospital due to abnormal shadow on chest X-ray. Multiple nodules of 0.2~1.0 cm in size with clear but irregular margin were found in bilateral lungs on chest computed tomography(CT) scan. Nodules were found to be increased both in size and in number compared to those of 10 years ago. Pulmonary metastases of lymphoma, lung cancer or granulomatous disease were suspected and a thoracoscopic lung biopsy was performed, which led to a diagnosis of PEH pathologically.

[Pericardial Cavernous Hemangioma；Report of a Case].

A case of pericardial cavernous hemangioma is presented. A 62-year-old man had a chest pain and was referred to our hospital because of an abnormal shadow in the mediastinum. Chest computed tomography showed a hypervascular tumor of 2.0 cm in size at the left side of pulmonary artery. Magnetic resonance imaging findings suggested the mucinous part of the tumor, suggesting liposarcoma, thymoma, and neurinoma etc. At surgery, the tumor was found to be in the pericardial cavity. After pericardotomy, the tumor was resected. The diagnosis of the tumor was cavernous hemangioma. There was no evidence of recurrence 2 years after the operation.

[Review of chemoradiotherapy followed by surgical resection in locally advanced non-small-cell lung cancer].

Chemoradiotherapy is recommended for locally advanced non-small-cell lung cancer(NSCLC). However, the overall median survival time remains poor(<20 months). We evaluated the outcome and complications of chemoradiotherapy, followed by surgical resection, in locally advanced NSCLC. Eight patients(7 men and 1 woman; median age, 59.5 years (range, 47-68 years) who underwent chemoradiotherapy followed by surgical resection for locally advanced NSCLC from 2002 to 2011 were retrospectively analyzed. In all cases, chemotherapy consisted of platinum-based combination therapy. Postoperatively, bronchopleural fistula occurred in 1 patient and Horner syndrome was observed in 1 patient. No treatment -related deaths were observed. The median of progression-free survival was 34.2 months. In conclusion, chemoradiotherapy should be the standard of care for locally advanced NSCLC. Trimodality therapy is still experimental but seems to be promising for certain subgroups of patients with locally advanced NSCLC.

[Stereotactic radiotherapy following chemo-radiotherapy for lymph node metastasis of stage III non-small-cell lung cancer].

It has been expected that stereotactic radiotherapy (SRT) is one of the useful treatments for non-resectable early lung cancer. In the case radiotherapy was thought to be difficult due to the wideness of irradiation area, it is probable to undergo chemo-radiotherapy safely using SRT for a primary lesion. We report two cases of Stage III non-small-cell lung cancer, which underwent SRT for primary tumors following chemo-radiotherapy for the lymph node metastasis. In both two cases, a reduction of V20 (the normal pulmonary volume to receive radiation exposure: more than 20 Gy) was a possibility, and symptomatic radiation pneumonitis was not observed.

Our tips for bronchoplasty using suture holder and tourniquet.

Bronchial anastomosis is an important part of successful bronchoplasty, but it takes time to achieve stable results because of few opportunities to do it. To ensure a stable outcome, we have applied some tips for bronchial anastomosis. One of the tips is the use of a suture holder to obtain appropriate suture pitches, adjusting the discrepancy of the bronchial diameter, and another one is the use of a tourniquet to obtain an adequate tension upon tying the knots, ensuring good operative view.

[Treatment of tracheobronchial malignant tumors using a new high power diode contact laser (GaAlAs) system].

We treated ten patients with tracheobronchial malignant tumors using a new high power diode contact laser (GaAlAs) system (DIOMED 25, OLYMPUS) with a flexible bronchofiberscope (OLYMPUS BF IT200 or BF IT240). The total energy of the high power diode laser was 811 J, with a range of 64-3,960 J. With this method 85.7 percent of the symptoms such as dyspnea and hemoptysis were improved, and there was no incidence of massive hemorrhage or serious respiratory failure. The results confirmed the usefulness and safety of this method of treatment for obstructive lesions due to tracheobronchial polypoid malignant tumor and bleeding of the tracheobronchial tree.

Pleuroperitoneal shunting for intractable cardiogenic pleural effusions.

A 72-year-old man underwent post-infarction ventricular septal defect repair. Postoperatively, he required prolonged ventilation and could not be weaned from positive-pressure-assisted ventilation because of intractable bilateral pleural effusions. Conservative therapy was ineffective. After instituting pleuroperitoneal shunting, the patient could be weaned easily from a respirator.

Hybrid myocardial revascularization complicated by delayed anastomotic bleeding.

We present a case of hybrid coronary revascularization complicated by delayed bleeding from an anastomotic site. Anastomosis of the left internal mammary artery to the left anterior descending coronary artery was successfully performed via a lateral anterior small thoracotomy. Scheduled subsequent percutaneous coronary intervention of residual stenoses was successfully performed 13 days after the surgery, but cardiac tamponade due to anastomotic site dehiscence was disclosed soon after the percutaneous procedure. We discuss the causation of the delayed bleeding that occurred after the hybrid coronary revascularization.