[Anomalous systemic arterial supply to normal basal segments of the left lung (Pryce type I)].

Patient 1 was a 54-year-old female diagnosed with anomalous systemic arterial supply to normal basal segments of the left lung discovered as an abnormality on chest X-ray radiography. Patient 2 was a 47-year-old male in whom the disease was diagnosed by close examination of bloody sputum. Division of the abnormal artery and left lower lobectomy were performed in patient 1. Arterial congestion and serpentine distribution were noted in the basal segments of the lung, which was the region perfused by the abnormal artery, on histopathological examination. Arteriosclerotic changes were noted in the vascular wall, but no abnormal vascular wall or alveolar structure was noted in S6, which was not included in theperfused region. Based on the above findings, division of the abnormal artery and left basal segmentectomy were performed in patient 2. Bloody sputum disappeared, and activity of daily living( ADL) were not impaired after surgery.

[Efficacy and safety of administration of low-dose unfractionated heparin (LDUH) for the prevention of pulmonary thromboembolism after surgery for lung cancer; the long term outcome].

We evaluated the efficacy and safety of the administration of low-dose unfractionated heparin(LDUH)for the prevention of pulmonary thromboembolism after lung cancer surgery. We operated on 206 patients with primary lung cancer for 8 years;128 males and 78 females, mean age:69.9±8.8 years. All patients were administrated LDUH 5,000 units every 12 hours from the operation day until the day when the patient could walk around the floor. No patients suffered from clinical pulmonary thromboembolism in this period. The duration of treatment was 4.6±2.6 days and the chest tube duration was 5.4±3.0 days. We experienced post-operative intra-thoracic bleeding in 2 patients during the previous 4 years. Based on this experience, we introduced new eligibility criteria;we discontinued LDUH administration on the operation day if diffuse adhesion in the thoracic cavity was observed at operation or intraoperative blood loss was over 500 ml. The dose of LDUH was decreased to 2,500 unit every 12 hours if the postoperative bleeding was over 400 ml on the operation day or the patient's body weight was less than 40 kg. After introduction of the new criteria, no severe bleeding complications occurred during the latter 4 years.

[Post-renal transplant pulmonary cryptococcosis, which was difficult to differentiate from a pulmonary tumor].

A 61-year-old man, with a history of renal transplant for immunoglobulin A (IgA) nephropathy and surgery for advanced gastric carcinoma, was noted to have a nodular shadow of 1.3 cm in diameter in the left lung( S8) based on chest computed tomography( CT), and was suspected to have primary pulmonary carcinoma or a metastatic pulmonary tumor, for which surgical resection was performed. A rapid pathological diagnosis of inflammatory granuloma was made, and the patient was finally diagnosed as having pulmonary cryptococcosis based on the histopathology, and received fluconazole postoperatively. Patients with organ transplant history showing a nodular shadow in the lung should undergo a careful workup in consideration of both malignant tumor and infection.

[Benign pulmonary mass suspected of primary lung cancer for the high level of Pro gastrin-releasing peptide（ProGRP）].

A 71-year-old male consulted a physician for a chest abnormal shadow detected by mass screening. As computed tomography (CT) revealed a nodular shadow in the left upper lobe, he was referred to our hospital. Positron emission tomography (PET) showed high-level accumulation of fluorodeoxy glucose (FDG) at the same site, and the level of Pro gastrin-releasing peptide(ProGRP) as a tumor marker was high(59.5 pg/ml). The level of ProGRP increased to 83.0 pg/ml 2 months later and the surgery was performed to make a diagnosis, however, historological examination during surgery by both needle biopsy and partial resection showed no malignancy. A final diagnosis of fibrosis associated with anthracosis was made, and neither active inflammation nor neoplastic lesion was not demonstrated. At 2 years and 2 months postoperatively, the level of ProGRP was still high(58.5 pg/ml). Although the high level of ProGRP is well known as a useful marker for the diagnosis of lung small cell carcinoma, some patients with renal dysfunction, pneumonia, interstitial pneumonia, pleurisy, or lung carcinoma that is not small cell carcinoma are also positive for ProGRP. Since the present case showed a mild impairment of renal function, it was suggested that the cause of the high level of ProGRP was other than lung cancer.

[Intercostal lung hernia diagnosed by computed tomography images under the semilateral position].

A 62-year-old man developed a swelling of the left anterior chest after surgery for a thoracic aortic aneurysm. Chest computed tomography (CT) images in the left semilateral position, which were obtained when his intrathoracic pressure was elevated through the Valsalva maneuver, showed a herniated lung with a fragile site of the surgical wound in the chest wall as a hernial orfice, as well as a hernial sac in the posterior of the greater pectoral muscle. A diagnosis of traumatic hernia occurring after thoracotomy was made, for which radical surgery involving direct closure was performed.

[Bronchial fibroepithelial polyp completely resected by left upper sleeve lobectomy; report of a case].

Cough and fever persisted in a 48-year-old female, and left pneumonia was diagnosed. A polyp-like lesion obstructing the left main bronchial lumen was observed on chest computed tomography (CT) and bronchoscopy. Since the root of the lesion could not be confirmed, treatment through the airway was considered difficult, and surgery was performed. Since continuation of the root of the lesion to the peripheral bronchus of the left superior lobe was observed during surgery, the left superior lobe was resected by sleeve lobectomy. The entire length of the excised lesion was about 8 cm, and the root arose from the bronchial wall of the left B(5) periphery. Pathologically, bronchogenic fibroepithelioma was definitely diagnosed.

Laparoscopic Splenectomy in a Patient with Sclerosing Angiomatoid Nodular Transformation.

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a specific, tumor-forming, non-neoplastic, vascular lesion with few reported cases worldwide. Herein, we describe the case of a patient who underwent laparoscopic splenectomy for SANT. A 47-year-old woman underwent upper gastrointestinal endoscopy for suspected gastric submucosal tumor. Contrast-enhanced abdominal computed tomography revealed the presence of a gradually enhancing lesion in the splenic hilum. Although we suspected splenic fibrotic hamartoma, malignancy could not be ruled out. Therefore, the patient underwent laparoscopic splenectomy, resulting in the histopathological diagnosis of SANT. Although SANT is a benign tumor, it may be difficult to obtain definitive diagnosis using preoperative imaging alone. Because the long-term natural history of SANT is unknown, we believe that splenectomy could be an appropriate technique for the diagnosis and treatment of SANT.

Risk factors preventing success of a minilaparotomy approach in the resection of colorectal cancer.

BACKGROUND: A minilaparotomy approach is technically feasible for the resection of colorectal cancer in select patients. The aim of this study was to clarify the risk factors preventing the success of a minilaparotomy in the resection of colorectal cancer. METHODS: Between April 2005 and August 2008, 141 consecutive patients were enrolled in this prospective study and scheduled to undergo resection of colorectal cancer using a minimal skin incision. The minilaparotomy involved a colorectal resection performed through a skin incision <7 cm in length. Neither a hand-port nor a laparoscope was used. RESULTS: A minilaparotomy was successful in 74 (52.5%) of 141 patients. Multivariate logistic regression analysis revealed that the failure of the minilaparotomy in the remaining 67 (47.5%) was independently related to gender (male), BMI (> or =25.5), tumor location (splenic flexure and rectum), tumor adhesion/invasion on/into adjacent organs and the maximum tumor diameter (> or =7.0 cm). CONCLUSION: Gender (male), BMI (> or =25.5), tumor location (splenic flexure and rectum) and tumor aggressiveness [tumor adhesion/invasion on/into adjacent organs and maximum tumor diameter (> or =7.0 cm)] were independent risk factors preventing the success of the minilaparotomy approach in the resection of colorectal cancer.