ABSTRACT
Empyema caused by methicillin-resistant Staphylococcus aureus (MRSA) remains an intractable infection producing high mortality. The authers report a case of MRSA empyema following video-assisted thoracic surgery (VATS) for lung cancer. The case was 73-year-old male with some risks such as pulmonary emphysema, decreased renal function, and previous history of brain infarction. He received wedge resection and the staple lines were wrapped with polyglycolic acid (PGA) felt. Ten days after the operation, he was complicated MRSA pyothorax. By thoracoscopic procedures under local anesthesia, fibrinopurulent tissues were cleaned and 3 of chest tubes were replaced. Intrathoracic infected space was cleaned with physiological saline solution. The patient made favorable progress and recovered. Further empyema has not been developed for 24 months. VATS under local anesthesia and irrigation technique was safe and so useful. Nowadays, PGA felt is often used to reinforce the staple lines of lung. PGA felt is an absorbable but artificial material. We have to care about infectious problems. However, we could control the MRSA pyothrax without removing the PGA felt.
Subject(s)
Empyema, Pleural/surgery , Lung Neoplasms/surgery , Postoperative Complications/surgery , Thoracic Surgery, Video-Assisted , Aged , Anesthesia, Local , Empyema, Pleural/microbiology , Humans , Male , Methicillin Resistance , Perioperative Care , Pneumonectomy/methods , Polyglycolic Acid , Postoperative Complications/microbiology , Staphylococcal Infections , Suture Techniques , Sutures , Therapeutic Irrigation , Treatment OutcomeABSTRACT
The case was 54-year-old male with some risks such as chronic heart failure, atrial fibrillation, and liver chirrhosis. He was admitted because of severe back pain and diagnosed as empyema by preoperative thoracentesis. By thoracoscopic procedures under local anesthesia, fibrinopurulent tissues were cleaned as much as possible and 3 of chest tubes were replaced. The final diagnosis was Bacillus cereus pyothorax by bacterial cultures of pleural effusion. Intrathoracic cavity was cleaned with physiological saline solution. The patient made favorable progress and recovered. Thoracoscopic surgery under local anesthesia with thoracic irrigation was so effective and safe methods to control the infection.
Subject(s)
Anesthesia, Local , Bacillus cereus , Empyema, Pleural/surgery , Gram-Positive Bacterial Infections , Thoracoscopy , Anti-Bacterial Agents/therapeutic use , Cardiomyopathy, Dilated/complications , Clarithromycin/therapeutic use , Empyema, Pleural/microbiology , Humans , Liver Cirrhosis/complications , Male , Middle Aged , Therapeutic Irrigation , Thoracic CavityABSTRACT
We report a case of a previously healthy 76-year-old male with cavitating pleomorphic carcinoma of the lung. He was admitted because of an abnormal lung shadow on chest X-ray. Computed tomography (CT) showed a well-demarcated nodular shadow within thin-walled cavity in the right upper lobe. Because the lesion was revealed as adenocarcinoma by transbronchial lung biopsy, right upper lobectomy was performed. By histopathologic examination of the resected specimen, the nodule contained a component of spindle cell features and the cavity wall was composed of adenocarcinoma. The final diagnosis was pleomorphic carcinoma. Postoperative course has been uneventful for 12 months after surgery.
Subject(s)
Carcinoma/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Adenocarcinoma/diagnosis , Aged , Carcinoma/pathology , Carcinoma/surgery , Diagnosis, Differential , Humans , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Pneumonectomy , Radiography, Thoracic , Tomography, X-Ray ComputedABSTRACT
A 61-year-old female was admitted because of an abnormal lung shadow on chest X-ray. She had suffered from idiopathic thrombocytopenic purpura (ITP) for more than 7 years. Computed tomography (CT) revealed that an irregular shadow, about 2 cm in diameter, was located in the upper lobe of the right lung. After intravenous immunogrobulin injections for 5 days, a hematology test indicated increased platelet counts and we performed thoracoscopic surgery successfully without blood transfusions. However, 4 months after surgery, a hematology test indicated decreased platelet counts again. Thirteen months after the operation, gastrointestinal fiberscopic examination showed Helicobacter pylori infection. After the urea breath test, eradication therapy let to a recovery in platelet counts.
Subject(s)
Adenocarcinoma/complications , Helicobacter Infections/complications , Helicobacter pylori , Lung Neoplasms/complications , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Purpura, Thrombocytopenic, Idiopathic/etiology , Female , Helicobacter Infections/drug therapy , Humans , Middle AgedABSTRACT
An asymptomatic 67-year-old female was admitted because of an abnormal shadow on chest X-ray. Computed tomography (CT) revealed that a well-marginated round mass with low density, about 4 cm in diameter, was located in the right hilum. The border was enhanced at contrast material-enhanced CT. Magnetic resonance imaging (MRI) [T2-weighted] showed the lesion as a high intensity tumor. Because of the extra-pleural sign on CT and normal results of broncho-fiberscopic (BFS) examination, mediastinal tumor was suspected. We performed thoracoscopic surgery and revealed that the tumor was in lung, not in mediastinum. Biopsy of the easy-bleeding tumor was performed. The histopathological diagnosis was hemangiopericytoma. There was no remarkable change for 1 years. Hemangiopericytomas should be considered in the differential diagnosis of well-marginated masses. Thoracoscopic surgery is the useful methods to diagnose the hemangiopericytoma.
Subject(s)
Hemangiopericytoma/diagnosis , Lung Neoplasms/diagnosis , Aged , Diagnostic Errors , Female , Humans , Mediastinal Neoplasms/diagnosis , ThoracoscopyABSTRACT
INTRODUCTION: In vivo gene transfection using a recombinant adenoviral vector leads to diminished gene expression in a time-dependent manner that disappears within 4 weeks. CTLA4Ig blocks CD28-mediated costimulatory signal, and inhibits immune responses. We investigated the duration of transgene expression after administration of adenoviral vector containing CTLA4Ig gene (AdCTLA4Ig). METHODS: We injected 1 x 10(9) plaque forming units (pfu) of AdCTLA4Ig into rats (n = 7) via the tail vein. Thereafter, the blood samples were collected for assay of serum CTLA4Ig levels using enzyme-linked immunosorbent assay. RESULTS: The CTLA4Ig level reached the maximum (range, 65-86 microg/mL; average, 75 microg/mL) on days 3 to 5 after injection. Detectable levels of CTLA4Ig were observed up to 49 days. When we injected AdCTLA4Ig in combination with FTY720 administration, the maximum levels were higher and the detectable levels persisted longer. CONCLUSIONS: Because directly injected adenoviral transgene expression had been reported to disappear between 21 to 30 days, we conclude that AdCTLA4Ig inhibits the immune response and prolongs the transgene (CTLA4Ig gene) expression. Some additional immunosuppressants, like FTY720, may be useful to enhance AdCTLA4Ig effects.
Subject(s)
Gene Expression Regulation , Immunoconjugates/genetics , Abatacept , Adenoviridae , Animals , Enzyme-Linked Immunosorbent Assay , Genetic Vectors , Immunoconjugates/blood , Kinetics , Male , Rats , Rats, Inbred Lew , Recombinant Fusion Proteins/biosynthesis , TransfectionABSTRACT
A 57-year-old female was admitted because of chest and back pain. Computed tomography (CT) revealed that many well-marginated lymph nodes were located in mediastinum and abdominal para-aortic area, especially in the right lower mediastinum. These lymph nodes were enhanced at contrast material-enhanced CT. We performed thoracoscopic surgery. The histopathologic diagnosis was multicentric Castleman disease (MCD). MCD should be considered in the differential diagnosis of multiple lymph nodes swelling with hyper globulinemia. Thoracoscopic surgery is the useful method to resect the lymph nodes and diagnose MCD.
Subject(s)
Castleman Disease/diagnosis , Castleman Disease/surgery , Thoracoscopy , Adult , Castleman Disease/pathology , Female , Humans , Lymph Node Excision , Lymph Nodes/pathology , MediastinumABSTRACT
An asymptomatic 66-year-old female was admitted because of an abnormal shadow on chest X-ray. Computed tomography (CT) revealed that a well-marginated round mass with low density, about 3 cm in diameter, was located in the right anterior superior mediastinum. The border was partially enhanced at contrast material-enhanced CT. Magnetic resonance imaging (MRI) [T 2-weighted] showed the lesion as a high intensity tumor. We performed thoracoscopic surgery and resected the easy-bleeding tumor completely. The tumor was dark red in color and contained old blood. The histopathological diagnosis was hemangioma. There was no recurrence for 3 years. Hemangiomas should be considered in the differential diagnosis of well-marginated masses. Thoracoscopic surgery is the very useful methods to resect the mediastinal hemangioma.
Subject(s)
Hemangioma/diagnosis , Mediastinal Cyst/diagnosis , Mediastinal Neoplasms/diagnosis , Thoracoscopy , Aged , Diagnosis, Differential , Female , Hemangioma/surgery , Humans , Magnetic Resonance Imaging , Mediastinal Cyst/surgery , Mediastinal Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
We reported a case of thymic carcinoma. A 61-year-old man was admitted to evaluate an abnormal shadow of lung field by chest X-ray. Routine chest computed tomography (CT) showed no abnormal findings on the lung field, but thymic tumor was incidentally detected. We suspected thymoma, performed a mediansternotomy and thymectomy with partial resection of pericardium. Pathological findings diagnosed undifferentiated carcinoma (large cell type) of thymus, the patient underwent radiation therapy of the mediastinum at a total dosage of 50 Gy and chemotherapy [cisplatin (CDDP) + vinorelbine ditartrate + mitomycin C (MMC)]. He has been doing well without recurrence for 2 years after the operation.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Large Cell/surgery , Radiography, Thoracic , Thymus Neoplasms/surgery , Tomography, X-Ray Computed , Vinblastine/analogs & derivatives , Carcinoma, Large Cell/drug therapy , Carcinoma, Large Cell/radiotherapy , Cisplatin/administration & dosage , Combined Modality Therapy , Humans , Male , Middle Aged , Mitomycin/administration & dosage , Radiotherapy Dosage , Thymectomy , Thymus Neoplasms/drug therapy , Thymus Neoplasms/radiotherapy , Vinblastine/administration & dosage , VinorelbineABSTRACT
A case of a patient with a intrathoracic chronic expanding hematoma presenting as a neoplasm is reported. A chronic encapsulated intrathoracic hematoma is rare condition and is clinically included in a category of chronic hemorrhagic empyemas as a type of chronic empyemas in Japan. The clinical picture of our case suggested a slowly growing tumor. Though needle biopsy was performed, only blood was aspirated. Intraoperative findings revealed a intrathoracic hematoma with a tough capsule. It adhered to the chest wall hardly. Histopathological investigations revealed that the capsule consisted of a collagenous outer layer and a newly vascularized inner layer with fibrosis. Hemosiderin deposits suggested recurrent bleeding from fragile vessels. The mechanisms of hematoma formation and its expanding nature are discussed. The hematoma appeared to have been enlarged by repeated exudation or bleeding from capillaries inside the capsule.
Subject(s)
Hematoma/surgery , Thoracic Diseases/surgery , Chronic Disease , Humans , Male , Middle AgedSubject(s)
Graft Survival/physiology , Immunoconjugates/genetics , Lung Transplantation/physiology , Abatacept , Animals , Graft Survival/genetics , Immunoconjugates/therapeutic use , Male , Models, Animal , Rats , Rats, Inbred Lew , Rats, Inbred Strains , Recombinant Proteins/therapeutic use , Transfection , Transplantation, HomologousSubject(s)
Immunoconjugates/genetics , Propylene Glycols/therapeutic use , Trachea/transplantation , Transfection/methods , Transplantation, Homologous/immunology , Abatacept , Animals , Combined Modality Therapy , Fingolimod Hydrochloride , Immunoconjugates/therapeutic use , Immunosuppressive Agents/therapeutic use , Male , Models, Animal , Postoperative Period , Rats , Rats, Inbred Lew , Rats, Inbred Strains , Recombinant Proteins/therapeutic use , Sphingosine/analogs & derivatives , Time Factors , Trachea/pathology , Transplantation, Heterotopic , Transplantation, Homologous/methods , Transplantation, Homologous/pathologySubject(s)
Immunosuppression Therapy/methods , Lung Transplantation/immunology , Adenoviridae/genetics , Animals , Antigens, Differentiation/analysis , Antigens, Differentiation/immunology , Genetic Vectors , Humans , Immunosuppressive Agents , Rats , Rats, Inbred Lew , Rats, Inbred Strains , Transplantation, Heterotopic , Transplantation, Homologous/immunologySubject(s)
Graft Survival/immunology , Immunosuppression Therapy/methods , Immunosuppressive Agents/therapeutic use , Lung Transplantation/immunology , Propylene Glycols/therapeutic use , Adenoviridae/genetics , Animals , Fingolimod Hydrochloride , Genetic Vectors , Graft Survival/drug effects , Male , Rats , Rats, Inbred Lew , Sphingosine/analogs & derivatives , Transfection/methods , Transplantation, HomologousABSTRACT
The question whether the tumor is primary or metastatic sometimes arises in patients with intrathoracic tumor. Especially, adenocarcinoma presents more difficulties in distinguishing primary tumors from secondary or deciding its origin. We reported a case of mediastinal signet-ring cell carcinoma. A 51-year-old female was admitted because of an abnormal shadow during mass screening. Chest X-ray showed a semicircular, well-demarcated shadow on right cardiophrenic angle. Chest computed tomography (CT) revealed a homogeneous mass, approximately 4 cm in diameter. The investigations of whole body failed to reveal any other tumor. At operation, the tumor was adherent to the esophagus but easily resected. Histologically, the tumor was mainly composed of signet-ring cells. Immunohistochemically, surfactant apoprotein (SPA) was strongly demonstrated in tumor cells. SPA is specific to the lung and the tumor was diagnosed as the metastasis in mediastinal lymph nodes. The primary site was considered to exist in lung. But the primary site was not found over 46 months in spite of repeated further examinations.
Subject(s)
Carcinoma, Signet Ring Cell/surgery , Mediastinal Neoplasms/surgery , Neoplasms, Unknown Primary , Carcinoma, Signet Ring Cell/pathology , Female , Humans , Mediastinal Neoplasms/pathology , Middle AgedSubject(s)
Antigens, Differentiation/genetics , Graft Rejection/prevention & control , Immunoconjugates , Immunosuppressive Agents , Trachea/transplantation , Transplantation, Homologous/immunology , Abatacept , Adenoviridae , Animals , Antigens, CD , Antigens, Differentiation/therapeutic use , CTLA-4 Antigen , Chronic Disease , Genetic Therapy/methods , Genetic Vectors , Graft Rejection/immunology , Graft Rejection/pathology , Graft Survival/immunology , Immunosuppression Therapy/methods , Male , Rats , Rats, Inbred Lew , Rats, Inbred Strains , Time Factors , Trachea/pathology , Transplantation, Heterotopic , Transplantation, Homologous/pathologyABSTRACT
Pulmonary aspergillosis and lung cancer rarely occur simultaneously. We report a 66-year-old man with a round shadow in the thin-wall cavity of the right upper lobe. Radiological findings and transbronchial biopsy revealed squamous cell carcinoma complicated by aspergilloma at the site. Right upper lobectomy suggested that early lung cancer arose from preexisting lung scars containing an aspergilloma.
Subject(s)
Aspergillosis/complications , Carcinoma, Squamous Cell/complications , Lung Diseases, Fungal/complications , Lung Neoplasms/complications , Aged , Carcinoma, Squamous Cell/surgery , Humans , Lung Neoplasms/surgery , MaleABSTRACT
Pulmonary amyloidosis is a rare pulmonary lesion. We report a 42-year-old male admitted for further evaluation of abnormal chest shadow. A chest CT demonstrated a nodular shadow in right S3. We tried transbronchial and percutaneous lung biopsy, but could not diagnose. We performed partial lung resection by video-assisted thoracoscopic surgery. Pathological diagnosis of the lesion was pulmonary amyloidosis. Immunohistochemical examination revealed this amyloid composed of AL kappa protein. No clinical evidence of amyloid deposits were found in other organs. We finally diagnosed this case as a localized nodular pulmonary amyloidosis.
Subject(s)
Amyloidosis/surgery , Lung Diseases/surgery , Thoracic Surgery, Video-Assisted , Adult , Amyloidosis/diagnosis , Humans , Lung Diseases/diagnosis , Male , Solitary Pulmonary Nodule/diagnosis , Solitary Pulmonary Nodule/surgeryABSTRACT
In patients undergoing pneumonectomy with concomitant pericardiectomy, patch closure of the defect in the pericardium is required to prevent postoperative cardiac herniation. We used harvested autologous fascia lata as a pericardial patch in such operations on 6 patients with progressive lung cancer after induction chemoradiotherapy.
Subject(s)
Fascia Lata/transplantation , Pericardiectomy , Pericardium/surgery , Pneumonectomy , Humans , Lung Neoplasms/surgery , Methods , Transplantation, AutologousABSTRACT
A 71-year-old male, diagnosed as lung cancer, underwent unilateral pulmonary occulusion test. Through the guidewire, 7.5 Fr thermodilution catheter with occlusion balloon was introduced to the left pulmonary artery from the right internal jugular vein. Heparinized physiological saline solution was injected into the distal site of the occulusion. The occulusion time was 15 minutes. Pulmonary artery pressure and wedge pressure were within normal range. Soon after the examination, the pulmonary arteriogram (PAG) showed the defect of the branch to the lingular segment and the lower lobe. We made a diagnosis of pulmonary thrombosis. Three days after the administration of urokinase and heparin, both pulmonary perfusion scintigram and PAG exhibited the reperfusion to these areas. After the thrombolytic therapy was accomplished, antithrombin III and protein C in the serum showed within normal range. It was possible that the damage on the intima due to the thermodilution catheter or the guidewire and the following blood congestion by the pulmonary artery occulusion caused the thrombosis.