[Strategy for preventing recurrence after video-assisted thoracoscopic surgery for spontaneous pneumothorax; efficacy of talc pleurodesis and absorbable mesh covering].

Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of spontaneous pneumothorax. The unexpectedly high increase of the recurrence rate is the most important problem. We examined the interaction between recurrence, clinical features and patient's backgrounds. The main causes of recurrence were oversight of bullae and the emphysematous changes at the periphery of the site where an autosuture device was used. 90% of the recurrence occurred in the patients with type III small diffuse bullae. Introduction of the regional talc pleurodesis and covering stapled line with absorbable mesh were extremely useful to lower the recurrence rate after VATS for spontaneous pneumothorax.

Angiomyolipoma of the lung.

Extrarenal angiomyolipomas are rare tumors that have been reported in several organs, including the liver, reproductive organs, skin, and retroperitoneum. In this report, we present the clinicopathologic findings of an angiomyolipoma of the lung in a 67-year-old man with no history of tuberous sclerosis or lymphangioleiomyomatosis. To our knowledge, this is the second reported case of pulmonary angiomyolipoma. The tumor was coincidentally found in the left lower lung in association with a hemothorax. Our case was histologically identical to angiomyolipoma occurring in the kidney, but immunohistologic staining for HMB-45 was negative, similar to the first reported case.

[A case of postoperative recurrence of hepatocellular carcinoma successfully treated with arterial infusion chemotherapy using cisplatin and 5-fluorouracil].

We reported a 71-year-old male patient with multiple liver recurrence of hepatocellular carcinoma, who responded to arterial infusion chemotherapy using CDDP and 5-FU. The patient was administered 10mg/body CDDP and 250 mg/body 5-FU on day 1-5./1 course. As a result, the tumor decreased and AFP was decreased to 50.8 ng/ml (from 93099 ng/ml). The patient is alive 13 months after the beginning of therapy in a condition of partial response (PR).

Thoracoscopic surgical treatment of spontaneous pneumothorax: selection of surgical therapy according to thoracoscopic findings.

We report our experience with thoracoscopy used for the treatment of spontaneous pneumothorax and idiopathic emphysematous bullae. Fifty-one patients with pneumothorax were admitted to the hospital and received a pleurography and CT scanning before thoracoscopy. End-GIA resection or end-loop ligation were used alone or in combination, with or without laser coagulation. Only one patient developed recurrent pneumothorax, whereas another required repeated resection. Our results indicate that surgical treatment of pneumothorax using thoracoscopy results in a rapid expansion of the lung, minimum postoperative pain, early hospital discharge, and return of normal activity.

[A case of benign mixed tumor of the trachea].

A very rare case of benign mixed tumor of the trachea was reported. A 52-year-old male was admitted to our hospital because of hemoptysis, slight dyspnea and stridor. Bronchoscopic examination revealed a polypoid tumor which arose from the anterior wall of the upper trachea, obstructing about 70% of the tracheal lumen. For the purpose of getting pathological specimen and securing the air way in anesthesia, endoscopic polypectomy (2/3 of the tumor) was done by using GIF-XP 20. Circumferential resection of the trachea (4 rings) with end-to-end anastomosis was performed one month after polypectomy. To our knowledge, this was the 7th reported case in Japan. Clinical studies and operative procedures of this disease were briefly discussed.

[Results of abdominal surgery in patients over 90 years old].

During a year period (1978-1987), 105 cases of abdominal surgery were performed at Sasebo Chuo Hospital on patients over 80 years of age. This study discusses 4 patients who were over 90 years old at time of their surgery. Emergency surgery had been required for 2 patients (a 91-year-old male with a sigmoid colon ca., and a 91-year-old female with a descending colon ca.), and elective surgery had been performed on the other two patients (a 95-year-old male with a caecum ca., and a 97-year-old female with a leiomyosarcoma of stomach). The patients who underwent elective surgery had a uniformly smoother hospital course and an overall better prognosis then the patients who underwent emergency surgery, whose prognosis was poor. We have concluded that early diagnosis and elective surgery is the necessary procedure in the elderly patient.