[Thymoma from the Thymus Covering Bypass Grafts in Previous Coronary Surgery].

To prevent graft injury at the thoracic surgery after coronary artery bypass grafting (CABG), thymus is often used to cover the grafts. We report a thymoma that developed 12 years after CABG in a 65-year-old woman. The patient had undergone percutaneous coronary intervention (PCI) with stenting of the left anterior descending( LAD) artery, 13 years ago, and a 4-vessel CABG, 12 years ago. Three-dimensional(3D) coronary computed tomography (CT) and angiography before surgery showed that all grafts were intact, but LAD artery occlusion was presented just distal to the stent. Since the thymoma was located in front of the ascending aorta and trunk of the pulmonary artery, abutting the left and right internal thoracic artery and radial artery graft, we performed PCI for LAD recanalization preoperatively, and complete resection of the thymoma with redo sternotomy was performed safely using an ultrasonic stethoscope without damage to the graft.

[Giant Cell Tumor of the Rib;Report of a Case].

We report a rare case of giant cell tumor of the rib. A 33-year-old man was admitted to our hospital because of a recently appearing mass and pain in the right chest wall. Chest computed tomography and magnetic resonance imaging revealed a heterogeneous mass of 8-cm in diameter arising from and destroying the right 7th rib. The tumor was resected together with the 6th, 7th, and 8th ribs and the adjacent muscle and diaphragm. The pathological diagnosis was giant cell tumor of the bone. The patient has been free from recurrence or metastasis for 4 years after the operation.

[Three cases of spontaneous pneumothorax by ruptured paravertebral gourd-shaped bullae].

We reported 3 elderly patients with right pneumothorax caused by ruptured paravertebral gourdshaped bullae. Two patients showed the characteristic symptom of air leakage of this type of pneumothorax, which decreased in the supine position, but increased in the sitting position. Chest computed tomography imaging showed bullae spreading in the space of the azygoesophageal recess. All patients underwent video-assisted thoracic surgery (VATS), and 2 patients underwent mini-thoracotomy because of adhesion and pyothorax. Ruptured bullae with stalks were found at the mediastinal sides of their right lower lobes in all patients. Bullectomy using an endoscopic stapler or ligation at the bulla root was performed easily and safely. The right pneumothorax caused by ruptured paravertebral gourd-shaped bulla was considered to be a good indication for the VATS due to the unique shape of the bulla, which has a stalk at its root.

[Surgery for benign schwannoma arising at the thoracic apex].

It is difficult to determine surgical approaches for treating a tumor arising at the thoracic outlet. Here we report a case of benign schwannoma arising at the thoracic apex, in which both pleural and cervical approaches were adopted. Chest radiographs of a 58-year-old male at the medical checkup in 2009 showed a tumor shadow in the right apical region that was increasing since 2003. He had no symptoms. Computed tomography(CT)and magnetic resonance imaging (MRI) showed a 35-mm tumor, which had a smooth surface and was suspected as a neurogenic tumor arising at the right thoracic outlet. Surgery for this tumor was performed by the thoracoscopic approach with a mini thoracotomy through the 3 intercostal space 1. The tumor was suspected to arise from the brachial plexus, and was not able to be enucleated. Then we made a cervical incision and the tumor was resected safely using a pleural approach together with a cervical approach. The pathological finding was benign shwannoma. Mild ulnar nerve palsy was observed in the patient after surgery, which gradually improved within 3 years.

Chemosensitivity of lung cancer: Differences between the primary lesion and lymph node metastasis.

In this study, chemosensitivity tests were performed on both primary lesions (PLs) and lymph node metastases (LMs) from surgically resected non-small cell lung cancer (NSCLC). Differences between the results obtained were evaluated. Operative specimens were obtained from 13 patients with NSCLC [6 with squamous cell carcinoma (SQ) and 7 with adenocarcinoma (AD)] whose lymph nodes were confirmed to be positive for metastasis. Both the PL and LM from the same patient were examined immediately after resection. The collagen gel droplet-embedded culture drug sensitivity test (CD-DST) was used as the chemosensitivity test against six anticancer drugs [5-fluorouracil (5-FU), cisplatin, gemcitabine, docetaxel, vinorelbine and SN-38 (an active metabolite of irinotecan)]. When the growth rate, determined by the T/C ratio (T, signal for viable cells in the treated group and C, signal in the control) was less than 50%, the tumor cells were considered to be sensitive to the drug. Only in 4 cases (2 SQ and 2 AD) was the chemosensitivity of the primary lesion identical to that of LM. In the SQ cases, chemosensitivity of the primary lesions to 5-FU tended to be consistent with that of LMs. In contrast, the primary lesions in 4 of the 7 AD cases were negative for chemosensitivity to 5-FU; however, LMs were sensitive. In many cases, the chemosensitivity of the PLs to each anticancer drug differed from that of the LMs. In conclusion, both primary and metastatic tumors should be examined to ensure maximum clinical efficacy of in vitro drug-sensitivity testing for adjuvant chemotherapy after complete resection of n1 and n2 NSCLC.

[Evaluation of the relation between the depth of left double-lumen endobronchial tube and the patient's height--comparison between patients over 20 years of age and those under 19 years].

BACKGROUND: In adult patients, there is a strong correlation between the appropriate depth of insertion of a left double-lumen endobronchial tube (DLT) and height. However, for patients with the same height, we noted the tendency of the depth of insertion being about 1 cm shorter for patients under 19 years of age compared to that for those over 20 years. METHODS: We compared the depth of insertion between patients over 20 years and those under 19 years. RESULTS: In both groups, the depth of DLT insertion correlated strongly with patient's height. For patients of the same height, the depth of insertion for those under 19 years was 0.7-1.2 cm shorter than that for patients over 20 years. For patients with a height between 160-179 cm, the mean depth of insertion for patients under 19 years was significantly shorter than that for those over 20 years. CONCLUSIONS: During intubation of the bronchi with DLT in patients under 19 years, the optimal depth of DLT insertion is less than that for patients over 20 years.

Effective chemotherapy based on a chemosensitivity test for malignant pleural mesothelioma.

Malignant pleural mesothelioma (MPM) is an aggressive and fatal tumor of the pleura and its incidence has been increasing as a result of the widespread use of asbestos worldwide. Numerous chemotherapeutic agents have been tested in many clinical trials, but the response rate does not exceed 20% for most of the investigated regimens. Here we report a case of MPM in which the chemotherapy based on the chemosensitivity test was very effective on palliation with stable disease for a long time.

Double-layered collagen gel hemisphere for cell invasion assay: successful visualization and quantification of cell invasion activity.

Although various methods for collagen gel-based cell invasion assays have been described, there continues to be a need for a simpler and more objective assay. Here, we describe an easy-to-prepare double-layered collagen gel hemisphere (DL-CGH) system that satisfies these requirements, and we demonstrate the advantages of this new system for visualizing cell movements during invasion. DL-CGH consists of a central core collagen layer surrounded by an outer cover collagen layer. A droplet of collagen I solution (containing cells to be examined) naturally forms a small hemisphere on the bottom of the culture dish. After this central core layer gels, a second droplet is placed atop the first gel, encapsulating it completely. The hemisphere is submerged in the medium and cultured. The invasive activity of cells that infiltrate from the inner to the outer layer can be evaluated optically. Using this in vitro system, we measured the inhibitory effect of E-cadherin expression on cancer cell invasion. DL-CGH also allowed visualization of interactions between invading cancer cells and the stroma. Cancer cells, which lack the proteases required for direct entrance into the three-dimensional collagen matrix, were seen to slip like amoebas through matrix gaps generated by the pericellular proteolytic activity of fibroblasts. [Supplementary materials are available for this article. Go to the publisher's online edition of Cell Communication and Adhesion for the following free supplemental resources: Movies 1-3; 4a and b].