Tuberculous aortitis, ruptured 48 years after therapeutic implantation of synthetic balls.

A case of tuberculous aortitis, ruptured 48 years after an implantation of synthetic balls into the extrapleural space was reported. Those balls were implanted as a therapeutic alternative to artificial pneumothorax for treating pulmonary tuberculosis. Free perforation was triggered by debridement of an expanding cold abscess. A tuberculous abscess adjacent to the arterial wall should be carefully managed even in the absence of the blood flow by image analysis.

[A case of mediastinal thoracic duct cyst].

This is a rare case of thoracic duct cyst in 34-year-old woman. She complained of a left supraclavicular mass and admitted our hospital. A clinical examinations were all within normal limit. The chest X-ray and the magnetic resonance imaging examinations revealed a round tumor 65 x 40 mm in diameter with clear margin located at the left upper mediastinum. The slightly dilated thoracic duct was connected to the tumor. The left supraclavicular vein was compressed by the tumor. The cystectomy was performed under diagnosis of thoracic duct cyst by Trap door method on September, 17, 1999. Macroscopically, thin-capsulated elastic soft tumor contained chyle, and it was connected to the thoracic duct and the left jugular vein. The histological diagnosis was thoracic duct cyst. The postoperative course was uneventful, and the patient was discharged 9 days after operation. The patient remains disease-free at 8 months after the operation.

High cyclin E and low p27/Kip1 expressions are potentially poor prognostic factors in lung adenocarcinoma patients.

Cyclin E is an important regulator of entry into the S phase of the cell cycle. p27/Kip1 (p27) binds to cyclin E/Cdk2 complex and negatively regulates cell proliferation. We immunohistochemically examined the expression of cyclin E and p27 in 98 cases of resected lung adenocarcinoma to evaluate the prognostic significance of cyclin E and p27. Cyclin E was expressed in 16 cases (16%), and p27 was expressed in 41 cases (42%). Using Kaplan-Meier survival analysis, patients with cyclin E positive (P=0.0017) and p27 negative (P=0.011), both individually and in combination (P<0.0001), had a worse prognosis. We also analyzed the relationship of these findings to clinicopathological parameters, which revealed that cyclin E-positive, p27-negative cases had a higher Ki67 expression (P=0.012) and a higher rate of lymph node metastasis (P=0.0078) than other groups. Our results suggested that cyclin E over expression, in association with p27 reduction in particular, may potentially be a poor prognostic factor in lung adenocarcinoma patients. However, to verify the prognostic significance of these factors, a multivariate analysis of a larger number of patients should be undertaken.

[Prognostic assessment of the new UICC TNM classification for resected lung cancer].

To evaluated the new UICC TNM classification, we investigated the prognosis of patients who had resection of non-small cell lung cancer. A total of 670 patients with non-small cell lung cancer underwent complete resection and pathologic staging of the disease from 1987 to 1994. The survivals were calculated with Kaplan-Meier methods on the basis of overall deaths, and the survival curves were compared by Logrank test. The 5-year survival rates were 84.6% in stage I A (n = 187), 65.2% in stage I B (n = 177), 41.5% in stage IIA (n = 24), 46.7% in stage IIB (n = 100), 25.6% in stage IIIA (n = 139), 25.8% in stage IIIB and 0 in stage IV. There were significant differences in survival between stage I A and stage I B as well as between stage IIB and stage IIIA. However, there were no significant differences in survival between stage IIA and stage IIB, between stage IIIA and stage IIIB. No significant difference in survival was observed among patients with T1N1M0, T2N1M0 and T3N0M0 (43.9%). In stage IIIB, the patients with pm1 N2 disease (8.9%) had more poorly prognosis than the patients with pm1N0 disease (70.1%) and pm1N1 (38.9%) disease. We concluded that the dividing stage I into A and B categories and placing T3N0M0 in stage II and placing pm2 in stage IV were adequate. In the patients with satellite tumors within the primary lobe of the lung, we think that a new category depended on the N-category is necessary.

[Invasive thymoma associated with pure red cell aplasia and liver metastasis: a case report].

A case of invasive thymoma associated with pure red cell aplasia and liver metastasis was reported. A 57-year-old male was admitted to our hospital because of hepatic abnormal shadow on computed tomography. Malignant tumor was suspected by imaging procedures. Left lateral segmental resection of liver was performed and histo-pathological examination proved the tumor to be liver metastasis of thymoma. He was received 50 Gy irradiation after incomplete resection of thymoma. In the course of time he contracted pure red cell aplasia. But he is well controlled medically and alive 7 years after the surgery.

[Evaluation of an ultrasonic cutting and coagulating system (harmonic scalpel) for performing a segmental and wedge resection of the lung].

In order to prevent the local recurrence of malignant tumors, it is important for surgeon to maintain a sufficient margin between the tumor and the edge at resection. For this reason we do not use an auto-suturing device, but instead use the ultrasonic cutting and coagulating system (HARMONIC SCALPEL, ETHICON ENDO-SURGERY Cincinnati, Ohio) whenever we perform either a segmental resection or a wedge resection of the lung. The subjects investigated consisted of 24 cases of lung tumors (15 metastatic tumors, 5 cases with primary lung cancer, 3 inflammatory tumors; and one benign tumor). The type of operation included 10 segmental resections and 14 wedge resections, with 21 open thoracotomies and 3 instances of thoracoscopic surgery, while 15 were single resections and 9 were multiple resections. Little bleeding was seen at the resection of the parenchyma and the vessels of the lung. However prolonged air leakage was observed in some cases that needed pleurodesis. The mean duration time of the surgery was 266 minutes, and the mean blood loss was 173 ml. The operative duration was a little longer than normal, because many cases were not first thoracotomies and some cases had multiple tumors. Nevertheless the amount of blood loss was slight. The longest post-operative period was two years and six months, no local recurrence has yet been seen in any of malignant cases. We consider this system to be very effective for performing a resection of the lung parenchyma because of the reduced blood loss and the apparent increased prevention of recurrence.

[Results of resection of T3 primary lung cancer].

Primary resection for lung cancer was performed in 711 patients. Extensive surgery was performed in 99 T3 lung cancer (13.7%). Overall 5-year survival rate was 31.7%. Overall hospital mortality was 7.5%. Mean 5-year survival was 34.9% for patients with complete resection, 0% for patients with incomplete resection (p < 0.05). In patients with complete resection, mean 5-year survival was greater in patients with N0 (39.1%) than in patients with N1 (23.5%) or N2 (27.7%), but there was no statistically significant difference. There was also no statistically significant difference between adenocarcinoma and squamous cell carcinoma. Mean 5-year survival rate for patients with invasion of chest wall was 34.1%, with invasion of mediastinal pleura was 37.5%, with invasion of main bronchus was 58.3%, with interlobular invasion was 18.7%. Complete resection of T3 lung cancer may yield long time survival.

[Repeated pneumonia in the middle lobe caused by congenital bronchoesophageal fistula].

A 52-year-old woman was admitted to our hospital because of repeated episodes of pneumonia in the middle lobe. She had also experienced coughing during meals. The history and chest CT findings suggested the presence of a bronchoesophageal fistula. An upper GI series revealed a fistula between an esophageal diverticulum and the superior segment bronchus of the right lower lobe. Fiberoptic bronchoscopy done immediately after the upper GI series revealed barium sulfate leaking from the superior segment bronchus of the right lower lobe into the middle lobe bronchus. These findings indicated that the repeated pneumonia in the middle lobe was caused by a congenital bronchoesophageal fistula. Examination of the resected fistula showed that it was a Braimbridge type I bronchoesophageal fistula. Although of at least 49 cases of congenital bronchoesophageal fistulas with esophageal diverticula have been reported in the Japanese medical literature, we know of no previous case in which such a fistula was associated with middle-lobe pneumonia.

[Empyema caused by perforation of metastatic colon cancer: a case report].

The patient was a 51-year-old female, underwent total gastrectomy for gastric cancer 6 years ago. She was admitted to a local hospital with the complaint of fever, the chest X-ray showed niveau in the left pleural cavity. Fecal material flowed out by drainage. Barium enema showed fistula of diaphragma from transverse colon. She was transferred to our hospital. Partial transverse colon resection and removal of the diaphragma fistula were performed. The colon tumor was histologically determined to be metastasis from gastric cancer with thoracic empyema.

[A case of Salmonella osteomyelitis of the rib].

Salmonella osteomyelitis is a rare disease occurring at a frequency of less than 1% of all cases of osteomyelitis, we report a case of salmonella osteomyelitis of the rib, which was hard to differentiate from chest wall tumor. A 40-year-old man without gastrointestinal symptoms was admitted to our hospital for swelling of the right mammary region. It was suggestive of inflammatory pseudotumor because the swelling diminished, and we could not establish a diagnosis of abscess by scintigraphy with gallium-67 or by computed tomogram (CT). Drainage was carried out in the chest and about 10 ml of pus was removed. A culture was taken from the pus, revealing salmonella enteritidis, he was treated by local wound care and ABPC (aminobenzyl-penicillin). The open wound became sterile in 40 days, and was closed 46 days after being opened for drainage.