Extralobar sequestration with a pulmonary arterial feeding vessel.

Extralobar sequestrations are rare congenital malformations of the lung. They are usually located between the diaphragm and left lower lobe and receive their blood supply from the aorta. We report a case of extralobar sequestration in an atypical location with a pulmonary arterial feeding vessel. An 18-year-old woman presented with an abnormality on chest X-ray. Chest computed tomography revealed a lung field not communicating with the bronchus between the upper and lower right lung lobes. Three-dimensional reconstruction computed tomography demonstrated a feeding artery from the pulmonary artery draining into the pulmonary vein. We diagnosed her with extralobar sequestration and resected the sequestered lung using video-assisted thoracic surgery. Therefore, three-dimensional reconstruction computed tomography helped identify the abnormal blood vessels, and video-assisted thoracic surgery may be useful in the treatment of extralobar sequestration.

Successful Resection of a Giant Pulmonary Colloid Adenocarcinoma via Median Sternotomy.

We report on a giant pulmonary colloid adenocarcinoma successfully resected using a median sternotomy approach. A 69-year-old woman visited our hospital owing to a giant mass detected on chest radiography. A giant cystic mass measuring 115 × 90 mm was detected in the right upper lung using computed tomography. We suspected mucinous adenocarcinoma and performed right upper lobectomy and mediastinal lymph node dissection with median sternotomy. The surgical field of view for the tumor and superior vena cava was satisfactory, and compression but not invasion of the superior vena cava and chest wall by the tumor was observed. The tumor was pathologically diagnosed as a colloid adenocarcinoma of stage IIIA with pT4N0M0. The postoperative course was uneventful, with no signs of recurrence at one and a half years after operation. Thus, this case demonstrates that for giant lung tumor surgery, median sternotomy is useful and safe for improving the surgical field of view.

Metachronous Thin-Walled Cavity Lung Cancers Exhibiting Variable Histopathology.

We report a case of metachronous thin-walled cavity lung cancers exhibiting variable histopathology. A 70-year-old man visited our hospital because of a thin-walled cavity located in the right upper lobe, detected by chest computed tomography. Right upper lobectomy was performed and a histological diagnosis of squamous cell carcinoma was made. Computed tomography at 7 years posttreatment detected a new thin-walled cavity in the left lower lobe. Histopathology after video-assisted thoracic surgery left S6 segmentectomy revealed adenocarcinoma. Patients with primary lung carcinoma may present with thin-walled cavities; postoperative screening can aid early the detection of metachronous primary lung cancers of variable origin.

Empyema and pyogenic spondylitis caused by direct Streptococcus gordonii infection after a compression fracture: a case report.

BACKGROUND: Empyema and pyogenic spondylitis are common diseases that are often caused by oral pathogens in direct or hematogenous infection. However, there exists no report describing empyema and pyogenic spondylitis caused by oral pathogens after a compression fracture of the vertebral body. Herein, we report a case of empyema and pyogenic spondylitis caused by direct Streptococcus gordonii infection after a compression fracture of the vertebral body. CASE PRESENTATION: A 74-year-old man had back pain while working. At 1 week after experiencing back pain, he underwent periodontal debridement. At 3 weeks after periodontal debridement, he visited our hospital owing to the absence of improvement in back pain. He was admitted on the same day with a diagnosis of compression fracture of the 12th thoracic vertebral body. Magnetic resonance imaging (MRI) revealed a compression fracture of the 12th thoracic vertebral body and a hematoma anterior to the vertebral body. Computed tomography (CT) showed no findings suggestive of infection. After admission, antibiotic therapy was initiated, as the patient developed fever and his blood cultures grew S. gordonii. CT performed after antibiotic therapy revealed a right-sided pleural effusion, and drainage was performed. As the inflammation did not improve after thoracic drainage for empyema, surgical debridement through video-assisted thoracic surgery was performed. Intraoperative pleural effusion cultures also grew S. gordonii. Postoperative MRI showed low T1-weighted signals and high T2-weighted signals in the 12th thoracic vertebral body, and the signals spread to the upper and lower intervertebral disk space; hence, a diagnosis of empyema and pyogenic spondylitis due to direct infection spread was established. Intravenous antibiotic therapy was continued for 6 weeks and then was switched to oral antibiotic treatment. His C-reactive protein level and erythrocyte sedimentation rate gradually decreased and remained within normal limits. Neither empyema nor pyogenic spondylitis had recurred at 12 months after surgery. CONCLUSIONS: Compression fracture with dental procedures possibly results in the thoracic cavity and spinal infection caused by oral pathogens. We emphasize the importance of early imaging examinations, diagnosis, and appropriate treatment for patients with compression fractures who develop a fever.

A solitary fibrous tumor arising from the thymus.

Solitary fibrous tumors (SFTs) are localized mesenchymal lesions which most frequently arise in the pleura but have also been observed in many other sites. SFTs arising from the thymus are relatively rare, however, and only a few cases have been reported to date. We report such a case in our current study.

Hepatocyte growth factor prevents pulmonary ischemia-reperfusion injury in mice.

BACKGROUND: Ischemia-reperfusion (IR) injury after lung transplantation leads to significant morbidity and mortality in recipients, which remains the major obstacle in clinical lung transplantation. To reduce pulmonary graft dysfunction and improve prognosis after lung transplantation, prevention of IR-induced lung injury in the peri-operative period is required. In the present study, we investigated the effects of recombinant hepatocyte growth factor (HGF) on pulmonary IR injury using a murine model system. METHODS: To assess the protective effect of HGF against lung injury, mice with pulmonary IR were divided into two groups and injected with 500 microg/kg of human recombinant HGF or the same dose of saline alone as a control. RESULTS: After pulmonary IR injury, the lung injury score increased in a time-dependent manner up to 24 hours. A significant reduction of lung injury score was observed with the administration of exogenous HGF. Moreover, the ratio of apoptotic cells was significantly reduced in mice treated with HGF. Significantly increased expression of Bcl-xL was observed after IR in mice administered HGF as compared with saline-treated controls. In contrast, expression of Bax was reduced significantly in HGF-treated mice. Serum levels of endogenous murine HGF were increased significantly in HGF-treated mice. CONCLUSIONS: Our findings indicate that administration of exogenous HGF ameliorates the pulmonary tissue injury induced by IR, which may provide an alternative for prevention of IR-induced lung injury in the peri-operative period in lung transplantation.

Suppression of acute and chronic rejection by hepatocyte growth factor in a murine model of cardiac transplantation: induction of tolerance and prevention of cardiac allograft vasculopathy.

BACKGROUND: Although treatment with immunosuppressive agents has contributed to overcoming acute rejection and improving the midterm survival of transplanted hearts, cardiac allograft vasculopathy (CAV) has remained the main cause of primary graft failure. Recent approaches have shown that hepatocyte growth factor (HGF) exhibits cardiotrophic functions. We therefore addressed whether HGF would regulate acute and chronic rejection in cardiac transplantation. METHODS AND RESULTS: We used a murine heterotopic cardiac transplantation model between fully incompatible strains and administered 500 microg x kg(-1) x d(-1) HGF during the initial 14 days after transplantation. The HGF-treated allografts showed significantly prolonged survival (42.3+/-4.1 days, P<0.001) compared with the controls (11.1+/-0.6 days), with tolerance induction in 47.4%. Histopathologically, the number of infiltrating cells was significantly decreased and myocardial necrosis was less prominent with a reduction of apoptosis in the allografts by HGF treatment during acute rejection. In the long-term surviving allografts, HGF significantly inhibited the development of CAV and interstitial fibrosis. With respect to intragraft cytokine mRNA expression, HGF treatment reduced the early expression of interferon-gamma and enhanced the expression of transforming growth factor-beta1 during the acute phase and of interleukin-10 continuously through the acute phase to the chronic phase. CONCLUSIONS: Our findings demonstrate that HGF can prolong the survival of allografts by its cardioprotective and immunomodulative potencies. Thus, HGF administration may constitute a new therapeutic approach to preventing cardiac graft failure that has not been overcome by conventional immunosuppressive agents.

Chest wall myxoma protruding into the thoracic cavity.

Myxoma protruding from the chest wall into the thoracic cavity is very rare. We report our experience in treating a 42-year-old man admitted for a painless mass on the anterior chest wall. Magnetic resonance imaging showed a sharply defined 5 x 4 x 4 cm mass protruding from the chest wall into the thoracic cavity, which we excised surgically. Histologically, the tumor proved to be a myxoma.