[Traumatic Diaphragmatic Hernia due to Rib Fracture Caused by a Tumble:Report of a Case].

A 63-year-old female was admitted to our hospital on the fifth day after a tumble. Computed tomography showed multiple rib fractures, massive hemothorax and diaphragmatic hernia in the left side of the chest and the emergency operation was performed. About 20 mm sized omental diaphragmatic hernia was found and repaired with direct suture. The hernia was thought to be caused by fractured rib. The postoperative course was uneventful, and the patient was discharged on the 11th day after the operation.

Angiolipoma of the chest wall: a case report.

BACKGROUND: Angiolipoma is a rare histological variant of lipoma. Angiolipoma commonly occurs in the subcutaneous tissues of the extremity and trunk. There are few reports of angiolipoma occurring in the chest wall. CASE PRESENTATION: A 78-year-old woman was referred to our hospital for evaluation of angina pectoris. Coronary computed tomography (CT) showed a soft tissue nodule in the left chest wall by chance. Enhanced chest CT showed a heterogeneous enhanced nodule in the left chest wall. On magnetic resonance imaging (MRI), the lesion showed low signal intensity on T1-weighted images, heterogeneous high signal intensity on T2-weighted images and high signal intensity on fat-suppressed T2-weighted images. The lesion showed heterogeneous enhanced effect on gadolinium-based contrast agent. These radiological findings suggested neurogenic tumor with abundant blood flow or hemangioma. Video-assisted thoracic surgery (VATS) was performed for both diagnostic and therapeutic purposes. Histopathological examination of the tumor showed mature adipose tissue and capillary hyperplasia containing fibrin thrombi. These appearances were consistent with angiolipoma. She had an uneventful recovery and did not show recurrence until 8 months post-surgery. CONCLUSIONS: Angiolipoma of the chest wall is extremely rare. Preoperative diagnosis is very difficult because the imaging findings of angiolipoma vary depending on the amount of vascular component and fat component, so surgical resection is suggested to be both diagnostic and therapeutic.

Secondary systemic artery to pulmonary artery and pulmonary vein fistulas following the video-assisted thoracic surgery for pneumothorax: a case report.

BACKGROUND: The systemic artery to pulmonary vessel fistula (SAPVF) is a vascular anomaly characterized by penetration of nonbronchial systemic chest wall arteries into the lung parenchyma. To our knowledge, about 150 cases of SAPVF have been reported to date. Fifteen percent of SAPVF are congenital and occur in the presence of cardiopathy or pulmonary artery hypoplasia. Secondary SAPVF are caused by pleural adhesions that occur subsequent to inflammatory changes associated with conditions such as pleuritis, empyema, trauma, and surgery. Though several cases of secondary SAPVF as a post coronary artery bypass graft (CABG) complication have been reported, secondary SAPVF especially following video-assisted thoracic surgery (VATS) are relatively rare. CASE PRESENTATION: A 19-year-old man was admitted to our hospital because of recurrence of left pneumothorax. His previous history included left and right pneumothorax at the ages of 15 and 16 years, respectively, which were treated by VATS. VATS was planned for the surgical indication of second postoperative recurrence. In the operation, the lingular segment with dilated pulsating pulmonary vessels adhered to the port scar of the chest wall, which was made at first VATS for pneumothorax. The computed tomography showed an abnormal connection between the branch of the systemic artery of the chest wall and the dilated pulmonary artery and pulmonary vein in the lingular segment. Left subclavian selective arteriography also showed hypertrophic blood vessels arose from the internal thoracic artery, the lateral thoracic artery, and the subscapular artery, which drained into the both the pulmonary artery and the pulmonary vein in the lingular segment. Despite of four sessions of embolization for aberrant arteries, the abnormal blood flow persisted. Partial resection of the left lingular segment was therefore performed. The patient has been disease-free about SAPVF for 2 years and 2 months after the last operation. CONCLUSIONS: We described our experience with a case of secondary SAPVF that was associated with fistulas between a systemic artery and both the pulmonary artery and pulmonary vein, which was developed after first VATS for pneumothorax. Radical resection was safely performed and effective after four sessions of embolization.

The pathological features of idiopathic interstitial pneumonia-associated pulmonary adenocarcinomas.

AIMS: To investigate the pathological features of idiopathic interstitial pneumonia (IIP)-associated pulmonary adenocarcinoma. METHODS AND RESULTS: Surgically resected adenocarcinomas associated with IIP (the IIP group) and adenocarcinomas without IIP (the non-IIP group) were subjected to analysis. Adenocarcinomas in the IIP group were subdivided into two groups: one group included tumours connected to bronchiolar metaplasia in honeycomb lesions (the H-IIP group), and the other included tumours unrelated to honeycomb lesions (the NH-IIP group). Histomorphological appearance and immunohistochemical expression were compared among the H-IIP group, the NH-IIP group, and the non-IIP group. Most of the tumour cells in the H-IIP group had a tall, columnar shape that showed similar features to proximal bronchial epithelium, whereas tumour cells in the NH-IIP group and the non-IIP group had a club-like shape that showed similar features to respiratory bronchiolar/alveolar epithelium. Adenocarcinomas in the H-IIP group tended to be negative for thyroid transcription factor-1 (TTF-1) and positive for hepatocyte nuclear factor-4α (HNF-4α). The frequency of EGFR mutations was significantly lower in adenocarcinomas in the H-IIP group, although the frequencies of KRAS and ALK mutations did not differ among the three groups. CONCLUSIONS: Idiopathic interstitial pneumonia-associated pulmonary adenocarcinomas, especially those arising from honeycomb lesions, have distinct pathological features.

Pulmonary Resection for Lung Cancer in Patients With Idiopathic Interstitial Pneumonia.

BACKGROUND: After pulmonary resection, patients with lung cancer who have idiopathic pulmonary fibrosis (IPF) have been reported to have higher pulmonary morbidity and mortality and poorer outcomes than patients without IPF. However, whether morbidity, mortality, and outcomes differ according to the subtype of idiopathic interstitial pneumonia (IIP) remains unclear. METHODS: The clinical records of 678 patients with non-small cell lung cancer who underwent pulmonary resection were reviewed retrospectively. A total of 103 patients had IIP and were classified into an IPF group and a non-IPF group in accordance with the 2011 statement. RESULTS: The IPF group comprised 46 patients, and the non-IPF group comprised 57. The 5-year survival rate was significantly higher in the non-IPF group (53.2%) than in the IPF group (22.1%; p = 0.0093). Cause of death was IIP-related respiratory failure in 26.1% (12 of 46) of the patients in the IPF group as compared with 7.0% (4 of 57) of patients in the non-IPF group (p = 0.008). Multivariate Cox analysis indicated that IPF was a significant predictor of long-term survival (hazard ratio 1.910, 95% confidence interval: 1.102 to 3.313; p = 0.021). CONCLUSIONS: Idiopathic pulmonary fibrosis is independently associated with poorer overall survival in patients with lung cancer who undergo pulmonary resection. The decision whether to perform surgery in patients who have lung cancer with IIP should therefore take into account the subtype of IIP and the poorer outcomes associated with IPF.

Thoracoscopic lung biopsy in 285 patients with diffuse pulmonary disease.

BACKGROUND: Surgical lung biopsy is generally considered the most appropriate method for diagnosing diffuse lung disease. However, there are few reports focusing on only one thoracoscopic technique. This study was designed to determine the morbidity and mortality related to video-assisted thoracoscopic lung biopsy in a single center, thereby providing data on the severity of morbidity and clarifying the risk factors. METHODS: We analyzed 285 patients with undiagnosed diffuse lung disease who underwent video-assisted thoracoscopic lung biopsy at Kanagawa Cardiovascular and Respiratory Center from February 2007 to April 2012. We recorded the severity of postoperative complications using the Clavien-Dindo classification. RESULTS: The surgical morbidity was 7.0% (20/285), including delayed pulmonary fistulas in 11 patients, acute exacerbation in 3, prolonged air leakage (>7 days) in 2, hypoxemia in 2, atrial fibrillation in 1, and premature ventricular contraction in 1. Based on the Clavien-Dindo classification, grade I, II, IIIa, IIIb, and IVa complications accounted for 20%, 10%, 50%, 5%, and 15%, respectively. The 30-day mortality was 0%. The diagnostic yield was 100%. Although acute exacerbation occurred in 2 patients with idiopathic pulmonary fibrosis and 1 with fibrotic nonspecific interstitial pneumonia, there were no distinctive features that allowed preoperative prediction of acute exacerbation. CONCLUSIONS: Our findings indicate that video-assisted thoracoscopic lung biopsy is a feasible procedure. We hope to clarify risk factors in future research.

Inflammatory malignant fibrous histiocytoma of thymus origin.

A 46-year-old man was referred to our department complaining of anterior chest pain. A chest computed tomographic scan revealed an anterior mediastinal tumor measuring 38 x 35 x 50 mm. Suspecting a thymoma, we performed extended thymectomy through a median sternotomy under general anesthesia. Pathologically, the tumor was composed of pleomorphic spindle-shaped cells arranged in a storiform pattern, with marked inflammatory cell infiltration. The tumor was contiguous with the thymus tissue. Based on these findings, we made the diagnosis of inflammatory malignant fibrous histiocytoma originating from the thymus. Until now, 12 months later, the patient has shown no evidence of tumor recurrence.

A case of epithelial-myoepithelial carcinoma of the bronchus - a review of reported cases and a comparison with other salivary gland-type carcinomas of the bronchus.

We present a case of a polypoid tumor located in the right middle lobe bronchus. The tumor was composed of bi-layered glandular or ductular structures consisting of inner cuboidal cells and outer multipolar cells. Immunohistochemical examinations confirmed epithelial and myoepithelial differentiation in the inner and outer components, respectively. Consequently, the tumor was diagnosed as an epithelial-myoepithelial carcinoma. Epithelial-myoepithelial carcinomas of the bronchus are very rare neoplasms with low-grade malignant potential. To date, including our case, only 27 cases have been reported in the English literature. Here, we review the reported cases and compare them with other salivary gland-type carcinomas regarding clinical, biological, and genetic features.

[Case of bilateral chylothorax with systemic lupus erythematosus complicated by steroid-/immunosuppressant-resistant pleural effusion].

A 20-year-old woman, with systemic lupus erythmatosus complicated by steroid-and immunosuppressant-resistant bilateral pleural effusion, was admitted to the emergency room because of dyspnea and fever. Chest Xray film revealed bilateral massive pleural effusion. Bilateral thoracocentesis yielded fluid with chyle. Conservative treatment including intravenous hyper-alimentation and continuous drainage were performed but with no remarkable improvement. She underwent thoracoscopy-aided ligation of the thoracic duct. After the operation, bilateral pleurodesis was performed by intrathoracic injection of OK-432, because of uncontrolled pleural effusion. There have been no signs of recurrence at 10 months in this case of SLE with steroid-and immunosuppressant-resistant pleural effusion.

Phylogenetic analysis of the genus Petunia (Solanaceae) based on the sequence of the Hf1 gene.

Polymerase chain reaction fragment length polymorphisms and nucleotide sequences for a cytochrome P450 gene encoding flavonoid-3',5'-hydroxylase, Hf1, were studied in 19 natural taxa of Petunia. Natural Petunia taxa were classified into six groups based on major insertion or deletion events that occurred only in intron II of the locus. The maximum parsimony method was used to calculate strict consensus trees based on nucleotide sequences in selected regions of the Hf1 locus. Petunia taxa were divided into two major clades in the phylogenetic trees. Petunia axillaris (including three subspecies), P. exserta, and P. occidentalis formed a clade with 100% bootstrap support. This clade is associated with a consistently inflexed pedicel, self-compatibility in most taxa, and geographical distribution in southern and western portions of the genus range. The other clade, which comprised the remainder of the genus is, however, less supported (up to 71% bootstrap); it is characterized by a deflexed pedicel in the fruiting state (except P. inflata), self-incompatibility, and a northeastern distribution. A nuclear gene, Hf1, seems to be a useful molecular marker for elucidating the phylogeny of the genus Petunia when compared with the nucleotide sequence of trnK intron of chloroplast DNA.

Breakdown of self-incompatibility in a natural population of Petunia axillaris caused by loss of pollen function.

Although Petunia axillaris subsp. axillaris is described as a self-incompatible taxon, some of the natural populations we have identified in Uruguay are composed of both self-incompatible and self-compatible plants. Here, we studied the self-incompatibility (SI) behavior of 50 plants derived from such a mixed population, designated U83, and examined the cause of the breakdown of SI. Thirteen plants were found to be self-incompatible, and the other 37 were found to be self-compatible. A total of 14 S-haplotypes were represented in these 50 plants, including two that we had previously identified from another mixed population, designated U1. All the 37 self-compatible plants carried either an S(C1)- or an S(C2)-haplotype. S(C1)S(C1) and S(C2)S(C2) homozygotes were generated by self-pollination of two of the self-compatible plants, and they were reciprocally crossed with 40 self-incompatible S-homozygotes (S(1)S(1) through S(40)S(40)) generated from plants identified from three mixed populations, including U83. The S(C1)S(C1) homozygote was reciprocally compatible with all the genotypes examined. The S(C2)S(C2) homozygote accepted pollen from all but the S(17)S(17) homozygote (identified from the U1 population), but the S(17)S(17) homozygote accepted pollen from the S(C2)S(C2) homozygote. cDNAs encoding S(C2)- and S(17)-RNases were cloned and sequenced, and their nucleotide sequences were completely identical. Analysis of bud-selfed progeny of heterozygotes carrying S(C1) or S(C2) showed that the SI behavior of S(C1) and S(C2) was identical to that of S(C1) and S(C2) homozygotes, respectively. All these results taken together suggested that the S(C2)-haplotype was a mutant form of the S(17)-haplotype, with the defect lying in the pollen function. The possible nature of the mutation is discussed.