[Long-term survival case of primitive neuroectodermal tumor in the chest wall of a young adult].

A very rare case of Askin's tumor is described. A 22-year-old male was admitted to our hospital because of an abnormal shadow on chest roentgenogram. His chest X-ray film showed a tumor shadow (4.0×5.0 cm) of chest wall protruding into the upper right lung field. The tumor shadow had markedly enlarged in size compared to previous examinations of chest X-ray film 1 month before. Chest computed tomography(CT) and magnetic resonance imaging( MRI) revealed an heterogenous tumor fixed on the right 4th rib, which did not infiltrate the surrounding tissues. In the examination of bone scintigram, no abnormal accumulation was seen at the site of the chest wall tumor. Because of the possibility of malignancy, an en bloc excision of the tumor was performed including the surrounding pleura. The histologic examination revealed primitive neuroectodermal tumors of the chest wall (Askin's tumor).The patient underwent both additional adjuvant chemotherapy and radiation therapy postoperatively, being alive and well without any sign of recurrence 10 years after the operation. Askin's tumor is a very rare disease with an extremely poor prognosis, however, the effective treatment has not been established yet. Complete excision at initial operation seemed to be correlated with long-term survival in this case.

[Patient with massive hemothorax due to blunt trauma saved by transcatheter arterial embolization (TAE)].

A 78-year-old man who fell from a step ladder was transported to our hospital by ambulance under the diagnosis of multiple rib fractures and right hemothorax. Since he was in shock on arrival, endotracheal intubation and tube thoracotomy were immediately performed. Though 2 liters of blood was evacuated, persistent hemorrhage was observed, requiring continuous rapid infusion and blood transfusion. Emergency thoracic arteriography revealed active bleeding from a branch of the right internal thoracic artery. Transcatheter arterial embolization (TAE) was performed using vascular embolization coils and porous gelatin particles. These procedures successfully controlled active hemorrhage from the chest. Intrathoracic hematoma was evacuated through the 2nd large chest tube. Chest tubes were removed on the 7th day. He was discharged on the 17th day without any complications.

The new method to make diagnosis and identify the location of leakage of pleuroperitoneal communication in peritoneal dialysis patients.

Pleuroperitoneal communication is a severe complication in peritoneal dialysis, and about half of the patients forced to discontinue peritoneal dialysis. The method of coloring dialysis solution by indocyanine green or CT peritoneography have been reported to make diagnosis of pleuroperitoneal communication, however sensitivity of these tests is not a satisfactory level. By repairing the pleural hole with thoracoscopic surgery, it is possible to resume peritoneal dialysis. However, the recurrence rate is very high unless precisely detecting the location of the pleural hole during surgery. We report three cases of pleuroperitoneal communication in peritoneal dialysis patients, in which we found the combination of contrast-enhanced ultrasonography and the indocyanine green fluorescence system are reliable method to make diagnosis and identify the location of leakage of pleuroperitoneal communication. By making definite diagnosis and precisely identifying the localization, we were able to close diaphragm holes by video-assisted thoracoscopic surgery.