[Graft-versus-host Disease Detected Early Due to Repeated Pneumothorax after Bone Marrow Transplantation].

A 15-year-old boy who presented recurrent bilateral pneumothoraces after allogenic bone marrow transplantation for the treatment of myelodysplastic syndrome is presented. We performed bulla resection under the thoracoscopic surgery for three times. Pathological examination revealed irregular fibrous thickening of the visceral pleura and alveolar fibrosis, consistent with a diagnosis of pleuroparenchymal fibroelastosis (PPFE). Also the findings of bronchiolitis obliterans (BO) was noted and chronic graftversus-host disease( GVHD) was strongly suggested. Twenty-five months after the operation, bilateral living-donor lobar lung transplantation was performed and the diagnosis of GVHD was established.

[Mediastinal seminoma with hemangiosarcoma].

A 30-year-old man visited a local hospital with the chief complaints of a cough and tightness of the chest. He was found to have an anterior mediastinal tumor, and was referred to our hospital for treatment. He was diagnosed with a large mediastinal tumor, over 15 cm in long diameter, compressing the heart and superior vena cava. The tumor was resected, and diagnosed as a multilocular thymic cyst. He followed an uneventful postoperative course, and was discharged. Later, he re-visited us with severe cough and bloody sputum. Despite further evaluation, no definitive diagnosis could be made. Chest computed tomography (CT) revealed a mass in the left pulmonary hilum and multiple nodules in the left lung field. The symptoms rapidly worsened until his death. At autopsy, the left lung lesion was diagnosed as hemangiosarcoma. It was also confirmed that the multilocular thymic cyst contained minute germ cell neoplastic (seminomatous) and hemangiosarcomatous components. We speculate that the hemangiosarcomatous component arising in association with the seminoma metastasized to the left lung.

Encoscopic management of stenotic anastomosis using a rendezvous technique after pancreatogastrostomy.

A 46-year-old female patient was referred to our hospital for endoscopic treatment of stenotic pancreatogastrostomy. She had undergone pylorus-preserving pancreatoduodenectomy due to duodenal carcinoma of the papilla of Vater 5 years before referral. Two years after the operation, she had to be hospitalized several times during a 1-year period because of acute recurrent pancreatitis caused by stenosis of the anastomosis of the pancreatoduodenostomy. An endoscopic ultrasound (EUS)-guided rendezvous technique was selected to puncture the main pancreatic duct via a transgastric approach. We identified the dilated main pancreatic duct with a convex array echoendoscope from the lower gastric body near the anastomosis and successfully punctured the dilated main pancreatic duct. The guidewire passed through the stenosis to the gastric cavity and we could place a stent through the stenotic anastomosis. After the procedure, the patient has not experienced acute recurrent pancreatitis for 9 months. Pancreatogastrostomy has been the preferred method used to carry out post-pancreatoduodenectomy reconstruction. However, stenosis of the anastomosis has been reported as one of the late complications of pancreatogastrostomy. The main symptom of this complication is recurrent epigastralgia due to obstructive pancreatitis. As a result, patients are compelled to stay in the hospital for an extended duration with no oral intake allowed. Surgical resection of the stenosis is often the treatment of choice but can be troublesome due to post-operative adhesions. Here, we report a case of pancreatogastrostomy complicated by stenosis, which was treated using the EUS-guided rendezvous technique.

Effects of induction therapy on wound healing at bronchial anastomosis sites in rats.

OBJECTIVES: Preoperative chemotherapy is frequently used for advanced lung cancer. As a valid alternative to pneumonectomy, bronchoplasty has the advantage of enabling lung parenchyma function to be preserved. The effects of antineoplastic agents on healing bronchial anastomosis remain unclear. We studied the effects of preoperative chemotherapy on wound healing in bronchial anastomoses and clarified causes of wound healing impairment in rats. METHODS: In experiment I, at 3 days before surgery, rats were injected with cyclophosphamide, doxorubicin, and vincristine (CAV group) or cisplatin and etoposide (PVP treated rats). In experiment II, at 48 hrs before surgery, rats were treated with rabbit antirat macrophage serum and antirat monocyte chemoattractant protein-1 antibody to inhibit macrophage infiltration. On days 3, 5, and 7 after bronchus anastomosis, wound healing was assessed by examining bursting strength and hydroxyproline tissue content. RESULTS: CAV-treated rats showed significant impaired wound healing, marked severe leucopenia, and reduced macrophage infiltration. The PVP group showed no significant changes. In experiment II, rats exhibited inhibited macrophage infiltration, which is associated with significantly impaired of wound healing. CONCLUSIONS: Our study suggests that induction chemotherapy, associated with leukopenia in the early phase of wound healing, increases the risk of bronchial anastomosis leakage. Postoperative macrophage depletion is one of the most important causes of impaired wound healing.

Preoperative irradiation combined with chemotherapy impairs healing of bronchial anastomosis during the early postoperative period in rats.

The effect of preoperative irradiation and antineoplastic agents on healing at the site of bronchial anastomosis was investigated using rats. The bursting pressure in irradiation group and combined irradiation and chemotherapy group was significantly lower than in control and chemotherapy group at day 5 after operation. There was no significant difference in bursting pressure in all groups at day 7. The histologic finding of the anastomosis with H & E stain showed that submucosal connective tissue had not regenerated, and defects were seen in the submucosal tissue in irradiation and combined therapy group at day 3 and day 5. But, the connective tissue had matured in irradiation group at day 7 compared with control group. In conclusion, this study demonstrated that the healing of bronchial anastomosis was markedly delayed in early postoperative days in the rats receiving irradiation and combined therapy.