Search

Empyema and complicated para-pneumonic effusion (CPPE) often require surgical intervention because of insufficient antibiotic effect and chest tube drainage. From January 2017 to September 2021, we encountered seven patients who underwent intrapleural urokinase injection after medical thoracoscopy for the treatment of empyema or CPPE. None of the seven patients required further surgical interventions or showed any complications associated with the therapeutic procedures. The combined use of intrapleural urokinase injections and medical thoracoscopy may be an effective and safe therapeutic option for the management of empyema and CPPE.

Background/Aim: COVID-19 started to spread as a pandemic in December 2019 and COVID-19 vaccination has been initiated worldwide. The efficacy of vaccination has been scientifically proven, but it might cause axillary lymph node swelling. To diagnose patients with axillary lymph node swelling caused by COVID-19 vaccination, we herein reviewed existing literature on this symptom. Case Report: We report the case of a 70-year-old woman with a breast tumour. She had undergone cecum cancer surgery and regular computed tomography (CT). During breast tumour follow-up, she received scheduled CT that indicated severe axillary lymph node swelling mimicking breast cancer metastasis. We performed aspiration biopsy cytology of that lymph node, and determined this was not cancer metastasis but an effect of the COVID-19 vaccine. We confirmed this diagnosis at one month after computed tomography showed that the lymph node swelling had improved. Conclusion: Axillary lymph node swelling can occur after COVID-19 vaccination. Therefore, it is important to consider the effect of the COVID-19 vaccination on axillary lymph node swelling when diagnosing breast tumours.

Hemorrhagic rupture is a very rare and life-threatening hepatic cyst complication. Several treatment methods have been used for hepatic cyst hemorrhage and/or rupture; however, transcatheter arterial embolization for hepatic cyst hemorrhage has been poorly documented. An 80-year-old man receiving dual antiplatelet therapy was diagnosed with hemorrhagic rupture of a hepatic cyst. Transcatheter arterial embolization using a coil was performed for A6 branch confirmed active extravasation. His condition improved promptly after treatment, and the hepatic cyst gradually became smaller as compared to the size before hemorrhage. Transcatheter arterial embolization is suitable for hepatic cyst hemorrhage and might be a minimally invasive treatment option for a symptomatic hepatic cyst.

Background/Aim: COVID-19 has been a global pandemic for more than 2 years, and vaccination against COVID-19 using an mRNA vaccine is widespread. The COVID-19 vaccination can cause specific side-effects, such as axillary lymph node swelling; therefore, breast oncologists should pay attention to such occurrences. Initially, only two COVID-19 vaccinations were planned; however, in some countries third or fourth vaccines have been administered. Here, we present a female case who developed axillary lymph node swelling after her third vaccination. We have also reviewed the literature regarding this side-effect after a third or fourth COVID-19 vaccination. Case Report: A 64-year-old woman who came to our clinic regarding a mammography abnormality in her left breast. She had no palpable mass, but a left breast mass was shown by mammography, and ultrasonography and magnetic resonance imaging indicated a hamartoma. At 2 months after her second COVID-19 vaccination when she underwent these tests, she had no axillary lymph node swelling. We planned a follow-up after 6 months. At her next visit, by chance, she underwent ultrasonography 14 days after she received a third COVID-19 vaccination, and a swollen axillary lymph node was observed. Conclusion: Axillary lymph node swelling can occur after a third COVID-19 vaccination. Therefore, breast oncologists will have to consider this side-effect of COVID-19 vaccination when diagnosing breast tumors.

Background/Aim: Breast cancer treatment mainly involves interventional methods such as surgical resection and chemotherapy. How to best perform these treatments during the COVID-19 pandemic remains to be established. Patients and Methods: Patients with breast cancer who received SARS-CoV-2 PCR screening before cancer treatment from December 2020 to April 2021 were included. PCR screening was performed within 72 hours of the scheduled admission time and treatment. Results: A total of 19 tests in 15 patients were analysed. Fourteen cases displayed no symptoms, and five cases had some symptoms. COVID PCR tests were negative in all cases. Conclusion: COVID-19 screening can ensure that breast cancer patients do not miss scheduled treatments as a result of the pandemic. Diagnosis of patients with symptoms that are shared by COVID-19 infection, chemotherapy, and breast cancer recurrence must be performed carefully.

Highlights • The arterio-enteric fistula between lumbar artery and duodenum is rare pathology. • Aneurysm may occur in the collateral circulation in patients with Leriche syndrome. • Endovascular embolization can control hemorrhage immediately. • Fistula closure and debridement is recommended for control of local infection. • Endovascular embolization can serve as a landmark for the debridement of aneurysm., Introduction Various collateral pathways maintain blood flow to the lower extremities in patients with Leriche syndrome. The occurrence of true aneurysms in the lumbar artery—a component of an extensive collateral circulation network in patients with Leriche syndrome—is extremely rare. Presentation of case A 73-year-old man with Leriche syndrome was diagnosed with lumbar artery aneurysm complicated by a duodenal fistula. The patient underwent endovascular repair, surgical duodenal fistula closure, and debridement of the aneurysm wall until coil exposure. Discussion With the same mechanism, patients with aortic occlusive disease may develop an aneurysm and arterio-enteric fistula in the collateral circulation. Combination of treatments may be important for hemostasis, control of infection, and maintaining adequate distal perfusion. Conclusion Endovascular embolization can control bleeding as well as serve as a landmark for the debridement of contaminated aneurysm. Surgical fistula closure and aneurysm-wall debridement are useful for control of local infection.

Background/Aim: COVID-19 vaccination is now performed in most of the world to limit the spread of the disease. The first mRNA vaccine was approved in clinical settings and has specific side effects including axillary lymph node swelling, which can be misdiagnosed as breast cancer metastasis. The timing of axillary lymph node swelling and its duration are unclear. Here, we present a Japanese case and review of the existing literature. Case Report: We report the case of a 67-year-old woman with breast calcification. She had regular follow ups in our hospital for this calcification and received ultrasonography of the breast and axilla at every visit. She visited 6 months before having her COVID-19 vaccination, and 7 days and 6 months after the first COVID-19 vaccination. She had a swollen axillary lymph node 7 days after the first vaccination, which although it was improved, remained for 6 months. Conclusion: Axillary lymph node swelling occurred 7 days after vaccination and remained up to 6 months after it.

Introduction We report a case of a patient who underwent laparoscopic surgery for intestinal obstruction caused by the mesodiverticular band of Meckel's diverticulum, with pathological specimens showing ectopic pancreas. Presentation of case A 56-year-old woman presented to our hospital with complaints of abdominal pain and vomiting. Upon close examination, we suspected strangulated intestinal obstruction, and performed an emergency surgery. An internal hernia with a band leading to a Meckel's diverticulum was noted. Focusing on the attachment of the band, leading to the Meckel's diverticulum, we suspected a mesodiverticular band and deemed it necessary to be resected. Surgery was completed with resection of the band to relieve the intestinal obstruction, with simultaneous resection of the Meckel's diverticulum. It was necessary to resect Meckel's diverticulum simultaneously for histopathological examination. Histopathological examination revealed a mesodiverticular band in the resected band and ectopic pancreas in the Meckel's diverticulum. Discussion We chose to perform a complete laparoscopic resection because of the presence of simple intestinal obstruction caused by mesodiverticular bands or diverticula. We believe that small laparotomy can be opted in less severe cases, regardless of laparoscopic completion. Conclusion We suspected adherent bowel obstruction and detected a band. We focused on band attachment and determined that the band should be resected if it was attached to Meckel's diverticulum. The resection method should be carefully selected, and the specimen should be histopathalogically examined., Highlights • We report a case of intestinal obstruction due to a mesodiverticular band. • The resection method for Meckel's diverticulum should be carefully selected. • Histopathological examination of the specimen should be performed. • Small laparotomy can be opted for less severe cases.

An 81-year-old man complaining of exertional dyspnoea underwent coronary angiography using an iodinated contrast medium. After angiography, the patient required systemic corticosteroid therapy because of respiratory failure due to alveolar haemorrhage. Percutaneous coronary intervention was performed 29 days after angiography using the same contrast medium. After the intervention, the patient required intubated mechanical ventilation and renal replacement therapy. Bronchoalveolar lavage was bloody with many haemosiderin-filled macrophages. Systemic corticosteroid therapy again improved his clinical condition. Iodinated contrast media may cause alveolar haemorrhage and re-exposure to contrast media may induce a more severe adverse reaction. LEARNING POINTS: Iodinated contrast media may cause alveolar haemorrhage. Re-exposure to iodinated contrast media may induce a more severe adverse reaction.

Highlights • Many advantages of endovascular repair for aneurysms have been reported. • The compression by aneurysms was not resolved early after endovascular repair. • Rectal necrosis caused by residual aneurysms early after endovascular repair is rare. • Aneurysm reduction and intestinal resection after embolization was a useful method. • Embolization performed earlier assisted surgical decompression of aneurysms., Introduction Recently, endovascular repair has become the first-line treatment for internal iliac artery aneurysm (IIAA). However, rectal necrosis due to the compression of the residual IIAA early after endovascular repair is rare. Presentation of case We present a rare case of a huge, isolated left IIAA that severely compressed the rectum and ureter. The patient underwent emergency endovascular repair; however, rectal necrosis occurred 10 days later because the repair failed to shrink the size of the aneurismal sac. Discussion We hypothesize that the compression of the residual IIAA caused rectal necrosis. During open surgery, endovascular repair disrupted blood flow within the IIAA, which probably allowed for aneurysm dissection and residual hematoma removal. Conclusion Endovascular repair alone could not immediately release compression on the surrounding organs; however, open surgical removal of aneurysms after successful endovascular repair may be a useful option for IIAAs with compression of surrounding organs.

Highlights • It is very rare case that each esophageal stump become connected and patent spontaneously. • Two-stage surgery is useful for esophageal perforation if radical operation is difficult. • Esophageal perforation can be resolved without direct closure if appropriate drainage is performed., Introduction Successful nonoperative management has been reported for esophageal perforation; however, some cases require surgery. Case presentation We presented the case of an 85-year-old woman with iatrogenic thoracic esophageal perforation in whom primary repair or resection of the perforated esophagus was difficult because she was elderly and had severe aortic valve stenosis. Therefore, we selected a two-stage surgery; laparoscopic gastrostomy, jejunostomy, posterior mediastinal drainage, and cervical esophagostomy were performed. We planned reconstruction after the perforation was closed, but endoscopic examination revealed spontaneous patency of each esophageal stump. Endoscopic balloon dilation was necessary because of esophageal stenosis; however, anastomotic surgery was unnecessary. Conclusion This case report suggests that esophageal perforation is resolved without direct closure if appropriate drainage is performed.

Highlights • The optimal management for synchronous advanced cancer remains controversial. • Multidisciplinary treatment strategies are important for synchronous advanced cancer. • Combined laparoscopic and robotic surgery allows minimally invasive resection. • Simultaneous endoscopic surgery is recommended for synchronous advanced cancer., Introduction The optimal management strategy for synchronous gastric cancer (GC) and prostate cancer (PCa) remains unclear, particularly in cases in which two cancers are progressive. Presentation of case A 68-year-old man diagnosed with synchronous advanced GC and locally advanced PCa was referred to our institution. Laparoscopic total gastrectomy (LTG) and robotic-assisted radical prostatectomy were simultaneously performed. The postoperative course was similar to the standard postoperative course of LTG alone. Pathological diagnoses were T3N3aM0 gastric adenocarcinoma and T3N0M0 prostatic adenocarcinoma. Adjuvant chemotherapy and adjuvant androgen deprivation therapy (ADT) for GC and PCa were initiated on postoperative days 15 and 27, respectively. Six months subsequent to surgery, the patient received adjuvant chemotherapy and ADT, and no evidence of cancer recurrence was observed. Discussion In terms of survival, curative resection with adjuvant therapy is advantageous for patients with advanced GC or locally advanced PCa. At present, treatment for synchronous cancer should be combined with optimal management for individual cancers. Minimally invasive surgery may play an important role in the multidisciplinary treatment of synchronous advanced cancer. Conclusion Combined laparoscopic and robotic surgery for synchronous GC and PCa allows for minimally invasive radical resection and appropriate adjuvant therapy.

Introduction Advances in diagnostic techniques and treatment have resulted in an increase in patients with synchronous cancer. Surgical reports of combined laparoscopic and robotic resection for synchronous colorectal and genitourinary cancer are rare. Materials and methods Between August 2015 and November 2017, three patients underwent combined laparoscopic and robotic surgery for synchronous colorectal and genitourinary cancer in our hospital. Results Case 1 was a 59-year-old man with synchronous rectal and prostate cancer treated by combined laparoscopic anterior resection and robotic-assisted prostatectomy. Case 2 was a 77-year-old man with synchronous cancer of transverse colon and left kidney treated by combined laparoscopic transverse colectomy and robotic-assisted partial nephrectomy. Case 3 was a 74-year-old man with synchronous adenocarcinoma of descending colon and prostate treated by combined laparoscopic left hemicolectomy and robotic-assisted prostatectomy. Discussion In simultaneous endoscopic surgery, it is necessary to consider sequence of resection, intraoperative position of patient and port arrangement. Simultaneous surgery allows promptly for postoperative adjuvant chemotherapy. Conclusion Combined laparoscopic and robotic surgery for synchronous colorectal and genitourinary cancer is suitable for advanced cancer cases requiring multidisciplinary treatment.

Highlights • The case of synchronous primary colorectal cancer and bladder cancer remains rare. • Multidisciplinary treatment is required for synchronous advanced colorectal cancer and bladder cancer. • Simultaneous laparoscopic resection may be proposed for postoperative multidisciplinary treatment., Introduction Advances in diagnostic techniques have resulted in an increase in the diagnosis of numerous patients with multiple primary cancers. However, the diagnosis of synchronous primary colorectal cancer and bladder cancer remains rare. Presentation of case A 69-year-old man diagnosed with synchronous advanced cancer of the ascending colon and urinary bladder underwent simultaneous laparoscopic resection. His postoperative course was similar to that of routine colorectal cancer. The patient refused adjuvant therapy. The patient was diagnosed as having recurrence of bladder cancer 3 months after surgery; he died 9 months after surgery. Discussion For multiple primary malignant tumors, simultaneous tumor resection is preferred. Simultaneous laparoscopic resection may be proposed for postoperative multidisciplinary treatment. If an established regimen is determined in the future, neoadjuvant chemotherapy may be an option for the treatment of synchronous advanced cancer. Conclusion Simultaneous laparoscopic surgery is a greatly beneficial approach for synchronous cancer requiring multidisciplinary treatment. Additionally, an appropriate support system for patients is indispensable for completing multidisciplinary treatment.

The association between pancreaticoduodenal artery aneurysm (PDAA) and local hemodynamic changes in pancreaticoduodenal arcades is well established. However, there are few case reports of PDAA associated with acute aortic dissection. In this article, we outline and discuss the case of a 61-year-old man diagnosed with a type A acute aortic dissection who underwent emergency surgery and developed sudden-onset severe abdominal pain and shock 10 days later. Contrast-enhanced computed tomography showed a ruptured PDAA with feeding vessels from the gastroduodenal and superior mesenteric arteries, with evidence that the celiac artery was diverged from a false lumen. Transarterial embolization via the superior mesenteric artery alone was not expected to achieve hemostasis, so we performed a hybrid procedure involving transarterial embolization cannulated from superior mesenteric artery with complementary surgical ligation of the gastroduodenal artery. The postoperative course was uneventful, and follow-up contrast-enhanced computed tomography showed no persistence of the aneurysm 8 days after the second operation. This case proposed that visceral arterial malperfusion due to acute aortic dissection can cause PDAA in the early postoperative period. Although previous reports suggest that endovascular treatment is preferable, it may not always be feasible. Since ruptured PDAAs are often not detected during surgery, surgical treatment can be overly invasive. Whereas, transarterial embolization with complementary clamping or ligation of the gastroduodenal artery for ruptured PDAA is less invasive and can control hemorrhage, especially when cannulation to the celiac artery is impossible. Notably, the technique did not cause organ ischemia, presumably because the small collateral vessels of the pancreaticoduodenal arcades permitted sufficient blood flow. If endovascular treatment is unable to achieve rapid hemostasis, this technique may be a useful option for ruptured PDAA.

PURPOSE The complexity of lung cancer treatment is rapidly increasing, necessitating the use of multidisciplinary approaches for improving outcomes. Although it is common for institutions to have their own tumor boards, tumor boards connecting several general hospitals, and therefore allowing for more diverse opinions, are not prevalent. MATERIALS AND METHODS A tumor board connecting eight hospitals was formed to discuss patients for whom formulating a treatment strategy was difficult. Physicians and hospital staff accessed a high-security communication line via LiveOn ( Japan Media Systems Corporation, Tokyo, Japan), which is completely isolated from the Internet and password protected, that enables each hospital to share the electronic medical records and images of relevant patients at other hospitals on desktop computers in real time. The lung cancer tumor board began in April 2017 and has since been held every Tuesday evening for 1 hour. Preparatory records containing the age, sex, histology, TNM classification, background, and discussion points for each patient are created before each tumor board meeting. After the tumor board discussion, all conclusions and related articles used in the board are added to the minutes, which are finalized as Microsoft Word files, consolidated, and archived. These files can be retrieved later using key words. RESULTS From April 2017 to June 2018, 202 patients were discussed. Although TNM classification was not changed for any patient, diverse opinions led to a change in the proposed strategy for 49 of 202 patients. CONCLUSION The multidisciplinary tumor board was useful in obtaining various opinions from the perspectives of different experts. This should be evaluated in a prospective study.

Prolonged immunosuppressive therapy is a risk factor for invasive pulmonary aspergillosis. We report a case of a 79-yearold man who underwent immunosuppressive therapy with methylprednisolone and cyclosporine for an acute exacerbation of interstitial lung disease. Ten days after initiation of immunosuppressive therapy, the patient reported night sweats and purulent sputum, and chest computed tomography scan revealed consolidation. He was diagnosed with invasive pulmonary aspergillosis, and required vasopressor support with oxygen therapy. After the administration of voriconazole and the modulation of immunosuppressive therapy, his condition improved. Short-term immunosuppressive therapy can also induce invasive pulmonary aspergillosis.

A 78-year-old woman with lumboperitoneal (LP) shunt was diagnosed with advanced cancer of the ascending colon. Laparoscopic right hemicolectomy was performed without manipulating the catheter. The patient’s postoperative course was uneventful, with no shunt-related complications or neurological deficit. The number of patients with cerebrospinal fluid (CSF) shunt who require abdominal surgery has been increasing. There are only few studies on laparoscopic surgery for patients with LP shunt, and the safety of pneumoperitoneum in the CSF shunt remains controversial. Consistent with other studies, we considered that pneumoperitoneum with a pressure of 10 mmHg has few negative effects. Our recommendations are as follows: (1) during colorectal resection, laparoscopic surgery can be performed without routine manipulation of the shunt catheter; (2) altering the location of the port is necessary to prevent both damage to the shunt tube during surgery and wound infection postoperatively; and (3) laparoscopic surgery is superior to laparotomy because it is associated with reduced surgical site infections and postoperative adhesions. However, laparoscopy should be performed at least 3 months after the construction of CSF shunt.

Background. Schwannoma arises from Schwann’s cell of the neural sheath. Schwannoma of the large intestine, particularly of the appendix, is rare. We report a case of appendiceal schwannoma resected using laparoscopic surgery. Case Presentation. A 75-year-old man was referred to our hospital for abdominal fullness and nausea since 2 months. Abdominal CT revealed a well-demarcated oval mass of 25 mm at the tip of the appendix. Contrast-enhanced CT revealed a lesion with gradually enhanced contrast from the arterial phase to the equilibrium phase. Abdominal US revealed a well-demarcated hypoechoic tumor. Preoperative diagnosis indicated appendiceal mesenchymal or neuroendocrine tumor. Ileocecal resection with D3 lymph node dissection was performed. Pathological and immunohistochemical findings confirmed the diagnosis of appendiceal schwannoma. Conclusions. For determining the surgical procedure of nonepithelial tumor of the appendix, preoperative diagnosis of mesenchymal or neuroendocrine tumors is required. However, appendiceal schwannoma is extremely rare, and its characteristic findings have not yet been established. Accumulating cases of appendiceal schwannomas is necessary for improving imaging diagnosis and surgical treatment.

We report the case of a 72-year-old man with occlusion of the left main bronchus due to squamous cell carcinoma of the lung. He required tracheal intubation and mechanical ventilation because of the aggravation of atelectasis and obstructive pneumonia. Electrocautery using hot biopsy forceps was performed during mechanical ventilation with a 40% fraction of inspired oxygen. He was extubated following improvement in the atelectasis and obstructive pneumonia and discharged with shrinkage of the tumor after chemotherapy. We describe a safe electrocautery procedure using hot biopsy forceps during mechanical ventilation with reference to previous reports.

Purpose The use of staplers for thoracic surgery has been widely accepted and regarded as a safe procedure. However, sometimes adverse events (AEs) of stapling are experienced. The aim of the present study was to retrospectively analyze AEs of stapling in thoracic surgery. Methods A retrospective multi-institutional review was conducted by the 27 institutions of the Central Japan Lung Cancer Surgery Study Group. Between January 2009 and December 2010, 4495 patients underwent thoracic surgery using mechanical stapling. Results Stapling of various tissues was performed 16403 times. Total number of AEs related to stapling was 126 (0.77%). One hundred and nine events occurred intraoperative and 17 events occurred postoperative. The AE rates ranged from 0% to 1.8%. No relationship was seen between the incidence of AE and a stapling volume of thoracic surgery. Conclusion We have investigated intraoperative and postoperative AEs of stapling. Generally, stapling in thoracic surgery was safe. An AE rate of stapling in thoracic surgery is not influenced by the numbers of stapling in institutions.

A 60-year-old man was performed right middle and lower bilobectomy. High fever was observed on the 17th postoperative day and the patient was diagnosed as having empyema with bronchopleural fistula(BPF). Chest tube drainage and antibiotics were started followed by open window thoracotomy on the 61st postoperative day. The repetition of closing package procedure was done daily or every other day. BPF was successfully covered by good granulation and was healed 6 months after open thoracotomy. The empyema cavity gradually decreased in size, and was completely epithelized 1 year after fenestration. Usually, the treatment of empyema with BPF is surgical treatment such as muscle flap plombage, following open window thoracotomy. But if the fistula is small and the infection is controlled effectively non-surgical treatment following open window thoracotomy is potentially useful way to cure the empyema with BPF.

顆粒細胞腫は皮膚, 食道など全身の臓器に発生する腫瘍である.胸腔内へ突出するように発育する胸壁発生の顆粒細胞腫は極めて稀である.今回我々は肋間神経由来と思われる本症の一手術例を経験したので報告する.症例は68歳, 女性.胸部異常陰影を主訴に当科を受診した.腫瘍は大きさ4.5×2.5×2cmで第3肋間神経より発生していた.第3, 4肋骨を切除するとともに, 肺への浸潤が疑われたため左肺上葉の一部を合併切除した.病理学的には顆粒細胞腫で悪性所見はなく, 肺, 肋骨への浸潤は認められなかった.

Objective: Locally advanced lung cancer has a poor prognosis, despite extensive surgery conducted in an effort to improve survival. We evaluated the safety and efficacy of induction therapy prior to extensive surgery for locally advanced lung cancer. Methods: Primary resection for lung cancer was done in 549 consecutive patients divided into three groups; 446 undergoing standard pulmonary resection (no extensive surgery), 87 undergoing extensive surgery without induction therapy, and 16 undergoing surgery after induction therapy. Results: Morbidity was 23.5%, 28.6%, and 43.8%, respectively. The rate was significantly higher in the induction group compared with the no extensive surgery group (P < 0.05). Surgical mortality was 0.67%, 3.4%, and 6.3%, respectively. The difference was statistically significant between the no extensive surgery and extensive surgery groups (P < 0.02), and between the no extensive surgery and induction groups (P < 0.02). Hospital mortality was 2.2%, 9.2%, and 6.3%, respectively. The rates were significantly higher in the extensive surgery (P < 0.01) and induction (P < 0.05) groups compared to the no extensive surgery group. Five-year survival was 50.3% for the patients who received induction therapy, and 14.7% for the patients who did not receive induction therapy. Conclusions: Survival differences between the induction and non induction groups were not significant, but some patients with T3 or T4 disease may benefit from induction therapy. The high morbidity of induction treatment should be recognized, and strict candidate selection and careful postoperative care used to help prevent increased mortality.

症例は56歳, 男性.胸部異常陰影を主訴に当科を受診した.CT, MRIより胸腺嚢胞を最も疑い手術を施行した.嚢胞と周囲組織との剥離を容易にする目的で気縦隔を併用し胸腔鏡下に胸腺左葉と共に嚢胞を摘出した.嚢胞は完全に縦隔内に位置し頚部との連続性はみられなかった.病理組織学的に副甲状腺嚢胞と診断された.縦隔副甲状腺嚢胞は稀な疾患であり胸腔鏡下の摘出は容易であった.

カルボプラチンを使用した気管支動脈注入 (broncho arterial injection, BAI) による薬剤性肺臓炎の1例を経験した.症例は80歳男性.右肺癌の治療目的にてカルボプラチンのBAI治療を行った.その後発熱, 呼吸困難等出現し, 胸部X線写真上両肺野に網状影が出現した.ステロイド使用後胸部X線所見が一旦改善するも徐々に増悪し, BAI施行後20日目に死亡した.カルボプラチンによる薬剤性肺臓炎は本症例が1例目である.

Bronchoscopic balloon dilation (BBD) is a useful method of treating tracheobronchial stenosis. Tracheobronchial stenosis in adults can arise from benign or malignant disease. Benign stenosis causes include sarcoidosis, tuberculosis, Wegener’s granulomatosis, trauma, berylliosis, and foreign body reaction. Furthermore, it can arise after prolonged endotracheal intubation, after sleeve resection or after lung transplantation. Despite adequate systemic therapy, airway stenosis may progress due to tuberculosis or sarcoidosis. In infants, prior use of endobronchial and tracheostomy tubes or congenital stenosis from complete cartilaginous rings are the primary reasons for such stenosis (McDonald & Stocks, 1965; Parkin ea al., 1976). Subglottic or tracheal sites are thus common and may continue to present serious and often fatal respiratory problems in infants. In adults, the etiologies are variable and the stricture can happen in any part of the airway. Tracheobronchial stenosis may produce symptoms such as dyspnea, cough, wheeze, stridor, or recurrent lower respiratory tract infections, and these symptoms cause the airway stricture to mimic asthma. There are various treatments including surgical resection, laser resection, and bougie dilation during rigid bronchoscopy. For lesions causing impending respiratory failure, surgical resection or stent placement is the most prudent treatment. In less urgent conditions, BBD has been considered a simple, rapid, and safe method to restore airway caliber. BBD has been used alone or in combination with other modalities such as laser resection, cryotherapy, and electrocautery. In 1984, Cohen et al. (Cohen et al., 1984) reported a successful balloon dilation through a tracheostomy tube under propylidone injection for a stricture after segmental resection of congenital stenosis in an infant. In 1987, Fowler et al. (Fowler et al., 1987) described bronchoscopic balloon dilation using a rigid bronchoscope for anastomotic stenosis in an adult who had had a sleeve resection for an endobronchial squamous cell carcinoma of the right main-stem bronchus 2 years earlier. The following year Carlin et al. (Carlin et al., 1988) reported two cases of bronchial stenosis successfully treated with a combination of bronchoscopic balloon dilation and Nd-YAG laser photoresection with a rigid bronchoscope. In 1991, balloon dilation using flexible bronchoscopy was described for the first time by Nakamura et al. (Nakamura et al., 1991). They treated two patients with tuberculous bronchial stenosis through a flexible bronchoscope under local anesthesia. Since then, several reports of BBD have been published (Ball et al., 1991; Keller &