Katsuhiko Isogami

Delayed cardiac rupture occurring two months after blunt chest trauma

We describe a rare case of successful repair of delayed cardiac rupture due to blunt chest trauma; the cardiac rupture occurred 74 days after the trauma. A 75-year-old woman with a history of blunt chest trauma that caused multiple rib fractures underwent an emergent thoracotomy due to left hemothorax. A coin-sized pericardial defect and cardiac rupture on the left ventricle was found to be close to a fractured rib, which was thought to have damaged the myocardium and thus induced timedependent myocardial degeneration. The cardiac rupture and the pericardial defect did not induce life-threatening cardiac tamponade; however, the cardiac rupture did induce hemothorax, which could be successfully treated.

Chest wall abscess due to Mycobacterium bovis BCG after intravesical BCG therapy

ABSTRACT We report a case of chest wall abscess caused by Mycobacterium bovis BCG that arose as a complication 1 year after intravesical BCG instillation. We identified M. bovis BCG Tokyo 172 in the abscess by PCR-based typing of Mycobacterium tuberculosis complex and analysis of variable number of tandem repeats data.

Extended sleeve lobectomy for interlobar lymph node metastasis invading the bronchus from peripheral lung cancer

Although extended sleeve lobectomy has been used as an alternative to pneumonectomy for the treatment of centrally located lung cancer, the validity of this surgical procedure is unclear in patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus. We herein report four patients with peripheral lung cancer in the left lower lobe who underwent extended sleeve lobectomy consequent to interlobar lymph node metastasis. The tumor and metastasized lymph node was extirpated en bloc with division of the main bronchus and upper division bronchus, and those bronchi were anastomosed using the telescope method. All patients were doing well without recurrence. Extended sleeve lobectomy may be applicable to patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus to avoid pneumonectomy.

A Case of Mucoepidermoid Carcinoma of the Subsegmental Bronchus.

症例は75歳, 女性. 住民検診にて胸部異常陰影を指摘され, 精査目的に当科に入院となった. 気管支鏡検査にてlB1+2a亜区域支内に内腔をほぼ完全閉塞する複数のポリープ状腫瘍が認められた. 生検組織診では腺腫が疑われた. 胸部X線写真およびCTにて腫瘍閉塞部より末梢肺は軽度の閉塞性肺炎像を呈していた. 確定診断および肺炎増悪を防ぐ目的にて開胸, 左下区々域切除を施行した. 腫瘍はlB1+2a亜区域～亜々区域支にかけた気管支内腔に発育し, 壁外浸潤は認められなかった. 迅速診断にて低悪性度の粘表皮癌と診断された. 術後1年健在である. 粘表皮癌は術前診断に難渋を来す疾患である.

Role of neutrophil migration on increased pulmonary microvascular permeability.

The precise role of neutrophils in adult respiratory distress syndrome is not yet clear. Endotoxin administration is known to induce the permeability pulmonary edema with neutrophil migration into alveolar spaces. Leukotriene B4 is known as a strong chemotactic factor. To clearify the roles of neutrophils on pulmonary microvascular injury, we compared the effects of endotoxin and leukotriene B4 on lung lymph dynamics and neutrophil migration. Endotoxin caused increase in microvascular permeability and migration of neutrophils into alveolar spaces.Whereas leukotriene B4 did not affect lung microvascular permeability. Neutrophils in broncho-alveolar lavage fluid after leukotriene B4 administration increased to the same value as which after endotoxin administration. These results suggest that the neutrophil migration into alveolar spaces is not essential to develop the permeability pulmonary edema.