Katsuya Morita

Comparison of pleuropneumonectomy and limited surgery for lung cancer with pleural dissemination

The role of surgery in the management of lung cancer with pleural dissemination is controversial. We performed a retrospective analysis of our patients with lung cancer and pleural dissemination who were treated surgically. Between 1973 and 1993, 1,206 patients with lung cancer underwent pulmonary resection at Kanazawa University Hospital. Among them, 40 (3.3%) had pleural dissemination without pleural effusion. The 1‐, 3‐, and 5‐year survival rates for 38 patients (except 2 patients undergoing exploratory thoracotomy alone) were 51.5%, 19.4%, and 19.4%, respectively. The 1‐year survival rate in the 10 patients who underwent pleuropneumonectomy was only 20%, and 9 of these patients died within 18 months postoperatively (1 patient has survived for 25 months). In contrast, the 1‐, 3‐, and 5‐year survival rates for the 14 patients who underwent resection of the primary tumor plus parietal pleurectomy were 85.1%, 35.5%, and 35.5%, respectively, a significantly better outcome (P < 0.01). Seven patients are still alive (the longest survival time is 65 months with the disease). The average survival time in the seven fatal cases was 18 months. In patients with lung cancer accompanied by pleural dissemination, it is quite possible that local excision plus pleurectomy will be justified.

Malignant fibrous histiocytoma originating in the mediastinum: Report of a case

Malignant fibrous histiocytoma (MFH) is a tumor which most often develops in the soft tissues of the extremities and retroperitoneum, but very rarely originates in the mediastinum. We report herein the case of a 63-year-old man who underwent surgical resection of a rapidly growing tumor in the right thoracic cavity which was diagnosed as an MFH of mediastinal origin on the basis of histological findings, the definitive diagnosis ultimately being made by specific immunostaining.

Delayed Infection of a Lymphocele Following Mastectomy with Immediate Breast Reconstruction : Report of a Case

We report herein a rare case of delayed infection of a lymphocele following mastectomy with immediate breast reconstruction. A 38-year-old woman presented to our hospital 7 months after undergoing a left-modified radical mastectomy with an immediate breast reconstruction, following the sudden development of a giant mass in the left thoracoabdominal region as well as a high fever and shivering. Ultrasonography and a computed tomographic scan revealed massive fluid retention extending from the left axilla to the lower abdominal region. Puncture drainage was performed three times and the injection of an antibiotic directly into the cyst resulted in resolution of the fluid. This massive retraction of fluid was considered to have resulted from a delayed infection of an axillary lymphocele.

A Clinical Analysis of Small-Sized Lung Cancer with Advanced Disease

A clinical analysis of small-sized lung cancers with advanced disease was conducted on a total of 58 patients: 34 diagnosed as T1N2, 6 as T1N3, 9 as T1M1, and 9 as T4 due to pleural dissemination. The cumulative 5-year survival rate after surgery for the 34 patients with a T1N2 lesion was 17.4%. Of these 34 patients, 24 underwent a curative operation resulting in a 5-year survival rate of 23.7%, but the remaining 10 patients, who underwent a non-curative operation, had a 5-year survival rate of 0%. Extended lymph node dissection for N3 disease has only been performed in recent years, so it is not yet clear whether it will affect the survival rate or not. T4 disease due to pleural dissemination and T1M1 disease associated with intrapulmonary metastasis encountered at thoracotomy could be expected to have relatively long-term survival with the combined use of systemic immunochemotherapy after surgery. In cases diagnosed as T4 due to pleural dissemination, we have recently employed resection of the primary lesion with parietal pleurectomy as the standard operative procedure. For cases of T1M1 with intrapulmonary metastasis confined to the same lobe as the primary lesion, a lobectomy is usually performed, while for cases with intrapulmonary metastasis extending to another lobe, a lobectomy with enucleation of metastatic nodules or pneumonectomy is most often performed instead of an exploratory thoracotomy.

A Case of Adenocarcinoma of the Lung Combined with Metastatic Pulmonary Osteosarcoma Originating from the Fibula in a 13-year-old Girl.

骨肉腫肺転移と原発性肺癌が同時に存在した13歳女児の1例を経験した. 右腓骨の骨肉腫を手術後, 両肺野の多発性肺転移の治療中に, 原発性肺癌が発見されたものである.初診時に胸部CTで両側肺野に5個みられた腫瘍陰影は, CDDP, またはMTXを中心とした化学療法 (計11クール) を施行後, 左下葉の1個を残し消失した. 残存結節を化学療法が無効の肺転移巣と考え, 腫瘍を含めた肺部分切除術を施行したところ, 原発性肺腺癌と病理診断された. 化学療法の組織効果は, Ef. 0と判定された.この症例は術後4ヵ月目に両肺野に5個の結節陰影が出現した. うち, 3個は初診時の腫瘤陰影とは全く違う部位であり, 新たな転移巣と思われた. 肺癌または骨肉腫の肺転移再発と診断し, 再手術を施行した. 病理検査では, いずれも骨肉腫の肺転移と診断された.

A CASE OF ISCHEMIC STRICTURE OF THE SMALL INTESTINE AFTER REPAIRING OF AN INCARCERATED INGUINAL HERNIA

A 66-year-old man experienced incarceration of a left inguinal hernia on June 13, 1991. The incarcerated inguinal hernia was repaired without taxis after 24 hours. Six days later the patient underwent radical operation for the hernia at elsewhere, however, abdominal pain and vomiting appeared 3 days after the operation. From physical symptoms and imaging findings, the patient was diagnosed as having an intestinal obstruction and was referred to the department for examination because of persistent symptoms. Conservative therapy did not provide any symptomatic remission and operation was performed on August 28. During surgery a stenosis was found in the ileum 40cm oral from the ileum end and the 20cm ileum was removed. From histological findings, the patient was diagnosed as ischemic enteritis with stenotic change following the ligation of incarcerated inguinal hernia. We rarely encounter a case of incarcerated inguinal hernia with ischemic stenotic change after repair of the hernia causing ileus. We should carefully follow the patient after repairing of incarcerated inguinal hernia, entertaining a possible occurrence of the delayed small bowel stenosis following ischemic enteritis.