Ryoji Yamamoto

Effects of preoperative chemotherapy and radiation therapy on human bronchial blood flow

OBJECTIVE We investigated the relationship between bronchial mucosal blood flow around the area of lung resection and the state of healing of the bronchial stump in patients after chemotherapy with or without radiation therapy. METHODS Ninety patients with primary lung cancer were divided into the following 3 groups: group A, 72 patients who had no preoperative therapy; group B, 10 patients who had chemotherapy; and group C, 8 patients who had chemoradiation (60 Gy) therapy. Bronchial mucosal blood flow was measured preoperatively, intraoperatively, and postoperatively (days 8-10) with a laser Doppler flowmeter. RESULTS In groups A and B bronchial mucosal blood flow was preserved sufficiently around the surgical site, and the healing of the bronchial stump was satisfactory. On the contrary, preoperative blood flow in group C was 70% of the preoperative value in group A and decreased further intraoperatively. Healing of the bronchial stump was poor, and a bronchopleural fistula occurred in one patient of group C. CONCLUSION Preoperative chemoradiation therapy may adversely affect bronchial mucosal blood flow and healing of the bronchial stump, although lymphadenectomy and preoperative chemotherapy had little effect. It is recommended that the bronchial stump should be covered with pedicled viable tissue after chemoradiation therapy for prophylaxis against bronchial complications.

Double stent for malignant combined esophago-airway lesions

OBJECTIVE Combined esophago-airway stenosis and/or esophago-airway fistula due to malignancy bodes a dismal prognosis. We describe our work with double stents for combined esophago-airway lesions. METHODS Between February 1994 and July 2000, we treated 11 patients using double stents--the Dumon stent for the airway and the covered Ultraflex for the esophagus. Double stenting was necessitated by combined esophago-airway stenosis in 8 patients and fistulas in 3, of these, 6 had lung cancer and 5 esophageal cancer. RESULTS In all but 1 ventilator-dependent patient, dyspnea and dysphagia were significantly reduced and fistula was successfully closed after double stenting. This palliation effectively continued more than 1 month in 5 patients, more than 2 months in 3, and more than 3 months in 2. Mean survival was 64 days (range: 9 to 148 days). Life-threatening complications developed in 5 (45%)--massive bleeding in 3 and uncontrollable esophago-airway fistula in 2. All 5 had received prior radiation. CONCLUSION Although patients who received radiation frequently had life-threatening complications after double stenting, this procedure improved the quality of life in patients with esophago-airway stenosis or fistulas due to lung or esophageal cancer.

Successful surgical treatment of pulmonary artery aneurysm in Behçet's syndrome

We report herein an uncommon clinical case of pulmonary artery aneurysm in Behçets syndrome, for which only a few reports have been published in the literature to date. A 68-year-old Japanese male, who was referred for recurrent fever of unknown origin, anemia and pulmonary nodular opacities, was treated by right lower lobectomy followed by postoperative oral administration of colchicine and corticosteroid. Postoperative pathological examination confirmed a diagnosis of pulmonary artery aneurysm accompanied by vasculitis and thrombi. Clinical and radiographic feature are presented herein.

Extrathoracic protrusion of a chronic expanding hematoma in the chest mimicking a soft tissue tumor

We report an uncommon clinical case of extrathoracic protrusion of a chronic expanding hematoma in the chest, mimicking a soft tissue sarcoma. A 77-year-old Japanese man was successfully treated by chest wall resection and partial decortication of the lung. The postoperative pathology examination confirmed a diagnosis of a granular cell reaction. Details of the clinical and radiographic features are presented.

Sclerosing Mediastinitis Mimicking Anterior Mediastinal Tumor

A 54-year-old asymptomatic man presented with an anterior mediastinal mass discovered on chest roentgenogram. Chest computed tomography revealed a noncalcified round mass in the mediastinum. A white solid mass, 5-cm in diameter, had arisen from the pericardial adipose tissue with multiple small nodular lesions mimicking mediastinal tumor with pleural dissemination. Postoperative pathologic examination confirmed a diagnosis of sclerosing mediastinitis. Details of the clinical and radiographic feature are presented.

Neuroblastoma resection in an adult with a 10-year history of chest-mass shadow.

Neuroblastoma is rare in adults. We encountered this tumor in an asymptomatic 21-year-old man with a 10-year history of a mass-like shadow in chest radiography. Diagnosis was confirmed after resection, and 60 Gy radiation therapy was started. One year later, the patient has no clinical or radiological evidence of recurrence.

Lung metastases from various malignancies combined with primary lung cancer

Various tumors metastasize to the lung, and they are often detected as multiple nodules. We report on two cases of such multiple lung metastases combined with primary lung cancer: a myxoid liposarcoma in the right thigh and a colon cancer. In each case, a pulmonary metastasectomy revealed that one of the tumors was primary lung cancer. Regardless of recent advances in computed tomography for detecting small pulmonary nodules and ground-glass opacity components, which indicate possible primary lung cancer, the preoperative differential diagnosis for either metastatic or primary lung cancers is usually difficult because they are too small to obtain enough tissue for diagnosis, except by surgery. When nodules are removed and diagnosed as lung metastasis combined with primary lung cancer, additional treatment should be considered depending on the prognosis of each disease.

Surgery for multiple and diffuse pulmonary arteriovenous fistulas during childhood.

We report an uncommon clinical case of multiple, diffuse pulmonary arteriovenous fistulas that occurred during childhood. A 15-year-old Japanese girl with multiple pulmonary arteriovenous fistulas presented with moderate hypoxemia and was treated by left lower lobectomy for complete resection of the arteriovenous fistulas. Clinical and radiographic features are presented.

Sequential Stenting for Extensive Malignant Airway Stenosis

PURPOSE Malignant airway stenosis extending from the bronchial bifurcation to the lower lobar orifice was treated with airway stenting. We herein examine the effectiveness of airway stenting for extensive malignant airway stenosis. METHODS Twelve patients with extensive malignant airway stenosis underwent placement of a silicone Dumon Y stent (Novatech, La Ciotat, France) at the tracheal bifurcation and a metallic Spiral Z-stent (Medicos Hirata, Osaka, Japan) at either distal side of the Y stent. We retrospectively analyzed the therapeutic efficacy of the sequential placement of these silicone and metallic stents in these 12 patients. RESULTS The primary disease was lung cancer in eight patients, breast cancer in two patients, tracheal cancer in one patient, and thyroid cancer in one patient. The median survival period after airway stent placement was 46 days. The Hugh-Jones classification and performance status improved in nine patients after airway stenting. One patient had prolonged hemoptysis and died of respiratory tract hemorrhage 15 days after the treatment. CONCLUSION Because the initial disease was advanced and aggressive, the prognosis after sequential airway stent placement was significantly poor. However, because respiratory distress decreased after the treatment in most patients, this treatment may be acceptable for selected patients with extensive malignant airway stenosis.

Resection of a second primary lung cancer in a lobe where small-cell lung cancer was previously treated with chemoradiotherapy: report of a case.

There are few reports of resected cases of second primary lung cancer in post-treatment survivors of small-cell lung cancer. Here, we report a surgical case of a 62-year-old female with second primary lung adenocarcinoma after chemoradiotherapy against small-cell lung cancer. She had been treated for small-cell lung cancer 2 years earlier, and achieved complete response after the treatment. A new nodular lesion was detected at a different segment in the right lower lobe. We performed a right lower lobectomy accompanied with systemic mediastinal nodal dissection. Histopathological findings revealed that the new nodular lesion was a second primary lung adenocarcinoma. No metastatic tumor was seen in the dissected lymph node; the initial tumor had disappeared completely. The postoperative course was uneventful, and she was discharged on day 10 after the operation. Ten months after the operation, she was free of recurrent tumor.