Ryuichirou Kobayashi

Indications for an expandable metallic stent for tracheobronchial stenosis

An expandable metallic stent was used in 9 patients with tracheobronchial stenosis. Of the 8 patients with malignant stenosis, 6 had extrinsic compression and 2 had intraluminal tumor invasion. The 1 patient with nonmalignant stenosis had postreconstruction bronchomalacia and granulation tissue affecting different parts of the tracheobronchial tree. The expandable metallic stent successfully dilated tracheobronchial stenosis due to extrinsic tumor compression and malacia. However, it was not effective for stenosis due to intraluminal tumor invasion or granulation tissue because of the growth of tumor or granulation tissue between the wires of the stent. However, an expandable metallic stent covered with Dacron mesh was effective in 1 patient with intraluminal tumor invasion because tumor growth was blocked by the mesh. We conclude that an expandable metallic stent is effective for tracheobronchial stenosis due to extrinsic tumor compression, but not for stenosis due to intraluminal tumor invasion or granulation tissue.

Descending Necrotizing Mediastinitis Secondary to Pharyngitis: A Case Report

The patient was a 38-year-old female with descending necrotizing mediastinitis (DNM) originating from pharyngitis. The pus from infection by Bacteroides and aerobic streptococci had collected in the anterior and posterior mediastinum and bilateral thoracic cavity. Systemic antibiotic treatment with clindamycin and gentamycin was administered promptly after admission under a diagnosis of DNM, without waiting for results of culture and sensitivity studies. Four puncture drainages were performed by echoguide to treat bilateral empyema and left upper mediastinal pus collections. Additional surgical drainage via the transcervical approach was performed to drain right upper mediastinal pus. the patient was discharged on hospital day 50, and has since been in good health. Proper drainage at all pus collection sites by echo at both aerobic and anaerobic organisms are essential in the treatment of DNM.

Long Survival after Extrapleural Pneumonectomy for Pleural Malignant Mesothelioma with Metastasis to Infradiaphragmatic Lymph Node

A woman who at the age of 47 years underwent extrapleural pneumonectomy for malignant pleural mesothelioma with metastasis to an infradiaphragmatic lymph node is alive and well 63 months later. Because such metastasis is readily caused by lymphatic tumour-cell permeation from the diaphragm and parietal pleura, the infradiaphragmatic nodes should be dissected at extrapleural pneumonectomy for malignant pleural mesothelioma.

Serum clara cell protein levels in lung cancer patients: An assessment of preoperative values and postoperative changes

Serum levels of protein 1 (P1), a Clara cell protein known to have an antiinflammatory effect, were studied in 33 patients with lung cancer before surgery, and 3, 7, 14, 21 days, and 2 months after surgery. The preoperativeP1 values of the lung cancer patients were compared with those of 66 healthy controls matched by sex and age. The postoperative changes in P1 which occurred in the lung cancer patients were compared with those in 16 patients who underwent laparotomy for gastric or colon cancer. There was no significant difference in the P1 values between the lung cancer patients and the healthy controls; however, the postoperativeP1 values showed a significant decrease 3, 7, (P<0.001), and 14 days (P <0.05) postoperatively, recovering to normal within 2 months after surgery. One patient who died of postoperative pneumonia showed decreasing serum P1 levels until death. None of the laparotomy patients showed any decrease inP1 serum levels. Thus, we conclude that: (a) serumP1 levels do not differ between lung cancer patients and healthy individuals; (b) serumP1 levels significantly decrease in the early postoperative period, but recover within 2 months after lung resection; and (c) the postoperative changes that occur in serumP1 levels could provide important information about recovery from intraoperative lung damage.

Solitary, Thin-Walled Cavitary Lung Metastasis of Osteogenic Sarcoma

Three years after removal of a femoral osteosarcoma, a solitary, thin-walled cavitary lesion (diameter 1 cm) appeared in the lung of a young man. When the lesion enlarged, it was resected. Histology showed sarcoma metastasis with central necrosis and involving a peripheral bronchus. Cavitary metastasis can occasionally result from drainage of necrotizing tumor cells via a peripheral bronchus.