Teruhiro Aoki

Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: A preliminary experience

Stereotactic radiation therapy is highly effective in the treatment of small brain metastases, regardless of the histology. This suggests that small extracranial malignancies may be curable with similar radiation therapy. The authors developed a novel treatment unit for administering such therapy.

Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy

BACKGROUND Data regarding pulmonary function and prognosis after video-assisted thoracic surgery lobectomy are limited. METHODS From September 1992 to April 2000, 204 video-assisted thoracic surgery lobectomies were performed, and their preoperative and postoperative pulmonary function test results and prognoses were evaluated. RESULTS The postoperative to preoperative ratio of pulmonary function tests (vital capacity and forced expiratory volume in 1 s) were better in video-assisted thoracic surgery lobectomy than in open thoracotomy (p < 0.0001). Furthermore, the 5-year survival rate of pathologic stage I lung cancers after video-assisted thoracic surgery was 97.0%, whereas that after open thoracotomy was 78.5% (p = 0.0173; Mantel-Cox). CONCLUSIONS Pulmonary function and prognosis were far better after video-assisted thoracic surgery lobectomy than after open thoracotomy.

Thoracoscopic resection of the lung with the ultrasonic scalpel

We used an ultrasonic scalpel, the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH), for limited thoracoscopic resection of the lung in 30 consecutive patients. There were no problems with bleeding in any of the 30 patients. After resection with Harmonic Scalpel the lung was closed with absorbable sutures. In 10 patients the operation was converted to lobectomy, and lymph node dissection was done because intraoperative histopathologic examination revealed lung cancer. Postoperative complications were not observed in the remaining 20 patients who had limited resection only. The Harmonic Scalpel is a useful tool for partial lung resection procedures.

Successful resection of a glomus tumor arising from the lower trachea: Report of a case

Tracheal glomus tumors are extremely rare. We present herein the case of a 43-year-old man with hoarseness who was found to have a glomus tumor arising from the lower trachea. Bronchoscopy and chest computed tomography revealed a polypoid mass in the membranous portion of the trachea just above the carina. The patient underwent successful tracheal sleeve resection and reconstruction. A pathologic diagnosis of a glomus tumor with clear surgical margins was subsequently confirmed, and the patient is well 20 months postoperatively with an intact anastomosis.

A comparison of biopsy through a parasternal anterior mediastinotomy under local anesthesia and percutaneous needle biopsy for malignant anterior mediastinal tumors

The various methods of treating the numerous types of anterior mediastinal neoplasms are undergoing refinements; however, prior to the commencement of any treatment, an accurate histologic diagnosis must be established. We conducted a retrospective analysis of biopsies performed through a parasternal anterior mediastinotomy (PAM) on 21 patients with an anterior mediastial mass suspected of being malignant by computed tomography (CT) and other clinical information. Patients with possible localized thymomas were excluded. Mediastinotomy, which enables relatively large tissue samples to be taken, was performed through the bed of the second or third costal cartilage under local anesthesia. In 19 of the 21 patients (90%), the histologic diagnosis made from the mediastinotomy biopsy was identical to the final diagnosis. Conversely, although the tissue obtained from needle biopsy was sufficient for a histologic diagnosis in 11 of 12 patients, the histologic diagnosis made from the needle biopsy was the same as the final diagnosis in only 5 of 10 patients (50%). Thus, diagnostic accuracy was significantly higher in the mediastinotomy biopsies than in the needle biopsies (P=0.0318). Moreover, the mediastinotomy biopsy specimens revealed subtypes of lymphomas and germ cell tumors. All of the patients from whom a mediastinotomy biopsy had been taken began appropriate therapy without delay according to the histologic diagnosis. These results suggest that the PAM approach should be chosen as the preferred method of biopsy for suspected malignant anterior mediastinal tumors.

Techniques for Treating Aberrant Arteries During Resection of Pulmonary Sequestration by Video-Assisted Thoracic Surgery: Report of Two Cases

Abstract.We describe the techniques we used for treating aberrant arteries during resection of pulmonary sequestration by video-assisted thoracic surgery (VATS) in two patients. In patient 1, the aberrant artery was transected after securing six rows of staples with a knifeless vascular endostapler. In patient 2, the aberrant artery was cut after ligation with special forceps that designed by one of us (S.K.) to push a knot, tied outside the body, into the thoracic cavity, then ligate the suture. Left lower lobectomy and right basal segmentectomy were both successfully performed by these methods. These two cases are reported to show that VATS lobectomy is a feasible and minimally invasive technique of treating pulmonary sequestration and other diseases of the lung.

Empyema and mediastinitis complicating retropharyngeal abscess.

A 21 year old man with a retropharyngeal abscess complained of right sided chest pain, and chest radiography and thoracocentesis revealed an empyema. A computed tomographic scan of the chest showed a posterior mediastinal abscess communicating with the right pleural cavity. Emergency thoracotomy was performed and the mediastinal abscess and empyema were drained.

Development of primary leiomyosarcoma of the sternum postirradiation: report of a case.

We report herein the case of a 30-year-old man who developed a primary leiomyosarcoma (LMS) 11 years after undergoing a median sternotomy for mediastinal seminoma followed by 50 Gy radiotherapy. He was given two courses of chemotherapy, resulting in 90% tumor regression, after which resection of the tumor with adjacent chest wall structures was carried out. Reconstruction was performed using a methylmethacrylate prosthesis prepared preoperatively. Post-operatively, he received two additional courses of chemotherapy and has had no sign of recurrence for 45 months.

Cartilage folding method for main bronchial stapling

Bronchopleural fistula is one of the most severe complications of lung operations. To prevent bronchopleural fistula, we modified the stapling technique to include folding of both sides of the cartilaginous main bronchus. This reduces the tension at the center of the membranous portion of the airway. From 1991 to 1994, this technique was performed in 7 patients. Despite the fact that 4 of these patients received adjuvant therapy, none had development of a bronchopleural fistula.

Mesenchymal chondrosarcoma of the rib: Report of a case

Mesenchymal chondrosarcoma is a rare malignant cartilaginous tumor arising within the bone or soft tissue. An 18-year-old woman presented with a tumor on her left fourth rib. We performed a wide resection of the tumor and administered three cycles of postoperative adjuvant chemotherapy. Three years after the operation, the patient is alive without any evidence of either local recurrence or distant metastases. The findings of this case may thus support the usefulness of a radical resection and adjuvant chemotherapy for mesenchymal chondrosarcoma.