Novel bronchofiberscopic catheter spray device allows effective anesthetic spray and sputum suctioning

AbstractStudy objectives: To evaluate how serum lidocaine concentrations (SLC) rise when lidocaine is administered by a Bronchofiberscopic Catheter Spray Device (BCSD), and to demonstrate the effect on the aspiration speed of a substitute for sputum when a catheter spray remains in the channel of the bronchofiberscope (BF).Methods: This is a prospective randomized clinical study. After lidocaine ultrasonic nebulizer, the BF was inserted orally. During the procedure patients received 4% lidocaine by two methods. In Group 1, 11 patients received lidocaine by bronchofiberscopic (BF) injection. In Group 2, 15 patients received lidocaine by spraying from the ∅1.06mm catheter through the BF channel. SLC were measured at 40min from onset of nebulization. Separately, we examined how effectively sputum was aspirated through the BF channel with a catheter.Results: Total lidocaine dose (TLD) is the total dose used for nebulization and for the BF injection or spray. The TLD for Groups 1 and 2 were 698.2±162.1mg (mean±sd) and 498.7±103.8mg, respectively (P=0.03). The SLC for Groups 1 and 2 were 1.28±0.72 and 1.48±0.70mg/l, respectively (P=0.49).Conclusions: Using BCSD allows easier in administration of lidocaine and is not associated with a significant increase in SLC in comparison with BF injection. Although sputum aspiration using the BF inserted with our catheter was somewhat slow, we did not feel inconvenient so much. Compared to the conventional method, using BCSD may be preferable for patients and bronchoscopists

Photodynamic therapy for submucosal tumor of the central bronchus

A 75-year-old man was referred to our hospital because of the emphysema and tumor of the right intermediate bronchus. Thoracic CT scan and bronchoscopic examination demonstrated a spherical tumor of the right intermediate bronchus covering a normal mucosa. The biopsy specimen obtained from this tumor was histologically diagnosed as“glandular type of adenocarcinoma in the bronchus”. Surgical treatment was not feasible because of poor pulmonary function. Therefore, the patient underwent Photodynamic therapy (PDT) using porfimer sodium (Photofrin) and an excimer dye laser. After 4 months, the tumor disappeared and there has been no recurrence for 3 years 3 months. PDT can affect a submucosal tumor of the central airway, and is safe for patients with poor pulmonary function. Our report recommends that PDT should be applied not only to early lung cancer but also submucosal tumor of the central bronchus

A case of primary breast cancer with chronic phase chronic myelogenous leukemia

A female patient in her ４０s was admitted because of right breast swelling and pain. She had been taking Nilotinib（a molecular targeted drug）for ４months as treatment for chronic-phase chronic myelogenous leukemia. She was diagnosed with advanced breast cancer by cytology and histological examinations. She received neoadjuvant chemotherapy and had obtained a partial response. She then underwent a nipple-sparing mastectomy and axillary lymph node dissection. Therefore, in this patient, breast cancer and chronic myelogenous leukemia coexisted. Chemotherapy for breast cancer and a molecular targeted drug for chronic-phase chronic myelogenous leukemia were administered concurrently

術後肺ヘルニアに対し，緊急修復手術を施行した１症例

A male patient, in his ５０s, was admitted owing to rear neck pain and stomachache. He was diagnosed Type A acute aortic dissection and underwent a total arch aortic replacement operation. Five days later, he developed dyspnea after he coughed. He was diagnosed left lung hernia, mediastinal emphysema and pneumothorax by a chest CT scan. We repaired pulmonaly fistula and lung hernia using an ePTFE patch

甲状腺癌リンパ節転移との鑑別が困難であった頸部神経鞘腫の１例

A female patient in her 60s visited her previous doctor because of a right cervical mass that exist for 7 years and gradually increased in size. As she was suspected of cervical lymph node metastasis of thyroid cancer, she was referred to our hospital. At the initial visit, a 5-cm right cervical mass and enlargement of the right lobe of the thyroid gland were observed. Fine needle aspiration cytology was performed on both, but no malignant findings were observed. To confirm the diagnosis and improve the patient’s appearance, a right lobectomy of the thyroid gland and resection of the right cervical mass were performed. A rapid intraoperative histological examination of the cervical mass revealed a schwannoma. The right thyroid tumor was diagnosed as follicular adenoma. Her postoperative course was good, and after several years of follow-up, patient consultation was terminated. Neurolemmoma is a benign tumor arising from Schwann cells in the nerve sheath, and it occurs frequently throughout the head and neck region, with 25%-45% of cases occurring in this region. Cervical schwannomas are characterized by irritation of the vagus nerve, brachial plexus, and sympathetic nerves. However, many patients present with only a painless neck mass, as in this case. Although the mass can be diagnosed by puncture aspiration cytology in some cases, sufficient specimens are often unavailable, and the diagnosis is made preoperatively in about half of all cases. Differential diagnoses of an anterior cervical mass include malignant lymphoma, cervical lymph node metastases of malignant tumors, submandibular gland tumors, and tuberculous lymph node metastases. In this patient, we also considered lymph node metastasis of thyroid cancer. However, a histological examination did not detect malignancy in either the thyroid gland or neck mass, and we considered that the thyroid follicular adenoma and the cervical schwannoma occurred independently. We report our experience of cervical schwannoma combined with thyroid tumor which was suspected of lymph node metastasis of thyroid cancer

Diagnosis of the presence of lymph node metastasis and decision of operative indication using fluorodeoxyglucose-positron emission tomography and computed tomography in patients with primary lung cancer

Objectives : We evaluate whether integrated fluorodeoxyglucose-positron emission tomography and computed tomography (FDG-PET/CT) scan can diagnose the presence of lymph node metastasis more accurately than computed tomography (CT) scan alone. Methods : Forty-two patients with lung cancer preoperatively underwent integrated PET/CT scan using FDG and CT scan and underwent pulmonary resection and lymph node dissection. We judged cases as lymph node metastasis if the lymph node visually accumulated FDG at PET/CT scan and measured 1 cm or greater in the short axis at CT scan. We retrospectively analyzed whether our judgments in each modality were consistent with the pathological diagnosis. Results : Two-hundred and seventeen stations of lymph node were dissected and 21 stations (9.7%) were histologically diagnosed as positive metastasis. Thirty-two stations of lymph node visually accumulated FDG at PET/CT scan and 17 stations measured 1 cm or greater in the short axis at CT scan. Concerning the diagnosis of lymph node metastasis, PET/CT scan showed significantly higher sensitivity than CT scan (81% vs. 48%, p=0.024). The false-positive rate was significantly high in PET-positive lymph nodes measuring less than 1 cm in diameter. There were 4 falsenegative lymph nodes with both scans. All of these were less than 7 mm in diameter and had a low percentage of metastatic foci in the lymph node. Concerning the diagnosis of N staging, there was no significant difference between PET/CT scan and CT scan (83% vs. 69%, p=0.124). However, the identification of N2 disease at PET/CT scan was significantly more accurate than that at CT scan (100% vs. 38%, p=0.031). Conclusions : PET/CT is superior to CT scan in lymph node staging. However, because the false-positive rate is high in PET-positive lymph nodes measuring less than 1 cm in diameter, we think that clinical background should be considered and other modalities or histological examinations should be undertaken if necessary

ハイガン ジュツゴ チイキ レンケイ クリニカル パス ノ ゲンジョウ

In recent years, medical administration has changed. It has been necessary to promote functionaldifferentiation of hospital and to form new network of community medicine. Our hospitalwas approved as a base hospital of community medicine for cancer medicine in 2007. So we mustplay a leading part to present the latest medical technology about cancer and to form new medicalnetworks cooperated with community doctors. The necessity of the preparation of clinical pathway（CP）cooperated with community doctors was enacted in basic law of measures against cancerin January, 2007.We have already prepared postoperative CP for resected patients for lung cancer and used. Inthis review, we introduced the state of our CP and discussed future views of CP

Two cases of pulmonary dirofilariasis

Pulmonary dirofilariasis is almost always asymptomatic. An abnormal nodule was accidentally discovered by a chest x-ray during a medical checkup and detailed examination for other diseases was performed. Case １. A female patient, in her ７０s, was admitted owing to flu-like symptoms and bloody sputum. A chest computed tomography（CT）scan revealed a nodular shadow with １０‐mm ground glass opacity in the right lower lobe. Case２. A female patient, in her ６０s, was admitted due to an abnormal shadow on a chest xray in the left lung during a regular medical checkup. A chest CT scan revealed a nodular shadow with １３‐mm ground glass opacity in the left upper lobe. Lung cancer was suspected in both cases. Thoracoscopy and partial lung resection were performed to confirm the diagnosis. The specimen consisted of granulation tissue and no malignancy was found at operation. Final pathological diagnosis revealed pulmonary dirofilariasis. Pulmonary dirofilariasis can be definitively diagnosed by detecting a worm body. We believe partial lung resection during video-assisted thoracic surgery is a minimally invasive and an effective treatment for this disease

ゴウセイ キュウシュウセイ ユチャク ボウシザイ オ シヨウシタ イ ゼンテキ ジュツゴ ニ ハッショウシタ コウヤクセイ イレウス ノ イチレイ

The patient was a 50-year-old male. He underwent total gastrectomy with complication ablationof the greater omentum for gastric cancer. We used composition absorbent materials toprevent adhesion（seprafilm_）at closing of the abdominal wall. When he consulted our hospital forabdominal pain after 7 months later, we diagnosed the patient as having adhesive ileus. Severalhours later, he demonstrated abdominal swelling and fell into shock. Therefore, we performedurgent abdominal surgery. There were large quantities of cacosmia ascites and no adhesion exceptat only one point between the bottom of the previous wound and the small intestine. Weconfirmed strangulation ileus that had turned the small intestine with 360°dextroversion centeringon the adhesion point and the superior mesenteric artery root. Because most of small intestinehad become swollen and necrotized, we performed wide small intestinal resection with about 60cmsmall intestines survived. Currently we are following the patient with at-home intravenous hyperalimentationafter two further reoperations. At the time of the first operation, we had applied　seprafilm. This patient had a very late case of strangulation ileus, because there was almost noadhesion. This case represents a rare r side effect reports, involving shock, infection developingafter the use of seprafilm

キョウクウキョウカ ニ セツジョ シタ ジュウカクナイ イショセイ フクコウジョウセン センシュ

A woman in her ６０s who was diagnosed as having hypercalcemia and hyperparathyroidism was referred to our hospital. Serum calcium and intact parathyroid hormone levels were１１．４mg/ ml and １０７ pg/ml, respectively. Chest computed tomography revealed an enhanced mass measuring approximately１．５cm located in the anterior mediastinum. ９９mTc-Methoxy-isobutylisonitrile scintigraphy demonstrated an anterior mediastinal mass. These findings suggested an ectopic parathyroid tumor located in the mediastinum. The patient underwent resection of the parathyroid tumor with video-assisted thoracic surgery（VATS）. The operation time was １１４ min. The postoperative day１（POD１）calcium level rapidly decreased to８．３mg/ml. The patient was discharged on POD５, and there have been no signs of recurrence １ year after the surgery. Parathyroidectomy by VATS for ectopic mediastinal parathyroid tumors is advantageous because it is less invasive and more cosmetic. VATS may be used as a standard approach for ectopic mediastinal parathyroid tumors. We report the surgical treatment of a case of ectopic mediastinal parathyroid adenoma using video-assisted thoracoscope