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.
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.
In 1989-90, all 37 lung cancer patients scheduled for surgery underwent transesophageal endoscopic ultrasonography (EUS) for pre-operative detection of hilar and mediastinal lymph node metastases. An electronic ultrasonic fiberscope with a linear array (EPB-503-FS, Machida-Toshiba) was used. Of 380 nodes surgically removed and that could have been detected by EUS, the detection rates for histologically metastatic and non-metastatic nodes were 65% (33 of 51) and 44% (144 of 329), respectively (p less than 0.01). Metastatic nodes were detected readily in every lymph node site, especially subaortic and subcarinal. Non-metastatic nodes were detected at low rates, especially in the superior mediastinum, paratracheal, and tracheobronchial locations. For greater long or short axes of the detected nodes, or for rounder nodes, the metastasis rate was higher. Detected nodes were classified into six types by their internal echo patterns; three were rarely metastatic (called "negative") and the other three were often metastatic (called "positive"). Of the "negative" nodes histologically proved to be metastatic, metastasis was often diffuse. The "positive" nodes found to be metastatic tended to have one of two patterns of internal echoes when invasion was diffuse and a third pattern when it was localized. In an examination of the diagnostic usefulness of EUS, we made more correct diagnoses from the internal echo pattern than by reference to either the long or short axis alone. The short axes, node shape, and internal echoes were examined by Hayashi's second method of quantification. The sensitivity, specificity, and accuracy of the diagnoses were 85%, 84%, and 84%, respectively, superior to those by computed tomography done of the same patients.
The purpose of this study was to investigate the clinical characteristics of chronic hemodialysis (HD) patients with lung cancer who underwent pulmonary resection at the authors' hospital. Subjects were 24 chronic HD patients (1.1%) from among 2178 patients who underwent pulmonary resection for lung cancer at our hospital between December 1994 and March 2009. Subjects included 20 males (83.3%), and mean age was 65.9 years. Twenty-two patients underwent lobectomy, one underwent a wedge resection and one underwent a segmentectomy. Histological diagnoses included squamous cell carcinoma in 12 patients, adenocarcinoma in nine, small cell carcinoma in two and adenosquamous carcinoma in one. The distribution of pathological staging was IA in nine cases, IB in five, IIB in five, IIIA in three, and IIIB in two. There was no operative mortality, and the overall morbidity rate was 58.3%. Disease-free interval was six to 102 months with a median of 54 months, and the five-year survival rate was 43.0%. Cases of pulmonary resection for lung cancer in chronic HD patients were investigated. There were no operative deaths or deaths in hospital, but three patients had serious complications. These data indicate that surgery can be performed safely with appropriate HD and general management in the perioperative period.
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