Biomedical subjects

Koji Chihara

Publications and source records attributed to Koji Chihara.

10 recordsLinked to original sources

PubMed2006

Position of a chest tube at video-assisted thoracoscopic surgery for spontaneous pneumothorax.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is a good therapeutic option for young patients with primary spontaneous pneumothorax (PSP), but there sometimes exists unexpected prolonged hospital stay due to air leak after the operation. OBJECTIVES: The goal of this retrospective study was to clarify if the position of the chest tube placed at VATS for PSP affected the periods of postoperative hospital stay. METHODS: Seventy-one cases with PSP under age 40 who undertook VATS from January 1994 to February 2001 were examined for several factors. They were classified into two groups by the location of the tip of the chest tube placed at VATS as follows: upper medial pleural space (group I) and outside of there (group II). RESULTS: Fifty-three of the 71 cases (75%) were classified in group I and 18 (25%) were in group II. Between the two groups, there were no differences as to preoperative characteristics of the patients and intraoperative findings of blebs or bullae. On the other hand, postoperative air leak-related complications were more frequent in group II than in group I (p=0.004). Mean postoperative hospital stay was 5.1+/-1.9 days in group I and 8.4+/-4.3 days in group II (p<0.0001). CONCLUSIONS: Patients with the tip of the chest tube in the upper medial pleural space at VATS could be discharged earlier than the other patients. The chest tube placement is one of the important factors for the outcome of VATS for PSP.

Adult↗

PubMed2006

[Can video-assisted thoracoscopic surgery change the indication of lung resection for patients with lung cancer?].

Video-assisted thoracoscopic surgery (VATS) is associated with reduced pain, postoperative complications, release and responses of proinflammatory cytokines, and better ventilatory function during very early postoperative period after lung resection than standard thoracotomy. Because of the concern of local recurrence with pulmonary wedge resection by thoracotomy, anatomical lobectomy remains the curative procedure for lung cancer. However, same or better prognosis with a lesser resection by extended segmentectomy or wedge resection with VATS in patients with small lung cancer has been recently published. It suggests that these procedures would be applied for patients with poor pulmonary reserve who have not been considered as candidates for pulmonary resection.

Humans↗

PubMed2006

[Intrapulmonary bronchogenic cysts].

Bronchogenic cysts are commonly found in the mediastinum, but occasionally in lung parenchyma. We report 3 patients with intrapulmonary bronchogenic cysts. A female presented back pain and a large cystic lesion with an air-fluid level on chest X-ray and computed tomography (CT). Another female was asymptomatic. A well-defined round mass with soft tissue intensity on magnetic resonance imaging (MRI) was found. A girl with repeated pulmonary infection and treatment in hospital for several years presented pulmonary infiltrate, air-fluid level, and oval linear shadow on X-rays. All patients underwent lobectomy because of the size and the non-anatomical location of their lesions. Definite diagnosis on their lesions was determined by pathological study. Several small communications between the cyst and adjunctive parenchyma was found in the symptomatic girl, while the cyst was isolated from surrounding parenchyma in the asymptomatic female. We suggest symptoms and various presentations on imaging modalities in patients with intrapulmonary bronchogenic cysts might relate to the amount of original communication between their cysts and native lung.

Adolescent↗

PubMed2006

[A case of hypersensitivity pneumonitis caused by zinc fume].

A 55-year-old man with a 3-year occupational history of welding was admitted for repeated episodes of fever, cough and dyspnea after inhalation of smoke while welding galvanized steel. A computed tomography (CT) showed diffuse centrilobular nodules, panlobular ground-glass opacity and interlobular septal thickening in both lung fields, and he suffered from hypoxemia (PaO2 = 55.3Torr) while breathing room air. Percentage of lymphocytes in bronchoalveolar lavage fluid increased, and lung biopsy specimens at thoracoscopy revealed lymphocytic alveolitis and organization in air spaces. His symptoms and signs disappeared spontaneously only when he ceased welding. Panlobular ground-glass opacity and interlobular septal thickening improved immediately with oral corticosteroids. Patch tests using metal series gave positive reactions to zinc. We diagnosed this case as hypersensitivity pneumonitis caused by zinc fumes.

Alveolitis, Extrinsic Allergic↗

PubMed2005

Pericardial metastasis of myxoid liposarcoma causing cardiac tamponade.

Although myxoid liposarcoma often metastasizes to various organs, cardiac metastasis is rare. We present herein a rare case with pericardial metastasis of myxoid liposarcoma, which expanded the pericardial sac extraordinarily and required an emergency operation because of acute cardiac tamponade. We undertook a review of the English literature regarding liposarcoma.

Cardiac Tamponade↗

PubMed2005

[Placement of an ultraflex nitinol stent for severe tracheobronchial obstruction in a case of relapsing polychondritis].

A 59-year-old man, who had been treated for bronchial asthma since 2000, was hospitalized with high fever and productive cough in November 2003. Chest radiography on admission showed consolidations in both lower lung fields, and computed tomography demonstrated anteroposterior narrowing of both main bronchi. A physical examination revealed deformity of auricular cartilage and saddle nose, and we diagnosed him relapsing polychondritis (RP). When he was readmitted 4 months later because of severe tracheobronchial stenosis and respiratory failure he required mechanical ventilation, but it was difficult to wean him from the ventilator. Self-expandable metallic stents were placed in the left main bronchus and the trachea. After the procedure, he was successfully weared from mechanical ventilation. Since airway complications of RP can be fatal, stent implantation should be considered in the management of RP with airway manifestations.

Alloys↗

PubMed2004

Rapid occurrence of pulmonary aspergillosis after pulmonary wedge resection.

A 61-year-old man with diabetes mellitus undertook wedge resection of pulmonary tuberculoma in the left upper lobe. He was discharged uneventfully. However, he became febrile with productive cough five weeks after the discharge, and was readmitted. Imaging studies showed a cavitary lesion at the formerly resected site and multiple infiltrates in the other lobes. A diagnosis was rapidly deteriorating pulmonary aspergillosis. While medical treatments helped his general condition to improve, pulmonary shadows remained unchanged. Finally, we successfully treated him firstly, by performing left upper lobectomy and secondly, by treating multiple infiltrates with postoperative medical treatments. Multiple infiltrates improved gradually and diminished one month after surgery. He remains well without relapse for ten years after surgery.

Aspergillosis↗

PubMed2004

Successful thoracoscopic debridement of descending necrotizing mediastinitis.

Descending necrotizing mediastinitis results from odontogenic, deep neck infection that spreads along fascial planes into the mediastinum. Although the optimal surgical approach remains controversial, nearly half of the cases require mediastinal debridement by thoracotomy. We report a case of successful thoracoscopic debridement for descending necrotizing mediastinitis due to odontogenic infection that failed to be drained by transcervical approach. Because of less invasiveness as compared with standard thoracotomy, the thoracoscopic approach should be used as early as possible in case of unsuccessful transcervical approach.

Abscess↗

PubMed2003

Thymic atypical carcinoid with Cushing's syndrome manifesting in the terminal stage.

A 56-year-old man with recurrent thymic atypical carcinoid presented with Cushing's syndrome only in the terminal stage. Eighteen months after the resection of an anterior mediastinal mass, he presented with hypernatremia and hypokalemia with high serum levels of adrenocorticotropic hormone and cortisol, and died two months later. An autopsy demonstrated multiple metastases of the tumor to the mediastinum, lungs, heart, liver, kidneys, bone, pituitary gland, and ocular muscles. The adrenocorticotropic hormone level of the tumor tissue was 26,000 pg/g.

Carcinoid Tumor↗

PubMed2003

Right ventricular infarction during a lung lobectomy in a patient with chronic obstructive pulmonary disease: report of a case.

A 63-year-old man with a low forced expiratory volume in 1 s underwent a wedge resection for peripheral lung cancer; however, it relapsed in the residual lobe. We decided that a lobectomy was feasible after further examinations focusing on gas exchange. During the lobectomy right ventricle myocardial infarction occurred, possibly due to coronary spasm, and it was successfully treated with intra-aortic balloon pumping. The patient has been doing well without relapse for 7 years. Our findings indicate that some patients with low spirometry data may therefore be candidates for a lobectomy.

Electrocardiography↗