Simple palliative mediastinal tracheostomy.

We describe a simple palliative mediastinal tracheostomy procedure in 3 patients with respiratory deficiency resulting from cervical tracheal stenosis caused by unresectable advanced tumors. A hole in the "apron" skin flap was anastomosed to the tracheostomy in the unaffected upper mediastinal trachea after partial resection of the manubrium and clavicle head. Simple palliative mediastinal tracheostomy helps to improve performance status by relieving respiratory deficiency or prolonged oroendotracheal intubation in patients with cervical tracheal stenosis caused by advanced tumors.

Phase II study of pemetrexed as first-line treatment in elderly (≥75) non-squamous non-small-cell lung cancer: Kyoto Thoracic Oncology Research Group Trial 0901.

Background: Single-agent chemotherapy with third-generation non-platinum agents, such as docetaxel, vinorelbine, is a standard therapeutic option for elderly patients with non-small-cell lung cancer (NSCLC). Subset analysis of a previous phase III study comparing pemetrexed with docetaxel in the second-line setting showed the superiority of pemetrexed in an elderly (≥70) population in both efficacy and toxicity.

Patients And Methods: This was a single-arm phase II study of pemetrexed in elderly (≥75) Japanese patients with advanced non-squamous NSCLC.

A novel method for determining adjacent lung segments with infrared thoracoscopy.

Objectives: We investigated a new technique for identifying the lung intersegmental line using infrared thoracoscopy with intravenous injection of indocyanine green.

Methods: This was an experimental animal study, and target segments were established preoperatively. Six adult beagle dogs underwent thoracotomy.

Widespread and early tracheal cartilage regeneration by synchronous slow release of b-FGF and BMP-2.

Our previous studies have demonstrated that slow release of basic fibroblast growth factor (b-FGF) or bone morphogenetic protein 2 (BMP-2) induces cartilage regeneration. In the present study, we investigated whether synchronous slow release of b-FGF and BMP-2 would induce more widespread and earlier cartilage regeneration than that induced by each growth factor alone. A 1-cm defect was made in the mid-ventral portion of each of 10 consecutive tracheal rings.

Dual time point FDG PET for evaluation of malignant pleural mesothelioma.

Objective: To evaluate whether 2-deoxy-2-18F-fluoro-D-glucose (FDG) positron emission tomography (PET) is more useful in differentiating malignant from benign pleural lesions, and whether delayed FDG PET imaging can improve the diagnostic performance in patients with suspicion of malignant pleural mesothelioma (MPM).

Methods: Thirty-three patients who were suspected of having MPM were examined with FDG PET. PET imaging (whole body) was performed at 60 min (early) post-FDG injection and repeated at 120 min (delayed) after injection only in the thoracic region.

Reconstruction of emphysematous lung tissue using slowly released basic fibroblast growth factor from gelatin microspheres.

Basic fibroblast growth factor (bFGF) has a variety of activities including regeneration and neovascularization. This study was an attempt to reconstruct emphysematous lung tissue employing slow release of bFGF. Twenty beagle dogs were randomly split into four groups: a) control group (n = 5), b) porcine pancreatic elastase (PPE)-induced emphysema group (n = 5), c) FGF-MS group [n = 5, a suspension of bFGF-incorporated gelatin microspheres (MS) was injected via the pulmonary artery of emphysema model animals], and d) MS group (n = 5, MS without bFGF were injected).

Closure of the pleural dead space after pneumonectomy in a rabbit model: use of bioabsorbable lactic acid and caprolactone copolymer cubes.

The remaining pleural dead space after pulmonary resection sometimes causes serious complications, such as empyema. The objective of this study was induction of granulation tissue in uninfected pleural space after pneumonectomy in a rabbit model using implantation of bioabsorbable and porous poly-l-lactic acid and epsilon-caprolactone copolymer (PLAC) cubes. Twelve Japanese white rabbits were randomly split into two groups: the control group (n = 6) underwent simple left pneumonectomy, whereas the experimental group (n = 6) underwent left pneumonectomy followed by filling of the left hemithorax with PLAC cubes.

Tracheal cartilage regeneration and new bone formation by slow release of bone morphogenetic protein (BMP)-2.

We investigated the efficiency of bone morphogenetic protein (BMP)-2 released slowly from gelatin sponge for tracheal cartilage regeneration. A 1-cm gap was made in the mid-ventral portion of each of 10 consecutive tracheal cartilages. In the control group (n = 4), the resulting gap was left untreated.

Clinical application of infrared thoracoscopy to detect bullous or emphysematous lesions of the lung.

Objective: We have previously reported that infrared thoracoscopy was useful in detecting emphysematous lesions in a canine model of lung emphysema. We applied infrared thoracoscopy to determine the feasibility and efficacy of planning bullectomy for patients with spontaneous pneumothorax.

Methods: A total of 8 patients with spontaneous pneumothorax were included in the study.

Intra-thoracic fibrous tissue induction by polylactic acid and epsilon-caprolactone copolymer cubes, with or without slow release of basic fibroblast growth factor.

Objective: We investigated whether implantation of polylactic acid and epsilon-caprolactone copolymer (PLAC) cubes with or without basic fibroblast growth factor (b-FGF) released slowly from gelatin microspheres was able to induce fibrous tissue in the dead space remaining after pneumonectomy in the thoracic cavity.

Methods: Left pneumonectomy was performed in Japanese white rabbits. In the control group (n=6), the left thoracic cavity was closed without any treatment.

Tracheal cartilage regeneration by slow release of basic fibroblast growth factor from a gelatin sponge.

Objective: We investigated whether implantation of a gelatin sponge, releasing basic fibroblast growth factor slowly (b-FGF) into a tracheal cartilage defect, would induce regeneration of autologous tracheal cartilage.

Methods: We created a 1-cm defect in the midventral portion of each of 10 consecutive cervical tracheal cartilage rings in 12 experimental dogs. In the control group (n = 4), the resulting defects were left untreated.

Induction chemoradiotherapy (carboplatin-taxane and concurrent 50-Gy radiation) for bulky cN2, N3 non-small cell lung cancer.

Objective: To improve the prognosis of cN2, N3 non-small cell lung cancer, we performed induction chemoradiotherapy (carboplatin-taxane chemotherapy and concurrent 50-Gy radiation) followed by surgery.

Methods: Patients with pathologically proven non-small cell lung cancer with bulky cN2, N3 disease were enrolled. Forty-one patients underwent an operation after chemoradiotherapy from January 2000 to April 2006.

A surgical case of primary lung cancer with peripheral intrapulmonary lymph node metastasis.

We report on a case of a patient with lung adenocarcinoma and peripheral intrapulmonary lymph node (IPLN) metastasis who was misdiagnosed as having intrapulmonary metastasis. A subpleural nodular shadow visualized by radiography was diagnosed as an intrapulmonary metastasis originating from primary lung cancer. Preoperative evaluation indicated that this case was a clinical T4N1 lung adenocarcinoma with metastasis in the same lobe.

En bloc partial vertebrectomy for lung cancer invading the spine after induction chemoradiotherapy.

Objective: The optimal surgical treatment for non-small cell lung cancer (NSCLC) with vertebral body invasion remains both controversial and challenging. We reviewed our experiences of NSCLC with vertebral body invasion, in which we have performed induction chemoradiotherapy followed by lung resection with en bloc partial vertebrectomy.

Methods: Six NSCLC patients with vertebral invasion underwent an operation following chemoradiotherapy from January 2001 to July 2006.

Large cell carcinoma with neuroendocrine morphology of the lung.

We experienced a surgical case of large cell carcinoma with neuroendocrine morphology (LCCNM) of the lung. A 76-year-old man was admitted to our hospital because a routine chest X-ray examination had revealed a nodular shadow in the left lung field. 18F-fluorodeoxyglucose positron emission tomography showed accumulation of fluorodeoxyglucose in an area corresponding to the shadow.

Regeneration of canine tracheal cartilage by slow release of basic fibroblast growth factor from gelatin sponge.

We investigated the efficiency of basic fibroblast growth factor (b-FGF) released from a gelatin sponge in the regeneration of tracheal cartilage. A 1-cm gap was made in the midventral portion of each of 10 consecutive cervical tracheal cartilages (rings 4 to 13) in 15 experimental dogs. In the control group (n = 5), the resulting gap was left blank.

Successful treatment for lung cancer associated with pulmonary sequestration.

We encountered a 69-year-old man with lung adenocarcinoma and pulmonary sequestration. The cancer lesion was located in the left upper lobe, with sequestration of the left lower lobe. Left upper lobectomy was performed after induction chemoradiotherapy, but the sequestered lung lobe was preserved because the preoperative respiratory function was poor.

Real time imaging and quantitative evaluation of the emphysematous lung by infrared thoracoscopy in experimental dogs.

To accurately excise emphysematous lung tissue in volume reduction surgery, we projected a digitally analyzed excision line on the real time image obtained by infrared thoracoscopy (IRT) with indocyanine green (ICG) intravenous injection. Emphysema was created in the canine lung by intrabronchial injection of elastase. We examined the emphysematous lung by IRT after intravenous injection of ICG.

Successful treatment of massive bleeding into the open thoracotomy space by pulmonary artery occlusion: report of a case.

A 69-year-old man underwent decortication and latissimus dorsi muscle transposition for the treatment of chronic empyema in January 2001. The empyema recurred in March 2002, and open drainage was thus started in July 2002. In February 2003, massive hemorrhaging from the thoracic cavity occurred.

A combined small cell carcinoma of the lung containing three components: small cell, spindle cell and squamous cell carcinoma.

A 61-year-old man was referred to our hospital because of rapid growth of a mass shadow revealed by chest radiography. The mass was diagnosed as pure small cell carcinoma by CT-guided needle biopsy, and the patient underwent chemotherapy. However, as the tumor showed no response, we considered the possibility of some other form of malignancy and performed surgery.

Clinical analysis of interstitial pneumonia after surgery for lung cancer.

Objective: The postoperative development or exacerbation of interstitial pneumonia (IP) in lung cancer patients often affects prognoses. We analyzed the patients who suffered from IP after surgery, to determine treatment and prevention of IP.

Methods: One hundred and one consecutive patients who underwent resection were enrolled in the study.

Video-assisted thoracoscopic pericardial fenestration for tuberculous pericardial effusion.

A 72-year-old woman was admitted with chest discomfort and general fatigue. She was diagnosed as having cardiac tamponade with massive pericardial effusion. Percutaneous pericardiocentesis yielded bloody effusion.

Slow release of bone morphogenetic protein 2 from a gelatin sponge to promote regeneration of tracheal cartilage in a canine model.

Objectives: We investigated whether bone morphogenetic protein 2, released slowly from a gelatin sponge, could induce cartilage regeneration in a canine model of tracheomalacia and evaluated the long-term results.

Methods: A 1 x 5-cm gap was made in the anterior cervical trachea by removing 5-cm long strips of 10 sequential cartilagines. In the control group (n = 5), the gaps were left untreated.

Development of a canine model of pulmonary emphysema and imaging of the emphysematous lung with infrared thoracoscopy.

Background: The surgeon must use the results of preoperative computed tomography findings and scintigraphic studies to make a subjective decision during lung volume reduction surgery with regard to the best incision line.

Objectives: Our purpose was to develop an objective and real-time method of detecting areas of pulmonary emphysema by using infrared thoracoscopy.

Methods: Pulmonary emphysema was developed in various lobes of the lung in the dog by injecting porcine pancreatic elastase through the bronchi.

[Development of new therapeutic method for empyema].

Objectives: We have investigated whether polylactic acid (PLA) sponge and fibroblast-growth-factor (FGF) released slowly from gelatin beads can induce fibrotic tissue in postpneumonectomy dead space.

Methods: Left pneumonectomy was performed in white Japanese rabbits. In the control group (N = 5), left chest was closed without any treatment.