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捶井, 達也 ; 小田, 誠 ; 田村, 昌也 ; 早稲田, 龍一 ; 松本, 勲 ; 渡邊, 剛 ; Tarui, Tatsuya ; Oda, Makoto ; Tamura, Masaya ; Waseda, Ryuichi ; Matsumoto, Isao ; Watanabe, Go
概要:
金沢大学医薬保健研究域医学系<br />症例は32歳，女性．乳房痛を自覚し，精査のため胸部造影CTを施行したところ後縦隔に均一な造影効果を伴う径3.1cmの腫瘤を認めた．右上肢からの静脈造影では造影剤が上大静脈から奇静脈弓へ逆行性に流入し，
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腫瘤が濃染した．これにより腫瘤を静脈瘤と診断した．血栓による肺血栓塞栓症や瘤の破裂の可能性を考え外科的切除の方針とした．手術は胸腔鏡下にて施行した．まず血栓の流出を防止するため奇静脈弓の上大静脈合流部を自動縫合器にて切離した．次に瘤に流入する肋間静脈と奇静脈本幹を結紮，切離し，血行を遮断したのち瘤を切除した．術後合併症はなく10日目に退院した．<br />The patient was a 32-year-old female with a chief complaint of mastodynia. A computed tomography (CT) scan incidentally presented a homogeneously enhanced tumor, 3.1 cm in diameter, in the posterior mediastinum. Venography by the right brachial vein showed retrograde flow from the superior vena cava to azygos vein in the early phase. In the delayed phase, pooling of contrast medium in the tumor was observed. Based on the above findings, the tumor was diagnosed as an azygos vein aneurysm. She underwent aneurysm resection under video-assisted thoracic surgery (VATS) due to the risk of pulmonary thrombosis and rupture of the aneurysm. Initially, the proximal end of the azygos vein was resected due to the risk of pulmonary embolism, and, then, three intercostal veins and the distal end of the azygos vein were resected. Finally, after complete blockage of the azygos vein, the aneurysm was resected. The patient followed an uneventful postoperative course, and was discharged on the 10th postoperative day without complication.
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| 2.
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渡辺, 俊一 ; 小田, 誠 ; 太田, 安彦 ; 林, 義信 ; 清水, 淳三 ; 渡辺, 洋宇 ; Watanabe, Shun-ichi ; Oda, Makoto ; Ota, Yasuhiko ; Hayashi, Yoshinobu ; Shimizu, Junzo ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />症例は6歳, 男児.生後7ヵ月頃から前胸部陥凹が目立つようになった.1歳6ヵ月頃から発育の遅延, X脚, 偏平足などを認めるようになり当院小児科を受診, Morquio症候群との診断を受けた.当科にて
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漏斗胸に対し腹直筋有茎胸骨翻転術を施行した.Morquio症候群は遺伝性ムコ多糖代謝異常症のIV型に属するまれな疾患で, 特別な治療法はなく対症療法のみが施行される.Morquio症候群にみられる胸郭や脊柱の変形に対しては, しばしぼ装具を用いた保存的療法が行われるがあまり効果はなく, 逆に心肺機能を抑える結果となったり, また本疾患は知能障害を伴わないため装具の着用が精神的に強い負担となることが多い.漏斗胸を合併したMorquio症候群患者に対する胸骨翻転術は, 精神的にも心肺機能上も有効な治療法であると思われた.<br />A 6-year-old boy with Morquio's syndrome was referred from the department of pediatrics in our hospital for a sterno-turnover operation to repair his funnel chest.In Morquio's syndrome, also termed mucopolysaccharidosis IV, there are many skeletal abnormalities and growth retardation because of acid sulfatase deficiency. This syndrome, however, has no neurological abnormalities. Instrumental repair of the skeletal deformities is not effective and even results in the suppression of cardiopulmonary functions or in mental depression. Therefore, the sterno-turnover operation seems to be the best therapy for funnel chest in patients with Morquio's syndrome.
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木下, 敬弘 ; 太田, 安彦 ; 平能, 康充 ; 渡邊, 俊一 ; 小田, 誠 ; 村上, 眞也 ; 渡辺, 洋宇 ; Kinoshita, Takahiro ; Ohta, Yasuhiko ; Hirano, Yasumitsu ; Watanabe, Shun-ichi ; Oda, Makoto ; Murakami, Shinya ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />症例は56歳, 女性.健診にて左下肺野の異常影を指摘された.胸部CTにて肺動静脈瘻が疑われ入院となった.肺動脈造影にて左下葉の動静脈痩は最大径60mm, 流入血管径が8mmと大きいため経皮的カテーテル
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塞栓術 (以下;TAE) は不可能と判断された.また同時に右下葉にも最大径10mmの動静脈瘻を認めたため, これに対してはTAEを施行した.左側の動静脈瘻に対して開胸下に瘻切除術を施行した.<br />A 56-year-woman was admitted to the hospital with an abnormal shadow in the left lower lung field on chest X-ray film. The findings on chest CT examination suggested a pulmonary arteriovenous fistula. Left pulmonary arteriogram showed a large fistula (60 mm) with feeding vessels of 8 mm in diameter in the left lower lobe. It seemed to be impossible to perform embolization because of the size of fistula and its feeding vessels. Right pulmonary arteriogram at the same time revealed a small fistula of 10 mm in diameter in the right lower lobe, which was treated by embolization. The fistula of the left lung was resected on thoracotomy.
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森田, 克哉 ; 林, 義信 ; 家接, 健一 ; 清水, 淳三 ; 村上, 眞也 ; 小田, 誠 ; 荒能, 義彦 ; 徳楽, 正人 ; 長尾, 信 ; 矢崎, 潮 ; 渡辺, 洋宇 ; Morita, Katsuya ; Hayashi, Yoshinobu ; Ietsugu, Kenichi ; Shimizu, Junzo ; Murakami, Shinya ; Oda, Makoto ; Arano, Yoshihiko ; Tokuraku, Masato ; Nagao, Shin ; Yamazaki, Ushio ; Watanabe, Yoh
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金沢大学医薬保健研究域医学系<br />原発性非小細胞肺癌切除65例に対し, PCNA発現率で評価した腫瘍増殖能とリンパ節転移との関連について検討を行い, 生物学的悪性度の指標としての有用性について考察した.PCNA標識率は, 手術材料を用
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いてflow cytometerにより複数部位で測定し, その平均値で評価した.腺癌36例中13例, 扁平上皮癌29例中5例にリンパ節転移を認め, その頻度は腫瘍径の増大にしたがって増加した.しかしPCNA標識率とリンパ節転移の頻度は相関を認めず, また腺癌では腫瘍径とも相関を認めなかった.腫瘍径が同一の場合, PCNA標識率が高値すなわちdoubling timeが短い方が発癌から発見までの期間が短かいと考えられ, 腺癌ではT1でかつPCNA標識率が高値のものでリンパ節転移を認めなかった.PCNA標識率は腫瘍の動的状態を反映すると考えられる増殖能を表しており, 癌のある時点での進行度を表すTNM分類とは独立した因子と考えられた.<br />Proliferating cell nuclear antigen (PCNA) expression was studied in relation to the frequency of lymphnode metastasis in 65 resected non-small cell lung cancers. PCNA labeling index (LI) % was assayed objectively with flow cytometry. Lymphnode metastasis was found in 13 of 36 adenocarcinomas and in 5 of 29 squamous cell carcinomas. The frequency of lymphnode metastasis correlated positively with tumor size but not with PCNA LI%. In adenocarcinomas, there was no currelation between tumor size and PCNA LI%, but there was no lymphnode metastasis when the tumor was less than 30 mm in diameter and the PCNA LI % was high. It was concluded that PCNA LI% did not correlate with other prognostic factors but showed proliferating potential.
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常塚, 宣男 ; 清水, 淳三 ; 小田, 誠 ; 関戸, 伸明 ; 和田, 真也 ; 渡辺, 洋宇 ; Tsunezuka, Yoshio ; Shimizu, Junzo ; Oda, Makoto ; Sekido, Nobuaki ; Wada, Masanari ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />症例は55歳, 女性.主訴は咳嗽.胸部X線写真にて, 右上肺野に腫瘤陰影を指摘された.術前に確定診断は得られなかったが肺癌を疑って, 右上葉切除術を施行した.切除標本の病理組織検査では形質細胞の腫瘍性
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増殖を認めたが, 一部にリンパ濾胞の形成, リンパ球の巣状配列を認め, 形質細胞腫とCastlemanリンパ腫-Plasma cell typeとの鑑別が問題となった.PAP法による免疫組織化学的検査の結果, IgA-λ型の単クローン性の染色性を持つ肺原発性の形質細胞腫と診断された.組織学的にCastlemanリンパ腫と類似した形質細胞腫は, われわれが調べ得た範囲では本邦3例目であるが, 肺原発の症例は過去に報告例がない.<br />Extramedullary plasmacytomas are uncommon tumors that affect various tissues, most commonly in the upper airways. We report a case of solitary plasmacytoma of the lung that was difficult to differentiate histopathologically from Castleman's lymphoma.A 55-year old woman was admitted to our hospital with an abnormal shadow on chest X-ray films but no symptoms. Chest CT scan disclosed a solitary nodule with low density in the right upper lobe. Right upper lobectomy was performed, and histological examination showed diffuse proliferation of plasma cells and lymphoid follicles partially similar to Castleman's lymphoma. Immunohistologically, the plasmacytoma cells were stained with IgA and λ chains in a monoclonal secretory pattern.
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| 6.
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西田, 沙貴 ; 小田, 誠 ; 松本, 勲 ; 田村, 昌也 ; 早稲田, 龍一 ; 渡邊, 剛 ; Nishida, Saki ; Oda, Makoto ; Matsumoto, Isao ; Tamura, Masaya ; Waseda, Ryuichi ; Watanabe, Go
概要:
金沢大学医薬保健研究域医学系<br />症例は59歳，女性．3年前に子宮体癌を疑われ準広汎子宮全摘術，S状結腸切除術を施行された．病理診断および精査の結果，原発性肺腺癌の腹腔内転移と診断された．その後の経過で，計6レジメンの化学療法と計10
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0Gyの放射線治療が施行された．転移巣の制御は良好であったが，原発巣の増大傾向を認めたため，手術目的に当科紹介となった．手術は，肺門部において，肺動脈および上葉気管支と周囲組織との強固な癒着を認めたため，これらを一括して鉗子にてクランプした後に切離し，断端を3-0vicryl糸にて縫合して閉鎖した．断端は有茎傍心膜脂肪織にて被覆した．術後の病理診断で，低分化肺腺癌と診断された．術後さらに補助化学療法を追加し，術後9ヵ月間再発転移は認めていない．高容量化学放射線療法による炎症にて肺門部の処理が困難な症例に対しては，肺門部一括処理および有茎傍心膜脂肪織による気管支・肺動脈切離断端の被覆が有用であると考える．<br />A 59-year-old female was referred to our hospital for stage IV (cT3N2M1b) adenocarcinoma of the right lung. At the age of 56, at another hospital, she had undergone extended hysterectomy and resection of the sigmoid colon for suspected endometrial carcinoma and had received a diagnosis of lung adenocarcinoma based on pathological findings, a CT scan, and other examinations. A total of six regimens of chemotherapy and radiotherapy with a total dose of 100 Gy had been performed over 3 years, but it was resistant. Therefore, she was referred to our hospital to consider surgical treatment. We performed a right upper lobectomy because the tumor was localized and no other metastatic lesion was found. We ablated the tumor from the chest wall because it grew to the apical chest wall. In the hilum of the lung, individual ligation and closure of the pulmonary vessels and bronchus was found to be impossible because they tightly adhered to the peripheral tissue. Therefore, the hilar vessels and bronchus were clamped and cut in one mass. Their stumps were oversewn with 3-0 vicryl and covered with a pedicled pericardial flap. The post operative course was favorable, and the patient underwent adjuvant chemotherapy at the hospital that had originally referred her to us. She was free of clinically evident recurrence 9 months after treatment. We suggest that the mass closure of the hilar vessels and bronchus and covering the stumps with a pedicled pericardial flap are useful for cases in which it is difficult to individually close the vessels and bronchus due to ligneous scarring caused by radiation.
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清水, 淳三 ; 渡辺, 洋宇 ; 林, 義信 ; 小田, 誠 ; 岩, 喬 ; 高松, 秀行 ; 藤村, 政樹 ; 水上, 勇治 ; Shimizu, Junzo ; Watanabe, Yoh ; Hayashi, Yoshinobu ; Oda, Makoto ; Iwa, Takashi ; Takamatsu, Hideyuki ; Fujimura, Masaki ; Mizukami, Yuji
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Leiomyoma of the trachea and bronchus is a rare tumor. Only 45 cases have been reported in the Japanese literature. We report here a case of leiomyoma of the intermediate bronchus which was successfully operated on. A 45-year-old man
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suffered from a repeated episode of pneumonia in the right lower lobe. Bronchoscopy revealed a polypoid mass on the intermediate bronchus. The diagnosis of leiomyoma was made by bronchoscopic biopsy. Sleeve resection of the intermediate bronchus including the tumor and end-to-end anastomosis was performed. His postoperative course was uneventful and bronchoscopic findings showed clear healing of the anastomotic site. The resected specimen contained a tumor with smooth surface having protrusion into the bronchial lumen with 6 x 5 x 4 mm in size. The final pathological diagnosis was leiomyoma of the intermediate bronchus with no evidence of malignancy.
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清水, 淳三 ; 渡辺, 洋宇 ; 小田, 誠 ; 林, 義信 ; 渡辺, 進一郎 ; 龍沢, 泰彦 ; 岩, 喬 ; Shimizu, Junzo ; Watanabe, Yoh ; Oda, Makoto ; Hayashi, Yoshinobu ; Watanabe, Shin-ichiro ; Tatsuzawa, Y. ; Iwa, Takashi
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This report analyzes the operative indication for the small lesion of advanced lung cancer. The subjects consisted of 25 patients with T1N2 lung cancer, one T1N3, four T1M1 and five small lung cancer lesion with dissemination, which was
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regarded as the small lesion of advanced lung cancer. The cumulative 5-year survival rate after operation for 25 patients with T1N2 lesion was 30.6%. Of 25 patients, 18 were selected patients who underwent a curative operation with a 5-year survival of 37.0%. In the remaining 7 patients, who underwent a non-curative operation, 5-year survival was 0%. As to mediastinal lymph node involvement, it is possible that metastasis to more than two levels of mediastinal lymph nodes or to the upper mediastinal lymph nodes (#1-3) are poor prognostic factors in T1N2 lesion. Another group except T1N2 could not be the comparative materials because they were much fewer in number. But T4 cases associated with small lung cancer lesion with dissemination and T1M1 cases associated with intrapulmonary metastasis encountered at thoracotomy could be expected to have a long-term survival. We conclude that T1N2 patients with metastasis to within one level of mediastinal lymph node, which will possibly have a curative operation, is a proper operative indication for the small lesion of advanced lung cancer.
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大竹, 由美子 ; 小田, 誠 ; 清水, 淳三 ; 太田, 安彦 ; 林, 義信 ; 川上, 卓久 ; 渡辺, 洋宇 ; 野々村, 昭孝 ; Ohtake, Yumiko ; Oda, Makoto ; Shimizu, Junzo ; Ohta, Yasuhiko ; Hayashi, Yoshinobu ; Kawakami, T. ; Watanabe, Yoh ; Nonomura, Akitaka
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金沢大学医薬保健研究域医学系<br />A 63-year-old male had squamous cell carcinoma in the left upper lobe. CT scan suggested the invasio
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n of the tumor into the vertebral body and the descending aorta. Left pneumonectomy and combined aortic resection under the temporary bypass using Anthron tube was performed. The bypass using Anthron tube provides us no systemic heparinization and the procedure is easy. So the danger of massive bleeding during and after the operation can be decreased and the operative time can also be shortened. This procedure may be a great help for carrying out the operation with combined aortic resection more safely and speedily.
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家持, 健一 ; 清水, 淳三 ; 村上, 眞也 ; 小田, 誠 ; 林, 義信 ; 龍沢, 泰彦 ; 小林, 孝一郎 ; 関戸, 伸明 ; 荒能, 義彦 ; 高橋, 敦 ; 渡辺, 洋宇 ; Ietsugu, Ken-ichi ; Shimizu, Junzo ; Murakami, Shinya ; Oda, Makoto ; Hayashi, Yoshinobu ; Tatsuzawa, Yasuhiko ; Kobayashi, Ko-ichi ; Sekido, Nobuaki ; Arano, Yoshihiko ; Takahashi, Atsushi ; Watanabe, Yoh
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金沢大学医薬保健研究域医学系<br />Sixty-seven patients with thymoma were surgically treated during the past 19 years in our department
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. The 5-year, 10-year and 15-year survival rates of total cases with thymomas were 69.2%, 59.6% and 59.6%, respectively. Survival rates of thymoma with MG and without MG were not significantly different. According to clinical stages in Masaoka's classification, there were significant difference between Stage I and Stag III (p < 0.05), Stage I and Stage IV a (p < 0.01), and Stage I and Stage IV b (p < 0.01). We can conclude that complete resection of thymomas lead to better prognosis, and immunochemotherapy using cyclophosphamide, vincristine and OK-432 are effective.<br />1
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