A pulmonary ligament approach for portal robotic segmentectomy of the lateral and posterior basal segments: a case report

Abstract Background Thoracoscopic segmentectomy of the lateral and posterior basal segments is extremely technically challenging. Appropriate segmentectomy requires exposure and recognition of the branches of the bronchi and pulmonary vessels deep in the lung parenchyma. Although various approaches for these segmentectomies have been reported, the use of a pulmonary ligament approach is rational because it does not require any interlobar separation. Here, we report a successful case of portal robotic segmentectomy of the lateral and posterior basal segments through the pulmonary ligament approach. Case presentation A 60-year-old Japanese man with a history of low anterior resection for rectal cancer was referred to our department because of a lung nodule. His chest computed tomography revealed a 15-mm tumor in the left posterior basal bronchus. Robotic left S9–10 segmentectomy through the pulmonary ligament was performed with five-port incisions. Conclusions An extremely technically challenging thoracoscopic segmentectomy of the lateral and posterior basal segments was performed through the pulmonary ligament using a robotic surgical system.

Download Full-text

Unicuspid aortic valve concomitant with aortic insufficiency presenting with infectious endocarditis: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2239-9 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

Naoko Yuzawa-Tsukada ◽

Toshikazu D. Tanaka ◽

Satoshi Morimoto ◽

Michihiro Yoshimura

Keyword(s):

Case Report ◽

Aortic Valve ◽

Aortic Insufficiency ◽

Infectious Endocarditis ◽

Cardiac Abnormality ◽

Case Presentation ◽

Old Japanese ◽

History Of ◽

Nonbacterial Thrombotic Endocarditis ◽

High Turbulence

Abstract Background A unicuspid aortic valve is a rare congenital cardiac abnormality. Despite its uncommon finding on an initial presentation, aortic insufficiency is accompanied with unicuspid aortic valve and this might reflect the natural history of progression in the morphology of unicuspid aortic valve. Case presentation We describe a 65-year-old Japanese man who was evaluated for endocarditis and found to have a unicuspid aortic valve concomitant with moderate aortic insufficiency, which was, owing to the lack of evidence of valve membrane destruction, independent of underlying infectious endocarditis. In addition, aortic insufficiency was progressed because of nonbacterial thrombotic endocarditis on the ventricular side, in areas of high turbulence around the heart valve. Conclusions Our case is unusual given the unicuspid aortic valve concomitant with aortic insufficiency, which was presumably independent of underlying infectious endocarditis because of the location of the vegetation and the lack of evidence of valve destruction. Therefore, attention should be paid to a variety of complications in the setting of unicuspid aortic valve.

Download Full-text

Obstructive Pneumonia With Bronchial Foreign Body: A Case Report

10.21203/rs.3.rs-331826/v1 ◽

2021 ◽

Author(s):

Hitomi Tanaka ◽

Takatoshi Anno ◽

Haruka Takenouchi ◽

Hideaki Kaneto ◽

Toru Oga ◽

...

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Laboratory Data ◽

Vital Signs ◽

Fish Bone ◽

Case Presentation ◽

Bronchial Foreign Body ◽

Old Japanese ◽

History Of ◽

Normal Chest

Abstract Background: Bronchial foreign bodies are relatively uncommon in adults. There are a variety of symptoms induced by airway foreign bodies, although the typical symptoms of some bronchial foreign bodies are cough, wheezing, chest pain, hemoptysis and fever up. Case presentation: An 80-year-old Japanese man was referred to our hospital with symptom of 7-month history of cough and pneumonia. His chest radiograph showed a slight increase in opacity. His vital signs and his laboratory data were almost normal. Chest computed tomography revealed obstructive pneumonia and a bronchial foreign body. We performed bronchoscopy and detected a fish bone as an intrabronchial foreign body and finally removed it from the bronchi.Conclusions:It is very important to carefully perform medical consultation about the current and past medical history. People in some countries and regions such as Japan have a habit of eating fish. It is necessary to more carefully consider the possibility of some bronchial foreign body such as a fish bone, when we observe symptoms of persistent cough.

Download Full-text

Primary leiomyoma of the ureter: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02960-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Shingo Morinaga ◽

Shigeyuki Aoki ◽

Motoi Tobiume ◽

Genya Nishikawa ◽

Hiroyuki Muramatsu ◽

...

Keyword(s):

Malignant Tumors ◽

Histopathological Examination ◽

Urine Cytology ◽

Benign Tumors ◽

Case Presentation ◽

Old Japanese ◽

Retrograde Pyelogram ◽

History Of ◽

The Right ◽

Enhanced Computed Tomography

Abstract Background Only 14 cases of leiomyoma with ureteral origin have been reported previously. Such primary leiomyomas often present as hydronephrosis, making the diagnosis difficult. Radical nephroureterectomy is often performed because of the possible diagnosis of a malignant tumor. We report the 15th case of primary leiomyoma with a ureteral origin. Case presentation A 51-year-old Japanese man presented with a chief complaint of asymptomatic gross hematuria with a history of hypertension. Enhanced computed tomography showed a tumor at the upper part of the right ureter that appeared to be the cause of hydronephrosis and contracted kidney; no retroperitoneal lymphadenopathy and distal metastasis were observed. A well-defined 20-mm (diameter) defect was identified at the upper of the right ureter on retrograde pyelogram with no bladder cancer on cystoscopy. Urine cytology and right divided renal urine cytology findings were negative. Laparoscopic nephroureterectomy was performed, and the extracted tumor measured 20 × 13 mm. Histopathological examination revealed primary leiomyoma with no recurrence 16 months after the operation. Conclusions Preoperative examination with the latest available ureteroscopic technology can help preserve renal function in the case of benign tumors by enabling preoperative ureteroscopic biopsy or intraoperative rapid resection. Moreover, nephroureterectomy is recommended in the case of preoperative suspicion of ureteral malignant tumors.

Download Full-text

Pneumoconiosis with a Sarcoid-Like Reaction Other than Beryllium Exposure: A Case Report and Literature Review

Medicina ◽

10.3390/medicina56110630 ◽

2020 ◽

Vol 56 (11) ◽

pp. 630

Author(s):

Fumiko Hayashi ◽

Takashi Kido ◽

Noriho Sakamoto ◽

Yoshiaki Zaizen ◽

Mutsumi Ozasa ◽

...

Keyword(s):

Chest Radiography ◽

Analytical Electron Microscopy ◽

Clinical Manifestations ◽

Dust Exposure ◽

Dust Deposition ◽

High Resolution Computed Tomography ◽

Case Presentation ◽

Old Japanese ◽

History Of ◽

Beryllium Disease

Background: Chronic beryllium disease (CBD) is a granulomatous disease that resembles sarcoidosis but is caused by beryllium. Clinical manifestations similar to those observed in CBD have occasionally been reported in exposure to dusts of other metals. However, reports describing the clinical, radiographic, and pathological findings in conditions other than beryllium-induced granulomatous lung diseases, and detailed information on mineralogical analyses of metal dusts, are limited. Case presentation: A 51-year-old Japanese man with rapidly progressing nodular shadows on chest radiography, and a 10-year occupation history of underground construction without beryllium exposure, was referred to our hospital. High-resolution computed tomography showed well-defined multiple centrilobular and perilobular nodules, and thickening of the intralobular septa in the middle and lower zones of both lungs. No extrathoracic manifestations were observed. Pathologically, the lung specimens showed 5–12 mm nodules with dust deposition and several non-necrotizing granulomas along the lymphatic routes. X-ray analytical electron microscopy of the same specimens revealed aluminum, iron, titanium, and silica deposition in the lung tissues. The patient stopped smoking and changed his occupation to avoid further dust exposure; the chest radiography shadows decreased 5 years later. Conclusion: The radiological appearances of CBD and sarcoidosis are similar, although mediastinal or hilar lymphadenopathy is less common in CBD and is usually seen in the presence of parenchymal opacities. Extrathoracic manifestations are also rare. Despite limited evidence, these findings are similar to those observed in pneumoconiosis with a sarcoid-like reaction due to exposure to dust other than of beryllium. Aluminum is frequently detected in patients with pneumoconiosis with a sarcoid-like reaction and is listed as an inorganic agent in the etiology of sarcoidosis. It was also detected in our patient and may have contributed to the etiology. Additionally, our case suggests that cessation of dust exposure may contribute to improvement under the aforementioned conditions.

Download Full-text

Cocaine-Induced Giant Bullous Emphysema

Case Reports in Medicine ◽

10.1155/2020/6410327 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Steven Douedi ◽

Vandan D. Upadhyaya ◽

Ishan Patel ◽

Usman Mazahir ◽

Eric Costanzo ◽

...

Keyword(s):

Cocaine Abuse ◽

Stable Condition ◽

Lung Parenchyma ◽

Case Presentation ◽

Chronic Cocaine ◽

Giant Bulla ◽

History Of ◽

Alpha 1 Antitrypsin ◽

Lung Periphery ◽

The Right

Background. Emphysematous bullae, defined as airspaces of greater than or equal to one centimeter in diameter, have a variety of etiologies such as tobacco use and alpha-1 antitrypsin being the most common. Emphysematous bullae have also been reported in patients using cocaine usually involving the lung periphery and sparing the central lung parenchyma. We present a case of a male with a history of cocaine abuse found to have a singular giant emphysematous bulla occupying >95% of the right hemithorax requiring video-assisted thoracic surgery (VATS) with a favorable outcome. Case Presentation. A 50-year-old male with a history of chronic cocaine abuse was found unresponsive in the field and given multiple doses of naloxone without any improvement in mental status. On presentation to the emergency department, chest X-ray as well as CT scan of the chest were performed which were suggestive of an extensive pneumothorax of the right lung requiring placement of a chest tube. The patient was subsequently intubated and underwent bronchoscopy with right chest VATS which found a giant bulla encasing the entire right pleural cavity. During the procedure, he underwent resection of the bullae and a partial right pleurodesis. After the procedure, patient’s respiratory status significantly improved, and he was discharged in a stable condition. Conclusion. Cocaine use is a rare but identifiable factor that can cause giant bullous emphysema (GBE) resulting in severe complications and even death. The purpose of this case presentation is to support early identification and treatment of GBE using bullectomy with VATS, improving outcomes and decreasing morbidity and mortality.

Download Full-text

History of the Robotic Surgical System

Robotic Approaches to Colorectal Surgery ◽

10.1007/978-3-319-09120-4_1 ◽

2015 ◽

pp. 3-17

Author(s):

Joshua I. S. Bleier ◽

Brian R. Kann

Keyword(s):

History Of ◽

Robotic Surgical System ◽

Surgical System

Download Full-text

Kawasaki Disease with an Initial Manifestation Mimicking Bacterial Inguinal Cellulitis

Case Reports in Pediatrics ◽

10.1155/2020/8889827 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Tsukasa Tanaka ◽

Masaki Shimizu ◽

Oshi Tokuda ◽

Hiroko Yamamoto ◽

Natsuki Matsunoshita ◽

...

Keyword(s):

Kawasaki Disease ◽

Cervical Lymphadenopathy ◽

Cytokine Profile ◽

Conjunctival Injection ◽

Initial Manifestation ◽

Case Presentation ◽

Old Japanese ◽

History Of ◽

Hands And Feet ◽

Left Inguinal Region

Background. Kawasaki disease (KD) is typically characterized by fever, oral cavity erythematous changes, bilateral bulbar conjunctival injection, skin rash, erythema and edema of the hands and feet, and cervical lymphadenopathy. Some atypical patients with KD initially develop cervical and pharyngeal cellulitis; however, an initial presentation with inguinal cellulitis is extremely rare. In addition, to our knowledge, no report has documented the cytokine profile in a KD patient with cellulitis. Case presentation. A previously healthy 8-year-old Japanese girl was hospitalized following a 2-day history of fever and a 5-day history of pain and erythema in the left inguinal region. She was diagnosed with bacterial inguinal cellulitis and was administered antibiotics. The next day, a polymorphous rash emerged on her trunk. After 3 days of antibiotics, however, her fever continued and the cellulitis had spread over the entire lower abdomen. Simultaneously, the bilateral bulbar conjunctival injection without exudate became more prominent and her lips became erythematous. In addition, erythematous changes on her palms appeared a few hours later, which led to the diagnosis of KD. Since she had a high risk score that predicted no response to initial intravenous immunoglobulin (IVIG) at the initiation of treatment, she was treated with IVIG, intravenous prednisolone (PSL), and oral aspirin. The KD symptoms improved the next day, but the cellulitis did not completely resolve until 2 months after discharge. The patient’s serum cytokine profile at admission had an IL-6 dominant pattern which was consistent with that of patients with KD despite her initial lack of KD symptoms, and the pattern observed at admission was sustained until IVIG and PSL administration. Conclusion. KD should be included in the differential diagnosis for patients presenting with inguinal cellulitis who are unresponsive to initial empiric antibiotics.

Download Full-text

Laparoscopic Repair of Internal Transmesocolic Hernia of Transverse Colon

Case Reports in Surgery ◽

10.1155/2015/853297 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Tomokazu Kishiki ◽

Toshiyuki Mori ◽

Yoshikazu Hashimoto ◽

Hiroyoshi Matsuoka ◽

Nobutsugu Abe ◽

...

Keyword(s):

Small Intestine ◽

Internal Hernia ◽

Transverse Colon ◽

Surgical Procedure ◽

History Of Surgery ◽

Case Presentation ◽

Internal Hernias ◽

Old Japanese ◽

History Of ◽

Rule Out

Introduction. Internal hernias are often misdiagnosed because of their rarity, with subsequent significant morbidity.Case Presentation. A 61-year-old Japanese man with no history of surgery was referred for intermittent abdominal pain. CT suggested the presence of a transmesocolic internal hernia. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We found internal herniation of the small intestine loop through a defect in the transverse mesocolon, without any strangulation of the small intestine. We were able to complete the operation laparoscopically. The patient’s postoperative course was uneventful and the patient was discharged on postoperative day 6.Discussion. Transmesocolic hernia of the transverse colon is very rare. Transmesocolic hernia of the sigmoid colon accounts for 60% of all other mesocolic hernias. Paraduodenal hernias are difficult to distinguish from internal mesocolic transverse hernias. We can rule out paraduodenal hernias with CT.Conclusion. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We report a case of a transmesocolic hernia of the transverse colon with intestinal obstruction that was diagnosed preoperatively and for which laparoscopic surgery was performed.

Download Full-text

Life-threatening airway obstruction caused by angioedema in a morbidly obese postoperative patient: a case report

JA Clinical Reports ◽

10.1186/s40981-020-00408-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Makiko Konda ◽

Satoki Inoue ◽

Yusuke Naito ◽

Junji Egawa ◽

Masahiko Kawaguchi

Keyword(s):

Tracheal Intubation ◽

Airway Obstruction ◽

Respiratory Arrest ◽

Morbidly Obese ◽

Case Presentation ◽

Obese Female ◽

Morbidly Obese Patient ◽

Old Japanese ◽

Life Threatening ◽

History Of

Abstract Background We report a case of a morbidly obese patient who developed life-threatening airway obstruction due to angioedema. Case presentation A 50-year-old Japanese morbidly obese female was treated with enalapril for 10 years, with no history of angioedema. After 3 h of completion of breast cancer resection under general anesthesia with tracheal intubation, she developed airway obstruction and respiratory arrest. Her oral cavity was occupied with a swollen tongue. It was extremely difficult to determine the airway anatomical orientation although tracheal intubation was attempted using a videolaryngoscope. At this time, she probably started gasping respiration, which generated a faint bubble and revealed a possible airway. Her airway was established using a tracheal tube without confirming the glottis or the vocal cord. Conclusions Angioedema induced by angiotensin-converting enzyme (ACE) inhibitors is rare; however, once it occurs, it can be potentially life threatening, especially for patients with possible difficult airway. Considering the risk–benefit ratio, we must be careful in administering ACE inhibitor therapy in morbidly obese patients.

Download Full-text