Updated on 2025/08/22

写真a

 
MIYAJIMA Masahiro
 
Organization
School of Medicine Department of Thoracic Surgery Lecturer
Title
Lecturer
External link

Research Interests

  • mediastinal tumor

  • lung cancer

  • Thoracic Surgery

  • transplant immunology

Research Areas

  • Life Science / Immunology  / organ transplant, synergy

  • Life Science / Respiratory surgery  / lung cancer, mediastinal tumor, metastatic tumor

  • Life Science / Respiratory surgery  / robotic surgery

Education

  • Sapporo Medical University

    1994.4 - 2000.3

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    Country: Japan

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Professional Memberships

Papers

  • The Roles and Regulatory Mechanisms of Tight Junction Protein Cingulin and Transcription Factor Forkhead Box Protein O1 in Human Lung Adenocarcinoma A549 Cells and Normal Lung Epithelial Cells. International journal

    Daichi Ishii, Yuma Shindo, Wataru Arai, Takumi Konno, Takayuki Kohno, Kazuya Honda, Masahiro Miyajima, Atsushi Watanabe, Takashi Kojima

    International journal of molecular sciences   25 ( 3 )   2024.1

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    Tight junction (TJ) protein cingulin (CGN) and transcription factor forkhead box protein O1 (FOXO1) contribute to the development of various cancers. Histone deacetylase (HDAC) inhibitors have a potential therapeutic role for some cancers. HDAC inhibitors affect the expression of both CGN and FOXO1. However, the roles and regulatory mechanisms of CGN and FOXO1 are unknown in non-small cell lung cancer (NSCLC) and normal human lung epithelial (HLE) cells. In the present study, to investigate the effects of CGN and FOXO1 on the malignancy of NSCLC, we used A549 cells as human lung adenocarcinoma and primary human lung epithelial (HLE) cells as normal lung tissues and performed the knockdown of CGN and FOXO1 by siRNAs. Furthermore, to investigate the detailed mechanisms in the antitumor effects of HDAC inhibitors for NSCLC via CGN and FOXO1, A549 cells and HLE cells were treated with the HDAC inhibitors trichostatin A (TSA) and Quisinostat (JNJ-2648158). In A549 cells, the knockdown of CGN increased bicellular TJ protein claudin-2 (CLDN-2) via mitogen-activated protein kinase/adenosine monophosphate-activated protein kinase (MAPK/AMPK) pathways and induced cell migration, while the knockdown of FOXO1 increased claudin-4 (CLDN-4), decreased CGN, and induced cell proliferation. The knockdown of CGN and FOXO1 induced cell metabolism in A549 cells. TSA and Quisinostat increased CGN and tricellular TJ protein angulin-1/lipolysis-stimulated lipoprotein receptor (LSR) in A549. In normal HLE cells, the knockdown of CGN and FOXO1 increased CLDN-4, while HDAC inhibitors increased CGN and CLDN-4. In conclusion, the knockdown of CGN via FOXO1 contributes to the malignancy of NSCLC. Both HDAC inhibitors, TSA and Quisinostat, may have potential for use in therapy for lung adenocarcinoma via changes in the expression of CGN and FOXO1.

    DOI: 10.3390/ijms25031411

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  • Experimental and histological evaluation of each clamp technique for pulmonary artery. Reviewed International journal

    Yoshiki Chiba, Yuki Takahashi, Yoshiaki Takase, Kodai Tsuruta, Ryunosuke Maki, Masahiro Miyajima, Hirofumi Ohnishi, Atsushi Watanabe

    Interdisciplinary cardiovascular and thoracic surgery   2023.7

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    OBJECTIVES: The double-loop technique has been used in our clinical settings for pulmonary arterioplasty and/or injured artery repair during thoracoscopic anatomical lung resection. We evaluated the pressure resistance capacity and intimal load to determine the effectiveness and safety of the double-loop technique. METHODS: The double-loop technique, DeBakey clamp, Fogarty clamp, endovascular clips, and vessel loop technique were evaluated. During an experimental study, a polyvinyl alcohol main pulmonary artery model, manometer, and in-deflation device were used to measure the burst pressure. The maximum clamp pressure was measured using a pressure-measuring film. Each measurement was performed 10 times. During the histological study, we measured the burst pressure and evaluated the intimal damage of the human pulmonary artery associated with the double-loop technique and DeBakey clamp. RESULTS: The experimental burst pressure (mmHg) and maximum clamp pressure (MPa) between the double-loop technique and DeBakey at the third notch were not significantly different (24.6 ± 2.8 and 21.8 ± 2.8, P = 0.094; 1.54 ± 0.12 and 1.49 ± 0.12, P = 0.954). During the histological study, the burst pressures of the double-loop technique and DeBakey at the third notch were also not significantly different (P = 0.754). Furthermore, the double-loop technique resulted in only intimal deformation in each five samples. CONCLUSIONS: The double-loop technique is feasible for thoracoscopic anatomical lung resection because it has similar pressure resistance capacity and intimal load as DeBakey at the third notch.

    DOI: 10.1093/icvts/ivad119

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  • 特集 縦隔・胸壁腫瘍に対する低侵襲手術 1. ロボット支援下手術 手術支援ロボットを用いた縦隔腫瘍に対する低侵襲手術-ポート配置の工夫と適応の変遷 Reviewed

    槙 龍之輔, 鶴田 航大, 千葉 慶宜, 石井 大智, 大湯 岳, 佐藤 大軌, 宮島 正博, 渡辺 敦

    胸部外科   76 ( 7 )   506 - 509   2023.7

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  • Recognition of subsuperior segmental vein for thoracoscopic subsuperior segmentectomy. Reviewed International journal

    Daichi Ishii, Yoshiaki Takase, Ryunosuke Maki, Yoshiki Chiba, Yuki Takahashi, Kodai Tsuruta, Masahiro Miyajima, Atsushi Watanabe

    JTCVS techniques   19   135 - 139   2023.6

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  • Metastatic pulmonary pleomorphic carcinoma replaced by a granulomatous lesion after spontaneous regression and PD-1 blockade-induced regression: can epithelioid granuloma be a histological hallmark of cancer immunity? International journal

    Naoki Shijubou, Yuichiro Asai, Michiko Hosaka, Keiko Segawa, Terufumi Kubo, Masahiro Miyajima, Tomohide Tsukahara, Yoshihiko Hirohashi, Takayuki Kanaseki, Kenji Murata, Atsushi Watanabe, Tadashi Hasegawa, Hirofumi Chiba, Toshihiko Torigoe

    Immunological medicine   46 ( 2 )   93 - 96   2023.6

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    Immune checkpoint inhibitors (ICIs) for various types of malignancy, including non-small-cell lung cancer, have improved prognosis in some cases. Granuloma formation after ICI administration suggests a tumor antigen-specific cytotoxic T cell response with abundant interferon-gamma production, which can be used to estimate the curative effect of ICIs. In this report, we present a case with a resected lung lesion, clinically suspected to be lung cancer, that consisted of a granulomatous lesion. A tumor was also found in the duodenum that was presumed to be derived from the pulmonary pleomorphic carcinoma. Duodenal tumor cells highly expressed PD-L1, suggesting PD-1/PD-L1 axis-mediated immune escape. As expected, pembrolizumab induced a complete response for the duodenal lesion. Interestingly, in histopathological analysis, the duodenal lesion was also replaced by an epithelial granuloma and multinucleated giant cells. We conclude that autoimmunity regressed the untreated primary lung lesion spontaneously, while the metastatic duodenal lesion responded to PD-1 blockade. Tumor-associated epithelioid granulomas, even before ICI administration, may be an important pathological finding indicating an immune response with interferon-gamma production by cytotoxic T cells to the tumor.

    DOI: 10.1080/25785826.2023.2193283

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  • クリーゼ中に胸腺摘除術を施行し良好な転帰が得られた胸腺腫合併抗AChR抗体陽性全身型重症筋無力症の一例

    河田 由香, 種本 真将, 山田 稔, 横川 和樹, 齋藤 太郎, 岩原 直敏, 松村 晃寛, 鈴木 秀一郎, 久原 真, 高瀬 貴章, 宮島 正博, 渡辺 敦

    臨床神経学   63 ( 5 )   325 - 325   2023.5

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    Language:Japanese   Publisher:(一社)日本神経学会  

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  • Number of lymph nodes dissected and upstaging rate of the N factor in robot-assisted thoracic surgery versus video-assisted thoracic surgery for patients with cN0 primary lung cancer. Reviewed

    Yuma Shindo, Masahiro Miyajima, Yasuyuki Nakamura, Yoshiki Chiba, Wataru Arai, Miho Aoyagi, Ryunosuke Maki, Kodai Tsuruta, Yuki Takahashi, Makoto Tada, Yoshiaki Takase, Atsushi Watanabe

    Surgery today   53 ( 4 )   428 - 434   2023.4

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    PURPOSE: The accuracy of lymph node (LN) dissection in robotic surgery for lung cancer remains controversial. We compared the accuracy of LN dissection in robot-assisted thoracic surgery (RATS) vs. video-assisted thoracic surgery (VATS). METHODS: The subjects of this retrospective analysis were 226 patients with cN0 primary lung cancer who underwent robot-assisted or video-assisted thoracic lobectomy with LN dissection, in our department, between April, 2016 and February, 2021. We compared the numbers of all LNs and mediastinal LNs dissected, the time required for LN dissection, complications, and upstaging rates of the N factor between the groups. Furthermore, we performed an inverse probability of treatment weighting-adjusted analysis to reduce potential bias between the groups. RESULTS: The number of dissected LNs was higher in the RATS group in both the unweighted and weighted analyses. The time required for lymph node dissection was also longer in RATS. There was no significant difference in complications or in the upstaging rate of the N factor between the groups. CONCLUSION: More LNs were dissected with RATS. Thus, the usefulness of robot-assisted surgery for LN dissection needs to be investigated further.

    DOI: 10.1007/s00595-022-02578-5

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  • Downregulation of angulin-1/LSR induces malignancy via upregulation of EGF-dependent claudin-2 and TGF-β-dependent cell metabolism in human lung adenocarcinoma A549 cells. Reviewed International journal

    Wataru Arai, Takumi Konno, Takayuki Kohno, Yuki Kodera, Mitsuhiro Tsujiwaki, Yuma Shindo, Hirofumi Chiba, Masahiro Miyajima, Yuji Sakuma, Atsushi Watanabe, Takashi Kojima

    Oncotarget   14   261 - 275   2023.3

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    Abnormal expression of bicellular tight junction claudins, including claudin-2 are observed during carcinogenesis in human lung adenocarcinoma. However, little is known about the role of tricellular tight junction molecule angulin-1/lipolysis-stimulated lipoprotein receptor (LSR). In the lung adenocarcinoma tissues examined in the present study, expression of claudin-2 was higher than in normal lung tissues, while angulin-1/LSR was poorly or faintly expressed. We investigated how loss of angulin-1/LSR affects the malignancy of lung adenocarcinoma cell line A549 and normal human lung epithelial (HLE) cells. The EGF receptor tyrosine kinase inhibitor AG1478 prevented the increase of claudin-2 expression induced by EGF in A549 cells. Knockdown of LSR induced expression of claudin-2 at the protein and mRNA levels and AG1478 prevented the upregulation of claudin-2 in A549 cells. Knockdown of LSR induced cell proliferation, cell migration and cell metabolism in A549 cells. Knockdown of claudin-2 inhibited the cell proliferation but did not affect the cell migration or cell metabolism of A549 cells. The TGF-β type I receptor inhibitor EW-7197 prevented the decrease of LSR and claudin-2 induced by TGF-β1 in A549 cells and 2D culture of normal HLE cells. EW-7197 prevented the increase of cell migration and cell metabolism induced by TGF-β1 in A549 cells. EW-7197 prevented the increase of epithelial permeability of FITC-4kD dextran induced by TGF-β1 in 2.5D culture of normal HLE cells. In conclusion, downregulation of angulin-1/LSR induces malignancy via EGF-dependent claudin-2 and TGF-β-dependent cell metabolism in human lung adenocarcinoma.

    DOI: 10.18632/oncotarget.27728

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  • ロボット支援下手術で摘出した後縦隔Muller管囊胞の1例 Reviewed

    76 ( 3 )   246 - 250   2023.3

  • [Mullerian Cyst in the Posterior Mediastinum Resected by Robot-assisted Thoracic Surgery:Report of a Case]. Reviewed

    Junji Nakazawa, Daichi Ishii, Takeshi Oyu, Taiki Sato, Yoshiki Chiba, Yuki Takahashi, Ryunosuke Maki, Kodai Tsuruta, Yoshiaki Takase, Masahiro Miyajima, Shinji Nakajima, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   76 ( 3 )   246 - 250   2023.3

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    Mullerian cyst in the posterior mediastinum is a rare disorder. We report on the case of a woman in her 40s with a cystic nodule which is located in the right posterior mediastinum next to the vertebra at the level of tracheal bifurcation. The tumor was suggested to be cystic by preoperative magnetic resonance imaging (MRI). The tumor was resected with robot-assisted thoracic surgery. Pathology by hematoxylin-and-eosin (H&E) revealed a thin-walled cyst lined by ciliated epithelium without cellular atypia. The diagnosis of Mullerian cyst was confirmed by immunohistochemical staining which showed the positive findings for estrogen receptor (ER) and progesterone receptor of the lining cells.

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  • 特集 肺癌縮小手術における工夫と現況 1. 区域切除の実際と手技 低侵襲肺悪性腫瘍縮小手術に対する手術手技の工夫 Reviewed

    鶴田 航大, 宮島 正博, 石井 大智, 大湯 岳, 佐藤 太軌, 千葉 慶宜, 高橋 有毅, 槙 龍之輔, 高瀬 貴章, 渡辺 敦

    胸部外科   76 ( 1 )   9 - 13   2023.1

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  • [Novel Surgical Techniques for Lung Segmentectomy of Malignant Lung Tumors]. Reviewed

    Kodai Tsuruta, Masahiro Miyajima, Daichi Ishii, Takeshi Oyu, Taiki Sato, Yoshiki Chiba, Yuki Takahashi, Ryunosuke Maki, Yoshiaki Takase, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   76 ( 1 )   9 - 13   2023.1

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    For a long time, lobectomy and lymph node dissection have been the standard surgery for treating non-small cell lung cancer. Recently, segmentectomy has been introduced as an alternative surgical procedure for treating early-stage lung cancer. Moreover, a growing number of segmentectomies are performed due to the increasing number of elderly patients, and the expansion of indications, including early- stage lung cancer with a ground glass nodule or peripheral nodule under 2 cm in diameter. However, the use of segmentectomy remains under debate. We have been performing thoracoscopic lung segmentectomy for malignant lung tumors since 2003. The number of surgeries has increased over the past few years, since robot-assisted lung resection of the right lobe became covered by health insurance in April 2018. In addition, lung segmentectomy is performed for lung metastases of malignant tumors in other organs. In deciding on the surgical approach, the increased technical difficulty of segmentectomy compared to lobectomy, owing to the anatomical complexity of the peripheral vessels and bronchi, needs to be considered, and novel surgical procedures and preoperative planning based on three-dimensional computed tomography( CT) images are necessary. We describe the preoperative management and surgical techniques used in approximately 250 lung segmentectomy procedures performed at our hospital up to May 2022, with no conversion to thoracotomy.

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  • Intraoperative Displacement of a Radiofrequency Identifier Tag into the Proximal Bronchus Requiring Extension of Lung Resection—Report of a Case— Reviewed

    ISHII Daichi, TAKASE Yoshiaki, CHIBA Yoshiki, TSURUTA Kodai, MIYAJIMA Masahiro, WATANABE Atsushi

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)   84 ( 1 )   76 - 81   2023

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    Palpation of the lesions is challenging during lung resection for small, deep-seated and ground glass opacity nodules, which often require preoperative localization marking. Radiofrequency identification (RFID), a digital marking technology using a bronchoscope, has clinically been applied in recent years. RFID marking accurately localizes even deep-seated lesions, however, little is known about its complications. Here, we report intraoperative displacement of the tag placed from the airway for the first time. A 71-year-old woman with suspected metastatic lung cancer (an 8-mm nodular shadow in the S10 of the left lung) underwent thoracoscopic wedge resection after RFID-based localization at two sites. We experienced RFID tag displacement in one out of the two tags requiring a wider wedge resection during the surgery than scheduled. The displacement might be caused by shaft wire distortion secondary to gripping with the ring forceps and extrusion with multiple clamping by the endo-staplers during lung resection. Manipulation using ring forceps or multiple clamping by endo-staplers should be avoided in the vicinity of RFID tags during lung resection. A RFID tag should be placed in the peripheral airway near the lesion.

    DOI: 10.3919/jjsa.84.76

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  • 今月の話題 肺癌に対する右肺S6+S*区域切除 Reviewed

    石井 大智, 槙 龍之輔, 大湯 岳, 佐藤 太軌, 千葉 慶宜, 髙橋 有毅, 鶴田 航大, 髙瀬 貴章, 宮島 正博, 渡辺 敦

    胸部外科   75 ( 13 )   1088 - 1091   2022.12

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  • [Thoracoscopic Superior and Subsuperior Segmentectomy of the Right Lower Lung for Lung Cancer]. Reviewed

    Daichi Ishii, Ryunosuke Maki, Takeshi Ohyu, Taiki Sato, Yoshiki Chiba, Yuki Takahashi, Kodai Tsuruta, Yoshiaki Takase, Masahiro Miyajima, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   75 ( 13 )   1088 - 1091   2022.12

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    The subsuperior segment (S*) is not frequently observed between the superior (S6) and posterior basal segments (S10). We present a case of video-assisted thoracoscopic surgery of S6+S* segmentectomy for a primary lung cancer patient. A 71-year-old man with a 20-mm nodule on the right S6, suspected of primary lung cancer( cT1bN0M0, stageⅠA2), was admitted to our hospital. Three-dimensional chest computed tomography (CT) revealed a subsuperior segmental bronchus (B*), originating from the common trunk of the lateral basal segmental bronchus( B9) and posterior basal segmental bronchus (B10). In order to obtain enough surgical margin, we performed S6+S* segmentectomy. The pathological diagnosis was invasive adenocarcinoma( pT1cN0M0, stageⅠA3). S* segmentectomy was considered to be useful method to ensure sufficient surgical margin when the lesion is in S* or in segments adjacent to it.

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  • Robotic free pericardial fat pledget technique for treating pulmonary air leak. Reviewed International journal

    Yoshiaki Takase, Yuki Takahashi, Masahiro Miyajima, Atsushi Watanabe

    JTCVS techniques   16   153 - 156   2022.12

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    DOI: 10.1016/j.xjtc.2022.10.007

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  • 肺腺癌におけるタイト結合分子cingulinおよび転写因子FOXO1の役割

    石井 大智, 進藤 悠真, 新井 航, 金野 匠, 幸野 貴之, 宮島 正博, 小島 隆, 渡辺 敦

    肺癌   62 ( 6 )   635 - 635   2022.11

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  • Clinical effect of soft coagulation for air leak treatment during pulmonary lobectomy. Reviewed International journal

    Yuki Takahashi, Ryunosuke Maki, Kodai Tsuruta, Makoto Tada, Wataru Arai, Yuma Shindo, Yasuyuki Nakamura, Masahiro Miyajima, Atsushi Watanabe

    Journal of cardiothoracic surgery   17 ( 1 )   253 - 253   2022.10

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    BACKGROUND: Soft coagulation using the VIO soft coagulation system is used to treat minor lung air leaks during pulmonary resection in Japan. We previously reported that it has a similar effect as the air leak treatment with fibrin glue. We evaluated the efficacy of soft coagulation using the VIO soft coagulation system for lung air leakage during pulmonary resection. METHODS: Intraoperative air leaks from the interlobar lung parenchyma were observed in 42 of the 283 patients who underwent video-assisted thoracoscopic surgery lobectomy between 2016 and 2018. We retrospectively reviewed these 42 patients who were treated using the VIO soft coagulation system for air leaks. We classified the air leaks in to grades using the Macchiarini scale score and evaluated the surgical outcomes of air leak treatment. RESULTS: Air leaks from the interlobar lung parenchyma having Macchiarini scale scores 1, 2, and 3 occurred in 8, 17, and 17 patients, respectively. In all the 8 patients with score 1 air leaks (100%), the air leaks could be controlled using the VIO soft coagulation system alone, and none had delayed pneumothorax requiring intervention. Of the score 2 and 3 air leaks, 52.9% and 35.3% were controlled using the VIO soft coagulation system alone, respectively. CONCLUSIONS: Macchiarini scale score 1 air leaks from the interlobar lung parenchyma could be well controlled using the VIO soft coagulation system. Therefore, soft coagulation with this system may be an alternative method for treating minor air leaks during pulmonary resection surgery.

    DOI: 10.1186/s13019-022-01948-x

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  • Causes and management of intraoperative complications in robot-assisted anatomical pulmonary resection for lung cancer. Reviewed International journal

    Yoshiaki Takase, Masahiro Miyajima, Yoshiki Chiba, Daichi Ishii, Taiki Sato, Yuma Shindo, Yasuyuki Nakamura, Miho Aoyagi, Kodai Tsuruta, Atsushi Watanabe

    Journal of thoracic disease   14 ( 9 )   3221 - 3233   2022.9

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    BACKGROUND: To perform safe robot-assisted anatomical lung resections, the details of intraoperative complications need to be shared among thoracic surgeons. However, only limited data are available. METHODS: This retrospective, single-institutional study evaluated 134 patients who underwent robot-assisted anatomical lung resection. We examined the causes, management, and outcomes of all intraoperative complications. RESULTS: Of the 134 eligible patients, 118 (88%) underwent lobectomy and 16 (12%) underwent segmentectomy. Intraoperative complications occurred in 17 (12.7%) patients. These complications included pulmonary artery (PA) injuries in seven patients, pulmonary vein (PV) injuries in three, azygos vein (AV) injury in one, superior vena cava (SVC) injury in one, bronchial injuries in three, and lung injuries in four. Most PA injuries were at a distal side and controlled by pressure, fibrin sealant, or stapling of the proximal side. In the three PV injuries, right upper PV was sandwiched by robotic instruments, V6 was punctured by the tip of the Maryland bipolar forceps, and the distal side of V2t was injured during tunneling of a minor interlobar fissure. These were controlled the same way as the PA injuries. The AV injury occurred during hilar lymph node (LN) dissection and was controlled by suturing. The SVC injury was caused by interference of the robotic forceps and the suction tube outside the field of view during upper mediastinal LN dissection. The injury was controlled by continuous pressure while layering polyglycolic acid sheets and fibrin glue. In the three bronchial injuries, B10 was injured during subcarinal LN dissection, right main bronchus was injured during upper bronchus dissection and the stapling failure of the bronchus occurred by strong traction. They were all repaired by suturing. All lung parenchymal injuries were caused by manipulation of robotic instruments outside the field of view. The lung injuries were repaired by suturing with pledgets. No cases were converted to thoracotomy. The 30-day mortality rate was 0.7%. The cause of mortality was pneumonia. CONCLUSIONS: In robot-assisted anatomical pulmonary resection for lung cancer, most major intraoperative complications can be safely managed robotically without conversion to thoracotomy.

    DOI: 10.21037/jtd-22-553

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  • [Simultaneous Resection of Mediastinal and Liver Hydatid Disease]. Reviewed

    Takeshi Uzuka, Kei Mukawa, Hiroki Uchiyama, Ayaka Arihara, Hitoki Hashiguchi, Kenji Yamada, Masahiro Miyajima, Ryoichi Yokota, Akihiko Sasaki

    Kyobu geka. The Japanese journal of thoracic surgery   75 ( 9 )   674 - 677   2022.9

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    Cystic echinococcosis is an uncommon zoonosis in Japan. Typical location of the cyst is the liver and the lung. Mediastinal hydatidosis is found in less than 0.1% of all hydatid disease patients. We report a rare case of 68 years old male with mediastinal and liver hydatid cysts. Serological test confirmed the diagnosis of hydatidosis. The patient underwent complete resection of mediastinal and liver cysts successfully. Postoperative follow-up for two years has not shown any signs of recurrence. Simultaneous resection of the cysts in different sites including mediastinum is rare and has not been reported in Japan. Hydatid disease is an important differential diagnosis for patient who has cryptogenic liver cyst and history of contact to wildlife or unsterile water.

    DOI: 10.15106/j_kyobu75_674

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  • Robot-assisted and video-assisted thoracoscopic surgery for thymoma: comparison of the perioperative outcomes using inverse probability of treatment weighting method. Reviewed International journal

    Yoshiki Chiba, Masahiro Miyajima, Yoshiaki Takase, Kodai Tsuruta, Yuma Shindo, Yasuyuki Nakamura, Daichi Ishii, Taiki Sato, Miho Aoyagi, Tomoko Shiraishi, Tomoko Sonoda, Atsushi Watanabe

    Gland surgery   11 ( 8 )   1287 - 1300   2022.8

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    BACKGROUND: Minimally invasive surgery is the standard treatment for early-stage thymoma. We compared the perioperative outcomes between robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for thymoma. METHODS: Between April 2011 and August 2021, patients with thymoma who underwent thymectomy by RATS (n=20) or VATS (n=37) at our hospital were retrospectively reviewed. We evaluated the postoperative quality of life (QOL), surgical outcomes, complications, mortality, and pain grade. Postoperative QOL was assessed according to the time to achieve "B duration" and "CIII duration" based on the Nursing Dependency Score and Nursing Criteria, respectively. RESULTS: After the inverse probability of treatment weighting (IPTW), the B duration and CIII duration were significantly shorter with RATS than with VATS (P<0.001 and P=0.037, respectively). These superior results of RATS group compared to those of the VATS group were confirmed with logistic regression analysis (OR 0.25, 95% CI: 0.10-0.63, P=0.003; and OR 0.31, 95% CI: 0.12-0.76, P=0.011, respectively). After the IPTW, the VATS group had significantly fewer patients with epidural analgesia than the RATS group (P=0.018). In contrast, additional regular analgesics (including those for wound pain and neuralgia) were prescribed significantly more often during postoperative hospitalization in the VATS group (P=0.033). Patients in both groups had no myasthenic crisis or mortality. The postoperative pain grade at the first and second follow-ups did not significantly differ between the two groups after the IPTW (P=0.376 and P=0.109, respectively). CONCLUSIONS: RATS offered the advantages of improved postoperative QOL according to nursing care systems compared to VATS.

    DOI: 10.21037/gs-22-333

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  • Anatomy of the left subsuperior segment for segmentectomy. Reviewed

    Ryunosuke Maki, Masahiro Miyajima, Keishi Ogura, Makoto Tada, Yuki Takahashi, Hirofumi Adachi, Atsushi Watanabe

    Surgery today   52 ( 7 )   1054 - 1062   2022.7

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    PURPOSE: The subsuperior segmental bronchi (B*) forms the subsuperior segment (S*) between the superior (S6) and basal segment (S7, S8, S9, S10) of the lung. However, the anatomical planes of S* remains undefined. The present study clarified the anatomical features of S*. METHODS: We reviewed the anatomical patterns of pulmonary vessels and the left lung bronchus in 539 patients using three-dimensional computed tomography. We report the anatomic structure in S*. RESULTS: A total of 537 patients were analyzed. B* was observed in 129 (24.0%) patients. The intersegmental vein between S6 and S* was complete in all cases. The absence of intersegmental veins of S* was observed in 77 (14.3%) patients, reaching 59.7% of B* cases. Twenty-two (4.1%) cases of B* diverged from the trunk of the basal bronchus, and about half of the B* branched to the dorsolateral (n = 77, 14.3%) or dorsal (n = 2, 0.37%) direction. CONCLUSION: Our study revealed the branching patterns of B* and anatomical intersegmental veins of S*. Our results provide useful information regarding anatomical segmentectomy including or adjusting to the left S*.

    DOI: 10.1007/s00595-021-02417-z

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  • Robot-assisted vs. video-assisted thoracoscopic surgery in lung cancer. International journal

    Masahiro Miyajima, Ryunosuke Maki, Wataru Arai, Kodai Tsuruta, Yuma Shindo, Yasuyuki Nakamura, Atsushi Watanabe

    Journal of thoracic disease   14 ( 6 )   1890 - 1899   2022.6

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    BACKGROUND: The major advantages of robot-assisted surgery are the fine field of view provided by the high-precision three-dimensional (3D) images and the good operability provided by the robotic arms that enables precise movements. A growing number of retrospective studies have compared robotic-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS), but the number of cases is limited and the results are contradictory. METHODS: We studied the medical records of primary lung cancer patients who underwent lobectomy with lymph node dissection between 2017 and 2020. Four hundred and eleven patients fulfilled the inclusion criteria in this study (RATS: 103; VATS: 308). We compared the perioperative factors and postoperative results of the VATS and RATS groups. Further, we adjusted background factors using propensity score matching (PSM) then compared the results of 200 patients (100 patients in each group). In this study, we matched interlobar fissure completeness, which affects operative difficulty and operative time; however, this has been superficially compared in previous studies. RESULTS: After PSM, a significant difference was observed in the intraoperative blood loss (RATS: 53.3 mL, VATS: 120.3 mL, P=0.04). The rates of surgical complications were comparable between the groups (10.0% vs. 13.0%, P=0.66) with similar mean operation times (RATS: 215.0 min, VATS: 210.1 min, P=0.57). The mean postoperative stay in the RATS group was shorter than that in the VATS group (10.0 vs. 11.5 days, P=0.04). CONCLUSIONS: Initial experience of RATS had no obvious drawbacks when compared with that of VATS on propensity-matched analysis.

    DOI: 10.21037/jtd-21-1696

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  • Interlobar division using vessel-sealing system in robot-assisted pulmonary lobectomy. Reviewed International journal

    Masahiro Miyajima, Yuma Shindo, Kodai Tsuruta, Yasuyuki Nakamura, Yoshiaki Takase, Miho Aoyagi, Atsushi Watanabe

    JTCVS techniques   13   211 - 216   2022.6

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    OBJECTIVE: We investigated the safety of a novel interlobar fissure division technique using the da Vinci vessel sealing system in robot-assisted pulmonary lobectomy. METHODS: The medical records of patients who underwent robotic pulmonary lobectomy with node dissection for primary lung cancer between 2018 and 2020 were reviewed. The inclusion criteria were fulfilled by 111 patients, whose perioperative factors and postoperative results were compared with those previously reported. Furthermore, the new robotic lung interlobar division technique using the da Vinci vessel sealing system without a robotic stapler was evaluated in patients with low-grade incomplete fissure. We considered the Craig and Walker classification of lung fissures grades 1 and 2 as a good adaptation for the vessel sealing system interlobar fissure division. RESULTS: The vessel sealing system group had shorter mean operative and console times (P = .03 and P = .01, respectively) and lesser median intraoperative blood loss (20 mL vs 50 mL; P = .01). The vessel sealing system group had lower surgical complication rates (2.2% vs 20.0%; P = .01). The incidence of persistent postoperative air leak was lower (0% vs 10.0%; P = .06), and fewer robotic stapler cartridges were used during surgery (3.4 vs 5.6; P < .001) in the vessel sealing system group than in the stapler group. CONCLUSIONS: We report the safety of using the da Vinci vessel sealing system as an alternative to the use of robotic staples for interlobar fissure division in robot-assisted pulmonary lobectomy. This technique seems easy and feasible though limited to the low-grade incomplete fissure.

    DOI: 10.1016/j.xjtc.2022.02.019

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  • Robotic single right anterior medial (S3b) subsegmentectomy for early primary lung cancer in a patient with a small physique. International journal

    Yoshiaki Takase, Masahiro Miyajima, Atsushi Watanabe

    Multimedia manual of cardiothoracic surgery : MMCTS   2022   2022.5

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    Subsegmentectomy is an optional treatment for early primary lung cancer presenting without adequate surgical margins for wedge resection. There are no previous reports regarding a robotic single subsegmentectomy. We report a robotic single subsegmentectomy of the right anterior medial subsegment (S3b). The lung parenchyma was dissected with a Vessel Sealer Extend along the intersubsegmental veins for proper lung mobilization to solve the directional limitations of the robotic stapler. Additionally, we inserted the most ventral port from the subcostal region to increase the distance between the ports. Performing a robotic single subsegmentectomy is challenging. However, our techniques help to achieve a safe and effective operation.

    DOI: 10.1510/mmcts.2022.027

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  • Pulmonary vessels and bronchus anatomy of the left upper lobe.

    Ryunosuke Maki, Masahiro Miyajima, Keishi Ogura, Makoto Tada, Yuki Takahashi, Hirofumi Adachi, Atsushi Watanabe

    Surgery today   52 ( 4 )   550 - 558   2022.4

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    PURPOSES: The bronchopulmonary vascular bifurcation patterns in the upper lobe of the left lung are diverse. Therefore, it is important for general thoracic surgeons to understand the detailed anatomy of the pulmonary segments when performing thoracoscopic anatomical pulmonary resection. This study aimed to analyze the bronchovascular patterns of the left upper lobe and summarize the anatomical information associated with pulmonary anatomical pulmonary resection. METHODS: We reviewed the anatomical patterns of pulmonary vessels and the left lung bronchus of 539 patients using computed tomography imaging data including those obtained using three-dimensional computed tomography. We herein report the anatomic structure in the left upper lobe. RESULTS: Regarding the superior division bronchi, a pattern of trifurcation into B1+2, B3, lingular division bronchus was observed in nine patients (1.7%). A pattern of proximal bifurcation of B4 was found in eight patients (1.5%). Regarding the lingular veins (LV), patterns of LV drainage into the left lower pulmonary vein were observed in 22 patients (4.1%). Regarding the pulmonary artery, mediastinal lingular arteries (MLA) were found in 161 patients (29.9%). CONCLUSION: The bifurcation patterns of the bronchovascular region in the upper lobe of the left lung were clarified. These results should be carefully noted when performing anatomical pulmonary resection.

    DOI: 10.1007/s00595-022-02471-1

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  • Subcarinal Lymph Node Dissection in Solo Robot-assisted Thoracic Surgery. International journal

    Ryunosuke Maki, Masahiro Miyajima, Kodai Tsuruta, Atsushi Watanabe

    The Annals of thoracic surgery   113 ( 3 )   e235-e237   2022.3

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    The surgical instruments used in robot-assisted thoracic surgery are flexible to enable the surgeon to approach the surgical field from any direction. However even in robot-assisted thoracic surgery subcarinal lymph node dissection requires a precise technique suitable for a small area surrounded by important organs. We present a method of subcarinal node dissection with solo robot-assisted thoracic surgery using a bronchial traction method and a metal basket suction device, the Dobon (Senko Medical Instrument Mfg, Tokyo, Japan).

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  • 胸腔鏡下左肺上葉切除術時に偶然発見された先天性心膜欠損症の1例

    74 ( 12 )   1051 - 1054   2021.11

  • [Congenital Pericardial Defect Incidentally Found at Thoracoscopic Left Upper Lobe Resection:Report of a Case].

    Yasuyuki Nakamura, Kodai Tsuruta, Yuma Shindo, Wataru Arai, Ryunosuke Maki, Masahiro Miyajima, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   74 ( 12 )   1051 - 1054   2021.11

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    We report a rare case of a congenital pericardial defect that was incidentally found at thoracoscopic left upper lobe resection in a patient with lung cancer. A 75-year-old man with a left upper lobe lung cancer was referred to our hospital. We performed thoracoscopic left upper lobectomy and incidentally found a pericardial defect intraoperatively. Careful lymph node dissection was necessary to avoid injury of phrenic nerve and pulmonary artery. Surgery for lung cancer was completed without pericardial repair. After surgery, no complications associated with the pericardial defect has not been encountered.

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  • Easy Suction Technique During Robotic-Assisted Thoracoscopic Lobectomy. International journal

    Kodai Tsuruta, Ryunosuke Maki, Masahiro Miyajima, Atsushi Watanabe

    The Annals of thoracic surgery   112 ( 5 )   e381-e382   2021.11

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    In robotic-assisted thoracoscopic surgery, surgeons may encounter bleeding issues requiring compression techniques and time to achieve hemostasis. During this time, surgeons cannot use the robot arm and may require an assistant to perform suction, thus increasing the cost of the procedure. This report describes an alternative suction device, Dobon (Senko Medical Instrument Mfg, Tokyo, Japan), which is usually used for pediatric cardiac surgery, for use in robotic-assisted thoracoscopic surgery. The report presents the technique for using this device and comments on the advantages, including decreased cost and an improved surgical visual field.

    DOI: 10.1016/j.athoracsur.2021.03.019

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  • 臨床経験 右上葉胸壁合併切除後の脊髄梗塞

    中村 泰幸, 槙 龍之輔, 進藤 悠真, 新井 航, 鶴田 航大, 宮島 正博, 渡辺 敦

    胸部外科   74 ( 9 )   664 - 667   2021.9

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  • [Spinal Cord Infarction after Right Upper Lobectomy Combined with Chest Wall Resection].

    Yasuyuki Nakamura, Ryuunosuke Maki, Yuma Shindo, Wataru Arai, Kodai Tsuruta, Masahiro Miyajima, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   74 ( 9 )   664 - 667   2021.9

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    A 42-year-old man presented with a one-month history of back pain. Chest computed tomography revealed a mass (7.6×5.7 cm) in the right upper lobe, suspicious of chest wall invasion. We performed right upper lobectomy combined with chest wall resection. Partial dissections of the second to sixth ribs and the third and fourth vertebral bodies were conducted. Postoperatively, motor paralysis of the right lower extremity was observed and a diagnosis of spinal infarction was made. After cerebrospinal fluid drainage and administration of edaravone with early rehabilitation, he was able to walk with a brace and was discharged from the hospital.

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  • Two cases of left recurrent laryngeal nerve paralysis after right superior mediastinal node dissection. International journal

    Yasuyuki Nakamura, Yuma Shindo, Wataru Arai, Kodai Tsuruta, Ryunosuke Maki, Masahiro Miyajima, Atsushi Watanabe

    Surgical case reports   7 ( 1 )   151 - 151   2021.6

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    BACKGROUND: Ipsilateral recurrent laryngeal nerve paralysis is one of the rare complications during the superior mediastinal node dissection for lung cancer. However, very few reports of contralateral recurrent laryngeal nerve paralysis during the procedure are available. CASE PRESENTATION: Two women aged 74 and 80 years developed hoarseness after undergoing right upper lobectomy and right superior mediastinal node dissection for primary lung cancer. Postoperative laryngoscopy in the two patients confirmed left vocal cord paralysis. CONCLUSION: Node dissection is performed in the standard procedure for right upper lobe lung cancer. At this time, care must be taken not to cause damage not only to the recurrent laryngeal nerve on the ipsilateral side but also to the recurrent laryngeal nerve on the contralateral side.

    DOI: 10.1186/s40792-021-01236-1

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  • Effects of histone deacetylase inhibitors Tricostatin A and Quisinostat on tight junction proteins of human lung adenocarcinoma A549 cells and normal lung epithelial cells. International journal

    Yuma Shindo, Wataru Arai, Takumi Konno, Takayuki Kohno, Yuki Kodera, Hirofumi Chiba, Masahiro Miyajima, Yuji Sakuma, Atsushi Watanabe, Takashi Kojima

    Histochemistry and cell biology   155 ( 6 )   637 - 653   2021.6

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    Histone deacetylase (HDAC) inhibitors have a potential therapeutic role for non-small cell lung cancer (NSCLC). However, more preclinical studies of HDAC inhibitors in NSCLC and normal lung epithelial cells are required to evaluate their antitumor activities and mechanisms. The bicellular tight junction molecule claudin-2 (CLDN-2) is highly expressed in lung adenocarcinoma tissues and increase the proliferation of adenocarcinoma cells. Downregulation of the tricellular tight junction molecule angulin-1/LSR induces malignancy via EGF-dependent CLDN-2 and TGF-β-dependent cellular metabolism in human lung adenocarcinoma cells. In the present study, to investigate the detailed mechanisms of the antitumor activities of HDAC inhibitors in lung adenocarcinoma, human lung adenocarcinoma A549 cells and normal lung epithelial cells were treated with the HDAC inibitors Trichostatin A (TSA) and Quisinostat (JNJ-2648158) with or without TGF-β. Both HDAC inhibitors increased anguin-1/LSR, decrease CLDN-2, promoted G1 arrest and prevented the migration of A549 cells. Furthermore, TSA but not Quisinostat with or without TGF-β induced cellular metabolism indicated as the mitochondrial respiration measured using the oxygen consumption rate. In normal human lung epithelial cells, treatment with TSA and Quisinostat increased expression of LSR and CLDN-2 and decreased that of CLDN-1 with or without TGF-β in 2D culture. Quisinostat but not TSA with TGF-β increased CLDN-7 expression in 2D culture. Both HDAC inhibitors prevented disruption of the epithelial barrier measured as the permeability of FD-4 induced by TGF-β in 2.5D culture. TSA and Quisinostat have potential for use in therapy for lung adenocarcinoma via changes in the expression of angulin-1/LSR and CLDN-2.

    DOI: 10.1007/s00418-021-01966-1

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  • Vessel sealing system for video-assisted lung resection for cancer reduces chylothorax and bleeding. International journal

    Masahiro Miyajima, Ryunosuke Maki, Makoto Tada, Kodai Tsuruta, Yuki Takahashi, Wataru Arai, Atsushi Watanabe

    Journal of thoracic disease   13 ( 6 )   3458 - 3466   2021.6

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    BACKGROUND: The objective of this study was to analyze the efficacy of the LigaSureTM vessel sealing system for lung cancer resection with node dissection, as this has not been sufficiently evaluated. METHODS: From 2004 to 2018, 948 patients underwent anatomical pulmonary resection with node dissection for non-small cell lung carcinoma (NSCLC) via the video-assisted thoracoscopic surgery (VATS) approach. Medical records of these patients were reviewed retrospectively. Univariate and multivariate analyses were conducted to determine the risk factors for chylothorax and blood loss. RESULTS: Of the 948 patients, 318 (33.5%) who underwent anatomical lung resection with node dissection by conventional methods without vessel sealing system and 630 (66.5%) who underwent lung resection with node dissection with the vessel sealing system were included. The median intraoperative blood loss was 100 mL. Postoperative chylothorax occurred in 9 (2.8%) patients in the conventional method group with 2 (0.3%) patients in the vessel sealing system group (P=0.001). Patients in the vessel sealing group who developed chylothorax were cured by conservative treatment. Univariate and multivariate analyses identified male sex [odds ratio (OR) 2.053; 95% confidence interval (CI): 1.494-2.820; P<0.001] and the use of vessel sealing system (OR 0.342; 95% CI: 0.256-0.457; P<0.001) as independent predictors of intraoperative blood loss. The univariate and multivariate analyses identified the use of the vessel sealing system (OR 0.108; 95% CI: 0.023-0.504; P=0.005) as an independent predictor of chylothorax incidence. CONCLUSIONS: Vessel sealing system for lung cancer resection could decrease chest tube duration, amount of intraoperative bleeding, and incidence of chylothorax in patients who undergo lung resection with node dissection.

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  • 正常ヒト肺上皮細胞におけるTGF-βとHDAC阻害剤のタイト結合分子および上皮バリアへの影響

    進藤 悠真, 新井 航, 金野 匠, 幸野 貴之, 宮島 正博, 小島 隆, 渡辺 敦

    日本呼吸器外科学会雑誌   35 ( 3 )   RO18 - 3   2021.5

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  • 臨床経験 縦隔腫瘍との鑑別を要した準確定診断免疫グロブリンG4(IgG4)関連大動脈周囲炎

    千葉 慶宜, 新井 航, 大川 美穂, 多田 周, 槙 龍之輔, 三品 泰二郎, 宮島 正博, 渡辺 敦, 杉田 真太朗

    胸部外科   74 ( 2 )   108 - 111   2021.2

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  • 区域切除のための左肺下葉における気管支肺血管の解剖—Pulmonary vessels and bronchial anatomy of the left lower lobe

    槙 龍之輔, 宮島 正博, 小倉 圭史, 多田 周, 高橋 有毅, 安達 大史, 渡辺 敦, Wataru Arai

    北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会 編   65 ( 2 )   186 - 188   2020.12

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  • The left main bronchus transected incorrectly during video-assisted thoracoscopic lobectomy: a case report. International journal

    Yuma Shindo, Masahiro Miyajima, Yasuyuki Nakamura, Wataru Arai, Ryunosuke Maki, Kodai Tsuruta, Atsushi Watanabe

    Surgical case reports   6 ( 1 )   291 - 291   2020.11

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    BACKGROUND: Several severe intraoperative complications of lung cancer surgery have been reported, but the incorrect transection of the main bronchus is a very rare and serious complication. We report a surgical case of a patient with left lower lobe lung cancer invading the inferior segment of the lingula, with fused interlobar fissure and dense pleural adhesion, in which the left main bronchus was mistaken for the left lower lobe bronchus and was transected. CASE PRESENTATION: A 64-year-old woman with lung adenocarcinoma was referred to our hospital for surgical treatment. Chest computed tomography (CT) scan showed a 30-mm nodule with a clear border and irregular margins in the center of the anterior (S8) segment of the lower lobe of the left lung and another similar 30-mm nodule in the lateral (S9) segment of the same lobe. Metastasis within the same lobe was suspected. A thoracoscopic left lower lobectomy was scheduled for the patient. As the patient had a moderately, fused fissure, dense pleural adhesion, and suspicious tumor invasion from the left S8 segment to the left S5 segment, and the interlobar node tightly adhered to the main PA at the site of basilar artery origin of the LLL, we performed left lower lobectomy and a left S5 segmentectomy using the fissureless fissure-last technique. During surgery, the left main bronchus was mistaken for the left lower lobe bronchus and was transected. After transecting the left main bronchus, we performed a sleeve bronchoplasty to prevent pneumonectomy. CONCLUSIONS: We experienced the rare and serious intraoperative complication of the incorrect transection of the main bronchus. There are few reports of this intraoperative complication, and it should not be overlooked by surgeons.

    DOI: 10.1186/s40792-020-01073-8

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  • 今月の話題 左上縦隔腫瘍に対するロボット支援下手術

    進藤 悠真, 宮島 正博, 槙 龍之輔, 高橋 有毅, 鶴田 航大, 新井 航, 渡辺 敦

    胸部外科   73 ( 9 )   663 - 666   2020.9

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  • [Successful Robotic Resection of Left Upper Mediastinal Tumor].

    Yuma Shindo, Masahiro Miyajima, Ryunosuke Maki, Yuki Takahashi, Koudai Tsuruta, Wataru Arai, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   73 ( 9 )   663 - 666   2020.9

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    A man was diagnosed with a left upper mediastinal mass. The mass was located near the left subclavian vein, phrenic nerve, vagus nerve, left subclavian artery, and left brachiocephalic vein. He underwent a robotic surgery without additional approaches such as cervical approach on transmanubrial approach. Robotic surgery enabled to remove the tumor safely due to the highly flexible robot forceps under a 3-dimensional visual field. Robotic surgery may be effective for tumors in the upper mediastinum, where important blood vessels and nerves are closely present.

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  • Pulmonary vessels and bronchial anatomy of the left lower lobe.

    Ryunosuke Maki, Masahiro Miyajima, Keishi Ogura, Makoto Tada, Yuki Takahashi, Wataru Arai, Hirofumi Adachi, Atsushi Watanabe

    Surgery today   50 ( 9 )   1081 - 1090   2020.9

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    PURPOSE: To identify and clarify the comprehensive anatomic patterns in the left lower lobe (LLL). METHODS: Using computed tomography (CT) imaging data, including that obtained using three-dimensional CT, we reviewed the anatomic patterns of the pulmonary vessels and bronchi in the left lungs of 539 patients, focusing on the LLL. RESULTS: The two-stem type in A6 was observed in 131 (24.7%) patients and the three-stem type in A6 was observed in 11 (2.1%) patients. The independent two-stem type in B6 was observed in four (0.75%) patients. The B7 with independent branching from the basal bronchi was observed in 42 (7.9%) patients. B* was observed in 129 (24.0%) patients and B* was accompanied by A* in all patients. An extrapericardial common trunk of the left pulmonary veins was identified in five patients (0.93%). CONCLUSION: We identified various bronchovascular patterns in the LLL of a large number of patients. Our results provide useful information for anatomic pulmonary resection, especially segmentectomy.

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  • [Left Upper Lobectomy Followed by Left Lower Pulmonary Vein Reconstruction after Miscutting the Common Trunk of the Left Pulmonary Veins].

    Yuma Shindo, Ryunosuke Maki, Wataru Arai, Yuki Takahashi, Masahiro Miyajima, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   73 ( 8 )   590 - 593   2020.8

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    A 65-year-old woman was diagnosed with lung cancer on the left upper lobe. During thoracoscopic left upper lobectomy, the common trunk of pulmonary vein was mistaken for the left upper pulmonary vein and divided incorrectly. Instead of left pneumonectomy, we successfully performed pulmonary vein reconstruction. As a result of anticoagulant therapy for 1 month, postoperative course was uneventful.

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  • 特集 ロボット支援下肺葉切除術—Robot-assisted thoracic surgery for lung cancer

    宮島 正博, 槙 龍之輔, 高橋 有毅, 多田 周, 鶴田 航大, 新井 航, 進藤 悠真, 渡辺 敦

    北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会 編   65 ( 1 )   14 - 17   2020.6

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    Other Link: https://search.jamas.or.jp/link/ui/2020344974

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  • Pulmonary metastasectomy is associated with prolonged survival among patients with bone and soft tissue sarcoma. International journal

    Junya Shimizu, Makoto Emori, Yasutaka Murahashi, Tomoko Sonoda, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe, Shintaro Sugita, Kohichi Takada, Kazuyuki Murase, Tadashi Hasegawa, Toshihiko Yamashita

    Molecular and clinical oncology   12 ( 5 )   429 - 434   2020.5

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    The aim of the present study was to evaluate the survival impact of surgical resection among patients with pulmonary metastases from bone and soft tissue sarcomas. A total of 34 consecutive patients with ≤5 pulmonary metastases from bone and soft tissue sarcomas were retrospectively reviewed. The patients included 19 men and 15 women, with a median age of 64.0 years and a median follow-up of 14.5 months. The oncological outcome was compared between patients who underwent surgical and non-surgical treatment. A total of 22 patients underwent surgery and 12 patients did not undergo surgery. The surgery group had 3- and 5 year overall survival rates of 62 and 53%, respectively. None of the patients in the non-surgery group survived to 3 years. Compared with the non-surgery group, surgery achieved significantly better 3- and 5 year overall survival rates. Pulmonary metastasectomy was associated with significantly improved survival among patients who were aged <64 years (P=0.0155), as well as those who were aged ≥64 years (P=0.0444), which indicated that age was not associated with a difference in survival between the two groups. Therefore, pulmonary metastasectomy may improve the prognosis of patients with pulmonary metastases from bone and soft tissue sarcomas.

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  • Treatment outcome of chest wall soft tissue sarcomas: Analysis of prognostic factors. International journal

    Naoya Nakahashi, Makoto Emori, Hiroyuki Tsuchie, Hiroyuki Nagasawa, Tomoko Sonoda, Kohichi Takada, Masahiro Miyajima, Atsushi Watanabe, Yoichi Shimada, Toshihiko Yamashita

    Journal of surgical oncology   120 ( 7 )   1235 - 1240   2019.12

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    BACKGROUND: Primary soft tissue sarcomas (STSs) involving the chest wall are uncommon. The aim of this study was to identify factors that influence the prognosis of patients with primary chest wall STS. METHODS: The records of 38 patients (23 men and 15 women) who were treated at our institutions during 2002 to 2018 were reviewed. The following variables were evaluated as potential prognostic factors: sex, tumor size, chemotherapy, and completeness of surgical margins. Multivariate analysis was conducted to identify predictors of overall survival (OS) and disease-free survival (DFS). RESULTS: Of the 38 included patients, 5 had low-grade tumors and 33 had high-grade tumors. Five patients required chest wall reconstruction including rib resection. Thirty patients (79%) underwent R0 resection. The 5-year OS and DFS rates were 45% and 27%, respectively. Local recurrence developed in 7 patients. Multivariate analysis identified tumor size (hazard ratio [HR]: 4.13; 95% confidence interval [CI]: 1.05-16.24; P = .04) and R1/2 resection (HR: 3.92; 95% CI: 1.12-13.66; P = .03) as predictors of OS. CONCLUSIONS: Prognostic factors for survival included tumor size and completeness of surgical margins. Complete tumor excision is desirable, particularly in cases of early detection.

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  • Quality assessment using EQ-5D-5L after lung surgery for non-small cell lung cancer (NSCLC) patients.

    Ryo Koide, Ami Kikuchi, Masahiro Miyajima, Taijiro Mishina, Yuki Takahashi, Miho Okawa, Izumi Sawada, Junko Nakajima, Atsushi Watanabe, Toru Mizuguchi

    General thoracic and cardiovascular surgery   67 ( 12 )   1056 - 1061   2019.12

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    OBJECTIVES: Aim of this study was to elucidate an alteration of quality of life (QOL) score before and after video-assisted thoracoscopic surgery (VATS) for non-small cell lung cancer (NSCLC) patients using the 5-level EuroQol-5D questionnaire (EQ-5D-5L). We also investigated how the preoperative QOL scores affected the postoperative clinical outcome prospectively. METHODS: Between July 2018 and December 2018, 24 consecutive NSCLC patients who underwent VATS were recruited. The EQ-5D-5L for Japanese was used with face-to-face interviews to estimate the utility values of QOL. RESULTS: QOL scores were significantly declined after surgery (0.81 ± 0.19 vs. 0.74 ± 0.11: P = 0.049). The levels of EQ-5D-5L questionnaire were not significantly different before and after surgery except Q4 (pain control). The levels of Q4 were significantly worsened after surgery (1.33 ± 0.56 vs. 1.88 ± 0.61, P < 0.001). Operation time and bleeding in the preoperative low-QOL score group (N = 13) was longer (215.4 ± 52.3 min. vs. 173.5 ± 42.3 min., respectively: P = 0.045) and more (116.2 ± 152.7 ml vs. 22.7 ± 20.1 ml, respectively: P = 0.049) than those in the high-QOL score group (N = 11). CONCLUSIONS: QOL survey for lung cancer patients using EQ-5D-5L is simple and useful to identify the issue facing at the medical team. Preoperative low QOL score could be a predicting factor for the longer operation time and more bleeding.

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  • Left upper pulmonary vein connected to the persistent left superior vena cava and the left atrium.

    Ryunosuke Maki, Masahiro Miyajima, Taijiro Mishina, Atsushi Watanabe

    General thoracic and cardiovascular surgery   67 ( 8 )   723 - 725   2019.8

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    Persistent left superior vena cava (PLSVC) is the most common anomalous thoracic venous drainage. A PLSVC usually drains into the right atrium through a dilated coronary sinus. It is rare that a PLSVC flows directly into the left atrium, and even rarer that it connects to the left upper pulmonary vein (LUPV). We report a case, wherein the LUPV connected to both the PLSVC and the left atrium.

    DOI: 10.1007/s11748-018-1018-7

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  • MCL1 inhibition enhances the therapeutic effect of MEK inhibitors in KRAS-mutant lung adenocarcinoma cells. International journal

    Makoto Tada, Toshiyuki Sumi, Yusuke Tanaka, Sachie Hirai, Miki Yamaguchi, Masahiro Miyajima, Toshiro Niki, Hiroki Takahashi, Atsushi Watanabe, Yuji Sakuma

    Lung cancer (Amsterdam, Netherlands)   133   88 - 95   2019.7

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    OBJECTIVES: MCL1 is an anti-apoptotic BCL2 family member that is highly expressed in various malignant tumors. However, little is known about the role of MCL1 in KRAS-mutant lung adenocarcinomas. In this study, we aimed to clarify whether MCL1 could be a therapeutic target in KRAS-mutant lung adenocarcinomas for which no effective molecular targeted drugs are available. MATERIALS AND METHODS: We examined to what extent MCL1 knockdown either alone or in combination with MEK inhibitor trametinib suppressed growth or induced apoptosis in the KRAS-mutant lung adenocarcinoma cell line H441 and EGFR-mutant lung adenocarcinoma cell line H1975. Furthermore, we investigated the therapeutic effects of dual inhibition of MCL1 and Bcl-xL, another anti-apoptotic BCL2 family member, in these two cell lines. RESULTS: MCL1 knockdown alone did not induce apoptosis in H441 or H1975 cells. However, MCL1-depleted H441 and H1975 cells underwent apoptosis and decreased in number in the presence of trametinib. We also confirmed that combined therapy by MCL1 knockdown and trametinib almost completely suppressed the growth of H441 cells in vivo. Moreover, dual knockdown of MCL1 and Bcl-xL induced extensive apoptosis in H441 and H1975 cells. CONCLUSION: These findings suggest that combined treatments of MCL1 knockdown and trametinib or dual inhibition of MCL1 and Bcl-xL would be effective therapies for lung adenocarcinomas including the KRAS-mutant subtype.

    DOI: 10.1016/j.lungcan.2019.05.014

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  • Outcomes of completion lobectomy long after segmentectomy. International journal

    Yuki Takahashi, Masahiro Miyajima, Makoto Tada, Ryunosuke Maki, Taijiro Mishina, Atsushi Watanabe

    Journal of cardiothoracic surgery   14 ( 1 )   116 - 116   2019.6

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    BACKGROUND: Completion lobectomy long after segmentectomy in the same lobe is extremely difficult because of severe adhesions around hilar structures, especially in cases involving video-assisted thoracoscopic surgery (VATS) completion lobectomy. We report and compare the surgical outcomes of patients who underwent VATS or thoracotomy completion lobectomy long after radical segmentectomy for lung cancer. METHODS: We retrospectively evaluated the surgical outcomes of completion lobectomies performed at our institute long after radical segmentectomies for lung cancer in the same lobe. The efficacy and safety of VATS completion lobectomy was compared to that of thoracotomy completion lobectomy. RESULTS: Ten of 228 patients who underwent radical segmentectomy for lung cancer between 2009 and 2018 underwent completion lobectomy at least a month after segmentectomy; five patients underwent VATS completion lobectomy. None of the patients underwent VATS left upper completion lobectomy, and conversion to thoracotomy was required in one patient. There were no significant differences between VATS and thoracotomy completion lobectomies in the median operative times (VATS 295 min, thoracotomy 339 min, p = 0.55), intraoperative blood loss volumes (VATS 350 mL, thoracotomy 500 mL, p = 0.84), intervals between initial segmentectomy and completion lobectomy (VATS 40 months, thoracotomy 48 months, p = 0.55), and number of patients with pulmonary artery injury (VATS 1, thoracotomy 2, p = 0.49). There was no operation-related mortality. CONCLUSIONS: VATS completion lobectomy long after segmentectomy for lung cancer could be performed without fatal complications unless severe adhesions are observed around each main pulmonary artery.

    DOI: 10.1186/s13019-019-0941-8

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  • 今月の話題 パラフィン充塡術40年後に起きた脊髄麻痺

    新井 航, 大川 美穂, 高橋 有毅, 多田 周, 槙 龍之介, 三品 泰二郎, 宮島 正博, 渡辺 敦

    胸部外科   72 ( 5 )   344 - 347   2019.5

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  • [Paraffinoma with Spinal Paralysis 40 Years After Pleural Plombage for Tuberculosis].

    Wataru Arai, Miho Ohkawa, Yuki Takahashi, Makoto Tada, Ryunosuke Maki, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   72 ( 5 )   344 - 347   2019.5

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    Paraffin had been used for pleural plombage in the treatment of tuberculosis. However, paraffin use has been reported to cause late postoperative complications. A 79-year-old man was presented with an extramedullary tumor and spinal paralysis. Forty-seven years ago, he had undergone pleural plombage using paraffin for the treatment of pulmonary tuberculosis. Since the extramedullary tumor was found to be paraffinoma, paraffin in the vertebral canal and thoracic cavity was removed surgically. All the paraffin in the vertebral canal and thoracic cavity was removed. After surgery, the patient remains well, without spinal paralysis.

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  • 臨床経験 膵液瘻に伴う膿気胸に対する外科治療

    大川 美穂, 新井 航, 髙橋 有毅, 槇 龍之輔, 多田 周, 三品 泰二郎, 宮島 正博, 渡辺 敦

    胸部外科   72 ( 3 )   209 - 212   2019.3

  • [Surgical Treatment for Pneumopyothorax Secondary to Pancreatic Fistula].

    Miho Ohkawa, Wataru Arai, Yuki Takahashi, Ryunosuke Maki, Makoto Tada, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   72 ( 3 )   209 - 212   2019.3

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    A 46-year-old woman with cervical cancer with multiorgan metastasis visited our hospital. She underwent a total gastrectomy, splenectomy, distal pancreatectomy, left adrenalectomy, and left partial diaphragmatic resection. Postoperatively, she developed pleural effusion with high level of amylase secondary to a pancreatic fistula, consequently causing left-sided empyema. She developed acute respiratory distress syndrome. Urgent surgical treatment was scheduled, and left lower lobectomy, with diaphragmatic partial resection were performed under the venovenous extracorporeal membrane oxygenation. After surgery, intensive care for 45 days was necessary and she was discharged home 6 months post operatively.

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  • Thoracoscopic Right Basilar Segmentectomy After Right Upper Lobectomy. International journal

    Makoto Tada, Masahiro Miyajima, Taijiro Mishina, Yuki Takahashi, Ryunosuke Maki, Atsushi Watanabe

    The Annals of thoracic surgery   107 ( 2 )   e123-e125   2019.2

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    This report describes a case of thoracoscopic right basilar segmentectomy after upper lobectomy. A 76-year-old man who underwent right upper lobectomy for lung tuberculosis 50 years earlier had a diagnosis of squamous cell carcinoma, stage IB (T2a N0 M0), in the right lower lobe and underwent right basilar segmentectomy for limited resection. The postoperative course was uneventful. The patient showed no recurrence clinically, and the 1-year postoperative chest computed tomographic scan showed adequate volume of the middle and residual right lower lobe without emphysematous changes.

    DOI: 10.1016/j.athoracsur.2018.06.041

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  • Three cases of thoracic solitary fibrous tumor with an unusual pathophysiology

    Takahashi Yuki, Miyajima Masahiro, Tsujiwaki Mitsuhiro, Tada Makoto, Maki Ryunosuke, Watanabe Atsushi

    The Journal of the Japanese Association for Chest Surgery   33 ( 1 )   37 - 41   2019.1

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    We report 3 cases of thoracic solitary fibrous tumor (SFT) with an unusual pathophysiology. The first patient was a 76-year-old man with a tumor in the right upper lobe of the lung that was 60×45 mm. He underwent right upper lobectomy. Histopathological examination revealed primary SFT of the lung. He is currently doing well without recurrence 5 years after surgical treatment. The second patient was a 46-year-old woman with metastatic lung carcinoma and pleural dissemination of malignant primary SFT of the lung that appeared 4 years after the initial operation. Although she underwent right middle lobectomy with resection of the disseminated tumor, she died of relapse 77 months after the first operation. The third patient was a 63-year-old woman with a giant SFT mimicking a chronic expanding hematoma because of her clinical history of a 190×170×120-mm hematoma projecting into the right thoracic cavity. She underwent preoperative transcatheter arterial embolization, followed by tumor resection. She is currently doing well without recurrence 14 months after surgical treatment.

    Other Link: https://search.jamas.or.jp/link/ui/2019127197

    DOI: 10.2995/jacsurg.33.37

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  • A Case of Ankylosing Spinal Hyperostosis with Massive Hemothorax Due to Thoracic Vertebral Fracture Caused by Minor Trauma.

    Ryosuke Hirota, Hideto Irifune, Nobuyuki Takahashi, Makoto Emori, Atsushi Teramoto, Mitsunori Yoshimoto, Masahiro Miyajima, Atsushi Watanabe, Toshihiko Yamashita

    Spine surgery and related research   3 ( 3 )   274 - 276   2019

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    DOI: 10.22603/ssrr.2018-0049

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  • Video-assisted Thoracoscopic Segmentectomy of Right Lung Cancer with Extracorporeal Lung Assist After Left Completion Pneumonectomy

    Tada Makoto, Takahashi Yuki, Maki Ryunosuke, Mishina Taijiro, Miyajima Masahiro, Watanabe Atsushi

    Haigan   58 ( 4 )   298 - 302   2018.8

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    <b><i>Background. </i></b>Few reports have described the outcomes of three-time lung resection for metachronous multiple lung cancers or anatomical lung resection after pneumonectomy. <b><i>Case. </i></b>A 66-year-old man with a nodule in the left lung was treated with left upper lobectomy at 50 years of age and left lower lobectomy at 61 years of age. In both cases, the pathological diagnosis was minimally invasive adenocarcinoma, stage IA1. He visited our hospital for the further examination of an abnormal chest shadow noted at a medical checkup. The preoperative residual pulmonary function was as follows: VC 2.32 <i>l</i>, %VC 70.7%, FEV<sub>1.0</sub> 1.59 <i>l</i>, and FEV<sub>1.0%</sub> 70.1%. Although there was no definitive diagnosis, computed tomography revealed findings suggestive of primary lung cancer. He underwent superior segmentectomy (segment 6) of the right lower lobe with extracorporeal lung assist (ECLA). The postoperative course was uneventful. He was discharged home 14 days after the surgery. The pathological diagnosis was still adenocarcinoma <i>in situ</i>. <b><i>Conclusion. </i></b>Using ECLA, we were able to perform thoracoscopic segmentectomy for a metachronous multiple lung cancers (metachronous triple cancers) safely after pneumonectomy.

    Other Link: https://search.jamas.or.jp/link/ui/2019010655

    DOI: 10.2482/haigan.58.298

    DOI: 10.2995/jacsurg.34.746_references_DOI_YSb6HuZxGp1gacqXpWN5ICzLTq3

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  • Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer. International journal

    Yuki Takahashi, Masahiro Miyajima, Taijiro Mishina, Ryunosuke Maki, Makoto Tada, Kodai Tsuruta, Atsushi Watanabe

    Journal of cardiothoracic surgery   13 ( 1 )   86 - 86   2018.7

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    BACKGROUND: Combined resection of a phrenic nerve is occasionally required in T3 primary lung carcinomas invading the phrenic nerve to completely remove a malignant tumour, resulting in diaphragmatic paralysis. We describe the first case of thoracoscopic lobectomy and diaphragmatic plication as a one-stage surgery for lung cancer invading the phrenic nerve. CASE PRESENTATION: A 56-year-old woman with a T3N0M0 primary adenosquamous carcinoma in the left upper lobe presented with suspicious invasion to the anterior mediastinal fat tissue and left phrenic nerve and underwent left upper lobectomy, node dissection, and partial resection of the anterior mediastinal fat tissue with the left phrenic nerve. Furthermore, thoracoscopic diaphragmatic plication was performed as a concomitant procedure. The patient's postoperative course was favourable, without any complications, and respiratory function was preserved for 1 year postoperatively. CONCLUSIONS: Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer invading the phrenic nerve is effective for preservation of postoperative pulmonary function.

    DOI: 10.1186/s13019-018-0766-x

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  • 症例 p40陰性肺類基底細胞型扁平上皮癌の1例

    槙 龍之輔, 杉田 真太朗, 小野 祐輔, 宮島 正博, 多田 周, 高橋 有毅, 三品 泰二郎, 渡辺 敦

    胸部外科   71 ( 7 )   547 - 550   2018.7

  • [p40 Negative Basaloid Squamous Cell Carcinoma of the Lung;Report of a Case].

    Ryunosuke Maki, Shintaro Sugita, Yusuke Ono, Masahiro Miyajima, Makoto Tada, Yuki Takahashi, Taijirou Mishina, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   71 ( 7 )   547 - 550   2018.7

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    Immunohistochemical staining is important for the differential diagnosis of basaloid squamous cell carcinoma(BSC)and other similar carcinomas, such as small-cell carcinomas and large-cell neuroendocrine carcinomas. p40 is a useful marker of squamous cell carcinoma that can be used for the diagnosis of BSC. We present the case of a 64-year-old man who was referred to our hospital for investigation of an abnormal shadow revealed on chest radiography. Computed tomography(CT) revealed a 16×11 mm nodule in the left lung(S1+2), and a thoracoscopic left upper lobectomy was performed. Histologically, lobular pattern with peripheral palisading was observed and the immunohistochemical staining revealed the tumor cells to be positive for p63 and negative for both p40 and neuroendocrine markers, leading to the diagnosis of BSC.

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  • Truncus Superior Artery Ventral to the Apical Vein of the Right Upper Lobe. International journal

    Ryunosuke Maki, Masahiro Miyajima, Taijiro Mishina, Atsushi Watanabe

    The Annals of thoracic surgery   106 ( 1 )   e39   2018.7

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    DOI: 10.1016/j.athoracsur.2018.01.049

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  • 特集 呼吸器外科領域の救急外科治療—Emergency treatment for chest trauma

    三品 泰二郎, 宮島 正博, 高橋 有毅, 槙 龍之輔, 多田 周, 大川 美穂, 新井 航, 渡辺 敦

    北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会 編   63 ( 1 )   2 - 5   2018.6

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    Other Link: https://search.jamas.or.jp/link/ui/2018299769

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  • Reply to Suciu et al. International journal

    Taijiro Mishina, Atsushi Watanabe, Masahiro Miyajima

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery   53 ( 4 )   896 - 896   2018.4

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  • What factors determine the survival of patients with an acute exacerbation of interstitial lung disease after lung cancer resection?

    Masahiro Miyajima, Atsushi Watanabe, Toshihiko Sato, Satoshi Teramukai, Masahito Ebina, Kazuma Kishi, Yukihiko Sugiyama, Haruhiko Kondo, Satoru Kobayashi, Yutaka Takahashi, Hiroyuki Ito, Ryoji Yamamoto, Shigeki Sawada, Hideki Fujimori, Kazunori Okabe, Jun Arikura, Yasushi Shintani, Hiroshige Nakamura, Shinichi Toyooka, Tohru Hasumi, Takehiro Watanabe, Yoshinobu Hata, Hisashi Iwata, Minoru Aoki, Kazuhito Funai, Shuhei Inoue, Osamu Kawashima, Tomohiko Iida, Hiroshi Date

    Surgery today   48 ( 4 )   404 - 415   2018.4

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    PURPOSES: Acute exacerbation of interstitial pneumonia (AEIP) is a leading cause of death after lung cancer resection in patients with interstitial lung disease. METHODS: We retrospectively analyzed 1763 patients with non-small cell lung cancer with a clinical diagnosis of interstitial lung disease (ILD) who underwent lung cancer resection between 2000 and 2009 at 61 hospitals in Japan. AEIP occurred in 164 of 1763 (9.3%) patients with a mortality rate of 43.9% (72/164). Univariate and multivariate analyses were carried out to identify possible risk factors of fatal AEIP. We then analyzed the 164 patients who developed postoperative AEIP and identified the preoperative and postoperative risk factors. RESULTS: A multivariate regression analysis identified that the sex, percent vital capacity, neoadjuvant radiation, preoperative history of AEIP, preoperative use of steroids, usual interstitial pneumonia pattern on CT, and surgical procedures were independent preoperative risk factors for death due to AEIP. ILD patients with emphysema somehow showed a lower risk of fatal AEIP than those without emphysema in this study. CONCLUSIONS: This study revealed eight risk factors for fatal AEIP.

    DOI: 10.1007/s00595-017-1605-8

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  • A new ENG mutation in a Japanese family with hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformations. International journal

    Keiki Yokoo, Gen Yamada, Hirofumi Chiba, Aki Ishikawa, Hiroko Morisaki, Hiroshi Saijo, Sayaka Kudoh, Yasuo Kitamura, Naoki Hirokawa, Masahiro Miyajima, Atsushi Watanabe, Hiroki Takahashi

    Respiratory medicine case reports   25   73 - 77   2018

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    We present a case series of four siblings with hereditary hemorrhagic telangiectasia (HHT) and pulmonary arteriovenous malformations (PAVM). The patients' mother has HHT. Case 1: A 22-year-old man developed dyspnea and epistaxis. CT revealed a large PAVM, treated by segmentectomy. Case 2: A 27-year-old woman developed epistaxis and dyspnea. CT revealed three PAVMs, treated by partial resection. Case 3: A 20-year-old woman developed dyspnea. CT revealed multiple PAVMs, treated with endovascular occlusion of the largest one. Case 4: A 12-year-old woman developed epistaxis. CT revealed multiple PAVMs, observed without treatment. Genetic testing identified a new mutation, ENG c.1517T>C (p.Leu506Pro), in all patients and their mother. We suspect that HHT in these patients may be associated with this ENG mutation.

    DOI: 10.1016/j.rmcr.2018.07.001

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  • Video-assisted thoracoscopic surgery node dissection for lung cancer treatment.

    Atsushi Watanabe, Masahiro Miyajima, Taijiro Mishina, Kodai Tsuruta, Yuki Takahashi, Ryunosuke Maki, Makoto Tada

    Surgery today   47 ( 12 )   1419 - 1428   2017.12

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    PURPOSE: Mediastinal node dissection (MND) is an integral component of the surgical treatment for non-small cell lung cancer (NSCLC). Although video-assisted thoracoscopic surgery (VATS) has been used increasingly for lung cancer treatment, the accuracy of by VATS MND still remains controversial. We reviewed the surgical results of VATS MND for NSCLC. METHODS: A systematic review of literature was performed, and articles that fully described the surgical procedure, devices, and results of VATS MND were selected to compare the efficacy of MND by VATS and thoracotomy. RESULTS: Various techniques and equipments have been shown to perform adequate MND, but there is an argument as to the method of estimation of the accuracy of MND. Most of the recent studies showed that the nodal upstaging and number of dissected nodes are significantly lower by VATS than after thoracotomy. Oppositely, some studies showed VATS noninferiority in these issues. Complications such as chylothorax, pleural effusion, bleeding, and nerve damage were similar in both groups. CONCLUSIONS: Although ND by VATS remains controversial, VATS MND is becoming easier and more feasible owing to the development of more advanced endoscopic cameras and equipments. We should learn further to become more adept at performing adequate ND by VATS.

    DOI: 10.1007/s00595-017-1494-x

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  • Elevated expression of JAM-A promotes neoplastic properties of lung adenocarcinoma. International journal

    Kazufumi Magara, Akira Takasawa, Makoto Osanai, Misaki Ota, Yohei Tagami, Yusuke Ono, Kumi Takasawa, Masaki Murata, Yoshihiko Hirohashi, Masahiro Miyajima, Gen Yamada, Tadashi Hasegawa, Norimasa Sawada

    Cancer science   108 ( 11 )   2306 - 2314   2017.11

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    A cell-cell adhesion protein, junctional adhesion molecule-A (JAM-A), has been shown to be involved in neoplasia of various organs. However, the fundamental role of JAM-A in tumorigenesis is still under debate because dysregulated expression of this protein has distinct effects, playing opposite roles in carcinogenesis depending on the target tissues. In the present study, we found elevated levels of JAM-A expression in lung adenocarcinoma and its preinvasive lesions, including atypical adenomatous hyperplasia and adenocarcinoma in situ by immunohistochemistry. We also showed that suppression of constitutive JAM-A expression conferred target cells with increased susceptibility to apoptosis in lung adenocarcinoma cells. Consequently, inhibition of JAM-A activity decreased colony-forming capability in vitro and tumorigenicity in vivo. The transformed phenotype following suppression of JAM-A expression was sufficient to reduce motile and invasive capacities. Importantly, knockout of JAM-A had striking effects on cells. Our observations suggest that increased expression of JAM-A promotes neoplasia of lung adenocarcinoma. In addition, an anti-JAM-A antibody efficiently reduced cell proliferation and provoked apoptosis, indicating the potential feasibility of JAM-A-inhibitory cancer therapy.

    DOI: 10.1111/cas.13385

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  • Relationship between onset of spontaneous pneumothorax and weather conditions. International journal

    Taijiro Mishina, Atsushi Watanabe, Masahiro Miyajima, Junji Nakazawa

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery   52 ( 3 )   529 - 533   2017.9

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    OBJECTIVES: Spontaneous pneumothorax (SP) results from the rupture of blebs or bullae. It has been suggested that changes in weather conditions may trigger the onset of SP. Our aim was to examine the association between the onset of primary SP with weather changes in the general population in Sapporo, Japan. METHODS: From January 2008 through September 2013, 345 consecutive cases with a diagnosis of primary SP were reviewed. All cases of primary SP developed in the area within 40 km from the Sapporo District Meteorological Observatory. Climatic measurements were obtained from the Observatory, which included 1-h readings of weather conditions. Logistic regression model was used to obtain predicted risks for the onset of SP with respect to weather conditions. RESULTS: SP occurred significantly when the atmospheric pressure decreased by - 18 hPa or less during 96 h before the survey date (odds ratio = 1.379, P = 0.026), when the pressure increased by 15 hPa or more during 72 h before the survey date (odds ratio = 1.095, P = 0.007) and when maximum fluctuation in atmospheric pressure over 22 hPa was observed during 96 h before the survey date (odds ratio = 1.519, P = 0.001). Other weather conditions, including the presence of thunderstorms, were not significantly correlated with the onset of pneumothorax. CONCLUSIONS: Changes in atmospheric pressure influence the onset of SP. Future studies on the relationship between the onset of SP and weather conditions on days other than before the onset and with large number of patients may enable us to predict the onset of SP in various regions and weather conditions.

    DOI: 10.1093/ejcts/ezx128

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  • [Management of Pulmonary Thromboembolism].

    Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   70 ( 8 )   678 - 682   2017.7

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    Pulmonary thromboembolism is a fatal perioperative complication in general thoracic surgery. There is a report on its incidence of 2.68 cases out of 10,000 general thoracic surgeries. To prevent pulmonary thromboembolism, risk evaluation of an individual case and steady implementation of recommended preventive techiques are required. Because of the prevalence of guidelines for prevention, the incidence of pulmonary thromboembolism in the perioperative period is reducing. However, maximum prevention of deep vein thrombosis(DVT), which can lead to pulmonary thromboembolism, is impossible even if preventive measures are strictly implemented in the perioperative period. Mindful of potential DVT postoperatively, it is crucial to speculate perioperative acute pulmonary thromboembolism when sudden sensation of postoperative dyspnea occurs. For lifesaving measures, treatment along with diagnosis is necessary. In the presence of shock, pulmonary endarterectomy is recommended with percutaneous cardiopulmonary support, while in the absence of shock, treatment depends on a patient's condition.

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  • Fibroblastic foci, covered with alveolar epithelia exhibiting epithelial-mesenchymal transition, destroy alveolar septa by disrupting blood flow in idiopathic pulmonary fibrosis. International journal

    Miki Yamaguchi, Sachie Hirai, Yusuke Tanaka, Toshiyuki Sumi, Masahiro Miyajima, Taijiro Mishina, Gen Yamada, Mitsuo Otsuka, Tadashi Hasegawa, Takashi Kojima, Toshiro Niki, Atsushi Watanabe, Hiroki Takahashi, Yuji Sakuma

    Laboratory investigation; a journal of technical methods and pathology   97 ( 3 )   232 - 242   2017.3

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    Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease of unknown cause. IPF has a distinct histopathological pattern of usual interstitial pneumonia in which fibroblastic foci (FF) represent the leading edge of fibrotic destruction of the lung. Currently there are three major hypotheses for how FF are generated: (1) from resident fibroblasts, (2) from bone marrow-derived progenitors of fibroblasts, and (3) from alveolar epithelial cells that have undergone epithelial-mesenchymal transition (EMT). We found that FF dissociated capillary vessels from the alveolar epithelia, the basement membranes of which are fused in normal physiological conditions, and pushed the capillaries and elastic fibers down ~100 μm below the alveolar epithelia. Furthermore, the alveolar epithelial cells covering the FF exhibited a partial EMT phenotype. In addition, normal human alveolar epithelial cells in vitro underwent dynamic EMT in response to transforming growth factor-β signaling within 72 h. Because it seems that resident fibroblasts or bone marrow-derived cells cannot easily infiltrate and form FF between the alveolar epithelia and capillaries in tight contact with each other, FF are more likely to be derived from the epithelial-to-mesenchymal transitioned alveolar epithelia located over them. Moreover, histology and immunohistochemistry suggested that the FF formed in the lung parenchyma disrupt blood flow to the alveolar septa, thus destroying them. Consequently, collapse of the alveolar septa is likely to be the first step toward honeycombing in the lung during late stage IPF. On the basis of these findings, inhibition of transforming growth factor-β signaling, which can suppress EMT of the alveolar epithelial cells in vitro, is a potential strategy for treating IPF.

    DOI: 10.1038/labinvest.2016.135

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  • Tracheal Sleeve Resection and Reconstruction for a Senile Patient with Adenoid Cystic Carcinoma

    Tada Makoto, Takahashi Yuki, Maki Ryunosuke, Mishina Taijiro, Miyajima Masahiro, Watanabe Atsushi

    Haigan   57 ( 7 )   870 - 874   2017

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    <b><i>Background. </i></b>There are still few reports of tracheal sleeve resection and reconstruction in elderly patients. <b><i>Case. </i></b>An 84-year-old woman was referred to our hospital with a diagnosis of tracheal adenoid cystic carcinoma, which was revealed by a transbronchial biopsy. Chest computed tomography (CT) revealed a tumor in the anterior wall of the thoracic trachea. We performed tracheal sleeve resection and reconstruction through median sternotomy. The postoperative course was uneventful. The patient was discharged from the hospital and allowed to return home 33 days after the surgery. <b><i>Conclusion. </i></b>A female octogenarian patient with tracheal adenoid cystic carcinoma was successfully treated with tracheal sleeve resection and has been well for 12 months without any signs of recurrence.

    Other Link: https://search.jamas.or.jp/link/ui/2018135703

    DOI: 10.2482/haigan.57.870

    DOI: 10.2995/jacsurg.35.687_references_DOI_FwXyBs0UR0OmxLC7jslD5qKShED

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  • RESECTION OF FRACTURED RIBS TO PREVENT DESCENDING AORTA INJURY IN A PATIENT WITH CHEST TRAUMA

    UEMURA Shuji, MIYAJIMA Masahiro, KUBOTA Narumi, KYAN Reiko, HIRAYAMA Suguru, INOUE Hiroyuki, WATANABE Atsushi, NARIMATSU Eichi

    Journal of the Japanese Association for the Surgery of Trauma   30 ( 1 )   23 - 26   2016

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    A 19-year old female was involved in a car accident and was diagnosed with multiple rib fractures, bilateral pulmonary contusions and pneumothorax, liver injury, and iliac open fracture. Because a computed tomography scan showed that the distance between the left ninth rib fracture end and the descending aorta was 12 mm, we initially planned conservative management for her injuries. However, on the fifth post-trauma day, CT showed bone particles migrating to the thoracic aorta (4 mm), and thoracoscopic surgery to excise the rib fragments was performed. Although traumatic rupture of the thoracic aorta is rare, in the present case, we were able to prevent descending aorta injury through prophylactic resection of the fractured rib ends.

    DOI: 10.11382/jjast.30.23

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  • [Pulmonary Carcinoid Tumor with Cushing's Syndrome in a Patient who Underwent Pulmonary Resection by Video-Assisted Thoracic Surgery;Report of a Case].

    Hiroshi Sato, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe

    Kyobu geka. The Japanese journal of thoracic surgery   68 ( 7 )   543 - 5   2015.7

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    Pulmonary carcinoid tumor with Cushing's syndrome is comparatively rare disease. It is difficult to make an early diagnosis due to small size lesion in its early stage. We report a case of pulmonary carcinoid tumor with Cushing's syndrome successfully localised by positron emission tomography/computed tomography and was resected in the early stage. The levels of serum cortisol and adrenocorticotropic hormone( ACTH) decreased immediately after surgery, and the symptoms of Cushing's syndrome were relieved.

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  • 低用量造影剤による肺癌術前3D-CT肺動静脈選択撮影法

    小倉 圭史, 渡辺 敦, 宮島 正博, 三品 泰二郎, 吉川 健太, 蝶野 大樹, 三角 昌吾, 田仲 健朗, 虻川 雅基

    日本呼吸器外科学会雑誌   29 ( 3 )   P38 - 1   2015.4

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  • 転移性肺腫瘍—Metastatic lung tumors—特集 肺に対する外科治療

    宮島 正博, 三品 泰二郎, 渡辺 敦

    北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会 編   59 ( 1 )   9 - 13   2014.6

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    Other Link: https://search.jamas.or.jp/link/ui/2015044670

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  • 救急領域における呼吸器外科—Emergency thoracic surgery—外科的な救急疾患

    宮島 正博, 三品 泰二郎, 渡辺 敦

    北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会 編   59 ( 1 )   19 - 23   2014.6

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    Other Link: https://search.jamas.or.jp/link/ui/2015044672

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  • 長径多穴性金属プレートによる曲面を維持した胸壁再建術後の遠隔期成績

    67 ( 1 )   54 - 59   2014.1

  • [Evaluation of long-term results in patients who underwent reconstruction of thoracic wall with curved metal plates].

    Akihiko Tanaka, Motoki Sakuraba, Toshihisa Matsui, Taijiro Mishina, Masahiro Miyajima, Takuro Obama, Akihiko Yamauchi, Satoshi Muraki, Hisayoshi Osawa

    Kyobu geka. The Japanese journal of thoracic surgery   67 ( 1 )   54 - 9   2014.1

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    Between 1992 and 2011, 22 patients underwent surgery of reconstruction of thoracic wall with curved metal plates for multiple rib fracture and resection of thoracic wall tumor. They were divided into 2 groups according to original disorders. Twelve cases of group A accepted surgical stabilization of traumatic multiple rib fractures with the metal plates fixed on the fractured ribs as an external brace. Ten patients of group B were suffered from thoracic wall tumors, including 1 fibrous dysplagia, 1 chondroma, 5 invasive lung cancer, 2 rib metastases and 1 primary chest wall cancer. After the resection of tumors, an average of 3.2 ribs were removed, the defects of full thickness chest wall were reconstructed using a combination of a polypropylene mesh and the metal plates. In both groups, there were no displacement of the plates and allergic reaction. Only 2 patients needed removal of the fixed plates due to pyothorax caused by pneumonia after crushing thoracic injuries. The long metal reconstruction plates with many perforations were very useful for reconstruction of chest wall because they were long enough to cover the whole length of widely resected chest defects and moderately soft enough to be appropriately bent or twist by hand at the time of operation. Moreover long-term result of the reconstructed chest wall was safe and satisfactory without severe complication.

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  • [Henoch-Schönlein Purpura with lung abscess].

    Junji Nakazawa, Atsushi Watanabe, Tomohiro Nakajima, Taijiro Mishina, Masahiro Miyajima, Tetsuya Higami

    Kyobu geka. The Japanese journal of thoracic surgery   66 ( 10 )   886 - 9   2013.9

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    A 72-year-old man had underwent left lower lobectomy for squamous cell carcinoma in our hospital in 2008. Postoperative stage was I A (T1N0M0). In 2010, follow-up chest computed tomography (CT) images showed similar cavitary nodules in segments 2 and 8 of the right lung with positive uptake on fluorodeoxyglucose-positron emission tomography (FDG-PET) images. Physical examination, blood tests, and levels of serum tumor markers showed no abnormality. Transbronchial lung biopsy revealed the absence of malignant cells. Segment 8 of the right lower lobe with the nodule was partially resected, and pathological examination demonstrated lung abscess. He was discharged but was hospitalized in another hospital for purpuric rash, fever, and arthralgia. Microscopic albuminuria was noted, and renal biopsy revealed nephritis with immunoglobulin A( IgA)deposition. He was made a diagnosis of Henoch-Schönlein purpura. Oral steroid therapy( prednisolone 60 mg/d) was initiated, resulting in the improvement of symptoms and disapearance of the cavitary nodule in the right lung segment 2.

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  • Two separate thoroscopic segmentectomies with vessel sealing system. International journal

    Atsushi Watanabe, Masahiro Miyajima, Nobuyoshi Kawaharada, Tetsuya Higami

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery   41 ( 4 )   e62-4   2012.4

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    Total thoracoscopic segmentectomy is an appealing concept in terms of providing a parenchyma-sparing treatment. We describe our technique of two seperate total thoracoscopic segmentectomies by using a vessel sealing system (VSS). A 76-year old female with four gradually enlarging ground glass lesions on the right segment 2 (10 and 3 mm) and segment 6 (8 and 3 mm) was admitted to our institute for surgical diagnosis and treatment. Preoperative three-dimensional computed tomography showed that the A2 is composed of descending A2 and ascending A2, branch of V6 coursed to V2 and B1a originated from B2 and B1b from B3. Two separate segmentectomies were subsequently scheduled. Pulmonary vessel division was performed with VSS after proximal ligation. Intersegmental division by VSS and electrocautery was performed with the use of inflation-deflation demarcation line and the pulmonary veins along the intersegmental plane (V2a and V2c for segment 2 and V6b and V6c for segment 6) as guides to confirm the intersegmental plane after pulmonary artery and bronchial divisions. The intraoperative frozen-section examinations revealed adenocarcinoma in situ. Two separate segmentectomies were successfully completed, with a total operative time of 240 min and blood loss of 30 ml. VSS is a very useful and safe device for intersegmental division and pulmonary vessel division.

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  • Thoracoscopic mediastinal lymph node dissection for lung cancer. International journal

    Atsushi Watanabe, Jyunnji Nakazawa, Masahiro Miyajima, Ryo Harada, Shinji Nakashima, Tohru Mawatari, Tetsuya Higami

    Seminars in thoracic and cardiovascular surgery   24 ( 1 )   68 - 73   2012

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    In lung cancer, mediastinum lymphatic spread occurs. We review our technique and experience of thoracoscopic mediastinal lymphnode dissection (MLND). Between 1997 and 2011, 992 patients with primary lung cancer underwent thoracoscopic major pulmonary resection with MLND. Initially we used a combination of electrocautery and clips to divide blood vessels and lymphatic channels; our current technique relies on a vessel sealing system (VSS) which is expeditious and leads to less lymphorrhea. Furthermore, dissection of station 7 nodes is performed after each main bronchus or right intermediate bronchus is taped with a 0 silk suture, which is then brought out of the thorax through the access incision for antero-lateral retraction of the tracheal carina. We dissect between 3 and 4 N2 lymph node stations and a total of approximately 20 N2 lymph nodes. Postoperative complications related to MLND occurred in 35 of 992 patients (3.5%), 15 (1.5%) for recurrent laryngeal nerve injury, 3 (0.3%) for bilateral vagal injury, 14 (1.4%) for chylothorax and 3 (0.3%) for airway injury. However, none were lethal. Thoracoscopic mediastinal dissection is safe and feasible in treating lung cancer. We believe our technique and VSS are very useful for thoracoscopic MLND.

    DOI: 10.1053/j.semtcvs.2012.03.002

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  • Successful treatment by fibrin glue sealant for pneumothorax with chronic GVHD resistant to autologous blood patch pleurodesis.

    Satoshi Iyama, Tsutomu Sato, Kazuyuki Murase, Shohei Kikuchi, Yusuke Kamihara, Kaoru Ono, Kohichi Takada, Koji Miyanishi, Yasushi Sato, Rishu Takimoto, Masayoshi Kobune, Takuro Obama, Masahiro Miyajima, Atsushi Watanabe, Tetsuya Higami, Yasuo Hirayama, Junji Kato

    Internal medicine (Tokyo, Japan)   51 ( 15 )   2011 - 4   2012

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    Pneumothorax associated with chronic graft-versus-host disease (cGVHD) after stem cell transplantation is a rare complication. Autologous blood has been used successfully for pleurodesis, which was less toxic than chemical agents. However, when pneumothorax is resistant to pleurodesis, no other procedure is more effective and conservative. Here, we describe a case of myelodysplastic syndromes complicated with cGVHD-related pneumothorax. His pneumothorax has been resistant to pleurodesis using autologous blood and was treated successfully with fibrin glue sealant. In our limited experience, we believe the best success could be achieved when this method is used to treat persistent pneumothorax with cGVHD.

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  • Total thoracoscopic lung segmentectomy of anterior basal segment of the right lower lobe (RS8) for NSCLC stage IA (case report). International journal

    Masahiro Miyajima, Atsushi Watanabe, Mayuko Uehara, Takuro Obama, Junji Nakazawa, Tomohiro Nakajiima, Keishi Ogura, Tetsuya Higami

    Journal of cardiothoracic surgery   6   115 - 115   2011.9

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    A 69-year-old woman with a pulmonary nodule in anterior basal segment of the right lower lobe (RS8) was referred to our department. The diameter of the tumor was 12 mm, and it had increased over a few months. First, video-assisted thoracoscopic lung surgery (VATS) biopsy of the pulmonary nodule was carried out. Frozen section examination of this nodule confirmed the diagnosis of bronchioloalveolar carcinoma (BAC). Segmentectomy of RS8 with lower mediastinal node dissection (ND2a-1) was performed. The intersegmental plane was identified using the intersegmental veins as landmarks and the demarcation between the resected (inflated) and preserved (collapsed) lungs. Electrocautery at 70 watts was used to divide the intersegmental plane. A vessel sealing system was used to seal and cut the pulmonary arteries. Postoperative histopathological examination revealed that the tumor was T1aN0M0 BAC, and the minimal distance between the surgical margin and the tumor edge was 15 mm. The patient was discharged from hospital on postoperative day 5 without any complications.

    DOI: 10.1186/1749-8090-6-115

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  • Early acceptance of renal allografts in mice is dependent on foxp3(+) cells. International journal

    Masahiro Miyajima, Catharine M Chase, Alessandro Alessandrini, Evan A Farkash, Patricia Della Pelle, Gilles Benichou, Jay A Graham, Joren C Madsen, Paul S Russell, Robert B Colvin

    The American journal of pathology   178 ( 4 )   1635 - 45   2011.4

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    Mouse renal allografts have a remarkable ability to promote acceptance across full major histocompatibility complex incompatibilities in certain strain combinations without immunosuppression. The mechanism is unknown but is believed to involve immunoregulation. This study tests whether Foxp3(+) T-regulatory cells are responsible in the early phase of graft acceptance, using B6.Foxp3(DTR) mice that express diphtheria toxin receptor (DTR) in Foxp3(+) cells. The administration of DT to B6.Foxp3(DTR) recipients with accepted DBA/2 kidneys, 3 weeks to 3 months after transplantation, caused a marked depletion of Foxp3 cells and triggered acute cellular rejection, manifested by a sudden increase in blood urea nitrogen within a week. None of the controls showed an increase in blood urea nitrogen, including DT-treated B6 wild-type recipients of DBA/2 kidneys or B6.Foxp3(DTR) recipients of isografts. Accepted DBA/2 allografts showed prominent lymphoid sheaths around arteries containing numerous CD3(+)Foxp3(+) cells, CD4(+) cells, dedritic cells, and B cells, which was independent of CCR4. The lymphoid sheaths disintegrate after Foxp3 depletion, accompanied by widespread CD8 interstitial mononuclear inflammation, tubulitis, and endarteritis. The Foxp3 depletion caused an increased frequency of donor-reactive cells in the spleen by interferon (IFN) γ enzyme-linked immunosorbent spot (ELISPOT) assays and increased expression of the maturation markers, CD86 and IA(b), on dendritic cells in the spleen and kidney. We conclude that Foxp3(+) cells are needed to maintain acceptance of major histocompatibility complex-incompatible renal allografts in the first 3 months after transplantation and may act by inhibiting DC maturation.

    DOI: 10.1016/j.ajpath.2010.12.024

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  • Dendritic cell maturation occurs through the inhibition of GSK-3β. International journal

    Alessandro Alessandrini, Stephanie De Haseth, Michael Fray, Masahiro Miyajima, Robert B Colvin, Winfred W Williams, A Benedict Cosimi, Gilles Benichou

    Cellular immunology   270 ( 2 )   114 - 25   2011

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    Dendritic cell (DC) maturation results in changes in antigen processing and presentation, governing the fate of adaptive immunity. Understanding the intracellular signaling pathways governing DC maturation is therefore critical. In this study, we observed that the kinase, GSK-3β, is present in its active form in resting immature DCs isolated from the spleen and bone marrow of mice. Induction of DC maturation using GM-CSF, IL-4 and TNF-α resulted in GSK-3β inhibition, as reflected by increased phosphorylation of Serine 9 on the kinase, and concomitant stabilization of its substrate, β-catenin. Treatment of immature DCs with a GSK-3β inhibitor increased cell surface expression of CD80, CD86 and CD40 on DCs, enhancing their ability to present antigen and activating IL-2 secretion by T cells. GSK-3β inhibition also parallels dendritic cell maturation in vivo. Our results show that GSK-3β signaling controls DC maturation and suggest that this kinase could be manipulated to modulate adaptive immunity.

    DOI: 10.1016/j.cellimm.2011.04.007

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  • Severe hemoptysis due to systemic arterio-pulmonary venous fistula with proximal anastomotic pseudoaneurysm after surgery for descending thoracic aneurysm

    Nakajima Tomohiro, Watanabe Atushi, Obama Takuro, Miyajima Masahiro, Nakazawa Jyunji, Higami Tetsuya

    The Journal of the Japanese Association for Chest Surgery   25 ( 5 )   497 - 501   2011

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    Systemic arterio-pulmonary venous fistula is a very rare disorder. This report describes a case of systemic arterio-pulmonary venous fistula, that presented with hemoptysis, with a concomitant proximal anastomotic pseudoaneurysm after surgery for a descending thoracic aortic aneurysm. Chest computed tomography showed a subpleural nodule in the lower lobe of the left lung with a dilated pulmonary vein. A left inferior phrenic arteriograph demonstrated the dilated artery with a fistula flowing into the pulmonary vein. The patient underwent a left lower lobectomy, and was discharged after an uneventful postoperative course.

    DOI: 10.2995/jacsurg.25.497

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  • A case of metastatic rib tumor resection using video-assisted thoracoscopic surgery (VATS)

    Nakajima Tomohiro, Watanabe Atsushi, Obama Takuro, Miyajima Masahiro, Nakazawa Jyunji, Higami Tetsuya

    The Journal of the Japanese Association for Chest Surgery   25 ( 6 )   621 - 625   2011

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    We report a case of metastatic rib tumor of hepatocellular carcinoma. The patient presented with pain in the right thoracic area. Chest radiograph demonstrated a rib tumor. Chest CT showed a rib tumor protruding from the posterior portion of the right fourth rib. Abdominal CT revealed a hypervascular mass, which measured 40×32 mm, in the S6 of the liver in the arterial phase. The mass was washed-out in the delayed phase. The rib tumor was suspected to be metastasis from hepatocellular carcinoma. Partial extirpation of the fourth rib, fifth rib, and rib tumor was performed using VATS with a minithoracotomy and two ports. Histopathological study confirmed metastatic hepatocellular carcinoma. This study presents the usefulness of video-assisted thoracoscopic surgery (VATS) for posterior rib tumors.

    DOI: 10.2995/jacsurg.25.621

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  • Delayed closure of postinfarction ventricular septal rupture.

    Masahiro Miyajima, Toshiya Kawashima, Tatsuya Saito, Hideo Yokoyama, Katsumi Ohori, Kenji Kuwaki, Akihiko Sasaki, Tetsuya Higami

    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia   16 ( 2 )   128 - 30   2010.4

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    We present the case of a patient with postinfarction ventricular septal rupture (VSR) who underwent delayed repair using a modified infarction exclusion technique. The patient was taken to the operating room 21 days after the first incidence of acute myocardial infarction because the intra-aortic balloon pump maintained a stable circulatory condition without cardiogenic shock. In our procedure, a Dacron patch was sutured to the healthy endocardium to exclude the infarcted septum, and the VSR was subsequently closed with another Dacron patch. After three years of postoperation, the patient's condition remains normal with good ventricular kinesis and no residual shunt. We describe herein a novel procedure for repairing postinfarction VSR by using two Dacron patches.

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  • Suppression of alloreactivity and allograft rejection by SP600125, a small molecule inhibitor of c-Jun N-terminal kinase. International journal

    Akihiro Tabata, Masayuki Morikawa, Masahiro Miyajima, Brydon L Bennett, Yoshitaka Satoh, Jianhua Huang, Yasuaki Tamura, Noriyuki Sato, Tomio Abe

    Transplantation   83 ( 10 )   1358 - 64   2007.5

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    BACKGROUND: c-Jun N-terminal kinase (JNK) is reported to play crucial roles in T-cell activation and differentiation, and SP600125 is a small molecule that inhibits JNK. The aim of this study was to examine immunosuppressive action of this compound. METHODS: Rat heterotopic heart transplantation, popliteal lymph node (PLN) hyperplasia bioassay and lymphocyte proliferation assay. RESULTS: SP600125 treatment reduced histological rejection, and dose-dependently extended median survival time of cardiac allografts from 7 days (vehicle) up to 20 days (40 mg/kg/day). Alloantigen-induced PLN hyperplasia was also inhibited by SP600125 in a similar fashion. SP600125 suppressed mixed lymphocyte reaction and OX52-positive lymphocyte proliferation (IC50: 1.5-5.7 microM). Thus, SP600125 inhibits both T-lymphocyte expansion in vitro and T-cell-mediated alloimmune responses in vivo. In addition, SP600125 interacted with cyclosporine additively to prolong cardiac allograft survival. CONCLUSION: Our data provide the first evidence indicating the potential for JNK as a therapeutic target to inhibit the alloimmune response.

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  • 肺・気管刺創に対する術式の工夫

    59 ( 11 )   1018 - 1022   2006.10

  • Adamkiewicz artery demonstrated by MRA for operated posterior mediastinal tumors.

    Satoshi Muraki, Akihiko Tanaka, Masahiro Miyajima, Ryo Harada, Noriyasu Watanabe, Hideki Hyodoh

    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia   12 ( 4 )   270 - 2   2006.8

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    In the thoracolumbar region, it is well known that the great anterior medullary artery (the artery of Adamkiewicz: AKA) is the dominant feeder of the spinal cord. During surgery for posterior mediastinal tumor adjacent to the lower thoracic aorta, perioperative distortion of the spinal cord blood supply could lead to neurological complication. To avoid postoperative paralysis, it would be useful to know the level of the intercostal artery from which the AKA originates. Recently, we have attempted to identify the AKA preoperatively using magnetic resonance angiography (MRA).

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  • JNK特異的阻害剤による免疫抑制の可能性とその機序

    宮島 正博, 森川 雅之, 田畑 哲寿, 一宮 慎吾, 佐藤 昇志, 安倍 十三夫

    日本外科学会雑誌   107 ( 2 )   709   2006.3

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  • Concomitant mitral and tricuspid valve infective endocarditis: report of a case.

    Yoshikazu Hachiro, Hideyuki Harada, Toshio Baba, Yukiko Honma, Masahiro Miyajima, Tomio Abe

    Surgery today   34 ( 8 )   695 - 7   2004

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    A rare case of native valve endocarditis affecting both the normal mitral and tricuspid valves is presented. A 25-year-old woman with an acute ischemic stroke was found to have vegetation secondary to infective endocarditis as the embolic source. One month after the onset of embolic cerebrovascular intervention, a valve repair with the implantation of artificial chordae, sliding commissuroplasty, and ring annuloplasty resulted in a complete recovery.

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  • Medical students' views on thoracic surgery residency programs in a Japanese medical school.

    Kiyofumi Morishita, Shu-ichi Naraoka, Masahiro Miyajima, Takeshi Uzuka, Tatsuya Saito, Tomio Abe

    The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai zasshi   51 ( 9 )   475 - 7   2003.9

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    There has been a decline in the number of medical students applying for thoracic surgery training programs. We obtained knowledge of medical students' views on thoracic surgery residency programs. After completion of thoracic surgery clerkship, 17 students were asked to fill out questionnaires on first-year thoracic surgery residency programs. The majority of students considered thoracic surgery to be held in high regard by the general public, and felt that the salary was sufficient. However, only one student chose a thoracic surgery training program. The main reason for not applying for thoracic surgery residency was lifestyle issues. The factors in determining career choice included quality of education and work hours. Medical students are likely to select specialties other than thoracic surgery. Since the main factor influencing medical students' career is the quality of education in a residency program, efforts should be made to improve the quality of education.

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  • Descending or thoracoabdominal aortic aneurysm repair without intercostal vessel reconstruction using contrast magnetic resonance angiography: report of two cases.

    Johji Fukada, Kiyofumi Morishita, Hideki Hyodoh, Nobuyoshi Kawaharada, Satoshi Muraki, Masahiro Miyajima, Tomio Abe

    Surgery today   32 ( 2 )   163 - 6   2002

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    Two high-risk patients underwent a graft replacement for descending thoracic or thoracoabdominal aortic aneurysms without the reconstruction of any intercostal and lumbar arteries. The first patient was an 81-year-old woman with asthma and renal dysfunction who was diagnosed to have a descending thoracic aortic aneurysm extending from the Th8 to Th12 level. Contrast magnetic resonance angiography (MRA) demonstrated the Adamkiewicz artery to originate from the left second lumbar artery. The second patient was a 59-year-old man with left ventricular dysfunction due to aortic and mitral stenoses who was diagnosed to have a Crawford type IV thoracoabdominal aortic aneurysm. Contrast MRA showed the Adamkiewicz artery to originate from the left ninth intercostal artery. In general, the reestablishment of the spinal cord's blood supply, whenever possible, is generally considered to be necessary in such patients to prevent spinal cord injury. However, the reimplantation of intercostal vessels is the most complex aspect of this surgical modality, and therefore, it may cause a substantial increase in the cardiopulmonary bypass time. However, at least in some cases, such as the two cases presented herein, the use of contrast MRA was found to reduce the risk in surgery for descending thoracic or thoracoabdominal aortic aneurysms by eliminating the need for any intraoperative management of the intercostal and lumbar arteries.

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  • 50) 再大動脈弁置換後に発生した左室-右室,右房交通症

    宮島 正博, 塚本 勝, 小松 幹志, 小柳 哲也, 藤澤 康聡, 奈良岡 秀一, 安倍 十三夫

    65   590   2001.4

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  • 3) 急性冠症候群による心停止症例に対する治療戦略

    小柳 哲也, 小松 幹志, 宮島 正博, 宇塚 武司, 奈良岡 秀一, 塚本 勝, 安倍 十三夫, 栗本 義彦, 長谷 守, 浅井 康文

    65   585   2001.4

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  • クリーゼ中に胸腺摘除術を施行し良好な転帰が得られた胸腺腫合併抗AChR抗体陽性全身型重症筋無力症の一例

    河田 由香, 種本 真将, 山田 稔, 横川 和樹, 齋藤 太郎, 岩原 直敏, 松村 晃寛, 鈴木 秀一郎, 久原 真, 高瀬 貴章, 宮島 正博, 渡辺 敦

    臨床神経学   63 ( 5 )   325 - 325   2023.5

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  • 大動脈浸潤を認めるT4肺癌に対してステントグラフト内挿術および肺葉切除を施行した1例

    大湯 岳, 槙 龍之輔, 石井 大智, 佐藤 太軌, 千葉 慶宜, 鶴田 航大, 高橋 有毅, 高瀬 貴章, 宮島 正博, 渡辺 敦

    肺癌   63 ( 2 )   130 - 131   2023.4

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  • 原発性肺癌浸潤CD4陽性T細胞組成と浸潤メカニズムの解析

    佐藤 太軌, 石井 大智, 大湯 岳, 千葉 慶宜, 鶴田 航大, 高橋 有毅, 槙 龍之輔, 高瀬 貴章, 宮島 正博, 渡辺 敦, 池上 一平, 一宮 慎吾

    肺癌   63 ( 2 )   130 - 130   2023.4

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  • ロボット支援下肺葉切除術中気道損傷に対してロボット支援下で修復を行った2例

    大湯 岳, 高橋 有毅, 千葉 慶宜, 槙 龍之輔, 鶴田 航大, 高瀬 貴章, 宮島 正博, 渡辺 敦

    日本内視鏡外科学会雑誌   27 ( 7 )   1465 - 1465   2022.12

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  • 呼吸器外科領域におけるトラブルシューティング Double Looping Techniqueの臨床成績と有用性

    千葉 慶宜, 高橋 有毅, 鶴田 航大, 槙 龍之輔, 高瀬 貴章, 宮島 正博, 渡辺 敦

    日本内視鏡外科学会雑誌   27 ( 7 )   1320 - 1320   2022.12

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  • 呼吸器外科領域におけるトラブルシューティング ロボット支援下解剖学的肺切除術における術中トラブルシューティング

    高瀬 貴章, 千葉 慶宜, 高橋 有毅, 鶴田 航大, 槙 龍之輔, 宮島 正博, 渡辺 敦

    日本内視鏡外科学会雑誌   27 ( 7 )   1322 - 1322   2022.12

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  • 肺癌低侵襲手術のニューウエーブ:RATS、Uniportal VATSの適応拡大とピットフォール RATS肺葉切除のピットホール ピットホールに陥らないための我々の工夫

    渡辺 敦, 石井 大智, 佐藤 大軌, 大湯 岳, 千葉 慶宜, 高橋 有毅, 槙 龍之輔, 鶴田 航大, 高瀬 貴章, 宮島 正博

    日本胸部外科学会定期学術集会   75回   LPD2 - 3   2022.10

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  • ポリビニルアルコール製肺動脈モデルを用いた各遮断方法における耐圧能,遮断圧の検討

    千葉 慶宜, 石井 大智, 大湯 岳, 佐藤 太軌, 高橋 有毅, 槙 龍之輔, 高瀬 貴章, 宮島 正博, 渡辺 敦

    日本胸部外科学会定期学術集会   75回   LP13 - 4   2022.10

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  • 前縦隔発生骨外性形質細胞腫におけるAireの発現と胸腺局在B細胞との関連について

    佐藤 太軌, 石井 大智, 大湯 岳, 千葉 慶宜, 高橋 有毅, 鶴田 航大, 槙 龍之輔, 高瀬 貴章, 池上 一平, 宮島 正博, 一宮 慎吾, 渡辺 敦

    日本胸部外科学会定期学術集会   75回   LOP2 - 5   2022.10

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  • ヒト左肺S*の区域間肺静脈の分岐パターンの解析

    槙 龍之輔, 宮島 正博, 小倉 圭史, 高橋 有毅, 鶴田 航大, 千葉 慶宜

    日本胸部外科学会定期学術集会   75回   LOP11 - 6   2022.10

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  • ロボット支援下手術にて横隔膜縫縮を行なった胸腺腫の1例

    進藤 悠真, 石井 大智, 佐藤 太軌, 中村 泰幸, 千葉 慶宜, 青柳 美穂, 鶴田 航大, 高瀬 貴章, 宮島 正博, 渡辺 敦

    日本呼吸器外科学会雑誌   36 ( Suppl. )   O95 - 2   2022.5

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  • 術前RFIDマーキングの使用経験

    青柳 美穂, 石井 大智, 佐藤 太軌, 進藤 悠真, 中村 泰幸, 千葉 慶宜, 鶴田 航大, 高瀬 貴章, 宮島 正博, 渡辺 敦

    日本呼吸器外科学会雑誌   36 ( Suppl. )   O79 - 2   2022.5

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  • RFID tagが術中に中枢気管支に変位し,肺切除範囲の拡大を要した1例

    石井 大智, 佐藤 太軌, 中村 泰幸, 進藤 悠真, 千葉 慶宜, 青柳 美穂, 鶴田 航大, 高瀬 貴章, 宮島 正博, 渡辺 敦

    日本呼吸器外科学会雑誌   36 ( Suppl. )   O79 - 4   2022.5

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  • 肺動脈血管モデルと圧力測定システムを用いた肺動脈遮断圧値および耐圧能の比較

    千葉 慶宜, 石井 大智, 佐藤 太軌, 進藤 悠真, 中村 泰幸, 青柳 美穂, 鶴田 航大, 高瀬 貴章, 宮島 正博, 渡辺 敦

    日本呼吸器外科学会雑誌   36 ( Suppl. )   O82 - 3   2022.5

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  • 免疫チェックポイント阻害薬は炎症性リンパ節に影響を及ぼすのか?免疫療法後肺切除を行った症例からの考察

    中村 泰幸, 高瀬 貴章, 石井 大智, 佐藤 太軌, 進藤 悠真, 千葉 慶宜, 青柳 美穂, 鶴田 航大, 宮島 正博, 渡辺 敦

    日本呼吸器外科学会雑誌   36 ( Suppl. )   O85 - 1   2022.5

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  • ロボット支援下右肺S3b単一亜区域切除術を行うための工夫

    高瀬 貴章, 石井 大智, 佐藤 太軌, 進藤 悠真, 中村 泰幸, 千葉 慶宜, 青柳 美穂, 鶴田 航大, 宮島 正博, 渡辺 敦

    日本呼吸器外科学会雑誌   36 ( Suppl. )   O89 - 5   2022.5

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  • Solo surgeryを目指したロボット支援下肺悪性腫瘍手術

    鶴田 航大, 石井 大智, 佐藤 太軌, 進藤 悠真, 中村 泰幸, 千葉 慶宜, 青柳 美穂, 高瀬 貴章, 宮島 正博, 渡辺 敦

    日本呼吸器外科学会雑誌   36 ( Suppl. )   O90 - 1   2022.5

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  • 当科におけるロボット支援下手術の定型化 staplerを使用しない葉間処理

    宮島 正博, 佐藤 太軌, 石井 大智, 中村 泰幸, 進藤 悠真, 千葉 慶宜, 青柳 美穂, 鶴田 航大, 高瀬 貴章, 渡辺 敦

    日本呼吸器外科学会雑誌   36 ( Suppl. )   O91 - 2   2022.5

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  • 整形外科手術 名人のknow-how 胸壁軟部肉腫に対する広範切除と胸壁再建法

    江森 誠人, 宮島 正博

    整形・災害外科   65 ( 2 )   106 - 109   2022.2

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  • VIO soft-coagulation systemによる肺瘻修復メカニズムについての検討

    高橋 有毅, 多田 周, 槙 龍之輔, 宮島 正博, 渡辺 敦, 佐久間 裕司, 齋藤 充史

    日本呼吸器外科学会雑誌   35 ( 3 )   RO23 - 6   2021.5

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  • 臨床経験 左肺静脈共通幹誤切断後の左下肺静脈血行再建

    進藤 悠真, 槙 龍之輔, 新井 航, 高橋 有毅, 宮島 正博, 渡辺 敦

    胸部外科   73 ( 8 )   590 - 593   2020.8

  • 肺血栓塞栓症 : 予防のための周術期管理と発症後の治療

    70 ( 8 )   678 - 682   2017.7

  • 症例 発症早期に切除手術を施行しえたCushing症候群を伴う副腎皮質刺激ホルモン産生肺腫瘍の1例

    68 ( 7 )   543 - 545   2015.7

  • 肺癌再発を疑った成人Henoch-Sconlein紫斑病

    66 ( 10 )   886 - 889   2013.9

  • SF-003-1 マウス腎移植の自然免疫寛容系における制御性T細胞の重要性(SF-003 サージカルフォーラム(3)移植-2,第111回日本外科学会定期学術集会)

    宮島 正博, 樋上 哲哉

    日本外科学会雑誌   112 ( 1 )   339   2011.5

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  • O8-4 Vessel Sealing Systemを用いた完全鏡視下肺切除術および縦隔リンパ節廓清術(VATS,一般口演8,第34回日本呼吸器内視鏡学会学術集会)

    宮島 正博, 上原 麻由子, 小浜 卓朗, 渡辺 敦, 樋上 哲哉

    気管支学   33 ( Special )   S184   2011

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    DOI: 10.18907/jjsre.33.special_s184_1

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  • Successful Treatment of Left Ventricular Pseudoaneurysm after Felt Repair for Left Ventricular Free Wall Rupture Associated with Acute Myocardial Infarction

    Ohori Shunsuke, Miyajima Masahiro, Sasaki Akihiko

    Japanese Journal of Cardiovascular Surgery   38 ( 6 )   361 - 363   2009

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    A 70-year-old man who had undergone felt repair for a left ventricular free wall rupture associated with acute myocardial infarction at age 66. A computed tomography at 4 years postoperatively showed left ventricular pseudoaneurysm and a 1-cm perforating hole. A patch closure with a Dacron patch was performed using cardiopulmonary bypass under ventricular fibrillation through a left thoracotomy. The postoperative course was uneventful and he was discharged on the 18th postoperative day.

    DOI: 10.4326/jjcvs.38.361

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  • A Rescue Case of Coronary Artery Rupture after Video-Assisted Thoracic Surgery

    Sasaki Akihiko, Miyajima Masahiro, Nakashima Shinji

    Japanese Journal of Cardiovascular Surgery   37 ( 1 )   65 - 68   2008

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    A 64-year-old man had a history of interstitial pneumonia and emphysema since 2000. He underwent video-assisted thoracic surgery (VATS) for lung carcinoma at another hospital on June 30, 2003. Because he suddenly suffered anterior chest pain with shock in September 11 2003, he came to our emergency room. His blood pressure showed 90mmHg, his consciousness level was drowsy and it changed to shock status. Cardiac tamponade was diagnosed by cardiac echography showing an echo-free space and pericardiocentesis was carried out for urgent management of acute tamponade. After the removal of pericardial effusion, his consciousness and blood pressure returned to a normal level. As pericardial blood effusion was continued without aortic dissection by CT, we performed an emergency operation. We set up an external cardiac bypass immediately and removed a massive hematoma weighing 422g, we colud then find the ruptured circumflex coronary artery with a small hole of pericardium penetrating the left pleural space and repaired that ruptured coronary artery during cardiac arrest. His postoperative course was uneventful, and he was discharged on October 6.

    DOI: 10.4326/jjcvs.37.65

    DOI: 10.1093/ehjcr/ytab484_references_DOI_UdPGRu5CJR8RKag7Bo9hamPky5U

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  • Rupture of the Aortic Arch and Descending Aortic Aneurysm in a 24-Year-Old Man with Systemic Lupus Erythematosus

    Sasaki Akihiko, Fujii Akira, Miyajima Masahiro

    Japanese Journal of Cardiovascular Surgery   37 ( 1 )   17 - 20   2008

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    A 24-year-old man with systemic lupus erythematosus (SLE) had received long term steroid therapy 10 years prior to this admission. He presented with sudden-onset chest pain. Enhanced CT scan showed the presence of an aortic arch aneurysm 63mm in maximum diameter and a hematoma surrounding the anterior mediastinum. The diameter of the descending thoracic aorta was also dilated to 5cm. We performed ascending and total arch replacement on December 8, 2005. From the 11th postoperative day, he developed fever, indicating mediastinitis. Open drainage was carried out for one week resulting in gradual lysis of fever and the levels of WBC and CRP returned to normal values. The omentum was transplanted to close the defect in the mediastinum. The rest of the postoperative course was uneventful. He was discharged from the hospital last January 25, 2006. Although close medical follow-up was implemented, he had severe chest pain in the morning on June 9, 2006. Enhanced CT showed an expanding descending aortic aneurysm 60mm in diameter. Since antihypertensive therapy was effective, we considered an elective operation. On the 3rd hospital day, he complained of a severe back pain wherein he rapidly progressed into a state of shock. He died due to rupture of the descending aortic aneurysm. We needed emergency operation or endovascular stent graft therapy because of the risk of rupture.

    DOI: 10.4326/jjcvs.37.17

    DOI: 10.4009/jsdt.44.957_references_DOI_aLgW5ES3Cx0ZQZyzn6oYE08cPEZ

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  • Clinical Study of Nine Cases of Extraanatomic Bypass from the Thoracic Aorta to Bifemoral Arteries

    Sasaki Akihiko, Nakashima Shinji, Fujii Akira, Miyajima Masahiro

    Japanese Journal of Cardiovascular Surgery   36 ( 4 )   225 - 227   2007

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    We performed extraanatomic bypass from the thoracic aorta to bifemoral arteries for 4 aortoiliac occlusive disease (AIOD) patients (including 2 dialysis patients) with severe calcification of abdominal aorta and 5 high aortic occlusion (HAO) patients between January 2001 and September 2006. The average age was 69 years old (range 46-80) including 6 men. Two HAO cases were in the acute phase, one of whom had accompanying lower limb paralysis. Two of the AIOD cases showed small aorta syndrome. The mean operation time was 145min and intra- or postoperative bleeding was very low. We lost one peritoneal dialysis patient with AIOD in the 2nd postoperative week, due to infection from the CAPD tube. Perigraft seroma which is a complication of the artificial blood vessel itself was seen in 3 patients but graft patency was 100 percent at 2 years postoperatively.

    DOI: 10.4326/jjcvs.36.225

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  • P-320 縦隔原発奇形腫5例の検討(一般示説45 奇形腫,世界をリードする呼吸器外科医に!,第23回日本呼吸器外科学会総会)

    宮島 正博, 田中 明彦

    日本呼吸器外科学会雑誌   20 ( 3 )   920   2006

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    Other Link:: https://search.jamas.or.jp/link/ui/2006213788

    DOI: 10.2995/jacsurg.20.920_4

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  • P-152 同時性両側転移性肺腫瘍に対する切除術の検討(一般示説23 転移性肺腫瘍(3),世界をリードする呼吸器外科医に!,第23回日本呼吸器外科学会総会)

    田中 明彦, 宮島 正博, 村木 里誌, 黒田 陽介, 松井 俊尚, 原田 亮

    日本呼吸器外科学会雑誌   20 ( 3 )   878   2006

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    Other Link:: https://search.jamas.or.jp/link/ui/2006213620

    DOI: 10.2995/jacsurg.20.878_4

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  • V-050 自動縫合器の使用が不可能な硬化肺に対する肺切除術(先天異常・その他,一般ビデオ11,ビデオセッション,世界をリードする呼吸器外科医に!,第23回日本呼吸器外科学会総会)

    田中 明彦, 宮島 正博, 村木 里誌, 黒田 陽介, 原田 亮, 松井 俊尚

    日本呼吸器外科学会雑誌   20 ( 3 )   779   2006

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    Other Link:: https://search.jamas.or.jp/link/ui/2006213264

    DOI: 10.2995/jacsurg.20.779_2

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  • JNK特異的阻害剤SP600125のin vitroにおける免疫抑制効果と作用機序

    宮島 正博

    札幌医学雑誌   74 ( 3・4 )   T169 - 178   2005.8

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